Iso-osmotic dehydration

Outlined surgical patients most vulnerable to water shortages occur; Sodium and water in proportion to the loss, which in normal serum sodium, extracellular osmotic pressure also remained normal. It creates extracellular fluid volume (including the circulating blood volume) of the rapid decline; Due to the loss of liquid isotonic, basically do not change the extracellular osmolality, the initial solution is not within the cell to the extracellular space transfer, Compensatory cells to the extracellular fluid reduction, the intracellular fluid volume does not change. But this time fluid loss sustained over a long time, the intracellular fluid will be gradually elsewhere, accompanied extracellular fluid loss together, resulting in dry cells. Cause pathogenesis common causes are : a. the acute digestive fluid loss, as a large number of vomiting, intestinal fistula; b. transfer of the body fluid loss or infection in the soft tissue; If abdominal infection, intestinal obstruction, burns, their loss of body fluids and extracellular components similar. Clinical manifestations of patients do not feel thirsty, disturbance, loss of appetite, nausea, fatigue, dry tongue, eyeballs subsidence, dry skin, etc. Relaxation performance. As soon lost too many body fluids lost up to 5% of the weight above, it is the loss of extracellular 25%; patients to small pulse rate, acromegaly damp and cool, unstable blood pressure or inadequate blood volume reduction of the symptoms. Humoral continue to lose weight to the 6% - 7%; Considerable loss of the extracellular 30% ~ 35%; Shock has demonstrated very serious. Accompanied metabolic acidosis. If patients lose body fluids mainly gastric juice, a CL-the massive loss; Can be accompanied by metabolic alkalosis, there alkalosis some clinical manifestations. Diagnosis rely mainly on the history and clinical performance. To be asked in detail about the loss of body fluids, the daily loss of fluid is the number? Sustained amount of time? Fluid loss of such traits. Determination of extracellular fluid volume and serum sodium and water in order to understand the situation and loss of sodium. Serum Na + and Cl-general without significantly decreased serum osmolality in the normal range. Hyperchloremic increased. RBC count, hemoglobin and hematocrit increased significantly, hemoconcentration. Necessary for determination of blood gas analysis to determine whether the acid-base balance. First, as far as possible to deal with the treatment caused the loss of isotonic sexual reasons, in order to reduce water and sodium loss. Against extracellular fluid volume reduction generally available isotonic saline or balanced salt solution as soon as possible supplementary blood volume. According to the pulse rate and blood pressure Fine declined to estimate symptoms such as loss of body fluid volume has reached 5% of the body weight, Quick importation of these liquids about 3.0 L, (by weight 60kg). To restore blood volume, or hematocrit need to calculate the volume of liquid supplement. - Isotonic saline volume (L) = hematocrit on the appreciation x weight (kg) × 0.25 hematocrit Besides normal , but also the same day supply requirements, the general 2.0L of water and sodium 4.5g. Isotonic saline containing Na + and Cl-the 154mmol / L, serum Na + and Cl-content of the 142mmol / L and 103mmol / L. In comparison, isotonic saline Cl-content serum Cl-content 50mmol / L, in severe shortage or a state of shock, renal blood flow, affecting the function of chlorine, from the large vein defeated isotonic saline, Cl lead to a blood-too high, cause high chloride acidosis danger. Therefore, the application of isotonic saline in the treatment of water there are a number of deficiencies. Balanced salt solution electrolyte content and plasma levels similar to that used for the treatment of dry more in line with physical, avoid excessive importation of Cl-and acidosis corrected to a certain extent help. In addition, the correct water, potassium excretion increased K + concentration will result in extracellular fluid volume and lower diluted, it should be noted the incidence of hypokalemia. In urine should generally reach 40 ml / h after the potassium chloride added.