{"id":28002,"date":"2023-04-24T22:30:53","date_gmt":"2023-04-24T15:30:53","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=28002"},"modified":"2023-04-24T22:30:53","modified_gmt":"2023-04-24T15:30:53","slug":"ha-natri-mau-co-che-theo-nguyen-nhan","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/24\/ha-natri-mau-co-che-theo-nguyen-nhan\/","title":{"rendered":"H\u1ea1 Natri m\u00e1u: c\u01a1 ch\u1ebf theo nguy\u00ean nh\u00e2n"},"content":{"rendered":"

H\u1ea1 natri m\u00e1u (Hyponatremia) g\u00e2y ra do suy y\u1ebfu s\u1ef1 b\u00e0i ti\u1ebft\u00a0 n\u01b0\u1edbc t\u1ea1i th\u1eadn trong khi n\u01b0\u1edbc v\u1eabn ti\u1ebfp t\u1ee5c \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o.\u00a0<\/em>N\u1ebfu h\u1ea1 natri m\u00e1u xu\u1ea5t hi\u1ec7n\u00a0 nhanh, c\u00f3 th\u1ec3 c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng n\u1eb7ng g\u00e2y ra do b\u1edfi ph\u00f9 n\u00e3o<\/a>, nh\u01b0 ng\u1ee7 l\u1ecbm, h\u00f4n m\u00ea,\u00a0 v\u00e0 co gi\u1eadt<\/strong>. N\u1ebfu m\u1ee9c \u0111\u1ed9 t\u01b0\u01a1ng t\u1ef1 c\u1ee7a h\u1ea1 natri xu\u1ea5t hi\u1ec7n t\u1eeb t\u1eeb trong v\u00e0i ng\u00e0y, s\u1ebd kh\u00f4ng\u00a0 c\u00f3 tri\u1ec7u ch\u1ee9ng g\u00ec. M\u1ed9t b\u1ec7nh nh\u00e2n v\u1edbi c\u00e1c tri\u1ec7u ch\u1ee9ng n\u1eb7ng c\u1ee7a h\u1ea1 natri m\u00e1u c\u1ea7n ph\u1ea3i\u00a0 c\u00f3 li\u1ec7u ph\u00e1p kh\u1ea9n c\u1ea5p, trong khi nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng nh\u1eb9 ho\u1eb7c kh\u00f4ng\u00a0 tri\u1ec7u ch\u1ee9ng th\u00ec n\u00ean \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb d\u1ea7n d\u1ea7n.\u00a0\u00a0<\/strong><\/p>\n

\"ha-natri-mau\"<\/h2>\n

1. C\u00e1c nguy\u00ean nh\u00e2n h\u1ea1 Na m\u00e1u\u00a0\u00a0<\/strong><\/h2>\n

\u00a0<\/strong>Trong \u0111a s\u1ed1 c\u00e1c nguy\u00ean nh\u00e2n c\u1ee7a h\u1ea1 natri m\u00e1u, m\u00e1u gi\u1ea3m th\u1ea9m th\u1ea5u ngo\u1ea1i\u00a0 tr\u1eeb hai t\u00ecnh hu\u1ed1ng trong \u0111\u00f3 d\u1ecbch ngo\u1ea1i b\u00e0o kh\u00f4ng gi\u1ea3m th\u1ea9m th\u1ea5u c\u0169ng kh\u00f4ng nh\u01b0\u1ee3c\u00a0 tr\u01b0\u01a1ng \u0111\u01b0\u1ee3c th\u1ea3o lu\u1eadn \u0111\u1ea7u ti\u00ean:<\/p>\n

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  • Gi\u1ea3 h\u1ea1 natri m\u00e1u<\/li>\n
  • H\u1ea1 natri m\u00e1u k\u00e8m \u01b0u tr\u01b0\u01a1ng<\/li>\n<\/ul>\n

    1.1 Gi\u1ea3 h\u1ea1 natri m\u00e1u\u00a0<\/strong><\/p>\n

    Gi\u1ea3 h\u1ea1 Na m\u00e1u l\u00e0 m\u1ed9t t\u00ecnh hu\u1ed1ng r\u1ea5t hi\u1ebfm m\u00e0 trong \u0111\u00f3 n\u1ed3ng \u0111\u1ed9 Na huy\u1ebft thanh\u00a0 th\u1ea5p nh\u01b0ng n\u1ed3ng \u0111\u1ed9 th\u1ea9m th\u1ea5u d\u1ecbch ngo\u1ea1i b\u00e0o th\u1ea5p v\u00e0 tr\u01b0\u01a1ng l\u1ef1c b\u00ecnh th\u01b0\u1eddng<\/em>. N\u1ed3ng\u00a0 \u0111\u1ed9 th\u1ea5p c\u1ee7a Na l\u00e0 gi\u1ea3 <\/em>do s\u1ef1 t\u00edch t\u1ee5 c\u1ee7a c\u00e1c y\u1ebfu t\u1ed1 c\u1ea5u th\u00e0nh kh\u00e1c c\u1ee7a huy\u1ebft t\u01b0\u01a1ng\u00a0 (c\u00e1c triglyceride ho\u1eb7c protein) trong huy\u1ebft t\u01b0\u01a1ng. Gi\u1ea3 h\u1ea1 Na m\u00e1u x\u1ea3y ra trong 3\u00a0 t\u00ecnh hu\u1ed1ng:<\/p>\n

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    • T\u0103ng triglyceride m\u00e1u n\u1eb7ng (n\u1ed3ng \u0111\u1ed9 triglyceride t\u1edbi h\u00e0ng ng\u00e0n mg\/dl)\u00a0 \u2022 T\u0103ng protein m\u00e1u n\u1eb7ng, c\u00f3 th\u1ec3 x\u1ea3y ra trong \u0111a u t\u1ee7y (n\u1ed3ng \u0111\u1ed9 protein huy\u1ebft\u00a0 t\u01b0\u01a1ng > 10 mg\/dl)<\/li>\n
    • Ki\u1ec3m tra b\u1ea3ng (t\u00ecnh hu\u1ed1ng hay g\u1eb7p nh\u1ea5t, v\u00e0 l\u00e0 nguy\u00ean nh\u00e2n ch\u00ednh \u0111\u01b0\u1ee3c th\u1ea3o\u00a0 lu\u1eadn)<\/li>\n<\/ul>\n

      N\u1ed3ng \u0111\u1ed9 th\u1ea9m th\u1ea5u huy\u1ebft thanh \u0111o \u0111\u01b0\u1ee3c b\u00ecnh th\u01b0\u1eddng, nh\u01b0ng n\u1ed3ng \u0111\u1ed9 th\u1ea9m th\u1ea5u\u00a0 t\u00ednh to\u00e1n th\u1ea5p v\u00ec natri huy\u1ebft thanh th\u1ea5p gi\u1ea3. V\u00ec th\u1ebf, kho\u1ea3ng tr\u1ed1ng osmol t\u0103ng. B\u1ec7nh\u00a0 nh\u00e2n kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng h\u1ea1 natri m\u00e1u v\u00ec tr\u01b0\u01a1ng l\u1ef1c b\u00ecnh th\u01b0\u1eddng. Kh\u00f4ng c\u1ea7n \u0111i\u1ec1u\u00a0 tr\u1ecb cho n\u1ed3ng \u0111\u1ed9 th\u1ea5p natri huy\u1ebft thanh. Gi\u1ea3 h\u1ea1 Nam\u00e1u kh\u00f4ng x\u1ea3y ra khi \u0111i\u1ec7n c\u1ef1c natri \u0111\u01b0\u1ee3c d\u00f9ng \u0111\u1ec3 \u0111o n\u1ed3ng \u0111\u1ed9 Na trong m\u1ed9t m\u1eabu nghi\u1ec7m kh\u00f4ng h\u00f2a lo\u00e3ng. K\u0129\u00a0 thu\u1eadt \u0111i\u1ec7n c\u1ef1c Na hi\u1ec7n nay \u0111\u01b0\u1ee3c d\u00f9ng r\u1ed9ng r\u00e3i tr\u00ean l\u00e2m s\u00e0ng, cho n\u00ean hi\u1ec7n nay gi\u1ea3\u00a0 h\u1ea1 natri \u0111\u1eb7c bi\u1ec7t hi\u1ebfm.<\/p>\n

      1.2 Gi\u1ea3 h\u1ea1 natri m\u00e1u (v\u00f4 c\u00f9ng hi\u1ebfm)\u00a0\u00a0<\/strong><\/p>\n

      \u00a0<\/strong>T\u0103ng triglyceride m\u00e1u \u0111\u00e1ng k\u1ec3<\/p>\n

      T\u0103ng protein m\u00e1u<\/p>\n

      1.3 H\u1ea1 natri m\u00e1u k\u00e8m \u01b0u tr\u01b0\u01a1ng\u00a0\u00a0<\/strong><\/p>\n

      \u00a0<\/strong>H\u1ea1 natri m\u00e1u k\u00e8m \u01b0u tr\u01b0\u01a1ng <\/em>l\u00e0 m\u1ed9t t\u00ecnh hu\u1ed1ng \u0111\u1eb7c bi\u1ec7t kh\u00e1c c\u1ee7a h\u1ea1 natri m\u00e1u, hay\u00a0 g\u1eb7p nh\u1ea5t l\u00e0 do t\u0103ng \u0111\u01b0\u1eddng m\u00e1u n\u1eb7ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u00e1i \u0111\u01b0\u1eddng kh\u00f4ng ki\u1ec3m\u00a0 so\u00e1t. Natri th\u1ea5p v\u00ec s\u1ef1 chuy\u1ec3n d\u1ecbch qua t\u1ebf b\u00e0o c\u1ee7a n\u01b0\u1edbc, nh\u01b0ng c\u1ea3 tr\u01b0\u01a1ng l\u1ef1c v\u00e0 n\u1ed3ng\u00a0 \u0111\u1ed9 th\u1ea9m th\u1ea5u huy\u1ebft thanh \u0111o \u0111\u01b0\u1ee3c \u0111\u1ec1u r\u1ea5t cao. Do glucose l\u00e0 m\u1ed9t ch\u1ea5t th\u1ea9m th\u1ea5u\u00a0 h\u1eefu hi\u1ec7u, n\u1ed3ng \u0111\u1ed9 glucose cao g\u00e2y d\u1ecbch chuy\u1ec3n n\u01b0\u1edbc t\u1eeb khoang n\u1ed9i b\u00e0o ra khoang\u00a0 ngo\u1ea1i b\u00e0o, qua \u0111\u00f3 l\u00e0m gi\u1ea3m n\u1ed3ng \u0111\u1ed9 natri ngo\u1ea1i b\u00e0o. H\u1ec7 qu\u1ea3 l\u00e0 n\u1ed3ng \u0111\u1ed9 natri gi\u1ea3m,\u00a0 ngay c\u1ea3 khi tr\u01b0\u01a1ng l\u1ef1c c\u1ee7a ECFV t\u0103ng. N\u1ed3ng \u0111\u1ed9 natri gi\u1ea3m kho\u1ea3ng 1.6 mEq\/L <\/strong>cho m\u1ed7i\u00a0 100 <\/strong>mg\/dl glucose. \u0110\u1ec3 ch\u1ea9n \u0111o\u00e1n h\u1ea1 natri m\u00e1u k\u00e8m v\u1edbi \u01b0u tr\u01b0\u01a1ng, n\u1ed3ng \u0111\u1ed9 th\u1ea9m\u00a0 th\u1ea5u \u0111o \u0111\u01b0\u1ee3c ph\u1ea3i t\u0103ng r\u00f5 r\u00e0ng b\u1edfi t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft<\/em>.<\/p>\n

      S\u1eed d\u1ee5ng mannitol \u01b0u tr\u01b0\u01a1ng c\u00f3 th\u1ec3 g\u00e2y h\u1ea1 Na m\u00e1u v\u1edbi t\u0103ng tr\u01b0\u01a1ng l\u1ef1c. N\u00f3 kh\u00f4ng\u00a0 ph\u1ed5 bi\u1ebfn b\u1eb1ng t\u0103ng \u0111\u01b0\u1eddng m\u00e1u, nh\u01b0ng c\u01a1 ch\u1ebf th\u00ec gi\u1ed1ng nhau: Mannitol g\u00e2y d\u1ecbch\u00a0 chuy\u1ec3n n\u01b0\u1edbc t\u1eeb khoang t\u1ebf b\u00e0o sau \u0111\u00f3 g\u00e2y gi\u1ea3m n\u1ed3ng \u0111\u1ed9 natri. N\u1ed3ng \u0111\u1ed9 th\u1ea9m th\u1ea5u \u0111o\u00a0 \u0111\u01b0\u1ee3c v\u00e0 tr\u01b0\u01a1ng l\u1ef1c t\u0103ng m\u1eb7c d\u00f9 n\u1ed3ng \u0111\u1ed9 natri huy\u1ebft thanh \u0111o \u0111\u01b0\u1ee3c v\u00e0 n\u1ed3ng \u0111\u1ed9\u00a0 th\u1ea9m th\u1ea5u t\u00ednh to\u00e1n l\u00e0 th\u1ea5p.<\/p>\n

      1.4 H\u1ea1 natri m\u00e1u k\u00e8m nh\u01b0\u1ee3c tr\u01b0\u01a1ng (h\u1ea1 natri m\u00e1u \u201cth\u1eadt s\u1ef1\u201d)\u00a0\u00a0<\/strong><\/p>\n

      \u00a0<\/strong>H\u1ea1 natri m\u00e1u k\u00e8m nh\u01b0\u1ee3c tr\u01b0\u01a1ng l\u00e0 nguy\u00ean nh\u00e2n ph\u1ed5 bi\u1ebfn nh\u1ea5t c\u1ee7a h\u1ea1 natri m\u00e1u v\u00e0\u00a0 g\u00e2y ra do suy gi\u1ea3m s\u1ef1 b\u00e0i ti\u1ebft n\u01b0\u1edbc c\u1ee7a th\u1eadn trong khi n\u01b0\u1edbc v\u1eabn ti\u1ebfp t\u1ee5c \u0111\u01b0\u1ee3c \u0111\u01b0a\u00a0 v\u00e0o. H\u1ea1 natri m\u00e1u k\u00e8m nh\u01b0\u1ee3c tr\u01b0\u01a1ng \u0111\u00f2i h\u1ecfi hai \u0111i\u1ec1u:<\/p>\n

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      • suy gi\u1ea3m s\u1ef1 b\u00e0i ti\u1ebft n\u01b0\u1edbc c\u1ee7a th\u1eadn<\/li>\n
      • n\u01b0\u1edbc v\u1eabn ti\u1ebfp t\u1ee5c \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o<\/li>\n<\/ul>\n

        B\u00ecnh th\u01b0\u1eddng, th\u1eadn b\u00e0i ti\u1ebft n\u01b0\u1edbc th\u1eeba b\u1eb1ng c\u00e1ch s\u1ea3n xu\u1ea5t m\u1ed9t th\u1ec3 t\u00edch l\u1edbn n\u01b0\u1edbc ti\u1ec3u\u00a0 h\u00f2a lo\u00e3ng. T\u00ecm nguy\u00ean nh\u00e2n t\u1ea1i sao th\u1eadn kh\u00f4ng th\u1ec3 b\u00e0i ti\u1ebft n\u01b0\u1edbc th\u1eeba m\u1ed9t c\u00e1ch h\u1ee3p\u00a0 l\u00fd l\u00e0 ch\u00eca kh\u00f3a cho ch\u1ea9n \u0111o\u00e1n nguy\u00ean nh\u00e2n h\u1ea1 Na m\u00e1u. <\/em>Suy gi\u1ea3m s\u1ef1 b\u00e0i ti\u1ebft n\u01b0\u1edbc\u00a0 c\u1ee7a th\u1eadn c\u00f3 th\u1ec3 do:<\/p>\n

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        • Suy gi\u1ea3m GFR (suy th\u1eadn)<\/li>\n
        • Thi\u1ebfu h\u1ee5t ECFV (th\u01b0\u1eddng do n\u00f4n v\u00e0 v\u1eabn ti\u1ebfp t\u1ee5c d\u00f9ng n\u01b0\u1edbc)<\/li>\n
        • C\u00e1c t\u00ecnh tr\u1ea1ng ph\u00f9: suy tim xung huy\u1ebft, x\u01a1 gan, v\u00e0 h\u1ed9i ch\u1ee9ng th\u1eadn h\u01b0\u00a0 \u2022 C\u00e1c l\u1ee3i ti\u1ec3u thiazide<\/li>\n
        • H\u1ed9i ch\u1ee9ng ti\u1ebft ADH kh\u00f4ng ph\u00f9 h\u1ee3p (SIADH) do c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c nhau\u00a0 (h\u00ecnh 3-2)<\/li>\n<\/ul>\n

          M\u1ed9t trong hai b\u1ea5t th\u01b0\u1eddng n\u1ed9i ti\u1ebft: gi\u1ea3m ho\u1ea1t gi\u00e1p ho\u1eb7c thi\u1ec3u n\u0103ng th\u01b0\u1ee3ng\u00a0 th\u1eadn<\/p>\n

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          • Gi\u1ea3m \u0111\u00e1ng k\u1ec3 d\u1ecbch \u0111\u01b0a v\u00e0o k\u1ebft h\u1ee3p v\u1edbi s\u1eed d\u1ee5ng nhi\u1ec1u n\u01b0\u1edbc (\u201cch\u1ebf \u0111\u1ed9 \u0103n tr\u00e0 v\u00e0\u00a0 b\u00e1nh m\u00ec\u201d v\u00e0 u\u1ed1ng nhi\u1ec1u beer)<\/li>\n<\/ul>\n

            B\u1ea5t k\u00ec t\u00ecnh hu\u1ed1ng n\u00e0o trong n\u00e0y l\u00e0m suy y\u1ebfu b\u00e0i ti\u1ebft n\u01b0\u1edbc c\u00f3 th\u1ec3 g\u00e2y h\u1ea1 natri m\u00e1u \u1edf\u00a0 b\u1ec7nh nh\u00e2n c\u00f3 n\u1ed3ng \u0111\u1ed9 natri huy\u1ebft thanh b\u00ecnh th\u01b0\u1eddng n\u1ebfu nh\u01b0 n\u01b0\u1edbc t\u1ef1 do \u0111\u01b0\u1ee3c\u00a0 cung c\u1ea5p \u0111\u1ea7y \u0111\u1ee7. V\u00ec th\u1ebf, m\u1ed9t b\u1ec7nh nh\u00e2n c\u00f3 m\u1ed9t trong nh\u1eefng t\u00ecnh tr\u1ea1ng k\u1ec3 tr\u00ean c\u00f3\u00a0 nguy c\u01a1 <\/em>h\u1ea1 natri m\u00e1u n\u1ebfu cung c\u1ea5p d\u1ecbch t\u0129nh m\u1ea1ch nh\u01b0\u1ee3c tr\u01b0\u01a1ng ho\u1eb7c m\u1ed9t t\u1ea3i l\u01b0\u1ee3ng\u00a0 n\u01b0\u1edbc \u0111\u1ed9t ng\u1ed9t.<\/p>\n

            Suy gi\u1ea3m m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn (suy th\u1eadn)\u00a0\u00a0<\/strong><\/p>\n

            \u00a0<\/strong>\u0110\u1ec3 th\u1eadn b\u00e0i ti\u1ebft n\u01b0\u1edbc th\u1eeba b\u1eb1ng c\u00e1ch t\u1ea1o ra l\u01b0\u1ee3ng l\u1edbn n\u01b0\u1edbc ti\u1ec3u h\u00f2a lo\u00e3ng, c\u1ea7n ph\u1ea3i\u00a0 c\u00f3 m\u1ee9c l\u1ecdc c\u1ea7u th\u1eadn \u0111\u1ea7y \u0111\u1ee7. D\u1ec5 th\u1ea5y l\u00e0 n\u1ebfu m\u1ed9t ng\u01b0\u1eddi kh\u00f4ng th\u1ec3 l\u1ecdc n\u01b0\u1edbc, th\u00ec n\u00f3\u00a0 kh\u00f4ng th\u1ec3 \u0111\u01b0\u1ee3c b\u00e0i ti\u1ebft! N\u00f3i chung, c\u1ea7n gi\u1ea3m \u0111\u00e1ng k\u1ec3 s\u1ef1 l\u1ecdc c\u1ea7u th\u1eadn kho\u1ea3ng 20%\u00a0 b\u00ecnh th\u01b0\u1eddng m\u1edbi g\u00e2y ra v\u1ea5n \u0111\u1ec1 nghi\u00eam tr\u1ecdng v\u1edbi ki\u1ec3m so\u00e1t n\u01b0\u1edbc. N\u1ebfu \u0111\u01b0a v\u00e0o m\u1ed9t\u00a0 l\u01b0\u1ee3ng l\u1edbn n\u01b0\u1edbc, th\u00ec s\u1ef1 suy y\u1ebfu th\u1eadn \u00edt h\u01a1n \u0111\u1ee7 \u0111\u1ec3 g\u00e2y h\u1ea1 natri m\u00e1u.<\/p>\n

            Thi\u1ebfu h\u1ee5t ECFV\u00a0\u00a0<\/strong><\/p>\n

            \u00a0<\/strong>M\u1eb7c d\u00f9 thi\u1ebfu h\u1ee5t ECFV c\u00f3 th\u1ec3 xu\u1ea5t hi\u1ec7n do nhi\u1ec1u nguy\u00ean nh\u00e2n, nguy\u00ean nh\u00e2n ph\u1ed5\u00a0 bi\u1ebfn nh\u1ea5t l\u00e0 m\u1ea5t qua d\u1ea1 d\u00e0y do n\u00f4n v\u1edbi s\u1eed d\u1ee5ng n\u01b0\u1edbc \u0111i k\u00e8m (n\u01b0\u1edbc c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c h\u1ea5p\u00a0 thu r\u1ea5t nhanh ngay c\u1ea3 khi n\u00f4n). Thi\u1ebfu h\u1ee5t n\u1eb7ng ECFV c\u0169ng g\u00e2y ti\u1ebft ADH, g\u00f3p th\u00eam\u00a0 v\u00e0o s\u1ef1 xu\u1ea5t hi\u1ec7n c\u1ee7a h\u1ea1 natri m\u00e1u. Trong thi\u1ebfu h\u1ee5t ECFV, \u1ed1ng l\u01b0\u1ee3n g\u1ea7n gi\u1eef c\u1ea3 natri v\u00e0\u00a0 n\u01b0\u1edbc m\u1ed9t c\u00e1ch h\u1ee3p l\u00fd. N\u1ed3ng \u0111\u1ed9 natri n\u01b0\u1edbc ti\u1ec3u th\u01b0\u1eddng th\u1ea5p (<10 mEq\/L) trong thi\u1ebfu\u00a0 h\u1ee5t ECFV, do s\u1ef1 gi\u1eef natri h\u1ee3p l\u00fd t\u1ecba th\u1eadn. Th\u1ec3 t\u00edch n\u01b0\u1edbc ti\u1ec3u c\u00f3 th\u1ec3 c\u0169ng th\u1ea5p\u00a0 (<500ml\/24 gi\u1edd).<\/p>\n

            T\u00ecnh tr\u1ea1ng ph\u00f9\u00a0\u00a0<\/strong><\/p>\n

            \u00a0<\/strong>H\u1ea1 Na m\u00e1u c\u00f3 th\u1ec3 x\u1ea3y ra trong suy tim xung huy\u1ebft m\u1ea5t b\u00f9, x\u01a1 gan, v\u00e0 h\u1ed9i ch\u1ee9ng\u00a0 th\u1eadn h\u01b0. Nh\u01b0 t\u1ea5t c\u1ea3 c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c c\u1ee7a h\u1ea1 natri m\u00e1u k\u00e8m nh\u01b0\u1ee3c tr\u01b0\u01a1ng, suy\u00a0 y\u1ebfu ch\u1ee9c n\u0103ng b\u00e0i ti\u1ebft n\u01b0\u1edbc c\u1ee7a th\u1eadn x\u1ea3y ra c\u00f9ng v\u1edbi vi\u1ec7c ti\u1ebfp t\u1ee5c d\u00f9ng n\u01b0\u1edbc l\u00e0\u00a0 nguy\u00ean nh\u00e2n c\u1ee7a h\u1ea1 natri m\u00e1u. Ph\u00f9 g\u00e2y ra do khi\u1ebfm khuy\u1ebft b\u00e0i ti\u1ebft natri. Nh\u1eefng\u00a0 b\u1ec7nh nh\u00e2n h\u1ea1 natri m\u00e1u v\u1edbi ph\u00f9 c\u00f3 s\u1ef1 gi\u1eef b\u1ea5t th\u01b0\u1eddng t\u1ea1i th\u1eadn c\u1ee7a c\u1ee7a natri (g\u00e2y qu\u00e1\u00a0 t\u1ea3i ECFV v\u00e0 ph\u00f9) v\u00e0 n\u01b0\u1edbc (g\u00e2y h\u1ea1 natri m\u00e1u). N\u1ed3ng \u0111\u1ed9 natri n\u01b0\u1edbc ti\u1ec3u th\u01b0\u1eddng th\u1ea5p\u00a0 (<10 mEq\/L) trong t\u00ecnh tr\u1ea1ng ph\u00f9 v\u00ec th\u1eadn gi\u1eef natri b\u1ea5t th\u01b0\u1eddng.\u00a0\u00a0<\/strong><\/p>\n

            L\u1ee3i ti\u1ec3u thiazide\u00a0\u00a0<\/strong><\/p>\n

            C\u00e1c l\u1ee3i ti\u1ec3u thiazide l\u00e0m suy y\u1ebfu kh\u1ea3 n\u0103ng b\u00e0i ti\u1ebft n\u01b0\u1edbc c\u1ee7a th\u1eadn do \u1ee9c ch\u1ebf kh\u1ea3 n\u0103ng\u00a0 s\u1ea3n xu\u1ea5t n\u01b0\u1edbc ti\u1ec3u h\u00f2a lo\u00e3ng c\u1ee7a th\u1eadn (ch\u01b0\u01a1ng 1). L\u1eddi ti\u1ec3u thiazide l\u00e0 nguy\u00ean nh\u00e2n\u00a0 quan tr\u1ecdng c\u1ee7a h\u1ea1 natri m\u00e1u, \u0111\u1eb7c bi\u1ec7t \u1edf nh\u1eefng ph\u1ee5 n\u1eef l\u1edbn tu\u1ed5i. H\u1ea1 natri m\u00e1u nh\u01b0\u00a0 th\u1ebf c\u00f3 th\u1ec3 n\u1eb7ng n\u1ebfu nh\u01b0 ch\u1ea5t h\u00f2a tan \u0111\u01b0a v\u00e0o th\u1ea5p ho\u1eb7c n\u01b0\u1edbc \u0111\u01b0a v\u00e0o nhi\u1ec1u. L\u1ee3i\u00a0 ti\u1ec3u thiazide b\u1ecb ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u1edbi t\u1ea5t c\u1ea3 nh\u1eefng b\u1ec7nh nh\u00e2n h\u1ea1 natri m\u00e1u, bao g\u1ed3m\u00a0 nh\u1eefng ng\u01b0\u1eddi c\u00f3 xu\u1ea5t hi\u1ec7n th\u00eam t\u00ecnh tr\u1ea1ng ph\u00f9.\u00a0<\/strong><\/p>\n

            SIADH\u00a0\u00a0<\/strong><\/p>\n

            \u00a0<\/strong>\u0110i\u1ec1u g\u00ec s\u1ebd x\u1ea3y ra n\u1ebfu s\u1ef1 ti\u1ebft ADH v\u1eabn ti\u1ebfp di\u1ec5n m\u1eb7c d\u00f9 gi\u1ea3m n\u1ed3ng \u0111\u1ed9 natri huy\u1ebft\u00a0 thanh v\u00e0 ti\u1ebfp t\u1ee5c s\u1eed d\u1ee5ng n\u01b0\u1edbc? N\u01b0\u1edbc s\u1ebd ti\u1ebfp t\u1ee5c \u0111\u01b0\u1ee3c gi\u1eef l\u1ea1i, v\u00e0 n\u1ed3ng \u0111\u1ed9 natri\u00a0 huy\u1ebft thanh s\u1ebd ti\u1ebfp t\u1ee5c gi\u1ea3m. \u0110\u00e2y l\u00e0 c\u01a1 s\u1edf c\u1ee7a h\u1ed9i ch\u1ee9ng ti\u1ebft ADH kh\u00f4ng ph\u00f9 h\u1ee3p\u00a0 (SIADH), b\u1eaft ngu\u1ed3n theo nhi\u1ec1u c\u00e1ch kh\u00e1c nhau (h\u00ecnh 3-2):<\/p>\n

              \n
            • T\u0103ng b\u1ea5t th\u01b0\u1eddng s\u1ef1 ti\u1ebft ADH c\u1ee7a tuy\u1ebfn y\u00ean<\/li>\n
            • U ti\u1ebft ADH l\u1ea1c ch\u1ed7<\/li>\n
            • Hi\u1ec7u qu\u1ea3 gi\u1ed1ng ADH \u1edf \u1ed1ng g\u00f3p g\u00e2y ra do c\u00e1c ch\u1ea5t ngo\u1ea1i sinh nh\u01b0 thu\u1ed1c\u00a0 \u2022 T\u0103ng hi\u1ec7u qu\u1ea3 l\u00ean \u1ed1ng th\u1eadn c\u1ee7a ADH b\u1edfi thu\u1ed1c<\/li>\n<\/ul>\n

              B\u1ea5t k\u00ec c\u01a1 ch\u1ebf n\u00e0o trong n\u00e0y c\u00f3 th\u1ec3 g\u00e2y ra v\u1ea5n \u0111\u1ec1 gi\u1ed1ng nhau: h\u1ea1 Na m\u00e1u. B\u1ea5t k\u00ec v\u1ea5n\u00a0 \u0111\u1ec1 nghi\u00eam tr\u1ecdng n\u00e0o c\u1ee7a h\u1ec7 th\u1ea7n kinh TW (kh\u1ed1i u, nhi\u1ec5m khu\u1ea9n, v\u00e0 ch\u1ea5n th\u01b0\u01a1ng) v\u00e0\u00a0 nhi\u1ec1u v\u1ea5n \u0111\u1ec1 c\u1ee7a ph\u1ed5i (\u0111\u1eb7c bi\u1ec7t l\u00e0 ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o nh\u1ecf v\u00e0 lao ph\u1ed5i) c\u00f3 th\u1ec3 g\u00e2y\u00a0 ra SIADH. T\u00ecnh tr\u1ea1ng h\u1eadu ph\u1eabu <\/strong>th\u01b0\u1eddng k\u1ebft h\u1ee3p v\u1edbi t\u0103ng ti\u1ebft ADH. M\u1ed9t s\u1ed1 nh\u1eefng\u00a0 thu\u1ed1c th\u01b0\u1eddng s\u1eed d\u1ee5ng hi\u1ec7n nay c\u00f3 th\u1ec3 g\u00e2y ra h\u1ed9i ch\u1ee9ng n\u00e0y, b\u1edfi t\u0103ng ti\u1ebft ADH, t\u0103ng\u00a0 hi\u1ec7u l\u1ef1c ADH \u1edf th\u1eadn, ho\u1eb7c l\u00e0 t\u0103ng hi\u1ec7u qu\u1ea3 c\u1ee7a ADH n\u1ed9i sinh.<\/p>\n

              H\u00ecnh 3-2: H\u1ed9i ch\u1ee9ng ti\u1ebft ADH kh\u00f4ng ph\u00f9 h\u1ee3p (SIADH)<\/p>\n

              2. C\u00e1c b\u1ec7nh l\u00fd h\u1ec7 th\u1ea7n kinh TW, c\u01a1 quan kh\u00e1c g\u00e2y h\u1ea1 Na m\u00e1u\u00a0\u00a0<\/strong><\/h2>\n

              2.1 Th\u1ea7n kinh<\/strong><\/p>\n

              \u00a0<\/strong>\u00c1p-xe n\u00e3o<\/p>\n

              U n\u00e3o<\/p>\n

              Vi\u00eam m\u00e0ng n\u00e3o<\/p>\n

              Xu\u1ea5t huy\u1ebft d\u01b0\u1edbi m\u00e0ng nh\u1ec7n<\/p>\n

              T\u1ee5 m\u00e1u d\u01b0\u1edbi m\u00e0ng c\u1ee9ng<\/p>\n

              \u0110\u1ed9t qu\u1ef5<\/p>\n

              Ch\u1ea5n th\u01b0\u01a1ng<\/p>\n

              2.2 C\u00e1c b\u1ec7nh l\u00fd ph\u1ed5i\u00a0\u00a0<\/strong><\/p>\n

              \u00a0<\/strong>Vi\u00eam ph\u1ed5i vi khu\u1ea9n<\/p>\n

              H\u1ed9i ch\u1ee9ng suy h\u00f4 h\u1ea5p c\u1ea5p ti\u1ebfn tri\u1ec3n (ARDS_<\/p>\n

              Lao ph\u1ed5i<\/p>\n

              2.3 S\u1ef1 t\u1ea1o u\u00a0\u00a0<\/strong><\/p>\n

              \u00a0<\/strong>Ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ebf b\u00e0o nh\u1ecf c\u1ee7a ph\u1ed5i<\/p>\n

              Ung th\u01b0 bi\u1ec3u m\u00f4 t\u1ee5y<\/p>\n

              Ung th\u01b0 bi\u1ec3u m\u00f4 t\u00e1 tr\u00e0ng<\/p>\n

              N\u00f4n\u00a0\u00a0<\/strong><\/p>\n

              H\u1eadu ph\u1eabu\u00a0\u00a0<\/strong><\/p>\n

              Thu\u1ed1c\u00a0\u00a0<\/strong><\/p>\n

              Amitriptyline<\/p>\n

              Carbamazepine<\/p>\n

              Chlorpropamide<\/p>\n

              Clofibrate<\/p>\n

              Cyclophosphamide<\/p>\n

              Haloperidol<\/p>\n

              Narcotics<\/p>\n

              Nicotine<\/p>\n

              C\u00e1c thu\u1ed1c kh\u00e1ng vi\u00eam kh\u00f4ng steroid<\/p>\n

              C\u00e1c ch\u1ea5t \u1ee9c ch\u1ebf Serotonin<\/p>\n

              Thiothixene<\/p>\n

              Thioridazine<\/p>\n

              Vincristine<\/p>\n

              2.4 Gi\u1ea3m ho\u1ea1t gi\u00e1p v\u00e0 thi\u1ec3u n\u0103ng th\u01b0\u1ee3ng th\u1eadn\u00a0\u00a0<\/strong><\/p>\n

              \u00a0<\/strong>C\u1ea3 hai t\u00ecnh tr\u1ea1ng n\u00e0y \u0111\u1ec1u quan tr\u1ecdng \u0111\u1ec3 xem x\u00e9t trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p h\u1ea1 Na m\u00e1u kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n, b\u1edfi v\u00ec ch\u00fang l\u00e0 nh\u1eefng nguyen nh\u00e2n c\u00f3 th\u1ec3 h\u1ed3i ph\u1ee5c c\u1ee7a\u00a0 h\u1ea1 Na m\u00e1u. C\u01a1 ch\u1ebf h\u1ea1 Na m\u00e1u trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p n\u00e0y kh\u00e1 ph\u1ee9c t\u1ea1p.<\/p>\n

              T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/strong>\u00a0 \u201c<\/span>ACID-BASE, FLUIDS, AND ELECTROLYTES MADE RIDICULOUSLY SIMPLE<\/em>\u201d<\/em> ,\u00a0 \u00a0Richard A. Preston, M.D. M.B.A.\u00a0\u00a0<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

              H\u1ea1 natri m\u00e1u (Hyponatremia) g\u00e2y ra do suy y\u1ebfu s\u1ef1 b\u00e0i ti\u1ebft\u00a0 n\u01b0\u1edbc t\u1ea1i th\u1eadn trong khi n\u01b0\u1edbc v\u1eabn ti\u1ebfp t\u1ee5c \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o.\u00a0N\u1ebfu h\u1ea1 natri m\u00e1u xu\u1ea5t hi\u1ec7n\u00a0 nhanh, c\u00f3 th\u1ec3 c\u00f3 c\u00e1c tri\u1ec7u ch\u1ee9ng n\u1eb7ng g\u00e2y ra do b\u1edfi ph\u00f9 n\u00e3o, nh\u01b0 ng\u1ee7 l\u1ecbm, h\u00f4n m\u00ea,\u00a0 v\u00e0 co gi\u1eadt. N\u1ebfu m\u1ee9c \u0111\u1ed9 t\u01b0\u01a1ng […]<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[23,33],"tags":[],"yoast_head":"\nH\u1ea1 Natri m\u00e1u: c\u01a1 ch\u1ebf theo nguy\u00ean nh\u00e2n - Vinmec<\/title>\n<meta name=\"description\" content=\"H\u1ea1 natri m\u00e1u th\u01b0\u1eddng l\u00e0 t\u00ecnh tr\u1ea1ng g\u00e2y ra do suy y\u1ebfu s\u1ef1 b\u00e0i ti\u1ebft\u00a0 n\u01b0\u1edbc t\u1ea1i th\u1eadn trong khi n\u01b0\u1edbc v\u1eabn ti\u1ebfp t\u1ee5c \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"H\u1ea1 Natri m\u00e1u: c\u01a1 ch\u1ebf theo nguy\u00ean nh\u00e2n - Vinmec\" \/>\n<meta property=\"og:description\" content=\"H\u1ea1 natri m\u00e1u th\u01b0\u1eddng l\u00e0 t\u00ecnh tr\u1ea1ng g\u00e2y ra do suy y\u1ebfu s\u1ef1 b\u00e0i ti\u1ebft\u00a0 n\u01b0\u1edbc t\u1ea1i th\u1eadn trong khi n\u01b0\u1edbc v\u1eabn ti\u1ebfp t\u1ee5c \u0111\u01b0\u1ee3c \u0111\u01b0a v\u00e0o.\" \/>\n<meta property=\"og:url\" content=\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/24\/ha-natri-mau-co-che-theo-nguyen-nhan\/\" \/>\n<meta property=\"og:site_name\" content=\"Vinmec\" \/>\n<meta property=\"article:published_time\" content=\"2023-04-24T15:30:53+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/unnamed-file-1-300x169.jpg\" \/>\n<meta name=\"author\" content=\"Dai Tran Van\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Dai Tran Van\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"8 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/24\/ha-natri-mau-co-che-theo-nguyen-nhan\/\",\"url\":\"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/24\/ha-natri-mau-co-che-theo-nguyen-nhan\/\",\"name\":\"H\u1ea1 Natri m\u00e1u: c\u01a1 ch\u1ebf theo nguy\u00ean nh\u00e2n - 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