too much water
Introduction
Introduction to excessive water Refers to the body intake or input of too much water, so that water retention in the body, causing blood osmotic pressure and increased circulating blood volume, also known as "water poisoning" or dilute hyponatremia, less water poisoning, only in In the case of excessive secretion of vasopressin or renal insufficiency, the body consumes too much water or receives excessive intravenous infusion, which causes water to accumulate in the body, resulting in water poisoning. Because the kidney has a strong ability to regulate water balance, when normal people consume more water, water retention does not occur, and it does not cause water poisoning. However, the thirst center is stimulated to cause excessive drinking water or spirituality. Excessive drinking water, exceeding the maximum limit of renal drainage capacity (1,200ml / h), water poisoning may also occur, especially in infants and young children, due to its water, electrolyte regulation function is not yet mature, too much to give electrolyte-free liquid easier Water poisoning occurs. basic knowledge The proportion of illness: 0.03%--0.08% Susceptible people: no special people Mode of infection: non-infectious Complications: pulmonary edema hyponatremia cerebral palsy
Cause
Excessive cause of water
1. Ingest or input too much electrolyte-free liquid
Because the kidney has a strong ability to regulate water balance, when normal people consume more water, water retention does not occur, and it does not cause water poisoning. However, the thirst center is stimulated to cause excessive drinking water or spirituality. Excessive drinking water, exceeding the maximum limit of renal drainage capacity (1,200ml / h), water poisoning may also occur, especially in infants and young children, due to its water, electrolyte regulation function is not yet mature, too much to give electrolyte-free liquid easier Water poisoning occurs.
2. Acute and chronic renal insufficiency
When renal insufficiency occurs, the drainage capacity of the kidney is reduced, and water poisoning is prone to occur, especially in acute renal failure, oliguria or chronic renal failure, and the intake of water is not controlled. In this case, it is functional. The nephron is too small to discharge the daily water load, so even taking normal water can cause water poisoning.
3. ADH (anti-diuretic hormone) excessive secretion
Excessive secretion of ADH enhances the reabsorption of water in the renal distal convoluted tubules and collecting ducts, and the renal drainage capacity is reduced. If the water intake is slightly increased, it will cause obvious symptoms of water intoxication. The excessive secretion of ADH here is not due to plasma infiltration. Increased secretion of ADH caused by physiological stimuli such as increased blood pressure or decreased blood volume, but refers to abnormal secretion of ADH under certain pathological conditions, the reasons are:
(1) ADH secretory augmentation syndrome (SIADH): common in:
1 diseases that can cause increased secretion of ADH in the lower thalamus, central nervous system diseases such as encephalitis, brain tumors, brain abscesses, cerebral thrombosis, cerebral hemorrhage, etc.; acute psychosis; drugs such as cyclophosphamide, vincristine, etc.; Pneumonia, tuberculosis, lung abscess, atelectasis, etc.
2 ADH ectopic secretion, found in a variety of tumors such as lung oat cell cancer, pancreatic cancer and so on.
(2) Other reasons: mainly
1 pain, nausea and emotional stress,
2 Adrenal cortical function is low, glucocorticoid deficiency, and the inhibition of ADH secretion from the hypothalamus is weakened.
3 The effects of certain drugs such as morphine, chlorpropamide, etc., these factors also increase the secretion of ADH through stimulation independent of osmotic pressure and blood volume, while chlorpropamide can stimulate the secretion of ADH, but also enhance the renal tubular pair The sensitivity of ADH,
4 Exogenous ADH, such as vasopressin, oxytocin.
4. Some special pathological conditions
Heart failure, hepatic ascites, etc. can cause a reduction in effective circulating blood volume, a decrease in glomerular filtration rate, and a decrease in renal drainage. If the water load is increased, it is easy to cause water intoxication; using vasopressin, the thirst center is affected. Excessive drinking water and excessive mental drinking water are also common causes of water poisoning.
In the state of hypotonic dehydration, the body is in a state of water loss, but due to the increase of intracellular fluid, if a large amount of liquid containing no electrolyte is added at this time, it may lead to a larger amount on the basis of increasing extracellular fluid. Water enters the cell, causing the occurrence of water poisoning.
According to the speed of occurrence of water poisoning, there is a distinction between acute and chronic water poisoning. Usually, in patients with acute and chronic renal failure, the glomerular filtration rate is significantly reduced, and the drainage function is greatly reduced. The water load of this patient is slightly increased. Serious water intoxication may occur soon, called acute water poisoning.
Prevention
Excessive water prevention
Prevention is more important than treatment. Firstly, prevention and treatment of primary diseases should be prevented to prevent the cause of water poisoning. Mild patients can recover spontaneously after suspending water supply. For patients with severe acute water poisoning, intravenous infusion of mannitol and sorbitol should be given immediately. Isotonic diuretic or furosemide and other strong diuretics to reduce brain cell edema and promote the body's water discharge, 3 ~ 5% hypertonic sodium chloride solution intravenous drip can quickly relieve the hypotonic state of body fluids, but must pay close attention Excessive sodium ion can increase the capacity of extracellular fluid and increase cardiac load.
Complication
Excessive water complications Complications pulmonary edema hyponatremia cerebral palsy
Water intoxication often occurs as a complication, often as an intraoperative complication of some surgical treatment. The most common complications are pulmonary edema and dilute hyponatremia. Pulmonary edema is characterized by difficulty breathing and coughing pink. The foamy sputum, sputum blockage of the lungs and bronchus and trachea will also lead to a progressive reduction in oxygen saturation. If not treated in time, severe water poisoning will also have symptoms of brain damage, such as headache, aphasia, confusion, orientation. Disorders, lethargy, restlessness, paralysis, and even coma, further development, the possibility of cerebral palsy, resulting in breathing, sudden cardiac arrest.
Symptom
Symptoms of excessive water Common symptoms Inability to convulsion hyponatremia nausea conscious disorder coma
The balance of normal human water is mainly regulated by the antidiuretic hormone and the drainage function of the kidney. When the body loses water, the plasma crystal osmotic pressure increases, the stimulation of the hypothalamic osmotic receptor is enhanced, and the release of vasopressin is increased. The reabsorption activity is enhanced, and the amount of urine is reduced, thereby retaining the body's water. Conversely, after drinking plenty of water, the plasma osmotic pressure is reduced, the release of vasopressin is reduced, and the reabsorption of water by the kidney is weakened, so that the excess water in the body is reduced. Excreted from the urine, the urine produced by the kidneys is transported to the bladder. When the urine volume of the bladder is filled to a certain extent (400-500 ml), the stretch receptor of the bladder wall is stimulated and excited, and the urination process is completed through a series of nerve reflexes. When the above regulation mechanism is abnormal, after drinking plenty of water or inputting a large amount of 5% glucose solution, the amount of extracellular fluid increases sharply, which is dilute hyponatremia, the extracellular fluid osmotic pressure decreases, and water enters the cell from outside the cell. Causes cell edema, especially brain cell edema, which causes neurological symptoms. Generally, serorrhea occurs when serum sodium is lower than 125 mmolPL. When it is less than 120 mmolPL, there will be convulsions, disturbance of consciousness, coma, etc. In the short term, drinking plenty of water (too much primary drinking water) will lead to clinically rare water poisoning, mainly in patients with schizophrenia. This patient may have water poisoning, which may be related to Older people are less sensitive to water, salt metabolism regulation and insensitive to bladder filling, and decreased urinary sensation.
Examine
Excessive water inspection
The examination of this disease is mainly the examination of clinical symptoms and blood biochemical examination.
After examination, patients often show circulatory system and nervous system dysfunction. There are irritability, apathy, nausea, vomiting, difficulty breathing, hypotension, oliguria, convulsions and coma, severe cases can cause death, blood biochemical laboratory tests can be found Red blood cell count, hemoglobin, hematocrit and plasma protein were all decreased, and serum sodium and chlorine were also measured.
Diagnosis
Excessive diagnosis of water
diagnosis
According to the history and clinical manifestations, it can be diagnosed. Due to blood dilution, laboratory tests can find red blood cell counts, hemoglobin, hematocrit and plasma protein levels are reduced, serum sodium and chlorine are also reduced.
Differential diagnosis
Can be divided into acute and chronic water poisoning.
1, acute water poisoning: acute onset, due to increased intracellular and extracellular fluid volume, cranial cavity and spinal canal inelastic, brain cell edema caused by increased intracranial pressure symptoms, such as headache, aphasia, confusion, disorientation, lethargy, agitation, paralysis Even coma, further development, there is the possibility of cerebral palsy, resulting in breathing, sudden cardiac arrest.
2, chronic water poisoning: symptoms are generally not obvious, often covered by the symptoms of the primary disease, may be weak, nausea, vomiting, lethargy, etc., weight gain, pale and moist skin.
