Hypertonic dehydration

Overview of water and sodium lost both, but more than lack of dry sodium, the serum sodium than the normal range, extracellular fluid is hypertonic state. When the water shortage than sodium, extracellular osmolality, antidiuretic hormone secretion increased, tubular water absorption increased, decreased urine output. Aldosterone secretion, sodium and water re-absorption, in order to maintain blood volume. If it is short of water, extracellular osmolality increased further, intracellular fluid shift cells, eventually dry cells in excess of extracellular water level. Brain cells dry will lead to brain dysfunction. Pathology and pathogenesis are : a. inadequate water intake, such as trauma, coma, esophageal diseases dysphagia, and unable to eat. Water shortage critical patients, diet or hypertonic nasal feeding large infusion of hypertonic salt solution; b. excessive water loss, not timely, high fever, sweating, extensive burns, tracheotomy, chest and abdomen surgery viscera exposed for a long period. diabetic coma. According to clinical symptoms, generally dry hyperosmolar divided into three degrees : mild dry : In addition to a thirsty, have no other symptoms. Dry weight capacity of the 2% - 4%. Moderate water shortage : extreme thirst, with weak disturbance, high specific gravity. She Sao dry lips, skin elasticity poor orbital Depression, often troubled. Dry weight capacity of the 4% - 6%. Severe water shortages : In addition to the above symptoms, there manic, hallucination, delirium, coma or even brain dysfunction symptoms. Dry weight capacity of more than 6%. Diagnosis based on clinical manifestations and history often make the diagnosis. Laboratory examination : a. high specific gravity; B. elevated serum sodium in more than 150 mmol / L or more. c. red blood cell count, hemoglobin, hematocrit mildly higher. Causes for removal, so that patients no longer lose fluid. Has been added to the loss of liquid, intravenous glucose infusion of 5% or low permeability salt solution. Supplementary estimates have lost their liquid content has two methods : a. Based on the clinical performance of the magnitude by the percentage of weight loss estimate. For example, moderate water content of the dry weight of the 4% - 6%, rehydration is about 2.5 ~ 3.0 L L. B. based on the blood concentration of Na + to calculate. - Water (ml) = [value measured serum sodium (mmol) - normal serum sodium (mmol)] x weight (kg) × 4. For example, weight 60 kg male patient serum sodium concentration of 152 mmol / L, then fill stood = (152-142) × 60 × 4 = 2.4L. Try giving a day-half of water, 1.2 L, and the other half the next day supply, and should supply the same day requirements. Attention to the need for rehydration, although blood increased Na +, but the water shortage and hemoconcentration, in fact, the total body sodium or decrease the volume, at the same time pay due sodium to rectify the shortage of sodium. The same time as a potassium deficiency corrected, should the urine over 40 ml / h after the potassium in order to avoid excessive potassium. After rehydration therapy, acidosis has not yet been rectified when supply sodium bicarbonate solution.