Musialik D, Raszeja-Wanic B, Boruczkowska A
Kliniki Nadciśnienia Tetniczego Instytutu Kardiologii AM, Poznaniu.
Pol Tyg Lek. 1994;49(10-11):235-8.
The study aimed at evaluating an incidence of hypo- and hypernatremia in the elderly and the results of therapy. Hyponatremia. The studies involved 18 patients aged 69.8 +/- 5.9 years with hyponatremia of 126.8 +/- 2.7 mmol/L. The main causes of hyponatremia were: diuretics, diarrhoea, and vomiting. Sodium deficit was calculated prior to the treatment in all patients. An analysis of hyponatremia incidence indicates that hyponatremia was diagnosed in 1.39% of patients over 60 years, hospitalized within 1989-1990. Sodium deficit in this group was 495.5 +/- 167.7 mmol. Sodium chloride solution was given intravenously to 12 patients, according to the "free correction" principle (a mean increase in serum sodium level was 0.17 +/- 0.07 mmol/L per hour). Mortality in such treated patients was 33%. Sodium chloride was not given to 6 out of examined patients. In 12 patients (66.6%) hyponatremia developed prior to hospitalization, in 6 patients (33.3%) during hospitalization. Mortality rate was 16.6% and 50%, respectively. This confirms higher mortality rate of the rapidly developing hyponatremia in the hospitalized elderly patients. In some cases hyponatremia may constitute iatrogenic complication, especially in the elderly given diuretics in an uncontrollable way. Own experience suggests that elderly patients with a risk of hyponatremia require close monitoring and early compensation of the electrolyte disorders. Hypernatremia. The studies involved 20 patients aged 71.4 +/- 7.7 years with hypernatremia of 155.6 +/- 8.4 mmol/L. A total water deficit (DH20) was calculated in this group. An analysis of hypernatremia incidence showed that this state was diagnosed in 1.55% of patients treated at the Department of Arterial Blood Hypertension within 1989-1990. Total water deficit was 3.9 +/- 1.9 L. A 5% glucose was given intravenously to 15 patients whereas oral fluid therapy was carried out in 5 patients. A mean corrected DH2O in the first day was 46.0 +/- 21.0%. Mortality rate in this group was 65%. It is worth mentioning that 37% of patients with chronic hypernatremia which developed prior to hospitalization died while in case of the acute hypernatremia developed in the hospital mortality rate was 83%. A significant effect on the results of therapy plays an early correction of hypernatremia. Mortality rate in case of DH2o supplementation below 30% during the first 24 hours is about 66%., if DH2o supplementation is 31-60%, a mortality rate is 63%, and in DH2o supplementation over 60% mortality rate is 100%. The obtained results suggest that hypernatremia in the elderly is related to the high mortality rate (65%). An early decrease of water deficit increases mortality rate in patients with hypernatremia.
该研究旨在评估老年人低钠血症和高钠血症的发生率以及治疗结果。低钠血症。研究纳入了18例年龄为69.8±5.9岁、血钠水平为126.8±2.7 mmol/L的低钠血症患者。低钠血症的主要病因包括：利尿剂、腹泻和呕吐。所有患者在治疗前均计算了钠缺乏量。低钠血症发生率分析表明，1989 - 1990年期间住院的60岁以上患者中，1.39%被诊断为低钠血症。该组患者的钠缺乏量为495.5±167.7 mmol。12例患者根据“自由纠正”原则静脉输注氯化钠溶液（血清钠水平平均每小时升高0.17±0.07 mmol/L）。此类治疗患者的死亡率为33%。6例受检患者未输注氯化钠。12例患者（66.6%）在住院前发生低钠血症，6例患者（33.3%）在住院期间发生。死亡率分别为16.6%和50%。这证实了住院老年患者中快速发展的低钠血症死亡率更高。在某些情况下，低钠血症可能构成医源性并发症，尤其是在无法控制地使用利尿剂的老年患者中。自身经验表明，有低钠血症风险的老年患者需要密切监测并尽早纠正电解质紊乱。高钠血症。研究纳入了20例年龄为71.4±7.7岁、血钠水平为155.6±8.4 mmol/L的高钠血症患者。计算了该组患者的总体水缺乏量（DH20）。高钠血症发生率分析显示，1989 - 1990年期间在动脉高血压科接受治疗的患者中，1.55%被诊断为此种情况。总体水缺乏量为3.9±1.9 L。15例患者静脉输注5%葡萄糖，5例患者进行口服补液治疗。第一天平均纠正的DH2O为46.0±21.0%。该组患者的死亡率为65%。值得一提的是，住院前发生慢性高钠血症的患者中有37%死亡，而住院期间发生急性高钠血症的患者死亡率为83%。高钠血症的早期纠正对治疗结果有显著影响。如果在最初24小时内DH2o补充量低于30%，死亡率约为66%；如果DH2o补充量为31 - 60%，死亡率为63%；如果DH2o补充量超过60%，死亡率为100%。所得结果表明，老年人高钠血症与高死亡率（65%）相关。水缺乏量的早期降低会增加高钠血症患者的死亡率。
