Characteristics, Symptoms, and Outcome of Severe Dysnatremias Present on Hospital Admission
Characteristics, Symptoms, and Outcome of Severe Dysnatremias Present on Hospital Admission
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DOI：
10.1016/j.amjmed.2012.04.041
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发表时间：
2012-11-01
影响因子：
5.9
通讯作者：
Lindner, Gregor
中科院分区：
文献类型：
--
作者：
Arampatzis, Spyridon;Frauchiger, Bettina;Lindner, Gregor
目的：钠血症异常在危重患者中很常见，并与不良结局相关，但其发病率、性质和治疗方法在急诊科就诊的人群中很少有系统的研究。我们对到伯尔尼大学急诊科就诊的患者进行了一项研究。方法：在瑞士一所大学医院的回顾性病例系列中，纳入了2008年4月1日至2011年3月31日期间急诊科收治的77,847例患者。对其中43,911例患者进行了血清钠测定。重度低钠血症定义为小于121 mmol/L，重度高钠血症定义为小于149 mmol/L。结果：2%的患者出现高钠血症（钠浓度为145 mmol/L）， 10%的患者出现低钠血症（钠浓度< 135 mmol/L）。重度高钠血症74例，重度低钠血症168例。约38%的严重高钠血症患者和64%的低钠血症患者有神经系统症状。症状的发生与血清钠的绝对升高有关。嗜睡和定向障碍是高钠血症患者的主要症状，恶心、跌倒和虚弱是低钠血症患者的主要症状。矫正率在有症状和无症状患者之间没有差异。有症状的高钠血症患者在入院后24小时内血清钠浓度进一步升高。18%的高钠血症患者和4%的低钠血症患者未采取纠正措施。结论：钠血症异常在急诊科很常见。低钠血症和高钠血症有不同的症状。与建议相反，在有症状的患者中，血清钠并没有得到更快的纠正。(C) 2012爱思唯尔公司版权所有。美国医学杂志（2012）125,1125. 01 -1125. 07
OBJECTIVE: Dysnatremias are common in critically ill patients and associated with adverse outcomes, but their incidence, nature, and treatment rarely have been studied systematically in the population presenting to the emergency department. We conducted a study in patients presenting to the emergency department of the University of Bern.METHODS: In this retrospective case series at a university hospital in Switzerland, 77,847 patients admitted to the emergency department between April 1, 2008, and March 31, 2011, were included. Serum sodium was measured in 43,911 of these patients. Severe hyponatremia was defined as less than 121 mmol/L, and severe hypernatremia was defined as less than 149 mmol/L.RESULTS: Hypernatremia (sodium > 145 mmol/L) was present in 2% of patients, and hyponatremia (sodium < 135 mmol/L) was present in 10% of patients. A total of 74 patients had severe hypernatremia, and 168 patients had severe hyponatremia. Some 38% of patients with severe hypernatremia and 64% of patients with hyponatremia had neurologic symptoms. The occurrence of symptoms was related to the absolute elevation of serum sodium. Somnolence and disorientation were the leading symptoms in hypernatremic patients, and nausea, falls, and weakness were the leading symptoms in hyponatremic patients. The rate of correction did not differ between symptomatic and asymptomatic patients. Patients with symptomatic hypernatremia showed a further increase in serum sodium concentration during the first 24 hours after admission. Corrective measures were not taken in 18% of hypernatremic patients and 4% of hyponatremic patients.CONCLUSIONS: Dysnatremias are common in the emergency department. Hyponatremia and hypernatremia have different symptoms. Contrary to recommendations, serum sodium is not corrected more rapidly in symptomatic patients. (C) 2012 Elsevier Inc. All rights reserved. The American Journal of Medicine (2012) 125, 1125.e1-1125.e7