偽性低ナトリウム血症
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出典(authority):フリー百科事典『ウィキペディア(Wikipedia)』「2018/01/17 21:23:03」(JST)
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Isotonic hyponatremia |
Classification and external resources |
ICD-10 |
Xxx.x |
ICD-9-CM |
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Isotonic hyponatremia is a form of hyponatremia with mOsm measured between 280 and 295. It can be associated with pseudohyponatremia, or with isotonic infusion of glucose or mannitol.[1]
Pseudohyponatremia
Certain conditions, such as extraordinarily high blood levels of lipid (hyperlipidemia/hypertriglyceridemia) or protein (hyperparaproteinemia), magnify the electrolyte exclusion effect. This interferes with the measurement of serum sodium concentration by certain methods, leading to an erroneously low measurement of sodium, or pseudohyponatremia. The methods affected are the flame-photometric and indirect (but not direct) ion-selective electrode assays.[2][3] This is distinct from a true dilutional hyponatremia that can be caused by an osmotic shift of water from cells to the bloodstream after large infusions of mannitol or intravenous immunoglobulin.
It is associated with hyperlipidemia more frequently than with elevated protein.[4]
References
- ^ Gottschlich MM, Matarese LE (2003). Contemporary nutrition support practice: a clinical guide. Philadelphia: Saunders. p. 130. ISBN 0-7216-9357-1.
- ^ Weisberg LS (Mar 1989). "Pseudohyponatremia: a reappraisal". The American Journal of Medicine. 86 (3): 315–8. doi:10.1016/0002-9343(89)90302-1. PMID 2645773.
- ^ Nguyen MK, Ornekian V, Butch AW, Kurtz I (May 2007). "A new method for determining plasma water content: application in pseudohyponatremia". American Journal of Physiology. Renal Physiology. 292 (5): F1652–6. doi:10.1152/ajprenal.00493.2006. PMID 17299138.
- ^ Garibaldi BT, Cameron SJ, Choi M (Feb 2008). "Pseudohyponatremia in a patient with HIV and hepatitis C coinfection". Journal of General Internal Medicine. 23 (2): 202–5. doi:10.1007/s11606-007-0446-3. PMC 2359164 . PMID 17994269.
Electrolyte imbalance and acid–base imbalance (E86–E87, 276)
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Volume status |
- Volume contraction (dehydration/hypovolemia)
- Hypervolemia
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Electrolyte |
Sodium |
- High
- Hypernatremia
- Salt poisoning
- Low
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Potassium |
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Chloride |
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Calcium |
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Acid–base |
Acidosis |
- Metabolic: High anion gap
- Ketoacidosis
- Diabetic ketoacidosis
- Lactic
- Normal anion gap
- Hyperchloremic
- Renal tubular
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Alkalosis |
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Both |
- Mixed disorder of acid-base balance
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UpToDate Contents
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English Journal
- [Direct and indirect ion selective electrodes methods: the differences specified through a case of Waldenström's macroglobulinemia].
- Zelmat MS1.
- Annales de biologie clinique.Ann Biol Clin (Paris).2015 May-Jun;73(3):345-52. doi: 10.1684/abc.2015.1046.
- Direct and indirect ion selective electrodes (ISEs) are two methods commonly used in biochemistry laboratories in order to measure the electrolytes such as sodium. In the clinical practice, it's the sodium concentration in plasma water -measured by direct ISE- which is important to consider as it is
- PMID 26069070
- Extreme hypercholesterolemia presenting with pseudohyponatremia - a case report and review of the literature.
- Hussain I1, Ahmad Z1, Garg A2.
- Journal of clinical lipidology.J Clin Lipidol.2015 Mar-Apr;9(2):260-4. doi: 10.1016/j.jacl.2014.11.007. Epub 2014 Nov 28.
- Pseudohyponatremia has been reported in association with severe hypertriglyceridemia and hyperparaproteinemia, but its association with severe hypercholesterolemia is not well-known. We report a 43-year-old woman with refractory primary biliary cirrhosis who presented with asymptomatic hyponatremia
- PMID 25911084
- Pseudohypernatremia and pseudohyponatremia: a linear correction.
- Goldwasser P1, Ayoub I2, Barth RH1.
- Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.Nephrol Dial Transplant.2015 Feb;30(2):252-7. doi: 10.1093/ndt/gfu298. Epub 2014 Sep 14.
- BACKGROUND: Serum sodium is commonly measured by direct potentiometry (DNa), in blood gas panels, or indirect potentiometry (INa), in metabolic panels run on chemistry analyzers. Abnormal values of the serum non-water fraction interfere with INa, with low values causing pseudohypernatremia (INa >
- PMID 25223856
Japanese Journal
- True hyponatremia secondary to intravenous immunoglobulin
- NGUYEN Minhtri K.,RASTOGI Anjay,KURTZ Ira
- Clinical and experimental nephrology 10(2), 124-126, 2006-06-01
- NAID 10017612892
- Severe Hypercholesterolemia Associated with Decreased Hepatic Triglyceride Lipase Activity and Pseudohyponatremia in Patients after Allogeneic Stem Cell Transplantation
- INAMOTO Yoshihiro,TERAMOTO Tamio,SHIRAI Koji,TSUKAMOTO Hideko,SANDA Takaomi,MIYAMURA Koichi,YAMAMORI Ikuo,HIRABAYASHI Noriyuki,KODERA Yoshihisa
- International journal of hematology 82(4), 362-366, 2005-11-15
- NAID 10016879097
- Intravenous immunoglobulin causing pseudohyponatremia
Related Links
- pseudohyponatremia pseu·do·hy·po·na·tre·mi·a (sōō'dō-hī'pō-nə-trē'mē-ə) n. A low serum sodium concentration resulting from volume displacement by massive hyperlipidemia or hyperproteinemia, or by hyperglycemia.
- pseudohyponatremia [soo″do-hi″po-nah-tre´me-ah] a decreased serum sodium concentration that does not correspond to a real hypotonic disorder, i.e., the serum osmolality is normal. It occurs when hyperlipemia increases the serum ...
Related Pictures
★リンクテーブル★
[★]
- 英
- pseudohyponatremia
- 同
- 偽性低Na血症
- 関
- 低ナトリウム血症、等張性偽性低Na血症
メカニズム
- 1. (高脂血症、高蛋白血症)血漿は正常では容積の93%が水。極端な血漿の脂質や蛋白の上昇は血漿成分の非液相部分を増加させる。このような状況では、計測されたナトリウム濃度は実際の液相部分のなおtりうむのウドより有意に低いものになる(ICU.524)
- 2. (高血糖)上昇したブドウ糖の浸透圧作用により細胞内から細胞外へ水が移動し、血清ナトリウム値は低下する。 → 高張性低Na血症として別に分類している資料もある(SPE.200)