H2O

&

.

+ =+e + K+e

H2O

Na+e + K+e : + +

+ = ( +e + Ke+ ) / H2O

+ ( +) > 2

( )

H2O

2 ( Na+)

H2O

H2O

( )

o o

. Posm ( )

. Posm

Na+

Posm H2O

+

Na+

Na+ :

400mg/dl: 100 mg/dl Na+ 2.4 mEq/L

Katz MA. Hyperglycemia-induced hyponatremia--calculation of expected serum sodium depression. N Engl J Med 1973;289:843-844.Hillier TA et al. Hyponatremia: evaluating the correction factor for hyperglycemia. Am J Med 1999;106:399-403.

+ TOY

Posm

H2O +

2 > + + + +

2

ADH ( )

( /)

: :

H2O

H2O

ADH +

+

+

( , )

ADH

H2O

H2O

ADH

ADH

H2O Na+

+

+ 2

ADH

:

: ,, ,

ADH

(+ TE)

: , ,

Liberopoulos EN et al. SIADH and Hyponatremia with Theophylline.Annals of Pharmacotherapy 2002;36: 1180-2

H2O

:

(())

PosmPosm

:: (( : : , , & & ) )

::

(())

UosmUosm ..

UosmUosm< 100 < 100 mosmolmosmol//kgkg ((.. < 1003):< 1003):

UosmUosm > 100 > 100 mosmolmosmol//kgkg::

(())

aa+ + oo ((UNaUNa+))

UNaUNa++< 20 < 20 meqmeq//LL::

((VV))

UNaUNa++ >> 40 40 meqmeq//LL: : SIADHSIADH

: : NaNa++ ::

, , , , & &

+ (25/1)

(>5mg/dl)

Na+

&

ADH

( FE > 55%)

( 12%)

PO43-

SIADHSIADH

(>(> 100 100

mosmolmosmol //kgkg))

(>(> 40 40 mmolmmol //LL)) , ,

+

(MRI)

-, , ,

(1)

9 :Na+ =114mEq/L- 40L

1 lt NaCl (154 meq +): + 1mEq/L

9 : ADH +

(2)

9 +

+ +

SIADH

(.. )

H2O NaCl

SIADH

H2O

2

:

+

ADH H2O

H2O

+ = (+e + +e ) / H2O

:

+ ()

H2O > + + + =

Na+

2

H2O :

(, , )

Elisaf M et al. Survival after severe iatrogenic hypernatremia Am J Kidney Dis 1989;14:230-1

( / ) : ,

: , ,

(30%)

(,shock, Sheehan)

:/(/)

: , , , , Wegener

: Li,

(Ca++>11mg/dl)

(+

NaCl 0.9% + KCl

( )

Uosm

>800mosmol/kg +

(>1023) H2O

Na+

-

()

H2O:

TBW* Na+

140

TBW= 0.5 & 0.4

TBW* = H2O

- 1

H2O a+

: / Na+

( NaCl 0.9%)

()

2 ( , ) () () () (V) ADH SIADH SIADH ()