IHyponatremia yenzeka lapho umzimba uqukethe isodium encane kakhulu kunenani loketshezi oluqukethe. Izimbangela ezivamile zifaka ukusetshenziswa kwe-diuretics, isifo sohudo, ukwehluleka kwenhliziyo, ne-SIADH. Ukubonakaliswa komtholampilo ngokuyinhloko kungokwemizwa, kulandela ukudluliswa kwamanzi nge-osmotic kumangqamuzana obuchopho, ikakhulukazi ku-acute hyponatremia, futhi kufaka phakathi ikhanda elibuhlungu, ukudideka, nokuquleka. Ukuquleka kanye nekhoma kungenzeka. Ukuphathwa kuncike ezimpawu nasezimpawu zomtholampilo, ikakhulukazi ukuhlolwa kwevolumu yangaphandle, kanye nezifo ezingaphansi. Ukwelashwa kusekelwe ekunciphiseni ukuphuza uketshezi, ukwandisa ukuphuma koketshezi, ukwenezela ukuntuleka kwe-sodium, nokwelapha isifo esiwumsuka.

I-Hyponatremia yisifo se-electrolyte esibonakala ngamanzi amaningi omzimba ahlobene ne-sodium yomzimba wonke. Sikhuluma nge-hyponatremia lapho izinga le-sodium lingaphansi kwe-136 mmol / l. Iningi le-hyponatremia lingaphezulu kuka-125 mmol / L futhi alibonakali. I-hyponatremia enzima kuphela, okusho ukuthi ngaphansi kwe-125 mmol / l, noma i-symptomatic, iyisimo esiphuthumayo sokuxilonga nesezokwelapha.

Izigameko ze-hyponatremia zifaka:

• cishe amacala ayi-1,5 ezigulini eziyi-100 ngosuku esibhedlela;
• i-10 kuya ku-25% emsebenzini we-geriatric;
• I-4 kuya ku-5% ezigulini ezivunyelwe eminyangweni ephuthumayo, kodwa le mvamisa ingakhuphukela ku-30% ezigulini ezine-cirrhosis;
• cishe i-4% ezigulini ezinesifo se-tumor noma i-hypothyroidism;
• Izikhathi ezi-6 ezinkulu ezigulini esezikhulile ekwelashweni kwe-antidepressant, njenge-serotonin reuptake inhibitors ekhethiwe (SSRIs);
• ngaphezu kwama-50% ezigulini ezilaliswe esibhedlela ezinengculazi.
  

I-Hyponatremia ingavela ngenxa yalokhu:

• ukulahlekelwa kwe-sodium okukhulu kunokulahlekelwa kwamanzi, ngokuncipha kwevolumu yoketshezi lomzimba (noma ivolumu engaphandle kwamangqamuzana);
• ukugcinwa kwamanzi ngokulahleka kwe-sodium, ehambisana nomthamo ogciniwe we-extracellular;
• ukugcinwa kwamanzi okukhulu kunokugcinwa kwe-sodium, okuholela ekwandeni kwevolumu ye-extracellular.

Kuzo zonke izimo, i-sodium iyahlanjululwa. Ukuhlanza isikhathi eside noma isifo sohudo esibi kakhulu kungaholela ekulahlekelweni kwe-sodium. Lapho ukulahlekelwa ketshezi kunxeshezelwa ngamanzi kuphela, i-sodium iyahlanjululwa.

Ukulahleka kwamanzi kanye ne-sodium kuvame ukuvela ezinso, lapho amandla okuphindaphinda kwe-renal tubule encishiswa, kulandela ukuphathwa kwe-thiazide diuretics. Le mithi inyusa ukuphuma kwe-sodium, okwandisa ukuphuma kwamanzi. Lezi ngokuvamile zibekezelelwa kahle kodwa zingabangela i-hyponatremia kubantu abathambekele ekubeni ne-sodium ephansi, ikakhulukazi asebekhulile. Ukulahlekelwa kokugaya noma kwesikhumba kuvame ukuvela.

Ukugcinwa koketshezi kuwumphumela wokwenyuka okungafanele kokukhiqizwa kwehomoni ye-antidiuretic (ADH), ebizwa nangokuthi i-vasopressin. Kulokhu, sikhuluma nge-SIADH noma i-syndrome yemfihlo engafanele ye-ADH. I-Vasopressin isiza ukulawula inani lamanzi akhona emzimbeni ngokulawula inani lamanzi akhishwa yizinso. Ukukhishwa ngokweqile kwe-vasopressin kuholela ekwehlisweni kokukhishwa kwamanzi yizinso, okuholela ekugcineni okukhulu kwamanzi emzimbeni futhi kunciphise i-sodium. Ukukhiqizwa kwe-vasopressin nge-pituitary gland kungagqugquzelwa:

• ubuhlungu;
• ukucindezeleka;
• umsebenzi womzimba;
• i-hypoglycemia;
• ukuphazamiseka okuthile kwenhliziyo, i-thyroid, izinso noma i-adrenals. 

I-SIADH ingase ibangelwe ukuphuza izidakamizwa noma izinto ezikhuthaza ukukhiqizwa kwe-vasopressin noma ezishukumisa isenzo sayo ezinso ezifana nalezi:

• i-chlorpropamide: umuthi owehlisa ushukela wegazi;
• i-carbamazepine: i-anticonvulsant;
• i-vincristine: umuthi osetshenziswa ekwelapheni ngamakhemikhali;
• clofibrate: umuthi owehlisa amazinga e-cholesterol;
• antipsychotics kanye antidepressants;
• i-aspirin, ibuprofen;
• i-ecstasy (3,4-methylenedioxy-methamphetamine [MDMA]);
• i-vasopressin (i-synthetic antidiuretic hormone) ne-oxytocin esetshenziselwa ukudala ukubeletha ngesikhathi sokubeletha.

I-SIADH nayo ingavela ekusetshenzisweni ngokweqile koketshezi okungaphezu kwamandla omthethonqubo wezinso noma ezimweni ze:

• potomanie;
• i-polydipsie;
• Isifo sika-Addison;
• i-hypothyroidism. 

Okokugcina, kungase kube umphumela wokuncipha kwevolumu ejikelezayo ngenxa yalokhu:

• ukwehluleka kwenhliziyo;
• ukwehluleka kwezinso;
• ukuqina kwesibindi;
• i-nephrotic syndrome.

Ukugcinwa kwe-sodium kungumphumela wokwanda kwe-aldosterone secretion, kulandela ukwehla kwevolumu yokujikeleza.

Iningi leziguli ezine-natremia, okusho ukugxila kwe-sodium okungaphezu kwe-125 mmol / l, azinazimpawu. Phakathi kuka-125 no-130 mmol / l, izimpawu ikakhulukazi zesisu: isicanucanu nokuhlanza.

Ubuchopho buzwela kakhulu ekushintsheni ezingeni le-sodium egazini. Futhi, kumanani angaphansi kwe-120 mmol / l, izimpawu ze-neuropsychiatric zivela njenge:

• ikhanda;
• ukukhathala;
• isimo esididekile;
• ukuqunjelwa;
• ukusikwa kwemisipha nokudlikizela;
• isithuthwane;
• ukukhoma.

Ziwumphumela we-cerebral edema, okubangela ukungasebenzi, futhi ukuqala kwayo kuncike ebukhulu nesivinini sokuqala kwe-hyponatremia.

Izimpawu kungenzeka zibe zimbi kakhulu kubantu asebekhulile abanezimo ezingamahlalakhona.

I-Hyponatremia ingasongela impilo. Izinga, ubude besikhathi kanye nezimpawu ze-hyponatremia kusetshenziselwa ukunquma ukuthi kuzodingeka masinyane kangakanani ukulungisa i-serum yegazi. I-hyponatremia enezimpawu idinga ukulaliswa esibhedlela kuzo zonke izimo.

Lapho kungekho zimpawu, i-hyponatremia ivame ukulungiswa okungalapheki futhi ngokushesha akubalulekile ngaso sonke isikhathi. Kodwa-ke, kunconywa ukulaliswa esibhedlela uma izinga le-serum sodium lingaphansi kuka-125 mmol / l. Nge-hyponatremia engabonakali noma ngaphezulu kwe-125 mmol / l, abaphathi bangahlala be-ambulensi. Udokotela ube esehlola ukuthi kudingekile yini ukulungisa i-hyponatremia futhi aqinisekise ukuthi ayibi kakhulu. Ukulungisa imbangela ye-hyponatremia ngokuvamile kwanele ukuyilungisa. Ngempela, ukumisa umuthi owonayo, ukwenza ngcono ukwelashwa kokuhluleka kwenhliziyo noma i-cirrhosis, noma ngisho nokwelashwa kwe-hypothyroidism kuvame ngokwanele.

Lapho kuboniswa ukulungiswa kwe-hyponatremia, kuya ngevolumu ye-extracellular. Uma ethi:

• evamile: ukuvinjelwa kokungena kwamanzi, ngaphansi kwelitha elilodwa ngosuku, kunconywa, ikakhulukazi esimweni se-SIADH, futhi ukwelashwa okuqondiswe ngokumelene nembangela (hypothyroidism, insufficiency adrenal, ukuthatha i-diuretics) isetshenziswa;
• kukhuphukile: i-diuretics noma i-vasopressin antagonist, efana ne-desmopressin, ehlotshaniswa nokuvinjelwa kokungeniswa kwamanzi, bese kuba ukwelashwa okuyinhloko, ikakhulukazi ezimweni zokwehluleka kwenhliziyo noma i-cirrhosis;
• kwehlile, kulandela ukulahleka kokugaya ukudla noma kwezinso: kukhonjisiwe ukungena kwe-sodium okuhambisana nokubuyiselwa emzimbeni. 

Abanye abantu, ikakhulukazi labo abane-SIADH, badinga ukwelashwa isikhathi eside kwe-hyponatremia. Ukuvinjelwa kuketshezi kukodwa akwanele ukuvimbela ukuphindeka kwe-hyponatremia. Amaphilisi e-sodium chloride angasetshenziswa kubantu abane-hyponatremia engapheli emaphakathi noma elinganiselayo. 

I-hyponatremia enzima iyisimo esiphuthumayo. Ukwelashwa wukwenyusa kancane kancane izinga le-sodium egazini kusetshenziswa uketshezi olufakwa emithanjeni futhi kwesinye isikhathi okokukhipha isisu. Ngezinye izikhathi kudingeka ama-vasopressin receptor inhibitors akhethiwe, njenge-coniaptan noma i-tolvaptan.