Therapeutische Interventionen bei Dysnatriämie hängen vom akuten und chronischen,
asymptomatischen und symptomatischen Zustand sowie vom extrazellulären Volumenstatus
der Patienten ab. Pathophysiologisch orientierte Ansätze helfen sowohl Ärzten als
auch Patienten. Das therapeutische Arsenal für Hyponatriämie und Hypernatriämie ist
vielfältig. In folgendem Beitrag werden die grundlegenden Konzepte der Behandlung
bei Dysnatriämie besprochen.
Abstract
Osmotic gradients over cell membranes lead to water movement into or out of cells.
An intact osmoregulation prevents osmotic gradients, thereby protecting cells from
swelling or shrinking. Na+ is the major cation in the extracellular fluid (ECF) and the major determinant of
the osmolarity in the ECF, including plasma. Therefore, the plasma-Na+ concentration needs to be tightly regulated. An excess of electrolyte-free water
decreases the concentration of osmolytes leading to hyponatremia. In contrast, a free
water deficit increases the osmolyte concentration leading to hypernatremia. Pathophysiology-oriented
approaches to dysnatremic patients help both clinicians and patients. Therapeutic
interventions depend on the differentiation between acute and chronic, asymptomatic,
and symptomatic dysnatremia, and on the patient’s extracellular volume status. The
therapeutic armamentarium for hyponatremia consists of water restriction, hypertonic
infusions, urea, V2 receptor-blockers, and sodium-glucose cotransporter 2 (SGLT2)
inhibitors. Patients with hypernatremia are treated with electrolyte-free water or
hypotonic sodium-containing solutions depending on their volume status. Basic concepts
in the management of dysnatremic patients are discussed.
Schlüsselwörter
Dysnatriämie - Hyponatriämie - Hypernatriämie - Osmolarität - klinisches Management
Keywords
dysnatremia - hyponatremia - hypernatremia - osmolarity - clinical management
