Continuous Versus Bolus Infusion of Hypertonic Saline in the Treatment of Symptomatic Hyponatremia Caused by SIAD
Continuous Versus Bolus Infusion of Hypertonic Saline in the Treatment of Symptomatic Hyponatremia Caused by SIAD
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DOI：
10.1210/jc.2019-00044
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发表时间：
2019-09-01
影响因子：
5.8
通讯作者：
Thompson, Chris J.
中科院分区：
文献类型：
--
作者：
Garrahy, Aoife;Dineen, Rosemary;Thompson, Chris J.
背景：急性低钠血症是一种死亡率高的内科急症，主要原因是脑水肿。专家指南提倡使用高渗盐水静脉推注而不是传统的连续输注，以实现血浆钠（pNa）浓度的更快初始升高。然而，这一政策变化的证据基础有限。方法：我们前瞻性评估了3%生理盐水静脉推注治疗不当抗利尿综合征引起的症状性低钠血症患者的临床和生化结局（100 mL，重复两次以上），并将结果与接受低剂量（结果：22例患者采用快速静脉推注，28例患者采用持续静脉推注。3%生理盐水推注导致6小时pNa更快升高[中位数（范围）6（2 - 11）vs 3（1 - 4）mmol/L，P < 0.0001]，6小时格拉斯哥昏迷评分（GCS）也随之改善[中位数（范围）3（1 - 6）vs 1（-2至2），P < 0.0001]。两个治疗组在24小时时的中位pNa浓度相似。第三次盐水推注的给药与葡萄糖/dDAVP的更大需求相关，以防止过度矫正（OR 24; P = 0.006）。两组均无渗透性脱髓鞘病例。结论：3%生理盐水推注比连续输注产生更快的pNa初始升高，GCS恢复更快，且无渗透性脱髓鞘。需要频繁的电解质监测和dDAVP的明智干预，以防止推注治疗的过度校正。
Background: Acute hyponatremia is a medical emergency that confers high mortality, attributed primarily to cerebral edema. Expert guidelines advocate the use of intravenous boluses of hypertonic saline rather than traditional continuous infusion to achieve a faster initial rise in plasma sodium (pNa) concentration. However, there is a limited evidence base for this recommended policy change.Methods: We prospectively assessed the clinical and biochemical outcomes in patients treated for symptomatic hyponatremia caused by syndrome of inappropriate antidiuresis in response to intravenous bolus treatment with 3% saline (100 mL, repeated up to two more times) and compared the outcomes to retrospective data from patients treated with continuous intravenous infusion of low-dose (20 mL/h) 3% saline.Results: Twenty-two patients were treated with bolus infusion and 28 with continuous infusion. Three percent saline bolus caused more rapid elevation of pNa at 6 hours [median (range) 6 (2 to 11) vs 3 (1 to 4) mmol/L, P < 0.0001], with a concomitant improvement in Glasgow Coma Scale (GCS) [median (range) 3 (1 to 6) vs 1 (-2 to 2), P < 0.0001] at 6 hours. Median pNa concentration was similar at 24 hours in the two treatment groups. The administration of a third saline bolus was associated with greater need for dextrose/dDAVP to prevent overcorrection (OR 24; P = 0.006). There were no cases of osmotic demyelination in either group.Conclusion: Three percent saline bolus produces faster initial elevation of pNa than continuous infusion with quicker restoration of GCS, and without osmotic demyelination. Frequent electrolyte monitoring, and judicious intervention with dDAVP is required to prevent overcorrection with bolus therapy.