Ji dɔlɔmin, farikoloɲɛnajɛ min bɛ sɔrɔ farikoloɲɛnajɛ fɛ, ani kunsɛmɛ funu ni sodiyɔmu dɔgɔman ye¶

Ji minni nafa ka bon ɲɛnamaya ma, o bɛɛ n’a ta, ni aw ye ji gansan min kojugu walima farikoloɲɛnajɛ minfɛn minnu natirili ka dɔgɔn, olu min teliya la ka tɛmɛ hadamaden sugunɛw kan, o bɛ kɛ sababu ye ka acute dilution hyponatremie ("ji dɔlɔmin") lase mɔgɔ ma, o ye furakɛli kɔrɔtɔlen ye min bɛ mɔgɔ faga joona, natirili hakɛ bɛ joli la (Na+) bɛ jigin kosɛbɛ 135 mEq/L (mmol/L) duguma (ani a ka ca a la a bɛ 120 fo 125 mEq/L duguma), o bɛ ji tɛmɛnen wajibiya ka joli-sɔgɔsɔgɔninjɛ barika tigɛ ka taa a yɛrɛ la ka don kunsɛmɛnasumaya fɛ. Ni kunsɛmɛnasumaya bɛ funu kolotuguda gɛlɛn kɔnɔ, min tɛ wuli (acute hyponatremic cerebral edema / encephalopathy), banabagatɔw bɛ kungolodimi sɔrɔ min bɛ wuli, kɔnɔboli, fɔɔnɔ projectile, funu, bolow ni senw bɛ funu, hakili ɲagami, kɛwale kabakomaw, balansi sennasumaya, seizures tonic-clonic generalisées, herniation de la brainstem, neurogénique fogonfogon la kirinni, ani saya.

Jiko jugumanba bɛ kulu duuru de minɛ minnu tɛ kelen ye: (1) maraton bolilaw, ultramaraton bolilaw, triathletes, taamakɛlaw, ani sɔrɔdasi minnu bɛ don a la minnu bɛ ji min jidagayɔrɔ bɛɛ la "ka kɔn minnɔgɔ ɲɛ" (Exercise-Associated Hyponatremia [EAH]) (2) kɛnɛma jɔli, foro, ani izini baarakɛlaw ka ji jɛlen litiri caman min samiyɛ funteni waatiw la; . (4) denmisɛn minnu si tɛ kalo 6 bɔ ni ji jɛlen di u ma walima den ka dumunikɛminɛn min dilannen don kojugu; ani (5) ji minni gɛlɛyaw ɲɛɲinibagaw walima banabagatɔ minnu bɛ ni hakiliɲagami polidipisi ye. Ni mɔgɔ min tun bɛ ji caman min, ni hakili ɲagamina, ka sennatiɲɛ, fɔɔnɔ, walima ka kirin, aw bɛ aw ka sigida kɔrɔtɔko nimɔrɔ wele (911 Ameriki ni Kanada, 112 Erɔpu tɔnba bɛɛ kɔnɔ, 999 Angletɛri) an ka kɔrɔtɔko nimɔrɔw ɲɛbilasɛbɛn o yɔrɔnin bɛɛ, ka segin a kan funteni sɔgɔli vs funteni sɛgɛn, . funteni bana dɛmɛ fɔlɔ, ani kɔnɔboli dɛmɛ fɔlɔ.

Aw bɛ o kɛ sisan¶

1. AW KA JI NI JI MIN BƐƐ DƆGƆ YƆRƆBƆLI: Fili kelen min bɛ mɔgɔ faga maraton sira kan, taama sira kan, sɔrɔdasi taama sira kan, walima baarakɛyɔrɔ funteniman kan, o ye k’a miiri ko farikoloɲɛnajɛla walima baarakɛla min ɲɛnaminilen don, a kɔnɔnafililen don, a hakili ɲagamina” ani ka u wajibiya ka ji caman min walima ka IV drip normal-saline/hypotonic daminɛ. Ni a tigi tun bɛ ji caman min, ni sugunɛ jɛlen don walima ni a fununa, walima ni a farikolo girinya ma dɔgɔya, aw bɛ ji gansanw, farikoloɲɛnajɛ minfɛnw, ani ji minnu bɛ kɛ ni farikolojidɛsɛ ye, olu bɛɛ bali joona.
2. Aw bɛ telefɔni 911 / 112 / 999 wele joona ni hakiliɲagami taamasiɲɛw bɛ a la: Aw bɛ dɔgɔtɔrɔso kɔrɔtɔlenw wele joona ni kungolodimi bɛ ka juguya ka taa a fɛ, ni fɔɔnɔ segin-segin, hakili ɲagami, hakili ɲagamina, kuma gɛlɛn, senna-tɛgɛrɛ (ataxia), farikolojidɛsɛ, sɛgɛn, walima kirinni. Aw bɛ a fɔ ciden ni kɛnɛyabaarakɛlaw ye u ka sigasiga Acute Exercise-Associated Hyponatremia (Water Intoxication) ni Cerebral Edema ye walasa u kana boli teliya la IV standard jilama foroko kɔnɔ sira kan.
3. Aw bɛ kɔgɔ caman kɛ da la (hypertonic) DƆRƆN ni a tigi kununna ka ɲɛ, ni a kɔrɔtɔlen don, ani ni taamasiɲɛ fɔlɔw bɛ a la: Kungo kɔnɔ, maraton, walima foro kɔnɔ, mɔgɔ sigalen don EAH misɛnni na (kɔnɔnafili, kungolodimi, bolokɔnincininw wulilen, minni tɛmɛnen tariku) ani ni a kɛmɛsarada la 100 kununna, a ɲɛsinnen don, ani a bɛ se ka a munumunu lafiya la k’a sɔrɔ fɔɔnɔ ma kɛ, Wilderness Medical Society (WMS) ani International EAH Consensus ka laadilikanw b’a fɔ ko aw ka kɔgɔ doni dawolo la di: bulon kubɛ 3 fo 4 min bɛ kɛ ji mililitiri 120 (tase tilancɛ / onsi 4) la, walima kɔgɔlen pretzel/kɔgɔ pake 2 fo 3 ni ji fitini dɔ ye. Aw kana foyi di a da la abada ni a tigi hakili ɲagamina, ni sunɔgɔ bɛ a la, ni fɔɔnɔ bɛ a la, walima ni a bɛ a minɛ.
4. Aw bɛ "Tight Ring / Watchband Sign" lajɛ ani ka sugunɛ jɛlen kɛ: Aw bɛ a tigi bolokɔnincininw, a bolokɔniw ani a senkɔniw lajɛ. A tɛ i n’a fɔ farikolojidɛsɛbagatɔ (min fari jalen don, a ɲɛw bɛ jigin, ani a sugunɛ ye amber dibi ye), ji minna mɔgɔ min na, a ka ca a la, a bolokɔnincininw bɛ funu, u bɛ funu yɔrɔ minnu na bololanɛgɛw walima kɔlɔsilikɛminɛnw bɛ barika sɔrɔ yɔrɔ minnu na, kɔnɔbara bɛ funu ka sɔgɔsɔgɔ, a girinya bɛ caya kabini a ye farikoloɲɛnajɛ daminɛ, ani a bɛ to ka koli kɛ walima ka koli jɛlen kɛ.
5. Aw bɛ fiɲɛbɔyɔrɔ lakana fɔɔnɔ ni kirinni waatiw la: Sugunɛ funu juguman bɛ fɔɔnɔ barikama bila mɔgɔ la min bɛ se ka bɔn ani ka fɔɔnɔ tonic-clonic generalized. Aw bɛ sunɔgɔbagatɔ, hakili ɲagaminen, walima mɔgɔ minɛlen dɔ bila u kɛrɛ fɛ a kɛnɛyacogo la walasa fɔɔnɔ ka bɔ da la sanni ka don fogonfogon la.
6. Aw bɛ dɔgɔtɔrɔso walima furakɛli fanibugu min bɛ a sɔrɔ, aw bɛ o lasɔmi walasa ka 3% Hypertonic Saline (3% NaCl): Banabagatɔ o banabagatɔ min bɛ ni kunsɛmɛnasumaya ye min bɛ wele ko hyponatremique (hakilijagabɔ, kɔma, kirinni, walima ninakilidegun), fura min bɛ mɔgɔ kisi teliya la, o ye bolus intravenous in 100 mL of 3% Hypertonic Sodium Chloride (3% NaCl) pikiri kɛ miniti 10 kɔnɔ, ka segin a kan fo siɲɛ fila wɛrɛ miniti 10 ni ɲɔgɔn cɛ fo ka se hakiliɲagami taamasiɲɛw ma.

Desizɔn jiri : Ji minta (EAH) ni farikolojidɛsɛ ni funteni sɔgɔli danfara¶

flowchart TD
    Start["Fɛnɲɛnɛmakɛla, taamakɛla, Baarakɛla, Rave Attendee, walima Denmisɛnnin min bɛ bin, min hakili ɲagamina, walima min bɛ fɔɔnɔ"] --> CheckHistory["Aw bɛ ji minta tariku jateminɛ: Yala mɔgɔ tun bɛ ji/spor minfɛnw hakɛ caman min (walima furakisɛ min dilannen don denmisɛnniw na) wa?"]

    CheckHistory --> VitalsCheck["Aw bɛ Core Temperature (Kɔnɔbara basigilen ni funteni sigalen don) ani Point-of-Care Blood Sodium (Na+) lajɛ ."]

    VitalsCheck -->|Core Temp > 40 C (104 F) + CNS Delirium| HeatStroke["Farikoloɲɛnajɛ funteni: teliya la jisuma-ji su ji la nɛnɛ fɔlɔ; Aw bɛ Serum Na+ lajɛ sani aw ka IV jilama bololanɛgɛ belebelebaw di"]

    VitalsCheck -->|Blood Sodium (Na+) < 135 mEq/L (Often < 125 mEq/L) OR Clinical Clues of Overhydration (Weight Gain, Tight Rings, Sloshing Stomach)| EAH_Severity{"Aw bɛ farikolojidɛsɛ jugumanba jateminɛ"}

    EAH_Severity -->|SEVERE: Confusion, Delirium, Obtundation, Ataxia, Seizures, Coma, or Pulmonary Edema (Hyponatremic Encephalopathy)| Give3Percent["ƝƐNAMAYA KISI TƆGƆN:\n1. Da kɔnɔ/Hypotonic ji bɛɛ dantigɛ\n2. Aw bɛ 3% Hypertonic Saline (3% NaCl) IV Bolus mililitiri 100 kɛ miniti 10 kɔnɔ (militiri 2/kg denmisɛnw na)\n3. Aw bɛ segin mililitiri 100 kan NaCl 3% Bolusi la miniti 10 o miniti 10 (Fo ka se boloci bɛɛ lajɛlen 3 ma) fo ka se kirinni/delirium jɔli ma ani ka Na+ wuli ni mililitiri 4 fo 6 ye"]

    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{"Aw bɛ waatibolodacogo sɛgɛsɛgɛ: A jugumanba (< Lɛrɛ 24-48) ni A basigilen (> Lɛrɛ 48) Hponatrémie"}
    AcuteVsChronic -->|Acute Water Intoxication / EAH / MDMA (< 24-48h)| RapidSafe["Ladili teliya la ni 4-6 mEq/L ye lɛrɛ fɔlɔ la, o ye LAfiya ye, wa a wajibiyalen don walasa ka kunsɛmɛnasumaya bali (ODS farati fitinin don a daminɛ jugumanba la tiɲɛ na)"]
    AcuteVsChronic -->|Chronic Hyponatremia (> 48h: Diuretics, Heart/Liver Failure, Chronic SIADH)| CapRate["4-6 mEq/L Kisili Bolus fɔlɔ kɔfɛ ka ɲɛsin kirinni ma, ka soja bɛɛ lajɛlen wuli ka se <= 6 ka se 8 mEq/L ma Lɛrɛ 24 kɔnɔ walasa ka Osmotic Demyelination Syndrome (ODS) bali"]

Banakisɛfagalanw: Mun na ji tɛmɛnen bɛ kɛ sababu ye ka kunsɛmɛ funu ani mun na sugunɛ tɛ a koli dɔrɔn¶

Adamaden sugunɛ kɛnɛman min bɛ lafiɲɛbɔ la, o bɛ se ka ji fu bɔ fo ka se mililitiri 800 fo 1000 ma (litiri 1 ɲɔgɔn) lɛrɛ kelen kɔnɔ**. O bɛ ɲininkali jɛlen dɔ lawuli: ni farikoloɲɛnajɛla, taamakɛla walima selikɛla dɔ bɛ ji litiri 1,0 fo 1,5 min lɛrɛ kɔnɔ, mun na u sugunɛ tɛ koli kɛ dɔrɔn ka bɔ ji wɛrɛ la?

1. "Double Hit" fɛɛrɛ: Ji tali kojugu + ADH bɔli min tɛ osmotiki ye (SIADH) .¶

Exercise-Associé Hyponatrémie (EAH), funteni ji minni, ani MDMA-induite hyponatremie, farikoloko fila bɛ kɛ waati kelen tigitigi la:

1. Hit 1: Hypotonic Fluids (J walima Spor minfɛnw) dunni kojugu:
2. Adamaden joli la min bɛ kɛ cogo la, soja hakɛ bɛ se 135 fo 145 mEq/L (mmol/L).
3. Pompi walima buteliji gansan natiri 0 mEq/L bɛ sɔrɔ a la.
4. Jagokɛla ka farikoloɲɛnajɛ minfɛnw (i n’a fɔ Gatorade, Powerade, walima Lucozade Sport) natiri bɛ 18 fo 20 mEq/L dɔrɔn de la, o kɔrɔ ye ko farikoloɲɛnajɛ minfɛn ye hali bi ji sanuman kɛmɛsarada la 85 ye kɔgɔ tɛ min na ni i y’a suma ni hadamaden joli ye.
5. O la, jagokɛla ka farikoloɲɛnajɛ minfɛn litiri caman minni maraton walima funteni waati la TƐ se ka natirili dɔgɔyali bali; tiɲɛ na, farikoloɲɛnajɛ minfɛn caman minni bɛ joli la soja dilan teliya la i n’a fɔ ji gansan.
6. Hit 2: Sugunɛbilenni fura (Arginine Vasopressin / ADH) bɔli ma bɛn, o bɛ sugunɛw datugu:
7. A ka ca a la, ni aw ye ji caman min dɔrɔn ani ni aw ka joli-sira-funu dɔgɔyara dɔɔni, aw kɔfɛla sɔgɔsɔgɔninjɛ bɛ OFF ɔrimɔni Antidiurétique Hormone (ADH / Vasopressin) wuli, o bɛ a to aw sugunɛ bɛ sugunɛ dilu litiri caman fili.
8. Nka, farikoloɲɛnajɛ gɛlɛn kuntaalajan, funteni degun, dimi, kɔnɔboli, dusukunnataw degun, farikolo funu (interleukin-6 [IL-6] bɔli farikolo yɔrɔw la), walima MDMA ("Ecstasy") dunni, hakili bɛ ADH** (Syndrome of Inappropriate Antidiuretic Hormone secretion) camanba bɔ [SIADH]) ye baara kɛ.
9. O ADH jiginni in bɛ siri V2 minɛbagaw bɛ sugunɛ lajɛyɔrɔw la, ka Aquaporin-2 jibolisiraw don a kɔnɔ minnu bɛ sugunɛw wajibiya ka ji hɔrɔnma bɛɛ minɛ kokura ka segin joli la ka sɔrɔ ka sugunɛ bɔli dɔgɔya ka se sugunɛ caman ma.
10. Ni a sirilen don joli kɔnɔ, a tɛ taa yɔrɔ min na, ji minta bɛ serum soja bɔ joona 140 mEq/L jigin ka taa < 125 mEq/L lɛri damadɔ kɔnɔ.

2. Sugunɛ fununi min bɛ kɛ ni osmotique ye, kunsɛmɛnasumaya, ani Ayus-Arieff fogonfogonlabana¶

• Osmotic Ji jiginni ka kɛ Astrocytes ni Neurons ye: Ikomi sisan joli kɔkanna joli bɛ kɛ hypotonic (dilute) ye kosɛbɛ ni i y’a suma ni kunsɛmɛnasumaya kɔnɔna ye, ji bɛ boli joona ka tɛmɛ joli ni kunsɛmɛ barika kan Aquaporin-4 channels fɛ ka don astrocytes ni neurons kɔnɔ.
• Mun na jikuru jugumanw (< Lɛrɛ 24) bɛ mɔgɔ faga kosɛbɛ ka tɛmɛ jikuru basigilenw kan: Ni joli soja bɛ jigin dɔɔni dɔɔni dɔgɔkun caman kɔnɔ (natirimi basigilen), kunsɛmɛnasumaya bɛ lɛrɛ 48 sɔrɔ ka potasiyɔmu, kuloridi ani osmolytes organiques (glutamate, taurine, myo-inositol) bɔ selilɛri kɔnɔ walasa ka segin ka dɔgɔya. Ni joli soja bɛ jigin kosɛbɛ lɛrɛ 2 fo 8 kɔnɔ maraton, rave, walima ji minni ɲɛɲini senfɛ, waati zeru tɛ hakili la ka ladamu.
• The Unyielding Skull and Tentorial / Foramen Magnum Herniation: Ikomi balikuw kunkolo ye kolo kɛsu gɛlɛn ye, ni dɔ farala 6% fo 8% kan kunsɛmɛ ji hakɛ la o bɛ kunsɛmɛnasumaya yɔrɔ bɛɛ sɛgɛn. Kungolo kɔnɔ tansiyɔn bɛ wuli san fɛ, ka kunsɛmɛ joli siraw mugumugu, ka tonic-clonic seizures généralisées bila mɔgɔ la, ka kunsɛmɛ fununnen wajibiya ka jigin ka tɛmɛ foramen magnum fɛ min bɛ kungolo da la (**sɔgɔsɔgɔninjɛ **), o min bɛ ninakilidegun yɔrɔ tiɲɛ ani ka ninakili jɔ.
• Fogonfogonlabana min tɛ dusukunnabana ye (Ayus-Arieff Syndrome): Ni kunkolo kɔnɔ tansiyɔn bɛ ka bonya, katekolamini fɔɲɔba min bɛ kɛ ni hinɛ ye, ni a farala fogonfogon la joli-sira-funu caya kan, o bɛ fogonfogon fa ni ji ye min ɲɛ ye bulama ye (fogonfogon la sɔgɔsɔgɔninjɛ min bɛ kɛ ni senfagabana ye), o bɛ kɛ sababu ye ka oksizɛni dɔgɔyali jugumanba bila hakili la ka taa a fɛ funu min bɛ kɛ fɛn juguba dɔ la min bɛ mɔgɔ faga.

Dɔgɔtɔrɔsow ka ɲɔgɔn sangali: Ji minta (EAH) ni farikolojidɛsɛ / funteni sɛgɛn ni farikoloɲɛnajɛ funteni sɔgɔsɔgɔninjɛ¶

Aw bɛ nin dilan kɛrɛfɛ triage tabali in kɛ walasa ka fili fagalen bali, n’o ye ka ji jɛlen walima saline normal di banabagatɔ ma min ka natirili ka dɔgɔn:

Faratiba duuru minnu bɛ ji dɔlɔmin jugumanba la¶

1. Maratonkɛlaw, farikoloɲɛnajɛla saba, taamakɛlaw ani sɔrɔdasi (Exercise-associé Hyponatrémie) .¶

• Jɔn de bɛ faratiba la? A bɛ kɛ fɛn ye min tɛ fɛn ye, EAH bɛ kɛ ka caya ɲɛnajɛ maraton bolilaw la minnu ka surun (boli waati minnu bɛ tɛmɛ sanga 4 kan), farikoloɲɛnajɛla musow (farikolo ji hakɛ bɛɛ lajɛlen ka dɔgɔ), taamakɛlaw la Grand Canyon walima kungo kɔnɔ sigidaw la, ani sɔrɔdasi minnu bɛ sira taama jagoyalenw na minnu bɛ tugu laadilikanw kɔ minnu kɔrɔlen don walasa ka "min i seko la sani i ka a ye minnɔgɔ." Hali ni bolibaga ŋanaw bɛ ban sanga 2 kɔnɔ ka dɔlɔ min, sanga 5 maraton bolila min bɛ jɔ jidagayɔrɔ 20 bɛɛ la, ka tasa fila min jidagayɔrɔ kelen-kelen bɛɛ la, o bɛ se ka ji litiri 4 fo 6 munumunu k'a sɔrɔ a bɛ sumaya litiri 2 dɔrɔn bɔ.
• Sɔrɔ kɔfɛ binkanni min bɛ mɛn: Bololabaarakɛla caman bɛ boli ban ni kɔnɔnafili dɔɔni dɔrɔn ye ni ji litiri kelen min ma minɛ, o sigilen bɛ u kɔnɔbara la hali bi. Ni u ye boli dabila, joli bɛ segin ka bɔ u sen fasaw la ka taa u ka dumunikɛminɛnw na, a bɛ o kɔnɔbara ji litiri tɔ minɛ joona ka don joli la ka kɔnɔnafili ni kɔma bila miniti 30 fo 90 kɔnɔ, u kɛlen kɔ ka labanyɔrɔ tigɛ.

2. Kɛnɛma baarakɛlaw ni dutigiw funteni waati ("Ka sumaya falen ni ji jɛlen ye") .¶

Adamadenw ka sumaya ye kɔgɔ ye, a bɛ se ka kɛ 40 fo 60 mEq/L (0.9 to 1.4 grams/L) ka soja. Ni so sanfɛlan dilannikɛla, dugukolo labɛnbaga, sɛnɛkɛla, walima fɛnmarayɔrɔ baarakɛla dɔ sumayalen don litiri 6 fo 10 la sanga 8 kɔnɔ 38 degrees Celsius (100.4 degrees Fahrenheit) sumaya ani ka sumaya kɔgɔlen litiri kelen-kelen bɛɛ bila kɔgɔ tɛ min na pɔnpeji gansan nɔ na k’a sɔrɔ u ma dumuni kɔgɔlen dun, u bɛ farikolo natiri bɔnɛba sɔrɔ ka fara ji hɔrɔnyalen dilancogo kan. - Farakolo kirinni ye lasɔmini taamasiɲɛ #1 ye: Ni aw ye soja kɛ joona, o bɛ dimi bila funteni kirinni la misidenw, cɛya, ani kɔnɔbara la. Ni baarakɛla ye o kirinni kɔrɔ fɔ ko "Ne ka kan ka ji gansan galɔn wɛrɛ min", u bɛ taa ɲɛ joona ka bɔ funteni kirinni na ka taa senfalopathie hyponatremique et seizures la.

3. MDMA ("Ecstasy" / "Molly") ani Misikili ɲɛnajɛ ji minta¶

MDMA (3,4-methylenedioxymethamphetamine) ye farikolojidɛsɛ jugumanba dɔ ye min bɛ mɔgɔ faga, a bɛ musomanninw (san 15 fo san 30) minɛ ka kɛɲɛ ni a hakɛ ye, fɔlifɛnw na, ravew la, ani kulubaw la: - MDMA bɛ farikolojidɛsɛ siraw lawuli k’a ɲɛsin hipotalamu ma walasa ka Sugunɛbilenni Hormone (ADH / Vasopressin) wulicogo belebeleba dɔ bɔ, min bɛ mɛn sen na, o bɛ sugunɛw ka se ka ji gansan bɔ pewu fo lɛrɛ 12 fo sanga 24. - O waati kelen na, MDMA bɛ da jalen, dawolo sɔgɔsɔgɔ (bruxisme), farigan jugumanba, ani hakiliɲagami minnɔgɔ cɛmancɛ la, ka sɔrɔ a teriw b’a fɔ a kɛbaga ye ko "aw ka ji caman min walasa aw kana sumaya kojugu." - Ni aw ye hali ji litiri 1,5 fo 3 min MDMA furakisɛ kelen tali kɔfɛ, o bɛ se ka kɛ sababu ye ka joli soja jigin ka tɛmɛ 115 fo 120 mEq/L kan, o bɛ na ni kunsɛmɛnasumaya teliya ye, ka kɛ sababu ye ka kunsɛmɛnasumaya kɛ, ani ka kunsɛmɛ saya bila mɔgɔ la.

4. Denmisɛnw ka ji minni (Denmisɛn minnu si tɛ kalo 6 bɔ) .¶

Denmisɛn minnu si tɛ kalo 6 bɔ, olu man kan ka ji gansan di u ma abada u ka min, wa den ka dumunikɛminɛn man kan ka kɛ ni ji wɛrɛ ye abada walasa ka dumunikɛminɛn bidon "sɔrɔ" walima ka den nɛnɛ samiyɛ fɛ: - Den bangenen kura walima denmisɛnni sugunɛ ma kɔgɔ, ni a ɲɛkisɛw bɔli hakɛ ka dɔgɔn, o tɛ se ka ji hɔrɔnyalen doni bɔ joona, ka fara farikoloji bɛɛ lajɛlen hakɛ fitinin kan. - Ni den kalo 3 ye hali ji gansan mililitiri 120 fo 240 (onsi 4 fo 8) di a ma, walima ka ji kuturu fila fara a kan furakisɛ mugu kuuru kelen kelen bɛɛ la lɛri 24 kɔnɔ, o bɛ den ka soja hakɛ jigin joona ka tɛmɛ 120 mEq/L kan. - Denmisɛnw ka lasɔmini taamasiɲɛw: Farikolo funteni bɛ jigin (furakɛli ka dɔgɔn degere 36,1 duguma), ɲɛda ni ɲɛda funu, dimi walima sɛgɛn kojugu, fɔɔnɔ, ani banakisɛfagalan barikamaw.

5. Ji minni ɲɛɲiniw, Hazing, Sugunɛ dɔrɔgu sɛgɛsɛgɛli ko, ani Psychogenic Polydipsia¶

Ni aw ye ji litiri 4 fo 8+ (galɔn 1 fo 2+) munu sanga 1 fo lɛri 3 kɔnɔ, a kɛra balimaya hazing laada dɔ ye, a kɛra arajo/ɛntɛrinɛti ji minni ɲɛɲini ye, a kɛra a ɲinini ye ka "flush out" baarakɛyɔrɔ la sugunɛ fura sɛgɛsɛgɛli la, walima hakiliɲagami jugumanba, o bɛ hali sugunɛ kɛnɛman pewu, a ka ca a la 800 to 1,000 mL/hour bɔli plafond, o bɛ kɛ sababu ye ka kunsɛmɛnasumaya jugumanba bila mɔgɔ la sani sugunɛ ka se ka a minɛ.

Dɔgɔtɔrɔso ni foro furakɛlicogo dafalenw¶

1. Sanu-sɛnɛfura min bɛ kunsɛmɛnasumaya jugumanba furakɛ: Saline Hypertonic 3% Bolus mililitiri 100 (3% NaCl) .¶

Ni banabagatɔ nana ni senfalopathie hyponatremique acute symptomatic ye (hakilijagabɔ, hakiliɲagami, sɔgɔsɔgɔninjɛ, ataxia, fɔɔnɔ juguman, kɔma, kirinni, walima fogonfogon la sɔgɔsɔgɔninjɛ min bɛ sɔrɔ senfagabana fɛ), miniti kelen-kelen bɛɛ bɛ jate. Fluis isotoniques standards (0.9% Normal Saline, min ye 154 mEq/L ka soja) bɛ a man ɲi barisa ni ADH caman bɛ u la (SIADH), sugunɛ bɛ se ka bɔn 154 mEq soja ka don sugunɛ na min ka osmolality ka ca ka sɔrɔ a bɛ ji mara (desalination phenomenon), o bɛ kɛ sababu ye ka kunsɛmɛ funu ka juguya.

O nɔ na, Kloridi Sodiyɔmu Hypertonique 3% (3% NaCl) bɛ sɔrɔ 513 mEq/L natiri la (1,026 mOsm/L), o min ka ca ni hadamaden joli ka osmolality ye siɲɛ saba ani ka tɛmɛ a hakɛ dantɛmɛnen kan hadamaden sugunɛ bɛɛ bɛ se ka min dilan:

1. Bolus 1 teliya la (100 mL walima 150 mL ka 3% NaCl):
2. Aw bɛ ML 100 pikiri kɛ 3% Hypertonic Saline IV la miniti 10 kɔnɔ (Erɔpu/Amerika ka laadilikanw fana bɛ a to 150 mL miniti 20 kɔnɔ; denmisɛnw ni denmisɛnniw la, aw bɛ NaCl 3% mililitiri 2 fo mililitiri 3/kg [militiri 100] pikiri kɛ miniti 10 fo miniti 15 kɔnɔ).
3. Peripheral IV Line Rule: Aw kana 3% Hypertonic Saline bila kɔfɛ abada walasa ka cɛmancɛ joli sira bila. A 100 mL bolus ka 3% NaCl farati tɛ a la pewu ka pikiri kɛ ni sira IV lamini walima kolotuguda (IO) pikirijikɛlan ye min bɛ kɛ ni sariya ye.
4. Aw bɛ segin Bolusw kan miniti 10 kɔnɔ (Fo ka se Boluses bɛɛ lajɛlen 3 ma):
5. Ni hakili ɲagami, sɛgɛn, walima kirinni ma ɲɛ ka jɛya miniti 10 bololanɛgɛ fɔlɔ kɔfɛ, aw bɛ bololanɛgɛ 100 mililitiri 100 kɛ IV la miniti 10 kɔnɔ, ani ni aw mago bɛ a la, aw bɛ **bolosi mililitiri 100 sabanan kɛ a la miniti 10 o kɔfɛ.
6. Mun na ka dɔ fara Serum Sodium kan ni Just 4 to 6 mEq/L A bɛ Sugunɛ kisi:
7. Aw ma TƐ ka banabagatɔ ka serum sodium kɔrɔta ka bɔ 115 mEq/L sira bɛɛ la ka segin ka na 140 mEq/L lɛrɛ fɔlɔ kɔnɔ.
8. Raising the serum sodium concentration by just 4 to 6 mEq/L within the first 30 to 60 minutes creates an immediate osmotic gradient across the blood-brain barrier that pulls enough water out of the brain to reduce intracranial pressure by 50 percent, stopping seizures and reversing impending brainstem herniation within minutes.
9. Kɔrɔtɔko caman cili ni 3% NaCl bɔrɔw tɛ teliya la Crash Cart kan (8.4% Sodium Bicarbonate Ampules):
10. Ampules standard crash-cart de 8,4% Bicarbonate de sodium hypertonique (50 mL = 50 mEq of Na+ = 1,000 mEq/L) ye hypertonic ye siɲɛ fila ka tɛmɛ 3% NaCl kan. Ni banabagatɔ bɛ ka a yɛrɛ minɛ walima ka kirinni kɛ ka a sababu kɛ natirili jugumanba ye ani ni furakɛlitɔn ma a ci fɔlɔ 3% NaCl bɔrɔ kɔnɔ, ni aw ye Bikarbonati IV 8,4% mililitiri 50 (ampule 1) kɛ a la miniti 5 fo miniti 10 kɔnɔ** o bɛ o ɲɔgɔn kɛ tigitigi 50 mEq osmotique sodium kisi doni i n’a fɔ 100 mL of 3% NaCl.

2. Danfara min nafa ka bon: Acute (< 48 Hours) vs. Chronic (> Lɛrɛ 48) Ladili dantigɛliw ani bana min bɛ wele ko Osmotique Demyelination Syndrome (ODS) .¶

Bana kunbɛnni: Jidoncogo sariyaw minnu sinsinnen bɛ daliluw kan muɲuli farikoloɲɛnajɛ ni funteni hakɛw kan¶

1. Min fo ka se minnɔgɔ ma, aw kana "Mɔgɔnɔgɔ ɲɛfɛ" abada: Duniɲa ni farikoloɲɛnajɛ bɛnkanw yiriwali lajɛba ani Kungo kɔnɔ furakɛli jɛkulu y’a jira ko hadamaden farikolo minnɔgɔ ye ɲɛjiralan ye min farati ka bon, min bɛ kɛ waati yɛrɛ la, ka ɲɛsin ji magow ma maratonw, taamaw ani farikoloɲɛnajɛw senfɛ. Minni kɛli waati bolodalen na min bɛ kɛ ni fanga ye ("taji 2 miniti 15 o miniti 15") ye EAH sababu fɔlɔ ye.
2. Aw ka Sumaya Plafond (400 to 800 mL/hour): Ɲɛnajɛ bolibagaw ni taamakɛlaw fanba mago tɛ ji la ka tɛmɛ 400 fo 800 mL kan lɛrɛ kelen kɔnɔ farikoloɲɛnajɛ kɛtuma na, wa u man kan ka ka girinya abada boli walima taama senfɛ.
3. Aw bɛ ji ni dumuni kɔgɔ fara ɲɔgɔn kan tuma bɛɛ funteni ni taama jan waatiw la: Kɛnɛma baarakɛlaw ni taamakɛlaw minnu sumayalen don kosɛbɛ ka tɛmɛ lɛri 2 fo lɛri 3 kan, olu ka kan ka dumuni kɔgɔlenw dun (pretzel, nuts kɔgɔlen, crackers, pickles, broth, walima balannen da kɔnɔ farikolojidɛsɛ kɔgɔ) ji kɛrɛfɛ, aw kana ji gansan litiri kelen dun abada.
4. MDMA / Festival Harm Reduction: Aw kana tɛmɛ 250 fo 500 mL (taji 1 fo 2) kan abada, ji min bɛ sɔrɔ elekitoroliti la lɛrɛ kelen kɔnɔ ni aw bɛ dɔn kɛ yɔrɔ la min ka suma, ani ka dɔgɔtɔrɔso ɲini joona ni kungolodimi, kɔnɔboli walima hakiliɲagami kɛra.

Sigidaw ka kɔrɔtɔko nimɔrɔw ani baaradaw ka sariyaw¶

Ɲininkali minnu bɛ kɛ tuma caman na¶

Yala Gatorade walima jagokɛla ka farikoloɲɛnajɛ minfɛnw minni tɛ ji dɔlɔmin (hyponatrémie) bali maraton walima funteni waati wa?¶

Ayi, hadamaden joli la, soja 140 mEq/L ɲɔgɔn bɛ sɔrɔ, k’a sɔrɔ jagokɛla ka farikoloɲɛnajɛ minfɛn fanba la, soja 18 fo 20 mEq/L dɔrɔn de bɛ sɔrɔ. O kɔrɔ ye ko farikoloɲɛnajɛ minfɛn min bɛ jago kɛ, o bɛ kɛ hali bi kɛmɛsarada la 85 hypotonic (ji min tɛ kɔgɔ ye) ni i y’a suma ni i joli ye. Ni bolibaga walima kɛnɛma baarakɛla dɔ ye farikoloɲɛnajɛ minfɛn caman min joona ka tɛmɛ a ka sumaya ni a ka sugunɛ kan, kɛrɛnkɛrɛnnenya la ni farikolojidɛsɛbanakisɛfagalan (ADH) min bɛ sɔrɔ farikoloɲɛnajɛ fɛ, o bɛ u ka sugunɛw bali ka ji bɔ, o la, u joli natiri bɛna jigin kosɛbɛ fo ka se farati hakɛ ma. Farikoloɲɛnajɛ fɛ farikolojidɛsɛ kunbɛnni, o bɛ a ɲini ka minni kɛ ka kɛɲɛ ni minnɔgɔ ye (a kana min kojugu) ani ka dumuni kɔgɔ bɛrɛbɛrɛ dun ni cɛsiri jan kɛra.

Ne bɛ se k’a dɔn cogo di maraton labanyɔrɔ la walima taama sira kan ni ji dɔlɔminna mɔgɔ dɔ ye (hyponatrémie) ni farikolojidɛsɛ ye?¶

Aw bɛ taamasiɲɛ nɔgɔman saba lajɛ sani aw ka ji suguya o suguya di: (1) Ji minta ni a girinya: Ji dɔlɔminna mɔgɔ min na, o tigi tun bɛ ji min kosɛbɛ jidagayɔrɔ bɛɛ la, wa a girinyana (walima a girinya tora a la) ni a kɔnɔbara fununen don, a bɛ sɔgɔsɔgɔ, k’a sɔrɔ farikolojidɛsɛ bɛ mɔgɔ min na, o tigi tun bɛ dɔɔni min kojugu ani ka a girinya dɔgɔya (2) The Tight Ring / Watchband Sign: Ji dɔlɔmin bɛ kɛ sababu ye ka bolokɔniw ni bolokɔniw funu, ka funu yɔrɔ minnu na bololanɛgɛw ni watɛsiw bɛ barika sɔrɔ ka gɛlɛya, k’a sɔrɔ farikolojidɛsɛ bɛ kɛ sababu ye ka kan ja ani ka ɲɛw jigin ani (3) Hakilila-jɔ-cogo: Farikolojidɛsɛ nɔgɔman walima funteni-sɛgɛn bɛ sɛgɛn ni ɲɛnamini bila mɔgɔ la ni a jɔlen don, k’a sɔrɔ ji minni bɛ kɛ sababu ye ka kungolodimi jugumanba bila mɔgɔ la min bɛ kɛ ni sɔgɔsɔgɔ ye, fɔɔnɔ min bɛ se ka bɔn, ka hakili ɲagami, ka sennatiɲɛ ani ka kirinni bila mɔgɔ la.

Mun na farati ka bon ka ji jɛlen di den ma min si tɛ kalo 6 bɔ walima ka jisuma di a ma?¶

Den minnu si tɛ kalo 6 bɔ, olu sugunɛ tɛ kɔgɔ, minnu tɛ se ka ji jɛlen wɛrɛw sama joona, wa u farikolo misɛnninw bɛ soja bɛɛ lajɛlen dɔgɔya kosɛbɛ. Ni aw ye hali ji gansan onsi damadɔ di den ma, walima ni aw ye ji wɛrɛ fara den ka dumuni mugumugu kan, o bɛ soja min bɛ den joli la, o nɔgɔya joona. Lɛrɛ damadɔ kɔnɔ, ji bɛ taa den kunsɛmɛ na, o bɛ kɛ sababu ye ka farikolo funteni dɔgɔya (degere 36,1 / degere 97 duguma), ɲɛda funu, sɛgɛn, fɔɔnɔ, ani kirinni minnu bɛ se ka a ka ɲɛnamaya bila farati la. Den minnu si tɛ kalo 6 bɔ, olu ka kan ka sinji dɔrɔn de ta walima den ka dumunikɛcogo basigilen ɲagaminen ka ɲɛ.

Mun na MDMA ("Ecstasy" walima "Molly") bɛ ji dɔlɔmin faga min bɛ mɔgɔ faga ji buteli damadɔ dɔrɔn minni kɔfɛ?¶

A ka ca a la, ni aw ye ji litiri kelen walima fila wɛrɛ min, aw hakili bɛ sugunɛbanakisɛfagalan (ADH) bɔli dabila ani aw sugunɛ bɛ ji wɛrɛ koli bɔ lɛri kelen kɔnɔ. MDMA bɛ fɛnɲɛnamafagalanw (hypothalamus) lawuli walasa ka ADH wulicogo belebeleba dɔ bɔ, min bɛ to senna, o min bɛ sugunɛw datugu fo lɛri 12 fo lɛri 24 walasa u kana se ka koli bɔ ji la. O waati kelen na, MDMA bɛ farikolo funteni kɔrɔta ani ka minnɔgɔ jugumanba bila mɔgɔ la. Ni a kɛbaga ye ji buteli caman min walasa ka nɛnɛ, o ji kɛmɛsarada la, o bɛ to a joli la, o bɛ kɛ sababu ye ka a kunsɛmɛ funu teliya la, ka kirinni bila a la ani ka a kunkolo sɔgɔsɔgɔ.

Danfara jumɛn bɛ ji minta jugumanba furakɛli ni ɲɔgɔn cɛ (< 24 hours) and chronic low sodium (> lɛrɛ 48)?¶

Ji minni jugumanba la (yɔrɔ min na joli natiri bɛ jigin lɛri damadɔ kɔnɔ maraton, rave walima ji minni ɲɛɲini senfɛ), kunsɛmɛbanakisɛw ma waati sɔrɔ ka ladamu, o la, o teliya la, o ye kunsɛmɛ funu ni kirinni ye min bɛ se ka mɔgɔ faga. Dɔgɔtɔrɔw bɛ 3% Hypertonic Saline mililitiri 100 di jolisira fɛ teliya la walasa ka joli soja kɔrɔta joona ni mililitiri 4 fo 6 ye eq/L ani ka kunsɛmɛ segin ka dɔgɔya, ni demyelination farati bɛ se ka kɛ zeru ye. O ni mɔgɔ dɔ ta tɛ kelen ye, ni natirili dɔgɔyali basigilen bɛ mɔgɔ dɔ la dɔɔni dɔɔni tile walima dɔgɔkun caman kɔnɔ (ji furakisɛw fɛ, dusukun tantanni walima sugunɛbana fɛ), a kunkolo yɔrɔw y’u yɛrɛ ladamu kaban; k’a sɔrɔ dɔgɔtɔrɔw bɛ hali bi 4 fo 6 mEq/L hypertonic bolus fɔlɔ di ni banabagatɔ bɛ ka a minɛ, u ka kan ka soja hakɛ bɛɛ lajɛlen hakɛ dantigɛ kosɛbɛ, a kana tɛmɛ 6 fo 8 mEq/L kan sanga 24 kɔnɔ walasa ka Osmotic Demyelination Syndrome (ODS) bali.

Gafe minnu bɛ tali kɛ o ko la¶

• Funteni ni funteni sɛgɛn: Danfara bɛ danfara dɔn cogo min na
• Funtenibana dɛmɛ fɔlɔ ani nɛnɛ teliya
• Potassium kɔrɔtɔko gɛlɛnw: Kalɛmi caya ni kalisiyɔmu dɔgɔyali
• Kɔnɔboli dɛmɛ fɔlɔ ni lakana
• Status epilepticus, kirinni kuntaalajan, ani kisi furaw

Sosow ani ɲɛmɔgɔyaso ka bilasiralikan¶

• Dugukolo kan farikoloɲɛnajɛw ni farikolojidɛsɛ bɛnkanw yiriwali lajɛba: Duniɲa ka farikoloɲɛnajɛw ni ɲɔgɔn cɛ bɛnkanw yiriwali lajɛba sabanan ka fɔta (Clinical Journal of Sport Medicine).
• Wilderness Medical Society (WMS): Dɔgɔtɔrɔso baarakɛcogo laadilikanw ka ɲɛsin farikoloɲɛnajɛ dɔgɔyali ma: san 2019 kunnafoni kura.
• Erɔpu jamanaw ka furakɛli jɛkulu (ESICM) & Erɔpu jamanaw ka furakɛli jɛkulu: Dɔgɔtɔrɔso ka baarakɛcogo ɲɛfɔli min ɲɛsinnen bɛ jolidɛsɛbana sɛgɛsɛgɛli ni a furakɛli ma.
• Ameriki denmisɛnw ka kɛnɛyako kalanso (AAP): Denmisɛnw ka balocogo ni daji minni ni u ka kirinni dɔgɔyali kunbɛnni denmisɛnninw na.
• Banaw kɛlɛli ni u kunbɛnni baaradaw (CDC / NIOSH): Sariya minnu bɛ kɛ ka kɛɲɛ ni sariya ye min bɛ se ka kɛ: Baarakɛyɔrɔ la, funteni ni funteni na (Electrolyte Replacement and Hyponatremie Prevention).

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Nin gafe in ye kunnafonidi ye, wa a tɛ dɔgɔtɔrɔso baarakɛlaw ka jateminɛ walima dɔgɔtɔrɔso ladonni kɔrɔtɔlen nɔ na. Ikomi farikoloɲɛnajɛ min bɛ sɔrɔ farikoloɲɛnajɛ fɛ, o bɛ se ka kɛ sababu ye ka mɔgɔ hakili bɔ joona ani ka mɔgɔ bila ka kirin, an b’a fɔ aw ye kosɛbɛ ko aw ka bololabaara kɛcogo dɔ ta kungo kɔnɔ walima dɛmɛ fɔlɔ ni CPR kalan min bɛ kɛ ka kɛɲɛ ni diɲɛ jamanaw ka Croix Rouge ni Kɔrɔya bilen tɔnw ka tɔnba ye (IFRC), aw ka jamana Croix Rouge tɔnba fɛ, St John Ambulance, walima sigida furakɛlikɛla min ka lakɔliso sɛbɛn bɛ a bolo..