低鈉血癥診斷

低鈉血癥姓名：王婷婷時(shí)間：2016.5.21目錄1234生理性鈉代謝低鈉血癥分類低鈉血癥病因低鈉血癥治療鈉代謝正常范圍：135-145mmol/L病理生理學(xué)分類假性/等滲低鈉血癥高滲性低鈉血癥低滲性低鈉血癥低鈉血癥分類臨床表現(xiàn)輕度：130-135mmol/L中度：125-129mmol/L重度：<125mmol/L中度：惡心、意識(shí)混亂、頭痛重度：嘔吐、心臟呼吸窘迫、嗜睡、癲癇樣發(fā)作、昏迷(GCS≤8)急性：≤48h慢性:＞48h嚴(yán)重程度發(fā)生速度低鈉血癥分類FluiddepletedOedematousNormalormodestlyExpendedvolume(nooedema)>20<20Acute/chronicrenalfailure,temporaryimpairmentofwaterdiuresis(drugs,stress)SIADH,glucocorticoiddeficiency,hypothyroidsmSeverepolydipsiaInappropriateIVfluid>20Hypor-osmoticHyponatraemiaOsmolalityHyper-osmoticOsmoticegmannitolhyperglycaemiaArtefacutaleglaberror,hyperlipidaemiahyperproteinaemiaIso-osmoticECFstatusU[Na]U[Na]U[Na]Renallosspolyuricphaseacuterenalfailure,postobstructivediuresis,chronicrenalfailure,Cerebralsalt-wastingDiureticexcessMineralocorticoiddeficiency(primary/secondary)Extra-renallossAbdominalSequestrationegperitonitis,rapidreaccumulationofascitesGISkin>20<20<20Acute/chronicrenalfailureNephroticSyndromeCirrhosisCardiacfailure病因?qū)W腦耗鹽綜合征（CSWS）是指在中樞神經(jīng)系統(tǒng)病變基礎(chǔ)上出現(xiàn)的腎臟排水排鈉多度，導(dǎo)致患者出現(xiàn)低鈉血癥、細(xì)胞外液和循環(huán)容量減少的一類臨床綜合征腦耗鹽綜合征利鈉因子釋放增加：利鈉肽、內(nèi)源性哇巴因

ANPBNPCNPDNPVNPEO直接神經(jīng)效應(yīng):中樞神經(jīng)系統(tǒng)病變，交感神經(jīng)興奮性降低，腎臟交感神經(jīng)活性降低，抑制腎素合成和分泌，醛固酮的合成和分泌減少，腎小管重吸收鈉減少，尿鈉排出增多、血鈉濃度降低;血漿晶體滲透壓降低抑制ADH分泌，腎臟遠(yuǎn)端腎小管對(duì)水重吸收減少，排尿增多腦耗鹽綜合征發(fā)病機(jī)制低鈉血癥伴多尿尿鈉濃度升高、尿量增加而尿比重正常低血容量、CVP降低、體重減輕、常有脫水征、心率快、體位性低血壓、HCT和BUN升高補(bǔ)水補(bǔ)鈉后病情好轉(zhuǎn)腦耗鹽綜合征診斷標(biāo)準(zhǔn)FluiddepletedOedematousNormalormodestlyExpendedvolume(nooedema)>20<20Acute/chronicrenalfailure,temporaryimpairmentofwaterdiuresis(drugs,stress)SIADH,glucocorticoiddeficiency,hypothyroidsmSeverepolydipsiaInappropriateIVfluid>20Hypor-osmoticHyponatraemiaOsmolalityHyper-osmoticOsmoticegmannitolhyperglycaemiaArtefacutaleglaberror,hyperlipidaemiahyperproteinaemiaIso-osmoticECFstatusU[Na]U[Na]U[Na]Renallosspolyuricphaseacuterenalfailure,postobstructivediuresis,chronicrenalfailure,Cerebralsalt-wastingDiureticexcessMineralocorticoiddeficiency(primary/secondary)Extra-renallossAbdominalSequestrationegperitonitis,rapidreaccumulationofascitesGISkin>20<20<20Acute/chronicrenalfailureNephroticSyndromeCirrhosisCardiacfailure病因?qū)WSIADH綜合征是指由于多種原因引起的內(nèi)源性抗利尿激素(ADH，即精氨酸加壓素AVP)分泌異常增多，血漿抗利尿激素濃度相對(duì)于體液滲透壓而言呈不適當(dāng)?shù)母咚?，從而?dǎo)致水潴留、尿排鈉增多以及稀釋性低鈉血癥等有關(guān)臨床表現(xiàn)的一組綜合征。抗利尿激素分泌失調(diào)綜合征SIADH綜合征是指由于多種原因引起的內(nèi)源性抗利尿激素(ADH，即精氨酸加壓素AVP)分泌異常增多，血漿抗利尿激素濃度相對(duì)于體液滲透壓而言呈不適當(dāng)?shù)母咚?，從而?dǎo)致水潴留、尿排鈉增多以及稀釋性低鈉血癥等有關(guān)臨床表現(xiàn)的一組綜合征?？估蚣に胤置谑д{(diào)綜合征ABC異源性ADH分泌其他藥物或疾病導(dǎo)致的ADH分泌抗利尿激素分泌失調(diào)綜合征發(fā)病機(jī)制尿滲透壓＞血漿滲透壓尿鈉＞50mmol/L無(wú)水腫或低血容量表現(xiàn)未使用利尿劑甲狀腺、腎上腺、腎、心臟及肝功能正?？估蚣に胤置谑д{(diào)綜合征診斷標(biāo)準(zhǔn)FluiddepletedOedematousNormalormodestlyExpendedvolume(nooedema)>20<20Acute/chronicrenalfailure,temporaryimpairmentofwaterdiuresis(drugs,stress)SIADH,glucocorticoiddeficiency,hypothyroidsmSeverepolydipsiaInappropriateIVfluid>20Hypor-osmoticHyponatraemiaOsmolalityHyper-osmoticOsmoticegmannitolhyperglycaemiaArtefacutaleglaberror,hyperlipidaemiahyperproteinaemiaIso-osmoticECFstatusU[Na]U[Na]U[Na]Renallosspolyuricphaseacuterenalfailure,postobstructivediuresis,chronicrenalfailure,Cerebralsalt-wastingDiureticexcessMineralocorticoiddeficiency(primary/secondary)Extra-renallos