Verbalis J G
Department of Medicine, Georgetown University School of Medicine, Washington, DC 20007, USA.
Semin Nephrol. 1998 Jan;18(1):3-19.
Hyponatremia is often associated with a broad spectrum of neurological symptoms, occasionally leading to death in severe cases. Recent studies have clearly indicated that too rapid correction of severe hyponatremia can cause brain demyelination, which also produces neurological morbidity and mortality in some cases. This has caused a clinical conundrum regarding optimal treatment of hyponatremia, and may leave physicians uncertain about the most appropriate therapy for this important group of patients. Despite ongoing controversy about treatment guidelines and outcomes for specific subgroups of patients, a synthesis of recent clinical and experimental results suggests that the treatment of hyponatremic patients entails balancing the risks of hyponatremia against the risks of correction for each patient on an individualized basis. Although variability for both risks is great and one cannot accurately predict those patients who will develop neurological complications from either hyponatremia or its correction, a general consensus for rational treatment guidelines has nonetheless emerged. Following a discussion of the physiology and pathophysiology of brain adaptation to hyponatremia, this review will focus on the present consensus approach to therapy of hyponatremic patients.
低钠血症常伴有一系列广泛的神经症状，严重时偶尔会导致死亡。最近的研究清楚地表明，严重低钠血症纠正过快会导致脑脱髓鞘，在某些情况下这也会导致神经方面的发病和死亡。这在低钠血症的最佳治疗方面引发了一个临床难题，可能会让医生对于这类重要患者群体的最恰当治疗方法感到不确定。尽管对于特定患者亚组的治疗指南和治疗结果仍存在争议，但近期临床和实验结果的综合表明，低钠血症患者的治疗需要在个体化基础上平衡低钠血症的风险和纠正低钠血症的风险。虽然这两种风险的变异性都很大，而且无法准确预测哪些患者会因低钠血症或其纠正而出现神经并发症，但合理治疗指南的总体共识已经形成。在讨论了大脑适应低钠血症的生理学和病理生理学之后，本综述将重点关注目前针对低钠血症患者的共识性治疗方法。
