2014欧洲低钠血症诊疗指南

This usually occurs when hyponatraemia develops rapidly, and the brain has had too little time to adapt to its hypotonic environment.
Over time, the brain reduces the number of osmotically active particles within its cells (mostly potassium and organic solutes) in an attempt to restore the brain volume (Fig. 2). This process takes 24–48 h, hence the reason for using the 48-h threshold to distinguish acute (＜48 h) from chronic (≥48 h) hyponatraemia
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.
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
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）
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
6113： 重度（profound）低钠血症： 血钠：
<125mmol/l
依据发生时间分类:
6121： 急性低钠血症<48h
6122: 慢性低钠血症≥48h
6123 如果不能对其分类,除非有临床
或回顾性反证（表8），则应认 为系慢性低钠血症
为何以48小时为界限界定急慢性低钠血症?
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
In most cases, hyponatraemia reflects low effective osmolality or hypotonicity, which causes symptoms of cellular oedema.
6. 低钠血症诊断Diagnosis of hyponatraemia 6.1. 分类:Classification of hyponatraemia
根据血钠浓度分类:
6111： 轻度(mild)低钠血症：血钠：
130~135mmol/l
6112： 中度（moderate）低钠血症：血钠： 125~129mmol/l
2014 欧洲 低钠血症诊疗指南解读
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
低钠血症
wenku.baidu.com
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)
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。
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。
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.