Hypertonic Saline for Hyponatremia: Meeting Goals and Avoiding Harm.

Hypertonic Saline for Hyponatremia: Meeting Goals and Avoiding Harm.
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DOI:
10.1053/j.ajkd.2021.07.020
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发表时间:
2022-06
期刊:
American journal of kidney diseases : the official journal of the National Kidney Foundation
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高渗盐水用于治疗低钠血症已有近世纪的历史。目前普遍认为,对于伴有中度或重度症状的低钠血症患者应使用高渗盐水,以预防神经系统并发症。然而,专家们对使用的其他方面意见不一。高渗盐水应该以推注或连续输注的方式给药吗?合适的剂量是多少?是否需要中心静脉导管?去氨加压素是否应该同时使用,持续多长时间?本文考虑这些重要问题,简要探讨了高渗盐水用于低钠血症的历史起源,并回顾了其适应症,剂量,给药方式和途径,与去氨加压素联合使用以防止血清钠的快速纠正以及其他考虑因素(如液体限制的必要性和程度)背后的最新证据。最后,作者提供了一些实用的高渗盐水的使用建议。
Hypertonic saline has been used for the treatment of hyponatremia for nearly a century. There is now general consensus that hypertonic saline should be used in patients with hyponatremia associated with moderate or severe symptoms to prevent neurological complications. However, much less agreement exists among experts regarding other aspects of its use. Should hypertonic saline be administered as a bolus injection or continuous infusion? What is the appropriate dose? Is a central venous line necessary? Should desmopressin be used concomitantly and for how long? This article considers these important questions, briefly explores the historical origins of hypertonic saline use for hyponatremia, and reviews recent evidence behind its indications, dosing, administration modality and route, combined use with desmopressin to prevent rapid correction of serum sodium, and other considerations such as the need and degree for fluid restriction. The authors conclude by offering some practical recommendations for the use of hypertonic saline.
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