高钠血症评估

高钠血症是指血浆钠浓度高于 145 mmol/L (145 mEq/L)。

高钠血症是一种高渗状态，主要是由于水分不足，或较为少见的钠摄入增多所致。由于渗透平衡的维持，使细胞内液（ICF）的容量浓缩。相应的反应为由于口渴刺激使得的水摄入量增加，以及排泄极少量浓度极高的尿。

婴儿和有认知损害的成人最常发生高钠血症，因为他们无法表达渴感且取水受限。

高钠血症往往是几种疾病过程的结果，并且需要推导出基础病因，以纠正钠平衡。 高钠血症的生理后果很严重，并且与多种诱发因素相重叠。

流行病学

​高钠血症通常发生于幼龄或高龄患者，或者身体衰弱或认知障碍的患者。[1]Braun MM, Barstow CH, Pyzocha NJ. Diagnosis and management of sodium disorders: hyponatremia and hypernatremia. Am Fam Physician. 2015 Mar 1;91(5):299-307. http://www.ncbi.nlm.nih.gov/pubmed/25822386?tool=bestpractice.com

医院获得性高钠血症是最常见的高钠血症形式，并且在某些病例中是医源性的。[2]Tsipotis E, Price LL, Jaber BL, et al. Hospital-associated hypernatremia spectrum and clinical outcomes in an unselected cohort. Am J Med. 2018 Jan;131(1):72-82.e1. http://www.ncbi.nlm.nih.gov/pubmed/28860033?tool=bestpractice.com [3]Thongprayoon C, Cheungpasitporn W, Yap JQ, et al. Increased mortality risk associated with serum sodium variations and borderline hypo- and hypernatremia in hospitalized adults. Nephrol Dial Transplant. 2020 Oct 1;35(10):1746-52. https://academic.oup.com/ndt/article/35/10/1746/5521070 http://www.ncbi.nlm.nih.gov/pubmed/31219584?tool=bestpractice.com [4]Ranjan R, Lo SC, Ly S, et al. Progression to severe hypernatremia in hospitalized general medicine inpatients: an observational study of hospital-acquired hypernatremia. Medicina (Kaunas). 2020 Jul 17;56(7):358. https://www.mdpi.com/1648-9144/56/7/358 http://www.ncbi.nlm.nih.gov/pubmed/32709029?tool=bestpractice.com [5]Arzhan S, Roumelioti ME, Litvinovich I, et al. Hypernatremia in hospitalized patients: a large population-based study. Kidney360. 2022 Jul 28;3(7):1144-57. https://journals.lww.com/kidney360/Fulltext/2022/07000/Hypernatremia_in_Hospitalized_Patients__A_Large.8.aspx http://www.ncbi.nlm.nih.gov/pubmed/35919520?tool=bestpractice.com ​ 入院时出现高钠血症的情况较为少见。在一项针对 190 万名患者的研究中，3% 的患者在入院时有高钠血症。[5]Arzhan S, Roumelioti ME, Litvinovich I, et al. Hypernatremia in hospitalized patients: a large population-based study. Kidney360. 2022 Jul 28;3(7):1144-57. https://journals.lww.com/kidney360/Fulltext/2022/07000/Hypernatremia_in_Hospitalized_Patients__A_Large.8.aspx http://www.ncbi.nlm.nih.gov/pubmed/35919520?tool=bestpractice.com 在另一项研究中，25.9% 的住院患者发生医院获得性高钠血症。[2]Tsipotis E, Price LL, Jaber BL, et al. Hospital-associated hypernatremia spectrum and clinical outcomes in an unselected cohort. Am J Med. 2018 Jan;131(1):72-82.e1. http://www.ncbi.nlm.nih.gov/pubmed/28860033?tool=bestpractice.com

所有患者的死亡率为 40%-60%。[6]Muhsin SA, Mount DB. Diagnosis and treatment of hypernatremia. Best Pract Res Clin Endocrinol Metab. 2016 Mar;30(2):189-203. https://www.sciencedirect.com/science/article/abs/pii/S1521690X16000415?via%3Dihub http://www.ncbi.nlm.nih.gov/pubmed/27156758?tool=bestpractice.com ​​ 而危重患者和有合并症的老年患者死亡率更高。[7]Thongprayoon C, Mao MA, Keddis MT, et al. Hypernatremia subgroups among hospitalized patients by machine learning consensus clustering with different patient survival. J Nephrol. 2022 Apr;35(3):921-9. http://www.ncbi.nlm.nih.gov/pubmed/34623631?tool=bestpractice.com

一项有关 ICU 病房中发生钠代谢紊乱的流行病学综述发现，高钠血症和低钠血症均常见于 ICU 患者，且均与患者的不良结局相关。[8]​Stelfox HT, Ahmed SB, Khandwala F, et al. The epidemiology of intensive care unit-acquired hyponatremia and hypernatremia in medical-surgical intensive care units. Crit Care. 2008;12:R162. https://ccforum.biomedcentral.com/articles/10.1186/cc7162 http://www.ncbi.nlm.nih.gov/pubmed/19094227?tool=bestpractice.com ​​ 医院获得性高钠血症可能比入院时出现高钠血症的预后更差。[2]Tsipotis E, Price LL, Jaber BL, et al. Hospital-associated hypernatremia spectrum and clinical outcomes in an unselected cohort. Am J Med. 2018 Jan;131(1):72-82.e1. http://www.ncbi.nlm.nih.gov/pubmed/28860033?tool=bestpractice.com [3]Thongprayoon C, Cheungpasitporn W, Yap JQ, et al. Increased mortality risk associated with serum sodium variations and borderline hypo- and hypernatremia in hospitalized adults. Nephrol Dial Transplant. 2020 Oct 1;35(10):1746-52. https://academic.oup.com/ndt/article/35/10/1746/5521070 http://www.ncbi.nlm.nih.gov/pubmed/31219584?tool=bestpractice.com [4]Ranjan R, Lo SC, Ly S, et al. Progression to severe hypernatremia in hospitalized general medicine inpatients: an observational study of hospital-acquired hypernatremia. Medicina (Kaunas). 2020 Jul 17;56(7):358. https://www.mdpi.com/1648-9144/56/7/358 http://www.ncbi.nlm.nih.gov/pubmed/32709029?tool=bestpractice.com

高钠血症在男性和女性中的诊断数量相当。