Maandooriyaha Biyaha, Jimicsiga La Xiriira Hyponatremia, iyo Bararka Maskaxda ee Sodium-hoose¶

Biyaha la cabbo waxay lama huraan u yihiin nolosha, haddana cabbitaanka xad-dhaafka ah ee biyaha caadiga ah ama cabitaannada isboortiga ee soodhiyamku hooseeyaan si ka dhakhso badan kelyaha bini'aadamka ay u soo saari karaan waxay sababtaa ** hyponatremia aadka u daran (" sakhradda biyaha ")Na+) hoos u dhiga 135mEq/L (mmol/L) (oo inta badan ka hoosaysa 120 ilaa 125mEq/L), taasoo ku qasabta biyaha xad-dhaafka ah ee xannibaadda maskaxda-maskaxda si toos ah unugyada maskaxda osmosis. Marka unugyada maskaxdu ay bararaan gudaha qalfoofka qallafsan, qalfoofka laf dhabarta ah (** barar barar maskaxeed / encephalopathy**), dhibbanayaashu waxay yeeshaan madax-xanuun, lallabbo, matag, dibiro, gacmaha iyo cagaha oo bararsan, jahawareer, dabeecad aan caadi ahayn, dheelitirnaan turunturood, ** suuxdin guud oo tonic-clonic ah, suuxdin maskaxeed geeri**.

Maandooriyaha biyaha ba'an waxay ku dhuftaan shan kooxood oo kala duwan: (1) ** Marathoners, ultramarathoners, triathletes, tamashlayaasha, iyo askar qorista ** kuwaas oo ka cabba xarun kasta oo biyaha "kahor haraad" (** Layliga-Associated Hyponatremia [EAH]); (2) Dhismaha dibadda, beeralayda, iyo shaqaalaha warshadaha cabbida litir biyo caadi ah xilliga kulaylka xagaaga; (3) ** dabaal-degayaasha iyo dhalinyarada qaangaarka ah ee qaadanaya MDMA ("Ecstasy" ama "Molly"), kaas oo kiciya dheecaan weyn oo hormoonka-diuretic-ka ah oo keena harraad xad dhaaf ah; (4) ** dhallaanka da'doodu ka yar tahay 6 bilood *** la siiyo biyo cad ama caanaha ilmaha oo si xad dhaaf ah loo qasi karo; iyo (5) ** tartamayaasha caqabadaha cabbitaanka biyaha ama bukaanada qaba polydipsia maskaxiyan ***. Haddii qof cabay xaddi badan oo dareere ah uu ku dhaco jahawareer, turunturood, matag, ama suuxdin, wac nambarka degdega ah ee degaankaaga (911 gudaha Maraykanka iyo Kanada, 112 guud ahaan Midowga Yurub, 999 gudaha Boqortooyada Ingiriiska) adoo sii maraya our nambarada degdega ah tusaha isla markaaba, oo dib u eeg kulaylka istaroogga vs. kulayl daal, xanuunka kulaylka gargaarka degdega ahiyo qalal gargaarka degdega ah.

Hadda samee tan¶

1. ** JOOJIYA DHAMMAAN BIYAHA IYO dheecanka isla markiiba ***: Khaladka kaliya ee ugu dhimashada badan ee koorsada maaratoonka, socodka socodka, socodka militariga, ama goobta shaqada kulul waxay u maleeyaan dawakhsan, lalabo, jahawareer ciyaartooy ama shaqaale leh " fuuqbax ama kulayl daal" iyo ** ku qasbi inay cabbaan biyo badan ama bilaabaan dheecaan caadi ah-saline/hypotonic. Haddii qofku cabbayay cabitaano badan, uu leeyahay kaadi saafi ah ama dibiro, ama aanu lumin miisaanka jidhka, **dhamaan biyaha cad, cabitaanada isboortiga, iyo dareeraha hypotonic isla markiiba
2. Wac 911/112/999 si aad isla markiiba u hesho calaamadaha digniinta neerfaha**: Isla markiiba wac adeegyada caafimaadka degdega ah haddii qofku uu yeesho madax xanuun ka sii daraya, matag soo noqnoqda, jahawareer, jaahwareer, hadal qallafsan, turunturoosho (ataxia), muruq gariir, caajisnimo, ama suuxdin. U sheeg soo diraha iyo kalkaaliyayaasha caafimaadka inay ka shakiyaan ** Jimicsi Ba'an oo La Xidhiidha Hyponatremia (Biyo Maandooriyaha) oo leh bararka maskaxda** si aanay ugu socon bac degdeg ah oo dareere faleebbaha caadiga ah inta ay jidka ku jiraan.
3. ** Sii milix afka ah (hypertonic) xal kaliya haddii qofku si buuxda u soo jeedo, feejigan, oo uu leeyahay astaamo hore oo khafiif ah ***: Cidlada dhexdeeda, marathon, ama goobaha garoonka halkaas oo qofku ka shakiyay EAH khafiif ah (lallabbo, madax-xanuun, fara barar, taariikhda khamriga xad dhaafka ah) (WMS) iyo xeerarka caalamiga ah ee EAH Consensus waxay ku talinayaan in la siiyo ** culeyska milixda afka ee hypertonic ***: 3 ilaa 4 xabbadood oo bouillon ah oo lagu milmay 120 mL (nus koob / 4 wiqiyadood) oo biyo ah, ama 2 ilaa 3 baakidh pretzel/cusbo cusbo leh oo leh kabasho yar oo biyo ah. Weligaa afka waxba ha ka siin haddii qofku wareersan yahay, lulo, matagayo, ama uu qabsanayo.
4. ** Hubi "Ring Totten / Watchband Sign" iyo kaadi saafi ah ***: Fiiri qofka faraha, cududihiisa, iyo anqawyada. Si ka duwan qofka fuuqbaxay (maqaarkiisu waa engegan yahay, indhuhu way go'an yihiin, kaadiduna waa madow madow), dhibbanaha maandooriyaha biyaha wuxuu inta badan leeyahay ** barar, faraha barar leh halkaasoo faraanti ama xirmooyin si lama filaan ah u dareemaan cidhiidhi ***, calool jaban, miisaan * kor u kaca * tan iyo bilawga jimicsiga, iyo kaadida joogtada ah ama cad.
5. Ka ilaali marin-haweedka xilliga matagga iyo qalal Dhig qof lulsan, jahawareersan, ama wax qabsanaya dhinacooda ** booska soo kabashada si uu mataggu afka uga baxo halkii uu sanbabada gelin lahaa.
6. ** Ogaysii cisbitaalka helaya ama teendhada caafimaadka khadka-dhamaadka si aad u diyaariso 3% Salineed Hypertonic (3% NaCl***: Bukaan kasta oo qaba xanuunka 'hyponatremic encephalopathy' (jahawareerka, miyir-beelka, suuxdinta, ama cidhiidhiga neefsiga), dawada degdega ah ee badbaadinta nafta waa ** bolus xididka 100 mL ee 3% Hypertonic Sodium Chloride (3% NaCl) lagu shubay in ka badan 10 daqiiqo ***, lagu celceliyay ilaa laba jeer oo dheeri ah 10-daqiiqo gudahood ilaa calaamadaha neerfaha xaliyaan.

Geedka go'aanka: Kala soocida sakhradda biyaha (EAH) ee fuuq-baxa iyo istaroogga kulaylka¶

flowchart TD
    Start["Burbursan, Jahwareer, ama Matag Ciyaarte, Socod-socod, Shaqaale, Ka qaybgalayaasha Rave, ama Dhallaanka"] --> CheckHistory["Qiimee taariikhda qaadashada dareeraha: Qofku miyuu cabbi jiray mug weyn oo cabitaan biyo ah/cabitaan isboorti ah (ama caanaha la qaso ee dhallaanka)?"]

    CheckHistory --> VitalsCheck["Hubi Heerkulka Xudunta ah (malawadka haddii kulayl laga shakiyo) iyo Sodium Dhiiga Barta-Daryeelka (Na+)"]

    VitalsCheck -->|Core Temp > 40 C (104 F) + CNS Delirium| HeatStroke["Cadaadiska kulaylka ee jimicsiga: Isla markiiba qaboojinta biyaha barafka; Hubi Serum Na+ Kahor Intaadan Bixin Boluses Dheecaan Faleebeedka Weyn"]

    VitalsCheck -->|Blood Sodium (Na+) < 135 mEq/L (Often < 125 mEq/L) OR Clinical Clues of Overhydration (Weight Gain, Tight Rings, Sloshing Stomach)| EAH_Severity{"Qiimee darnaanta neerfayaasha ee Hyponatremia ba'an"}

    EAH_Severity -->|SEVERE: Confusion, Delirium, Obtundation, Ataxia, Seizures, Coma, or Pulmonary Edema (Hyponatremic Encephalopathy)| Give3Percent["BADBAADINTA NOLOSHA OO DEGDEG AH:\n1. Xakameyso Dhammaan Dheecaannada Afka/Hypotonic\n2. Maamul 100 ml oo ah 3% Hypertonic Saline (3% NaCl) IV Bolus Ka badan 10 Daqiiqo (2 ml/kg ee Carruurta)\n3. Ku celi 100 ml 3% NaCl Bolus 10kii Daqiiqoba (Illaa 3 Total Boluses) Ilaa Suuxdintu/Joojiso Delirium iyo Na+ Kaca 4 ilaa 6mEq/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{"Xaqiiji wakhtiga: Aad u daran (<24-48 saacadood) vs Chronic (> 48 saacadood) Hyponatremia"}
    AcuteVsChronic -->|Acute Water Intoxication / EAH / MDMA (< 24-48h)| RapidSafe["Sixitaanka degdega ah ee 4-6 mEq/L saacada kowaad waa badbaado waana qasab in laga hortago Herniation Maskaxda (khatarta ODS ee ugu yar ee Bilawga Runta ah)"]
    AcuteVsChronic -->|Chronic Hyponatremia (> 48h: Diuretics, Heart/Liver Failure, Chronic SIADH)| CapRate["Ka dib 4-6 mEq/L Badbaadinta Bolus ee Suuxdintu, Si Adag oo Koob Wadarta Sodium Kaca <= 6 ilaa 8mEq/L 24 saacba si looga hortago Osmotic Demyelination Syndrome (ODS)"]

Pathophysiology: Waa maxay sababta biyaha xad dhaafka ahi ay maskaxda u bararaan iyo sababta kelyuhu aanay u kaadin oo kaliya¶

Kelyaha caafimaadka qaba ee bini'aadamka ee nasashada ayaa soo saari kara ilaa ** 800 ilaa 1,000 millilitir (ku dhawaad 1 quart) oo biyo bilaash ah saacaddii. Tani waxay dhalinaysaa su'aal cad: haddii ciyaartoyga, tamashlaha, ama festifaalka uu cabbo 1.0 ilaa 1.5 litir oo biyo ah saacadiiba, maxay kelyahooda si fudud uga soo bixin biyaha dheeraadka ah?

1. Farsamaynta "Double Hit": Qaadashada dareeraha Xad-dhaafka ah + Dheecaan aan Osmotic ADH ahayn (SIADH)¶

Ku dhawaad kiis kasta oo dilaa ah oo ah ** Jimicsi-ku-xiran Hyponatremia (EAH)**, sakhradda biyaha kulaylka, iyo ** MDMA-ay keentay hyponatremia ***, ** laba dhacdo oo jireed ayaa dhacaya isla waqti isku mid ah ***:

1. ** garaac 1: Isticmaalka xad dhaafka ah ee Dheecaannada Hypotonic (Biyaha ama Cabbitaannada Ciyaaraha)**:
2. Dhiigga caadiga ah ee bini'aadamka wuxuu leeyahay uruurinta soodiyamka ee 135 ilaa 145 mEq/L (mmol/L).
3. ** Tuubada caadiga ah ama biyaha dhalada ah** waxay leeyihiin 0 mEq/L oo soodhiyam ah.
4. Cabitaanada isboorti ee caadiga ah *** (sida Gatorade, Powerade, ama Lucozade Sport) waxay ka kooban yihiin kaliya 18 ilaa 20mEq/L ee sodium, taasoo la micno ah in cabitaanka isboortiga uu wali yahay ** 85 boqolkiiba biyo aan cusbo lahayn marka loo eego dhiiga dadka.
5. Sidaa darteed, cabbitaanka litir ee cabitaannada isboortiga ganacsiga inta lagu jiro marathon ama kulaylka ** KA hortegi karto hyponatremia**; dhab ahaantii, cabbitaanka cabitaannada isboortiga ee xad-dhaafka ah waxay u milo sodium dhiiga sida ugu dhakhsaha badan sida biyaha caadiga ah.
6. ** garaac 2: Dheecaan aan habboonayn ee Hormoonka Antidiuretic (Arginine Vasopressin / ADH) wuxuu xidhaa kelyaha
7. Caadi ahaan, isla marka aad cabto biyo badan oo dhiigaaga osmolality-ku uu yara yara dhaco, qanjirkaaga dambe ee pituitary-ga ayaa dammaya OFF hoormoonka Hormoonka Antidiuretic Hormone (ADH/Vasopressin), taasoo u oggolaanaysa kelyahaaga inay daadiyaan litir oo kaadi dhalaalaysa oo cad.
8. Si kastaba ha noqotee, inta lagu jiro ** jimicsi adag oo dheer, diiqad kulayl ah, xanuun, lallabbo, walbahaarka dareenka, caabuqa muruqa (interleukin-6 [IL-6] oo laga sii daayo muruqyada shaqada), ama MDMA ("Ecstasy") oo la nuugo , maskaxdu waxay sii deysaa qulqulka weyn ee ** non-osmotic surge of ADH* (*** Syndrome of Inapproprimon)
9. Korodhkan ADH wuxuu ku xidhan yahay V2 reseptors ee tuubooyinka ururinta kelyaha, gelinaya Aquaporin-2 channels water taas oo kelyaha ku qasabta in ay **dib u soo celiyaan dhammaan biyaha xorta ah ee dhiiga
10. Ku xanniban gudaha marinka dhiigga iyada oo aan lahayn meel loo tago, biyaha la seexday waxay si degdeg ah u milmaan serum sodium ka 140 mEq/L hoos ilaa < 125 mEq/L dhowr saacadood gudahood.

2. Bararka Maskaxda Osmotic, Maskaxda Herniation, iyo Ayus-Arieff bararka sambabada¶

• ** Biyaha Osmotic waxay u beddelaan Astrocytes iyo Neurons ***: Sababtoo ah qulqulka unugyada ka baxsan hadda waa hypotonic (dilute) marka la barbar dhigo gudaha unugyada maskaxda, biyuhu waxay si degdeg ah ugu qulqulayaan xannibaadaha maskaxda ee dhiigga iyada oo loo marayo ** Aquaporin-4 channels ** galay astrocytes iyo neurons.
• Sababta (< 24 Hours ) Dhibcuhu aad uga khatar badan yihiin dhibco daba-dheeraada**: Marka soodhiyamku si tartiib tartiib ah u dhaco toddobaadyo (hyponatremia raaga), unugyada maskaxdu waxay haystaan ​​** 48 saacadood ** si ay u soo saaraan potassium, chloride, iyo osmolytes organic (glutamate, taurine, myo-inositol) si ay hoos ugu dhigaan. Marka soodhiyamku hoos u dhaco 2 ilaa 8 saacadood inta lagu jiro maaratoonka, rave, ama tartanka biyaha-cabitaanka, ** maskaxdu eber wakhti ay la qabsato ma leh.
• **Dhafoorka Aan Jilicsaneyn iyo Tentorial / Foramen Magnum Herniation ***: Sababtoo ah madaxa madaxa ee qaangaarka ah waa sanduuq adag oo lafo ah, ** 6% ilaa 8% korodhka mugga biyaha maskaxda *** wuxuu daaliyaa dhammaan bannaanka dareeraha cerebrospinal. Cadaadiska intracranial ayaa cirka isku shareeray, burburinta xididdada dhiigga ee maskaxda, kicinta ** suuxdin guud ee tonic-clonic ***, iyo ku qasbida maskaxda bararsan xagga hoose ee foramen magnum ee salka madaxa madaxa
• Bararka sambabada ee non-Cardiogenic Neurogenic (Ayus-Arieff Syndrome): Sida cadaadiska intracranial, duufaan weyn oo catecholamine ah oo naxariis leh oo ay weheliso kororka xididdada sambabada ee sambabada ayaa daadad sambabada oo leh dareere casaan ah oo baraf ah wareegga.

Isbarbardhigga Caafimaadka: Maandooriyaha Biyaha (EAH) vs. Fuuqbaxa / kulaylka oo dhan¶

Isticmaal miiska kala soocidda sariirta dhinaceeda si aad uga hortagto khaladka dilaaga ah ee siinta biyo caadi ah ama milix caadi ah bukaanka hyponatremic:

Shanta Xaaladood ee Khatarta Sarreeysa ee Maandooriyaha Biyaha Ba'an¶

1. Marathoners, Triathletes, Hikers, and Military Personers (Jimicsiga La Xiriira Hyponatremia)¶

• **Yaa Khatarta Ugu Saraysa Ku Sugan si fudud, maratoon 5-saacadood ah oo istaaga dhammaan 20ka goobood ee biyaha oo ka cabba laba koob saldhig kasta waxa uu liqi karaa 4 ilaa 6 litir oo dareere ah halka uu luminayo 2 litir oo dhidid ah.
• ** Burburka tartanka ka dib**: Orodyahanno badan ayaa dhammeeya tartanka iyagoo dareemaya lallabo khafiif ah oo keliya litir biyo ah oo aan la nuugin oo weli ku fadhiya calooshooda. Markay joojiyaan orodka, qulqulka dhiigu wuxuu ka soo noqdaa murqaha lugahooda una soo noqda hab-raacooda dheefshiidka, ** si degdeg ah ayey u nuugaan litirkaas biyaha caloosha ah ee dhiiga

2. Shaqaalaha dibadda iyo mulkiilayaasha guryaha inta lagu jiro mowjadaha kulaylka ("Ku beddelashada dhididka biyaha cad")¶

Dhididka bini'aadamku waa ** cusbo , oo ka kooban qiyaastii 40 ilaa 60 mEq/L (0.9 to 1.4 grams/L) ee sodium. Marka saqafka, dhul-beeraha, shaqaalaha beeraha, ama shaqaalaha bakhaarka ay dhididsan yihiin 6 ilaa 10 litir muddo 8 saacadood ah 38 degrees Celsius (100.4 degrees Fahrenheit) kulaylka oo ku beddela litir kasta oo dhidid milix leh Biyo qasabad ah oo aan milix lahayn iyaga oo aan cunin cunto milix leh, waxay la kulmaan luminta saafiga ah ee saafiga ah ee jirka oo ay weheliso qasitaan biyo-la'aan ah. - ** Muruqyo-xannuunku waa Digniinta Calaamadda #1: Kala-baxa hore ee soodhiyamku wuxuu keenaa xanuun badan ** xanuunka kulaylka* ee kubka, bowdada, iyo caloosha. Haddii shaqaaluhu u tarjumo casiraadyadaas "Waxaan u baahanahay inaan cabbo gallon kale oo biyo caadi ah," waxay si degdeg ah uga gudbaan kulaylka si toos ah ** hyponatremic encephalopathy iyo suuxdin ***.

3. MDMA ("Ecstasy" / "Molly") iyo Bandhiga Muusikada ee Balwadda Biyaha¶

MDMA (3,4-methylenedioxymethamphetamine) waa mid ka mid ah waxyaabaha ugu awooda badan ee keena hyponatremia ba'an ee dilaaga ah, si aan xad lahayn u saameeya ** haweenka da'da yar (da'da 15 ilaa 30) ** marka la joogo riwaayadaha, raves, iyo naadiyada: - MDMA waxay si toos ah u kicisaa dariiqyada serotonergic hypothalamic si ay u sii deyso ** aad u weyn, kor u kaca Hormoonka Antidiuretic (ADH / Vasopressin) ***, oo gebi ahaanba xiraya awoodda kelyaha ee ah inay soo saaraan biyo bilaash ah ** 12 ilaa 24 saacadood **. - Isla mar ahaantaana, MDMA waxay keentaa afka qalalan, daanka oo isku dhega (bruxism), hyperthermia, iyo harraad maskaxeed oo dhexe, halka facooda ay u sheegaan isticmaalaha inuu "cab biyo badan si aadan u kululayn." - Cabitaanka xitaa 1.5 ilaa 3 litir oo biyo ah kadib qaadashada hal kiniin oo MDMA ah waxay keeni kartaa in soodhiyamka dhiiga uu hoos u dhaco 115 ilaa 120mEq/L, taasoo keenta barar maskaxeed oo degdeg ah, xaalad suuxdin, iyo dhimasha maskaxda.

4. Sakhradda Biyaha Dhallaanka (Carruur Kayar 6 Bilood)¶

Ilamaha da'doodu ka yar tahay 6 bilood waa inaan waligood la siin biyo caadi ah oo ay cabbaan, caanaha caanaha dhallaanka ah waa inaan waligood lagu qasin biyo dheeraad ah si "loo fidiyo" qasac caano ah ama qaboojiso ilmaha xagaaga: - Dhallaanka yar ama dhallaanka yar ayaa leh kelyo aan qaan-gaarin oo leh heerka sifaynta glomerular hoose oo aan si dhakhso ah u soo saari karin culayska biyaha bilaashka ah, oo ay weheliso tiro yar oo mugga biyaha jidhka ah. - Siinta ilmo 3 bilood jir ah ** xitaa 120 ilaa 240 mL (4 ilaa 8 wiqiyadood) oo biyo caadi ah**, ama ku darida laba qaado oo biyo ah hal qaado oo ah budada caanaha ah mudo 24 saacadood ka badan, waxay si degdeg ah u soo daadinaysaa serum sodium ee ilmaha ka hooseeya 120mEq/L. - Calaamadaha Digniinta Dhallaanka *: Hoos u dhaca heerkulka jidhka ( hypothermia ka hooseeya 36.1 darajo Celsius [97 darajo Fahrenheit]**), bararka wejiga iyo daboolka indhaha, xanaaqa ama caajisnimada xad dhaafka ah, matag, iyo ** suuxdin guud oo suuxdin degdeg ah ***.

5. Tartamada Cabitaanka Biyaha, Xajka, Baadhista Dawada Kaadida, iyo Polydipsia Cilmi-nafsiga¶

Liqitaanka ** 4 ilaa 8+ litir (1 ilaa 2+ gallon) oo biyo ah 1 ilaa 3 saacadood gudahood, ha ahaato inta lagu jiro cibaadada walaaltinimada, tartanka biyaha cabbitaanka ee raadiyaha/internetka, isku day lagu doonayo in lagu "shubo" shaashadda daawada kaadida ee goobta shaqada, ama polydipsia xanuunka dhimirka ee degdega ah, waxay xad dhaaftaa xitaa ugu badnaan kelyaha caafimaad qaba. 800 to 1,000 mL/hour saqafka qashin-saarka, taasoo keenta herniation maskaxeed oo ba'an ka hor inta aysan kelyuhu qabsan.

Qeexitaanka Cusbitaalka iyo Hab-maamuuska Daaweynta Goobta¶

1. Daawada-Heerka-Dahab ee Ka-hortagga Dhiiga Dhiig-karka ee Xun: 100 ml Bolus oo ah 3% Cusbada Dhiig-karka (Hyponatremic Encephalopathy)3% NaCl)¶

Marka uu bukaanku la kulmo ** calamadaha ba'an ee hyponatremic encephalopathy** ( wareer, delirium, miyir beel, ataxia, matag daran, kooma, suuxdin, ama bararka sambabada neurogenic), daqiiqad kasta waa la xisaabiyaa. Dheecaannada isotonic caadiga ah (0.9% Normal Saline, kaas oo leh 154 mEq/L Soodhiyamka) waa ** la mamnuucay *** sababtoo ah joogitaanka ADH sareSIADH), kelyuhu waxay soo saari karaan 154 mEq Soodhiyamka oo gala kaadida-osmolality-sare iyadoo la ilaalinayo biyaha (** ifafaale naaxinta**), taasoo maskaxda ka dhigaysa barar * ka sii dara *.

Halkii, 3% Hypertonic Sodium Chloride3% NaCl* ka kooban 513 mEq/L oo sodium ah (1,026 mOsm/L*, taas oo ka badan saddex jeer osmolality ee dhiigga bini'aadamka oo ka sarreeya diiradda ugu badan ee kelyaha bini'aadamku weligood soo saari karaan:

1. Bolus 1100 mL ama 150 mL ee 3% NaCl*:
2. Ku shub 100 mL oo ah 3% Hypertonic Saline IV in ka badan 10 daqiiqo (Tusmada Yurub/Mareykanku sidoo kale waxay ogol yihiin 150 mL in ka badan 20 daqiiqo; gudaha ** carruurta iyo dhallaanka**, ku shub **2 ilaa 3 mL/kg of 3% NaCl [ilaa 100 mL] in ka badan 10 ilaa 15 daqiiqo
3. Xeerka xariiqda IV ee gadaashiisa: Weligaa ha dib u dhigin 3% cusbada Dhiig karka si aad u dhigto xariiqda xididada dhexe. A 100 mL bolus ee 3% NaCl si buuxda ayay ammaan u tahay in lagu geliyo halbeeg kasta ** xariiqda IV ee wareega ama irbadda gudaha (IO)**.
4. ** Ku celi Boluses inta u dhaxaysa 10-daqiiqo (Illaa 3 Total Boluses)**:
5. Haddii jahawareerka, caajiska, ama suuxdintu aanay si cad u roonayn 10 daqiiqo ka dib boluska ugu horreeya, maamul **labaad 100 mL IV bolus of 3% NaCl in ka badan 10 daqiiqo ***, iyo haddii loo baahdo, **saddexaad 100 mL bolus *** 10 daqiiqo ka dib.
6. **Waa maxay sababta loo kordhiyo Serum Sodium by Just 4 to 6 mEq/L Waxay badbaadisaa maskaxda ***:
7. Uma baahnid *** Uma baahnid inaad ka soo qaado serum sodiumka bukaanka 115 mEq/L oo dhan dib loogu noqdo 140 mEq/L saacada ugu horeysa.
8. Kor u qaadida fiirsashada soodhiyamka serum ** kaliya 4 ilaa 6 mEq/L gudahood 30 ilaa 60 daqiiqo ee ugu horeeya** waxay abuurtaa osmotic gradient degdeg ah oo ka gudba xayndaabka maskaxda ee ka soo saara biyo ku filan maskaxda si ** u yareeyo cadaadiska intracranial boqolkiiba 50 **, joojinta suuxdinta iyo dib u noqoshada soo socota herniation daqiiqado gudahood.
9. ** Beddelka Degdegga ah haddii 3% Bacaha NaCl aysan isla markiiba saarneyn Gaariga Shilka (8.4% Sodium Bicarbonate Ampules***:
10. Qalabka caadiga ah ee gaariga shilka ah ee 8.4% Hypertonic Sodium Bicarbonate (50 mL = 50 mEq of Na+ = 1,000 mEq/L* waa laba jeer ka badan hypertonic 3% NaCl ***. Haddii bukaanku si firfircoon uga qabto ama herniynaya hyponatremia ba'an oo farmashiyaha uusan weli soo dirin 3% NaCl bac, lagu shubo 50 mL (1 ampule) oo ah 8.4% Sodium Bicarbonate IV in ka badan 5 ilaa 10 daqiiqo waxay keentaa isla isku mid ah 50 mEq culeyska samatabbixinta sodium osmotic sida 100 mL of 3% NaCl.

2. Farqiga Muhiimka ah: Ba'an (< 48 Hours) vs. Chronic (> 48 saacadood) Xadka Saxitaanka iyo Osmotic Demyelination Syndrome (ODS)¶

Ka-hortagga: Xeerarka Fuuqbaxa Ku Salaysan Caddaynta ee Layliga Adkeysiga iyo Hirarka Kulaylka¶

1. Cabb ilaa harraad, waligaa "haraad ka hor"**: ** Layliga Caalamiga ah ee kuxiran Shirka Horumarinta Hyponatremia Consensus Development ** iyo ** Ururka Caafimaadka duurjoogta ** waxay xaqiijinayaan in haraadka jireed ee bini'aadanku yahay kan ugu badbaado badan, hagaha wakhtiga dhabta ah ee saxda ah baahiyaha dareeraha inta lagu jiro marathon, socodka, iyo ciyaaraha. Ku cabbitaanka jadwal khasab ah ("2 koob 15kii daqiiqaba") waa sababta koowaad ee EAH.
2. ** Ogow Saqafka dhididkaaga (400 to 800 mL/hour***: Inta badan orodyahannada madadaalada iyo tamashlaha waxay u baahan yihiin wax ka badan 400 ilaa 800 mL (13 ilaa 27 wiqiyadood) oo dareere ah saacadiiba inta lagu jiro jimicsiga, waana in ** waligood miisaan kor uma qaadin *** inta lagu jiro tartanka ama socodka.
3. ** Had iyo jeer Ku Laamba Biyaha Cusbada Cusbada Inta lagu jiro Kulaylka iyo Socodka Dheer ***: Shaqaalaha bannaanka iyo kuwa socod-baradka ah oo aad u dhididsan wax ka badan 2 ilaa 3 saacadood waa in ay cunaan cunto fudud oo cusbo leh (pretzels, lawska cusbada leh, buskudka, pickles, maraq, ama cusbada fuuqcelinta afka ee dheellitiran)
4. **MDMA / Festifaalka Dhimista Dhibta ***: Waligaa ha cabbin wax ka badan ** 250 ilaa 500 mL (1 ilaa 2 koob) oo dareere elektaroonik ah saacadii

Lambarada degdega ah ee gobolka iyo borotokoolka wakaalada¶

Su'aalaha soo noqnoqda¶

Cabitaanka Gatorade ama cabitaannada isboortiga ee ganacsiga miyaanay ka hortageynin sakhradda biyaha (hyponatremia) inta lagu jiro marathon ama kulaylka?¶

Maya. Dhiiga caadiga ah ee bini'aadamka wuxuu ka kooban yahay 140 mEq/L oo soodhiyam ah, halka inta badan cabitaannada ciyaaraha ganacsiga ay ka kooban yihiin 18 ilaa 20 mEq/L oo ah sodium. Taas macnaheedu waa cabitaanka isboortiga ee ganacsiga ayaa weli ah 85 boqolkiiba hypotonic (biyo aan cusbo lahayn) marka loo eego dhiiggaaga. Haddii orodyahanka ama shaqaalaha bannaanka uu cabbo cabitaannada isboortiga ee xad-dhaafka ah si ka dhaqso badan inta ay dhididsan yihiin iyo kaadidu, gaar ahaan marka ay tacab-ku-taaggu keeno Hormoonka Antidiuretic Hormone (ADH) ay ka hortagto kelyahooda inay soo saaraan biyaha, sodium dhiigoodu weli hoos buu u dhacayaa ilaa heerar khatar ah. Ka-hortagga hyponatremia-ku-xiran jimicsiga waxay u baahan tahay cabbitaanka si waafaqsan harraadka (aan la cabbin) iyo isticmaalka milix cunto oo ku filan dadaalka dheer.

Sideen u sheegi karaa khadka dhammaynta marathon-ka ama raad-socodka haddii qof uu qabo sakhradda biyaha (hyponatremia) iyo fuuq-bax?¶

Iska hubi saddex calaamadood oo fudud ka hor intaadan siin wax dareere ah: (1) Cabitaanka dareeraha iyo miisaanka: Qofka biyaha sakhraansan ayaa si aad ah u cabbaya goob kasta oo biyo ah oo uu ku kordhay miisaan (ama miisaankiisa) oo leh calool-barar, calool-xumo, halka qofka fuuqbaxaya uu cabbay wax yar oo miisaankiisu hoos u dhacay; (2) Calaamadda Garaacda Dhejisan: Maandooriyaha biyuhu waxa uu keenaa barar, fara barar iyo cududyo halkaas oo faraanti iyo saacaduhu si lama filaan ah u dareemaan cidhiidhi, halka fuuq-baxu uu keeno carrab qallalan iyo indho goglan; iyo (3) Xaaladda maskaxeed: fuuq-bax fudud ama kulayl-la'aana waxay sababtaa daal iyo dawakhaad markaad istaagto, halka sakhradda biyuhu ay keento madax-xanuun daran, matag qarxa, jahawareer, turunturooyin, iyo suuxdin.

Maxay khatar u tahay in la siiyo ilmo ka yar 6 bilood biyo caadi ah ama caanaha la waraabiyey?¶

Dhallaanka da'doodu ka yar tahay 6 bilood waxay leeyihiin kelyo aan qaan-gaarin oo aan si dhakhso ah u sifeyn karin biyaha cad ee dheeraadka ah, jirkooda yaryarna wuxuu hayaa wax yar oo soodhiyam ah. Siinta dhallaanka xitaa dhowr wiqiyadood oo biyo caadi ah, ama ku darista biyo dheeraad ah si ay u fidiyaan caanaha budada ah ee ilmaha, waxay si degdeg ah u milmaan sodium-ka ku jira dhiigga ilmaha. Saacado gudahood, biyuhu waxay u dhaqaaqaan unugyada maskaxda ee ilmaha, iyagoo keenaya hoos u dhaca heerkulka jidhka (ka hooseeya 36.1 darajo Celsius / 97 darajo Fahrenheit), barar wajiga, caajisnimo, matag, iyo suuxdin naf-gooyo ah oo halis gelinaya. Dhallaanka da'doodu ka yar tahay 6 bilood waa inay helaan caanaha naaska oo keliya ama caano dhallaanka caadiga ah oo la isku daray.

Waa maxay sababta MDMA ("Ecstasy" ama "Molly") ay u keento sakhradda biyaha dilaaga ah ka dib markay cabto dhawr dhalo oo biyo ah?¶

Caadiyan, haddii aad cabto litir ama laba biyo ah oo dheeraad ah, maskaxdaadu waxay joojinaysaa sii daynta Hormoonka Antidiuretic Hormone (ADH) oo kelyahaagu waxay kaadiyaan biyaha dheeraadka ah saacad gudaheed. MDMA waxay kimikal ahaan u kicisaa hypothalamus si ay u sii deyso kor u kac wayn oo joogto ah oo ADH ah kaas oo kelyaha xidha 12 ilaa 24 saacadood si aanay biyo bilaasha uga kaadi karin. Isla mar ahaantaana, MDMA waxay kor u qaadaa heerkulka jidhka waxayna sababtaa harraad daran. Marka isticmaaluhu uu cabbo dhowr dhalo oo biyo ah si uu u qaboojiyo, 100 boqolkiiba biyahaas ayaa ku xayiran qulqulka dhiigga, taasoo keenta barar degdeg ah maskaxda, suuxdin, iyo herniation maskaxda.

Waa maxay faraqa u dhexeeya daawaynta sakhradda biyaha ba'an (< 24 hours) and chronic low sodium (> 48 saacadood)?¶

Marka lagu jiro sakhradda biyaha ba'an (halkaas oo soodhiyamka dhiiggu ku dhaco dhowr saacadood inta lagu jiro maaratoonka, rave, ama tartanka biyaha-cabitaanka), unugyada maskaxdu ma helin wakhti ay ku qabsadaan, markaa khatarta degdega ah waa barar maskaxda ah oo dilaa ah iyo herniation. Dhakhaatiirtu waxay siinayaan boluses xididada degdega ah ee 100 ml oo ah 3% Hypertonic Saline si ay si dhakhso ah ugu kiciso sodium dhiiga 4 ilaa 6 mEq/L oo ay maskaxda dib u soo celiso, iyada oo ku dhawaad ​​eber khatarta ah demyelination. Taas bedelkeeda, marka qof uu si tartiib tartiib ah u yeesho soodhiyam hooseeya maalmo badan ama toddobaadyo (laga bilaabo kaniiniyada biyaha, wadna xanuunka, ama cudurada beerka), unugyada maskaxeed ayaa mar hore la qabsaday; halka takhaatiirtu ay weli siinayaan 4 ilaa 6 mEq/L hypertonic bolus haddii bukaanku qabanayo, waa inay si adag u xaddidaan wadarta kor u kaca soodhiyamka wax aan ka badnayn 6 ilaa 8 mEq/L 24 saacba si looga hortago Osmotic Demyelination Syndrome (ODS).

Tilmaamaha la xidhiidha¶

• Heat stroke vs. kulayl daal: Sida loo kala saaro
• Jirrada kulaylka gargaarka degdegga ah iyo qaboojin degdeg ah
• Xaaladaha degdega ah ee potassium: Hyperkalemia iyo hypokalemia
• Qabo gargaarka degdega ah iyo badbaadada
• Xaaladda suuxdin, suuxdin dabadheeraad ah, iyo dawooyinka samatabbixinta

Ilaha iyo hanuuninta rasmiga ah¶

• Layliga Caalamiga ah ee Ku Xidhan Shirka Horumarinta Hyponatremia Consensus: Bayaanka Saddexaad ee Layliga Caalamiga ah ee La Xiriira Shirka Horumarinta Hyponatremia Consensus Development (Journal Clinic of Sport Medicine).
• Wilderness Medical Society (WMS): * Tilmaamaha Dhaqanka Kiliinikada ee Maareynta Jimicsiga La Xiriira Hyponatremia: Cusboonaysiinta 2019*.
• Bulshada Reer Yurub ee Daawada Daryeelka Degdegga ah (ESICM) & Bulshada Yurub ee Dhakhaatiirta Cilmiga Dhakhaatiirta: * Tilmaamaha Dhaqanka Kiliiniga ee Cilad-sheegidda iyo Daaweynta Hyponatraemia*.
• Akademiyada Maraykanka ee Dhakhaatiirta Carruurta (AAP): Nafaqada Dhallaanka iyo Ka Hortagga Maandooriyaha Biyaha Afka iyo Suuxdinaha Dhiig-karka ee Dhallaanka.
• Xarumaha Xakamaynta iyo Kahortagga Cudurrada (CDC / NIOSH): Shuruudaha Heerarka lagu taliyay: Soo-gaadhista Shaqada Kulaylka iyo Deegaanka Kulul (Beddelka Korontada iyo Ka-hortagga Hyponatremia).

*Hagahan waxa loogu talagalay ujeeddooyin macluumaad mana beddelo qiimaynta caafimaadka xirfadleyda ama daryeelka degdegga ah ee isbitaalka. Sababtoo ah hyponatremia-ku-xiran jimicsiga iyo istaroogga kulaylku waxay sababi kartaa luminta miyir-beelka degdega ah iyo suuxdin, waxaan si adag kuugula talineynaa inaad qaadato gacmo-gacmeed la aqoonsan yahay oo cidlada ah ama gargaarka degdegga ah ee caadiga ah iyo koorsada CPR iyada oo loo marayo Xiriirka Caalamiga ah ee Laanqeyrta Cas iyo Ururada Bisha Cas (IFRC), bulshadaada Laanqayrta Cas ee qaranka, St John Ambulance, ama bixiye maxalli ah oo la aqoonsan yahay.