Nsu a Wɔbow, Hyponatremia a Ɛbata Apɔw-mu-teɛteɛ, ne Amemene a Sodium Nnɔɔso¶

Nsu a wɔnom ho hia ma nkwa, nanso sɛ wɔnom nsu a ɛnyɛ den pii anaasɛ agumadi mu anonne a sodium kakraa bi na wɔnom ntɛmntɛm sen sɛnea nnipa asaabo betumi ayi afi mu a, ɛde acute dilutional hyponatremia ("nsu a wɔbow"), aduruyɛ mu ntɛmpɛ a edi awu ntɛmntɛm a mogya mu sodium dodow (Na+) kɔ fam sen 135 mEq/L (mmol/L) (na mpɛn pii no ɛba fam sen 120 kosi 125 mEq/L), na ɛhyɛ nsu a ɛboro so ma fa mogya-amemene akwanside no mu tẽẽ kɔ amemene no mu nkwammoaa mu denam osmosis so. Bere a amemene mu nkwammoaa ahonhon wɔ nnompe ti nhwi a ɛyɛ den a entumi nnyae (acute hyponatremic cerebral edema / encephalopathy) no mu no, wɔn a wɔayɛ wɔn ayayade no nya tiyɛ a ɛbɔ denneennen, akisikuru, projectile fe a ɛfe, nsa ne anan a ɛhohoro, adwene a ɛyɛ basaa, suban a ɛyɛ nwonwa, hintidua a ɛkari pɛ, generalized tonic-clonic seizures, brainstem herniation, neurogenic ahurututu mu akisikuru, ne owu.

Nsuo a wɔnom denneennen no bɔ akuw ahorow anum a ɛsono emu biara: (1) wɔn a wotu mmirika denneennen, wɔn a wotu mmirika denneennen, mmirikatufo a wɔbɔ mmirika abiɛsa, wɔn a wɔnam fam, ne wɔn a wɔagye wɔn asraafo a wɔnom nsa wɔ nsu gyinabea biara "di sukɔm anim" (Exercise-Associated Hyponatremia [EAH]); (2) abɔnten adansifoɔ, afuo, ne mfiridwuma mu adwumayɛfoɔ a wɔnom nsuo a ɛnyɛ den lita wɔ ahohuru berɛ mu ɔhyew mu; (3) wɔn a wɔkɔ afahyɛ ne mmerante ne mmabaa a wɔadu mpanyin afe so a wɔnom MDMA ("Ecstasy" anaa "Molly"), a ɛkanyan hormone a ɛko tia nsu a ɛtɔ gu nipadua mu kɛse bere a ɛde sukɔm kɛse ba no; (4) nkokoaa a wonnii asram 6 a wɔama wɔn nsu a ɛnyɛ den anaasɛ nkokoaa aduan a wɔayam dodo; ne (5) akansifoɔ a wɔwɔ nsuo a wɔnom ho nsɛnnennen mu anaa ayarefoɔ a wɔwɔ psychogenic polydipsia. Sɛ obi a wanom nsu pii nya adwene mu naayɛ, ɔto hintidua, ɔfe, anaasɛ ne ho popo a, frɛ wo mpɔtam hɔ nɔma a egye ntɛmpɛ (911 wɔ United States ne Canada, 112 wɔ Europa Aman Nkabom no nyinaa mu, 999 wɔ United Kingdom) denam yɛn nɔma ahorow a egye ntɛmpɛ directory no ntɛm ara, na hwɛ mu ɔhyew a ɛba vs. ɔhyew mu ɔbrɛ, . ɔhyew yare mmoa a edi kan, na seizure mmoa a edi kan.

Yɛ eyi mprempren¶

1. GYAE NSU NE NSUO NYINAA NTƐM: Mfomsoɔ baako a ɛdi awu paa wɔ marathon kwan, akwantuo kwan, asraafoɔ nanteɛ, anaa adwuma a ɛyɛ hyeɛ beaeɛ ne sɛ wobɛfa no sɛ ogumadifoɔ anaa odwumayɛni bi a ne ti ayɛ basaa, ne ho ayɛ no yaw, n'adwene atu afra wɔ "dehydration anaa ɔhyeɛ brɛ" na hyɛ wɔn ma wɔnom nsuo pii anaasɛ wɔbɛhyɛ aseɛ ayɛ normal-saline/hypotonic IV drip. Sɛ onipa no anom nsu pii, ne nsu a emu da hɔ anaasɛ ne ho ayɛ no hyew, anaasɛ ne nipadua mu duru so antew a, gye nsu a ɛnyɛ den, agumadi mu anonne, ne hypotonic nsu nyinaa gu hɔ ntɛm ara.
2. Frɛ 911 / 112 / 999 ntɛm ara na woanya ntini mu kɔkɔbɔ sɛnkyerɛnne biara: Frɛ nnuruyɛfo a wɔhwɛ ntɛmpɛ so ntɛm ara sɛ onipa no nya tiyɛ a ɛrebɔ denneennen, ɔfe mpɛn pii, n’adwene tu fra, n’adwene tu fra, ɔkasa a ɛyɛ mmerɛw, hintidua (ataxia), ntini a ɛtwetwe, ɔbrɛ, anaasɛ akisikuru a. Ka kyerɛ nea ɔde nneɛma kɔma ne nnuruyɛfo a wɔboa nkurɔfo no sɛ wonsusuw sɛ Acute Exercise-Associated Hyponatremia (Nsu a Ɛnom Nnuru) a ɛwɔ Cerebral Edema sɛnea ɛbɛyɛ a WƆNNTU mmirika kotoku a ɛyɛ ntɛm a ɛyɛ standard IV nsu wɔ kwan so.
3. Sɛ onipa no ani da hɔ koraa, n’ani da hɔ, na ɔwɔ yare no ho sɛnkyerɛnne a ɛnyɛ den NKUTOO a ma no nkyene a wɔde ano aduru a ɛyɛ den (hypertonic) ma: Wɔ sare so, mmirikatu, anaa afuw mu tebea horow a obi asusuw sɛ EAH a emu nyɛ den (akisikuru, tiyɛ, nsateaa a ɛho ayɛ fĩ, abakɔsɛm a ɛkyerɛ sɛ ɔnom nsa boro so) na ɔha biara mu nkyem 100 ani da hɔ, n’ani da so, na otumi mene dwoodwoo a worenfe, Wilderness Medical Society (WMS) ne International EAH Consensus akwankyerɛ kamfo kyerɛ sɛ wɔmfa anom hypertonic nkyene adesoa: bouillon cubes 3 kosi 4 a wɔde apete nsu 120 mL (kuruwa fã / ounces 4) mu, anaa pretzel/nkyene a wɔde nkyene ahyɛ mu 2 kosi 3 a wɔde nsu ketewaa bi afra mu. Mfa ano mma biribiara da sɛ onipa no adwene atu afra, ɔda, ɔfe, anaasɛ ne ho kyere no a.
4. Hwɛ sɛ "Tight Ring / Watchband Sign" ne nsuo a ɛda adi pefee: Hwɛ onipa no nsateaa, ne nsateaa, ne ne nansoaa. Nea ɛnte sɛ obi a nsu ayɛ no ma (a ne honam ani ayɛ kusuu, n’ani akɔ fam, na ne nsu yɛ amber tuntum), obi a nsu anom no taa nya nsateaa a ɛho ahonhon na ɛho ayɛ kurukuruwa wɔ baabi a nkaa anaa dɔn nhama te nka mpofirim sɛ ɛyɛ den, ne yafunu a ɛho ayɛ fĩ a ɛyɛ mmerɛw, ne mu duru kɔ soro fi bere a ofii apɔw-mu-teɛteɛ ase, na ɔtaa tow nsu a emu da hɔ.
5. Bɔ mframa kwan no ho ban bere a worefe ne akisikuru: Amemene mu ahonhon a emu yɛ den ma ɔfe a ɛpae mpofirim ne generalized tonic-clonic seizures. Fa obi a ɔda, n’adwene atu afra, anaasɛ ɔkyere no to wɔn nkyɛn wɔ beae a ɛma obi ho tɔ no sɛnea ɛbɛyɛ a ɔfe no bɛkɔ anom mmom sen sɛ ɛbɛkɔ ahurututu mu.
6. Bɔ ayaresabea a wɔregye no anaa aduruyɛ ntamadan a wɔde wie no kɔkɔ sɛ wonsiesie 3% Hypertonic Saline (3% NaCl): Wɔ ɔyarefo biara a ɔwɔ hyponatremic encephalopathy (adwene mu naayɛ, coma, akisikuru, anaa ɔhome mu haw) fam no, aduru a egye nkwa ntɛm ara ne bolus a wɔde fa ntini mu a ɛyɛ 100 mL a ɛyɛ 3% Hypertonic Sodium Chloride (3% NaCl) a wɔde ahyɛ mu simma 10, a wɔsan yɛ no mpɛn abien foforo wɔ simma 10 ntam kosi sɛ ntini mu yare no befi hɔ.

Gyinaesi dua: Nsonsonoe a ɛda nsu a wɔnom (EAH) ne nsu a ɛtɔ ne ɔhyew a ɛma obi ho yɛ hyew ntam¶

flowchart TD
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    CheckHistory --> VitalsCheck["Hwɛ Core Temperature (Rectal sɛ Wosusuw sɛ Ɔhyew a) ne Point-of-Care Mogya Sodium (Na+) ."]

    VitalsCheck -->|Core Temp > 40 C (104 F) + CNS Delirium| HeatStroke["Ɔhyew a Wɔyɛ no Apɔw-mu-teɛteɛ: Nsukyenee-Nsu a Wɔde Hyehyɛ Mu Ntɛm ara a Wɔde Onwini Di Kan; Hwɛ Serum Na+ Ansa na Woama IV Nsu Boluses Kɛse"]

    VitalsCheck -->|Blood Sodium (Na+) < 135 mEq/L (Often < 125 mEq/L) OR Clinical Clues of Overhydration (Weight Gain, Tight Rings, Sloshing Stomach)| EAH_Severity{"Hwɛ sɛnea Ntini mu Nneɛma a Ɛyɛ Den a Ɛwɔ Acute Hyponatremia no Mu"}

    EAH_Severity -->|SEVERE: Confusion, Delirium, Obtundation, Ataxia, Seizures, Coma, or Pulmonary Edema (Hyponatremic Encephalopathy)| Give3Percent["NKYERƐKYERƐMU A WƆGYE NTAM NTAM:\n1. Siesie Nsuo a Wɔnom/Hypotonic Nyinaa\n2. Fa 3% Hypertonic Saline (3% NaCl) IV Bolus 100 mL ma Bɛboro Simma 10 (2 mL/kg wɔ Mmofra mu)\n3. Tia 100 mL 3% NaCl Bolus Simma 10 Biara (Ɛkɔsi 3 Total Bolus) Kosi sɛ Seizures/Delirium Begyae na Na+ Kɔ soro 4 kosi 6 mEq/L"]

    EAH_Severity -->|MILD-TO-MODERATE: Awake & Alert, Mild Headache/Nausea/Puffy Hands, No Confusion| MildCare["1. Strict Fluid Restriction Until Spontaneous Free-Water Diuresis (Urination) Begins\n2. If Awake & Able to Swallow Safely: Give Concentrated Oral Hypertonic Broth (3-4 Bouillon Cubes in 120 mL [4 oz] Water)\n3. Observe Until Urinating Freely and Serum Na+ Normalizes"]

    Give3Percent --> AcuteVsChronic{"Hwɛ Bere Nhyehyɛe: Hyponatremia a ɛyɛ hu (< Nnɔnhwerew 24-48) vs Nea enni sabea (> Nnɔnhwerew 48) Hyponatremia"}
    AcuteVsChronic -->|Acute Water Intoxication / EAH / MDMA (< 24-48h)| RapidSafe["Nteɛso a Ɛyɛ Ntɛmntɛm a ɛyɛ 4-6 mEq/L wɔ Dɔnhwerew a Edi Kan mu no Yɛ AHOHYEHYE na Ɛyɛ Ahyɛde a Wɔde Siw Amemene Mu Akisikuru (Minimal ODS Asiane wɔ Nokware Acute Onset)"]
    AcuteVsChronic -->|Chronic Hyponatremia (> 48h: Diuretics, Heart/Liver Failure, Chronic SIADH)| CapRate["Afei Mfiase 4-6 mEq / L Nkwagye Bolus ma Seizures, Strictly Cap Total Sodium Kɔ soro wɔ <= 6 kosi 8 mEq / L wɔ Nnɔnhwerew 24 biara mu de Siw Osmotic Demyelination Syndrome (ODS) ano"]

Pathophysiology: Nea Enti a Nsu a Ɛboro So Ma Amemene no Hohoro ne Nea Enti a Asaabo no Ntow Nsu Kwan¶

Onipa asaabo a ɛte apɔw bere a ɔregye n’ahome no tumi yi nsu a wontua hwee a ɛkɔ soro kodu mililita 800 kosi 1,000 (ɛkame ayɛ sɛ lita 1) fi mu dɔnhwerew biara. Eyi ma asɛmmisa bi a ɛda adi pefee sɔre: sɛ ogumadifo, ɔkwantufo, anaa obi a ɔrekɔ afahyɛ no nom nsu lita 1.0 kosi 1.5 dɔnhwerew biara a, dɛn nti na wɔn asaabo ntow nsu a ɛboro so no mfi mu kɛkɛ?

1. "Double Hit" Adwinnade: Nsu a Wɔnom Ntraso + Non-Osmotic ADH Secretion (SIADH) .¶

Ɛkame ayɛ sɛ wɔ Exercise-Associated Hyponatremia (EAH), ɔhyew mu nsu a wɔbow nsa, ne MDMA-induced hyponatremia a edi awu biara mu no, nipadua mu nsɛm abien si bere koro pɛpɛɛpɛ:

1. Hit 1: Hypotonic Fluids (Nsu anaa Agumadi Nsã) a Wɔnom boro So:
2. Onipa mogya a ɛteɛ no sodium dodow yɛ 135 kosi 145 mEq/L (mmol/L).
3. Tap a ɛnyɛ den anaa nsuo a wɔde ahyɛ toa mu wɔ 0 mEq/L sodium.
4. Agumadi mu anonne a wɔtɔn no gyinapɛn (te sɛ Gatorade, Powerade, anaa Lucozade Sport) no wɔ sodium 18 kosi 20 mEq/L pɛ, a ɛkyerɛ sɛ agumadi mu anonne da so ara yɛ nsu kronkron a nkyene nnim ɔha biara mu nkyem 85 sɛ wɔde toto onipa mogya ho a.
5. Enti, agumadi mu anonne a wɔde di gua lita lita a wɔbɛnom bere a wɔretu mmirika kɛse anaa ɔhyew a ɛretu no ENTUMI nsiw hyponatremia ano; nokwarem no, agumadi mu anonne a wɔnom boro so no ma mogya mu sodium yɛ mmerɛw ntɛmntɛm te sɛ nsu a ɛnyɛ den.
6. Hit 2: Antidiuretic Hormone (Arginine Vasopressin / ADH) a Ɛmfata a Ɛma Asaabo no To Mu:
7. Mpɛn pii no, sɛ wonom nsu pii na wo mogya mu osmolality so tew kakra pɛ a, w’akyi pituitary gland no dan OFF hormone Antidiuretic Hormone (ADH / Vasopressin) no, na ɛma w’asaabo tumi tow nsu a ɛyɛ mmerɛw a ɛyɛ crystal-clear lita pii gu.
8. Nanso, bere a apɔw-mu-teɛteɛ a emu yɛ den bere tenten, ɔhyew mu adwennwen, ɛyaw, akisikuru, nkate mu nhyɛso, ntini mu ɔfe (interleukin-6 [IL-6] a efi ntini a ɛyɛ adwuma mu), anaa MDMA ("Ecstasy") a wɔnom mu no, amemene no ma ADH** (**Syndrome of Inappropriate Antidiuretic Hormone secretion) kɛse bi non-osmotic surge [SIADH]) na ɛyɛ adwuma.
9. ADH a ɛkɔ soro yi kyekyere V2 receptors a ɛwɔ asaabo no mu nsu a ɛboaboa ano no mu, de Aquaporin-2 nsu kwan a ɛhyɛ asaabo no ma san twetwe nsu a ɛho nni hwee no nyinaa san kɔ mogya no mu bere a ɛtew nsu a ɛba no so ma ɛyɛ nsu a ɛyɛ den no.
10. Esiane sɛ nsu a wɔnom no akɔ mogya no mu a onni baabiara a wɔbɛkɔ nti, ɛma serum sodium fi mu yɛ mmerɛw ntɛmntɛm 140 mEq/L down to < 125 mEq/L wɔ nnɔnhwerew kakraa bi mu.

2. Amemene a Ɛyɛ Osmotic Swelling, Amemene Mu Ntini a Ɛyɛ Hu, ne Ayus-Arieff Ahurututu mu Edema¶

• Osmotic Water Shift into Astrocytes and Neurons: Esiane sɛ mprempren mogya a ɛwɔ nkwammoaa no akyi no yɛ hypotonic (a ɛyɛ mmerɛw) kɛse sɛ wɔde toto amemene mu nkwammoaa mu ho a, nsu de ahopere fa mogya-amemene akwanside no so fa Aquaporin-4 akwan so kɔ astrocytes ne neurons mu.
• Nea enti a Nsuo a ɛtɔ ntɛmntɛm (< Nnɔnhwerew 24) no di awu kɛse sen nea ɛtɔ bere tenten: Sɛ mogya mu sodium so tew nkakrankakra wɔ adapɛn pii mu (hyponatremia a enni sabea) a, amemene mu nkwammoaa wɔ ** nnɔnhwerew 48** a wɔde bɛbɔ potassium, chloride, ne organic osmolytes (glutamate, taurine, myo-inositol) a ɛwɔ nkwammoaa mu (glutamate, taurine, myo-inositol) asan akɔ fam. Sɛ mogya mu sodium so tew kɛse wɔ ** nnɔnhwerew 2 kosi 8** mu wɔ marathon, rave, anaa nsu a wɔnom akansi mu a, amemene no nni bere biara a ɛbɛma ayɛ nsakrae.
• The Unyielding Skull and Tentorial / Foramen Magnum Herniation: Esiane sɛ mpanyimfo ti nhwi yɛ nnompe adaka a ɛyɛ den nti, amemene mu nsu dodow a ɛkɔ soro 6% kosi 8% ma amemene mu nsu a ɛwɔ hɔ nyinaa sa. Intracranial pressure kɔ soro, ɛbubu amemene mu mogya ntini, na ɛkanyan generalized tonic-clonic seizures, na ɛhyɛ amemene a ahonhon no ma ɛkɔ fam fa foramen magnum a ɛwɔ ti nhwi no ase (brainstem herniation), a ɛbubu medullary respiratory center no na ɛma ɔhome.
• Neurogenic Non-Cardiogenic Pulmonary Edema (Ayus-Arieff Syndrome): Bere a nhyɛso a ɛwɔ atiridii mu no kɔ soro no, catecholamine ahum kɛse bi a ɛyɛ tema a ɛne ahurututu mu ntini a ɛma mogya fa mu a ɛkɔ soro ka ho no de nsu a ɛyɛ frothy pink (neurogenic pulmonary edema) hyɛ ahurututu no mu, na ɛde hypoxia a emu yɛ den a ɛma amemene no kɔ so ntɛmntɛm ba a ɛho ahonhon wɔ kyinhyia bɔne a edi awu mu.

Ayaresa mu Ntotoho: Nsu a Wɔbow (EAH) vs. Nsu a Ɛma Nnipa Yɛ Fɛ / Ɔhyew a Wɔbrɛ ne Ɔhyew a Wɔyɛ no Apɔw-mu-teɛteɛ¶

Fa mpa ho triage pon yi siw mfomso a edi awu a ɛne sɛ wode nsu a ɛnyɛ den anaa nkyene a ɛfata bɛma ɔyarefo a ɔwɔ hyponatremic no ano:

Nsɛm Anum a Asiane Kɛse a Ɛwɔ Nsu a Wɔnom Mu Ntɛmntɛm Ho¶

1. Wɔn a Wɔde Marathon, Agumadi Abiɛsa, Wɔn a Wɔnam Anamɔn, ne Asraafo (Apɔw-mu-teɛteɛ-Associated Hyponatremia) .¶

• Hena na Ɔwɔ Asiane Kɛse? Nea ɛyɛ nwonwa no, EAH taa ba wɔ wɔn a wotu mmirika denneennen a wɔde gye wɔn ani brɛoo (mmirikatu bere a ɛboro nnɔnhwerew 4), agumadifo mmea (nipadua mu nsu dodow a ɛyɛ ketewaa), wɔn a wɔnam fam wɔ Grand Canyon anaa anhweatam so mmeae a atwa yɛn ho ahyia, ne asraafo a wɔagye wɔn a wɔhyɛ wɔn ma wɔtu kwan wɔ kwan so a wodi afotu a ne bere atwam akyi sɛ "nom sɛnea wubetumi ansa na woate nka sukɔm de wɔn." Bere a mmirikatufo a wɔagye din wie wɔ nnɔnhwerew 2 mu na wɔnom nsa kakra no, mmirikatufo a ɔde nnɔnhwerew 5 tu mmirika a ogyina nsu gyinabea 20 no nyinaa na ɔnom nkuruwa abien wɔ gyinabea biara no betumi amene nsu lita 4 kosi 6 bere a fifiri lita 2 pɛ na ɔhwere no.
• Delayed Post-Race Collapse: Mmirikatufo pii wie mmirikatu no a wɔte nka sɛ wɔn ho ayɛ wɔn yaw kakra a nsu lita biako a wɔannye no da so ara te wɔn yafunu mu. Sɛ wogyae mmirikatu pɛ a, mogya san fi wɔn nan ntini mu kɔ wɔn aduan mu, ɛtwe saa yafunu mu nsu lita a aka no ntɛmntɛm kɔ mogya no mu na ɛkanyan akisikuru ne komayare simma 30 kosi 90 AKYI a wɔatwa awiei no.

2. Abɔnten Adwumayɛfo ne Afiewuranom Bere a Ɔhyew Asow ("Nsu a Ɛnyɛ Den Besi Fifiri Anan") .¶

Nnipa fifiri yɛ nkyene, bɛyɛ 40 kosi 60 mEq/L (0.9 to 1.4 grams/L) a ɛyɛ sodium. Sɛ ɔdan atifi adwumayɛfo, asase ho adwumayɛfo, kuayɛ adwumayɛfo, anaa adekoradan mu odwumayɛni fifiri fifiri lita 6 kosi 10 wɔ nnɔnhwerew 8 nsakrae mu 38 degrees Celsius (100.4 degrees Fahrenheit) ɔhyew na ɛde tap nsu a nkyene nnim si fifiri a nkyene wom lita biara ananmu a wonni nnuan a nkyene wom, wohu amane kɛse a wɔhwere nipadua mu sodium a wɔde ka ho ne nsu a ɛnyɛ hwee a wɔde ahyɛ mu. - Ntini mu Akisikuru Yɛ Kɔkɔbɔ Nsɛnkyerɛnne #1: Sodium a wɔde hyɛ mu ntɛm no ma ɛyɛ yaw ɔhyew a ɛyɛ yaw wɔ anantwi mma, asen, ne yafunu mu. Sɛ odwumayɛni no kyerɛ saa akisikuru no ase sɛ "Ɛsɛ sɛ menom nsu a ɛnyɛ den galɔn foforo" a, wonya nkɔso ntɛmntɛm fi ɔhyew mu akisikuru mu tẽẽ kɔ hyponatremic encephalopathy ne akisikuru.

3. MDMA ("Ecstasy" / "Molly") ne Nnwom Afahyɛ Nsu a Wɔnom¶

MDMA (3,4-methylenedioxymethamphetamine) yɛ nneɛma a ano yɛ den sen biara a ɛkanyan hyponatremia a emu yɛ den a ekum nnipa no mu biako, na ɛka mmebaa (mfe 15 kosi 30) wɔ kɔnsɛt, raves, ne club ahorow mu wɔ ɔkwan a ɛnsɛ so: - MDMA kanyan hypothalamic serotonergic akwan tẽẽ ma ɛma Antidiuretic Hormone (ADH / Vasopressin) a ɛkɔ soro kɛse, a ɛkyɛ, na ɛto tumi a asaabo no tumi yi nsu a enni mu ** nnɔnhwerew 12 kosi 24** no ano koraa. - Bere koro no ara mu no, MDMA ma ano yɛ kusuu, anom a ɛyɛ den (bruxism), hyperthermia, ne central psychogenic sukɔm, bere a atipɛnfo ka kyerɛ nea ɔde di dwuma no sɛ "nom nsu pii sɛnea ɛbɛyɛ a worenyɛ hyew dodo." - Sɛ obi nom nsu 1.5 kosi 3 lita mpo bere a woanom MDMA aduru biako awie a, ebetumi ama mogya mu sodium akɔ fam asen 115 kosi 120 mEq/L, na ama amemene mu ayɛ mmerɛw ntɛmntɛm, status epilepticus, ne amemene mu awu.

4. Nkokoaa Nsu a Wɔnom (Nkokoaa a wonnii Asram 6) .¶

ƐNSƐ sɛ wɔma nkokoaa a wonnii asram 6 nsu a ɛnyɛ den DA, na ɛnsɛ sɛ wɔde nsu foforo hyɛ nkokoaa aduannuru mu DA na ama "atrɛw" aduannuru toa bi mu anaasɛ ɛbɛma akokoaa ayɛ nwini wɔ awɔw bere mu: - Akokoaa a wɔawo no foforo anaa kumaa wɔ asaabo a ennyinii a glomerular filtration rate sua a entumi nyi nsu a ɛnyɛ hwee adesoa mfi mu ntɛmntɛm, a nipadua mu nsu dodow ketewaa bi ka ho. - Sɛ wode nsuo a ɛnyɛ den** ma akokoaa a wadi asram 3 **nsuo a ɛnyɛ den 120 kɔsi 240 mL (ounces 4 kɔsi 8) mpo, anaasɛ wode nsuo scoop mmienu ka ho ma formula powder scoop baako biara wɔ nnɔnhwereɛ 24 mu a, ɛma akokoaa no serum sodium so tew ntɛmntɛm kɔ fam 120 mEq/L. - Nkokoaa Kɔkɔbɔ Nsɛnkyerɛnne: Nipadua mu hyew a ɛkɔ fam (hypothermia a ɛba fam sen digrii Celsius 36.1 [digrii Fahrenheit 97]), anim ne aniwa a ɛyɛ hyew, abufuw anaasɛ ɔbrɛ kɛse, ɔfe, ne afebrile generalized seizures mpofirim.

5. Nsu a Wɔnom Akansi, Hazing, Nnuru a Wɔde Sɔ Nsu Mu Ho Hohoro, ne Psychogenic Polydipsia¶

Nsu a wɔmene 4 kosi 8+ lita (galɔn 1 kosi 2+) wɔ nnɔnhwerew 1 kosi 3 mu, sɛ́ ɛyɛ onuayɛ hazing amanne bi mu, radio/intanɛt so nsu a wɔnom akansi mu, mmɔden a wɔbɔ sɛ "wɔbɛhohoro" adwumam nnubɔne a wɔde hwɛ nsu mu nsu mu, anaasɛ adwenemhaw a emu yɛ den a wɔde hyɛ asaabo mu no so no, bunkam asaabo a ɛwɔ apɔwmuden koraa mpo so 800 to 1,000 mL/hour excretion ceiling, a ɛde amemene mu akisikuru a edi awu a emu yɛ den ba ansa na asaabo no atumi akɔ so.

Ayaresabea ne Mfuw mu Ayaresa Ho Nhyehyɛe a Ɛyɛ Pɛ¶

1. Sikakɔkɔɔ-Gyinapɛn Aduru a Wɔde Sa Mmene Mu Yare a Ɛyɛ Hu: 100 mL Bolus of 3% Hypertonic Saline (3% NaCl) .¶

Sɛ ɔyarefo bi de symptomatic acute hyponatremic encephalopathy (adwene mu naayɛ, adwenem naayɛ, ahodwiriw, ataxia, ɔfe a emu yɛ den, coma, akisikuru, anaa neurogenic pulmonary edema) ba a, simma biara ho hia. Nsu a ɛyɛ isotonic a wɔahyɛ da ayɛ ( .0.9% Normal Saline, a ɛwɔ 154 mEq/L of sodium) yɛ wɔbara efisɛ sɛ ADH a ɛdɔɔso wɔ hɔ a ( .SIADH), asaabo no tumi yi 154 mEq sodium a ɛkɔ nsu a ɛwɔ osmolality kɛse mu bere a ɛkora nsu no so (desalination phenomenon), na ɛma amemene no ho ahon kɛse.

Mmom no, 3% Hypertonic Sodium Chloride ( .3% NaCl) wɔ 513 mEq/L sodium ( .1,026 mOsm/L), a ɛboro nnipa mogya mu osmolality mmɔho abiɛsa na ɛboro dodow a ɛsen biara a onipa asaabo biara betumi ayɛ da:

1. Ntɛm ara Bolus 1 (100 mL anaasɛ 150 mL firi 3% NaCl):
2. Fa 100 mL 3% Hypertonic Saline IV gu mu wɔ simma 10 mu (Europa/U.S. akwankyerɛ nso ma kwan ma 150 mL wɔ simma 20 mu; wɔ mmofra ne nkokoaa mu no, fa 2 kosi 3 mL/kg a ɛyɛ 3% NaCl [ɛkɔsi 100 mL] gu mu simma 10 kosi 15).
3. Peripheral IV Line Rule: Ntwentwɛn 3% Hypertonic Saline ase da mfa nhyɛ ntini a ɛwɔ mfinimfini no mu. A 100 mL bolus a ɛyɛ 3% NaCl yɛ nea ahobammɔ wom koraa sɛ wɔde bɛhyɛ mu denam peripheral IV line anaa intraosseous (IO) needle biara a wɔahyɛ da ayɛ so.
4. Tia Boluses no mu wɔ Simma 10 ntam (Ɛkɔsi Boluses nyinaa 3):
5. Sɛ adwene mu naayɛ, ɔbrɛ, anaa akisikuru no nnyaa nkɔsoɔ pefee wɔ simma 10 akyi wɔ bolus a ɛdi kan no akyi a, fa 4 100 mL IV bolus a ɛtɔ so mmienu a 3% NaCl wom wɔ simma 10 mu, na sɛ ɛho hia a, fa 100 mL bolus a ɛtɔ so mmiɛnsa ma wɔ simma 10 akyi.
6. Nea Enti a Wɔma Serum Sodium Kɔ soro denam Just so 4 to 6 mEq/L Gye Amemene no:
7. Ɛho nhia sɛ ƐNYƐ sɛ wobɛma ɔyarefo bi serum sodium so afi 115 mEq/L kwan no nyinaa san kɔ 140 mEq/L wɔ dɔnhwerew a edi kan no mu.
8. Sɛ wɔma serum sodium dodow kɔ soro 4 kosi 6 mEq/L pɛ wɔ simma 30 kosi 60 a edi kan no mu a, ɛma osmotic gradient ba ntɛm ara fa mogya-amemene akwanside no so a ɛtwe nsu a ɛdɔɔso fi amemene no mu ma tew intracranial pressure so ɔha biara mu nkyem 50, na ɛma akisikuru no gyae na ɛdan amemene no mu ntini a ɛreba no akyi wɔ simma kakraa bi mu.
9. Emergency Substitution sɛ 3% NaCl Bags Nni Ntɛm ara wɔ Crash Cart no so a (8.4% Sodium Bicarbonate Ampules):
10. Wɔde 8.4% Hypertonic Sodium Bicarbonate (50 mL = 50 mEq of Na+ = 1,000 mEq/L) yɛ hypertonic mmɔho abien sen 3% NaCl. Sɛ ɔyarefo bi reyɛ nnam sɛ ɔregye anaasɛ ɔrebɔ herniating afi acute hyponatremia mu na nnurutɔnbea no nnya nkɔɔ soro a 3% NaCl bag, a wɔde 50 mL (1 ampule) 8.4% Sodium Bicarbonate IV gu mu simma 5 kosi 10 ma wonya saa ara pɛpɛɛpɛ 50 mEq osmotic sodium nkwagye adesoa sɛ 100 mL of 3% NaCl.

2. Nsonsonoe a Ɛho Hia: Acute ( .< 48 Hours) vs. Chronic (> Nnɔnhwerew 48) Nteɛso Anohyeto ne Osmotic Demyelination Syndrome (ODS) .¶

Siw a Wosiw Ano: Nsu a Wɔde Ma a Egyina Adanse So a Ɛfa Boasetɔ Apɔw-mu-teɛteɛ ne Ɔhyew Asorɔkye Ho¶

1. Nom Kosi Sukɔm, Mma "Nni Sukɔm Nni"**: Amanaman Ntam Apɔw-mu-teɛteɛ-Associated Hyponatremia Consensus Development Conference ne Wilderness Medical Society si so dua sɛ nnipa nipadua mu sukɔm ne bere ankasa mu akwankyerɛ a ahobammɔ wom, ɛyɛ pɛpɛɛpɛ sen biara a ɛfa nsu a wohia ho wɔ mmirikatu, akwantu, ne agumadi mu. Nsã a wɔnom wɔ nhyehyɛe a wɔhyɛ mu ("nkuruwa 2 simma 15 biara") ne ade titiriw a ɛde EAH ba.
2. Hu Wo Fifiri Ceiling (400 to 800 mL/hour): Mmirikatufo ne akwantufo dodow no ara a wɔde gye wɔn ani no nhia nsu a ɛboro 400 kosi 800 mL (13 kosi 27 ounces) dɔnhwerew biara bere a wɔreyɛ apɔw-mu-teɛteɛ, na ɛnsɛ sɛ woma wɔn mu duru yɛ kɛse da bere a wɔretu mmirika anaa wɔretu kwan no.
3. Bere nyinaa fa Nsuo ne Aduane mu Nkyene Bom Bere a Ɔhyew ne Nantew Tenten: Ɛsɛ sɛ abɔnten so adwumayɛfo ne wɔn a wɔnam fam a fifiri kɛse bɛboro nnɔnhwerew 2 kosi 3 di Nneɛma a nkyene wom (pretzels, nnuadewa a wɔde nkyene ayɛ, krak, pickles, broth, anaa nkyene a ɛkari pɛ a wɔde ma anom nsu) wɔ nsu ho, da nsu a ɛnyɛ den lita biako nkutoo.
4. MDMA / Afahyɛ Harm Reduction: Nnom nsuo a electrolyte wom bɛboro 250 kɔsi 500 mL (kuruwa 1 kɔsi 2) dɔnhwerew biara da berɛ a woresaw wɔ baabi a ɛhɔ yɛ hyeɛ, na sɛ tiyɛ, akisikuru, anaa adwene mu naayɛ ba a, hwehwɛ aduruyɛ ntɛm ara.

Mpɔtam hɔ ntɛmpɛ nɔma ne adwumakuw no nhyehyɛe ahorow¶

Nsɛm a wɔtaa bisa¶

So Gatorade anaa agumadi mu anonne a wɔde di gua a wɔnom no nsiw nsu a wɔnom (hyponatremia) ano bere a wɔretu mmirika kɛse anaa ɔhyew a ɛretu no?¶

Dabi, nnipa mogya a wɔtaa de di dwuma no kura sodium bɛyɛ 140 mEq/L, bere a agumadi mu anonne dodow no ara a wɔtɔn no wɔ sodium 18 kosi 20 mEq/L pɛ. Ɛno kyerɛ sɛ agumadi mu anonne a wɔtɔn da so ara yɛ hypotonic (nsu a nkyene nnim) ɔha biara mu nkyem 85 sɛ wɔde toto wo mogya ho a. Sɛ mmirikatufo anaa obi a ɔyɛ adwuma wɔ abɔnten nom agumadi mu anonne dodow a ɛboro so ntɛmntɛm sen sɛnea ne ho fifiri retu ne nea ɔretotɔ, titiriw bere a Antidiuretic Hormone (ADH) a wɔde mmɔdenbɔ ba no mma wɔn asaabo ntumi nyi nsu mfi mu no a, wɔn mogya mu sodium bɛda so ara akɔ fam akodu asiane mu. Sɛ́ wobesiw hyponatremia a ɛba bere a apɔw-mu-teɛteɛ mu no ano no hwehwɛ sɛ wɔnom nsa sɛnea sukɔm te (ɛnyɛ sɛ wɔnom boro so) na wɔnom nkyene a ɛfata wɔ aduan mu wɔ mmɔden a wɔbɔ bere tenten mu.

Mɛyɛ dɛn ahu wɔ mmirikatu mmirikatu awiei anaa ɔkwan a wɔfa so nantew so sɛ obi wɔ nsu a wabow nsa (hyponatremia) ne nsu a ɛho ayɛ fĩ?¶

Hwɛ nsɛnkyerɛnne abiɛsa a ɛnyɛ den ansa na wode nsu biara ama: (1) Nsu a ɔnom ne ne mu duru: Obi a wabow nsu no anom nsa pii wɔ nsu gyinabea biara na ne mu duru akɔ soro (anaasɛ wakɔ so ayɛ kɛse) a ne yafunu ayɛ kurukuruwa na ayɛ mmerɛw, bere a obi a nsu nnim no nom nsa kakraa bi dodo na ne mu duru so tew (2) The Tight Ring / Watchband Sign: Nsu a obi bow nsa ma nsateaa ne nsateaa hohoro na ɛho ahonhon wɔ baabi a nkaa ne dɔn te nka mpofirim sɛ ɛyɛ den, bere a nsu a ɛho ayɛ fĩ ma tɛkrɛma yɛ kusuu na aniwa a akɔ fam; ne (3) Adwene mu tebea: Nsu a ɛho ntew anaasɛ ɔhyew a ɛyɛ mmerɛw ma obi brɛ na ne ho popo bere a ogyina hɔ no, bere a nsu a obi bow no ma ne ti yɛ no yaw kɛse, ɔfe a ɛpae, adwene tu fra, hintidua, ne akisikuru.

Dɛn nti na asiane wom sɛ wɔbɛma akokoaa a onnii asram 6 nsu a ɛnyɛ den anaasɛ aduan a wɔde nsu gu mu?¶

Nkokoaa a wonnii asram 6 no wɔ asaabo a ennyinii a entumi yi nsu a ɛnyɛ den pii mfi mu ntɛmntɛm, na wɔn nipadua nketenkete no kura sodium a ɛyɛ pɛ no kakraa bi pɛ. Sɛ wɔde nsu a ɛnyɛ den ɔuns kakraa bi mpo ma akokoaa, anaasɛ wɔde nsu foforo ka akokoaa aduan a wɔde powder ayɛ mu a, ɛma sodium a ɛwɔ akokoaa no mogya mu no yɛ mmerɛw ntɛmntɛm. Wɔ nnɔnhwerew kakraa bi mu no, nsu kɔ akokoaa no amemene mu nkwammoaa mu, na ɛma nipadua no hyew so tew (a ɛba fam sen digrii Celsius 36.1 / digrii Fahrenheit 97), n’anim ho popo, ɔbrɛ, ɔfe, ne hyponatremic akisikuru a ɛde ne nkwa to asiane mu. Ɛsɛ sɛ nkokoaa a wonnii asram 6 ma wɔn nufusu anaa nkokoaa aduan a wɔtaa de di dwuma a wɔafra no yiye nkutoo.

Dɛn nti na MDMA ("Ecstasy" anaa "Molly") ma obi bow nsu a edi awu bere a wanom nsu nkotoku kakraa bi pɛ akyi?¶

Mpɛn pii no, sɛ wonom nsu lita biako anaa abien foforo a, w’amemene no gyae Antidiuretic Hormone (ADH) a ɛreyi no na w’asaabo no tow nsu a ɛboro so no gu wɔ dɔnhwerew biako mu. MDMA de nnuru kanyan hypothalamus no ma ɛma ADH a ɛkɔ soro kɛse a ɛkɔ so a ɛto asaabo no mu nnɔnhwerew 12 kosi 24 ma enti wontumi ntow nsu a enni mu. Bere koro no ara mu no, MDMA ma nipadua no hyew kɔ soro na ɛma sukɔm dee kɛse. Sɛ obi a ɔde di dwuma nom nsu nkotoku pii ma ne ho dwo a, saa nsu no mu ɔha biara mu nkyem 100 kɔ so tra wɔn mogya mu, na ɛma amemene no hohoro ntɛmntɛm, akisikuru, ne amemene no mu ntini a ɛyɛ mmerɛw.

Nsonsonoe bɛn na ɛwɔ nsu a wɔabow a emu yɛ den a wɔsa (< 24 hours) and chronic low sodium (> nnɔnhwerew 48)?¶

Wɔ nsu a wɔnom denneennen mu (baabi a mogya mu sodium so tew bɛboro nnɔnhwerew kakraa bi wɔ mmirikatu a ɛyɛ den, rave, anaa nsu a wɔnom akansi mu) mu no, amemene mu nkwammoaa nnyaa bere mfa nyɛ nsakrae, enti asiane a ɛwɔ hɔ ntɛm ara ne amemene no a ɛho ahonhon a edi awu ne akisikuru. Nnuruyɛfo de 3% Hypertonic Saline 100 mL boluses a wɔde fa ntini mu ma ntɛmntɛm na ama mogya mu sodium akɔ soro ntɛmntɛm 4 kosi 6 mEq/L na ama amemene no asan atew akɔ fam, na ɛkame ayɛ sɛ asiane biara nni ho sɛ ɛbɛma amemene no ayɛ demyelination. Nea ɛne eyi bɔ abira no, sɛ obi nya sodium a ɛba fam a enni sabea nkakrankakra wɔ nna anaa adapɛn pii mu (efi nsu mu nnuru, komayare, anaa mmerɛbo mu yare mu) a, n’amemene mu nkwammoaa ayɛ nsakrae dedaw; bere a nnuruyɛfo da so ara de hypertonic bolus a edi kan a ɛyɛ 4 kosi 6 mEq/L ma sɛ ɔyarefo no renya akisikuru a, ɛsɛ sɛ wɔde sodium a ɛkɔ soro nyinaa toto so katee a ɛnboro 6 kosi 8 mEq/L nnɔnhwerew 24 biara na wɔasiw Osmotic Demyelination Syndrome (ODS) ano.

Akwankyerɛ ahorow a ɛfa ho¶

• Heat stroke vs. heat exhaustion: Sɛnea wobehu nsonsonoe a ɛwɔ mu
• Ɔhyew yare mmoa a edi kan ne onwini a ɛba ntɛmntɛm
• Potassium ho ntɛmpɛ a ɛho hia: Hyperkalemia ne hypokalemia
• Seizure mmoa a edi kan ne ahobammɔ
• Status epilepticus, akisikuru a ɛkyɛ, ne nnuru a wɔde gye nkurɔfo nkwa

Fibea ne aban akwankyerɛ¶

• Amanaman Ntam Apɔw-mu-teɛteɛ a Ɛfa Apɔw-mu-teɛteɛ Ho Nkɔso Nhyiam: Amanaman Ntam Nkɔso Nhyiam a Ɛto so Abiɛsa a Ɛfa Apɔw-mu-teɛteɛ a Ɛbata Ho (Clinical Journal of Sport Medicine).
• Wilderness Medical Society (WMS): Ayaresabea Dwumadie Akwankyerɛ a ɛfa Hyponatremia a ɛbata apɔmuden ho no ho dwumadie ho: 2019 Update.
• European Society of Intensive Care Medicine (ESICM) & European Society of Endocrinology: Ayaresa mu Nneyɛe Akwankyerɛ a ɛfa Hyponatraemia a Wohu ne Nea Wɔsa Ho.
• Amerika Mmofra Ayaresa Sukuu (AAP): Nkokoaa Aduandi ne Nsu a Wɔnom a Wɔnom ne Hyponatremic Seizures a Wosiw Ano wɔ Nkokoaa Mu.
• Centers for Disease Control and Prevention (CDC / NIOSH): Ahwehwɛdeɛ a ɛfa Gyinapɛn a Wɔkamfo Kyerɛ: Adwumayɛ mu Ɔhyeɛ ne Ɔhyeɛ a Wɔde Siw Ano (Electrolyte Replacement ne Hyponatremia Prevention).

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Saa akwankyerɛ yi yɛ nsɛm a wɔde ma na ɛnsi adwumayɛfoɔ aduruyɛ mu nhwehwɛmu anaa ayaresabea hwɛ a wɔhwɛ ntɛm so ananmu. Esiane sɛ hyponatremia ne ɔhyew a ɛba bere a apɔw-mu-teɛteɛ mu ba no betumi ama obi adwene atu afra ntɛmntɛm na wayɛ basaa nti, yɛhyɛ nyansa denneennen sɛ fa sare so anaa mmoa a edi kan ne CPR adesua a wɔahyɛ da ayɛ a wɔagye atom denam International Federation of Red Cross and Red Crescent Societies (IFRC), wo man Red Cross fekuw, St John Ambulance, anaa mpɔtam hɔfo a ɔwɔ adansedi krataa so.