— 生理適應 · HARD · MCQ —
一位診斷為抗利尿激素分泌異常症候群（SIADH）的病人，下列護理措施何者最合適？
A client is diagnosed with SIADH. Which nursing intervention is most appropriate for this patient?
- AEncourage a high-sodium, high-protein diet鼓勵高鈉、高蛋白飲食。
- BAdminister IV fluids at a rate of 125 mL/hr以每小時 125 mL 的速度給予靜脈輸液。
- CRestrict fluid intake to 800-1000 mL per day✓ 正解將每日攝水量限制在 800-1000 mL。
- DMonitor for signs of hypernatremia監測高血鈉的徵象。
— Explanation · 中文詳解 —
SIADH 的核心病理是過多 ADH 導致水滯留與稀釋性低血鈉。治療首選為限水，以減少血管內液量。提供水分只會惡化低血鈉；飲食雖可補充鈉離子，但限水才是防止水分進一步滯留的關鍵機制；病人應監測的是稀釋性低血鈉而非高血鈉。
The core pathology of SIADH is excessive ADH leading to water retention and dilutional hyponatremia. The treatment of choice is fluid restriction to reduce intravascular volume. Providing fluid will only worsen the hyponatremia; although dietary sodium supplementation may help, fluid restriction is the key mechanism to prevent further fluid retention; the client should be monitored for dilutional hyponatremia, not hypernatremia.
✦ 台美臨床差異
台灣針對 SIADH 常規會使用口服食鹽水補充，美國則更嚴格執行水限制，並依賴藥物如 Vasopressin receptor antagonists。