低钠血症治疗要点.pptVIP

Disorders of Plasma Sodium — Causes, Consequences, and Correction 韩国锋 Jan-6-2015 /doi/story/10.1056/feature.205?query=TOC Presentation of Case A 55-year-old woman with a history of alcoholism was brought to the emergency department in a confused state by her daughter, who reported that the patient had been weak and had fallen several times in the past week. The daughter said that about 2 weeks previously her mother had been given a prescription for hydrochlorothiazide (氢氯噻嗪） to treat elevated blood pressure. Examination On examination, the patient was disoriented(定向障碍） and noncooperative but arousable. Her blood pressure was 140/82 mm Hg, the pulse was 88 beats/min, and she was afebrile(无发热）. The cranial nerves（颅神经） were intact. The optic（视觉的） disks were normal, as were extraocular movements（眼外运动）. An ear, nose, and throat examination was normal except for mucosa（粘膜） that appeared to be slightly dry. The lungs were clear. The heart sounds were normal, and there was no murmur. Abdominal examination revealed no organomegaly （器官增大症）or masses. The skin was cool and clammy. A neurologic examination revealed tremors（震颤） and increased deep-tendon reflexes. Laboratory data a plasma sodium concentration of 112 mmol/L, the potassium level was 2.6 mmol/L. The urine osmolality was 630 mOsm per kilogram of water Urinary sodium level was 12 mmol/L . Summary: A 55-year-old woman history of alcoholism 2 weeks ago : hydrochlorothiazide to treat elevated blood pressure had been weak and had fallen several times in the past week. confused state; disoriented(定向障碍） and noncooperative but arousable; tremors（震颤） Serum Na+ 112 mmol/L, K+ 2.6 mmol/L. The urine osmolality was 630 mOsm per kilogram of water, and the urinary Na+12 mmol/L. Question What strategy would provide the best support for this patient? 低钠血症 Hyponatraemia, defined as a serum sodium concentration135 mmol/l, is the most common disorder of body fluid and electrolyte balance encountered