以口服生理食鹽水治療低血鈉症患者的一例報告

A Simple Way to Treat Hyponatremia with Oral Administration of Intravenously Perfusionable Normal Saline Solution: A Case Report

低血鈉症是門診老年患者較常見的電解質失衡現象。臨床上，低血鈉症易被疏忽；只因其症狀由不自覺、虛弱、虛脫、無力、輕症神智異常、神智錯亂、嗜睡、昏迷、終至猝死，涵蓋範圍很廣，幾乎囊括了老年常見疾病的所有症狀；而且，病程多半緩慢進行，讓人失去警覺。大半低血鈉症患者會經歷憂鬱、意志消沉、情緒低落、鬱鬱寡歡、食慾不振的情境。由於老人多病，家人習以為常，看病之餘會失去積極面對的態度。而且低血鈉常與諸多老年性疾患併存，經常續發於老病的生活常態中，如果不做定期檢查，就錯失診治良機。一旦發現低血鈉症，治療的方法就是補充鈉；可口服食鹽、靜注含鈉針劑、或靜脈點滴含鈉溶液（常見的是生理食鹽水）。但是，迅速的鈉液輸注，有時矯枉過正，引發肺水腫或腦水腫，或會導致死亡。因此，合理有效的給鈉是必須的；可惜臨床上至今仍未建立一套給鈉的金標準。筆者在臨床服務中，意外地發現了一項安全的給鈉方法，口服生理食鹽水的簡易療法。由於教科書內找不著類似的治療方法，就翻遍文獻深入探討，終於找到蛛絲馬跡的立論根據：小腸鈉氫離子交換管道（intestine sodium-hydrogen exchanger 3）。因此，借助於本例的陳述，將之提出報告。
案例陳述：84歲女性患者因多重老年性疾病求診。所患疾病包括：動脈硬化性心血管疾病、多關節退化性病變、骨質疏鬆與T12胸椎塌陷、腎萎縮併慢性腎病變（CKD-3b；eGFR為34 ml/min/1.73M2）及右腎囊腫。在低鹽的食療下，因胃口不佳而食慾不振，導致全身乏力，抽測血鈉值而發現低血鈉。多次以生理食鹽水靜脈點滴輸注，加以改正；由於不耐久躺，加以如廁時漏針，而不願意繼續點滴。看到剩下大半瓶的生理食鹽水溶液，丟棄殊為可惜，就打開瓶蓋，讓她喝下；想不到喝下之後，患者精神大為提振，無力感也消失。於是，在後來的血鈉偏低時，患者均以口服注射用生理食鹽水溶液1,000 ml來處理。既然幾十年前，主治醫師們多讓低血鈉症患者口服鹽包應付低血鈉症，當然口服生理食鹽水代替鹽包就順理成章；何況，後者又可避免血壓驟升的弊害。筆者因此尋找口服注射用生理食鹽水的立論基礎，而提出報告。

Hyponatremia is a prevalent electrolyte disturbance frequently encountered in elderly patients attending outpatient departments. Clinically, hyponatremia can be overlooked due to the wide of manifestations, which can vary from being asymptomatic to experiencing fatigue, weakness, disorientation, confusion, drowsiness, coma, and even sudden death. These symptoms can present with various age-related health issues and their progression can be slow and inconspicuous. Moreover, patients with hyponatremia may suffer from depression, hopelessness, bad mood or gloominess, leading to severe anorexia and even resulting in being isolated from the family. Also, family members may become impatient about taking care of elderly individuals, and neglect their routine health check-ups. These elderly individuals could thus lose the chance of early diagnosis and early management of hyponatremia.
Sodium supplements are one of the primary approaches to managing hyponatremia, which can be administered orally or through intravenous injection/perfusion. However, rapid administration of sodium, such as hypertonic sodium solution, can lead to over-correction of hyponatremia, leading to pulmonary edema and/or brain edema, which can be fatal. Therefore, an effective and safe approach for delivering the sodium supplement must be established. To the best of our knowledge, such a method has yet to be identified.
This article reports an easy method for sodium supplement, which is effective and safe, and is supported by previous studies of intestineand the sodium-hydrogen exchanger 3. However, more observations and evidence are required to further validate this method.