{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T23:37:55Z","timestamp":1788305875262,"version":"build-2803163510"},"reference-count":44,"publisher":"Akademiai Kiado Zrt.","issue":"29","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2008,7,1]]},"abstract":"<jats:p>A tanulm\u00e1ny klinikusok sz\u00e1m\u00e1ra foglalja \u00f6ssze a hyponatraemi\u00e1k k\u00f3roktan\u00e1t, diagnosztik\u00e1j\u00e1t \u00e9s kezel\u00e9s\u00e9t. A hyponatraemia a leggyakoribb elektrolit-rendelleness\u00e9g. Az enyhe \u00e9s m\u00e9rs\u00e9kelt fok\u00fa hyponatraemia a hospitaliz\u00e1lt betegek 15\u201330%-\u00e1ban, s\u00falyosabb form\u00e1ja azok 1\u20134%-\u00e1ban fordul el\u0151. Patofiziol\u00f3giai szempontb\u00f3l a hyponatraemi\u00e1k k\u00e9t f\u0151 csoportja k\u00fcl\u00f6nb\u00f6ztethet\u0151 meg: nem ozmotikus eredet\u0171 hypervasopressinaemi\u00e1s hyponatraemi\u00e1k (hypovolaemi\u00e1s, hypervolaemi\u00e1s, euvolaemi\u00e1s) \u00e9s nem hypervasopressinaemi\u00e1s hyponatraemi\u00e1k (pseudohyponatraemia, v\u00edzm\u00e9rgez\u00e9s, cerebr\u00e1lis s\u00f3veszt\u0151 szindr\u00f3ma). Az enyhe hyponatraemi\u00e1s betegek sokszor t\u00fcnetmentesek. A s\u00falyos hyponatraemia az \u00e9letet vesz\u00e9lyeztet\u0151 k\u00f6zponti idegrendszeri t\u00fcneteket okozhat. A hyponatraemi\u00e1s \u00e1llapotok k\u00f3rism\u00e9z\u00e9se sor\u00e1n figyelemmel vagyunk az extracellul\u00e1ris folyad\u00e9k t\u00e9rfogat\u00e1ra, a klinikai t\u00fcnetekre, a hyponatraemia s\u00falyoss\u00e1g\u00e1ra, kifejl\u0151d\u00e9s\u00e9nek sebess\u00e9g\u00e9re \u00e9s tartam\u00e1ra. A hyponatraemia okainak felder\u00edt\u00e9sekor az els\u0151 feladat a nem hypervasopressinaemi\u00e1s hyponatraemi\u00e1k \u00e9s a hypervasopressinaemi\u00e1s hyponatraemi\u00e1k elk\u00fcl\u00f6n\u00edt\u00e9se a plazma ozmolalit\u00e1s\u00e1nak, a v\u00e9rcukornak, a sz\u00e9rumlipidek \u00e9s -feh\u00e9rj\u00e9k szintj\u00e9nek m\u00e9r\u00e9s\u00e9vel. A tov\u00e1bbi differenci\u00e1ldiagnosztikus t\u00e9nyked\u00e9st a vizelet ozmolalit\u00e1s\u00e1nak, az extracellul\u00e1ris folyad\u00e9k t\u00e9rfogat\u00e1nak \u00e9s a vizelet n\u00e1triumkoncentr\u00e1ci\u00f3j\u00e1nak meghat\u00e1roz\u00e1sa seg\u00edti. Az euvolaemi\u00e1s hyponatraemi\u00e1k legfontosabb megjelen\u00e9si form\u00e1ja a SIADH. A SIADH diagn\u00f3zis\u00e1t az egy\u00e9b k\u00f3rism\u00e9k kiz\u00e1r\u00e1sa biztos\u00edtja; itt kulcsadat, hogy a cs\u00f6kkent plazmaozmolalit\u00e1shoz (&lt;275 mosmol\/ttkg) viszony\u00edtva a vizelet ozmolalit\u00e1sa (&gt;100 mosmol\/ttkg) ar\u00e1nytalanul nagy. Az akut (&lt;48 \u00f3ra), s\u00falyos hyponatraemia (&lt;120 mmol\/l) intenz\u00edv ter\u00e1pi\u00e1t ig\u00e9nyel a norm\u00e1lis ozmotikus viszonyok gyors helyre\u00e1ll\u00edt\u00e1s\u00e1val. (A sz\u00e9rum n\u00e1triumemelked\u00e9s\u00e9nek sebess\u00e9ge \u00f3r\u00e1nk\u00e9nt 1 mmol\/l.) A kr\u00f3nikus (&gt;48 \u00f3ra), szimpt\u00f3m\u00e1s hyponatraemia kezel\u00e9se sor\u00e1n a sz\u00e9rum n\u00e1triumszintj\u00e9nek gyors emelked\u00e9se demyelinisati\u00f3s szindr\u00f3m\u00e1t okozhat. (A sz\u00e9rum n\u00e1triumemelked\u00e9s\u00e9nek sebess\u00e9ge ne haladja meg az \u00f3r\u00e1nk\u00e9nti 0,5 mmol\/l-t!) A kr\u00f3nikus aszimpt\u00f3m\u00e1s hyponatraemia (a hypovolaemia kiv\u00e9tel\u00e9vel) kezel\u00e9s\u00e9ben a hagyom\u00e1nyos elj\u00e1r\u00e1sokat (folyad\u00e9kbevitel-korl\u00e1toz\u00e1s, demeclocyclin, l\u00edtium, urea, furosemid + s\u00f3bevitel) a k\u00f6zeli j\u00f6v\u0151ben a vazopresszinreceptor-antagonist\u00e1k alkalmaz\u00e1sa v\u00e1lthatja fel. A 2-es t\u00edpus\u00fa vazopresszinreceptor-antagonista lixivaptan, tolvaptan \u00e9s satavaptan, tov\u00e1bb\u00e1 az 1A+2 t\u00edpus\u00fa vazopresszinreceptor-antagonista conivaptan elektrolitveszt\u00e9s n\u00e9lk\u00fcl n\u00f6veli a vese v\u00edzkiv\u00e1laszt\u00e1s\u00e1t \u00e9s emeli a sz\u00e9rum n\u00e1triumszintj\u00e9t.<\/jats:p>","DOI":"10.1556\/oh.2008.28409","type":"journal-article","created":{"date-parts":[[2008,7,10]],"date-time":"2008-07-10T12:48:46Z","timestamp":1215694126000},"page":"1347-1354","source":"Crossref","is-referenced-by-count":28,"title":["Etiology, diagnostics and therapy of hyponatremias"],"prefix":"10.1556","volume":"149","author":[{"given":"Ferenc","family":"Laczi","sequence":"first","affiliation":[{"name":"1 Szegedi Tudom\u00e1nyegyetem, Szent-Gy\u00f6rgyi Albert Klinikai K\u00f6zpont I. 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