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Anestezija i intenzivna terapija
2007, vol. 30, br. 2, str. 111-121
jezik rada: srpski
vrsta rada: poseban prilog
objavljeno: 29/07/2008
Diferencijalna dijagnoza hiponatremije kod bolesnika sa aneurizmalnom subarahnoidnom hemoragijom - terapijske mogućnosti
Klinički centar Srbije, Klinika za neurohirurgiju, Beograd

Sažetak

Hiponatremija (vrednosti serumskog natrijuma manji od 134 mmol/L) je čest elektrolitski poremećaj u oboljenjima CNS, pogotovo kod bolesnika sa subarahnoidnom hemoragijom (SAH). Brojne studije ukazuju da je cerebral salt-wasting syndrome (CSW) najčešći uzrok hiponatremija kao posledice SAH-a. Suprotno tome sindrom neadekvatnog lučenja antidiuretskog hormona (SIADH) smatran je, od druge grupe autora, kao glavni uzrok hiponatremija. SIADH se karakteriše hiponatremijom sa neadekvatnim koncetrovanim urinom, povećanom koncetracijom natrijuma u urinu i normalnim, ili lako povećanim intravaskularnim volumenom. CSW se karakteriše sa sličnim osobinama, ali sa klinički jasnim smanjenjem ekstracelularnog volumena tečnosti. Dok restrikcija u nadoknadi tečnošću predstavlja terapiju izbora kod SIADH, tretman CSW se zasniva na intenzivnoj nadoknadi solima i volumenom. Zbog različitog pristupa u tretmanu i potencijalne opasnosti da neadekvatna terapija može pogoršati osnovno kliničko stanje, ova dva entiteta moraju se prepoznati i razlikovati.

Ključne reči

hiponatremija; sindrom neadekvatnog lučenja antidiuretskog hormona; cerebralni salt-wasting sindrome; subarahnoidalna hemoragija

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