{"id":33878,"date":"2022-09-11T13:48:56","date_gmt":"2022-09-11T06:48:56","guid":{"rendered":"https:\/\/www.vnras.com\/drug\/?p=33878"},"modified":"2022-09-11T13:49:18","modified_gmt":"2022-09-11T06:49:18","slug":"phac-do-dieu-tri-ha-natri-mau-tai-khoa-cap-cuu","status":"publish","type":"post","link":"https:\/\/vnras.com\/drug\/phac-do-dieu-tri-ha-natri-mau-tai-khoa-cap-cuu\/","title":{"rendered":"Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb h\u1ea1 Natri m\u00e1u t\u1ea1i khoa c\u1ea5p c\u1ee9u"},"content":{"rendered":"

vnras.com\/drug – \u0110\u1ec3 t\u1ea3i file PDF c\u1ee7a b\u00e0i vi\u1ebft Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb h\u1ea1 Natri m\u00e1u t\u1ea1i khoa c\u1ea5p c\u1ee9u<\/a>,\u00a0<\/strong>xin vui l\u00f2ng click v\u00e0o link \u1edf \u0111\u00e2y<\/a>.<\/p>\n

Abstract \u2013 h\u1ea1 natri m\u00e1u \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a khi natri huy\u1ebft t\u01b0\u01a1ng <135 mmol\/L, l\u00e0 t\u00ecnh tr\u1ea1ng r\u1ea5t hay th\u01b0\u1eddng g\u1eb7p t\u1ea1i khoa c\u1ea5p c\u1ee9u. Tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng kh\u00f4ng \u0111\u1eb7c hi\u1ec7u v\u00e0 th\u01b0\u1eddng b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh s\u1eed t\u00e9 ng\u00e3, y\u1ebfu v\u00e0 ch\u00f3ng m\u1eb7t. C\u00e1c nguy\u00ean nh\u00e2n ch\u00ednh g\u00e2y h\u1ea1 natri m\u00e1u th\u01b0\u1eddng ph\u1ed5 bi\u1ebfn l\u00e0 l\u1ee3i ti\u1ec3u, suy tim c\u0169ng nh\u01b0 l\u00e0 h\u1ed9i ch\u1ee9ng SIAD (t\u1ea1m d\u1ecbch h\u1ed9i ch\u1ee9ng ch\u1ed1ng l\u1ee3i ni\u1ec7u kh\u00f4ng ph\u00f9 h\u1ee3p). \u0110i\u1ec1u tr\u1ecb h\u1ea1 Natri m\u00e1u n\u00ean \u0111\u01b0\u1ee3c d\u1eabn \u0111\u01b0\u1eddng b\u1edfi tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh nh\u00e2n c\u0169ng nh\u01b0 t\u1eadp trung ph\u00e2n bi\u1ec7t \u0111\u00e2y l\u00e0 h\u1ea1 natri m\u00e1u c\u1ea5p hay m\u1ea1n t\u00ednh.<\/p>\n

Background<\/h2>\n

H\u1ea1 natri m\u00e1u l\u00e0 r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i ph\u1ed5 bi\u1ebfn nh\u1ea5t tr\u00ean l\u00e2m s\u00e0ng. N\u00f3 \u1ea3nh h\u01b0\u1edfng tr\u00ean 10% b\u1ec7nh nh\u00e2n nh\u1eadp vi\u1ec7n. C\u01a1 ch\u1ebf g\u00e2y h\u1ea1 natri m\u00e1u r\u1ea5t ph\u1ee9c t\u1ea1p v\u00e0 \u0111\u00f4i khi n\u00f3 g\u00e2y ra s\u1ef1 nh\u0169ng nh\u0129u ho\u1eb7c nh\u1ea7m l\u1eabn cho c\u00e1c b\u00e1c s\u0129 l\u00e2m s\u00e0ng. Do vi\u1ec7c \u0111i\u1ec1u tr\u1ecb ph\u1ea3i \u0111i t\u1eeb c\u01a1 ch\u1ebf n\u1ec1n, n\u00ean vi\u1ec7c hi\u1ec3u c\u01a1 ch\u1ebf sinh l\u00fd b\u1ec7nh l\u00e0 \u0111i\u1ec1u t\u1ed1i c\u1ea7n thi\u1ebft \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u th\u00e0nh c\u00f4ng. B\u00e0i n\u00e0y s\u1ebd cho b\u1ea1n m\u1ed9t c\u00e1i nh\u00ecn t\u1ed5ng quan v\u1ec1 h\u1ea1 natri m\u00e1u, d\u1ecbch t\u1ec5 h\u1ecdc, sinh l\u00fd b\u1ec7nh, tri\u1ec7u ch\u1ee9ng v\u00e0 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n nh\u1eadp khoa c\u1ea5p c\u1ee9u. C\u00e1c khuy\u1ebfn c\u00e1o trong b\u00e0i n\u00e0y b\u00e1m theo c\u00e1c h\u01b0\u1edbng d\u1eabn l\u00e2m s\u00e0ng c\u1ee7a 3 hi\u1ec7p h\u1ed9i Ch\u00e2u \u00c2u t\u1eeb n\u0103m 2014. C\u0169ng l\u01b0u \u00fd r\u1eb1ng c\u00e1c khuy\u1ebfn c\u00e1o c\u1ee7a Ch\u00e2u \u00c2u v\u1ec1 \u0111i\u1ec3m ch\u00ednh n\u00f3 kh\u00e1 gi\u1ed1ng v\u1edbi h\u01b0\u1edbng d\u1eabn t\u1eeb Hoa K\u1ef3 n\u0103m 2013 duy ch\u1ec9 c\u00f3 v\u00e0i \u0111i\u1ec3m kh\u00e1c bi\u1ec7t nh\u1ecf.<\/p>\n

\u0110\u1ecbnh ngh\u0129a<\/h2>\n

H\u1ea1 natri m\u00e1u \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a b\u1eb1ng vi\u1ec7c gi\u1ea3m natri m\u00e1u d\u01b0\u1edbi ng\u01b0\u1ee1ng t\u01b0\u01a1ng \u0111\u1ed1i c\u1ee7a ph\u00f2ng x\u00e9t nghi\u1ec7m, v\u00e0 gi\u00e1 tr\u1ecb n\u00e0y c\u00f3 th\u1ec3 thay \u0111\u1ed5i gi\u1eefa c\u00e1c b\u1ec7nh vi\u1ec7n. Ph\u1ed5 bi\u1ebfn nh\u1ea5t, l\u00e0 gi\u00e1 tr\u1ecb natri d\u01b0\u1edbi 135mmol\/L s\u1ebd \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 h\u1ea1 natri m\u00e1u. S\u1ef1 xu\u1ea5t hi\u1ec7n tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng s\u1ebd c\u00f3 m\u1ed1i t\u01b0\u01a1ng quan v\u1edbi t\u1ed1c \u0111\u1ed9 h\u1ea1 natri v\u00e0 ph\u00e2n th\u00e0nh c\u00e1c m\u1ee9c \u0111\u1ed9 nh\u1eb9 (130\u2013135 mmol\/L), trung b\u00ecnh (125\u2013129 mmol\/L) v\u00e0 n\u1eb7ng (<125 mmol\/L).
\nB\u00e1c s\u1ef9 c\u1ea5p c\u1ee9u n\u00ean ch\u00fa \u00fd s\u1ef1 thay \u0111\u1ed5i trong m\u1ee9c \u0111\u1ed9 natri gi\u1eefa huy\u1ebft t\u01b0\u01a1ng v\u00e0 m\u00e1u to\u00e0n ph\u1ea7n c\u00f3 th\u1ec3 c\u00f3. S\u1ef1 kh\u00e1c bi\u1ec7t n\u00e0y c\u00f3 th\u1ec3 l\u00ean \u0111\u1ebfn 4 mmol\/L.<\/p>\n

D\u1ecbch t\u1ec5 h\u1ecdc c\u1ee7a h\u1ea1 natri m\u00e1u t\u1ea1i khoa c\u1ea5p c\u1ee9u<\/h2>\n

Trong c\u00e1c b\u1ec7nh nh\u00e2n nh\u1eadp ED, t\u1ea7n su\u1ea5t h\u1ea1 natri m\u00e1u r\u01a1i v\u00e0o kho\u1ea3ng 3- 10% , c\u00f3 l\u1ebd n\u00f3 ph\u1ee5 thu\u1ed9c v\u00e0o b\u1ed1i c\u1ea3nh t\u1eebng qu\u1ed1c gia v\u00e0 d\u00e2n c\u01b0 t\u1eebng v\u00f9ng.<\/p>\n

Trong nh\u00f3m b\u1ec7nh nh\u00e2n \u0111\u1eb7c bi\u1ec7t, ch\u1eb3ng h\u1ea1n nh\u01b0 c\u00e1c b\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i, t\u1ea7n su\u1ea5t h\u1ea1 natri m\u00e1u cao h\u01a1n h\u1eb3n.<\/p>\n

Nghi\u00ean c\u1ee9u d\u1ecbch t\u1ec5 h\u1ea1 natri m\u00e1u nh\u1eadp khoa c\u1ea5p c\u1ee9u cho th\u1ea5y t\u1ea7n su\u1ea5t nh\u01b0 sau : b\u1ec7nh nh\u00e2n t\u1eeb 16-21 tu\u1ed5i (2%); b\u1ec7nh nh\u00e2n tr\u00ean 80 tu\u1ed5i (17%). L\u00fd do gi\u1ea3i th\u00edch cho vi\u1ec7c h\u1ea1 natri m\u00e1u hay g\u1eb7p \u1edf ng\u01b0\u1eddi cao tu\u1ed5i l\u00e0 c\u00f3 th\u1ec3 do h\u1ecd c\u00f3 nhi\u1ec1u b\u1ec7nh \u0111\u1ed3ng m\u1eafc, d\u00f9ng nhi\u1ec1u thu\u1ed1c, c\u0169ng nh\u01b0 suy gi\u1ea3m ch\u1ee9c n\u0103ng c\u00f4 \u0111\u1eb7c\/pha lo\u00e3ng n\u01b0\u1edbc ti\u1ec3u c\u1ee7a th\u1eadn. C\u00f2n n\u1eefa, t\u1ea7n su\u1ea5t h\u1ea1 natri m\u00e1u c\u0169ng ch\u1ecbu s\u1ef1 \u1ea3nh h\u01b0\u1edfng thay \u0111\u1ed5i theo
\nm\u00f9a, khi m\u00e0 m\u00f9a n\u00f3ng c\u00f3 th\u1ec3 k\u00edch th\u00edch u\u1ed1ng nhi\u1ec1u n\u01b0\u1edbc l\u00e0 t\u0103ng l\u01b0\u1ee3ng d\u1ecbch nh\u01b0\u1ee3c tr\u01b0\u01a1ng thay d\u1ecbch \u01b0u tr\u01b0\u01a1ng trong c\u01a1 th\u1ec3. Nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh th\u1eadn c\u1ea5p ho\u1eb7c c\u1ea5p tr\u00ean n\u1ec1n th\u1eadn m\u1ea1n c\u0169ng c\u00f3 t\u1ef7 l\u1ec7 h\u1ea1 natri m\u00e1u cao khi nh\u1eadp khoa c\u1ea5p c\u1ee9u, con s\u1ed1 \u0111\u1ebfn 30%.<\/p>\n

D\u1ef1a v\u00e0o nh\u1eefng d\u1eef li\u1ec7u v\u1eeba n\u00eau, b\u00e1c s\u0129 c\u1ea5p c\u1ee9u n\u00ean nghi ng\u1edd h\u1ea1 natri m\u00e1u tr\u00ean c\u00e1c nh\u00f3m b\u1ec7nh nh\u00e2n \u0111\u1eb7c bi\u1ec7t nh\u01b0: b\u1ec7nh gi\u00e0, b\u1ec7nh d\u00f9ng l\u1ee3i ti\u1ec3u \u0111\u1eb7c bi\u1ec7t l\u00e0 l\u1ee3i ti\u1ec3u kh\u00e1ng aldosterone hay l\u1ee3i ti\u1ec3u thiazide ho\u1eb7c c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh th\u1eadn. Xu h\u01b0\u1edbng h\u1ea1 natri m\u00e1u theo m\u00f9a n\u00f3ng c\u0169ng n\u00ean l\u01b0u gi\u1eef trong suy ngh\u0129 c\u1ee7a m\u1ed5i b\u00e1c s\u0129 c\u1ea5p c\u1ee9u.<\/p>\n

Sinh b\u1ec7nh h\u1ecdc c\u1ee7a h\u1ea1 natri m\u00e1u<\/h2>\n

N\u1ed3ng \u0111\u1ed9 natri huy\u1ebft t\u01b0\u01a1ng<\/h3>\n

C\u00e1c c\u01a1 ch\u1ebf d\u1eabn \u0111\u1ebfn h\u1ea1 natri m\u00e1u th\u01b0\u1eddng ch\u1ed3ng ch\u00e9o l\u00ean nhau v\u00e0 d\u1ec5 g\u00e2y s\u1ef1 h\u1ed7n lo\u1ea1n. Hi\u1ec3u r\u00f5 to\u00e0n di\u1ec7n v\u1ec1 b\u1ec7nh sinh s\u1ebd l\u00e0 \u0111i\u1ec3m c\u1ed1t l\u00f5i \u0111\u1ec3 hi\u1ec3u lo\u1ea1i r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i n\u00e0y v\u00e0 kh\u1edfi tr\u1ecb th\u00e0nh c\u00f4ng.<\/p>\n

Natri m\u00e1u \u0111\u01b0\u1ee3c quy\u1ebft \u0111\u1ecbnh b\u1eb1ng t\u1ed5ng Na v\u00e0 K c\u00f3 th\u1ec3 trao \u0111\u1ed5i tr\u00ean t\u1ed5ng l\u01b0\u1ee3ng n\u01b0\u1edbc trong c\u01a1 th\u1ec3 qua c\u00f4ng th\u1ee9c c\u1ee7a Edelman<\/p>\n

\"c\u00f4ng
c\u00f4ng th\u1ee9c c\u1ee7a Edelman<\/figcaption><\/figure>\n

L\u01b0u \u00fd r\u1eb1ng c\u00f3 m\u1ed9t l\u01b0\u1ee3ng Natri d\u1ef1 tr\u1eef kh\u00f4ng trao \u0111\u1ed5i t\u1ed3n t\u1ea1i b\u00ean trong c\u01a1 th\u1ec3 m\u00e0 kh\u00f4ng \u0111\u01b0\u1ee3c th\u1ec3 hi\u1ec7n trong c\u00f4ng th\u1ee9c v\u1eeba n\u00eau. Kali trong c\u00f4ng th\u1ee9c c\u1ee7a Edelman g\u1ee3i \u00fd t\u1ed3n t\u1ea1i m\u1ed9t s\u1ef1 c\u00e2n b\u1eb1ng n\u1ed3ng \u0111\u1ed9 c\u00e1c ch\u1ea5t h\u00f2a tan qua c\u00e1c m\u00e0ng t\u1ebf b\u00e0o v\u1edbi Natri l\u00e0 ch\u1ea5t \u0111i ra ngo\u1ea1i b\u00e0o ch\u00ednh c\u00f2n Kali l\u00e0 ch\u1ea5t \u0111i v\u00f4 n\u1ed9i b\u00e0o ch\u00ednh y\u1ebfu. Do n\u01b0\u1edbc c\u00f3 th\u1ec3 ra v\u00e0o t\u1ebf b\u00e0o d\u1ec5 n\u00ean n\u1ed3ng \u0111\u1ed9 c\u00e1c ch\u1ea5t gi\u1eefa n\u1ed9i v\u00e0 ngo\u00e0i b\u00e0o l\u00e0 c\u00e2n b\u1eb1ng.<\/p>\n

Theo c\u00f4ng th\u1ee9c c\u1ee7a Edelman, vi\u1ec7c h\u1ea1 Natri m\u00e1u ch\u1ec9 c\u00f3 th\u1ec3 x\u1ea3y ra n\u1ebfu c\u00f3 s\u1ef1 m\u1ea5t Natri ho\u1eb7c t\u0103ng th\u1ec3 t\u00edch n\u01b0\u1edbc c\u0169ng nh\u01b0 c\u1ea3 2 c\u00f9ng x\u1ea3y ra. C\u0169ng c\u00f3 th\u1ec3 k\u1ebft lu\u1eadn r\u1eb1ng vi\u1ec7c t\u0103ng Kali c\u00f3 th\u1ec3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn n\u1ed3ng \u0111\u1ed9 Natri m\u00e1u. T\u1ea1i khoa c\u1ea5p c\u1ee9u \u0111i\u1ec1u n\u00e0y kh\u00e1 quan tr\u1ecdng trong \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n v\u1eeba h\u1ea1 natri v\u1eeba h\u1ea1 Kali m\u00e1u. S\u1ef1 thay th\u1ebf Kali c\u00f3 th\u1ec3 \u0111\u01b0a \u0111\u1ebfn m\u1ed9t t\u1ed1c \u0111\u1ed9 hi\u1ec7u ch\u1ec9nh Natri m\u00e1u cao h\u01a1n. Th\u00eam n\u1eefa, h\u1ea1 Natri m\u00e1u c\u00f3 th\u1ec3 x\u1ea9y ra do s\u1ef1 d\u1ecbch chuy\u1ec3n n\u01b0\u1edbc t\u1eeb n\u1ed9i b\u00e0o ra ngo\u1ea1i b\u00e0o, m\u00e0 c\u00f3 th\u1ec3 nguy\u00ean nh\u00e2n l\u00e0 do trong m\u00e1u c\u00f3 m\u1ed9t ch\u1ea5t th\u1ea9m th\u1ea5u n\u00e0o \u0111\u00f3 g\u00e2y k\u00e9o n\u01b0\u1edbc. T\u0103ng \u0111\u01b0\u1eddng huy\u1ebft ch\u00ednh l\u00e0 nguy\u00ean nh\u00e2n hay g\u1eb7p \u0111i\u1ec3n h\u00ecnh cho hi\u1ec7n t\u01b0\u1ee3ng n\u00e0y.<\/p>\n

Ng\u01b0\u1eddi ta th\u1ea5y r\u1eb1ng c\u1ee9 m\u1ed5i b\u01b0\u1edbc t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft 5.6 mmol\/L (100 mg\/dL) th\u00ec natri m\u00e1u s\u1ebd gi\u1ea3m 1.6 mmol\/L.<\/p>\n

C\u00e2n b\u1eb1ng n\u1ed9i m\u00f4 c\u1ee7a n\u01b0\u1edbc<\/h3>\n

Nh\u01b0 \u0111\u00e3 \u0111\u01b0\u1ee3c tr\u00ecnh b\u00e0y trong c\u00f4ng th\u1ee9c c\u1ee7a Edelman, n\u1ed3ng \u0111\u1ed9 natri m\u00e1u l\u00e0 t\u1ef7 l\u1ec7 gi\u1eefa l\u01b0\u1ee3ng natri tr\u00ean t\u1ed5ng l\u01b0\u1ee3ng n\u01b0\u1edbc trong c\u01a1 th\u1ec3. Do \u0111\u00f3, n\u1ed3ng \u0111\u1ed9 natri m\u00e1u c\u0169ng ph\u1ea3n \u1ee9ng t\u00ecnh tr\u1ea1ng c\u00e2n b\u1eb1ng n\u1ed9i m\u00f4 c\u1ee7a n\u01b0\u1edbc trong c\u01a1 th\u1ec3. Hi\u1ec7n t\u01b0\u1ee3ng kh\u00e1t n\u01b0\u1edbc, u\u1ed1ng n\u01b0\u1edbc, v\u00e0 ho\u1ea1t \u0111\u1ed9ng c\u1ee7a hormon ch\u1ed1ng l\u1ee3i ni\u1ec7u (ADH) l\u00e0 c\u00e1c th\u00e0nh t\u1ed1 thi\u1ebft y\u1ebfu \u0111i\u1ec1u h\u00f2a l\u01b0\u1ee3ng n\u01b0\u1edbc trong c\u01a1 th\u1ec3.<\/p>\n

Khi \u0111\u1ed9 th\u1ea9m th\u1ea5u huy\u1ebft t\u01b0\u01a1ng t\u0103ng tr\u00ean 285 mosm\/kg, hormon ADH s\u1ebd \u0111\u01b0\u1ee3c b\u00e0i xu\u1ea5t v\u00e0 xu\u1ea5t hi\u1ec7n c\u1ea3m gi\u00e1c kh\u00e1t. Cu\u1ed1i c\u00f9ng d\u01b0\u1edbi s\u1ef1 t\u00e1c \u0111\u1ed9ng c\u1ee7a ADH c\u00e1c k\u00eanh n\u01b0\u1edbc t\u1ea1i \u1ed1ng g\u00f3p s\u1ebd m\u1edf ra v\u00e0 t\u1ea1o thu\u1eadn l\u1ee3i cho vi\u1ec7c t\u00e1i h\u1ea5p thu n\u01b0\u1edbc t\u1ea1i th\u1eadn. V\u00e0 khi \u0111\u00f3 \u0111\u1ed9 th\u1ea9m th\u1ea5u c\u1ee7a huy\u1ebft t\u01b0\u01a1ng s\u1ebd quay v\u1ec1 ng\u01b0\u1ee1ng b\u00ecnh th\u01b0\u1eddng. M\u1ed9t \u0111i\u1ec1u l\u01b0u \u00fd quan tr\u1ecdng, ADH c\u0169ng \u0111\u01b0\u1ee3c k\u00edch th\u00edch b\u1edfi s\u1ef1 thay \u0111\u1ed5i trong th\u1ee5 th\u1ec3 baroreceptor. Ngay c\u1ea3 v\u1edbi m\u1ed9t s\u1eed gi\u1ea3m nh\u1eb9 c\u1ee7a huy\u1ebft \u00e1p c\u0169ng c\u00f3 th\u1ec3 k\u00edch th\u00edch b\u00e0i ti\u1ebft ADH. Trong c\u00e1c t\u00ecnh hu\u1ed1ng gi\u1ea3m th\u1ec3 t\u00edch n\u1eb7ng , s\u1ef1 \u0111i\u1ec1u h\u00f2a c\u1ee7a th\u1ee5 th\u1ec3 \u00e1p l\u1ef1c n\u00e0y c\u00f3 th\u1ec3 v\u01b0\u1ee3t lu\u00f4n c\u01a1 ch\u1ebf \u0111i\u1ec1u h\u00f2a th\u1ea9m th\u1ea5u, d\u1eabn \u0111\u1ebfn vi\u1ec7c b\u00e0i ti\u1ebft ADH \u1ed3 \u1ea1t b\u1ea5t ch\u1ea5p trong m\u00e1u hi\u1ec7n t\u1ea1i c\u00f3 t\u00ecnh tr\u1ea1ng gi\u1ea3m \u0111\u1ed9 th\u1ea9m th\u1ea5u.<\/p>\n

Ph\u00e2n lo\u1ea1i h\u1ea1 natri m\u00e1u<\/h2>\n

C\u00e1c ti\u1ebfp c\u1eadn kh\u00e1c nhau \u0111\u00e3 \u0111\u01b0\u1ee3c n\u00eau ra \u0111\u1ec3 ph\u00e2n lo\u1ea1i b\u1ec7nh nguy\u00ean c\u1ee7a h\u1ea1 natri m\u00e1u. Ch\u00fang t\u00f4i th\u00edch th\u00fa h\u01a1n v\u1edbi vi\u1ec7c ph\u00e2n lo\u1ea1i h\u1ea1 natri m\u00e1u d\u1ef1a v\u00e0o t\u00ecnh tr\u1ea1ng th\u1ec3 t\u00edch c\u1ee7a b\u1ec7nh nh\u00e2n. M\u1eb7t h\u1ea1n ch\u1ebf v\u00e0 v\u00e0i b\u1eaby trong c\u00e1ch ph\u00e2n lo\u1ea1i n\u00e0y s\u1ebd \u0111\u01b0\u1ee3c n\u00eau b\u00ean d\u01b0\u1edbi b\u00e0i.<\/p>\n

Xem x\u00e9t t\u00ecnh tr\u1ea1ng th\u1ec3 t\u00edch d\u1ecbch<\/h3>\n

S\u1ef1 m\u1ea5t d\u1ecbch, \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 m\u1ea5t natri (v\u00e0 d\u1ecbch), x\u1ea3y ra trong c\u00e1c b\u1ed1i c\u1ea3nh nh\u01b0 m\u1ea5t m\u00e1u, m\u1ea5t qua d\u1ea1 d\u00e0y-ru\u1ed9t ho\u1eb7c m\u1ea5t qua th\u1eadn, v\u00e0 c\u1ea7n \u0111\u01b0\u1ee3c ph\u00e2n bi\u1ec7t v\u1edbi vi\u1ec7c m\u1ea5t n\u01b0\u1edbc m\u00e0 do m\u1ea5t thu\u1ea7n t\u00fay ch\u1ec9 l\u00e0 n\u01b0\u1edbc m\u00e0 th\u01b0\u1eddng s\u1ebd g\u00e2y ra t\u0103ng natri m\u00e1u v\u00e0 t\u0103ng \u00e1p l\u1ef1c th\u1ea9m th\u1ea5u. C\u1ea7n ph\u1ea3i ph\u00e2n bi\u1ec7t cho r\u00f5 2 ph\u1ea1m tr\u00f9 n\u00e0y v\u00ec m\u1ea5t n\u01b0\u1edbc th\u00ec ch\u1ec9 c\u1ea7n b\u00f9 n\u01b0\u1edbc , c\u00f2n m\u1ea5t d\u1ecbch th\u00ec c\u1ea7n ph\u1ea3i b\u00f9 b\u1eb1ng d\u1ecbch tinh th\u1ec3.<\/p>\n

C\u00e1c d\u1ea5u hi\u1ec7u l\u00e2m s\u00e0ng c\u1ee7a gi\u1ea3m th\u1ec3 t\u00edch bao g\u1ed3m: ch\u00f3ng m\u1eb7t t\u01b0 th\u1ebf \u0111\u1ee9ng m\u1ee9c \u0111\u1ed9 n\u1eb7ng, t\u0103ng nh\u1ecbp tim tr\u00ean 30l\/p \u1edf t\u01b0 th\u1ebf \u0111\u1ee9ng , h\u1ed1 n\u00e1ch kh\u00f4, c\u00e1c ni\u00eam m\u1ea1c m\u1ecdi ch\u1ed5 \u0111\u1ec1u kh\u00f4, l\u01b0\u1ee1i kh\u00f4, nh\u0103n. S\u1ee9c tr\u01b0\u01a1ng c\u1ee7a da c\u0169ng nh\u01b0 CRT kh\u00f4ng c\u00f3 nhi\u1ec1u gi\u00e1 tr\u1ecb trong ch\u1ea9n \u0111o\u00e1n tr\u1ea1ng th\u00e1i d\u1ecbch trong c\u01a1 th\u1ec3.<\/p>\n

Si\u00eau \u00e2m Point-of-care \u0111\u01a1n \u0111\u1ed9c hay k\u1ebft h\u1ee3p v\u1edbi nghi\u1ec7m ph\u00e1p n\u00e2ng ch\u00e2n l\u00e0 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p \u0111\u01b0\u1ee3c \u0111\u1ec1 ngh\u1ecb \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng th\u1ec3 t\u00edch. Th\u01b0\u1eddng th\u01b0\u1eddng, \u0111\u01b0\u1eddng k\u00ednh v\u00e0 \u0111\u1ed9 x\u1eb9p c\u1ee7a c\u00e1c t\u0129nh m\u1ea1ch l\u1edbn s\u1ebd \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 tr\u00ean si\u00eau \u00e2m, v\u00e0i t\u00e1c gi\u1ea3 c\u00f2n \u0111\u1ec1 xu\u1ea5t n\u00ean \u0111\u00e1nh gi\u00e1 c\u00e1c \u0111\u1ed9ng m\u1ea1ch l\u1edbn lu\u00f4n. M\u1eb7c d\u00f9 v\u00e0i nghi\u00ean c\u1ee9u cho th\u1ea5y nhi\u1ec1u h\u1ee9a h\u1eb9n nh\u01b0ng c\u00e1c nghi\u00ean c\u1ee9u quan s\u00e1t cho th\u1ea5y \u0111\u1ed9 ti\u00ean l\u01b0\u1ee3ng c\u00f2n nhi\u1ec1u gi\u1edbi h\u1ea1n c\u1ee7a vi\u1ec7c si\u00eau \u00e2m t\u0129nh m\u1ea1ch ch\u1ee7 d\u01b0\u1edbi.<\/p>\n

B\u00e1c s\u1ef9 c\u1ea5p c\u1ee9u n\u00ean k\u1ebft h\u1ee3p nhi\u1ec1u m\u1ea3nh gh\u00e9p \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 t\u00ecnh tr\u1ea1ng th\u1ec3 t\u00edch c\u1ee7a b\u1ec7nh nh\u00e2n nh\u01b0 : d\u1ea5u hi\u1ec7u tr\u00ean l\u00e2m s\u00e0ng bao g\u1ed3m m\u1ea1ch v\u00e0 huy\u1ebft \u00e1p k\u1ebft h\u1ee3p c\u00f9ng c\u00e1c x\u00e9t nghi\u1ec7m c\u0169ng nh\u01b0 si\u00eau \u00e2m c\u00e1c t\u0129nh m\u1ea1ch l\u1edbn k\u1ebft h\u1ee3p nghi\u1ec7m ph\u00e1p n\u00e2ng ch\u00e2n.<\/p>\n

H\u1ea1 natri m\u00e1u \u0111i k\u00e8m t\u00ecnh tr\u1ea1ng gi\u1ea3m th\u1ec3 t\u00edch<\/h3>\n

C\u00f3 nhi\u1ec1u c\u01a1 ch\u1ebf kh\u00e1c nhau g\u00e2y gi\u1ea3m th\u1ec3 t\u00edch, l\u00e0m t\u0103ng ADH v\u00e0 cu\u1ed1i c\u00f9ng g\u00e2y h\u1ea1 natri m\u00e1u.<\/p>\n

L\u1ee3i ti\u1ec3u l\u00e0 nguy\u00ean nh\u00e2n d\u1eabn \u0111\u1ea7u g\u00e2y h\u1ea1 natri m\u00e1u. M\u1ea5t natri \u1edf th\u1eadn do l\u1ee3i ti\u1ec3u c\u00f3 th\u1ec3 g\u00e2y gi\u1ea3m th\u1ec3 t\u00edch nh\u1eb9 v\u00e0 do \u0111\u00f3 gi\u1ea3i ph\u00f3ng ADH \u2013 vi\u1ec7c thay th\u1ebf d\u1ecbch nh\u01b0\u1ee3c tr\u01b0\u01a1ng \u0111i k\u00e8m v\u1edbi m\u1ea5t d\u1ecbch d\u1eabn \u0111\u1ebfn s\u1ef1 b\u00f9ng ph\u00e1t c\u1ee7a h\u1ea1 natri m\u00e1u. Quan tr\u1ecdng nh\u1ea5t, l\u1ee3i ti\u1ec3u thiazide l\u00e0 nguy\u00ean nh\u00e2n tr\u1ef1c ti\u1ebfp g\u00e2y h\u1ea1 natri m\u00e1u. \u1ea2nh h\u01b0\u1edfng c\u1ee7a l\u1ee3i ti\u1ec3u thiazide l\u00ean h\u1ea1 natri m\u00e1u s\u1ebd ph\u1ee5 thu\u1ed9c v\u00e0o li\u1ec1u v\u00e0 lo\u1ea1i thu\u1ed1c. L\u01b0u \u00fd, thiazide c\u00f3 th\u1ec3 g\u00e2y gi\u1ea3m s\u1ef1 b\u00e0i ti\u1ebft n\u01b0\u1edbc t\u1ef1 do , gi\u1ea3m \u0111\u1ed9 l\u1ecdc c\u1ee7a \u1ed1ng l\u01b0\u1ee3n xa, v\u00e0 t\u0103ng t\u00ednh th\u1ea5m c\u1ee7a \u1ed1ng g\u00f3p. C\u00e1c y\u1ebfu t\u1ed1 n\u00e0y c\u00f9ng v\u1edbi nhau c\u00f3 th\u1ec3 t\u1ea1o ra m\u1ed9t s\u1ef1 suy r\u00f5 r\u1ec7t trong c\u01a1 ch\u1ebf pha lo\u00e3ng n\u01b0\u1edbc ti\u1ec3u. B\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i v\u00e0 gi\u1edbi t\u00ednh n\u1eef l\u00e0 c\u00e1c nguy c\u01a1 quan tr\u1ecdng \u0111\u1ec3 xu\u1ea5t hi\u1ec7n bi\u1ebfn c\u1ed1 h\u1ea1 natri m\u00e1u tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n d\u00f9ng thiazide, trong khi \u0111\u00f3 , BMI th\u1ea5p v\u1eabn c\u00f2n \u0111ang trong di\u1ec7n y\u1ebfu t\u1ed1 nguy c\u01a1 g\u00e2y tranh c\u00e3i. Do \u0111\u00f3, t\u1ea1i khoa c\u1ea5p c\u1ee9u, r\u1ea5t quan tr\u1ecdng \u0111\u1ec3 ki\u1ec3m tra k\u1ef9 thu\u1ed1c b\u1ec7nh nh\u00e2n \u0111ang u\u1ed1ng xem c\u00f3 l\u1ee3i ti\u1ec3u thiazide hay kh\u00f4ng.<\/p>\n

M\u1ea5t natri qua \u0111\u01b0\u1eddng ti\u00eau h\u00f3a c\u0169ng c\u00f3 th\u1ec3 g\u1eb7p tr\u00ean b\u1ec7nh nh\u00e2n ti\u00eau ch\u1ea3y.<\/p>\n

Th\u00eam n\u1eefa, \u00f3i nhi\u1ec1u c\u00f3 th\u1ec3 l\u00e0m kh\u1edfi ph\u00e1t m\u1ea5t natri th\u1eadn \u0111\u1ec3 ch\u1ed1ng l\u1ea1i vi\u1ec7c ki\u1ec1m chuy\u1ec3n h\u00f3a m\u00e1u do natri c\u0169ng b\u00e0i ti\u1ebft c\u00f9ng v\u1edbi bicarbonate qua n\u01b0\u1edbc ti\u1ec3u.<\/p>\n

Natri c\u0169ng c\u00f3 th\u1ec3 m\u1ea5t m\u1ed9t l\u01b0\u1ee3ng \u0111\u00e1ng k\u1ec3 th\u00f4ng qua vi\u1ec7c b\u00e0i ti\u1ebft m\u1ed3 h\u00f4i. Suy tuy\u1ebfn th\u01b0\u1ee3ng th\u1eadn, nguy\u00ean ph\u00e1t c\u0169ng nh\u01b0 th\u1ee9 ph\u00e1t c\u0169ng c\u00f3 th\u1ec3 g\u00e2y h\u1ea1 natri m\u00e1u do gi\u1ea3m ho\u1ea1t \u0111\u1ed9ng c\u1ee7a aldosterone. T\u0103ng m\u1ee9c \u0111\u1ed9 ADH m\u00e1u c\u0169ng g\u1eb7p tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n suy gi\u1ea3m glucocorticoid.<\/p>\n

Cerebral salt wasting (ph\u00ed ho\u00e0i l\u01b0\u1ee3ng mu\u1ed1i \u1edf n\u00e3o) c\u0169ng t\u01b0\u01a1ng t\u1ef1 nh\u01b0 ph\u00ed h\u00e0i l\u01b0\u1ee3ng mu\u1ed1i \u1edf th\u1eadn , \u0111\u1eb7c tr\u01b0ng b\u1eb1ng c\u00e1c t\u00ecnh tr\u1ea1ng gi\u1ea3m th\u1ec3 t\u00edch, h\u1ea1 natri m\u00e1u v\u00e0 \u0111a ni\u1ec7u nh\u01b0ng th\u01b0\u1eddng c\u00f3 nguy\u00ean nh\u00e2n sau m\u1ed9t ch\u1ea5n th\u01b0\u01a1ng n\u00e3o ho\u1eb7c ph\u1eabu thu\u1eadt n\u1ed9i s\u1ecd. C\u01a1 ch\u1ebf cho vi\u1ec7c n\u00e0y th\u00ec cho t\u1edbi nay v\u1eabn ch\u01b0a \u0111\u01b0\u1ee3c hi\u1ec3u th\u1ea5u \u0111\u00e1o. V\u00e0 \u0111i\u1ec1u tr\u1ecb ch\u1ee7 y\u1ebfu l\u00e0 b\u00f9 d\u1ecbch v\u00e0 b\u00f9 natri.<\/p>\n

H\u1ea1 natri m\u00e1u v\u1edbi t\u00ecnh tr\u1ea1ng t\u0103ng th\u1ec3 t\u00edch<\/h3>\n

Tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n suy tim, t\u1ea7n su\u1ea5t h\u1ea1 natri m\u00e1u l\u00ean \u0111\u1ebfn 25%. Th\u00eam n\u1eefa, vi\u1ec7c h\u1ea1 natri m\u00e1u v\u00e0o th\u1eddi \u0111i\u1ec3m nh\u1eadp vi\u1ec7n c\u00f3 li\u00ean quan \u0111\u1ebfn ti\u00ean l\u01b0\u1ee3ng d\u01b0 h\u1eadu \u0111i\u1ec1u tr\u1ecb. Tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n suy tim, vi\u1ec7c gi\u1ea3m th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n hi\u1ec7u qu\u1ea3 s\u1ebd k\u00edch ho\u1ea1t gi\u1ea3i ph\u00f3ng ADH kh\u00f4ng th\u1ea9m th\u1ea5u g\u00e2y t\u00edch t\u1ee5 n\u01b0\u1edbc t\u1ef1 do g\u00e2y n\u00ean h\u1ea1 natri m\u00e1u trong khi c\u00f9ng l\u00fac \u0111\u00f3, s\u1ef1 k\u00edch ho\u1ea1t h\u1ec7 renin-angiotensin-aldosterone s\u1ebd d\u1eabn \u0111\u1ebfn vi\u1ec7c t\u00edch t\u1ee5 natri. Th\u00eam n\u1eefa, ch\u1ea5t Angiotensin II s\u1ebd k\u00edch th\u00edch th\u1ee5 th\u1ec3 kh\u00e1t , t\u0103ng d\u1ecbch b\u1edfi k\u00edch th\u00edch ADH, t\u1ea5t c\u1ea3 nh\u1eefng y\u1ebfu t\u1ed1 v\u1eeba n\u00eau v\u01b0\u1ee3t xa vi\u1ec7c t\u00edch t\u1ee5 natri do h\u1ec7 renin-angiotensin- aldosterone, n\u00ean cu\u1ed1i c\u00f9ng h\u1ec7 qu\u1ea3 v\u1eabn l\u00e0 h\u1ea1 natri m\u00e1u.
\nX\u01a1 gan c\u0169ng l\u00e0 m\u1ed9t nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn kh\u00e1c g\u00e2y n\u00ean h\u1ea1 natri m\u00e1u: s\u1ef1 gi\u00e3n c\u1ee7a c\u00e1c m\u1ea1ch m\u00e1u l\u00e1ch, v\u00e0 h\u1ec7 qu\u1ea3 c\u1ee7a vi\u1ec7c gi\u00e3n \u0111\u00f3 l\u00e0 s\u1ef1 k\u00edch ho\u1ea1t h\u1ec7 renin- angiotensin-aldosterone \u0111i c\u00f9ng v\u1edbi gi\u1ea3i ph\u00f3ng ADH \u0111\u1ec3 b\u00f9 tr\u1eeb cho vi\u1ec7c gi\u1ea3m th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n hi\u1ec7u qu\u1ea3 (v\u00ec th\u1ec3 t\u00edch b\u1ecb \u1ee9 l\u1ea1i trong tu\u1ea7n ho\u00e0n l\u00e1ch), cu\u1ed1i c\u00f9ng s\u1ebd d\u1eabn \u0111\u1ebfn h\u1ea1 natri m\u00e1u. Li\u1ec7u h\u1ea1 natri m\u00e1u c\u00f3 tr\u1edf th\u00e0nh m\u1ed9t y\u1ebfu t\u1ed1 ti\u00ean l\u01b0\u1ee3ng cho \u0111\u1ed9 n\u1eb7ng c\u1ee7a x\u01a1 gan \u0111\u01b0\u1ee3c hay kh\u00f4ng th\u00ec cho \u0111\u1ebfn nay v\u1eabn ch\u01b0a c\u00f3 k\u1ebft lu\u1eadn r\u00f5 r\u00e0ng.<\/p>\n

Tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n v\u1edbi h\u1ed9i ch\u1ee9ng th\u1eadn, th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n c\u00f3 th\u1ec3 gi\u1ea3m li\u00ean quan \u0111\u1ebfn gi\u1ea3m \u00e1p su\u1ea5t keo m\u00e0 nguy\u00ean nh\u00e2n l\u00e0 do th\u1eadn th\u1ea3i protein v\u00e0 c\u01a1 ch\u1ebf c\u0169ng s\u1ebd nh\u01b0 x\u01a1 gan v\u00e0 suy tim, l\u00fac n\u00e0y c\u01a1 th\u1ec3 ho\u1ea1t h\u00f3a h\u1ec7 renin-angiotensin- aldosterone v\u00e0 gi\u1ea3i ph\u00f3ng kh\u00f4ng th\u1ea9m th\u1ea5u hormon ADH d\u1eabn \u0111\u1ebfn hi\u1ec7n t\u01b0\u1ee3ng ph\u00f9 v\u00e0 h\u1ea1 natri m\u00e1u.<\/p>\n

H\u1ea1 natri m\u00e1u v\u1edbi t\u00ecnh tr\u1ea1ng d\u1ecbch b\u00ecnh th\u01b0\u1eddng<\/h3>\n

H\u1ed9i ch\u1ee9ng b\u00e0i ti\u1ebft ADH kh\u00f4ng ph\u00f9 h\u1ee3p (SIADH) \u0111\u01b0\u1ee3c \u0111\u1eb7c tr\u01b0ng b\u1edfi s\u1ef1 ph\u00f3ng th\u00edch ADH nh\u01b0ng kh\u00f4ng h\u1ec1 ph\u00f9 thu\u1ed9c v\u00e0o t\u00ecnh tr\u1ea1ng th\u1ec3 t\u00edch hay t\u00ecnh tr\u1ea1ng th\u1ea9m th\u1ea5u. T\u0103ng \u0111\u1ed9t bi\u1ebfn ch\u1ee9c n\u0103ng c\u1ee7a th\u1ee5 th\u1ec3 vasopressin V2 receptor \u0111\u01b0\u1ee3c cho l\u00e0 nguy\u00ean nh\u00e2n c\u1ee7a SIADH, th\u01b0\u1eddng c\u00f3 m\u1ed1i li\u00ean h\u1ec7 v\u1edbi m\u1ed9t m\u1ee9c \u0111\u1ed9 ADH tu\u1ea7n ho\u00e0n th\u1ea5p. Trong SIADH, n\u01b0\u1edbc t\u1ef1 do \u0111\u01b0\u1ee3c tr\u1eef l\u1ea1i v\u00e0 n\u01b0\u1edbc ti\u1ec3u \u0111\u01b0\u1ee3c c\u00f4 \u0111\u1eb7c \u0111\u1ebfn m\u1ed9t m\u1ee9c th\u1ea9m th\u1ea5u
\nt\u01b0\u01a1ng \u0111\u1ed1i \u2013 do \u0111\u00f3 , ti\u00eau chu\u1ea9n \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n SIADH s\u1ebd g\u1ed3m : \u0111\u1ed9 th\u1ea9m th\u1ea5u n\u01b0\u1edbc ti\u1ec3u >100mosm\/kg, nh\u01b0ng h\u1ea7u nh\u01b0 s\u1ebd >300 mosmol\/kg<\/p>\n

M\u1ed9t \u0111\u1eb1ng, h\u1ea1 natri m\u00e1u trong SIAD g\u00e2y ra b\u1edfi t\u00edch t\u1ee5 n\u01b0\u1edbc t\u1ef1 do th\u00f4ng qua vi\u1ec7c b\u00e0i ti\u1ebft qu\u00e1 nhi\u1ec1u ADH (ho\u1eb7c l\u00e0 do t\u0103ng ho\u1ea1t \u0111\u1ed9ng ho\u1eb7c t\u0103ng ch\u1ee9c n\u0103ng do \u0111\u1ed9t bi\u1ebfn c\u1ee7a th\u1ee5 th\u1ec3 vasopressin V2 receptor). M\u1eb7t kh\u00e1c, h\u1eadu qu\u1ea3 c\u1ee7a t\u0103ng th\u1ec3 t\u00edch tu\u1ea7n ho\u00e0n s\u1ebd t\u1ea1o ra s\u1ef1 b\u00e0i xu\u1ea5t natri qua n\u01b0\u1edbc ti\u1ec3u \u2013 c\u0169ng l\u00e0 ti\u00eau chu\u1ea9n ch\u1ea9n \u0111o\u00e1n th\u1ee9 2 c\u1ee7a SIADH: Natri ni\u1ec7u l\u1edbn h\u01a1n > 40 mmol\/L. Ti\u00eau chu\u1ea9n ph\u1ee5 g\u1ed3m: gi\u1ea3m \u0111\u1ed9 th\u1ea9m th\u1ea5u huy\u1ebft t\u01b0\u01a1ng, t\u00ecnh tr\u1ea1ng \u0111\u1eb3ng t\u00edch tr\u00ean l\u00e2m s\u00e0ng, b\u1ec7nh nh\u00e2n kh\u00f4ng s\u1eed d\u1ee5ng thu\u1ed1c l\u1ee3i ti\u1ec3u v\u00e0 kh\u00f4ng c\u00f3 t\u00ecnh tr\u1ea1ng suy gi\u00e1p, th\u01b0\u1ee3ng th\u1eadn, tuy\u1ebfn y\u00ean ho\u1eb7c suy th\u1eadn k\u00e8m c\u00f3. Vi\u1ec7c k\u1ebft lu\u1eadn ch\u1ea9n \u0111o\u00e1n SIADH c\u00f3 nhi\u1ec1u th\u00e1ch th\u1ee9c \u0111\u1ebfn t\u1eeb nhi\u1ec1u nguy\u00ean nh\u00e2n: Vi\u1ec7c x\u00e1c \u0111\u1ecbnh t\u00ecnh tr\u1ea1ng th\u1ec3 t\u00edch c\u1ee7a b\u1ec7nh nh\u00e2n hi\u1ec7n \u0111ang nh\u01b0 th\u1ebf n\u00e0o s\u1ebd l\u00e0 m\u1ed9t kh\u00f3 kh\u0103n th\u1eadt s\u1ef1, th\u00eam n\u1eefa, SIADH c\u00f3 th\u1ec3 b\u1ecb che l\u1ea5p b\u1edfi c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c c\u0169ng g\u00e2y ra h\u1ea1 natri m\u00e1u nh\u01b0: l\u1ee3i ti\u1ec3u thiazide c\u0169ng c\u00f3 th\u1ec3 g\u00e2y ra SIADH b\u1edfi c\u01a1 ch\u1ebf gi\u1ea3m s\u1ef1 pha lo\u00e3ng n\u01b0\u1edbc ti\u1ec3u nh\u01b0 v\u00ed d\u1ee5 \u0111\u00e3 n\u00eau \u1edf ph\u00e2n tr\u00ean. V\u1edbi c\u00e1c b\u00e1c s\u1ef9 c\u1ea5p c\u1ee9u , th\u1eadt s\u1ef1 l\u00e0 c\u1ea7n thi\u1ebft \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh b\u1ec7nh nh\u00e2n c\u00f3 SIADH hay kh\u00f4ng \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 g\u00e2y ra h\u1ea1 natri nhi\u1ec1u h\u01a1n do b\u00f9 d\u1ecbch kh\u00f4ng ph\u00f9 h\u1ee3p.<\/p>\n

R\u1ea5t l\u00e0 nhi\u1ec1u b\u1ec7nh m\u00e0 ch\u1ee7 y\u1ebfu l\u00e0 c\u00e1c b\u1ec7nh \u00e1c t\u00ednh v\u00e0 c\u00e1c b\u1ec7nh l\u00fd ph\u1ed5i , thu\u1ed1c v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng nh\u01b0 \u0111au, ho\u1eb7c n\u00f4n \u00f3i c\u00f3 th\u1ec3 k\u00edch kh\u1edfi cho SIADH.<\/p>\n

C\u00e1c t\u00ecnh tr\u1ea1ng nh\u01b0 t\u00ecnh tr\u1ea1ng gi\u1ea3m \u00e1p l\u1ef1c th\u1ea9m th\u1ea5u tr\u00ean c\u00e1c ng\u01b0\u1eddi nghi\u1ec7n bia (beer drinkers’ potomania), kh\u00e1t n\u01b0\u1edbc qu\u00e1 m\u1ee9c nguy\u00ean ph\u00e1t , ho\u1eb7c h\u1ea1 natri m\u00e1u g\u00e2y ra b\u1edfi tr\u00e0 v\u00e0 b\u00e1nh m\u1ef3 \u0111\u01b0\u1ee3c t\u00f3m g\u1ecdn
\ntheo c\u01a1 ch\u1ebf d\u1eabn \u0111\u1ebfn h\u1ea1 natri m\u00e1u nh\u01b0 sau: vi\u1ec7c u\u1ed1ng nhi\u1ec1u n\u01b0\u1edbc l\u1ecdc c\u00f9ng v\u1edbi \u0103n m\u1ed9t th\u1ee9c \u0103n m\u00e0 \u0111\u1ed9 h\u00f2a tan t\u01b0\u01a1ng \u0111\u1ed1i th\u1ea5p.\/<\/p>\n

Do vi\u1ec7c b\u00e0i xu\u1ea5t n\u01b0\u1edbc t\u1ef1 do \u1edf th\u1eadn c\u00f3 m\u1ed1i li\u00ean h\u1ec7 m\u1eadt thi\u1ebft v\u1edbi s\u1ef1 pha lo\u00e3ng n\u01b0\u1edbc ti\u1ec3u \u2013 t\u1ea1i gi\u00e1 tr\u1ecb \u0111\u1ed9 th\u1ea9m th\u1ea5u n\u01b0\u1edbc ti\u1ec3u l\u00e0 100mosm\/kg, th\u1eadn c\u1ea7n b\u00e0i xu\u1ea5t tr\u00ean 100 mmol ch\u1ea5t h\u00f2a tan tr\u00ean m\u1ed5i l\u00edt n\u01b0\u1edbc t\u1ef1 do \u2013 h\u1ea1 natri m\u00e1u c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n khi c\u01a1 th\u1ec3 nh\u1eadn m\u1ed9t l\u01b0\u1ee3ng qu\u00e1 l\u1edbn d\u1ecbch nh\u01b0\u1ee3c tr\u01b0\u01a1ng. Th\u00f4ng qua c\u01a1 ch\u1ebf b\u1ec7nh sinh, c\u00e1c b\u1ec7nh nh\u00e2n v\u1edbi t\u00ecnh tr\u1ea1ng h\u1ea1 natri m\u00e1u m\u1ea1n l\u00e0 c\u00e1c \u0111\u1ed1i t\u01b0\u1ee3ng s\u1ebd hay g\u1eb7p nhi\u1ec1u bi\u1ebfn ch\u1ee9ng c\u1ee7a vi\u1ec7c \u0111i\u1ec1u tr\u1ecb ch\u1ec9nh l\u1ea1i Natri m\u00e1u.<\/p>\n

Suy gi\u00e1p l\u00e0 m\u1ed9t nguy\u00ean nh\u00e2n kh\u00e1c nh\u01b0ng hi\u1ebfm khi g\u00e2y h\u1ea1 natri m\u00e1u, v\u00e0 th\u01b0\u1eddng ch\u1ec9 c\u00f3 th\u1ec3 ph\u00e1t hi\u1ec7n tr\u00ean c\u00e1c ca m\u00e0 tri\u1ec7u ch\u1ee9ng gi\u00e1p \u0111\u00e3 bi\u1ec3u hi\u1ec7n qu\u00e1 r\u00f5 r\u00e0ng \u0111i k\u00e8m v\u1edbi t\u0103ng n\u1ed3ng \u0111\u1ed9 TSH.<\/p>\n

Tri\u1ec7u ch\u1ee9ng c\u1ee7a h\u1ea1 natri m\u00e1u<\/h2>\n

Tri\u1ec7u ch\u1ee9ng h\u1ea1 natri m\u00e1u s\u1ebd tr\u00e3i r\u1ed9ng t\u1eeb nh\u1eb9 kh\u00f4ng \u0111\u1eb7c hi\u1ec7u cho \u0111\u1ebfn n\u1eb7ng th\u1eadm ch\u00ed ph\u00f9 n\u00e3o \u0111e d\u1ecda t\u00ednh m\u1ea1ng. Chung qui, \u0111\u1ed9 n\u1eb7ng c\u1ee7a h\u1ea1 natri m\u00e1u s\u1ebd ch\u1ee7 y\u1ebfu ph\u1ee5 thu\u1ed9c v\u00e0o m\u1ee9c \u0111\u1ed9 h\u1ea1 natri m\u00e1u di\u1ec5n ra c\u1ea5p nh\u01b0 th\u1ebf n\u00e0o: h\u1ea1 natri m\u00e1u qu\u00e1 nhanh, t\u01b0\u01a1ng \u0111\u1ed3ng v\u1edbi vi\u1ec7c n\u00e3o c\u00f3 \u00edt th\u1eddi gian h\u01a1n \u0111\u1ec3 th\u00edch nghi k\u1ecbp v\u1edbi t\u00ecnh tr\u1ea1ng gi\u1ea3m \u00e1p l\u1ef1c th\u1ea9m th\u1ea5u n\u1ed9i b\u00e0o. C\u01a1 ch\u1ebf th\u00edch nghi n\u00e0y s\u1ebd \u0111\u01b0\u1ee3c k\u00edch ho\u1ea1t qua con \u0111\u01b0\u1eddng b\u00f9 tr\u1eeb c\u1ef1c nhanh bao g\u1ed3m: n\u01b0\u1edbc s\u1ebd ch\u1ea3y t\u1eeb m\u00f4 k\u1ebb c\u1ee7a n\u00e3o v\u00e0o trong d\u1ecbch n\u00e3o t\u1ee7y, v\u00e0 \u0111\u1ed3ng th\u1eddi s\u1ebd c\u00f3 m\u1ed9t s\u1ef1 di chuy\u1ec3n c\u1ee7a \u0111i\u1ec7n gi\u1ea3i t\u1eeb n\u1ed9i b\u00e0o ra ngo\u1ea1i b\u00e0o. C\u01a1 ch\u1ebf n\u00e0y l\u00e0 c\u01a1 ch\u1ebf b\u00f9 tr\u1eeb c\u1ee7a n\u00e3o khi h\u1ea1 natri m\u00e1u x\u1ea3y ra, nh\u01b0ng \u0111i\u1ec1u g\u00ec th\u00ec c\u0169ng c\u00f3 gi\u1edbi h\u1ea1n c\u1ee7a n\u00f3, khi vi\u1ec7c di chuy\u1ec3n \u0111i\u1ec7n gi\u1ea3i t\u1eeb n\u1ed9i b\u00e0o ra ngo\u1ea1i b\u00e0o v\u01b0\u1ee3t qu\u00e1 20% t\u1ed5ng \u0111i\u1ec3n gi\u1ea3i n\u1ed9i b\u00e0o th\u00ec c\u01a1 ch\u1ebf b\u00f9 tr\u1eeb n\u00e0y s\u1ebd kh\u00f4ng c\u00f2n hi\u1ec7u qu\u1ea3 n\u1eefa. Do v\u1eady, trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p h\u1ea1 natri m\u00e1u qu\u00e1 n\u1eb7ng, b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 nhanh ch\u00f3ng r\u01a1i v\u00e0o ph\u00f9 n\u00e3o v\u00e0 t\u1eed vong s\u1ebd di\u1ec5n ra r\u1ea5t c\u1ea5p k\u1ef3. Ng\u01b0\u1ee3c l\u1ea1i, m\u1ed9t t\u00ecnh tr\u1ea1ng gi\u1ea3m natri m\u00e1u t\u1eeb t\u1eeb c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c b\u00f9 tr\u1eeb t\u1eeb t\u1eeb cho d\u00f9 m\u1ee9c natri huy\u1ebft t\u01b0\u01a1ng c\u00f3 th\u1ec3 gi\u1ea3m \u0111\u1ebfn th\u1eadm ch\u00ed \u0111\u1ebfn m\u1ee9c xung quanh gi\u00e1 tr\u1ecb 100 mmol\/L. Tuy nhi\u00ean, \u0111\u1ed9 th\u1ea9m th\u1ea5u c\u00f2n c\u00f3 vai tr\u00f2 trong d\u1eabn truy\u1ec1n th\u1ea7n kinh v\u00e0 chuy\u1ec3n h\u00f3a t\u1ebf b\u00e0o, n\u00ean khi gi\u1ea3m th\u1ea9m th\u1ea5u qu\u00e1 m\u1ee9c d\u00f9 cho l\u00e0 m\u1ea1n th\u00ec c\u0169ng s\u1ebd l\u00e0m suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1ea7n kinh c\u1ee7a b\u1ec7nh nh\u00e2n.<\/p>\n

S\u1ef1 kh\u00e1c bi\u1ec7t trong c\u01a1 ch\u1ebf b\u00f9 tr\u1eeb di\u1ec5n ra c\u1ea5p t\u00ednh v\u00e0 ch\u1eadm \u0111\u00f2i h\u1ecfi b\u00e1c s\u1ef9 ph\u1ea3i ph\u00e2n bi\u1ec7t \u0111\u01b0\u1ee3c gi\u1eefa h\u1ea1 natri c\u1ea5p v\u00e0 kh\u00f4ng c\u1ea5p \u0111\u1ec3 c\u00f2n c\u00f3 h\u01b0\u1edbng \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p.<\/p>\n

Trong m\u1ed9t ph\u00e2n t\u00edch h\u1ed3i c\u1ee9u, l\u1ea5y s\u1ed1 li\u1ec7u t\u1eeb m\u1ed9t khoa c\u1ea5p c\u1ee9u l\u1edbn, n\u00f4n \u00f3i, b\u1ec7nh s\u1eed nh\u1eadp vi\u1ec7n v\u00ec t\u00e9 ng\u00e3, y\u1ebfu m\u1ec7t, v\u00e0 ch\u00f3ng m\u1eb7t l\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng ph\u1ed5 bi\u1ebfn nh\u1ea5t c\u1ee7a h\u1ea1 natri m\u00e1u. C\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00e1c nh\u01b0 r\u1ed1i lo\u1ea1n \u0111\u1ecbnh h\u01b0\u1edbng, \u0111au \u0111\u1ea7u, co gi\u1eadt v\u00e0 ng\u1ea5t c\u0169ng \u0111\u00f4i khi g\u1eb7p. C\u00e1c b\u1eb1ng ch\u1ee9ng \u0111ang \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u c\u0169ng \u0111ang ng\u00e0y c\u00e0ng r\u00f5 vi\u1ec7c h\u1ea1 natri m\u00e1u c\u0169ng s\u1ebd g\u00e2y ra lo\u00e3ng x\u01b0\u01a1ng, v\u00e0 l\u00e0 y\u1ebfu t\u1ed1 nguy c\u01a1 t\u1ed3n t\u1ea1i \u0111\u1ed9c l\u1eadp v\u1edbi t\u00e9 ng\u00e3. Kh\u00f4ng ch\u1ec9 d\u1eebng l\u1ea1i \u1edf \u0111\u00f3, h\u1ea1 natri m\u00e1u c\u00f2n g\u00e2y ra nh\u1eefng h\u1eadu qu\u1ea3 tai h\u1ea1i l\u00ean ch\u1ee9c n\u0103ng c\u1ee7a h\u1ec7 th\u1ea7n kinh nh\u1eadn th\u1ee9c c\u0169ng nh\u01b0 v\u1eadn \u0111\u1ed9ng khi \u0111\u01b0\u1ee3c kh\u1ea3o s\u00e1t qua c\u00e1c test nh\u01b0 Mini-Mental-State, DemTect or TrailMaking test. M\u1ed9t \u0111i\u1ec1u kh\u00e1 th\u00fa v\u1ecb, t\u00ecnh tr\u1ea1ng suy gi\u1ea3m ch\u1ee9c n\u0103ng th\u1ea7n kinh nh\u1eadn th\u1ee9c c\u00f3 th\u1ec3 ph\u1ee5c h\u1ed3i sau khi t\u00ecnh tr\u1ea1ng h\u1ea1 natri m\u00e1u \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t.<\/p>\n

V\u1edbi c\u00e1c b\u00e1c s\u1ef9 c\u1ea5p c\u1ee9u, th\u1eadt s\u1ef1 l\u00e0 r\u1ea5t c\u1ea7n thi\u1ebft \u0111\u1ec3 \u0111\u1ec1 ph\u00f2ng, \u0111\u1ec3 coi ch\u1eebng kh\u1ea3 n\u0103ng b\u1ec7nh nh\u00e2n c\u00f3 h\u1ea1 natri m\u00e1u nh\u1ea5t l\u00e0 tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n l\u1edbn tu\u1ed5i nh\u1eadp c\u1ea5p c\u1ee9u v\u1edbi m\u1ed9t b\u1ec7nh s\u1eed t\u00e9 ng\u00e3 ho\u1eb7c m\u1ed9t than phi\u1ec1n kh\u00f4ng \u0111\u1eb7c hi\u1ec7u n\u00e0o \u0111\u00f3. V\u00e0 h\u01a1n n\u1eefa, h\u1ea1 natri m\u00e1u c\u0169ng n\u00ean \u0111\u01b0\u1ee3c ngh\u0129 \u0111\u1ebfn \u1edf t\u1ea5t c\u1ea3 c\u00e1c b\u1ec7nh nh\u00e2n v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00f4ng h\u1ec1 \u0111\u1eb7c hi\u1ec7u nh\u01b0 ch\u00f3ng m\u1eb7t, nh\u1ee9c \u0111\u1ea7u hay n\u00f4n \u00f3i, c\u00e1c b\u1ec7nh nh\u00e2n \u0111ang s\u1eed d\u1ee5ng l\u1ee3i ti\u1ec3u \u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u00f3m thiazide hay nh\u00f3m kh\u00e1ng aldosterone, v\u00e0 cu\u1ed1i c\u00f9ng l\u00e0 c\u00e1c b\u1ec7nh nh\u00e2n \u0111ang c\u00f3 b\u1ec7nh \u00e1c t\u00ednh trong ng\u01b0\u1eddi.<\/p>\n

Ch\u1ea9n \u0111o\u00e1n l\u00e2m s\u00e0ng v\u00e0 c\u1eadn l\u00e2m s\u00e0ng h\u1ea1 natri m\u00e1u t\u1ea1i khoa c\u1ea5p c\u1ee9u<\/h2>\n

Nhi\u1ec1u b\u01b0\u1edbc ch\u1ea9n \u0111o\u00e1n ti\u1ebfp t\u1edbi l\u00e0 c\u1ea7n thi\u1ebft sau khi \u0111\u00e3 x\u00e1c \u0111\u1ecbnh b\u1ec7nh nh\u00e2n c\u00f3 t\u00ecnh tr\u1ea1ng h\u1ea1 natri m\u00e1u: th\u00f4ng qua b\u1ec7nh s\u1eed c\u1ed1 g\u1eafng khai th\u00e1c \u0111\u01b0\u1ee3c th\u1eddi \u0111i\u1ec3m kh\u1edfi ph\u00e1t tri\u1ec7u ch\u1ee9ng (n\u1ebfu c\u00f3) v\u00e0 c\u00e1c th\u00f4ng tin v\u1ec1 thu\u1ed1c \u0111ang u\u1ed1ng , \u0111\u1eb7c bi\u1ec7t l\u00e0 c\u00e1c thu\u1ed1c nh\u00f3m l\u1ee3i ti\u1ec3u, corticosteroid v\u00e0 c\u00e1c nh\u00f3m thu\u1ed1c t\u00e2m th\u1ea7n. C\u00e1c tri\u1ec7u ch\u1ee9ng
\nli\u00ean quan \u0111\u1ebfn h\u1ea1 natri m\u00e1u n\u00ean \u0111\u01b0\u1ee3c \u0111\u00e1nh gi\u00e1 tr\u00ean ph\u01b0\u01a1ng di\u1ec7n to\u00e0n di\u1ec7n v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng \u00e2m t\u00ednh c\u0169ng n\u00ean \u0111\u01b0\u1ee3c ghi nh\u1eadn r\u00f5 r\u00e0ng. Vi\u1ec7c xem x\u00e9t v\u00e0 \u0111\u00e1nh gi\u00e1 c\u1ea9n th\u1eadn t\u00ecnh tr\u1ea1ng d\u1ecbch c\u1ee7a b\u1ec7nh nh\u00e2n b\u1eb1ng nhi\u1ec1u test nh\u01b0 \u0111\u00e3 n\u00eau \u1edf tr\u00ean l\u00e0 r\u1ea5t c\u1ea7n thi\u1ebft. Vi\u1ec7c xem l\u1ea1i c\u00e1c k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m l\u1ea7n tr\u01b0\u1edbc c\u1ee7a b\u1ec7nh nh\u00e2n n\u1ebfu c\u00f3 s\u1ebd cho bi\u1ebft h\u1ea1 natri k\u1ef3 n\u00e0y l\u00e0 c\u1ea5p hay m\u1ea1n. Glucose m\u00e1u n\u00ean \u0111\u01b0\u1ee3c th\u1eed \u0111\u1ec3 lo\u1ea1i tr\u1eeb kh\u1ea3 n\u0103ng nguy\u00ean nh\u00e2n do t\u0103ng \u0111\u01b0\u1eddng g\u00e2y h\u1ea1 natri m\u00e1u. B\u1edfi v\u00ec n\u1ed5i lo s\u1ee3 h\u00e0ng \u0111\u1ea7u khi b\u1ec7nh nh\u00e2n h\u1ea1 natri m\u00e1u l\u00e0 bi\u1ebfn ch\u1ee9ng ph\u00f9 n\u00e3o , l\u00e0 h\u1eadu qu\u1ea3 c\u1ee7a c\u00e1c bi\u1ebfn \u0111\u1ed5i v\u1ec1 th\u1ea9m th\u1ea5u v\u00e0 c\u0169ng kh\u00f4ng c\u00f3 m\u1ed9t m\u1ee9c natri n\u00e0o l\u00e0 tuy\u1ec7t \u0111\u1ed1i, n\u00ean h\u1ea1 natri do t\u0103ng glucose m\u00e1u kh\u00f4ng \u0111\u00f2i h\u1ecfi vi\u1ec7c ph\u1ea3i hi\u1ec7u ch\u1ec9nh m\u1ee9c \u0111\u1ed9 natri m\u00e1u, \u00edt nh\u1ea5t l\u00e0 cho \u0111\u1ebfn khi n\u00f3 kh\u00f4ng h\u1ea1 k\u00e9o d\u00e0i sau khi m\u1ee9c \u0111\u01b0\u1eddng huy\u1ebft \u0111\u00e3 \u0111\u01b0\u1ee3c hi\u1ec7u ch\u1ec9nh l\u1ea1i b\u00ecnh th\u01b0\u1eddng. M\u1ed9t d\u1ea1ng kh\u00e1c \u0111\u00f3 l\u00e0 h\u1ea1 natri m\u00e1u gi\u1ea3, m\u1ed9t hi\u1ec7n t\u01b0\u1ee3ng g\u1eb7p trong l\u00fac l\u00e0m x\u00e9t nguy\u00ean m\u00e0 nguy\u00ean nh\u00e2n l\u00e0 do gi\u00e1 tr\u1ecb protein ho\u1eb7c lipid qu\u00e1 cao, c\u00f3 th\u1ec3 h\u1ea1n ch\u1ebf vi\u1ec7c n\u00e0y b\u1eb1ng c\u00e1ch s\u1eed d\u1ee5ng m\u1ed9t \u0111i\u1ec7n c\u1ef1c ch\u1ea1y m\u1eabu ph\u00f9 h\u1ee3p. M\u1ee9c kali m\u00e1u c\u0169ng n\u00ean \u0111\u01b0\u1ee3c ki\u1ec3m tra, do th\u01b0\u1eddng h\u1ea1 natri s\u1ebd \u0111i k\u00e8m h\u1ea1 kali hay g\u1eb7p tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n l\u1ee3i ti\u1ec3u. Xa h\u01a1n n\u1eefa, Creatinine, Ure, TSH v\u00e0 \u0111\u1ed9 th\u1ea9m th\u1ea5u m\u00e1u c\u0169ng n\u00ean \u0111\u01b0\u1ee3c x\u00e9t nghi\u1ec7m. \u0110o cortisol m\u00e1u n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 nghi ng\u1edd suy th\u01b0\u1ee3ng th\u1eadn.<\/p>\n

\u0110i\u1ec1u tr\u1ecb h\u1ea1 natri m\u00e1u t\u1ea1i khoa c\u1ea5p c\u1ee9u<\/h2>\n

B\u01b0\u1edbc \u0111\u1ea7u ti\u00ean trong \u0111i\u1ec1u tr\u1ecb h\u1ea1 natri m\u00e1u khi b\u1ec7nh nh\u00e2n nh\u1eadp c\u1ea5p c\u1ee9u l\u00e0 lo\u1ea1i cho k\u1ef3 \u0111\u01b0\u1ee3c h\u1ea1 natri m\u00e1u do t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft. B\u00e1c s\u1ef9 c\u1ea5p c\u1ee9u n\u00ean c\u00f3 \u0111\u01b0\u1ee3c s\u1ef1 t\u1ef1 tin l\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh nh\u00e2n l\u00e0 do h\u1ea1 natri m\u00e1u g\u00e2y ra m\u00e0 kh\u00f4ng ph\u1ea3i l\u00e0 m\u1ed9t nguy\u00ean nh\u00e2n kh\u00e1c tr\u01b0\u1edbc khi mu\u1ed1n b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb. C\u00e1c b\u01b0\u1edbc \u0111i\u1ec1u tr\u1ecb ti\u1ebfp sau \u0111\u00e2y s\u1ebd d\u1ef1a tr\u00ean c\u00e1c h\u01b0\u1edbng d\u1eabn hi\u1ec7n h\u00e0nh t\u1eeb c\u00e1c guideline l\u00e2m s\u00e0ng \u0111\u01b0\u1ee3c tr\u00edch d\u1eabn trong ph\u1ea7n references cu\u1ed1i b\u00e0i. L\u01b0u \u0111\u1ed3 1 trinhg b\u00e0i ng\u1eafn g\u1ecdn c\u00e1c b\u01b0\u1edbc ti\u1ebfp c\u1eadn \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n t\u1ea1i khoa c\u1ea5p c\u1ee9u.<\/p>\n

H\u1ea1 natri m\u00e1u c\u00f3 tri\u1ec7u ch\u1ee9ng<\/h3>\n

\"H\u1ea1<\/p>\n

Theo c\u00e1c h\u01b0\u1edbng d\u1eabn th\u1ef1c h\u00e0nh l\u00e2m s\u00e0ng Ch\u00e2u \u00e2u, h\u1ea1 natri m\u00e1u c\u1ea5p (kh\u1edfi ph\u00e1t <48h) v\u1edbi tri\u1ec7u ch\u1ee9ng n\u1eb7ng ho\u1eb7c trung b\u00ecnh-n\u1eb7ng n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ngay l\u1eadp t\u1ee9c b\u1eb1ng c\u00e1ch truy\u1ec1n 150 ml NaCl 3% trong 20 ph\u00fat v\u00e0 sau \u0111\u00f3 l\u00e0 \u0111o l\u1ea1i gi\u00e1 tr\u1ecb Natri m\u00e1u sau 20 ph\u00fat. C\u00e1c tri\u1ec7u ch\u1ee9ng \u1edf m\u1ee9c \u0111\u1ed9 trung b\u00ecnh-n\u1eb7ng \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 c\u00f3 tri\u1ec7u ch\u1ee9ng n\u00f4n \u00f3i, r\u1ed1i lo\u1ea1n tri gi\u00e1c v\u00e0 nh\u1ee9c \u0111\u1ea7u ; ng\u01b0\u1ee3c l\u1ea1i tri\u1ec7u ch\u1ee9ng m\u1ee9c \u0111\u1ed9 n\u1eb7ng s\u1ebd g\u1ed3m: \u00f3i, nguy k\u1ecbch tu\u1ea7n ho\u00e0n h\u00f4 h\u1ea5p, ng\u1ee7 s\u00e2u ho\u1eb7c th\u1eadm ch\u00ed h\u00f4n m\u00ea c\u0169ng nh\u01b0 tri\u1ec7u ch\u1ee9ng co gi\u1eadt. C\u00e1c h\u01b0\u1edbng d\u1eabn c\u1ee7a Hoa k\u1ef3 c\u0169ng khuy\u1ebfn c\u00e1o n\u00ean \u0111i\u1ec1u tr\u1ecb h\u1ea1 natri m\u00e1u c\u1ea5p khi b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng nh\u1eb9 \u0111\u1ebfn trung b\u00ecnh. C\u00e1ch ti\u1ebfp c\u1eadn \u0111i\u1ec1u tr\u1ecb b\u01a1m ti\u00eam \u0111i\u1ec7n d\u1ef1a tr\u00ean c\u00e2n n\u1eb7ng (2ml\/kg) c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng khi truy\u1ec1n NaCl 3%. Vi\u1ec7c truy\u1ec1n ch\u1eadm nh\u01b0 v\u1eady kh\u00f4ng c\u00f3 kh\u00e1c bi\u1ec7t g\u00ec v\u1ec1 t\u1ed1c \u0111\u1ed9 hi\u1ec7u ch\u1ec9nh Natri m\u00e1u khi so v\u1edbi bolus nhanh ng\u1eaft qu\u00e3ng. T\u0103ng nhanh n\u1ed3ng \u0111\u1ed9 natri m\u00e1u m\u1ee9c 5mmol\/L l\u00e0 m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n h\u1ea1 natri m\u00e1u c\u00f3 tri\u1ec7u ch\u1ee9ng v\u00e0 c\u00f3 th\u1ec3 l\u1eb7p l\u1ea1i. N\u1ed3ng d\u1ed9 natri m\u00e1u n\u00ean \u0111\u01b0\u1ee3c ki\u1ec3m tra l\u1ea1i \u00edt nh\u1ea5t l\u00e0 6 ti\u1ebfng v\u00e0 12 ti\u1ebfng sau khi tri\u1ec7u ch\u1ee9ng \u0111\u00e3 c\u1ea3i thi\u1ec7n v\u00e0 m\u1ed5i ng\u00e0y cho \u0111\u1ebfn khi b\u00ecnh th\u01b0\u1eddng. Trong tr\u01b0\u1eddng h\u1ee3p c\u1ea7n l\u1eb7p l\u1ea1i li\u1ec1u NaCl 3% natri m\u00e1u n\u00ean \u0111\u01b0\u1ee3c ki\u1ec3m tra th\u01b0\u1eddng h\u01a1n (m\u1ed5i 4h). Nh\u00ecn chung, vi\u1ec7c b\u00f9 natri m\u00e1u kh\u00f4ng n\u00ean v\u01b0\u1ee3t qu\u00e1 m\u1ee9c t\u1ed1i \u0111a 8-10 mmol\/L\/24h. Sau khi tri\u1ec7u ch\u1ee9ng b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n th\u00ec s\u1ebd b\u1eaft tay v\u00e0o t\u00ecm nguy\u00ean nh\u00e2n g\u00e2y h\u1ea1 natri m\u00e1u.<\/p>\n

H\u1ea1 natri m\u00e1u kh\u00f4ng tri\u1ec7u ch\u1ee9ng<\/h3>\n

V\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n h\u1ea1 natri m\u00e1u kh\u00f4ng tri\u1ec7u ch\u1ee9ng, n\u00ean xem x\u00e9t \u0111\u1ebfn m\u1ed9t th\u00e0nh t\u1ed1 kh\u00e1 quan tr\u1ecdng l\u00e0 vi\u1ec7c h\u1ea1 natri m\u00e1u n\u00e0y c\u00f3 ph\u1ea3i c\u1ea5p t\u00ednh kh\u00f4ng (<48 gi\u1edd).<\/p>\n

Ch\u1ec9 n\u00ean x\u00e1c nh\u1eadn l\u00e0 c\u1ea5p t\u00ednh khi c\u00f3 b\u1eb1ng ch\u1ee9ng r\u00f5 r\u00e0ng tr\u00ean c\u00e1c x\u00e9t nghi\u1ec7m trong 48h qua. C\u00e1c h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb hi\u1ec7n h\u00e0nh khuy\u00ean ch\u00fang ta n\u00ean v\u1edbi 150 ml 3% NaCl (ho\u1eb7c li\u1ec1u 2 ml\/kg) trong kho\u1ea3ng 20 ph\u00fat, r\u1ed3i ki\u1ec3m tra l\u1ea1i gi\u00e1 tr\u1ecb natri m\u00e1u sau 4 gi\u1edd trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n \u0111\u00e3 ch\u1eafc ch\u1eafn l\u00e0 nh\u00f3m h\u1ea1 natri m\u00e1u c\u1ea5p v\u00e0 m\u1ee9c h\u1ea1 > >10 mmol\/L.<\/p>\n

V\u1edbi c\u00e1c t\u00ecnh hu\u1ed1ng kh\u00f4ng ph\u1ea3i h\u1ea1 c\u1ea5p t\u00ednh m\u00e0 b\u1ec7nh nh\u00e2n c\u00f3 t\u00ecnh tr\u1ea1ng thi\u1ebfu d\u1ecbch , v\u00ed d\u1ee5 nh\u01b0 ti\u00eau ch\u1ea3y, m\u1ea5t n\u01b0\u1edbc do \u0111i\u1ec1u tr\u1ecb l\u1ee3i ti\u1ec3u qu\u00e1 tay th\u00ec t\u00ecnh tr\u1ea1ng m\u1ea5t n\u01b0\u1edbc n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u ch\u1ec9nh l\u1ea1i b\u1eb1ng c\u00e1ch b\u00f9 d\u1ecbch tinh th\u1ec3 \u0111\u1eb3ng tr\u01b0\u01a1ng v\u1edbi li\u1ec1u 20ml\/kg\/24h. V\u1edbi c\u00e1c b\u1ec7nh nh\u00e2n m\u00e0 \u0111\u00e3 s\u1eb5n d\u01b0 d\u1ecbch (ch\u1eb3ng h\u1ea1n nh\u01b0 suy tim, x\u01a1 gan\u2026) h\u1ea1n ch\u1ebf d\u1ecbch l\u00e0 b\u01b0\u1edbc ti\u1ebfp c\u1eadn \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p ban \u0111\u1ea7u n\u1ebfu nh\u01b0 kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh l\u00fac \u0111\u00f3.<\/p>\n

C\u00e1c y\u1ebfu t\u1ed1 th\u00fac \u0111\u1ea9y vi\u1ec7c h\u1ea1 natri m\u00e1u nh\u01b0 d\u1ecbch d\u01b0 kh\u00f4ng c\u1ea7n thi\u1ebft, s\u1eed d\u1ee5ng l\u1ee3i ti\u1ec3u, ho\u1eb7c c\u00e1c thu\u1ed1c kh\u00e1c nghi ng\u1edd n\u00ean \u0111\u01b0\u1ee3c ng\u01b0ng d\u00f9ng t\u1ea1i b\u1ed1i c\u1ea3nh c\u1ea5p c\u1ee9u n\u1ebfu nh\u01b0 c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c. C\u00e1c x\u00e9t nghi\u1ec7m d\u00f9ng \u0111\u1ec3 x\u00e1c ch\u1ea9n nh\u01b0 \u0111\u00e3 n\u00eau \u1edf tr\u00ean n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n ngay l\u1eadp t\u1ee9c, l\u00fd t\u01b0\u1edfng nh\u1ea5t l\u00e0 n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n tr\u01b0\u1edbc
\nkhi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 tr\u00e1nh g\u00e2y ra sai s\u1ed1 trong k\u1ebft qu\u1ea3 x\u00e9t nghi\u1ec7m.<\/p>\n

Quan t\u00e2m s\u00e2u h\u01a1n n\u1eefa, \u0111i\u1ec1u tr\u1ecb c\u00e1c nguy\u00ean nh\u00e2n \u0111\u1eb7t bi\u1ec7t c\u1ee7a h\u1ea1 natri m\u00e1u, ch\u00fang t\u00f4i \u01b0u ti\u00ean d\u00f9ng c\u00e1c h\u01b0\u1edbng
\nd\u1eabn th\u1ef1c h\u00e0nh hi\u1ec7n h\u00e0nh. Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb h\u1ea1 natri m\u00e1u c\u1ea5p v\u00e0 c\u00f3 tri\u1ec7u ch\u1ee9ng c\u0169ng nh\u01b0 th\u1ef1c hi\u1ec7n c\u00e1c b\u01b0\u1edbc ch\u1ea9n \u0111o\u00e1n sao cho ch\u00ednh x\u00e1c n\u00ean \u0111\u01b0\u1ee3c l\u01b0u t\u00e2m b\u1edfi b\u00e1c s\u1ef9 c\u1ea5p c\u1ee9u. Ch\u00fang t\u00f4i k\u1ecbch li\u1ec7t ph\u1ea3n \u0111\u1ed1i kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb h\u1ea1 natri m\u00e1u tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng, kh\u00f4ng c\u00f3 t\u00ecnh tr\u1ea1ng thi\u1ebfu d\u1ecbch khi m\u00e0 ch\u01b0a th\u1ef1c hi\u1ec7n v\u00e0 l\u00e0m s\u00e1ng t\u1ecf m\u1ecdi c\u01a1 ch\u1ebf trong h\u1ea1 natri m\u00e1u, \u0111\u1ec3 tr\u00e1nh sai x\u00f3t kh\u00f4ng mong mu\u1ed1n trong k\u1ebft qu\u1ea3 \u0111i\u1ec1u tr\u1ecb c\u0169ng nh\u01b0 quan tr\u1ecdng h\u01a1n \u0111\u1ec3 tr\u00e1nh vi\u1ec7c l\u00e0m cho natri m\u00e1u t\u1ee5t xu\u1ed1ng th\u1ea5p h\u01a1n n\u1eefa , v\u00ed d\u1ee5 n\u1ebfu b\u1ec7nh nh\u00e2n h\u1ea1 natri m\u00e1u do h\u1ed9i ch\u1ee9ng SIAD, vi\u1ec7c truy\u1ec1n d\u1ecbch s\u1ebd c\u00e0ng l\u00e0m natri m\u00e1u gi\u1ea3m n\u1eb7ng h\u01a1n.<\/p>\n

B\u1ea3ng 2(xem cu\u1ed1i b\u00e0i) s\u1ebd tr\u00ecnh b\u00e0y c\u00e1c th\u00f4ng tin c\u1ed1t l\u00f5i \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n \u2013 x\u00e9t nghi\u1ec7m \u2013 \u0111i\u1ec1u tr\u1ecb h\u1ea1 natri m\u00e1u t\u1ea1i khoa c\u1ea5p c\u1ee9u<\/p>\n

Hi\u1ec7u ch\u1ec9nh h\u1ea1 natri m\u00e1u qu\u00e1 tay (Overcorrection of hyponatremia)<\/h3>\n

\u0110i\u1ec1u ch\u1ec9nh h\u1ea1 natri m\u00e1u qu\u00e1 tay \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 n\u1ed3ng \u0111\u1ed9 natri m\u00e1u t\u0103ng qu\u00e1 8\u201310 mmol\/L\/24h. C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 cho s\u1ef1 qu\u00e1 tay n\u00e0y s\u1ebd g\u1ed3m: gi\u00e1 tr\u1ecb kh\u1edfi \u0111i\u1ec3m c\u1ee7a natri m\u00e1u th\u1ea5p, li\u00ean quan v\u1edbi gi\u00e1 tr\u1ecb Kali th\u1ea5p, ch\u1ec9 s\u1ed1 kh\u1ed1i c\u01a1 th\u1ec3 th\u1ea5p, nghi\u1ec7n r\u01b0\u1ee3u m\u1ea1n, c\u00f3 b\u1ec7nh ung th\u01b0, v\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng n\u1eb7ng g\u00f3p ph\u1ea7n l\u00e0m h\u1ea1 natri m\u00e1u. Th\u00eam n\u1eefa, c\u00e1c b\u1ec7nh nh\u00e2n v\u1edbi t\u00ecnh tr\u1ea1ng th\u1ea3i ni\u1ec7u cao h\u01a1n b\u1ec7nh nh\u00e2n kh\u00e1c sau khi kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb
\ncugx s\u1ebd thu\u1ed9c nh\u00f3m b\u1ec7nh nh\u00e2n d\u1ec5 b\u1ecb hi\u1ec7u ch\u1ec9nh qu\u00e1 tay. C\u00e1c ca h\u1ea1 Kali m\u00e1u \u0111i k\u00e8m c\u00f3 th\u1ec3 l\u00e0 do m\u1ed9t s\u1ef1 t\u0103ng nhanh n\u1ed3ng \u0111\u1ed9 Natri m\u00e1u (do \u0111i\u1ec1u tr\u1ecb), d\u1eabn \u0111\u1ebfn vi\u1ec7c gi\u1ea3m Kali b\u00f9 tr\u1eeb b\u1eb1ng c\u00e1ch trao \u0111\u1ed5i qua k\u00eanh Na-K-ATPase.<\/p>\n

M\u1ed9t khi hi\u1ec7u ch\u1ec9nh qu\u00e1 tay \u0111\u00e3 \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh, h\u01b0\u1edbng \u0111i\u1ec1u tr\u1ecb l\u00e0 b\u00f9 ch\u1eadm l\u1ea1i sao cho d\u01b0\u1edbi ng\u01b0\u1ee1ng 8\u201310 mmol\/L\/24 h. Vi\u1ec7c gi\u1ea3m nhanh t\u1ed1c \u0111\u1ed9 natri huy\u1ebft t\u01b0\u01a1ng khi nh\u1eadn ra \u0111ang b\u00f9 qu\u00e1 tay c\u00f3 th\u1ec3 ph\u00f2ng ng\u1eeba v\u00e0 ng\u0103n ch\u1eb7n \u0111\u01b0\u1ee3c h\u1ed9i ch\u1ee9ng h\u1ee7y myeline do th\u1ea9m th\u1ea5u m\u00e0 \u0111\u00e3 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u tr\u00ean \u0111\u1ed9ng v\u1eadt v\u00e0 v\u00e0i ca b\u1ec7nh th\u1ef1c ch\u1ee9ng.<\/p>\n

Desmopressin l\u00e0 thu\u1ed1c \u0111\u01b0\u1ee3c g\u1ee3i \u00fd l\u00e0 hi\u1ec7u qu\u1ea3 trong vi\u1ec7c ph\u00f2ng ng\u1eeba v\u00e0 \u0111i\u1ec1u tr\u1ecb hi\u1ec7n t\u01b0\u1ee3ng hi\u1ec7u ch\u1ec9nh natri m\u00e1u qu\u00e1 tay v\u00e0 \u0111\u00e3 ch\u1ee9ng minh l\u00e0 th\u00e0nh c\u00f4ng trong \u00edt nh\u1ea5t m\u1ed9t nghi\u00ean c\u1ee9u h\u1ed3i c\u1ee9u.<\/p>\n

Truy\u1ec1n n\u01b0\u1edbc t\u1ef1 do d\u01b0\u1edbi dextrose-5 (2\u20133 ml\/kg\/h) c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng truy\u1ec1n b\u1ed5 sung k\u00e8m desmopressin (2\u20134 \u03bcg m\u1ed5i 6-8 h) ho\u1eb7c th\u1eadm ch\u00ed c\u00f3 th\u1ec3 s\u1eed d\u1ee5ng glucose \u0111\u01a1n \u0111\u1ed9c \u0111\u1ec3 pha lo\u00e3ng l\u1ea1i natri m\u00e1u \u0111ang b\u1ecb hi\u1ec7u ch\u1ec9nh t\u0103ng qu\u00e1 nhanh.<\/p>\n

C\u00e1c bi\u1ebfn ch\u1ee9ng<\/h3>\n

H\u1ed9i ch\u1ee9ng h\u1ee7y myeline do th\u1ea9m th\u1ea5u l\u00e0 m\u1ed9t bi\u1ebfn ch\u1ee9ng ho\u00e0n to\u00e0n c\u00f3 th\u1ec3 x\u1ea9y \u0111\u1ebfn khi natri m\u00e1u b\u1ecb t\u0103ng qu\u00e1 nhanh. N\u00f3 th\u1ec3 hi\u1ec7n vi\u1ec7c t\u1ebf b\u00e0o th\u1ea7n kinh m\u1ea5t kh\u1ea3 n\u0103ng \u0111\u1ec3 th\u00edch nghi k\u1ecbp th\u1eddi v\u1edbi \u0111\u1ed9 th\u1ea9m th\u1ea5u thay \u0111\u1ed5i qu\u00e1 nhanh. H\u1ea7u h\u1ebft, h\u1ed9i ch\u1ee9ng n\u00e0y s\u1ebd xu\u1ea5t hi\u1ec7n khi hi\u1ec7u ch\u1ec9nh natri m\u00e1u qu\u00e1 tay, nh\u01b0ng h\u1ed9i ch\u1ee9ng n\u00e0y c\u0169ng c\u00f3 th\u1ec3 g\u1eb7p trong c\u00e1c b\u1ec7nh l\u00fd kh\u00e1c mi\u1ec5n l\u00e0 natri m\u00e1u t\u0103ng l\u00ean qu\u00e1 nhanh. C\u00e1c y\u1ebfu t\u1ed1 nguy c\u01a1 d\u1ec5 g\u00e2y xu\u1ea5t hi\u1ec7n h\u1ed9i ch\u1ee9ng n\u00e0y bao g\u1ed3m: r\u1ed1i lo\u1ea1n v\u1ec1 chuy\u1ec3n h\u00f3a, b\u1ec7nh gan, nghi\u1ec7n r\u01b0\u1ee3u l\u00e2u n\u0103m, r\u1ed1i lo\u1ea1n dinh d\u01b0\u1ee1ng, thai k\u1ef3, b\u1ec7nh \u0111ang n\u1eb7ng, v\u00e0 cu\u1ed1i c\u00f9ng l\u00e0 suy tuy\u1ebfn th\u01b0\u1ee3ng th\u1eadn.<\/p>\n

Tri\u1ec7u ch\u1ee9ng ph\u1ed5 bi\u1ebfn nh\u1ea5t c\u1ee7a h\u1ed9i ch\u1ee9ng h\u1ee7y myeline \u0111\u00f3 l\u00e0 thay \u0111\u1ed5i tri gi\u00e1c theo sau \u0111\u00f3 s\u1ebd l\u00e0 c\u00e1c tri\u1ec7u ch\u1ee9ng y\u1ebfu ki\u1ec3u c\u1ee7a c\u00e1c neuron v\u1eadn \u0111\u1ed9ng v\u00f9ng t\u1ea7ng tr\u00ean. Tuy nhi\u00ean, th\u1ef1c t\u1ebf tri\u1ec7u ch\u1ee9ng bi\u1ebfn thi\u00ean r\u1ea5t r\u1ed9ng. Ch\u1ea9n \u0111o\u00e1n s\u1ebd d\u1ef1a v\u00e0o l\u00e2m s\u00e0ng v\u00e0 MRI n\u00e3o, m\u00e0 khi \u0111\u1ecdc phim s\u1ebd th\u1ea5y c\u00e1c sang th\u01b0\u01a1ng xu\u1ea5t hi\u1ec7n \u1edf v\u00f9ng c\u1ea7u n\u00e3o. Vi\u1ec7c \u0111i\u1ec1u tr\u1ecb bi\u1ebfn ch\u1ee9ng n\u00e0y g\u1ed3m: thay huy\u1ebft t\u01b0\u01a1ng, truy\u1ec1n globulin mi\u1ec5n d\u1ecbch, v\u00e0 cu\u1ed1i c\u00f9ng l\u00e0 s\u1eed d\u1ee5ng corticosteroid m\u1eb7c d\u00f9 c\u00e1c b\u1eb1ng ch\u1ee9ng c\u00f2n nhi\u1ec1u h\u1ea1n ch\u1ebf.<\/p>\n

K\u1ebft lu\u1eadn<\/h2>\n

H\u1ea1 natri m\u00e1u l\u00e0 ki\u1ec3u r\u1ed1i lo\u1ea1n \u0111i\u1ec7n gi\u1ea3i r\u1ea5t hay g\u1eb7p t\u1ea1i khoa c\u1ea5p c\u1ee9u. C\u00e1c nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn g\u1ed3m: gi\u1ea3m th\u1ec3 t\u00edch, l\u1ee3i ti\u1ec3u, suy tim, x\u01a1 gan c\u0169ng nh\u01b0 SIAD. Vi\u1ec7c t\u00e1ch b\u1ea1ch h\u1ea1 natri m\u00e1u c\u00f3 hay kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e0 t\u1ed1i c\u1ea7n thi\u1ebft \u0111\u1ec3 b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb ph\u00f9 h\u1ee3p c\u0169ng nh\u01b0 tr\u00e1nh c\u00e1c bi\u1ebfn ch\u1ee9ng cho ng\u01b0\u1eddi b\u1ec7nh.<\/p>\n

Tr\u00ean c\u00e1c b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng, vi\u1ec7c th\u1ef1c hi\u1ec7n b\u00e1m s\u00e1t c\u00e1c b\u01b0\u1edbc ch\u1ea9n \u0111o\u00e1n ban \u0111\u1ea7u n\u00ean \u0111\u01b0\u1ee3c \u01b0u ti\u00ean t\u1ea1i khoa c\u1ea5p c\u1ee9u b\u1edfi v\u00ec \u0111i\u1ec1u tr\u1ecb c\u1ea7n \u0111\u01b0\u1ee3c \u0111i theo sau ch\u1ea9n \u0111o\u00e1n tr\u00ean c\u00e1c ng\u01b0\u1eddi b\u1ec7nh kh\u00f4ng tri\u1ec7u ch\u1ee9ng n\u00e0y.<\/p>\n

B\u1ea3ng 2 \u2013 C\u00e1c th\u00f4ng tin quan tr\u1ecdng cho b\u00e1c s\u0129 c\u1ea5p c\u1ee9u \u0111\u1ec3 ch\u1ea9n \u0111o\u00e1n v\u00e0 \u0111i\u1ec1u tr\u1ecb h\u1ea1 natri m\u00e1u<\/p>\n\n\n\n\n\n\n\n\n\n
Khi n\u00e0o nghi ng\u1edd h\u1ea1 natri m\u00e1u?<\/td>\n\n
    \n
  • B\u1ec7nh nh\u00e2n \u0111ang s\u1eed d\u1ee5ng l\u1ee3i ti\u1ec3u, \u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u00f3m thiazide v\u00e0 nh\u00f3m \u0111\u1ed1i kh\u00e1ng aldosterone<\/li>\n
  • Ti\u1ec1n c\u0103n suy tim ho\u1eb7c x\u01a1 gan<\/li>\n
  • Ti\u1ec1n c\u0103n b\u1ec7nh \u00e1c t\u00ednh<\/li>\n
  • C\u00e1c b\u1ec7nh l\u00fd ph\u1ed5i<\/li>\n
  • C\u00e1c t\u00ecnh tr\u1ea1ng v\u1ec1 t\u00e2m th\u1ea7n kinh<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Tri\u1ec7u ch\u1ee9ng c\u1ee7a h\u1ea1 natri m\u00e1u l\u00e0 g\u00ec?<\/td>\n\n
    \n
  • T\u00e9 ng\u00e3<\/li>\n
  • Y\u1ebfu<\/li>\n
  • Ch\u00f3ng m\u1eb7t<\/li>\n
  • Co gi\u1eadt<\/li>\n
  • Suy nh\u1eadn th\u1ee9c (vd d\u1ee5 r\u1ed1i lo\u1ea1n \u0111\u1ecbnh h\u01b0\u1edbng)<\/li>\n
  • N\u00f4n, \u00f3i<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
X\u00e9t nghi\u1ec7m ch\u1ea9n \u0111o\u00e1n n\u00e0o n\u00ean \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n \u0111\u1ea7u ti\u00ean t\u1ea1i khoa c\u1ea5p c\u1ee9u?<\/td>\n\n
    \n
  • M\u00e1u: \u00e1p l\u1ef1c th\u1ea9m th\u1ea5u, \u0111\u01b0\u1eddng huy\u1ebft, kali, Creatinin, Ure, TSH<\/li>\n
  • N\u01b0\u1edbc ti\u1ec3u: natri, \u0111\u1ed9 th\u1ea9m th\u1ea5u<\/li>\n
  • Xem l\u1ea1i thu\u1ed1c b\u1ec7nh nh\u00e2n \u0111ang u\u1ed1ng, ch\u00fa \u00fd \u0111\u1eb7c bi\u1ec7t \u0111\u1ebfn l\u1ee3i ti\u1ec3u v\u00e0 c\u00e1c thu\u1ed1c h\u01b0\u1edbng th\u1ea7n<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Khi n\u00e0o c\u1ea7n \u0111i\u1ec1u tr\u1ecb kh\u1ea9n c\u1ea5p?<\/td>\n\n
    \n
  • B\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng m\u1ee9c \u0111\u1ed9 t\u1eeb trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng do h\u1ea1 natri m\u00e1u g\u00e2y ra\n
      \n
    • 150 ml NaCl 3% truy\u1ec1n kho\u1ea3ng 20 ph\u00fat<\/li>\n
    • \u0110o l\u1ea1i natri m\u00e1u sau 20 ph\u00fat<\/li>\n
    • L\u1eb7p l\u1ea1i NaCl 3% n\u1ebfu b\u1ec7nh nh\u00e2n v\u1eabn c\u00f2n tri\u1ec7u ch\u1ee9ng V\u00c0 Natri m\u00e1u t\u0103ng d\u01b0\u1edbi <5 mmol\/L<\/li>\n<\/ul>\n<\/li>\n
    • B\u1ec7nh nh\u00e2n v\u1edbi h\u1ea1 natri m\u00e1u c\u1ea5p (\u0111\u01b0\u1ee3c ghi nh\u1eadn b\u1eb1ng x\u00e9t nghi\u1ec7m l\u1ea7n tr\u01b0\u1edbc) v\u1edbi m\u1ee9c h\u1ea1 tr\u00ean >10 mmol\/L\n
        \n
      • 150 ml NaCl 3% truy\u1ec1n kho\u1ea3ng 20 ph\u00fat<\/li>\n
      • \u0110o l\u1ea1i natri m\u00e1u sau 20 ph\u00fat<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
C\u00e1c \u0111i\u1ec1u tr\u1ecb b\u1ed5 tr\u1ee3 kh\u00e1c l\u00e0 g\u00ec?<\/td>\n\n
    \n
  • T\u1ea1m ng\u01b0ng c\u00e1c thu\u1ed1c c\u00f3 th\u1ec3 th\u00fac \u0111\u1ea9y h\u1ea1 natri m\u00e1u (vd nh\u01b0 l\u1ee3i ti\u1ec3u)<\/li>\n
  • B\u1eaft \u0111\u1ea7u b\u00f9 d\u1ecbch t\u0129nh m\u1ea1ch tr\u00ean c\u00e1c case thi\u1ebfu d\u1ecbch<\/li>\n
  • \u0110o Natri m\u00e1u th\u01b0\u1eddng xuy\u00ean<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
C\u00e1c g\u1ee3i \u00fd, m\u1eb9o quan tr\u1ecdng?<\/td>\n\n
    \n
  • Lo\u1ea1i nguy\u00ean nh\u00e2n h\u1ea1 natri m\u00e1u do t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft: [Na+] gi\u1ea3m 1.6 mmol\/L cho m\u1ed5i b\u01b0\u1edbc t\u0103ng \u0111\u01b0\u1eddng 100 mg\/dL.<\/li>\n
  • Lo\u1ea1i h\u1ea1 natri m\u00e1u gi\u1ea3i b\u1eb1ng c\u00e1ch d\u00f9ng thi\u1ebft b\u1ecb x\u00e9t nghi\u1ec7m ph\u00f9 h\u1ee3p<\/li>\n
  • C\u1ea9n th\u1eadn khi truy\u1ec1n d\u1ecbch nhi\u1ec1u n\u1ebfu b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 thi\u1ebfu d\u1ecbch \u0111\u1ec3 tr\u00e1nh t\u00ecnh tr\u1ea1ng natri s\u1ebd h\u1ea1 th\u1ea5p h\u01a1n n\u1eefa c\u00f3 th\u1ec3 g\u1eb7p trong h\u1ed9i ch\u1ee9ng
    \nSIAD(H)<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Ti\u00eau chu\u1ea9n nh\u1eadp hay xu\u1ea5t vi\u1ec7n<\/td>\n\n
    \n
  • H\u1ea1 Natri m\u00e1u n\u1eb7ng v\u00e0\/ho\u1eb7c c\u00f3 tri\u1ec7u ch\u1ee9ng: nh\u1eadp vi\u1ec7n<\/li>\n
  • B\u1ec7nh nh\u00e2n kh\u00f4ng tri\u1ec7u ch\u1ee9ng k\u00e8m h\u1ea1 natri m\u00e1u m\u1ee9c \u0111\u1ed9 nh\u1eb9 v\u00e0 \u1ed5n \u0111\u1ecbnh c\u00f3 th\u1ec3 \u0111i\u1ec1u tr\u1ecb ngo\u1ea1i tr\u00fa v\u00e0 h\u1eb9n t\u00e1i kh\u00e1m.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n","protected":false},"excerpt":{"rendered":"

    vnras.com\/drug – \u0110\u1ec3 t\u1ea3i file PDF c\u1ee7a b\u00e0i vi\u1ebft Ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb h\u1ea1 Natri m\u00e1u t\u1ea1i khoa c\u1ea5p c\u1ee9u,\u00a0xin vui l\u00f2ng click v\u00e0o link \u1edf \u0111\u00e2y. Abstract \u2013 h\u1ea1 natri m\u00e1u \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a khi natri huy\u1ebft t\u01b0\u01a1ng <135 mmol\/L, l\u00e0 t\u00ecnh tr\u1ea1ng r\u1ea5t hay th\u01b0\u1eddng g\u1eb7p t\u1ea1i khoa c\u1ea5p c\u1ee9u. Tri\u1ec7u ch\u1ee9ng th\u01b0\u1eddng […]\n","protected":false},"author":1,"featured_media":33882,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-33878","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-y-te-suc-khoe"],"acf":[],"_links":{"self":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/33878","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/comments?post=33878"}],"version-history":[{"count":0,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/posts\/33878\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media\/33882"}],"wp:attachment":[{"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/media?parent=33878"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/categories?post=33878"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/vnras.com\/drug\/wp-json\/wp\/v2\/tags?post=33878"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}