Clinical management of SIADH
Clinical management of SIADH
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DOI：
10.1177/2042018812437561
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发表时间：
2012-04-01
影响因子：
3.8
通讯作者：
Gross, Peter
中科院分区：
文献类型：
--
作者：
Gross, Peter
低钠血症是最常见的电解质紊乱，抗利尿激素分泌不当综合征（SIADH）约占所有病例的三分之一。在SIADH的诊断中，重要的是确定细胞外液量的等容状态，无论是临床还是实验室测量。SIADH应治疗以治愈症状。虽然这在严重或晚期症状的存在下是无可争议的，但在轻度至中度症状的存在下的临床作用和治疗适应症目前尚不清楚。治疗方式包括非特异性措施和手段（液体限制、高渗盐水、尿素、地美环素），通常使用液体限制和高渗盐水。最近，血管加压素受体拮抗剂，称为vaptans，已被引入作为SIADH的特异性和直接治疗。虽然目前vaptans的临床经验有限，但它们似乎对患者有利，因为不需要限制液体，并且可以在短时间内舒适地纠正低钠血症。Vaptans似乎也有利于医生和工作人员，因为它们的效率和可靠性。副作用是口渴、烦渴和尿频。在慢性SIADH的任何治疗中，重要的是将血清钠的每日增加限制在低于8-10 mmol/L，因为较高的纠正率与渗透性脱髓鞘相关。在vaptan治疗的情况下，前24小时对于防止过快纠正低钠血症至关重要，应在治疗0、6、24和48小时后测量血清钠。应监测任何vaptan治疗停止超过5或6天，以防止低钠血症复发。可能需要逐渐减少vaptan剂量或限制液体摄入量或两者兼而有之。
Hyponatremia is the most frequent electrolyte disorder and the syndrome of inappropriate antidiuretic hormone secretion (SIADH) accounts for approximately one-third of all cases. In the diagnosis of SIADH it is important to ascertain the euvolemic state of extracellular fluid volume, both clinically and by laboratory measurements. SIADH should be treated to cure symptoms. While this is undisputed in the presence of grave or advanced symptoms, the clinical role and the indications for treatment in the presence of mild to moderate symptoms are currently unclear. Therapeutic modalities include nonspecific measures and means (fluid restriction, hypertonic saline, urea, demeclocycline), with fluid restriction and hypertonic saline commonly used. Recently vasopressin receptor antagonists, called vaptans, have been introduced as specific and direct therapy of SIADH. Although clinical experience with vaptans is limited at this time, they appear advantageous to patients because there is no need for fluid restriction and the correction of hyponatremia can be achieved comfortably and within a short time. Vaptans also appear to be beneficial for physicians and staff because of their efficiency and reliability. The side effects are thirst, polydipsia and frequency of urination. In any therapy of chronic SIADH it is important to limit the daily increase of serum sodium to less than 8-10 mmol/liter because higher correction rates have been associated with osmotic demyelination. In the case of vaptan treatment, the first 24 h are critical for prevention of an overly rapid correction of hyponatremia and the serum sodium should be measured after 0, 6, 24 and 48 h of treatment. Discontinuation of any vaptan therapy for longer than 5 or 6 days should be monitored to prevent hyponatremic relapse. It may be necessary to taper the vaptan dose or restrict fluid intake or both.