Is asymptomatic hyponatremia really asymptomatic?
Is asymptomatic hyponatremia really asymptomatic?
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DOI：
10.1016/j.amjmed.2006.05.013
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发表时间：
2006-07-01
影响因子：
5.9
通讯作者：
Decaux, Guy
中科院分区：
文献类型：
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作者：
Decaux, Guy
低钠血症的后果通常很轻微，并且医生和患者都没有注意到。当通常为避免水中毒而规定的限水措施未能使血清钠值正常化时，临床医生将容忍轻度稳定的低钠血症（特别是当血清钠> 125 mEq/L [1 mEq/L = 1 mmol/L]时）。在最近的一项研究中，我们观察到轻度慢性低钠血症会导致跌倒率增加，这可能是由于注意力、姿势和步态机制受损所致。采用八项注意力测试来评估 16 名因抗利尿激素分泌不当综合征而出现无症状低钠血症（平均血清钠，128 +/- 3 mEq/L）的患者。在视觉和听觉刺激的注意力测试中，平均反应潜伏期增加了 58 毫秒 (P < 0.001)，总错误数增加了 20% (P < 0.001)。与正常血钠患者相比，低钠血症患者（平均血清钠，128 3 mEq/L）睁眼“串联”平台上的 3 个定型步骤的结果（表示为压力中心的总行程）也不同（1.3 vs 1 m；P < 0.003）。值得注意的是，在年龄相近的志愿者中，轻度饮酒（0.55克/公斤体重）后，注意力和步态测试受到的影响较小。在另一组连续 122 名因轻度低钠血症从急诊室住院的患者中，大约 21% 因跌倒入院。在控制年龄、性别和其他已知的跌倒危险因素后，与对照组相比，低钠血症患者跌倒的调整后优势比为 67。这些数据表明，无症状低钠血症的概念经不起对跌倒或敏感姿势、步态和注意力测试的详细流行病学分析。 (c) 2006 Elsevier Inc. 保留所有权利。
Consequences of hyponatremia are generally mild and remain unnoticed by both physician and patient. When water restriction, usually prescribed to avoid water intoxication, fails to normalize serum sodium values, clinicians will tolerate mild stable hyponatremia (especially when serum sodium is > 125 mEq/L [1 mEq/L = 1 mmol/L]). In a recent study, we observed that mild chronic hyponatremia contributes to an increased rate of falls, probably due to impairment of attention, posture, and gait mechanisms. Eight attention tests were used to assess 16 patients with asymptomatic hyponatremia (mean serum sodium, 128 +/- 3 mEq/L) due to syndrome of inappropriate antidiuretic hormone secretion. On attention tests for visual and auditory stimuli, there was an increase in mean response latency of 58 msec (P < 0.001) and an increase in total error number of 20% (P < 0.001). The results of 3 stereotyped steps on a platform "in tandem" with eyes open, expressed as total traveled way of center of pressure, was also different in patients with hyponatremia (mean serum sodium, 128 3 mEq/L) when compared with normonatremic patients (1.3 vs 1 m; P < 0.003). Noteworthy, in volunteers of similar age, after mild alcohol intake (0.55 g/kg body weight), attention and gait tests were less affected. In another series of 122 consecutive patients hospitalized from the emergency room with mild hyponatremia, approximately 21% were admitted for falls. After controlling for age, sex, and other known risk factors for falls, the adjusted odds ratio for falls in patients with hyponatremia was 67, compared with a control group. These data show that the concept of asymptomatic hyponatremia does not withstand a detailed epidemiologic analysis of falls or of sensitive posture, gait, and attention tests. (c) 2006 Elsevier Inc. All rights reserved.