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高钠血症的病因及评估

Author
Richard H Sterns, MD
Section Editor
Michael Emmett, MD
Deputy Editor
John P Forman, MD, MSc
Translators
刘煜, 主任医师，教授

引言

高钠血症是一种相对常见的问题。例如，一项关于981例收入重症监护病房的成人的研究显示，高钠血症的患病率为9%：其中2%在入院时就已有高钠血症；7%在住院期间发生高钠血症[1]。高钠血症主要发生在那些由于精神状态受损而未正常产生渴感或者对渴感做出反应的患者(例如，老年及危重症患者)，以及能产生渴感但是需要他人提供液体摄入的婴儿。 (参见下文‘渴感的重要性’)

如下所述，高钠血症最常由失水所致，但是也可以由摄入盐而不摄入水或者给予高渗性钠溶液导致。由失水导致的高钠血症称为脱水。这不同于低血容量，低血容量同时存在盐和水的丢失[2]。 (参见“水平衡紊乱(低钠血症和高钠血症)和钠平衡紊乱(低血容量和水肿)的一般原理”)

高钠血症的病因及评估将总结在此(表 1)。高钠血症患者的治疗将单独讨论。 (参见“高钠血症的治疗”)

在讨论高钠血症的病因及评估之前，回顾血清钠浓度的决定因素是有帮助的。

血清钠浓度的决定因素

需要了解血清钠浓度的决定因素以鉴别哪些液体丢失情况可促进高钠血症的发生，以及必须用什么成分的静脉输液来纠正高钠血症。例如，呕吐或腹泻(均可导致血浆等渗性液体丢失)是如何导致高钠血症的？此外，为什么在5%的静脉用葡萄糖水溶液中添加钾盐(通常是氯化钾)可以减少这种葡萄糖溶液降低血清钠浓度的程度？

                    

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Literature review current through: 2017-06 . | This topic last updated: 2015-12-10.
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