血液透析滤过治疗高钠血症的临床分析

目的　探讨血液透析滤过 (HDF)治疗高钠血症的临床效果。方法　对 16例高钠血症患者行HDF治疗 ,动态观察血清钠以调整置换液成分。结果　 16例患者经 2～ 8h连续性静脉 -静脉血液滤过后血钠开始下降 ,6～ 2 8h可降至正常。结论　血液滤过透析治疗高钠血症效果确切 ,安全性好     

Sodium Abnormalities Are an Independent Predictor of Complications in Total Joint Arthroplasty: A Cautionary Tale!

BackgroundElectrolyte levels are commonly obtained as part of the preoperative workup for total joint arthroplasty, but limited information exists on the interplay between electrolyte abnormalities and outcomes.MethodsThe National Surgical Quality Improvement Program was queried for primary, elective total hip arthroplasty and total knee arthroplasty (THA, TKA) performed between 2011 and 2017. Three patient groups were compared: normal (control), hypernatremia, and hyponatremia. The primary outcomes were length of stay (LOS) and 30-day adverse events: complications, readmissions, reoperations, and mortality.ResultsA total of 244,538 TKAs and 145,134 THAs were analyzed. The prevalence of hyponatremia and hypernatremia was 6.9% and 1.0%, respectively. After controlling for any baseline differences, hypernatremia was an independent predictor of ventilation >48 hours (THA, odds ratio [OR] 3.53), unplanned intubation (THA, OR 3.14), cardiac arrest (THA, OR 2.42), pneumonia (THA, OR 2.16), Clostridium difficile infection (OR 4.66 and 3.25 for THA and TKA, respectively), LOS >2 days (THA, OR 1.16), and mortality (THA, OR 4.69). Similarly, hyponatremia was an independent predictor of LOS >2 days (TKA, OR 1.21), readmission (TKA, OR 1.40), reoperation (OR 1.32 and 1.47 for THA and TKA, respectively), surgical site infections (OR 1.39 and 1.54 for THA and TKA, respectively), and transfusion (OR 1.13 and 1.20 for THA and TKA, respectively).ConclusionAs the focus of total joint arthroplasty continues to shift toward value-based payment models and outpatient surgery, caution should be exercised in patients with abnormal preoperative sodium levels, particularly hypernatremia, because of significantly increased risk of prolonged LOS and 30-day adverse events.     

连续性静脉-静脉血液滤过治疗急性高钠血症

目的：探讨连续性静脉-静脉血液滤过（CVVHF）治疗急性高钠血症的作用和疗效。方法：分析7例高钠血症患者25例次CVVHF治疗的临床资料,观察治疗前后血钠及其纠正速度、肌酐、血渗量和血气的变化及血压、心率等改变。结果：采用CVVHF平均治疗40h,治疗后患者血钠、肌酐、血渗量明显下降（P〈0．01）。5例昏迷者中2例意识有所好转,1例抽搐症状消失,1例死亡;2例意识模糊者治疗后恢复正常。APACHEⅡ评分显著降低（P〈0.01）。结论：CVVHF治疗高钠血症血流动力学稳定、有效,可作为治疗急性高钠血症新的途径。     

Treatment of acute hypernatremia caused by sodium overload in adults: A systematic review

Background:Rapid-onset, acute hypernatremia caused by sodium overload is a rare, life-threatening condition. Although experts recommend rapid correction of sodium concentration [Na] based on pathophysiological theories, only a few reports have documented the specific details of sodium correction methods. The objective of this study was to systematically review the reported treatment regimens, achieved [Na] correction rates, and treatment outcomes.Methods:PubMed, Ichushi-database, and references without language restrictions, from inception to January 2021, were searched for studies that described ≥1 adult (aged ≥18 years) patients with rapid-onset hypernatremia caused by sodium overload, whose treatment was initiated ≤12 hours from the onset. The primary outcome of interest was the [Na] correction rate associated with mortality.Results:Eighteen case reports (18 patients; median [Na], 180.5 mEq/L) were included. The cause of sodium overload was self-ingestion in 8 patients and iatrogenic sodium gain in 10 patients; baseline [Na] and symptoms at presentation were comparable for both groups. Individualized rapid infusion of dextrose-based solutions was the most commonly adopted fluid therapy, whereas hemodialysis was also used for patients already treated with hemodialysis. The correction rates were more rapid in 13 successfully treated patients than in 5 fatal patients. The successfully treated patients typically achieved [Na] ≤160 within 8 hours, [Na] ≤150 within 24 hours, and [Na] ≤145 within 48 hours. Hyperglycemia was a commonly observed treatment-related adverse event.Conclusion:The limited empirical evidence derived from case reports appears to endorse the recommended, rapid, and aggressive sodium correction using dextrose-based hypotonic solutions.     

Diabetes Insipidus

Reviews in Endocrine and Metabolic Disorders -     

Management of Disorders of Water Metabolism in Patients with Pituitary Tumors

Disorders of body fluids, notably central diabetes insipidus (CDI) and the syndrome of inappropriate antidiuretic hormone secretion (SIADH), are relatively uncommon as a presenting symptom of sellar and suprasellar masses, but quite common following surgical resection of such lesions. It therefore behooves clinicians treating such patients to have a good understanding of the pathophysiology, the differential diagnosis and the management of these disorders. This review discusses some general issues concerning the pathogenesis, differential diagnosis, clinical manifestations and therapy of hyperosmolar and hypoosmolar syndromes, including CDI and SIADH, and then more specifically addresses the evaluation and treatment of pre- and postoperative disorders of water metabolism in patients with pituitary adenomas.     

High Sodium Rehydration Solutions in Well-Nourished Outpatients

ABSTRACT. We studied the safety and efficacy of high-sodium oral rehydration solution in the out-patient management of children with diarrhea, with or without dehydration. We studied 68 outpatients with acute diarrhea; 32% had mild-to-moderate dehydration; the rest were not dehydrated. They were treated at home for 24 h with either high-sodium (90 mmol/l) or low-sodium (30 mmol/l) solution. None of the patients given high-sodium solution became hyper-natremic. Of those patients who were dehydrated, 55% did not take enough fluid at home to repair their dehydration. We conclude that patients must be closely supervised for the initial rehydration period, but that high-sodium rehydration solutions can be safely given to outpatients for up to 24 hours.     

PRIMARY HYPOTHYROIDISM AND ESSENTIAL HYPERNATREMIA IN A PATIENT WITH HISTIOCYTOSIS X

Abstract: :A 27 year old woman with histiocytosis X had an unusual initial presentation with features of primary hypothyroidism and a goitre. Diagnosis was made by lung and thyroid biopsies. Endocrine tests showed the presence of hypopituitarism and a discrete suprasellar mass, consistent with hypothalamic histiocytosis X, was demonstrated by computerised tomography. Radiotherapy and chemotherapy arrested the clinical progression of the disease.