Die Hyponatriämie in der Notaufnahme – eine ernst zu nehmende Elektrolytstörung

Till Dringenberg; Matthias Schott

doi:10.1055/a-0971-2556

Notaufnahme up2date, Table of Contents

Notaufnahme up2date 2020; 2(01): 39-53
DOI: 10.1055/a-0971-2556

CME-Fortbildung

Metabolismus und Immunsystem

Die Hyponatriämie in der Notaufnahme – eine ernst zu nehmende Elektrolytstörung

Till Dringenberg

,

Matthias Schott

Subject Editor: Wissenschaftlich verantwortlich gemäß Zertifizierungsbestimmungen für diesen Beitrag ist Dr. med. Till Dringenberg, Düsseldorf.

Abstract

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Die Hyponatriämie ist die häufigste Elektrolytstörung in der Notaufnahme. Dieser Artikel soll dabei helfen, die verschiedenen Verlaufsformen der Hyponatriämie zu erkennen und deren zugrunde liegenden pathophysiologischen Mechanismen zu verstehen. Ein Hauptaugenmerk wird auf die differenzierte Therapie und deren Fallstricke gerichtet, um Behandlungsfehler in der täglichen Praxis zu vermeiden.

Schlüsselwörter

Hyponatriämie in der Notaufnahme - Pathophysiologie der Hyponatriämie - diagnostischer Algorithmus - differenzierte Therapie - Gefahren der Natriumkorrektur

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References

Literatur
1 Spasovski G, Vanholder R, Allolio B. et al. Hyponatraemia Guideline Development Group. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Eur J Endocrinol 2014; 170: G1-47
2 Cohen DM, Ellison DH. Evaluating hyponatremia. JAMA 2015; 313: 1260-1261
3 Chung HM, Kluge R, Schrier RW. et al. Clinical assessment of extracellular fluid volume in hyponatremia. Am J Med 1987; 83: 905-908
4 Hoorn EJ, Zietse R. Diagnosis and Treatment of Hyponatremia: Compilation of the Guidelines. J Am Soc Nephrol 2017; 28: 1340-1349
5 Dringenberg T, Schwitalla M, Haase M. et al. Control of CYP11B2/CYP11B1 expression ratio and consequences for the zonation of the adrenal cortex. Horm Metab Res 2013; 45: 81-85
6 Hoorn EJ, Hotho D, Hassing RJ. et al. Unexplained hyponatremia: seek and you will find. Nephron Physiol 2011; 118: 66-71
7 Hoorn EJ, Zietse R. Hyponatremia revisited: translating physiology to practice. Nephron Physiol 2008; 108: 46-59
8 Fenske W, Maier SK, Blechschmidt A. et al. Utility and limitations of the traditional diagnostic approach to hyponatremia: a diagnostic study. Am J Med 2010; 123: 652-657
9 Bichet D, Szatalowicz V, Chaimovitz C. et al. Role of vasopressin in abnormal water excretion in cirrhotic patients. Ann Intern Med 1982; 96: 413-417
10 Verbalis JG, Goldsmith SR, Greenberg A. et al. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med 2013; 126: S1-42
11 Schrier RW. Body water homeostasis: clinical disorders of urinary dilution and concentration. J Am Soc Nephrol 2006; 17: 1820-1832
12 Hanna FW, Scanlon MF. Hyponatraemia, hypothyroidism, and role of arginine-vasopressin. Lancet 1997; 350: 755-756
13 Almond CS, Shin AY, Fortescue EB. et al. Hyponatremia among runners in the Boston Marathon. N Engl J Med 2005; 352: 1550-1556
14 Guirguis E, Grace Y, Seetaram M. Management of Hyponatremia: Focus on Psychiatric Patients. US Pharm 2013; 38: HS3-HS6
15 Barlow ED, de Wardener HE. Compulsive water drinking. Q J Med 1959; 28: 235-258
16 McGee S, Abernethy WB, Simel DL. The rational clinical examination. Is this patient hypovolemic?. JAMA 1999; 281: 1022-1029
17 Fenske W, Störk S, Koschker AC. et al. Value of fractional uric acid excretion in differential diagnosis of hyponatremic patients on diuretics. J Clin Endocrinol Metab 2008; 93: 2991-2997
18 Fenske W, Störk S, Blechschmidt A. et al. Copeptin in the differential diagnosis of hyponatremia. J Clin Endocrinol Metab 2009; 94: 123-129
19 Sonnenblick M, Friedlander Y, Rosin AJ. Diuretic-induced severe hyponatremia. Review and analysis of 129 reported patients. Chest 1993; 103: 601-606
20 Kim GH, Lee JW, Oh YK. et al. Antidiuretic effect of hydrochlorothiazide in lithium-induced nephrogenic diabetes insipidus is associated with upregulation of aquaporin-2, Na-Cl co-transporter, and epithelial sodium channel. J Am Soc Nephrol 2004; 15: 2836-2843
21 Hannon MJ, Finucane FM, Sherlock M. et al. Clinical review: Disorders of water homeostasis in neurosurgical patients. J Clin Endocrinol Metab 2012; 97: 1423-1433
22 Beck LH. Hypouricemia in the syndrome of inappropriate secretion of antidiuretic hormone. N Engl J Med 1979; 301: 528-530
23 Schwartz WB, Bennett W, Curelop S. et al. A syndrome of renal sodium loss and hyponatremia probably resulting from inappropriate secretion of antidiuretic hormone. Am J Med 1957; 23: 529-542
24 Schrier RW. Water and sodium retention in edematous disorders: role of vasopressin and aldosterone. Am J Med 2006; 119: S47-53
25 Moritz ML, Ayus JC. 100 cc 3% sodium chloride bolus: a novel treatment for hyponatremic encephalopathy. Metab Brain Dis 2010; 25: 91-96
26 Sterns RH, Riggs JE, Schochet Jr. SS. Osmotic demyelination syndrome following correction of hyponatremia. N Engl J Med 1986; 314: 1535-1542
27 Brunner JE, Redmond JM, Haggar AM. et al. Central pontine myelinolysis and pontine lesions after rapid correction of hyponatremia: a prospective magnetic resonance imaging study. Ann Neurol 1990; 27: 61-66
28 Sterns RH, Nigwekar SU, Hix JK. The treatment of hyponatremia. Semin Nephrol 2009; 29: 282-299
29 Friedman E, Shadel M, Halkin H. et al. Thiazide-induced hyponatremia. Reproducibility by single dose rechallenge and an analysis of pathogenesis. Ann Intern Med 1989; 110: 24-30
31 Rossi J, Bayram M, Udelson JE. et al. Improvement in hyponatremia during hospitalization for worsening heart failure is associated with improved outcomes: insights from the Acute and Chronic Therapeutic Impact of a Vasopressin Antagonist in Chronic Heart Failure (ACTIV in CHF) trial. Acute Card Care 2007; 9: 82-86
32 Tamargo J, López-Sendón J. Novel therapeutic targets for the treatment of heart failure. Nat Rev Drug Discov 2011; 10: 536-555
33 Abbasoglu O, Goldstein RM, Vodapally MS. et al. Liver transplantation in hyponatremic patients with emphasis on central pontine myelinolysis. Clin Transplant 1998; 12: 263-269