Evaluation and Management of Hyponatremia in Heart Failure.

IF 3.8 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Current Heart Failure Reports Pub Date : 2024-06-01 Epub Date: 2024-02-27 DOI:10.1007/s11897-024-00651-3
Giulio M Mondellini, Frederik H Verbrugge
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引用次数: 0

Abstract

Purpose of review: To provide a contemporary overview of the pathophysiology, evaluation, and treatment of hyponatremia in heart failure (HF).

Recent findings: Potassium and magnesium losses due to poor nutritional intake and treatment with diuretics cause an intracellular sodium shift in HF that may contribute to hyponatremia. Impaired renal blood flow leading to a lower glomerular filtration rate and increased proximal tubular reabsorption lead to an impaired tubular flux through diluting distal segments of the nephron, compromising electrolyte-free water excretion. Hyponatremia in HF is typically a condition of impaired water excretion by the kidneys on a background of potassium and magnesium depletion. While those cations can and should be easily repleted, further treatment should mainly focus on improving the underlying HF and hemodynamics, while addressing congestion. For decongestive treatment, proximally acting diuretics such as sodium-glucose co-transporter-2 inhibitors, acetazolamide, and loop diuretics are the preferred options.

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心力衰竭患者低钠血症的评估与管理。
综述的目的:概述心力衰竭(HF)患者低钠血症的病理生理学、评估和治疗:营养摄入不足和利尿剂治疗导致的钾和镁损失会引起心力衰竭患者细胞内钠转移,从而导致低钠血症。肾血流量受损导致肾小球滤过率降低,近端肾小管重吸收增加,从而使肾小管通过稀释远端肾小管的通量受损,影响无电解质水的排泄。高血钾症中的低钠血症通常是在钾和镁耗竭的背景下肾脏排泄水功能受损所致。虽然这些阳离子可以而且应该很容易得到补充,但进一步的治疗应主要侧重于改善潜在的高血压和血液动力学,同时解决充血问题。在消除充血的治疗中,首选近端作用的利尿剂,如钠-葡萄糖共转运体-2 抑制剂、乙酰唑胺和襻利尿剂。
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来源期刊
Current Heart Failure Reports
Current Heart Failure Reports Medicine-Emergency Medicine
CiteScore
5.30
自引率
0.00%
发文量
44
期刊介绍: This journal intends to provide clear, insightful, balanced contributions by international experts that review the most important, recently published clinical findings related to the diagnosis, treatment, management, and prevention of heart failure. We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as investigative, pharmacologic, and nonpharmacologic therapies, pathophysiology, and prevention. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.
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