《2014歐洲低鈉血癥診斷和治療臨床實(shí)踐指南》內容簡(jiǎn)介

Hyponatraemia, defined as a serum sodium concentration!135 mmol/l, is the most common disorder of body fluid andelectrolyte balance encountered in clinical practice. It can lead to a wide spectrum of clinical symptoms, from subtle to severeor even life threatening, and is associated with increased mortality, morbidity and length of hospital stay in patientspresenting with a range of conditions. Despite this, the management of patients remains problematic. The prevalence ofhyponatraemia in widely different conditions and the fact that hyponatraemia is managed by clinicians with a broad varietyof backgrounds have fostered diverse institution- and speciality-based approaches to diagnosis and treatment. To obtain acommon and holistic view, the European Society of Intensive Care Medicine （ESICM）， the European Society of Endocrinology（ESE） and the European Renal Association – European Dialysis and Transplant Association （ERA–EDTA）， represented byEuropean Renal Best Practice （ERBP）， have developed the Clinical Practice Guideline on the diagnostic approach andtreatment of hyponatraemia as a joint venture of three societies representing specialists with a natural interest inhyponatraemia. In addition to a rigorous approach to methodology and evaluation, we were keen to ensure that thedocument focused on patient-important outcomes and included utility for clinicians involved in everyday practice

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    4. Methods for guideline development

    4.1. Establishment of the guideline developmentgroupThe councils of the three participating societies, ESICM,ESE and ERBP, selected the co-chairs of the guidelinedevelopment group. The co-chairs then assembled thesteering committee with representatives of the threesocieties involved in this joint venture. This steeringcommittee convened in October 2010 and decided on thecomposition of the guideline development group, takinginto account the clinical and research expertise of theproposed candidates. The guideline development groupconsisted of content experts, which included individualswith expertise in hyponatraemia, endocrinology, generalinternal medicine, intensive care medicine and clinicalnephrology as well as an expert in systematic reviewmethodology. The ERBP methods support team providedmethodological input and practical assistance throughoutthe guideline development process.

    4.2. Developing clinical questionsFrom the final scope of the guideline, specific researchquestions, for which a systematic review would beconducted, were identified.

    4.2.1. Diagnosis and differential diagnosis of hypotonichyponatraemia

    1. In patients with hypotonic hyponatraemia, howaccurate are various 'diagnostic strategies' in comparisonwith a reference test of infusing 2 l 0.9% sodiumchloride solution for differentiating hypovolaemic fromeuvolaemic hyponatraemia?

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