Ukunxila ngaManzi, iHyponatremia eNxulunyaniswa noMthambo, kunye nokuDumba koBuchopho obuphantsi kweSodium¶

Ukusela amanzi kubalulekile ebomini, kodwa ukusela umthamo ogqithisileyo wamanzi alula okanye iziselo zezemidlalo eziphantsi-sodium ngokukhawuleza kunokuba izintso zomntu zinokukhupha oko kubangela ** i-acute dilutional hyponatremia ("ukuxilwa kwamanzi")**, imeko engxamisekileyo yonyango ebulalayo ngokukhawuleza apho i-blood concentration ye-sodium (Na+) ithoba ngaphantsi 135 mEq/L (mmol/L) (kwaye kaninzi ngaphantsi kwe-120 ukuya kwi-125 mEq/L*), ukunyanzela amanzi agqithisileyo ngaphaya komqobo wegazi-buchopho ukuya ngqo kwiiseli zengqondo nge-osmosis. Njengoko iiseli zobuchopho zidumba ngaphakathi koKhakhayi oluqinileyo, olunganyibilikiyo (**acute hyponatremic cerebral edema / encephalopathy ), amaxhoba aba nentloko ebuhlungu, isicaphucaphu, ukugabha, ukuqunjelwa, izandla ezikhukhumeleyo kunye neenyawo, ukudideka, ukuziphatha okungaqhelekanga, ukukhubeka, ukuqaqanjelwa yingqondo, ukudumba, kunye nokufa.

Ukuxilwa kwamanzi abukhali kubetha amaqela amahlanu ahlukeneyo: (1) ** i-marathoners, i-ultramarathoners, i-triathletes, abakhweli, kunye nabasebenzi basemkhosini ** abasela kuzo zonke izitishi zamanzi "phambi kokunxanwa" (I-Exercise-Associated Hyponatremia [EAH]); (2) ulwakhiwo lwangaphandle, abasebenzi basezifama, nabasebenza kwimizi-mveliso basela iilitha zamanzi angenanto ngexesha lobushushu basehlotyeni; (3) ** i-festival-goers kunye nabantu abadala abancinci abathatha i-MDMA ("Ecstasy" okanye "Molly") **, ebangela ukukhutshwa okukhulu kwehomoni ye-antidiuretic ngelixa kubangela ukoma okukhulu; (4) iintsana ezingaphantsi kweenyanga ezi-6 ubudala zinikwe amanzi alula okanye ubisi olungumgubo oluxutywe ngokugqithiseleyo; kunye (5) ** abakhuphiswano kwimingeni yokusela amanzi okanye izigulane ezine-psychogenic polydipsia **. Ukuba umntu osele utywala kakhulu uye adideke, akhubeke, agabhise, okanye axhuzule, tsalela umnxeba kwinombolo yakho yexesha likaxakeka (911 eUnited States naseKhanada, 112 kulo lonke elaseEuropean Union, 999 eUnited Kingdom). amanani kaxakeka ulawulo ngoko nangoko, kwaye uphonononge ukubetha kobushushu vs. ukudinwa kobushushu, ukugula ubushushu uncedo lokuqala, kwaye ukubamba uncedo lokuqala.

Yenza oku ngoku¶

1. YEKA WONKE AMANZI NOLWAZI LOKUTSHA NGOKUKHAWULEYO: Eyona mpazamo inkulu kumdyarho wembaleki, uhambo lokuhamba intaba, uhambo lwasemkhosini, okanye indawo yomsebenzi oshushu kukuba nesiyezi, isicaphucaphu, imbaleki edidekileyo okanye umsebenzi “uphelelwe ngamanzi emzimbeni okanye udinwe bubushushu” kwaye ** ubanyanzele ukuba basele amanzi amaninzi okanye baqale i-dripline yesiqhelo* Ukuba umntu ebesele utywala kakhulu, unomchamo ocacileyo okanye udumbile, okanye akalahlekelwanga bubunzima bomzimba, ubambe onke amanzi alula, iziselo zezemidlalo, kunye nee-hypotonic fluids ngoko nangoko.
2. Fowunela u-911/112/999 ngoko nangoko malunga naziphi na iimpawu zesilumkiso se-neurological: Tsalela umnxeba kwiinkonzo zonyango ezingxamisekileyo ngoko nangoko ukuba umntu uba nentloko ebuhlungu ebuhlungu, ukugabha ngokuphindaphindiweyo, ukudideka, ukudideka, ukuthetha kakubi, ukukhubeka (ataxia), ukuxhuzula kwemisipha, ukutyhafa, okanye ukuxhuzula. Tshela i-dispatcher kunye ne-paramedics ukuba bakrokre ** I-Acute Exercise-Associated Hyponatremia (Ukuxilwa kwamanzi) kunye ne-Cerebral Edema ** ukuze ABAqhubeki isikhwama esikhawulezayo se-IV ye-fluid esemgangathweni endleleni.
3. **Nikeza isisombululo esigxininisiweyo setyuwa yomlomo (hypertonic) KUPHELA ukuba umntu uvukile ngokupheleleyo, ephaphile, kwaye uneempawu zokuqala ezincinci **: Kwintlango, i-marathon, okanye izicwangciso zentsimi apho umntu ekrokrela i-EAH epholileyo (isicaphucaphu, intloko ebuhlungu, iminwe ekhukhumeleyo, imbali yokusela ngokugqithiseleyo) kwaye ** i-100 ipesenti ivukile, i-Wildness, i-Wildness, i-Wildness ivukile, ikwazi ukugwinya, i-Wildness, i-Wildness, i-100 pesenti ivukile (WMS) kunye nezikhokelo ze-International EAH Consensus zincoma ukunika umthwalo wetyuwa yomlomo we-hypertonic: 3 ukuya kwi-4 iityhubhu ze-bouillon ezinyityilisiweyo kwi-120 mL (isiqingatha sekomityi / ii-ounces ezi-4) zamanzi, okanye 2 ukuya kwi-3 iipakethi ezinetyuwa zepretzel/zetyuwa ngokurhabula kancinci kwamanzi. Ungaze unike nantoni na ngomlomo ukuba umntu ubhidekile, uyozela, uyagabha, okanye uyaxhuzula.
4. **Khangela i-"Tight Ring / Watchband Sign" kunye nokuchama okucacileyo : Jonga iminwe yomntu, izihlahla kunye namaqatha. Ngokungafaniyo nomntu ophelelwe ngamanzi emzimbeni (olusu lwakhe lomile, amehlo atshone, nomchamo umnyama), ixhoba lokunxila ngamanzi lidla ngokudumba, iminwe ekhukhumeleyo apho imisesane okanye amabhanti ewotshi aziva eqinile ngequbuliso, isisu esidumbileyo, ubunzima ukuzuza ukususela ekuqaliseni umthambo, kunye nokuchama rhoqo okanye okucacileyo.
5. Khusela indlela yomoya ngexesha lokugabha kunye nokuxhuzula: Ukudumba kwengqondo okubukhali kubangela ukugabha okuqhumayo ngesiquphe kunye nokuxhuzula okuqhelekileyo kwetonic-clonic. Beka umntu owozelayo, obhidekileyo, okanye obambayo kwicala lakhe kwindawo ekuyo ukuchacha ukuze umgabho uphume ngomlomo kunokuba ungene emiphungeni.
6. ** Qaphela isibhedlele esifumanayo okanye intente yonyango yokugqiba ukulungiselela i-3% ye-Hypertonic Saline (3% NaCl): Nasiphi na isigulana esine-hyponatremic encephalopathy (ukubhideka, isiqaqa, ukuxhuzula, okanye ukuphefumla nzima), i-antidote yokusindisa ubomi kwangoko yiintravenous bolus ye-100 mL ye-3% Hypertonic Sodium Chloride (3% NaCl) ifakwe ngaphezu kwemizuzu ye-10 **, iphinda iphindwe ukuya kumaxesha amabini ongezelelweyo kwixesha lemizuzu ye-10 de iimpawu ze-neurological zixazulule.

Umthi wesigqibo: Ukwahlula ukuxiliswa kwamanzi (EAH) ukusuka kumanzi kunye nokushisa¶

flowchart TD
    Start["Imbaleki ewileyo, ebhidekileyo, okanye egabhayo, umkhweli, umqeshwa, umntu obekhona, okanye usana"] --> CheckHistory["Vavanya iMbali yokuTyalwa koLulwelo: Ngaba uMntu ebesela amanzi amaninzi/iziselo zezemidlalo (okanye iFomula eDiluted kwiNtsana)?"]

    CheckHistory --> VitalsCheck["Jonga iqondo lobushushu elingundoqo (iRectal ukuba ubushushu burhanelekile) kunye nePoint-of-Care Blood Sodium (Na+)"]

    VitalsCheck -->|Core Temp > 40 C (104 F) + CNS Delirium| HeatStroke["I-Exertional Heat Stroke: Ukuntywiliselwa ngokukhawuleza kwaManzi e-Ice-Water Ukupholisa kuqala; Jonga iSerum Na + ngaphambi kokuba unike iiBoluses ezinkulu ze-IV Fluid"]

    VitalsCheck -->|Blood Sodium (Na+) < 135 mEq/L (Often < 125 mEq/L) OR Clinical Clues of Overhydration (Weight Gain, Tight Rings, Sloshing Stomach)| EAH_Severity{"Vavanya ubunzima beNeurological of Acute Hyponatremia"}

    EAH_Severity -->|SEVERE: Confusion, Delirium, Obtundation, Ataxia, Seizures, Coma, or Pulmonary Edema (Hyponatremic Encephalopathy)| Give3Percent["UKUSINDISA UBOMI NGOKWANGOKO:\n1. Nciphisa Zonke Ulwelo Lomlomo/Hypotonic\n2. Lawula i-100 mL ye-3% ye-Hypertonic Saline (3% NaCl) IV Bolus Ngaphezu kweMizuzu eyi-10 (2 mL / kg kuBantwana)\n3. Phinda kwakhona i-100 mL 3% i-NaCl Bolus yonke iMizuzu eyi-10 (Ukuya kwi-3 iyonke yeBoluses) Kuze kube yi-Seizures/Delirium Stop kunye ne-Na+ Inyuka ngo-4 ukuya kwi-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{"Qinisekisa ixesha: Acute (< 24-48 Iiyure) vs Chronic (> 48 Iiyure) Hyponatremia"}
    AcuteVsChronic -->|Acute Water Intoxication / EAH / MDMA (< 24-48h)| RapidSafe["Ukulungiswa ngokukhawuleza kwe-4-6 mEq/L kwiyure yokuQala KUKHUSELEKILE kwaye kunyanzelekile uThintelo lweBrain Herniation (Umngcipheko omncinci we-ODS kwiNyaniso ye-Acute Acute)"]
    AcuteVsChronic -->|Chronic Hyponatremia (> 48h: Diuretics, Heart/Liver Failure, Chronic SIADH)| CapRate["Emva kwe-Initial 4-6 mEq/L Rescue Bolus for Seizures, Strictly Cap Total Rise yeSodium kwi <= 6 ukuya kwi-8 mEq/L ngeeyure ezingama-24 ukuThintela i-Osmotic Demyelination Syndrome (ODS)"]

I-Pathophysiology: Kutheni Amanzi Amanzi Ngokugqithisileyo Ebangela Ukuba Ubuchopho Budumbe kwaye Kutheni Izintso Zingayikhuphi Nje¶

Intso yomntu esempilweni xa iphumle inokukhupha ukuya kuthi ga ku 800 ukuya kwi-1,000 mililitha (phantse i-1 quart) yamanzi asimahla ngeyure. Oku kuphakamisa umbuzo ocacileyo: ukuba imbaleki, umhambi, okanye umnyhadala usela i-1.0 ukuya kwi-1.5 yeelitha zamanzi ngeyure, kutheni izintso zabo zingavele zikhuphe amanzi angaphezulu?

1. I-"Double Hit" Mechanism: I-Fluid Intake ngokugqithisileyo + i-Non-Osmotic ADH Secretion (SIADH)¶

Phantse kuzo zonke iimeko ezibulalayo ze-I-Exercise-Associated Hyponatremia (EAH), ukuxiliswa kwamanzi ashushu, kunye ne- **MDMA-induced hyponatremia **, **iziganeko ezimbini ze-physiological zenzeka ngexesha elifanayo **:

1. Betha 1: Ukusetyenziswa ngokugqithisileyo kwe-Hypotonic Fluids (Amanzi okanye Iziselo zeMidlalo):
2. Igazi lomntu eliqhelekileyo line-sodium concentration ye-135 ukuya kwi-145 mEq/L* (mmol/L).
3. Impompo engenanto okanye amanzi asebhotileni ane-0 mEq/L yesodium*.
4. **Iziselo eziqhelekileyo zezemidlalo zorhwebo ** (ezifana neGatorade, Powerade, okanye iLucozade Sport) ziqulethe kuphela ** 18 ukuya kwi-20 mEq / L yesodium **, oku kuthetha ukuba isiselo sezemidlalo sisekho ** i-85 yeepesenti ezihlambulukileyo zamanzi angenatyuwa ** ngokubhekiselele kwigazi lomntu.
5. Ngoko ke, ukusela iilitha zeziphuzo zezemidlalo zorhwebo ngexesha le-marathon okanye i-heatwave ** AYIKWAZI ukuthintela i-hyponatremia **; enyanisweni, ukusela iziselo zezemidlalo ezigqithisileyo kunciphisa isodium yegazi phantse ngokukhawuleza njengamanzi angenanto.
6. Betha i-2: Imfihlo engafanelekanga yeHormone ye-Antidiuretic (i-Arginine Vasopressin / ADH) Itshixa iZintso Ukuvala:
7. Ngokuqhelekileyo, ngokukhawuleza xa usela amanzi amaninzi kunye negazi lakho le-osmolality lehla kancinci, i-posterior pituitary gland ijika ** OFF ** ihomoni ** I-Antidiuretic Hormone (ADH / Vasopressin) **, evumela ukuba izintso zakho zilahle iilitha ze-crystal-clear dilute urine.
8. Nangona kunjalo, ngexesha ** ixesha elide lokuzilolonga, uxinzelelo lobushushu, intlungu, isicaphucaphu, uxinzelelo lweemvakalelo, ukuvuvukala kwemisipha (interleukin-6 [IL-6] ukukhululwa kwimisipha esebenzayo), okanye i-MDMA ("Ecstasy") yokungeniswa , ingqondo ikhupha enkulu ** non-osmotic surge ye-ADH (**Syndrome of Inapprmone secretion]I-SIAntition ye-ADH *diuretic).
9. Oku kunyuka kwe-ADH kuyabophelela V2 i-receptors kwii-ducts zokuqokelela izintso, ukufaka ** i-Aquaporin-2 iziteshi zamanzi ** ezinyanzela iintso ukuba ** ziphinde zibuyisele onke amanzi akhululekileyo kwigazi ** ngelixa ukunciphisa ukukhutshwa komchamo kwi-trickle yomchamo ogxininisiweyo.
10. Uvaleleke ngaphakathi egazini kungekho ndawo unokuya kuyo, amanzi agityisiweyo anciphisa ngokukhawuleza i-sodium ye-serum 140 mEq/L phantsi ukuya < 125 mEq/L kwiiyure ezimbalwa.

2. UkuDumba koBuchotho be-Osmotic, iBrainstem Herniation, kunye ne-Ayus-Arieff Pulmonary Edema¶

• ** I-Osmotic Water Shift ibe yi-Astrocytes kunye ne-Neurons **: Ngenxa yokuba igazi elingaphandle kwe-extracellular ngoku liphawuleka nge-hypotonic (i-dilute) xa kuthelekiswa nangaphakathi kweeseli zengqondo, amanzi agijima ngokukhawuleza ngaphaya komqobo we-blood-brain barrier nge ** Aquaporin-4 channels ** kwi-astrocytes kunye ne-neurons.
• ** Kutheni i-Acute (< Iiyure ze-24) I-Drops inobungozi kakhulu kune-Chronic Drops **: Xa i-sodium yegazi iwela kancinci kwiiveki (engapheliyo hyponatremia), iiseli zengqondo zine ** iiyure ezingama-48 ** ukumpompa i-intracellular potassium, i-chloride, kunye ne-organic osmolytes (glutamate, taurine, myo-inoshrinkitol). Xa i-sodium yegazi iyancipha kwi- ** 2 kwiiyure ze-8 ** ngexesha le-marathon, i-rave, okanye ukhuphiswano lokusela amanzi, ** ingqondo inexesha le-zero lokulungelelanisa **.
• **I-Skull engapheliyo kunye ne-Tentorial / Foramen Magnum Herniation **: Ngenxa yokuba i-skull yabantu abadala yibhokisi eqinile yamathambo, i- ** 6% ukuya kwi-8% yokwanda komthamo wamanzi engqondo ** ikhupha yonke indawo ye-cerebrospinal fluid. Uxinzelelo lwe-Intracranial skyrockets, ukutyumza imithambo yegazi ye-cerebral, kubangela ** i-generalized tonic-clonic seizures **, kunye nokunyanzela ubuchopho obudumbileyo buhla nge **foramen magnum ** kwisiseko sokakayi (**i-brainstem herniation **), etyumza i-medullary breathing centre kwaye iyeke ukuphefumla.
• I-Neurogenic Non-Cardiogenic Pulmonary Edema (Ayus-Arieff Syndrome): Njengoxinzelelo lwe-intracranial spikes, isaqhwithi esikhulu esinovelwano secatecholamine esidityaniswe nokonyuka kwe-pulmonary capillary permeability kukhukulisa imiphunga ngolwelo olupinki olunegwebu (*neurogenic spikes) oluthi lubangele i-hypoxia ethe kratya yepulmonary umjikelo okhohlakeleyo obulalayo.

Uthelekiso lweklinikhi: Ukunxila ngaManzi (EAH) vs. Ukuphelelwa ngamanzi emzimbeni / ukudinwa nguBubushushu vs.¶

Sebenzisa le theyibhile yovavanyo esecaleni kwebhedi ukunqanda impazamo ebulalayo yokunika amanzi alula okanye ityuwa eqhelekileyo kwisigulana se-hyponatremic:

Iimeko ezintlanu zoMngcipheko oPhakamileyo wokuSetyenziswa kwamanzi ngokukrakra¶

1. Ababaleki beMarathoni, abaThathu, abaHambi, kunye naBasebenzi baseMkhosini (i-Hyponatremia eNxibeleniswa noMthambo)¶

• Ngubani OseMngciphekweni Ophakamileyo? Okumangalisayo kukuba, i-EAH yenzeka rhoqo kwi-*-imbaleki ezicothayo zokuzonwabisa (amaxesha omdyarho kwiiyure ezi-4)**, iimbaleki zamabhinqa (umthamo omncinci wamanzi omzimba wonke), abakhweli e-Grand Canyon okanye kwiindawo ezisentlango, kunye nabasebenzi basemkhosini kwiimatshi ezinyanzeliswayo zendlela abalandela iingcebiso eziphelelwe lixesha ngaphambi kokuba usele usele usele kakhulu*. Iiyure ezi-2 kunye nokusela kancinci, i-marathoner yeeyure ezi-5 eyeka kuzo zonke izikhululo zamanzi ze-20 kwaye iphuze iikomityi ezimbini kwisikhululo ngasinye ingaginya ** 4 ukuya kwiilitha ze-6 zolwelo ** ngelixa ilahlekelwa kuphela iilitha ezi-2 zobila.
• Iembaleki zilibazisekile emva kogqatso: Iimbaleki ezininzi ziye zagqibezela ugqatso ziziva zinesicaphucaphu xa ilitha yamanzi engafunxwanga ehleli esuswini sazo. Emva kokuba beyekile ukubaleka, ukuhamba kwegazi kubuya kwimisipha yomlenze ukuya kwi-digestive tract, ** ngokukhawuleza ukufunxa ilitha eseleyo yamanzi esiswini kwigazi ** kwaye kubangele ** ukuxhuzula kunye ne-coma 30 kwimizuzu engama-90 EMVA kokuwela umgca wokugqibela **.

2. Abasebenzi bangaphandle kunye nabanini zindlu ngexesha le-Heatwaves ("Ukutshintsha i-Sweat ngamanzi angenanto")¶

Ukubila komntu netyuwa, kuqulathe malunga ne-40 ukuya ku-60 mEq/L (0.9 to 1.4 grams/L) yesodium*. Xa uphahla, umenzi-mhlaba, umsebenzi wezolimo, okanye umsebenzi wogcino ebila ephuma 6 ukuya kwi-10 ilitha phezu kweshifti yeeyure ezisi-8 38 degrees Celsius (100.4 degrees Fahrenheit) ubushushu kwaye endaweni nganye ilitha yombilo enetyuwa ngeamanzi etephu angenatyuwa angenanto ngaphandle kokutya ukutya okunetyuwa, bafumana ilahleko enkulu yesodium yomzimba edityaniswe nokuhlanjululwa kwamanzi asimahla. - Ii-Muscle Cramps ziSilumkiso Uphawu #1: I-sodium dilution kwangethuba ibangela ukuba kubuhlungu amahlaba obushushu ematholeni, emathangeni, nasesiswini. Ukuba umsebenzi utolika ezo cramps ngokuthi "Ndifuna ukusela enye igaloni yamanzi alula," baqhubela phambili ngokukhawuleza ukusuka kwiintlungu zokushisa ngqo kwi-**hyponatremic encephalopathy kunye nokuxhuzula **.

3. I-MDMA ("i-Ecstasy" / "Molly") kunye noMnyhadala woMculo wokuxilwa kwamanzi¶

** I-MDMA (i-3,4-methylenedioxymethamphetamine)** yenye yezona zinto zibangela i-fatal acute hyponatremia, echaphazela ngokungafanelekanga ** abafazi abancinci (abaneminyaka eyi-15 ukuya kwe-30)** kwiikonsathi, i-raves, kunye neeklabhu: - I-MDMA ivuselela ngokuthe ngqo i-hypothalamic serotonergic pathways ukukhulula ** ukukhutshwa okukhulu, ixesha elide le-Antidiuretic Hormone (ADH / Vasopressin) **, ukuvala ngokupheleleyo amandla ezintso zokukhupha amanzi akhululekile ** 12 kwiiyure ze-24 *. - Kwangaxeshanye, i-MDMA ibangela umlomo owomileyo, ukuqina kwemihlathi ( bruxism *), i-hyperthermia, kunye nonxano oluphakathi kwengqondo, ngelixa oontanga bexelela umsebenzisi ukuba * "selela amanzi amaninzi ukuze ungatshisi kakhulu." - Ukusela nokuba ** i-1.5 ukuya kwi-3 ilitha yamanzi ** emva kokuthatha ithebhulethi enye ye-MDMA inokubangela ukuba i-sodium yegazi idibanise ngaphantsi ** i-115 ukuya kwi-120 mEq / L **, ekhokelela kwi-edema ye-cerebral edema, isimo se-epilepticus, kunye nokufa kwengqondo.

4. Ukunxiliswa Kweentsana Zamanzi (Abantwana abangaphantsi kweenyanga ezi-6 ubudala)¶

Iintsana ezingaphantsi kweenyanga ezi-6 zobudala AKUMELE zinikwe amanzi aqhelekileyo ukuba zisele, kwaye ubisi olungumgubo lweentsana UNGAZE luxutywe ngamanzi angaphezulu "ukolula" inkonkxa yobisi olungumgubo okanye lupholise umntwana ehlotyeni: - Usana olusandul’ ukuzalwa okanye usana oluncinane lunezintso ezingekavuthwa ezinezinga eliphantsi lokuhluza iglomerular elingenako ukukhupha umthwalo wamanzi asimahla ngokukhawuleza, lidityaniswa nomthamo omncinci wamanzi wonke womzimba. - Ukunika umntwana oneenyanga ezi-3 ubudala nokuba yi-120 ukuya kwi-240 mL (ii-ounces ezi-4 ukuya kwezi-8) zamanzi alula, okanye wongeze iiskophu ezimbini zamanzi kwipuphu enye yomgubo wefomyula kwiiyure ezingama-24, yehla ngokukhawuleza i-serum yesodium yosana ngaphantsi 120 mEq/L. - IiMpawu zokuLumkisa iintsana: Ubushushu bomzimba wehla (hypothermia ngaphantsi kwe-36.1 degrees celcius [97 degrees Fahrenheit]), ukukhukhumala kobuso kunye nenkophe, ukucaphuka okanye ukomelela okugqithisileyo, ukugabha, kunye nokuxhuzula okuqhelekileyo ngesiquphe.

5. Ukhuphiswano lokusela amanzi, iHazing, ukuTyuswa kweziyobisi zomchamo, kunye nePolydipsia yePsychogenic¶

Ukuginya **4 ukuya kwi-8+ iilitha (i-1 ukuya kwi-2+ iilitha) zamanzi ngaphakathi kwe-1 kwiiyure ze-3 **, nokuba ngexesha le-fraternity hazing ritual, irediyo / ukhuphiswano lokusela amanzi kwi-intanethi, umzamo "wokukhupha" isikrini seziyobisi zomchamo, okanye i-polydipsia yengqondo, igqithise ubuninzi beentso '. 800 to 1,000 mL/hour ukukhupha isilingi, okubangela ukuqhambuka kobuchopho obubulalayo ngaphambi kokuba izintso zibambe.

ISibhedlele kunye neMigaqo yoNyango lweNdawo¶

1. I-Gold-Standard Antidote ye-Acute Hyponatremic Encephalopathy: I-100 mL Bolus ye-3% ye-Hypertonic Saline (3% NaCl)¶

Xa isigulana sibonisa simptomatic acute hyponatremic encephalopathy (ukubhideka, ukuqaqadeka, ukuqaqadeka, ataxia, ukugabha kakhulu, isiqaqa, ukuxhuzula, okanye i-neurogenic pulmonary edema), yonke imizuzu iyabala. Ulwelo oluqhelekileyo lwe-isotonic (0.9% Normal Saline, onayo 154 mEq/L zesodium) zi-** contraindicated ** ngenxa yokuba kukho i-ADH ephezulu (SIADH), izintso zinokukhupha 154 mEq yesodium ibe ngumchamo ophezulu we-osmolality ngelixa igcina amanzi (desalination phenomenon), yenza ukudumba kwengqondo kubi kakhulu.

Endaweni yoko, ** 3% Hypertonic Sodium Chloride (3% NaCl)** iqulethe 513 mEq/L yesodium (1,026 mOsm/L), engaphezulu kokuphindwe kathathu kune-osmolality yegazi lomntu kwaye iphezulu kunomlinganiselo ophezulu woxinaniso nayiphi na intso yomntu enokuthi ivelise:

1. Bolus kwangoko 1 (100 mL okanye 150 mL ye 3% NaCl):
2. Ukufakela ** i-100 mL ye-3% ye-Hypertonic Saline IV ngaphezu kwemizuzu eyi-10 ** (Izikhokelo zaseYurophu / zase-US nazo zivumela ** i-150 mL ngaphezu kwemizuzu engama-20 **; ku- ** abantwana kunye neentsana **, faka ** 2 ukuya ku-3 mL / kg ye-3% NaCl [ukuya kwi-100 mL] ngaphezu kwemizuzu eyi-10 * ukuya kwi-1 *).
3. I-Peripheral IV Line Rule: Ungaze ulibazise i-3% Hypertonic Saline ukubeka umgca we-venous ophakathi. A 100 mL ibolus ye 3% NaCl ikhuseleke ngokupheleleyo ukuba ifakwe kuwo nawuphi na umgangatho ** peripheral IV line okanye intraosseous (IO) inaliti **.
4. Phinda iiBoluses kwiMizuzu eli-10 (Ukuya kuthi ga kwi-3 iyonke yeBoluses):
5. Ukuba ukudideka, ukutyhafa, okanye ukuxhuzula akuphucukanga ngokucacileyo kwimizuzu eyi-10 emva kwe-bolus yokuqala, lawula i-*second 100 mL IV bolus ye-3% NaCl ngaphezu kwemizuzu eyi-10 **, kwaye ukuba kuyimfuneko, i- yesithathu 100 mL bolus imizuzu eyi-10 kamva.
6. Kutheni Ukwandisa iSerum Sodium nje 4 to 6 mEq/L Igcina Ingqondo:
7. Awunayo ** NOT ** kufuneka unyuse i-sodium ye-serum yesigulana ukusuka 115 mEq/L yonke indlela ebuyela 140 mEq/L ngeyure yokuqala.
8. Ukuphakamisa i-serum concentration ye-sodium nge-*-4 ukuya kwi-6 mEq/L phakathi kwe-30 yokuqala ukuya kwimizuzu engama-60 ** kudala i-osmotic gradient ekhawulezileyo kumqobo wengqondo-gazi okhupha amanzi aneleyo ngaphandle kwengqondo ukuze **ukunciphisa uxinzelelo lwe-intracranial ngama-50 ekhulwini **, ukumisa ukuxhuzula kunye nokubuyisela umva kwimizuzu yobuchopho obuzayo.
9. Ukutshintshwa ngokuNgxamisekileyo ukuba i-3% yeengxowa ze-NaCl azikho ngoko nangoko kwiNqwelo yokuNwabeka (8.4% Sodium Bicarbonate Ampules):
10. Ii-ampule zenqwelo yokuphahlazeka eqhelekileyo 8.4% yeHypertonic Sodium Bicarbonate (50 mL = 50 mEq of Na+ = 1,000 mEq/L) zi*** kabini njenge-hypertonic njenge-3% NaCl**. Ukuba isigulana sibamba okanye sikhupha i-herniating kwi-acute hyponatremia kwaye ikhemesti ayikayithumeli. 3% NaCl ibhegi, ifafa 50 mL (1 ampule) ye 8.4% yeSodium Bicarbonate IV ngaphezulu kwemizuzu emi-5 ukuya kweli-10 ihambisa kwa kanye kanye 50 mEq umthwalo osmotic sodium wokuhlangula njengoko 100 mL of 3% NaCl.

2. Umahluko obalulekileyo: Ubukhali (< 48 Hours) vs. Chronic (> Iiyure ezingama-48) iMida yoLungiso kunye ne-Osmotic Demyelination Syndrome (ODS)¶

Uthintelo: Ubungqina obuSekwe kwiMithetho ye-Hydration yokunyamezela uMthambo kunye nama-Heatwaves¶

1. Sela Ukunxanelwa, Ungaze "Ngaphambi Kokunxanwa": I-International Exercise-Associated Hyponatremia Consensus Development Conference kunye ne Wilderness Medical Society iqinisekisa ukuba unxano lwe-physiological physiological sesona sikhokelo sikhuselekileyo, esichanekileyo sexesha langempela kwiimfuno zamanzi ngexesha le-marathons, ukunyuka, kunye nemidlalo. Ukusela kwishedyuli yokunyanzeliswa ("iikomityi ezi-2 rhoqo ngemizuzu eyi-15") yimbangela ephambili ye-EAH.
2. Yazi iCeiling yakho yokubila (400 to 800 mL/hour): Uninzi lweembaleki zokuzonwabisa kunye nabahambi abafuni ngaphezu kwe-400 ukuya kwi-800 mL (ii-13 ukuya kwii-ounces ezingama-27) zolwelo ngeyure* ngexesha lokuzilolonga, kwaye akufanele* batyebe** ngexesha logqatso okanye uhambo.
3. Soloko udibanisa Amanzi kunye neTyuwa etyiwayo Ngexesha lobushushu kunye nokuHamba okude: Abasebenzi bangaphandle nabakhweli benyuka bebila kakhulu ngaphezulu kweeyure ezi-2 ukuya kwezi-3 kufuneka batye amashwamshwam anetyuwa (ama-pretzels, amandongomane anetyuwa, ii-crackers, iipickles, umhluzi, okanye iityuwa ezidityanisiweyo zokubuyisela amanzi emzimbeni) ecaleni kwamanzi, kungabikho ilitha yodwa.
4. ** I-MDMA / uMthendeleko wokuNcitshiswa koMbi **: Ungaze uphuze ngaphezu kwe- ** 250 ukuya kwi-500 mL (1 ukuya kwi-2 iikomityi) ze-electrolyte-containing fluid ngeyure ** ngelixa udansa kwindawo efudumeleyo, kwaye ufune unyango ngokukhawuleza ukuba intloko, isicaphucaphu, okanye ukudideka kuvela.

Iinombolo zengingqi zikaxakeka kunye neeprothokholi ze-arhente¶

Imibuzo ebuzwa qho¶

Ngaba ukusela i-Gatorade okanye iziselo zezemidlalo zorhwebo akuthinteli ukuxiliswa kwamanzi (hyponatremia) ngexesha le-marathon okanye i-heatwave?¶

Hayi. Igazi lomntu eliqhelekileyo liqukethe malunga ne-140 mEq / L ye-sodium, ngelixa iziphuzo ezininzi zezemidlalo ziqulethe i-18 kuphela kwi-20 mEq / L ye-sodium. Oko kuthetha ukuba isiselo semidlalo yentengiso sisengama-85 ekhulwini hypotonic (amanzi angenatyuwa) xa kuthelekiswa negazi lakho. Ukuba umgijimi okanye umsebenzi wangaphandle usela umthamo ogqithisileyo weziphuzo zezemidlalo ngokukhawuleza kunokuba abile kwaye echama, ngakumbi ngelixa i-Antidiuretic Hormone (ADH) eyenziwa ngamandla ikhusela izintso zabo ekukhupheni amanzi, i-sodium yegazi iya kuhla ukuya kumanqanaba ayingozi. Ukuthintela i-hyponatremia enxulumene nokuzivocavoca kufuna ukusela ngokonxano (hayi ukusela kakhulu) kunye nokutya ityuwa eyaneleyo kwimizamo ende.

Ndingatsho njani kugqatso lomdyarho okanye umkhondo wokunyuka intaba ukuba umntu unxile ngamanzi (hyponatremia) ngokuchasene nokuphelelwa ngamanzi emzimbeni?¶

Qwalasela imikhondo emithathu elula ngaphambi kokuba unike naluphi na ulwelo: (1) Ukusela nobunzima botywala: Umntu onxiliswe ngamanzi ebesele kakhulu kwisikhululo ngasinye samanzi yaye uye watyeba (okanye wagcina ubunzima) ngesisu esidumbileyo, esishwabeneyo, ngoxa umntu ophelelwe ngamanzi emzimbeni ebesele kancinci kakhulu waza wehla emzimbeni; (2) I-Tight Ring / Watchband Sign: Ukunxila kwamanzi kubangela ukukhukhumala, ukudumba kweminwe kunye nezihlahla apho iiringi kunye newotshi ziziva ziqinile ngequbuliso, ngelixa ukuphelelwa ngamanzi emzimbeni kubangela ukuba ulwimi olomileyo kunye namehlo atshone; kunye (3) Nesimo sengqondo: Ukuphelelwa ngamanzi emzimbeni okanye ukudinwa bubushushu kubangela ukuba umntu adinwe aze abe nesiyezi xa umile, ngoxa ukunxila kwamanzi kubangela intloko ebuhlungu eqaqambayo, ukuhlanza, ukudideka, ukukhubeka nokuxhuzula.

Kutheni kuyingozi ukunika umntwana ongaphantsi kweenyanga ezi-6 ubudala amanzi alula okanye ubisi olungumgubo olunkcenkceshelwayo?¶

Iintsana ezingaphantsi kweenyanga ezi-6 ubudala zinezintso ezingekakhuli ezingakwaziyo ukuhluza amanzi acacileyo ngokukhawuleza, kwaye imizimba yabo emincinci ibambe i-sodium encinci kakhulu. Ukunika usana ii-ounces ezimbalwa zamanzi alula, okanye ukongeza amanzi ongezelelweyo ukolula umgubo wosana olungumgubo, ngokukhawuleza kuhlambulula isodiyam egazini lomntwana. Kwiiyure nje ezingephi, amanzi angena kwiiseli zengqondo yosana, nto leyo ebangela ukuba ubushushu bomzimba wehle (ngaphantsi kwama-36.1 ngokukaCelsius / 97 ngokukaFahrenheit), ukukhukhumala kobuso, ukomelela, ukugabha, kunye nokuxhuzula okusongela ubomi. Iintsana ezingaphantsi kweenyanga ezi-6 kufuneka zifumane ubisi lwebele kuphela okanye ubisi olungumgubo lweentsana oluxutywe ngokufanelekileyo.

Kutheni i-MDMA ("i-Ecstasy" okanye "i-Molly") ibangela ukuxiliswa kwamanzi abulalayo emva kokusela kuphela iibhotile ezimbalwa zamanzi?¶

Ngokuqhelekileyo, ukuba usela ilitha eyongezelelweyo okanye ezimbini zamanzi, ingqondo yakho iyayeka ukukhupha i-Antidiuretic Hormone (ADH) kwaye izintso zakho zikhupha amanzi angaphezulu kwiyure. I-MDMA ngokwekhemikhali ivuselela i-hypothalamus ukuba ikhuphe utyando olukhulu, oluqhubekayo lwe-ADH oluvala izintso zivaliwe nge-12 ukuya kwiiyure ze-24 ukuze zingakwazi ukuchama amanzi asimahla. Kwangaxeshanye, i-MDMA inyusa ubushushu bomzimba kwaye ibangela unxano olukhulu. Xa umsebenzisi esela iibhotile ezininzi zamanzi ukuze aphole, i-100 ipesenti yaloo manzi ihlala ibanjwe egazini labo, ibangela ukudumba kwengqondo ngokukhawuleza, ukuxhuzula, kunye ne-brainstem herniation.

Uthini umahluko phakathi kokunyanga ukunxiliswa kwamanzi abukhali (< 24 hours) and chronic low sodium (> iiyure ezingama-48)?¶

Ekunxileni kakhulu emanzini (apho isodiyam yegazi ihla ngaphezulu kweeyure ezimbalwa ngexesha lomdyarho, irave, okanye ukhuphiswano lokusela amanzi), iiseli zengqondo azikhange zibenalo ixesha lokuziqhelanisa, ngoko ke isoyikiso esikhawulezileyo kukudumba kobuchopho obubulalayo kunye ne-herniation. Oogqirha banika i-intravenous boluses ekhawulezayo ye-100 mL ye-3% ye-Hypertonic Saline ukunyusa ngokukhawuleza i-sodium yegazi nge-4 ukuya kwi-6 mEq/L kwaye icuthe ingqondo ibuyele ezantsi, ngengozi engaphendukiyo yokudemyelination. Ngokwahlukileyo koko, xa umntu ehlakulela i-sodium ephantsi engapheliyo ngokukhawuleza kwiintsuku ezininzi okanye iiveki (ukusuka kwiipilisi zamanzi, ukungaphumeleli kwentliziyo, okanye isifo sesibindi), iiseli zabo zengqondo sele zilungelelanise; ngelixa oogqirha basanika i-4 yokuqala kwi-6 mEq / L ye-hypertonic bolus ukuba isigulane siyayibamba, kufuneka bakhuphe ngokungqongqo ukunyuka kwe-sodium eyonke ngaphandle kwe-6 ukuya kwi-8 mEq / L kwiiyure ze-24 ukukhusela i-Osmotic Demyelination Syndrome (ODS).

Izikhokelo ezinxulumeneyo¶

• Ukubetha kobushushu vs. Ukudinwa kobushushu: Ungawuchaza njani umahluko
• Ukugula kobushushu uncedo lokuqala kunye nokupholisa ngokukhawuleza
• Iimeko ezingxamisekileyo ze-potassium: i-Hyperkalemia kunye ne-hypokalemia
• Ukubamba uncedo lokuqala kunye nokhuseleko
• I-Status epilepticus, ukuxhuzula ixesha elide, kunye namayeza okuhlangula

Imithombo kunye nezikhokelo ezisemthethweni¶

• INkomfa yoPhuhliso lweMvumelwano ye-Hyponatremia yaMazwe ngaMazwe: Inkcazo yeNkomfa yesiThathu eNxulunyaniswe neNgqungquthela yoPhuhliso lwe-Hyponatremia (i-Clinical Journal of Sport Medicine).
• I-Wilderness Medical Society (i-WMS): *Izikhokelo zokuSebenza kweKlinikhi yoLawulo lwe-Hyponatremia eNxulunyaniswa noMthambo: Uhlaziyo lwe-2019 *.
• Umbutho waseYurophu we-Intensive Care Medicine (ESICM) kunye ne-European Society of Endocrinology: * Isikhokelo sokuSebenza kweKlinikhi kwi-Diagnostic kunye noNyango lwe-Hyponatraemia *.
• I-American Academy of Pediatrics (AAP): * Isondlo seNtsana kunye nokuThintelwa kokuThengwa kwaManzi oMlomo kunye ne-Hyponatremic Seizures kwiintsana *.
• Amaziko oLawulo lweSifo kunye noThintelo (i-CDC / i-NIOSH): *Iikhrayitheriya zoMgangatho oNyunyiweyo: Ukuvezwa koMsebenzi kwi-Heat and Hot Environmental (i-Electrolyte Replacement kunye ne-Hyponatremia Prevention) *.

*Esi sikhokelo senzelwe iinjongo zolwazi kwaye asithathi indawo yovavanyo lwezonyango okanye ukhathalelo lwesibhedlele olungxamisekileyo. Ngenxa yokuba i-hyponatremia enxulumene nokuzivocavoca kunye nobushushu bunokubangela ukulahleka kwengqondo kunye nokuxhuzula, sincoma kakhulu ukuthatha izandla ezivunyiweyo entlango okanye ikhosi yokuqala yoncedo lokuqala kunye ne-CPR ngokusebenzisa i-International Federation ye-Red Cross kunye ne-Red Crescent Societies (IFRC), uluntu lwakho lwesizwe lwe-Red Cross, i-St John Ambulance, okanye umboneleli wendawo oqinisekisiweyo.