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首页> 外文期刊>Quarterly Journal of Medicine >Severe hyponatraemia in medical in-patients: aetiology, assessment and outcome.
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Severe hyponatraemia in medical in-patients: aetiology, assessment and outcome.

机译：住院患者严重低钠血症：病因，评估和结果。

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BACKGROUND: Hyponatraemia is the most commonly identified electrolyte abnormality. Published data on severe hyponatraemia in general medical in-patients is lacking. AIM: To determine the aetiology, adequacy of assessment, and outcome of severe hyponatraemia in general medical in-patients. DESIGN: Retrospective case-note review. METHODS: All general medical in-patients (n = 108) with serum sodium < or =125 mmol/l were identified from the clinical chemistry database, over a six-month period. A full review of notes and computer records was undertaken at the index date and a pre-determined follow-up date. RESULTS: Follow-up data were available in 105 patients. There was a wide range of aetiologies: diuretic therapy (loop and thiazide), congestive cardiac failure and liver disease were the most common, and 75.3% of patients had multiple causes. None of the 48% of patients whose history suggested a possible diagnosis of the syndrome of inappropriate anti-diuretic hormone (SIADH) met the generally accepted diagnostic criteria. Overall mortality was 20% during the index admission and 44.6% at follow-up, vs. 7.1% and 22%, respectively, for other patients admitted to the same directorate over the same time period (p < 0.001). Mortality was linked to aetiology, but not to reduced absolute serum sodium concentration at admission. DISCUSSION: Severe hyponatraemia in general medical patients is associated with a complex, multifactoral aetiology and a very poor prognosis. Outlook is governed principally by aetiology, and not by serum sodium level. Assessment of patients with hyponatraemia requires a practical clinical algorithm for diagnosing SIADH.
机译：背景：低钠血症是最常见的电解质异常。缺乏关于普通住院患者严重低钠血症的公开数据。目的：确定普通内科住院患者严重低钠血症的病因，评估是否充分以及结果。设计：回顾性病例笔记审查。方法：从临床化学数据库中，在六个月的时间内，确定了所有血清钠含量≤125mmol / l的普通内科住院患者（n = 108）。在索引日期和预定的后续日期对笔记和计算机记录进行了全面审查。结果：有105例患者的随访数据。病因范围很广：利尿疗法（loop和噻嗪类），充血性心力衰竭和肝病是最常见的，并且75.3％的患者有多种原因。有48年病史提示可能诊断为抗利尿激素不适当综合征（SIADH）的患者中，没有一个符合公认的诊断标准。入院时的总死亡率为20％，随访时的总死亡率为44.6％，而同期同一时间入院的其他患者的总死亡率分别为7.1％和22％（p <0.001）。死亡率与病因相关，但与入院时绝对血清钠浓度降低无关。讨论：一般医学患者严重低钠血症与复杂的多因素病因和预后很差有关。前景主要由病因决定，而不由血清钠水平决定。对低钠血症患者的评估需要诊断SIADH的实用临床算法。

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