中醫對藥物誘發低血鈉症的治療探討

Study on the Treatment of the Induced Hyponatremia by Chinese Medicine

鄭淑鎂(Sue-Mei Zheng)

《中醫藥研究論叢》 11卷1期 (2008/03) Pp. 85-111

https://doi.org/10.6516/TJTCM.200803_11(1).0008

摘要

低血鈉症是住院病人最常見的電解質異常，更常發生於醫藥治療的患者，尤其是老人及兒童。臨床上的病因包括腹瀉、肝衰竭、腎衰竭、心臟衰竭、中樞神經系統感染、肺部感染、藥物誘發、化療或術後水分攝取過量、抗利尿激素分泌不適當症候群(SIADH)，及多重因素等。
臨床症狀主要影響中樞神經及肌肉系統，如意識混亂、頭痛、坐立不安、抽筋、嘔吐、惡心、無力、癲瘸、木僵、昏迷、甚至呼吸停止。
有許多藥物可能誘發低血鈉症，包括：利尿劑、非類固醇消炎劑、抗利尿激素藥物、抗焦慮藥物、抗精神病劑、抗生素類藥物、麻醉劑等二十餘種，須謹慎觀察病人臨床症狀，並即時停藥。
本文是針對低血鈉症病人，經西醫停用誘發藥物、輸液或口服NaCl、液體限制、補充電解質、利尿劑治療及白蛋白治等，仍反應不佳者，提供中醫藥以辨證論治、辨病，及辨別藥物誘發機轉等諸法參與治療，常能穫得滿意的療效。

關鍵字

低血鈉症 ； 電解質異常 ； 誘發低血鈉的藥物 ； 腦水腫 ； 中央性橋腦髓鞘溶解症

並列摘要

The abnormal electrolyte of impatient can cause the hyponatremia. It is often occurred for the patient with medicine treatment, especially the old people and children. The clinical causes include the diarrhea, the depletion of liver, the depletion of kidney, the depletion of heart, the infection of central nervous system, the infection of lung, the inducement of medicine, the excessive intake of water after chemotherapy or surgery, the syndrome of inappropriate antidiuretic hormones (SIADH), and the multiple factors etc.
The clinical symptom is the influence of central nerve and muscle systems mainly, such as the confused consciousness, headache, fidgety, clonus, emesis, qualm, asthenia, epilepsy, stiffness, coma, and even stop breathing.
A lot of medicines can induce the hyponatremia, including the diuretic, non-steroid anti-inflammation medicine, antidiuretic hormone, anti-depression medicine, mental disease resistant medicine, antibiotic medicine, and narcotic agent etc., which are more than 20 kinds of medicine. It has to observe the clinical symptom of patient prudently, and stop the intake of medicine immediately.
This paper reveals the treatment of patient with the hyponatremia. The Western medicine suggests to stop using the induced medicine, infusion solution or oral NaCl, restrain the liquid, supplement the electrolyte, treat it by the diuretic and albumin to treat etc. If the effect is not good, the Chinese Medicine syndrome can be used to cure it. It can often obtain satisfactory curative effect.

並列關鍵字

Hyponatremia ； abnormal electrolyte ； low blood sodium inducing medicine ； brain edema ； central pontine myelinolysis