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Erschienen in: Journal für Klinische Endokrinologie und Stoffwechsel 4/2022

07.11.2022 | Originalien

Durst und Trinken – Physiologie und Bedeutung für die Störungen des Wasserhaushalts

verfasst von: PD Dr. Christoph Schwarz, Gregor Lindner

Erschienen in: Journal für Klinische Endokrinologie und Stoffwechsel | Ausgabe 4/2022

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Zusammenfassung

Hypo- und Hypernatriämien sind die häufigsten Elektrolytstörungen in der täglichen Praxis. Obwohl renale und intestinale Verluste an Wasser bzw. Natrium häufige Ursachen dafür sind, wird der Bedeutung des Trinkverhaltens bei diesen Erkrankungen oft zu wenig Aufmerksamkeit geschenkt. Eine Erhöhung der Osmolalität bzw. der Natriumkonzentration im Serum wird bei Hypernatriämie in verschiedenen Kernen des Hypothalamus detektiert und an zentrale Hirnregionen weitergeleitet, welche ein Durstgefühl auslösen. Umgekehrt kann über dieselben hypothalamischen, aber andere zentrale Regionen des Gehirns nach der Zufuhr von Wasser eine Durstsättigungsgefühl vermittelt werden, was eine übermäßige Zufuhr von Wasser durch Trinken verhindern soll. Störungen in diesen hypothalamischen Strukturen, aber auch habituelle Trinkmuster können diese Regulationsmechanismen beeinflussen und Dysnatriämien auslösen oder verstärken. Eine Hypovolämie wird über Druck- beziehungsweise Volumenrezeptoren im Körper erkannt und über den Hirnstamm an den Hypothalamus weitergemeldet. Auch dieses Signal löst letztendlich ein Durstgefühl aus und erhöht zusätzlich den Appetit auf Salz, beides Maßnahmen, um den Volumenhaushalt wiederherzustellen. Parallel zu der Stimulation oder Inhibition von Durst kann über hypothalamische Kerne auch die Vasopressinsekretion angeregt oder gehemmt und damit die renale Wasserelimination reguliert werden. Trotz dieser renalen Regulationsmuster ist alleine das Trinken die einzige physiologische Möglichkeit, vorhandene Verluste an Wasser auszugleichen.
Glossar
ACC
vorderer zingulärer Kortex
ANP
Atriales natriuretisches Peptid
AP
Area postrema
GLP‑1
Glucagon-like Peptid 1
IC
insulärer Kortex
LT
Lamina terminalis: Hirnregion bestehend aus OVLT, SFO und MnPO
MnPO
medianer präoptischer Kern
NTS
Nucleus tractus solitarius
OVLT
Organum vasculosum laminae terminalis
PBN
parabrachialer Kern
PON
präoptischer Kern
PVH
paraventrikulärer Kern des Hypothalamus
RAAS
Renin-Angiotensin-Aldosteron-System
SCN
suprachiasmatischer Kern („innere Uhr“)
SFO
subfornikales Organ
SIAD
Syndrom der inadäquaten Antidiurese
SON
supraoptischer Kern
TRPV
Transienter Rezeptor-Potenzial-Kanal Vanilloid
vBNST
Kern der Stria terminalis
Zirkumventrikuläre Organe
Hirnregionen außerhalb der Blut-Hirnschranke: z. B. SFO, OVLT oder AP
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Metadaten
Titel
Durst und Trinken – Physiologie und Bedeutung für die Störungen des Wasserhaushalts
verfasst von
PD Dr. Christoph Schwarz
Gregor Lindner
Publikationsdatum
07.11.2022
Verlag
Springer Vienna
Erschienen in
Journal für Klinische Endokrinologie und Stoffwechsel / Ausgabe 4/2022
Print ISSN: 1998-7773
Elektronische ISSN: 1998-7781
DOI
https://doi.org/10.1007/s41969-022-00179-8

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