Kamel K S, Bear R A
Division of Nephrology, St Michael's Hospital, Toronto, Ontario, Canada.
Am J Kidney Dis. 1993 Apr;21(4):439-43. doi: 10.1016/s0272-6386(12)80274-5.
The bulk of clinical and experimental evidence seems to support the view that a catastrophic outcome can accompany rapid correction of chronic hyponatremia. However, the dilemma that faces the clinicians is controlling the rate at which the serum sodium concentration is increased during the treatment of hyponatremia. We present a case of severe hyponatremia and hypokalemia to illustrate, in a quantitative fashion, that the increase in serum sodium concentration will be determined not only by the tonicity of infused fluids, but also, and to a major degree, by the rate of excretion of free water by the kidney. A rapid increase in serum sodium concentration would occur if antidiuretic hormone (ADH) release is inhibited and water diuresis ensues. We suggest that the administration of potassium chloride (orally or via a central line) would have been the appropriate therapy for this patient.
大量临床和实验证据似乎支持这样一种观点，即慢性低钠血症的快速纠正可能会伴随灾难性后果。然而，临床医生面临的困境是控制低钠血症治疗期间血清钠浓度升高的速率。我们呈现一例严重低钠血症和低钾血症病例，以定量方式说明血清钠浓度的升高不仅取决于输注液体的张力，而且在很大程度上还取决于肾脏自由水的排泄速率。如果抗利尿激素（ADH）释放受到抑制并发生水利尿，血清钠浓度将迅速升高。我们认为，给予氯化钾（口服或通过中心静脉导管）对该患者来说是合适的治疗方法。
