Gross P, Reimann D, Neidel J, Döke C, Prospert F, Decaux G, Verbalis J, Schrier R W
Department of Medicine, Universitätsklinikum C.G. Carus, Dresden, Germany.
Kidney Int Suppl. 1998 Feb;64:S6-11.
Severe hyponatremia may be chronic (days) or acute (hours), symptomatic or asymptomatic. Severe chronic symptomatic hyponatremia (serum sodium concentration < 110 to 115 mM/liter) occurs most commonly in the syndrome of inappropriate antidiuretic hormone secretion (SIADH). The treatment of this hyponatremia is a challenge to practicing physicians, in part because an overly rapid correction of hyponatremia may cause brain damage. The latter sometimes takes the form of central pontine myelinolysis (CPM). On the basis of available clinical and experimental literature, the rate of correction of this symptomatic hyponatremia should be no more than 0.5 mM per liter per hour, and the initial treatment should be halted once a mildly hyponatremic range of the serum sodium concentration has been reached (approximately 125 to 130 mM/liter). In contrast, severe chronic asymptomatic hyponatremia may be treated sufficiently by a fluid restriction. On the other hand, severe symptomatic acute hyponatremia should be treated promptly and rapidly, using hypertonic saline, to initially reach a mildly hyponatremic level.
严重低钠血症可能是慢性的（数天）或急性的（数小时），有症状或无症状。严重慢性有症状低钠血症（血清钠浓度<110至115mmol/升）最常见于抗利尿激素分泌不当综合征（SIADH）。这种低钠血症的治疗对执业医师来说是一项挑战，部分原因是过度快速纠正低钠血症可能导致脑损伤。后者有时表现为中枢性桥脑髓鞘溶解症（CPM）。根据现有的临床和实验文献，这种有症状低钠血症的纠正速度不应超过每小时0.5mmol/升，一旦血清钠浓度达到轻度低钠范围（约125至130mmol/升），应停止初始治疗。相比之下，严重慢性无症状低钠血症可通过限液充分治疗。另一方面，严重有症状急性低钠血症应立即迅速使用高渗盐水治疗，最初达到轻度低钠水平。
