isotonic dehydration
Introduction
Introduction to isotonic dehydration Surgical patients are most prone to this lack of water, water and sodium are lost in proportion, so serum sodium is in the normal range, and extracellular fluid osmotic pressure is also maintained. It causes a rapid decrease in the amount of extracellular fluid (including circulating blood); since the lost fluid is isotonic, it does not substantially change the osmotic pressure of the extracellular fluid, initially the intracellular fluid does not transfer to the extracellular fluid gap, Compensatory extracellular fluid is reduced, so the amount of intracellular fluid does not change. However, after the liquid loss lasts for a long time, the intracellular fluid will gradually move outward and will be lost along with the extracellular fluid, causing the cells to be dehydrated. basic knowledge The proportion of illness: 0.13% Susceptible population: Occurs in surgical patients, such as burn patients. Mode of infection: non-infectious Complications: shock
Cause
Isotonic dehydration cause
Common causes are:
a. Acute loss of digestive juice, such as massive vomiting, intestinal fistula, etc.;
b. In vivo fluid transfer, loss in the infected area or soft tissue; such as abdominal infection, intestinal obstruction, burns, etc., the loss of body fluids and extracellular fluid components are basically similar.
Prevention
Isotonic dehydration prevention
Prevent isotonic dehydration after surgery.
Complication
Isotonic dehydration complications Complications
The most common complication of this disease is shock.
Symptom
Isotonic dehydration symptoms Common symptoms Increased urine specific gravity, nausea and vomiting, dehydration, diarrhea, fluid imbalance
The patient is not thirsty, has oliguria, anorexia, nausea, fatigue, dry tongue, eyeball depression, dry skin, and relaxation. If the loss is excessive in a short period of time, when the body fluid loses more than 5% of the body weight, that is, 25% of the extracellular fluid is lost; the patient has symptoms such as rapid pulse rate, wet limbs, unstable blood pressure, or decreased blood volume. Body fluids continue to lose 6% to 7% of body weight; when they lose 30% to 35% of extracellular fluid; shock has been very severe. Often accompanied by metabolic acidosis.
Examine
Isotonic dehydration check
Serum sodium, pulse, blood pressure, plasma osmolality (POP).
Water is lost in proportion to sodium, with a serum sodium concentration of 130-150 mmol/I and a plasma osmotic pressure of 280-310 mOsm/L.
The sodium in the body is mainly derived from the salt in the food, which is absorbed into the blood through the intestine, and 47% of it is present in the bone. About 10% is present in the intracellular fluid, 44% is present in the extracellular fluid, and is the most abundant cation in the extracellular fluid, mostly in the form of sodium chloride, and 95% of the sodium salt in the body is excreted by the kidney. The main function of sodium is to maintain the volume of extracellular fluid, maintain osmotic pressure and acid-base balance, and maintain the normal stress of muscles and nerves. Normal serum sodium: flame photometric analysis 136 ~ 146mmol / L (136 ~ 146mEq / L). The ion selective electrode method is 145 to 155 mmol/L (145 to 155 mEq/L).
Diagnosis
Isotonic dehydration diagnosis
Mainly rely on medical history and clinical manifestations. It is necessary to ask in detail about the loss of body fluids, the traits of fluid loss, and the like. The amount of extracellular fluid and serum sodium were measured to understand the lack of water and sodium loss. Serum Na+ and Cl- generally did not decrease significantly, plasma osmotic pressure was in the normal range, and urine specific gravity increased. Red blood cell count, hemoglobin volume, and hematocrit were significantly increased, indicating blood concentration. Blood gas analysis can be performed if necessary to determine whether there is an imbalance in acid-base balance.
