低血鈉症

低血鈉症
Sodium
类型血液系统症状[*]電解質不平衡
分类和外部资源
醫學專科腎臟科、​內分泌學
ICD-115C72
ICD-10E87.0
ICD-9-CM276.0
DiseasesDB6266
MedlinePlus[1]
eMedicineemerg/263
[编辑此条目的维基数据]

低血鈉症(英語:Hyponatremia)是人體血液中的含量過低時,所引起的臨床病徵[1]。低血鈉定義為血中鈉離子濃度低於135 mmol/L(135 mEq/L),若低於120 mEql/L,則為重度低血鈉症[2][3]。在臨床上, 可依神經症狀區分為輕度、中度以及重度[4][5]。輕度的低血鈉症可能沒有任何症狀;中度則可能伴隨有無法思考、頭痛、暈眩以及失去平衡[2];更嚴重的重度低血鈉症包括會使患者產生譫妄癲癇還有中風[4][5]

低血鈉症的病因一般會依血容量多少而區分為血容量少、血容量正常及血容量过多英语Hypervolemia三種[1]。低血容量的低血鈉症可能是因為腹瀉嘔吐利尿劑或是流汗所造成[1]。正常血容量的低血鈉症又可分為尿液清澈以及尿液濃稠兩種[1]。尿液清澈的低血鈉症可能是因為腎上腺功能不全甲狀腺機能低下症喝太多水或是喝啤酒過量英语potomania[1];尿液濃稠的低血鈉症可能和抗利尿激素不當分泌症候群英语Syndrome of inappropriate antidiuretic hormone secretion(SIADH)有關[1]。高血容量的低血鈉症可能是因為心臟衰竭肝衰竭或是腎功能衰竭[1]。有些疾病在量測血鈉時,會有誤診為低血鈉的情形,一般是出現在像多發性骨髓瘤高蛋白血英语Hyperproteinemia的情形,或是高脂血症高血糖症的情形[6][7]

低血鈉症的治療和其病因有關[1]。若在病因不明時,太快地處理低血鈉症的症狀,可能會造成併發症[6]。只有具明顯病狀的病患才建議用3%的標準生理食鹽水進行快速的局部修正,此療法偶爾也會用在突然出現症狀的情形[1][7]。低血容量的低血鈉症一般會注射生理食鹽水[1]。SIADH會用在限水的病患,若是高血容量的低血鈉症,會用限水及低鹽飲食的治療方法[1]。若是低血鈉症的症狀已出現兩天以上,修正措施需循序漸進地進行[1]

在住院的病患中,有20%有低血鈉症的症狀,在進行耐力運動英语Endurance sport中或運動後出現低血鈉症的約有10%[2][6]。針於住院的病患而言,低血鈉症會增加死亡風險[6]。美國在低血鈉症的花費成本估計有美金26億元[8]

病因

原因可能是攝取過多水分、腎臟功能損壞、肝硬化心臟病、長期腹瀉、ADH分泌不正常等也會令患者發生低血鈉症。當血液中的鈉濃度突降時,嚴重的症狀很快就出現。

症状

腦對鈉濃度很敏感,所以首先會無精打采及思考遲鈍。若情況更嚴重,接下來會肌肉抽搐、神志不清、昏迷甚至死亡。

治療

輕微的低血鈉症可由控制飲食中的液體量(一天少於1L)而治療。嚴重的低血鈉症很危急,醫生可用藥物或靜脈注射緩慢增加血液中的鈉含量。若血液中的鈉濃度增加太快,會造成嚴重且通常為永久的腦部損傷。

參考來源

  1. ^ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 Lee, JJ; Kilonzo, K; Nistico, A; Yeates, K. Management of hyponatremia.. CMAJ : Canadian Medical Association Journal. 13 May 2014, 186 (8): E281–6. PMC 4016091可免费查阅. PMID 24344146. doi:10.1503/cmaj.120887. 
  2. ^ 2.0 2.1 2.2 Henry, DA. In The Clinic: Hyponatremia.. Annals of Internal Medicine. 4 August 2015, 163 (3): ITC1–19. PMID 26237763. doi:10.7326/aitc201508040. 
  3. ^ Chatterjee, Kanu; Anderson, Mark; Heistad, Donald; Kerber, Richard E. Manual of Heart Failure. JP Medical Ltd. 30 May 2014: 142 [2018-04-19]. ISBN 9789350906309. (原始内容存档于2018-10-05) –通过Google Books. 
  4. ^ 4.0 4.1 Williams, DM; Gallagher, M; Handley, J; Stephens, JW. The clinical management of hyponatraemia.. Postgraduate Medical Journal. July 2016, 92 (1089): 407–11. PMID 27044859. doi:10.1136/postgradmedj-2015-133740. 
  5. ^ 5.0 5.1 Ball, S; De Groot, LJ; Beck-Peccoz, P; Chrousos, G; Dungan, K; Grossman, A; Hershman, JM; Koch, C; McLachlan, R; New, M; Rebar, R; Singer, F; Vinik, A; Weickert, MO. Hyponatremia. 2000. PMID 25905359. Accessed 1 August 2016. 
  6. ^ 6.0 6.1 6.2 6.3 Filippatos, TD; Liamis, G; Christopoulou, F; Elisaf, MS. Ten common pitfalls in the evaluation of patients with hyponatremia.. European Journal of Internal Medicine. April 2016, 29: 22–25. PMID 26706473. doi:10.1016/j.ejim.2015.11.022. 
  7. ^ 7.0 7.1 Marx, John; Walls, Ron; Hockberger, Robert. Rosen's Emergency Medicine – Concepts and Clinical Practice 8. Elsevier Health Sciences. 2013: 1639–42 [2018-04-19]. ISBN 1455749877. (原始内容存档于2016-08-15) (英语). 
  8. ^ Simon, Eric E. Hyponatremia: Evaluation and Treatment. Springer Science & Business Media. 2014: 205 [2018-04-19]. ISBN 9781461466451. (原始内容存档于2016-08-15) (英语). 

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