Hiponatremia: abordagem clínica e terapêutica
Palavras-chave:
antagonistas dos receptores da hormona anti-diurética, cirrose hepática, hiponatremia, hipovolemia, insuficiência cardíaca congestiva, polidipsia, síndroma de secreção inapropriada de hormona anti-diuréticaResumo
A hiponatremia é a alteração electrolítica mais
frequente na prática clínica hospitalar e reflecte uma
alteração do balanço de água, com consequente
diminuição da osmolalidade plasmática. Pode ter
várias causas que incluem: perda de fluidos, estados
edematosos, nomeadamente insuficiência cardíaca
congestiva, cirrose hepática e síndroma nefrótica,
síndroma de secreção inapropriada de hormona anti-diurética (SIADH), polidipsia primária e patologias
do foro endocrinológico. Na maioria dos casos, a
conjugação de parâmetros clínicos e analíticos
incluindo determinação das osmolalidades,
plasmática e urinária, concentração urinária de sódio
e avaliação clínica do compartimento extra-celular,
permite chegar ao diagnóstico causal. O tratamento
da hiponatremia assenta na terapêutica etiológica e
na correcção da concentração sérica de sódio,
mediante regras fundamentais e após ponderar de
forma individualizada o balanço entre os riscos
inerentes da própria hiponatremia e os da sua rápida
correcção, em particular da desmielinização
osmótica das células cerebrais. Os antagonistas dos
receptores da hormona anti-diurética, ou
aquaréticos, abrem novas perspectivas na
terapêutica da hiponatremia associada às situações
de insuficiência cardíaca, cirrose hepática e SIADH.
Neste artigo, pretendeu-se efectuar uma
abordagem essencialmente clínica desta perturbação
do equilíbrio hidro-electrolítico, sem descurar os
aspectos relacionados com a sua etiopatogénese, e
dando particular ênfase ao diagnóstico etiológico
diferencial e à respectiva terapêutica.
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