高血鈉、低血鈉、鼻胃管灌食

一位患者因為腦病變，而無法自行進食，必須要靠鼻胃管灌食，住在安養院，一開始是用商業配方加自行調配的牛奶，血鈉不足，128 mEq/L，因此告知安養院要牛奶中加鹽，下個月抽血時，發現血鈉 153 mEq/L，過高了。

一般人建議正常中飲食中的鹽量約 6 克/每天，若是有心血管疾病者，視情況需要減日常的鹽量。在以上這患者，血管已經過高了，所以目前應調整每日加的鹽量於 每天5公克以下，這樣才能讓高血管，慢慢的下降。

健康百分百~納多傷身- 

鈉」多傷身 臺北市文山區力行國小蔡坪娥營養師

然而，透析患者，有另一種可能會常見的高、低血鈉，文獻上分析的不錯，借用於此，

Patients with higher plasma sodium may have a higher ‘‘set point’’ or they drink little; patients with lower plasma sodium may have a lower ‘‘set point’’ or excessive free water intake because of hyperglycemia or other dipsogenic stimuli [6,7]. In summary, the concept of an individual ‘‘plasma sodium set point’’, while not perfect, is relatively accurate and serves as a reference point formanagement decisions.

Plasma sodium increases during dialysis in patients who have a positive D-P gradient (i.e., dialysate sodium higher than plasma sodium) [11] contributing to sodium overload, increased thirst, and interdialytic weight gain. On the other hand, negative D-P sodium gradient may predispose to intradialytic symptoms like hypotension and cramps [12]. Therefore, individualization of the dialysate sodium concentrationmakes clinical sense.

How should the predialysis plasma sodium level be interpreted in hemodialysis patients? Seminars in Dialysis—Vol 24, No 4 (July–August) 2011 pp. 409–411