...
  • 主题
高级搜索  >
历史搜索 清空历史
首页> 外文期刊>Critical care : >Clinical review: Practical approach to hyponatraemia and hypernatraemia in critically ill patients
【24h】

Clinical review: Practical approach to hyponatraemia and hypernatraemia in critically ill patients

机译：临床评论：重症患者低钠血症和高钠血症的实用方法

获取原文
           
页面导航
  • 摘要
  • 著录项
  • 相似文献
  • 相关主题

摘要

Disturbances in sodium concentration are common in the critically ill patient andassociated with increased mortality. The key principle in treatment and prevention isthat plasma [Na+] (P-[Na+]) is determined by external water andcation balances. P-[Na+] determines plasma tonicity. An importantexception is hyperglycaemia, where P-[Na+] may be reduced despite plasmahypertonicity. The patient is first treated to secure airway, breathing andcirculation to diminish secondary organ damage. Symptoms are critical when handling apatient with hyponatraemia. Severe symptoms are treated with 2 ml/kg 3% NaCl bolusinfusions irrespective of the supposed duration of hyponatraemia. The goal is toreduce cerebral symptoms. The bolus therapy ensures an immediate and controllablerise in P-[Na+]. A maximum of three boluses are given (increasesP-[Na+] about 6 mmol/l). In all patients with hyponatraemia, correctionabove 10 mmol/l/day must be avoided to reduce the risk of osmotic demyelination.Practical measures for handling a rapid rise in P-[Na+] are discussed. Therisk of overcorrection is associated with the mechanisms that cause hyponatraemia.Traditional classifications according to volume status are notoriously difficult tohandle in clinical practice. Moreover, multiple combined mechanisms are common. Morethan one mechanism must therefore be considered for safe and lasting correction.Hypernatraemia is less common than hyponatraemia, but implies that the patient ismore ill and has a worse prognosis. A practical approach includes treatment of theunderlying diseases and restoration of the distorted water and salt balances.Multiple combined mechanisms are common and must be searched for. Importantly,hypernatraemia is not only a matter of water deficit, and treatment of the criticallyill patient with an accumulated fluid balance of 20 litres and corresponding weightgain should not comprise more water, but measures to invoke a negative cationbalance. Reduction of hypernatraemia/hypertonicity is critical, but should not exceed12 mmol/l/day in order to reduce the risk of rebounding brain oedema.
机译：钠浓度紊乱在重症患者中很常见，并伴随死亡率增加。治疗和预防的关键原则是血浆[Na +]（P- [Na +]）由外部水和阳离子平衡确定。 P- [Na +]确定血浆渗透压。一个重要的例外是高血糖症，尽管血浆高渗性，P- [Na +]仍可能降低。首先对患者进行治疗以确保气道，呼吸和循环，以减少继发性器官损害。在处理低钠血症患者时，症状至关重要。严重的症状可通过2 ml / kg的3％NaCl推注输注来治疗，而不论低钠血症的持续时间如何。目的是减少脑部症状。推注疗法可确保P- [Na +]立即升高且可控制。最多可给予三个大剂量（增加P- [Na +]约6 mmol / l）。在所有低钠血症患者中，必须避免超过10 mmol / l /天的校正，以减少渗透性脱髓鞘的风险。讨论了处理P- [Na +]快速升高的实际措施。过度矫正的风险与引起低钠血症的机制有关。众所周知，根据容量状态进行传统分类在临床实践中很难处理。而且，多种组合机制是常见的。因此，必须考虑一种以上的机制来进行安全，持久的纠正。高钠血症比低钠血症少见，但暗示患者病情更重，预后更差。一种实用的方法包括治疗潜在疾病以及恢复扭曲的水和盐分平衡。多种组合机制是常见的，必须寻找。重要的是，高钠血症不仅是缺水的问题，对于重症患者的积液平衡为20升且相应体重增加的治疗不应包含更多的水，而是应采取措施使阳离子负平衡。减少高钠血症/高渗血症至关重要，但不应超过12 mmol / l /天，以减少脑水肿反弹的风险。

著录项

相似文献

  • 外文文献
  • 中文文献
  • 专利
获取原文

客服邮箱：kefu@zhangqiaokeyan.com

京公网安备：11010802029741号 ICP备案号：京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有

  • 客服微信

  • 服务号