water toxicity coma
Introduction
Introduction The toxic coma in water is due to the lack of corticosteroids, and the ability to regulate water metabolism is reduced. When too much infusion and drinking water, it is prone to toxic coma in water. In patients with anterior pituitary hypofunction, there will be a toxic coma in the water. In the process of poisoning reaction, dizziness, pulmonary encephalopathy, cardio-cerebral ischemia syndrome, hepatic encephalopathy, acidosis, uremia, drugs and food poisoning, etc., the stunned water poisoning is nausea and vomiting. Deficiency, insanity, convulsions and coma.
Cause
Cause
Symptoms that are unresponsive to environmental stimuli. Light is called syncope or fainting. Often due to turbidity, heat poisoning, trauma, qi and blood disorder, yin and yang failure and other strong stimuli, etc., caused by the loss of the gods. When there is dizziness or fainting during the course of the disease, it is often critically ill. The depth of dizziness is often related to the severity of the disease. A variety of exogenous warmth, disease-related diseases, all kinds of rickets, disease, epilepsy, stroke, heat stroke, poisoning, head injuries, electric shocks, etc., can appear dizziness or fainting. Due to the lack of corticosteroids, the ability to regulate water metabolism is reduced. When too much infusion and drinking water, it is prone to toxic coma in water.
Examine
an examination
Dynamic observation of changes in blood routine can also assist in the diagnosis of uterine rupture in some cases, especially uterine rupture in the broad ligament and atypical uterine rupture. For suspected uterine rupture in the broad ligament, dynamic monitoring of blood changes can assist in diagnosis, and can roughly estimate the amount of blood loss. The precautions are as follows: immediate hemoglobin and red blood cells are compared with admission; timed review of dynamic changes in hemoglobin and red blood cells; blood Conventional reduction of 10/L (1g/dl) of hemoglobin is equivalent to about 500ml of blood loss, pay attention to early shock, blood concentration, estimated blood loss may be less than the actual blood loss; comprehensive analysis with vaginal blood loss; pay attention to the progressive decline of platelets; It is possible to dynamically monitor the dynamic changes in coagulation function and D-dimer.
1. Abdominal puncture or posterior iliac puncture: It can be confirmed whether there is bleeding in the abdominal cavity, and the abdominal percussion is positive for mobile dullness. Combined with medical history and physical signs, it is not necessary to perform this examination.
2. B-mode ultrasound examination: the fetus is in the abdominal cavity, the fetal movement, the fetal heart disappears; the uterus shrinks and has a crack, and the abdomen has free liquid.
3. Vaginal examination: the first drop of the decline is retracted, the enlarged cervix is reduced, and blood is seen to flow out.
Diagnosis
Differential diagnosis
(a) hypoglycemic coma
The reason may be spontaneous, that is, due to eating too little or not eating, especially when there is infection; or insulin-induced (for insulin tolerance test or insulin treatment for loss of appetite), or because of high sugar diet Or after injecting a large amount of glucose, causing endogenous insulin secretion and causing hypoglycemia. In patients with this disease, due to lack of hydrocortin, liver glycogen storage is reduced, growth hormone is reduced, sensitivity to insulin is increased, and thyroid function is insufficient, and intestinal absorption of glucose is reduced, so the fasting blood glucose is low in normal times. In the above situation, it is easy to cause hypoglycemia and coma. This type of coma is most common.
When hypoglycemia occurs, the patient is weak, dizzy, dizzy, sweating, palpitation, pale, and may have headache, vomiting, and nausea. Blood pressure is generally low, and severe cases cannot be measured. It can be irritating or unconscious, and the pupils are reflected in the light. The healthy reflexes disappear after the initial intrusion. The extension test can be positive, and the muscle tension can be increased or convulsions, convulsions, and coma in severe cases.
(two) infection induced coma
The patient is deficient in a variety of hormones, mainly lack of adrenocorticotropic hormone and hydrocortin, so the body's resistance is low, prone to infection. After concurrent infection and high fever, it is prone to unconsciousness and even coma and hypotension and shock. The loss of consciousness caused by infection is mostly gradual. The body temperature can be as high as 39 to 400 C, and the pulse often does not increase accordingly. The blood pressure is lowered, and the systolic blood pressure is usually below 80 to 90 mm of mercury. In severe cases, shock occurs.
(C) sedation, anesthesia caused by slumber, coma patients with sedation, anaesthetics are very sensitive, the general commonly used amount can make patients fall into a long period of slumber and even coma. After intravenous injection of 0.1 g of sodium pentobarbital or less than 0.1 g of thiopental, the patient enters the third stage of anesthesia and maintains a semi-coma for 2 days. 16 mg of morphine can cause coma for 2 days. 0.1 gram of barbital and 50 mg of bismuth can produce a coma. Long-term lethargy can also occur after receiving a general therapeutic dose of chlorpromazine (oral or intramuscular).
(4) Loss of sodium coma
Sodium loss due to gastrointestinal disorders, surgery, infection, etc., can trigger a crisis like primary adrenal insufficiency. The peripheral circulatory failure of this type of crisis is particularly remarkable. It is worth noting that in the first few days of the start of the application of cortisol, the patient may have an increase in sodium excretion, which is due to the fact that the glomerular filtration rate is very low and is improved after treatment. Less than a week after treatment with cortisol, the patient entered a coma with a significant negative sodium balance. In addition, when thyroid preparations are used alone, especially when the dosage is too large, the body's need for adrenocortical hormone is increased due to an increase in metabolic rate, and the deficiency of adrenocortical hormone is more serious. On the other hand, thyroid preparations have a hypothyroidism. Promote solute excretion, causing loss of water and loss of sodium. In China, a case of a single thyroid tablet was used to treat the crisis.
Dynamic observation of changes in blood routine can also assist in the diagnosis of uterine rupture in some cases, especially uterine rupture in the broad ligament and atypical uterine rupture. For suspected uterine rupture in the broad ligament, dynamic monitoring of blood changes can assist in diagnosis, and can roughly estimate the amount of blood loss. The precautions are as follows: immediate hemoglobin and red blood cells are compared with admission; timed review of dynamic changes in hemoglobin and red blood cells; blood Conventional reduction of 10/L (1g/dl) of hemoglobin is equivalent to about 500ml of blood loss, pay attention to early shock, blood concentration, estimated blood loss may be less than the actual blood loss; comprehensive analysis with vaginal blood loss; pay attention to the progressive decline of platelets; It is possible to dynamically monitor the dynamic changes in coagulation function and D-dimer.
1. Abdominal puncture or posterior iliac puncture: It can be confirmed whether there is bleeding in the abdominal cavity, and the abdominal percussion is positive for mobile dullness. Combined with medical history and physical signs, it is not necessary to perform this examination.
2. B-mode ultrasound examination: the fetus is in the abdominal cavity, the fetal movement, the fetal heart disappears; the uterus shrinks and has a crack, and the abdomen has free liquid.
3. Vaginal examination: the first drop of the decline is retracted, the enlarged cervix is reduced, and blood is seen to flow out.
