低ナトリウム血症の診断と治療: レビュー

Horacio J Adrogué^1,2, Bryan M Tucker^1,2, Nicolaos E Madias^3,4

¹Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas.

JAMA

|July 19, 2022

まとめ

低ナトリウム血症は,一般的な電解質障害で,成人の5%に影響を与え,入院と死亡率を増加させます. 治療には根本的な原因に対処し,重症の場合にオスモス性脱ミエリン症などの危険な合併症を防ぐための特定の治療法が必要です.

科学分野:

腎臓科
内科医学
内分泌学

背景:

低ナトリウム症は最も一般的な電解質疾患で,成人の5%と入院患者の35%に罹患しています.
血清ナトリウム<135mEq/ Lで定義され,しばしば水分保持の結果であり,入院と死亡率の増加と関連しています.
症状は軽度 (弱さ) から重度 (発作,昏睡) まであり,発症速度,持続時間,重度によって影響を受ける.

研究の目的:

低ナトリウム血症の臨床的意義,症状,および管理戦略の検討
低ナトリウム血症と認知障害,転倒,骨折,骨粗鬆症の関連性を強調する
特定の状態と緊急管理のための治療法を含む低ナトリウム血症の治療ガイドラインを概説する.

主な方法:

低ナトリウム血症の流行,症状,臨床結果に関する文献レビュー
低ナトリウム血症と転倒,骨折,骨密度の関連性に関する研究の分析
尿素,ヴァプタン,高血圧塩素を含む現在の治療ガイドラインと治療選択肢の検討

主要な成果:

軽度の慢性低ナトリウム症は認知障害,歩行障害,転倒,骨折と関連しています.
低ナトリウム血症は骨粗鬆症の二次原因として特定されています.
治療戦略は,液体量状態 (低血圧,高血圧,高血圧) と症状の重症度によって異なります.

結論:

大抵の低ナトリウム血症は基礎疾患の治療が必要である.
尿素とヴァプトンは不適切な抗尿症症候群と心不全に関連する低ナトリウム症候群の選択肢であり,潜在的な副作用があります.
重度の症状の低ナトリウム症は,高血圧塩水による緊急治療を必要とし,オスモティック脱ミエリン化を避けるために注意深く監視する必要があります.

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