2014欧洲低钠血症的诊疗指南.pptVIP

Indeed, the risk benefit ratio seems to be negative: there is no proven outcome benefit aside from increase in serum sodium concentrations, while there are increasing concerns on safety. The most prominent safety related factor is the increased risk for overly rapid correction of hyponatraemia As this risk is greatest in patients with profound hyponatraemia, the guideline development group wanted to recommend against the use of vasopressin receptor antagonists in this specific patient group. 应用加压素受体拮抗剂的危益比（risk benefit ratio）似乎呈负性：除其增加血钠外，未见其对预后有益。但增加安全担忧。最大的隐患是可能快速升高血钠（而导致渗透性脱髓鞘）。 因在中毒低钠血症患者其危险最大，故指南制定小组不推荐将其用于重症低钠血症患者。 In addition, our concern around the toxicity profile of these compounds was increased by reports from the U.S. Food and Drug Administration warning for hepatotoxicity associated with the use of high tolvaptan doses in autosomal dominant polycystic kidney disease. 基于美国FDA公布的tolvaptan 对于多囊肾治疗的肝坏死等不良反应。该类化合物的安全性受到关注！ 谢 谢！ 放映结束 感谢各位批评指导！ 让我们共同进步 3低渗性低钠血症 Hypotonic hyponatraemia 5.7. 低容量低渗性低钠血症（Hypotonic hyponatraemia with decreased extracellular fluid volume） 循环血量不足，无论是否失钠均刺激加压素（抗利尿素）分泌 虽此时血液低张，但仍会继续吸收水以补容量不足。 因血容量不足刺激加压素释放的利弊： 1 对于低钠、低渗不利 2 对于维持循环血量有利 消化道丢失 肾保钠： 尿钠减少 皮肤丢失 多汗 利尿剂 原发性 肾上腺 皮质功能 减退： 醛固酮↓ 钠的非肾源性丢失 钠的肾源性丢失 脑耗盐： 需要容量 补充 肾疾病 第三腔室丢失 肠梗阻、急性胰腺炎、 sepsis、肌肉大面积损伤 血管内液体渗漏 循环血量显著减少 刺激压力感受器而释放加压素 低钠血症。 若再给予低张液体灌注则会使低钠血症恶化 低容量低渗性低钠血症示意图 5.8. 正常（等）容量低渗性低钠血症Hypotonic hyponatraemia with normal extracellular fluid volume Euvolaemic hyponatraemia is caused by an absolute increase in body water, which results from an excessive fluid intake in the presence of an impaired free water excretion, either due to inappropriate release of vasopressin or due to a low intake of solutes 在游离水排泄机制 ①或因加压素不当释放 ②或因低容质摄入而受损时，摄入液体过量可导致等容量低钠血症 正常（等）容量低渗性低钠血症 低渗液体摄入过多：加压素无变化，尿呈低渗 ＜100 mOsm/kg。见于原发性烦渴患者饮水量大于 肾排量 甲状腺功能低下 继发性肾上腺皮质