低钠血症诊断思路  

The differential diagnosis of hyponatremia

作　　者：陈适[1] 顾锋[1] 

机构地区：[1]中国医学科学院/北京协和医学院/北京协和医院内分泌科/卫生部内分泌重点实验室,北京100730

出　　处：《中国实用内科杂志》2013年第7期497-500,共4页Chinese Journal of Practical Internal Medicine

摘　　要：低钠血症(血清钠<135 mmol/L)是临床最常见的电解质紊乱之一,临床表现主要包括神经系统和肌肉系统表现两个方面。首先应该查血渗透压水平除外假性低钠血症,尿渗透压检查可以鉴别大量饮用低渗液体或其他肾外失钠的情况,容量判断有助于进一步鉴别低钠血症原因。利尿剂过量、脑耗盐综合征和盐皮质激素减少都能造成低容性低钠血症。而等容或高容性低钠血症则常常因为抗利尿激素不适当分泌综合征、甲状腺激素不足、糖皮质激素缺乏或心、肝、肾功能不全引起。Hyponatremia is a condition that the sodium ion concentration in the serum is lower than 135 mmol /L,which is one of the most common electrolyte disturbance.The clinical feature include neurological and muscular symptoms.Firstly,the patients should be measured the serum osmotic pressure to except factitious hyponatremia.The lower level of urine osmotic pressure suggested the diagnosis of beer potomania and extra-renal loss of sodium.The hypovolemia due to diuretic use,cerebral salt wasting syndrome(CSWS) and Addison's disease is consequent on total body sodium loss.The hypervolemic and euvolemic hyponatremia are the other reasons of hyponatremia,including syndrome of inappropriate antidiuretic hormone secretion(SIADH),hypothyroidism,glucocorticoid(steroid) deficiency,cirrhosis of the liver,congestive heart failure and nephrotic syndrome.

关 键 词：低钠血症 抗利尿激素不适当综合征 电解质紊乱 

分 类 号：R589[医药卫生—内分泌]