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Treatment of symptomatic hyponatremia with hypertonic saline: a real-life observational study.
用高渗盐水治疗有症状的低钠血症: 一项真实的观察性研究。
- 影响因子:5.04
- DOI:10.1530/EJE-20-1207
- 作者列表:"Chifu I","Gerstl A","Lengenfelder B","Schmitt D","Nagler N","Fassnacht M","Weismann D
- 发表时间:2021-05-01
Abstract
Objective:Treatment of symptomatic hyponatremia is not well established. The European guidelines recommend bolus-wise administration of 150 mL of 3% hypertonic saline. This recommendation is, however, based on low level of evidence. Design:Observational study. Methods:Sixty-two consecutive hyponatremic patients admitted to the emergency department or intensive care unit of the University Hospital Wuerzburg were divided in subgroups according to treatment (150 mL bolus of 3% hypertonic saline or conventional treatment) and symptom severity. Treatment target was defined as an increase in serum sodium by 5-10 mEq/L within first 24 h and maximum 8 mEq/L during subsequent 24 h. Results:Thirty-three out of sixty-two patients (53%) were presented with moderate symptoms and 29/62 (47%) with severe symptoms. Thirty-six were treated with hypertonic saline and 26 conventionally. In the hypertonic saline group, serum sodium increased from 116 ± 7 to 123 ± 6 (24 h) and 127 ± 6 mEq/L (48 h) and from 121 ± 6 to 126 ± 5 and 129 ± 4 mEq/L in the conventional group, respectively. Overcorrection at 24 h occurred more frequent in patients with severe symptoms than with moderate symptoms (38% vs 6%, P < 0.05). Diuresis correlated positively with the degree of sodium overcorrection at 24 h (r = 0.6, P < 0.01). Conventional therapies exposed patients to higher degrees of sodium fluctuations and an increased risk for insufficient sodium correction at 24 h compared to hypertonic saline (RR: 2.8, 95% CI: 1.4-5.5). Conclusion:Sodium increase was more constant with hypertonic saline, but overcorrection rate was high, especially in severely symptomatic patients. Reducing bolus-volume and reevaluation before repeating bolus infusion might prevent overcorrection. Symptoms caused by hypovolemia can be misinterpreted as severely symptomatic hyponatremia and diuresis should be monitored.
摘要
目的: 症状性低钠血症的治疗方法尚不明确。欧洲指南推荐推注150 mL 3% 高渗盐水。然而,这项建议是基于低水平的证据。 设计: 观察性研究。 方法: 将入住维尔茨堡大学医院急诊科或重症监护病房的62例连续低钠血症患者根据治疗 (150 mL推注3% 高渗盐水或常规治疗) 和症状严重程度分为亚组。治疗目标定义为在最初24小时内血清钠增加5-10meq/L,在随后的24小时内最大8 meq/L。 结果: 62例患者中有33例 (53%) 出现中度症状,29/62例 (47%) 出现严重症状。用高渗盐水治疗36例,常规治疗26例。高渗盐水组血清钠从116 ± 7增加到123 ± 6 (24 h) 和127 ± 6 mEq/L (48 h),常规组分别从121 ± 6增加到126 ± 5和129 ± 4 mEq/L。症状严重的患者24小时过度矫正的发生率高于症状中度的患者 (38% vs 6%,P <0.05)。利尿与24 h钠过度纠正程度呈正相关 (r = 0.6,P <0.01)。与高渗盐水相比,常规疗法使患者暴露于更高程度的钠波动和24小时钠校正不足的风险增加 (RR: 2.8,95% CI: 1.4-5.5)。 结论: 高渗盐水组的钠盐升高更恒定,但过度矫正率较高,尤其是在症状严重的患者中。减少推注量并在重复推注前重新评估可能会防止过度矫正。低血容量引起的症状可被误解为严重的症状性低钠血症,应监测利尿。
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