文档介绍：低钠血症姓名:王婷婷时间: 目录 1234 生理性钠代谢低钠血症分类低钠血症病因低钠血症治疗钠代谢正常人体: 40~50mmol/kg 60~70% 可交换 40% 不可交换(结合于骨骼基质)细胞外液— 50% 细胞内液— 10% Na +排出:肾脏(主要)、汗液、胃肠道代谢特点:多吃多排、少吃少排调节机制:醛固酮调节、肾脏调节正常范围: 135-145mmol/L 病理生理学分类假性/等渗低钠血症高渗性低钠血症低渗性低钠血症低钠血症分类临床表现轻度: 130-135mmol/L 中度: 125-129mmol/L 重度: <125mmol/L 中度: 恶心、意识混乱、头痛重度: 呕吐、心脏呼吸窘迫、嗜睡、癫痫样发作、昏迷(GCS ≤8) 急性: ≤48h 慢性:>48h 严重程度发生速度低钠血症分类 Fluid depleted Oedematous Normal or modestly Expended volume (no oedema ) >20 <20 Acute/chronic renal failure, temporary impairment of water diuresis (drugs, stress) SIADH, glucocorticoid deficiency, hypothyroidsm Severe polydipsia Inappropriate IV fluid >20 Hypor -osmotic Hyponatraemia Osmolality Hyper- osmotic Osmotic eg mannitol hyperglycaemi a Artefacutal eg lab error , hyperlipidaemia hyperproteinaemia Iso -osmotic ECF status U[Na] U[Na] U[Na] Renal loss polyuric phase acute renal failure, postobstructive diuresis, chronic renal failure, Cerebral salt-wasting Diuretic excess Mineralocorticoid deficiency (primary/secondary) Extra-renal loss Abdominal Sequestration eg peritonitis, rapid umulation of ascites GI Skin >20 <20 <20 Acute/chronic renal failure Nephrotic Syndrome Cirrhosis Cardiac failure 病因学脑耗盐综合征(CSWS )是指在中枢神经系统病变基础上出现的肾脏排水排钠多度,导致患者出现低钠血症、细胞外液和循环容量减少的一类临床综合征脑耗盐综合征?利钠因子释放增加: 利钠肽、内源性哇巴因 ANP BNP CNP DNP VNP EO ?直接神经效应: 中枢神经系统病变,交感神经兴奋性降低,肾脏交感神经活性降低,抑制肾素合成和分泌,醛固酮的合成和分泌减少,肾小管重吸收钠减少,尿钠排出增多、血钠浓度降低; 血浆晶体渗透压降低抑制 ADH 分泌, 肾脏远端肾小管对水重吸收减少,排尿增多脑耗盐综合征发病机制 9 ?低钠血症伴多尿?尿钠浓度升高、尿量增加而尿比重正常?低血容量、 CVP 降低、体重减轻、常有脱水征、心率快、体位性低血压、 HCT 和 BUN 升高?补水补钠后病情好转脑耗盐综合征诊断标准 10 Fluid depleted Oedematous Normal or modestly Expended volume (no oedema ) >20 <20 Acute/chronic renal failure, temporary impairment of water diuresis (drugs, stress) SIADH, glucocorticoid deficiency, hypothyroidsm Severe polydipsia Inappropriate IV fluid >20 Hypor -osmotic Hyponatraemia Osmolality Hyper- osmotic Osmotic eg mannitol hyperglycaemi a Artefacutal eg lab error , hyperlipida