欧洲低钠血症诊疗指南.ppt

2014 欧洲低钠血症诊疗指南解读
欧洲低钠血症诊疗指南
欧洲危重病学会（ESICM），
欧洲内分泌学会（ESE）
欧洲肾脏最佳临床实践（European Renal Best Practice ERBP)为代表的欧洲肾脏病协会和欧洲透析与移植协会（ERA-EDTA）共同制定了欧洲低钠血症临床诊疗指南
欧洲低钠血症诊疗指南
低钠血症
Hyponatraemia, defined as a serum sodium concentration＜135 mmol/l, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice. It occurs in up to 30% of hospitalised patients and can lead to a wide spectrum of clinical symptoms, from subtle to severe or even life threatening (10, 11)
定义：
血清钠低于135mmol/L
临床最常见的水盐失衡，其发生率约占住院患者的30%
症状不一，从轻微到致命
欧洲低钠血症诊疗指南
In most cases, hyponatraemia reflects low effective osmolality or hypotonicity, which causes symptoms of cellular oedema.
However, hyponatraemia may also (rarely) occur with isotonic or hypertonic serum if the serum contains many additional osmoles, such as glucose or mannitol. Therefore, we discuss not only how hypo-osmolar but also how isosmolar and hyperosmolar states develop.
绝大多数情况下，低钠血症反映了低有效渗透压状态，主要引起细胞水肿
然而，如果血清含有其他渗透性物质如葡萄糖和甘露醇，则低钠血症在个别情况下也可发生于等渗或高渗情况。
因此，低钠血症不仅见于低渗，也见于等渗和高渗的情况。
欧洲低钠血症诊疗指南
Severe symptoms of hyponatraemia are caused by brain oedema and increased intracranial pressure. Brain cells start to swell when water moves from the extracellular to the intracellular compartment because of a difference in effective osmolality between brain and plasma.
patients with chronic hyponatraemia and no apparent symptoms can have subtle clinical abnormalities when analysed in more detail. Such abnormalities include gait disturbances, falls, concentration and cognitive deficits
patients with chronic hyponatraemia more often have osteoporosis and more frequently sustain bone fractures than normonatraemic persons
低钠血症严重症状为脑水肿。
低渗的血浆向高渗的脑细胞进行水转移，导致细胞肿胀
慢性和无明显症状的低钠血症患者，可有如下轻微症状：步态不稳，跌倒，注意力不集中和认知障碍
慢性低钠血症患者更易发生骨质疏松和骨折
欧洲低钠血症诊疗指南
图示：大脑对低钠血症的适应过程：
1即可反应
2快速适应
3慢适应调节
4不适当纠正（快速升高渗透压）
5适当纠正（缓慢提高渗透压）
欧洲低钠血症诊疗指南
6. 低钠血症诊断Diagnosis of hyponatraemia. 分类：Classification of h