When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Hyponatremia

  • 概述
  • 理论
  • 诊断
  • 治疗
  • 随访
  • 资源
最后审阅： 18 Jun 2025
最后更新： 28 Feb 2024

小结

定义

病史和体格检查

关键诊断因素

  • high fluid intake
  • fluid losses
  • history of diabetes mellitus
  • history of cirrhosis, nephrosis, congestive heart failure
  • nausea/vomiting
  • mild cognitive symptoms
  • altered mental status, seizures, coma
  • low urine output
  • weight changes
  • orthostatic hypotension
  • abnormal jugular venous pressure
  • poor skin turgor
  • dry mucus membranes
  • absence of axillary sweat
  • edema
  • rales or crackles on lung auscultation
  • polyuria
完整详情

其他诊断因素

  • history of hyperlipidemia or paraproteinemia
完整详情

危险因素

  • older age
  • hospitalization
  • selective serotonin-reuptake inhibitor (SSRI) use
  • thiazide diuretic use
  • underlying medical conditions
  • severe hypothyroidism
  • adrenal insufficiency
  • malignancy
  • use of other medications
  • MDMA (ecstasy) use
完整详情

诊断性检查

首要检查

  • serum sodium concentration
  • serum electrolytes, BUN, creatinine, and glucose
  • serum osmolality
  • urine sodium concentration
  • urine osmolality
  • urine electrolytes
  • urine flow rate
  • electrolyte-free water excretion
  • fractional excretion of sodium
  • thyroid-stimulating hormone
  • serum cortisol level and/or adrenocorticotropic hormone test
  • serum lipids and serum protein electrophoresis
完整详情

需考虑的检查

  • CT brain, chest, abdomen/pelvis
  • other tests targeted at evaluating the underlying cause
完整详情

治疗流程

急症处理

acute onset (<48 hours) and/or symptomatic

持续性治疗

chronic onset (≥48 hours) or asymptomatic

overcorrection of serum sodium concentration

撰稿人

作者

Judith H. Veis, MD
Judith H. Veis

Section Director

Nephrology

MedStar Washington Hospital Center

Washington

DC

利益声明

JHV declares that she has no competing interests.

同行评议者

Gregor Lindner, MD

Director

Department of Internal & Emergency Medicine

Hirslanden Klinik Im Park

Zurich

Switzerland

利益声明

GL is an author of a number of references cited in this topic.

Michael E. Ullian, MD

Professor of Medicine

Division of Nephrology

Department of Medicine

Medical University of South Carolina

Charleston

SC

利益声明

MEU declares that he has no competing interests.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Spasovski G, Vanholder R, Allolio B, et al; Hyponatraemia Guideline Development Group. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Eur J Endocrinol. 2014 Feb 25;170(3):G1-47.全文  摘要

Adrogué HJ, Tucker BM, Madias NE. Diagnosis and management of hyponatremia: a review. JAMA. 2022 Jul 19;328(3):280-91. 摘要

Verbalis JG, Grossman A, Höybye C, et al. Review and analysis of differing regulatory indications and expert panel guidelines for the treatment of hyponatremia. Curr Med Res Opin. 2014 Jul;30(7):1201-7. 摘要

Hoorn EJ, Zietse R. Diagnosis and treatment of hyponatremia: compilation of the guidelines. J Am Soc Nephrol. 2017 May;28(5):1340-9.全文  摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Hyponatremia images

  • 鉴别诊断

    • Hypertonic hyponatremia
    • Pseudohyponatremia
    • Evaluation of hyponatremia
    更多 鉴别诊断

  • 指南

    • Clinical practice guidelines for the management of exercise-associated hyponatremia: 2019 update
    • Clinical practice guidelines for the management of exercise-associated hyponatremia: 2019 update​
    更多 指南

  • 患者教育信息

    Hyponatremia (low blood sodium)

    更多 患者教育信息

  • 医学计算器

    Sodium Correction in Hyperglycemia (Hillier 1999)

    Osmolality Estimator (serum)

    更多 医学计算器
  • padlock-locked登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容

内容使用需遵循免责声明