Nguyen Hong Thoai, Alkhidir Ayah, Lagos Yanira V, Le Pham Thao Vy, Nguyen Lac Han
Internal Medicine, Ascension Saint Joseph Hospital, Chicago, USA.
Cardiology, Methodist Hospital, Merrillville, USA.
Cureus. 2024 Jul 10;16(7):e64281. doi: 10.7759/cureus.64281. eCollection 2024 Jul.
Hypernatremia, characterized by a plasma sodium concentration above 145 mmol/L, is frequently observed in critically ill patients, often due to factors such as gastrointestinal losses, dehydration, and diabetes insipidus. Psychiatric patients, particularly those with major depressive disorder, are also at risk of developing hypernatremia due to abnormalities in thirst sensation, mineralocorticoid excess, or medication side effects. Severe hypernatremia in psychiatric patients is associated with a high mortality rate, presenting challenges in diagnosis and management. The treatment of chronic hypernatremia (>48 hours) typically involves administering isotonic saline to hypovolemic patients until normalization of vital signs, followed by dextrose 5% in water (D5W) based on water deficit and losses. The goal is to decrease plasma sodium by 8-10 mmol/day. Acute hypernatremia (<48 hours) is corrected with a plasma sodium reduction of 1 mmol/L/hour in the first six to eight hours. While there are no clear guidelines for sodium correction in severe hypernatremia, the literature suggests a safe correction rate of 8-10 mmol/day for chronic hypernatremia and 1 mmol/L/hour for acute cases. In a specific case, a 51-year-old female with severe depression and reduced oral intake was admitted. She exhibited signs of dehydration and was found to have severe hypernatremia (191 mmol/L) with acute kidney injury. Treatment involved D5W, followed by D5W/half-normal saline at 150 mL/hr. Within 24 hours, her plasma sodium decreased to 178 mmol/L and gradually normalized to 143 mmol/L without neurological complications. This case highlights the challenges and underscores the importance of early recognition and management of severe hypernatremia in psychiatric patients. The primary treatment approach addresses water deficits and losses and administers D5W. Recent findings suggest that rapid correction of the condition is acceptable.
高钠血症的特征是血浆钠浓度高于145 mmol/L，在危重症患者中经常出现，通常是由于胃肠道失液、脱水和尿崩症等因素引起。精神科患者，尤其是患有重度抑郁症的患者，也因口渴感觉异常、盐皮质激素过多或药物副作用而有发生高钠血症的风险。精神科患者的严重高钠血症与高死亡率相关，在诊断和管理方面存在挑战。慢性高钠血症（>48小时）的治疗通常包括对低血容量患者给予等渗盐水，直至生命体征恢复正常，然后根据水缺乏和失水量给予5%葡萄糖水（D5W）。目标是使血浆钠每天降低8 - 10 mmol。急性高钠血症（<48小时）在前6至8小时内以每小时降低血浆钠1 mmol/L的速度进行纠正。虽然对于严重高钠血症的钠纠正没有明确的指南，但文献表明慢性高钠血症的安全纠正率为每天8 - 10 mmol，急性病例为每小时1 mmol/L。在一个具体病例中，一名51岁患有重度抑郁症且口服摄入量减少的女性入院。她表现出脱水迹象，被发现患有严重高钠血症（191 mmol/L）并伴有急性肾损伤。治疗采用D5W，随后以150 mL/hr的速度给予D5W/半张生理盐水。24小时内，她的血浆钠降至178 mmol/L，并逐渐恢复正常至143 mmol/L，未出现神经并发症。该病例突出了挑战，并强调了精神科患者中早期识别和管理严重高钠血症的重要性。主要治疗方法是解决水缺乏和失液问题并给予D5W。最近的研究结果表明快速纠正这种情况是可以接受的。
