본문 바로가기
KERD
논문KCI 등재

Evaluating and Managing Hyponatremia

유민욱|Ozan Akca|Evelyn Bediako
대한중환자의학회 (The Korean Society Of Critical Care Medicine)|2008.12|Acute and Critical Care|제23권 제2호|pp. 67-74

2

조회

0

다운로드

1

인용

0

참고문헌

키워드

hyponatremiaSIADHcerebral salt wasting syndrome

초록

Although hyponatremia is a common electrolyte disorder, its evaluation and management are not well defined. When diagnosed, hyponatremia should be categorized based on four criteria: volume status, urinary Na+, serum K+, and acid-base balance. This approach helps to determine what the cause of hyponatremia is and how it should be treated. Initially, hypovolemic hyponatremia, including cerebral salt wasting syndrome (CSWS), is treated by volume resuscitation and salt supplementation. Euvolemic hyponatremia, including the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), is treated by fluid restriction and salt supplementation, and hypervolemic hyponatremia is treated by fluid restriction and salt restriction. Hyponatremia can be managed well using these primary treatments and medications.

Abstract

Although hyponatremia is a common electrolyte disorder, its evaluation and management are not well defined. When diagnosed, hyponatremia should be categorized based on four criteria: volume status, urinary Na+, serum K+, and acid-base balance. This approach helps to determine what the cause of hyponatremia is and how it should be treated. Initially, hypovolemic hyponatremia, including cerebral salt wasting syndrome (CSWS), is treated by volume resuscitation and salt supplementation. Euvolemic hyponatremia, including the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), is treated by fluid restriction and salt supplementation, and hypervolemic hyponatremia is treated by fluid restriction and salt restriction. Hyponatremia can be managed well using these primary treatments and medications.

참고문헌 (67)

  1. Tisdall M, "Disturbances of sodium in critically ill adult neurologic patients: a clinical review", J Neurosurg Anesthesiol, 18, pp.57~63 (2006)
  2. Hirshberg B, "The syndrome of inappropriate antidiuretic hormone secretion in the elderly", Am J Med, 103, pp.270~273 (1997)
  3. Goh KP, "Management of hyponatremia", Am Fam Physician, 69, pp.2387~2394 (2004)
  4. Betjes MG, "Hyponatremia in acute brain disease: the cerebral salt wasting syndrome", Eur J Intern Med, 13, pp.9~14 (2002)
  5. Berkenbosch JW, "Cerebral salt wasting syndrome following brain injury in three pediatric patients: suggestions for rapid diagnosis and therapy", Pediatr Neurosurg, 36, pp.75~79 (2002)
  6. Saeed BO, "Severe hyponatraemia: investigation and management in a district general hospital", J Clin Pathol, 55, pp.893~896 (2002)
  7. Song J, "Increased blood pressure, aldosterone activity, and regional differences in renal ENaC protein during vasopressin escape", Am J Physiol Renal Physiol, 287, pp.F1076~F1083 (2004)
  8. Musch W, "Low sodium excretion in SIADH patients with low diuresis", Nephron Physiol, 96, pp.P11~P18 (2004)
  9. Yeates KE, "Salt and water: a simple approach to hyponatremia", CMAJ, 170, pp.365~369 (2004)
  10. Yamaki T, "Cerebral salt wasting syndrome distinct from the syndrome of inappropriate secretion of antidiuretic hormone (SIADH)", Acta Neurochir, 115, pp.156~162 (1992)
  11. Kazama I, "BSC1 inhibition complements effects of vasopressin V2 receptor antagonist on hyponatremia in SIADH rats", Kidney Int, 67, pp.1855~1867 (2005)
  12. Ishikawa S, "Pathological role of aquaporin-2 in impaired water excretion and hyponatremia", J Neuroendocrinol, 16, pp.293~296 (2004)
  13. Reynolds RM, "Hyponatraemia for the clinical endocrinologist", Clin Endocrinol, 63, pp.366~374 (2005)
  14. Musch W, "Utility and limitations of biochemical parameters in the evaluation of hyponatremia in the elderly", Int Urol Nephrol, 32, pp.475~493 (2001)
  15. Milionis HJ, "The hyponatremic patient:a systematic approach to laboratory diagnosis", CMAJ, 166, pp.1056~1062 (2002)
  16. Janicic N, "Evaluation and management of hypo-osmolality in hospitalized patients", Endocrinol Metab Clin North Am, 32, pp.459~481 (2003)
  17. Flamenbaum W, "Diuretic use in the elderly: potential for diuretic-induced hypokalemia", Am J Cardiol, 57, pp.38A~43A (1986)
  18. Decaux G, "Normal acid-base equilibrium in acute hyponatremia and mixed alkalosis in chronic hyponatremia induced by arginine vasopressin or 1-deamino-8-D-arginine vasopressin in rats", J Lab Clin Med, 123, pp.892~898 (1994)
  19. Donati-Genet PC, "Acute symptomatic hyponatremia and cerebral salt wasting after head injury: an important clinical entity", J Pediatr Surg, 36, pp.1094~1097 (2001)
  20. Nakano M, "Hyponatremia with increased plasma antidiuretic hormone in a case of hypothyroidism", Intern Med, 39, pp.1075~1078 (2000)
  21. Gill G, "Hyponatraemia: biochemical and clinical perspectives", Postgrad Med J, 74, pp.516~523 (1998)
  22. Uribarri J, "Hyponatremia in peritoneal dialysis patients", Clin Nephrol, 61, pp.54~58 (2004)
  23. Zeltser D, "Assessment of the efficacy and safety of intravenous conivaptan in euvolemic and hypervolemic hyponatremia", Am J Nephrol, 27, pp.447~457 (2007)
  24. Verbalis JG, "Hyponatremia causes large sustained reductions in brain content of multiple organic osmolytes in rats", Brain Res, 567, pp.274~282 (1991)
  25. Decaux G, "Treatment of symptomatic hyponatremia", Am J Med Sci, 326, pp.25~30 (2003)
  26. Adroguée HJ, "Hyponatremia", N Engl J Med, 342, pp.1581~1589 (2000)
  27. Bender FH, "Successful treatment of severe hyponatremia in a patient with renal failure using continuous venovenous hemodialysis", Am J Kidney Dis, 32, pp.829~831 (1998)
  28. Andrew RD, "Seizure and acute osmotic change: clinical and neurophysiological aspects", J Neurol Sci, 101, pp.7~18 (1991)
  29. Sarnaik AP, "Management of hyponatremic seizures in children with hypertonic saline: a safe and effective strategy", Crit Care Med, 19, pp.758~762 (1991)
  30. Worthley LI, "Treatment of hyponatraemic seizures with intravenous 29.2% saline", Br Med J, 292, pp.168~170 (1986)
  31. Adroguée HJ, "Consequences of inadequate management of hyponatremia", Am J Nephrol, 25, pp.240~249 (2005)
  32. Ayus JC, "Rapid correction of severe hyponatremia with intravenous hypertonic saline solution", Am J Med, 72, pp.43~48 (1982)
  33. Sterns RH, "Osmotic demyelination syndrome following correction of hyponatremia", N Engl J Med, 314, pp.1535~1542 (1986)
  34. Baylis PH, "The syndrome of inappropriate antidiuretic hormone secretion", Int J Biochem Cell Biol, 35, pp.1495~1499 (2003)
  35. Soupart A, "Prevention of brain demyelination in rats after excessive correction of chronic hyponatremia by serum sodium lowering", Kidney Int, 45, pp.193~200 (1994)
  36. Soupart A, "Therapeutic recommendations for management of severe hyponatremia: current concepts on pathogenesis and prevention of neurologic complications", Clin Nephrol, 46, pp.149~169 (1996)
  37. Kusuki M, "The syndrome of inappropriate antidiuretic hormone secretion associated with chemotherapy for hypopharyngeal cancer", Acta Otolaryngol Suppl, 554, pp.74~77 (2004)
  38. Chanson P, "Severe hyponatremia as a frequent revealing sign of hypopituitarism after 60 years of age", Eur J Endocrinol, 149, pp.177~178 (2003)
  39. Thompson M, "Syndrome of inappropriate antidiuretic hormone secretion associated with oral squamous cell carcinoma", Br J Oral Maxillofac Surg, 40, pp.216~219 (2002)
  40. Decaux G, "Treatment of hyponatremic encephalopathy", J Lab Clin Med, 138, pp.403~ (2001)
  41. Goldberg M, "Effects of ethacrynic acid (a new saluretic agent) on renal diluting and concentrating mechanisms: evidence for site of action in the loop of Henle", J Clin Invest, 43, pp.201~216 (1964)
  42. Packer M, "Correction of dilutional hyponatremia in severe chronic heart failure by convertingenzyme inhibition", Ann Intern Med, 100, pp.782~789 (1984)
  43. Curtis NJ, "Irreversible nephrotoxicity from demeclocycline in the treatment of hyponatremia", Age Ageing, 31, pp.151~152 (2002)
  44. Forrest JN Jr, "Superiority of demeclocycline over lithium in the treatment of chronic syndrome of inappropriate secretion of antidiuretic hormone", N Engl J Med, 298, pp.173~177 (1978)
  45. Decaux G, "Use of urea for treatment of water retention in hyponatraemic cirrhosis with ascites resistant to diuretics", Br Med J, 290, pp.1782~1783 (1985)
  46. Decaux G, "Evidence in hyponatremia related to inappropriate secretion of ADH that V1 receptor stimulation contributes to the increase in renal uric acid clearance", J Am Soc Nephrol, 7, pp.805~810 (1996)
  47. Saito T, "Acute aquaresis by the nonpeptide arginine vasopressin (AVP) antagonist OPC-31260 improves hyponatremia in patients with syndrome of inappropriate secretion of antidiuretic hormone (SIADH)", J Clin Endocrinol Metab, 82, pp.1054~1057 (1997)
  48. Wong LL, "Vasopressin V2 receptor antagonists", Cardiovasc Res, 51, pp.391~402 (2001)
  49. Decaux G, "Long-term treatment of patients with inappropriate secretion of antidiuretic hormone by the vasopressin receptor antagonist conivaptan, urea, or furosemide", Am J Med, 110, pp.582~584 (2001)
  50. Decaux G, "Difference in solute excretion during correction of hyponatremic patients with cirrhosis or syndrome of inappropriate secretion of antidiuretic hormone by oral vasopressin V2 receptor antagonist VPA-985", J Lab Clin Med, 138, pp.18~21 (2001)
  51. Yatsu T, "Cardiovascular and renal effects of conivaptan hydrochloride (YM087), a vasopressin V1A and V2 receptor antagonist, in dogs with pacing-induced congestive heart failure", Eur J Pharmacol, 376, pp.239~246 (1999)
  52. Singh S, "Cerebral salt wasting: truths, fallacies, theories, and challenges", Crit Care Med, 30, pp.2575~2579 (2002)
  53. Diringer MN, "Hypervolemic therapy prevents volume contraction but not hyponatremia following subarachnoid hemorrhage", Ann Neurol, 31, pp.543~550 (1992)
  54. Harrigan MR, "Cerebral salt wasting syndrome", Crit Care Clin, 17, pp.125~138 (2001)
  55. Sivakumar V, "Management of neurosurgical patients with hyponatremia and natriuresis", Neurosurgery, 34, pp.269~274 (1994)
  56. Hasan D, "Effect of fludrocortisone acetate in patients with subarachnoid hemorrhage", Stroke, 20, pp.1156~1161 (1989)
  57. Kinik ST, "Fludrocortisone treatment in a child with severe cerebral salt wasting", Pediatr Neurosurg, 35, pp.216~219 (2001)
  58. Yamashiro S, "Initial and postoperative hyponatremia associated with pituitary adenoma: a case report", Acta Neurochir, 139, pp.987~990 (1997)
  59. Khalifeh N, "The role of peritoneal dialysis in the management of treatment-resistant congestive heart failure: a European perspective", Kidney Int Suppl, 103, pp.S72~S75 (2006)
  60. Verbalis JG, "An experimental model of syndrome of inappropriate antidiuretic hormone secretion in the rat", Am J Physiol, 247, pp.E540~E553 (1984)
  61. Coenraad MJ, "Plasma arginine vasopressin and atrial natriuretic peptide concentration in patients with hyponatremia at diagnosis and following treatment", Eur J Intern Med, 18, pp.221~229 (2007)
  62. Adroguée HJ, "Consequences of inadequate management of hyponatremia", Am J Nephrol, 25, pp.240~249 (2005)
  63. Cawley MJ, "Hyponatremia: current treatment strategies and the role of vasopressin antagonists", Ann Pharmacother, 41, pp.840~850 (2007)
  64. Gröonhagen-Riska C, "Effects of ACE inhibition on renal regulation of salt and water", Acta Med Scand Suppl, 707, pp.95~99 (1986)
  65. Vachharajani TJ, "Hyponatremia in critically ill patients", J Intensive Care Med, 18, pp.3~8 (2003)
  66. Cherney DZ, "A physiological analysis of hyponatremia: implications for patients on peritoneal dialysis", Perit Dial Int, 21, pp.7~13 (2001)
  67. Demetriou D, "Adequacy of automated peritoneal dialysis with and without manual daytime exchange: a randomized controlled trial", Kidney Int, 70, pp.1649~1655 (2006)

관련 논문AI추천

Evaluation and management of hypernatremia in adults: clinical perspectives김세중, 백선하, Giae Yun대한내과학회 · The Korean Journal of Internal Medicine2023 · 제38권 제3호Evidence-based hyponatremia management in liver disease백선하, Ji Young Ryu, Sejoong Kim대한간학회 · Clinical and Molecular Hepatology2023 · 제29권 제4호Effectiveness and Safety of Tolvaptan for the Management of Hyponatremia: Risk of Inadvertent Overcorrection김주신, 박미선, 박성주, 박승용, 범진선, 안효초, 이흥범한국병원약사회 · 병원약사회지2018 · 제35권 제4호뇌하수체기능저하증 환자 증례에서 확인해보는 저나트륨혈증 진단 접근법고승현, 윤재승대한내과학회 · 대한내과학회지2016 · 제91권 제1호만성 무증상 저나트륨혈증의 관리배은희대한내과학회 · 대한내과학회지2011 · 제80권 제1호Korean Society of Nephrology 2022 recommendations on controversial issues in diagnosis and management of hyponatremia김양균, 오국환, 지종현, Eun Mi Yang, Hyo Jin Kim, Hyponatremia Guideline Development Group, Jeonghwan Lee, Jin Hyuk Paek, Jin-Soon Suh, Ji Young Ryu, Kyung Don Yoo, Miyoung Choi, Sang Heon Suh, Sejoong Kim, Seon Ha Baek, Se Won Oh, Yae Lim Kim, Yeonhee Lee, Young Ho Park대한내과학회 · The Korean Journal of Internal Medicine2022 · 제37권 제6호

이 간행물의 다른 논문 (9건)

소화성 궤양 출혈에서 양성자펌프 억제제와 소마토스타틴 병합치료가 예후에 미치는 영향이윤선, 김원, 김인성, 고벽성, 임경수pp. 75-78중화상환자에서 6% Hydroxyethyl Starch Solution 투여가 혈액 응고 기능에 미치는 영향배지영, 김광민, 곽인숙pp. 79-83한 내과계 중환자실에서 사망한 환자들의 심폐소생술 거절 현황이광하, 고윤석, 임채만, 홍상범, 장항제pp. 84-89응급센터를 통해 중환자실에 입원한 패혈증 환자의 예후 예측에 있어서 응급센터 내원 초기의 APACHE 2 Score와 MEDS Score의 유용성 비교하영록, 신태용, 고찬영, 김영식pp. 90-95일개 응급센터를 통해 중환자실로 입원한 급성 심부 경부 감염 환자들의 임상 양상김정권, 이근, 류지호, 김진주, 현성열, 신종환, 임용수, 조진성pp. 96-101
원문 보기