Disorders of Sodium and Water Balance

Harring, Theresa R.; Deal, Nathan; Kuo, Dick

doi:10.1016/j.emc.2014.01.001

Cited by 35 publications

(37 citation statements)

References 101 publications

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“…Na + ile su dengesinin yakın ilişkisi ve santral sinir sisteminin bu konuda katı sınırlarının olması nedeniyle Na + -su dengesizliğinde nörolojik belirtiler sık izlenmektedir (34). Beyin ve plazma arasındaki osmotik fark nedeniyle su ilk 30 dakika içerisinde beyin hücresi içerisine kaymakta ve beyin ödemi ile sonuçlanmaktadır.…”

Section: Hiponatremide Beyin Dokusunda Görülen Değişikliklerunclassified

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Recent Developments in Hyponatremia and Its Management

Bardak¹,

Turgutalp²,

Demir³

et al. 2015

Turk Neph Dial Transpl

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ÖZEn sık izlenen elektrolit bozukluğu olan hiponatremi, sodyum ve su arasındaki mükemmel dengenin birçok farklı nedene bağlı olarak bozulması sonucu gelişebilmektedir. Hiponatremi tanı ve tedavisinde bu faktörlerin tespiti önemlidir. Hiponatremi ile ilişkili belirtiler çoğunlukla hiponatreminin gelişme hızı ve derinliğine bağlıdır. Akut hiponatremiye bağlı gelişen beyin ödemi ve kronik hiponatreminin hızlı düzeltilmesine bağlı gelişen osmotik demiyelinasyon artmış ölüm riskine neden olmaktadır. Bu nedenle uygun olmayan tedavi yaklaşımları morbidite ve mortalitede artışa yol açabilir. Yakın zamanda hiponatremi tanı ve tedavisi ile ilgili yeni kılavuz ve uzman görüşleri yayınlanmıştır. Ancak önerilerle ilgili tartışmalar hala sürmektedir. Biz bu derlemede, hiponatremi ile ilgili güncel gelişmeleri özetledik ve hiponatremi yönetimindeki farklı yaklaşımları tartıştık. ANAHTAR SÖZCÜKLER: Hiponatremi, Kılavuzlar, Sodyum ABSTRACTHyponatremia is the most common electrolyte disorder and can develop due to many different reasons disrupting the perfect balance of sodium and water. Determination of these factors is important in the diagnosis and treatment of hyponatremia. Symptoms of hyponatremia depend mostly on the rate of development. Brain edema due to acute hyponatremia and osmotic demyelination due to rapid correction of chronic hyponatremia can cause an increased risk of death. Inappropriate therapeutic approaches can therefore lead to an increase in morbidity and mortality. New guidelines about the diagnosis and treatment of hyponatremia have been published recently. However, there is controversy regarding some of these recommendations. In this review, we summarize the current literature on hyponatremia and discuss the different approaches in hyponatremia management. KEY WORDS: Hyponatremia, Guidelines, Sodium SODYUM ve SU DENGESIOrganizmada; su, arter kan basıncı, osmolarite ve pH gibi birçok kritik yapıyı sürekli olarak kontrol eden; algılayıcılar (afferent yapı), algılayıcılarla elde edilen bilgiyi değerlendiren bir merkez ve merkezin oluşturduğu yanıtı icra eden molekül ve dokular (efferent yapı) vardır. Su ve sodyum (Na + ) dengesi için; algılayıcılar kardiyovasküler sistemde bulunurken (baroreseptör vb.), merkez beyin (hipotalamus) ve beyin sapıdır. En önemli efferent organ ise böbreklerdir. Ek olarak, bu sistemin trafiğini kusursuz hale getiren birçok molekül (antidiüretik hormon[ADH], katekolaminler, anjiyotensin II vb.) bulunmaktadır (1). Bu sayede, serum Na + konsantrasyonu; çok değişken sıvı alımı, katı gıda tüketimi ve idrar dışı sıvı kayıplarına rağmen çok dar bir aralıkta (135-145 mmol/l) tutulur.Su ve Na + değerinin dengede tutulmasının temel amaçları; damar yatağındaki hacmin kontrolü, doku kan dolaşımının istenilen düzeyde kalmasının sağlanması için gereken arteriyel basınç kontrolü ve hücre içi ve dışı parçacık yoğunluğunun (tonisite) devamıdır (2). Dolayısıyla böbrek; su, Na + , osmolarite ve basınç kontrolünün tamamında anahtar rol oynayan icracı bir organdır.

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Section: Hiponatremide Beyin Dokusunda Görülen Değişikliklerunclassified

“…Altta yatan nedenin çözülmesi ile genellikle Na + düzeyi normale dönebilmektedir. Serum ve idrar elektrolitleri, osmolariteleri ve sıvı durumu değerlendirilmesi hiponatremi yönetimine yardımcıdır (34).…”

Section: Tedavi Yaklaşimi Tedavi Yaklaşımında Genel Prensiplerunclassified

Recent Developments in Hyponatremia and Its Management

Bardak¹,

Turgutalp²,

Demir³

et al. 2015

Turk Neph Dial Transpl

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“…Sodium contributes to various processes including blood and osmotic pressure regulation, transportation of water and nutrients across cells, and transmission of nerve impulses (Cruz et al, 2011;Harring, Deal, & Kuo, 2014). However, a high consumption of sodium has been associated with non-communicable diseases (including hypertension, cardiovascular disease and stroke), besides kidney disease and gastric cancer, among others (D'Elia, Rossi, Ippolito, Cappuccio, & Strazzullo, 2012;Kaplan, 2000).…”

Section: Introductionmentioning

confidence: 99%

Dissolution of NaCl crystals in artificial saliva and water by video-microscopy

Quilaqueo

Aguilera

2015

Food Research International

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mentioning

confidence: 99%

“…2 Chronic hypernatremia or hypernatremia of unknown duration should be corrected more slowly, with a maximum correction goal of a decrease in serum sodium of no greater than 10 mmol/L in 24 hours. 2 Intravenous correction with normal saline (0.9% sodium) will result in inadequate correction of the patient's hypernatremia, particularly if there are ongoing free water losses. 3 Although a nasogastric tube would allow for the delivery of solute free water via flushes, this approach is probably more invasive than is necessary if intravenous or oral fluid administration is possible.…”

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confidence: 99%

53-Year-Old Man With Hypernatremia and Encephalopathy

Norgan

Sarfani

Kautz

2015

Mayo Clinic Proceedings

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A 53-year-old man was admitted to the hospital medical service after an outpatient evaluation for encephalopathy revealed a serum sodium level of 166 mmol/L. The duration of the patient's hypernatremia was unknown. The patient had been previously healthy but in the past year had experienced progressive fatigue and neurologic disturbances including somnolence, constructional apraxia, cognitive impairment, narcolepsy, cataplexy, and rapid eye movement sleep behavior symptoms. Several months before the current admission, he was noted to be hyponatremic, likely as a consequence of syndrome of inappropriate antidiuretic hormone secretion, and he was treated with water restriction and demeclocycline. In the course of evaluating his symptoms, he was found to have a single lymph node on the right side of his neck that was positive for metastatic squamous cell carcinoma; a tonsillar origin was suspected, but ultimately no primary lesion was identified. Additional imaging evaluation at that time (approximately 2 months before admission) prompted a hypothalamic biopsy that revealed noncaseating granulomas in the absence of infection. In the time leading up to admission, his symptoms continued to progress, with fluctuating hypernatremia and hyponatremia, polydipsia, polyuria, and worsening hypersomnia.The patient's outpatient medications included treatments for neurosarcoidosis (initiated 2 months before the current admission), including prednisone (40 mg daily), methotrexate, cyclosporine, hydroxychloroquine, and infliximab. In addition, he was receiving demeclocycline (600 mg twice daily) for treatment of hyponatremia. He was not on fluid restriction but had unreliable oral intake because of his progressive encephalopathy. When aroused and prompted, he had an intact thirst mechanism and was able to drink.Laboratory evaluation at admission yielded the following (reference ranges provided parenthetically): serum sodium, 166 mmol/L (135-145 mmol/L); serum potassium, 4.0 mmol/L (3.6-5.2 mmol/L); serum glucose, 92 mg/dL (70-140 mg/dL); creatinine, 1.4 mg/dL (0.8-1.3 mg/dL); and serum urea nitrogen, 31 mg/dL (8-24 mg/dL).On examination, the patient was somnolent but arousable to voice (Glasgow Coma Scale score, 13). He was oriented to person but not place or time. His mentation precluded a comprehensive review of systems, but collateral information from his family was positive for progressive inability to perform activities of daily living and unintentional 11.25-kg weight loss.

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Disorders of Sodium and Water Balance

Cited by 35 publications

References 101 publications

Recent Developments in Hyponatremia and Its Management

Recent Developments in Hyponatremia and Its Management

Dissolution of NaCl crystals in artificial saliva and water by video-microscopy

53-Year-Old Man With Hypernatremia and Encephalopathy

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