Oster J R, Singer I
Department of Veterans Affairs Medical Center, Miami, Fla.
South Med J. 1994 Dec;87(12):1195-202. doi: 10.1097/00007611-199412000-00001.
Hyponatremia can be a serious medical problem, and severe hyponatremia can be a medical emergency. Nevertheless, considerable controversy remains with respect to the best way to avoid the important sequelae of hyponatremia, while minimizing the complications of its treatment. Unquestionably, severe hyponatremia may cause life-threatening and/or permanent neurologic abnormalities. The risk of these untoward events, however, is much greater with acute than with chronic hyponatremia. The adaptive changes in the brain that reduce the hazards of a low serum sodium concentration for patients with chronic hyponatremia increase the risk for therapy-induced central pontine myelinolysis. In general, acute, symptomatic hyponatremia should be corrected more rapidly than chronic hyponatremia, at least until severe symptoms abate. Detailed guidelines are provided for the management of acute and chronic hyponatremia. But regardless of guidelines, therapy must be individualized, with adjustments based on frequent assessments of clinical condition and laboratory data.
低钠血症可能是一个严重的医学问题，重度低钠血症可能是医疗急症。然而，关于如何以最佳方式避免低钠血症的重要后遗症，同时将其治疗并发症降至最低，仍存在相当大的争议。毫无疑问，重度低钠血症可能导致危及生命和/或永久性神经功能异常。然而，这些不良事件在急性低钠血症时的风险远高于慢性低钠血症。大脑中的适应性变化降低了慢性低钠血症患者血清钠浓度过低的危害，但增加了治疗引起的中枢性桥脑脱髓鞘病变的风险。一般来说，急性、有症状的低钠血症应比慢性低钠血症更快得到纠正，至少在严重症状缓解之前是这样。文中提供了急性和慢性低钠血症管理的详细指南。但无论有无指南，治疗都必须个体化，并根据对临床状况和实验室数据的频繁评估进行调整。
