Hyponatremia: zoyambitsa, anthu omwe ali pachiwopsezo ndi chithandizo

Hyponatremia: zoyambitsa, anthu omwe ali pachiwopsezo ndi chithandizo

Hyponatremia imachitika pamene thupi liri ndi sodium yochepa kwambiri pa kuchuluka kwa madzi omwe ali nawo. Zomwe zimayambitsa zimaphatikizapo kugwiritsa ntchito okodzetsa, kutsegula m'mimba, kulephera kwa mtima, ndi SIADH. Mawonetseredwe azachipatala amakhala makamaka a minyewa, kutsatira kusamutsidwa kwa osmotic kwa madzi kulowa m'maselo aubongo, makamaka mu hyponatremia, ndipo zimaphatikizapo mutu, chisokonezo, ndi chibwibwi. Kukomoka ndi chikomokere zimatha kuchitika. Kuwongolera kumadalira pazizindikiro ndi zizindikiro zachipatala, makamaka kuwunika kuchuluka kwa ma extracellular, ndi ma pathologies omwe amayambitsa. Chithandizo chimatengera kuchepetsa kumwa kwamadzimadzi, kuchulukitsa kutuluka kwamadzimadzi, kuwonjezera kuchepa kwa sodium, komanso kuchiza vuto lomwe limayambitsa.

Kodi hyponatremia ndi chiyani?

Hyponatremia ndi matenda a electrolyte omwe amadziwika ndi kuchuluka kwa madzi amthupi poyerekeza ndi thupi lonse la sodium. Timalankhula za hyponatremia pomwe mulingo wa sodium uli pansi pa 136 mmol / l. Ma hyponatremia ambiri amakhala opitilira 125 mmol / L ndipo alibe zizindikiro. Ndi hyponatremia yovuta kwambiri, ndiye kuti kuchepera 125 mmol / l, kapena symptomatic, ndizochitika mwadzidzidzi komanso zochizira.

Chiwopsezo cha hyponatremia ndi:

  • pafupifupi 1,5 milandu pa 100 odwala patsiku m'chipatala;
  • 10 mpaka 25% mu utumiki wa geriatric;
  • 4 mpaka 5% mwa odwala omwe amavomereza ku madipatimenti adzidzidzi, koma pafupipafupi izi zimatha kufika 30% mwa odwala omwe ali ndi matenda a cirrhosis;
  • pafupifupi 4% mwa odwala chotupa matenda kapena hypothyroidism;
  • 6 nthawi zambiri mwa odwala okalamba omwe amamwa mankhwala osokoneza bongo, monga kusankha serotonin reuptake inhibitors (SSRIs);
  • oposa 50% mu chipatala odwala AIDS.

Kodi zimayambitsa hyponatremia ndi chiyani?

Hyponatremia ikhoza kukhala chifukwa cha:

  • kuchepa kwa sodium kuposa kutaya madzi, ndi kuchepa kwa madzi a m'thupi (kapena kuchuluka kwa extracellular);
  • kusungidwa kwa madzi ndi kutayika kwa sodium, limodzi ndi voliyumu yosungidwa ya extracellular;
  • kusungirako madzi kwakukulu kuposa kusunga sodium, zomwe zimapangitsa kuwonjezeka kwa voliyumu ya extracellular.

Nthawi zonse, sodium imachepetsedwa. Kusanza kwa nthawi yayitali kapena kutsekula m'mimba kwambiri kungayambitse kutaya kwa sodium. Pamene zotayika zamadzimadzi zimalipidwa ndi madzi okha, sodium imachepetsedwa.

Kutayika kwa madzi ndi sodium nthawi zambiri kumachitika chifukwa cha aimpso, pomwe mphamvu zobwezeretsanso aimpso zimachepa, kutsatira makonzedwe a thiazide okodzetsa. Mankhwalawa amawonjezera kutulutsa kwa sodium, komwe kumawonjezera kutulutsa kwamadzi. Izi nthawi zambiri zimalekerera koma zimatha kuyambitsa hyponatremia mwa anthu omwe amakonda kuchepa kwa sodium, makamaka okalamba. Kutaya m'mimba kapena m'matumbo sikuchitika kawirikawiri.

Kusungidwa kwamadzimadzi ndi chifukwa cha kuwonjezeka kosayenera kwa katulutsidwe ka antidiuretic hormone (ADH), yotchedwanso vasopressin. Pankhaniyi, timalankhula za SIADH kapena matenda a katulutsidwe kosayenera kwa ADH. Vasopressin imathandizira kuwongolera kuchuluka kwa madzi omwe amapezeka m'thupi mwa kuwongolera kuchuluka kwa madzi otulutsidwa ndi impso. Kutulutsa kwambiri kwa vasopressin kumabweretsa kuchepa kwa madzi otuluka ndi impso, zomwe zimapangitsa kuti madzi azikhala ochulukirapo m'thupi ndikuchepetsa sodium. Kutulutsa kwa vasopressin ndi pituitary gland kumatha kulimbikitsidwa ndi:

  • ululu;
  • nkhawa;
  • ntchito zolimbitsa thupi ;
  • hypoglycemia;
  • matenda ena a mtima, chithokomiro, impso kapena adrenals. 

SIADH ikhoza kukhala chifukwa chomwa mankhwala osokoneza bongo kapena zinthu zomwe zimathandizira kutulutsa kwa vasopressin kapena kulimbikitsa zochita zake mu impso monga:

  • chlorpropamide: mankhwala omwe amachepetsa shuga m'magazi;
  • carbamazepine: anticonvulsant;
  • vincristine: mankhwala ntchito mankhwala amphamvu;
  • clofibrate: mankhwala omwe amachepetsa cholesterol;
  • antipsychotics ndi antidepressants;
  • aspirin, ibuprofen;
  • chisangalalo (3,4-methylenedioxy-methamphetamine [MDMA]);
  • vasopressin (synthetic antidiuretic hormone) ndi oxytocin zomwe zimagwiritsidwa ntchito poyambitsa ntchito yobereka.

SIADH imathanso kuchitika chifukwa chomwa madzi kwambiri kuposa mphamvu ya aimpso kapena ngati:

  • potomanie;
  • polydipsie;
  • Addison matenda;
  • hypothyroidism. 

Pomaliza, zitha kukhala chifukwa cha kuchepa kwa voliyumu yozungulira chifukwa cha:

  • mtima kulephera;
  • impso kulephera;
  • matenda enaake;
  • nephrotic syndrome.

Kusungidwa kwa sodium ndi chifukwa cha kuwonjezeka kwa katulutsidwe ka aldosterone, kutsatira kuchepa kwa kuchuluka kwa kuzungulira.

Kodi zizindikiro za hyponatremia ndi ziti?

Odwala ambiri omwe ali ndi natremia, mwachitsanzo, sodium ndende yoposa 125 mmol / l, amakhala asymptomatic. Pakati pa 125 ndi 130 mmol / l, zizindikiro zimakhala makamaka m'mimba: nseru ndi kusanza.

Ubongo umakhudzidwa kwambiri ndi kusintha kwa sodium m'magazi. Komanso, pamitengo yochepera 120 mmol / l, zizindikiro za neuropsychiatric zimawoneka ngati:

  • mutu;
  • ulesi;
  • mkhalidwe wosokonezeka;
  • kupumira;
  • kugunda kwa minofu ndi kugwedezeka;
  • matenda a khunyu;
  • ku koma.

Ndiwo zotsatira za edema yaubongo, yomwe imayambitsa kusagwira bwino ntchito, komanso kuyambika kwake kumadalira kuopsa komanso kuthamanga kwa hyponatremia.

Zizindikiro zimakhala zovuta kwambiri kwa anthu okalamba omwe ali ndi matenda aakulu.

Kodi mungachiritse bwanji hyponatremia?

Hyponatremia ikhoza kukhala pachiwopsezo cha moyo. Digiri, nthawi ndi zizindikiro za hyponatremia amagwiritsidwa ntchito kuti adziwe momwe kungafunikire kukonza seramu yamagazi. Symptomatic hyponatremia imafuna kuchipatala nthawi zonse.

Ngati palibe zizindikiro, hyponatremia nthawi zambiri imakhala yokhazikika ndipo kuwongolera nthawi yomweyo sikofunikira nthawi zonse. Komabe, kugonekedwa m'chipatala kumalimbikitsidwa ngati mulingo wa sodium mu seramu uli wochepera 125 mmol / l. Kwa asymptomatic hyponatremia kapena kupitilira 125 mmol / l, kuwongolera kumatha kukhala kwanthawi yayitali. Dokotala ndiye amawunika ngati kuli kofunikira kukonza hyponatremia ndikuwonetsetsa kuti sikukulirakulira. Kuwongolera zomwe zimayambitsa hyponatremia nthawi zambiri zimakhala zokwanira kuti zisinthe. Zowonadi, kuyimitsa mankhwala osokoneza bongo, kukonza chithandizo cha kulephera kwa mtima kapena matenda enaake, kapenanso chithandizo cha hypothyroidism nthawi zambiri chimakhala chokwanira.

Pamene kuwongolera kwa hyponatremia kukuwonetsedwa, zimatengera kuchuluka kwa extracellular. Ngati iye:

  • zachilendo: kuletsa kumwa madzi, pansi pa lita imodzi patsiku, kumalimbikitsidwa, makamaka pankhani ya SIADH, ndipo chithandizo cholimbana ndi zomwe zimayambitsa (hypothyroidism, adrenal insufficiency, kutenga okodzetsa) imayendetsedwa;
  • kuchuluka: okodzetsa kapena mdani wa vasopressin, monga desmopressin, wokhudzana ndi kuletsa kumwa madzi, ndiye kuti chithandizo chachikulu, makamaka pakulephera kwa mtima kapena cirrhosis,
  • kuchepa, kutsatira m'mimba kapena kuwonongeka kwa aimpso: kuchuluka kwa sodium yokhudzana ndi kubwezeretsa madzi m'thupi kumawonetsedwa. 

Anthu ena, makamaka omwe ali ndi SIADH, amafunikira chithandizo chanthawi yayitali cha hyponatremia. Kuletsa madzimadzi kokha nthawi zambiri sikokwanira kupewa kuyambiranso kwa hyponatremia. Mapiritsi a sodium chloride amatha kugwiritsidwa ntchito mwa anthu omwe ali ndi hyponatremia yofatsa kapena yocheperako. 

Hyponatremia yoopsa ndi yadzidzidzi. Chithandizo ndi kuonjezera pang'onopang'ono mlingo wa sodium m'magazi pogwiritsa ntchito madzi olowera m'mitsempha ndipo nthawi zina okodzetsa. Kusankha vasopressin receptor inhibitors, monga conivaptan kapena tolvaptan, nthawi zina kumafunika. 

Siyani Mumakonda