多发性骨髓瘤相关假性低钠血症致医源性高钠血症1例并回顾性分析  

A case of iatrogenic hypernatremia caused by multiple myeloma-associated pseudohyponatremia

作　　者：黄嫄 张路[2] 夏良裕[1] 雷金燕 魏冲[2] 李永哲[1] Huang Yuan;Zhang Lu;Xia Liangyu;Lei Jinyan;Wei Chong;Li Yongzhe(Department of Clinical Laboratory,Peking Union Medical College Hospital,Beijing 100730,China;Department of Hematology,Peking Union Medical College Hospital,Beijing 100730,China;Department of Cardiology,Peking Union Medical College Hospital,Beijing 100730,China)

机构地区：[1]北京协和医院检验科,北京100730 [2]北京协和医院血液科,北京100730 [3]北京协和医院心血管内科,北京100730

出　　处：《中华检验医学杂志》2024年第10期1212-1214,共3页Chinese Journal of Laboratory Medicine

摘　　要：患者男,55岁,以"乏力、纳差半年余,发现肌酐升高1周"于2024年2月16日就诊于北京协和医院。综合临床表现及检验检查结果诊断为多发性骨髓瘤,我院就诊期间患者持续"低钠血症"(间接离子选择电极法测得Na 124~136 mmol/L),结合患者临床症状及血清渗透压结果(327 mOsm/kg H2O)考虑为高球蛋白血症导致假性低钠血症,未予干预,后续外院治疗期间因未识别出假性低钠血症而予高张盐水补液导致严重医源性高钠血症。建议对于各类原因导致的血清固相比例高于正常的患者,采用间接离子选择电极法测定血清钠极易出现假性偏低,可用直接离子选择电极法复测血钠以判断是否为真性低钠,避免为患者带来医源性损伤。The patient was a 55-year-old man.On February 16,2024,he was admitted to Peking Union Medical College Hospital complaining of"weakness and poor appetite for more than half a year,and found creatinine increase for 1 week".The patient was diagnosed with multiple myeloma.During the treatment in our hospital,the patient sustained"hyponatremia"(Na 124-136 mmol/L measured by indirect ion selective electrode method),and combined with the patient′s clinical symptoms and serum osmotic pressure results(327 mOsm/kg H 2O),it was considered that hyperglobulinemia led to pseudohyponatremia.So no intervention was given.Subsequent failure to recognize pseudohyponatremia during treatment in other hospitals and the administration of hypertonic saline resulted in severe iatrogenic hypernatremia.By reviewing similar cases in our hospital,we found that hyperglobulinemia/hyperlipidemia associated pseudohyponatremia was not uncommon.This case reminds us that for patients whose serum solid phase ratio is higher than normal due to various reasons,the use of indirect ion selective electrode method to determine serum sodium is prone to false low,and direct ion selective electrode method can be used to re-test blood sodium to determine whether it is true,so as to avoid iatrogenic injury to patients.

关 键 词：多发性骨髓瘤 假性低钠血症 间接离子选择电极法 直接离子选择电极法 高球蛋白血症 

分 类 号：R733.3[医药卫生—肿瘤]