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H2O
&
.
+ =+e + K+e
H2O
Na+e + K+e : + +
+ = ( +e + Ke+ ) / H2O
+ ( +) > 2
( )
H2O
2 ( Na+)
H2O
H2O
( )
o o
. Posm ( )
. Posm
Na+
Posm H2O
+
Na+
Na+ :
400mg/dl: 100 mg/dl Na+ 2.4 mEq/L
Katz MA. Hyperglycemia-induced hyponatremia--calculation of expected serum sodium depression. N Engl J Med 1973;289:843-844.Hillier TA et al. Hyponatremia: evaluating the correction factor for hyperglycemia. Am J Med 1999;106:399-403.
+ TOY
Posm
H2O +
2 > + + + +
2
ADH ( )
( /)
: :
H2O
H2O
ADH +
+
+
( , )
ADH
H2O
H2O
ADH
ADH
H2O Na+
+
+ 2
ADH
:
: ,, ,
ADH
(+ TE)
: , ,
Liberopoulos EN et al. SIADH and Hyponatremia with Theophylline.Annals of Pharmacotherapy 2002;36: 1180-2
H2O
:
(())
PosmPosm
:: (( : : , , & & ) )
::
(())
UosmUosm ..
UosmUosm< 100 < 100 mosmolmosmol//kgkg ((.. < 1003):< 1003):
UosmUosm > 100 > 100 mosmolmosmol//kgkg::
(())
aa+ + oo ((UNaUNa+))
UNaUNa++< 20 < 20 meqmeq//LL::
((VV))
UNaUNa++ >> 40 40 meqmeq//LL: : SIADHSIADH
: : NaNa++ ::
, , , , & &
+ (25/1)
(>5mg/dl)
Na+
&
ADH
( FE > 55%)
( 12%)
PO43-
SIADHSIADH
(>(> 100 100
mosmolmosmol //kgkg))
(>(> 40 40 mmolmmol //LL)) , ,
+
(MRI)
-, , ,
(1)
9 :Na+ =114mEq/L- 40L
1 lt NaCl (154 meq +): + 1mEq/L
9 : ADH +
(2)
9 +
+ +
SIADH
(.. )
H2O NaCl
SIADH
H2O
2
:
+
ADH H2O
H2O
+ = (+e + +e ) / H2O
:
+ ()
H2O > + + + =
Na+
2
H2O :
(, , )
Elisaf M et al. Survival after severe iatrogenic hypernatremia Am J Kidney Dis 1989;14:230-1
( / ) : ,
: , ,
(30%)
(,shock, Sheehan)
:/(/)
: , , , , Wegener
: Li,
(Ca++>11mg/dl)
(+
NaCl 0.9% + KCl
( )
Uosm
>800mosmol/kg +
(>1023) H2O
Na+
-
()
H2O:
TBW* Na+
140
TBW= 0.5 & 0.4
TBW* = H2O
- 1
H2O a+
: / Na+
( NaCl 0.9%)
()
2 ( , ) () () () (V) ADH SIADH SIADH ()