婴儿高钠血症的病因和预防措施

目的 :分析婴儿高钠血症的主要病因 ,探讨其预防措施。方法 :对本院收治的血清钠 >15 0 mmol/ L的婴儿 4 2例进行回顾性分析 ,住院期间动态观察血清钠离子浓度、体重、头颅 B超和 CT。结果 :1血清钠浓度的峰值为 15 7mmol/ L ( 15 1～173mmol/ L) ,5 2 .38%的婴儿高钠血症是在医院内获得的 ,6 1.90 %的病儿在发展为高钠血症前有危重疾病、慢性病或早产 ,78.5 7%的婴儿有不同程度的体重减轻 ;2液体摄入不足是高钠血症的主要原因 ,占 6 4 .2 9% ,其中 9例 (占 33.33% )是母乳喂养的正常新生儿 ,胃肠炎引起的高钠血症仅占 2 3.81% ,盐中毒占 11.90 % ;3总死亡率为 7.14 % ,死亡者血清钠浓度均 >16 0 mmol/ L且难以纠正 ,在血清钠浓度 >16 0 mmol/ L的 19例患儿中 ,高钠血症未得到纠正的婴儿死亡率显著高于高钠血症已得到纠正的婴儿 ( P<0 .0 0 5 ) ,成活者和死亡者 ,血清钠离子浓度峰值无差异 ( P>0 .0 5 ) ;4 14 .2 9%的病人发生与高钠血症有关的神经系统并发症 ,血纳纠正过程中 19.0 5 %的病儿发生了脑水肿 ,患儿住院第一天血清纳浓度下降均 >12 mmol/ L,没有 1个婴儿死于脑水肿。结论 :婴儿高钠血症大多伴有潜在的医学问题 ,液体摄入不足是其主要原因。超过一半的婴儿高钠血症是在医院内获得的 ,主要是?

Etiologic evaluation and preventive measures in the hypernatremia of infant

Objective:To evaluate the cause of diease and discuss the preventive measures in the hypernatremia of infant. Methods: Medical records were reviewed for 42 patients admitted to our hospital from birth to 12-months period, all with a serum sodium greater than 150 mmol/L. The concentration of sodium in plasma,body weight and the result of B-ultrasound and CT in the examination of head were observered during hospitalization. Results:The peak serum sodium concentration was 157 mmol/L (range, 151-173 mmol/L). Hypernatremia was hospital acquired in 52.38% of children and 61.90% of the patients suffered from critical illness, chronic disease, or prematurity before developing hypernatremia. Decrease of body weight was observed in78.57% infants. In 64.29% of the patients, inadequate fluid intake was the main cause of hypernatremia. In the infants of dehyration,33.33%(9/27) were the infants of breast feeding. Gastroenteritis contributed to the hypernatremia in only 23.81% of children .And 11.90% of all were the infants of salt poisoning. The overall mortality was 7.14%.In 19 patients of serum sodium over 160 mmol/L ,patients in whom hypernatremia was not corrected had a significantly higher mortality than those in whom hypernatremia was corrected (2 out of 4 〔5〕 vs 1 out of 15〔6.67%〕, P <0.005). Peak serum sodium was no different for survivors than nonsurvivors. No deaths were attributable to cerebral edema caused by correction of hypernatremia. Neurologic complications related to hypernatremia occurred in 15% of patients. Conclusion: Hypernatremia of infants is with the vast majority having significant underlying medical problems. Inadequate fluid intake is the main cause of hypernatremia. Over a half hypernatremia is a hospital-acquired disease, produced by the failure to administer sufficient free water to patients.Failure to correct hypernatremia may result in a high mortality rate.Descent less than 12mmol/L of serum sodium in every 24 hours can prevent from cerebral edema.