Hyponatraemia: clinical approach and therapy
Autor(a) principal: | |
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Data de Publicação: | 2001 |
Outros Autores: | , |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://revista.spmi.pt/index.php/rpmi/article/view/1895 |
Resumo: | Hyponatraemia is the most common electrolytedisturbance in hospitalised patients and it reflects awater balance disturbance with associated hypo-osmolality. There are several associated conditions:fluid losses, oedematous states (heart failure, hepaticcirrhosis, nephrotic syndrome), syndrome ofinappropriate anti-diuretic hormone secretion(SIADH), primary polydipsia and endocrinediseases. Initial evaluations to reach an aetiologicdiagnosis should include: measurement of plasmaticand urinary osmolality, the plasma concentration ofsodium, and clinical assessment of the extracellularcompartment. Two basic principles are involved inthe treatment of hyponatraemia: raising plasmasodium concentration at a safe rate and treating theunderlying cause. However, treatment of thisdisorder also requires balancing the risks ofhypotonicity against those of therapy, in order toavoid central osmotic demyelination. A new class ofpromising agents, the vasopressin receptorantagonists, has been described, and it seemsreasonable to expect improvement in the treatmentof hyponatraemia associated with heart failure,hepatic cirrhosis and SIADH.This article focuses on the causes, differentialdiagnosis and treatment of this electrolyte disorder. |
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Hyponatraemia: clinical approach and therapyHiponatremia: abordagem clínica e terapêuticaantagonistas dos receptores da hormona anti-diuréticacirrose hepáticahiponatremiahipovolemiainsuficiência cardíaca congestivapolidipsiasíndroma de secreção inapropriada de hormona anti-diuréticacongestive heart failurehepatic cirrhosishyponatraemiahypovolaemiapolydipsiasyndrome of inappropriate anti-diuretic hormone secretion (SIADH)vasopressin receptor antagonistsHyponatraemia is the most common electrolytedisturbance in hospitalised patients and it reflects awater balance disturbance with associated hypo-osmolality. There are several associated conditions:fluid losses, oedematous states (heart failure, hepaticcirrhosis, nephrotic syndrome), syndrome ofinappropriate anti-diuretic hormone secretion(SIADH), primary polydipsia and endocrinediseases. Initial evaluations to reach an aetiologicdiagnosis should include: measurement of plasmaticand urinary osmolality, the plasma concentration ofsodium, and clinical assessment of the extracellularcompartment. Two basic principles are involved inthe treatment of hyponatraemia: raising plasmasodium concentration at a safe rate and treating theunderlying cause. However, treatment of thisdisorder also requires balancing the risks ofhypotonicity against those of therapy, in order toavoid central osmotic demyelination. A new class ofpromising agents, the vasopressin receptorantagonists, has been described, and it seemsreasonable to expect improvement in the treatmentof hyponatraemia associated with heart failure,hepatic cirrhosis and SIADH.This article focuses on the causes, differentialdiagnosis and treatment of this electrolyte disorder.A hiponatremia é a alteração electrolítica maisfrequente na prática clínica hospitalar e reflecte umaalteração do balanço de água, com consequentediminuição da osmolalidade plasmática. Pode tervárias causas que incluem: perda de fluidos, estadosedematosos, nomeadamente insuficiência cardíacacongestiva, cirrose hepática e síndroma nefrótica,síndroma de secreção inapropriada de hormona anti-diurética (SIADH), polidipsia primária e patologiasdo foro endocrinológico. Na maioria dos casos, aconjugação de parâmetros clínicos e analíticosincluindo determinação das osmolalidades,plasmática e urinária, concentração urinária de sódioe avaliação clínica do compartimento extra-celular,permite chegar ao diagnóstico causal. O tratamentoda hiponatremia assenta na terapêutica etiológica ena correcção da concentração sérica de sódio,mediante regras fundamentais e após ponderar deforma individualizada o balanço entre os riscosinerentes da própria hiponatremia e os da sua rápidacorrecção, em particular da desmielinizaçãoosmótica das células cerebrais. Os antagonistas dosreceptores da hormona anti-diurética, ouaquaréticos, abrem novas perspectivas naterapêutica da hiponatremia associada às situaçõesde insuficiência cardíaca, cirrose hepática e SIADH.Neste artigo, pretendeu-se efectuar umaabordagem essencialmente clínica desta perturbaçãodo equilíbrio hidro-electrolítico, sem descurar osaspectos relacionados com a sua etiopatogénese, edando particular ênfase ao diagnóstico etiológicodiferencial e à respectiva terapêutica.Sociedade Portuguesa de Medicina Interna2001-03-30info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://revista.spmi.pt/index.php/rpmi/article/view/1895Internal Medicine; Vol. 8 No. 1 (2001): Janeiro/ Março; 37-48Medicina Interna; Vol. 8 N.º 1 (2001): Janeiro/ Março; 37-482183-99800872-671Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporhttps://revista.spmi.pt/index.php/rpmi/article/view/1895https://revista.spmi.pt/index.php/rpmi/article/view/1895/1328Abreu, FernandoTeixeira de Sousa, FranciscoMartins Prata, M.info:eu-repo/semantics/openAccess2023-06-10T06:10:54Zoai:oai.revista.spmi.pt:article/1895Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T18:00:03.667097Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Hyponatraemia: clinical approach and therapy Hiponatremia: abordagem clínica e terapêutica |
title |
Hyponatraemia: clinical approach and therapy |
spellingShingle |
Hyponatraemia: clinical approach and therapy Abreu, Fernando antagonistas dos receptores da hormona anti-diurética cirrose hepática hiponatremia hipovolemia insuficiência cardíaca congestiva polidipsia síndroma de secreção inapropriada de hormona anti-diurética congestive heart failure hepatic cirrhosis hyponatraemia hypovolaemia polydipsia syndrome of inappropriate anti-diuretic hormone secretion (SIADH) vasopressin receptor antagonists |
title_short |
Hyponatraemia: clinical approach and therapy |
title_full |
Hyponatraemia: clinical approach and therapy |
title_fullStr |
Hyponatraemia: clinical approach and therapy |
title_full_unstemmed |
Hyponatraemia: clinical approach and therapy |
title_sort |
Hyponatraemia: clinical approach and therapy |
author |
Abreu, Fernando |
author_facet |
Abreu, Fernando Teixeira de Sousa, Francisco Martins Prata, M. |
author_role |
author |
author2 |
Teixeira de Sousa, Francisco Martins Prata, M. |
author2_role |
author author |
dc.contributor.author.fl_str_mv |
Abreu, Fernando Teixeira de Sousa, Francisco Martins Prata, M. |
dc.subject.por.fl_str_mv |
antagonistas dos receptores da hormona anti-diurética cirrose hepática hiponatremia hipovolemia insuficiência cardíaca congestiva polidipsia síndroma de secreção inapropriada de hormona anti-diurética congestive heart failure hepatic cirrhosis hyponatraemia hypovolaemia polydipsia syndrome of inappropriate anti-diuretic hormone secretion (SIADH) vasopressin receptor antagonists |
topic |
antagonistas dos receptores da hormona anti-diurética cirrose hepática hiponatremia hipovolemia insuficiência cardíaca congestiva polidipsia síndroma de secreção inapropriada de hormona anti-diurética congestive heart failure hepatic cirrhosis hyponatraemia hypovolaemia polydipsia syndrome of inappropriate anti-diuretic hormone secretion (SIADH) vasopressin receptor antagonists |
description |
Hyponatraemia is the most common electrolytedisturbance in hospitalised patients and it reflects awater balance disturbance with associated hypo-osmolality. There are several associated conditions:fluid losses, oedematous states (heart failure, hepaticcirrhosis, nephrotic syndrome), syndrome ofinappropriate anti-diuretic hormone secretion(SIADH), primary polydipsia and endocrinediseases. Initial evaluations to reach an aetiologicdiagnosis should include: measurement of plasmaticand urinary osmolality, the plasma concentration ofsodium, and clinical assessment of the extracellularcompartment. Two basic principles are involved inthe treatment of hyponatraemia: raising plasmasodium concentration at a safe rate and treating theunderlying cause. However, treatment of thisdisorder also requires balancing the risks ofhypotonicity against those of therapy, in order toavoid central osmotic demyelination. A new class ofpromising agents, the vasopressin receptorantagonists, has been described, and it seemsreasonable to expect improvement in the treatmentof hyponatraemia associated with heart failure,hepatic cirrhosis and SIADH.This article focuses on the causes, differentialdiagnosis and treatment of this electrolyte disorder. |
publishDate |
2001 |
dc.date.none.fl_str_mv |
2001-03-30 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://revista.spmi.pt/index.php/rpmi/article/view/1895 |
url |
https://revista.spmi.pt/index.php/rpmi/article/view/1895 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.none.fl_str_mv |
https://revista.spmi.pt/index.php/rpmi/article/view/1895 https://revista.spmi.pt/index.php/rpmi/article/view/1895/1328 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Sociedade Portuguesa de Medicina Interna |
publisher.none.fl_str_mv |
Sociedade Portuguesa de Medicina Interna |
dc.source.none.fl_str_mv |
Internal Medicine; Vol. 8 No. 1 (2001): Janeiro/ Março; 37-48 Medicina Interna; Vol. 8 N.º 1 (2001): Janeiro/ Março; 37-48 2183-9980 0872-671X reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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