# 病人已服用 carbamazepine 6週。護理師查看檢驗發現血清鈉126 mEq/L。優先護理措施是什麼？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391743&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

病人已服用 carbamazepine 6週。護理師查看檢驗發現血清鈉126 mEq/L。優先護理措施是什麼？

## 選項

1. 暫停用藥，並指導個案增加每日鈉攝取量，同時監測血鈉值。
2. 開始輸注 0.9% sodium chloride，以快速提高血清鈉濃度。
3. 開始輸注 0.45% sodium chloride，以謹慎處理低血鈉情形。
4. 暫停下一劑並通知醫療人員，需評估carbamazepine誘發SIADH **✔ 正確答案**

**正確答案: 4**

## 解析

正解 (1): Carbamazepine 可能造成SIADH（抗利尿激素分泌不當症候群），導致水分滯留與稀釋性低血鈉。Na 126且有神經症狀時，應暫停劑量並通知醫療人員評估，可能需要限水、換藥與謹慎校正鈉。(2) 更多自由水會使低血鈉惡化。(3) 低張液會更惡化。(4) 突然停藥需醫囑以避免癲癇反彈。

## 深入解析

記憶提示 Carbamazepine = 把水鎖住 → SIADH、低血鈉。CPG 治療前與治療中定期檢查鈉；高齡與女性風險較高。

## 臨床情境

情境 58歲男性，已服用carbamazepine 400 mg PO BID 6週，出現頭痛、輕度混亂與尿量減少。血清鈉126 mEq/L。

## 重要概念

- **SIADH** — ADH過度分泌造成水分滯留、稀釋性低血鈉，以及血清滲透壓低時仍有濃縮尿。
- **稀釋性低血鈉** — 因水分過多而非鈉流失造成的血清鈉低下；治療重點為限水。
- **Carbamazepine不良反應** — SIADH、顆粒性白血球缺乏、肝毒性、SJS與CYP3A4自我誘導都需監測。

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