以口服生理食鹽水治療低血鈉症患者的一例報告

A Simple Way for Treatment of Hyponatremia with Oral Administration of Intravenously Perfusionable Normal Saline Solution: a Case Report

吳重慶(Chun-Chin Wu)

《秀傳醫學雜誌》 預刊文章 Pp. 1-19

https://doi.org/10.30185/SCMJ.202212/PP.0030

摘要

低血鈉症是門診老年患者較常見的電解質失衡現象。臨床上，低血鈉症易被疏忽；只因其症狀由不自覺、虛弱、虛脫、無力、輕症神智異常、神智錯亂、嗜睡、昏迷、終至猝死，涵蓋範圍很廣，幾乎囊括了老年常見疾病的所有症狀；而且，病程多半緩慢進行，讓人失去警覺。大半低血鈉症患者會經歷憂鬱、意志消沉、情緒低落、鬱鬱寡歡、食慾不振的情境。由於老人多病，家人習以為常，看病之餘會失去積極面對的態度。而且低血鈉常與諸多老年性疾患倂存，經常續發於老病的生活常態中，如果不做定期檢查，就錯失診治良機。一旦發現低血鈉症，治療的方法就是補充鈉；可口服食鹽、靜注含鈉針劑、或靜脈點滴含鈉溶液（常見的是生理食鹽水）。但是，迅速的鈉液輸注，有時矯枉過正，引發肺水腫或腦水腫，或會導致死亡。因此，合理有效的給鈉是必須的；可惜臨床上至今仍未建立一套給鈉的金標準。筆者在臨床服務中，意外地發現了一項安全的給鈉方法，口服生理食鹽水的簡易療法。由於教科書內找不著類似的治療方法，就翻遍文獻深入探討，終於找到蛛絲馬跡的立論根據：小腸鈉氫離子交換管道（intestine sodium-hydrogen exchanger 3）。因此，借助於本例的陳述，將之提出報告。案例陳述：84歲女性患者因多重老年性疾病求診。所患疾病包括：動脈硬化性心血管疾病、多關節退化性病變、骨質疏鬆與T12胸椎塌陷、腎萎縮併慢性腎病變（CKD-3b；eGFR為34ml/min/1.73M^2）及右腎囊腫。在低鹽的食療下，因胃口不佳而食慾不振，導致全身乏力，抽測血鈉值而發現低血鈉。多次以生理食鹽水靜脈點滴輸注，加以改正；由於不耐久躺，加以如廁時漏針，而不願意繼續點滴。看到剩下大半瓶的生理食鹽水溶液，丟棄殊為可惜，就打開瓶蓋，讓她喝下；想不到喝下之後，患者精神大為提振，無力感也消失。於是，在後來的血鈉偏低時，患者均以口服注射用生理食鹽水溶液1,000ml來處理。既然幾十年前，主治醫師們多讓低血鈉症患者口服鹽包應付低血鈉症，當然口服生理食鹽水代替鹽包就順理成章；何況，後者又可避免血壓驟升的弊害。筆者因此尋找口服注射用生理食鹽水的立論基礎，而提出報告。

關鍵字

低血鈉症 ； 生理食鹽水 ； 靜脈輸注 ； 口服 ； 第3型鈉氫離子交換管道

並列摘要

Hyponatremiais a common electrolyte disturbance for senile patients encountered in the outpatient department. Clinically, hyponatremia could be neglected because of the wide pectrum of hyponatremic manifestations, varying from symptomless, fatigue weakness, lacking strength or powerlessness, mild disordientation, confusion, drowsiness, coma, even to sudden death. Such disorders could be present in various senile health problems. Besides, their progression could be slowly and inconspicuous. Mostly, patients with hyponatremia may be suffering from depression, hopelessness, bad mood or gloominess, leading to severe anorexia and even resulting in being kept far away from the family. Also, the family could be much impatient for taking care of such elderly persons gradually, and let the elderly persons neglect routine health check-up. The elderly persons thereafter loss the chance of early diagnosis and early management of hyponatremia. Sodium supplement is the only way of management of hyponatremia, either by oral administration or through intravenous injection/perfusion. Rapid administration of sodium, such as hypertonic sodium solution, could be leading to over-correction of hyponatremia and resulting in pulmonary edema and/or brain edema; the latters could be fatal. Therefore, an effective and safe way for sodium supplement must be set up, though it is so far not yet found, to my best. In this article, an easy way of sodium supplement is reported. It is effective and safe, and is supported by previous studies about intestine sodium-hydrogen exchanger 3. Although, more observations and more evidences are needed.

並列關鍵字

Hyponatremia ； Normal saline solution ； Intravenous perfusion ； Oral administration ； Sodium-hydrogen exchanger 3