Hydration: 5% dextrose solution should be given in hypertonic dehydration because of high blood sodium concentration. Severe hypernatremia can be injected intravenously with 2.5% or 3% glucose solution. It should be noted that hypertonic dehydration with high blood sodium concentration, but the patient still has sodium loss, so it should also be supplemented with a certain amount of sodium-containing solution to avoid extracellular fluid hypotonic. Then how to care for hypertonic dehydration?
1, observation of vital signs: if there is irritability, rapid pulse rate, rapid respiration, etc., should be alert to whether there is too much or too fast infusion rate, the occurrence of heart failure and pulmonary edema.
2. Observe the dehydration situation: pay attention to the child's state of mind, the dryness of the skin and mucous membranes, thirst, the degree of depression of the eye sockets and fontanel, the amount of urine, the number of times of vomiting and diarrhea and the amount of comparisons of the changes before and after treatment, and to determine whether the dehydration is alleviated or aggravated.
3. Observe the manifestation of acidosis: Observe the color of the child's face and respiratory changes, and whether the baby has mental depression. Note that after the correction of acidosis, due to plasma dilution, ionized calcium decreased, can appear hypocalcemic convulsions.
Two, what are the etiology of hypertonic dehydration
1. Insufficient water intake
such as trauma, coma, esophageal disease of dysphagia, can not eat, critical patients with insufficient water, nasal hypertonic diet or infusion of a large number of hypertonic saline solution, etc.. Constant insensible evaporation of water through the skin and respiration causes more water loss than sodium loss, and increases plasma osmolality. Mainly seen in the following cases:
(1) can not or will not drink water such as oral cavity, pharyngeal and esophageal disorders, patients with frequent vomiting, comatose patients or extremely debilitated patients, etc.;
(2) Thirst disorders Hypothalamic lesions can damage the thirst center, and some patients with cerebrovascular accidents also lose their thirst sensation;
(3) Water sources cut off such as lost in the desert, shipwreck at sea, etc..
2. Excessive water loss without timely replenishment
such as high fever, profuse sweating, extensive burns, tracheotomy, prolonged exposure of internal organs during thoracic and abdominal surgery, diabetic coma, and so on. This includes both simple water loss and loss of more water than sodium, i.e., loss of hypotonic fluids.
(1) Simple water loss has transdermal and respiratory water loss and transrenal water loss. The former is seen in hyperthermia, hyperthyroidism, and hyperventilation that enhances insensible evaporation; the latter is seen in central uremia when there is insufficient production and release of ethanol dehydrogenase (ADH) and in renal uremia when the kidneys excrete large amounts of water because of a lack of renal distal convoluted tubule and collecting duct response to ADH.
(2) Loss of water more than loss of sodium first through the gastrointestinal tract loss of digestive juices containing low sodium, mainly seen in some infants and young children with watery stool diarrhea, fecal sodium concentration of less than 60 mmol / L. The first is the loss of water in the gastrointestinal tract, and the second is the loss of water in the gastrointestinal tract. Loss of hypotonic fluids is seen secondly in profuse sweating, often occurring in hot environments. Also during repeated intravenous administration of hypertonic substances (such as mannitol, urea and hypertonic glucose), osmotic diuresis can occur due to increased osmotic pressure of renal tubular fluid, with more water loss than sodium loss.
Three, what are the clinical manifestations of hypertonic dehydration
1, classification
(1) Mild dehydration in addition to thirst, mostly no other symptoms. The amount of water deficit is 2% to 4% of body weight.
(2) Moderate dehydration has extreme thirst, accompanied by fatigue, low urine output and high urine specific gravity. Dry lips, poor skin elasticity, sunken eye sockets, and often irritability. Water deficit is 4% to 6% of body weight.
(3) Severe water deficiency in addition to the above symptoms, symptoms of brain dysfunction such as mania, hallucinations, delirium, and even coma. The amount of water deficit is more than 6% of body weight.
2. Effects on the body
(1) Thirst, due to loss of water more than loss of sodium, the osmotic pressure of extracellular fluid increases, which stimulates the thirst center (except for those with thirst disorders), prompting the patient to look for water to drink.
(2) Reduced urine output and increased specific gravity except in patients with uremia, increased extracellular fluid osmolality stimulates the hypothalamic osmolality receptors and increases ADH release, which leads to increased renal reabsorption of water, reduced urine output and increased specific gravity.
(3) Increased extracellular fluid osmolality can cause water from the intracellular fluid, which has a relatively low osmolality, to be transferred to the extracellular space.
(4) Urinary sodium content in early or mildly ill patients, due to the blood volume reduction is not obvious, aldosterone secretion does not increase, so there is still sodium discharged in the urine, and its concentration may also be increased due to the increased water reabsorption; in advanced and severe cases, it can be due to the reduction of blood volume, aldosterone secretion increased, resulting in a decrease in the amount of urinary sodium.
(5) Central nervous system dysfunction: Increased osmolarity of extracellular fluid can cause a series of symptoms of central nervous system dysfunction, including drowsiness, muscle twitching, coma, and even death. When the brain volume is significantly reduced due to dehydration, the vascular tension between the skull and the cerebral cortex increases, thus leading to venous rupture and localized intracerebral hemorrhage and subarachnoid hemorrhage.
(6) Dehydration fever can occur in cases of severe dehydration, especially in children, because of reduced evaporation of water from the skin and compromised heat dissipation.
Four, what are the treatments for hypertonic dehydration
Hypertonic dehydration Western medical treatment
Remove the cause of the disease, so that the patient no longer lose fluid. Replacement of lost fluids can be done by intravenous infusion of 5% dextrose or hypotonic saline solution. There are two methods of estimating the amount of fluid that has been lost by replacement:
1. Estimation by percentage of body weight lost according to the severity of the clinical presentation. For example, in moderate dehydration, the water deficit is 4% to 6% of body weight, and the volume of rehydration is about 2.5L to 3.0L.
2. Calculation is based on the measured blood Na+ concentration. The volume of rehydration (ml) = [blood sodium measured value (mmol) - blood sodium normal value (mmol)] × body weight (kg) × 4.
For example, body weight of 60kg male patient blood sodium concentration of 152mmol / L, the rehydration volume = (152-142) × 60 × 4 = 2.4L. Half of the rehydration volume of the day, i.e., 1.2L, the other half of the rehydration volume in the next day, should also be given to the need for the day. In addition, it should be replenished with the amount needed for that day.
When replenishing fluids, it should be noted that although the blood Na+ is elevated, but due to the lack of water, so that the blood is concentrated, in fact, the total amount of sodium in the body is still reduced, in the rehydration at the same time should be appropriate sodium supplementation, in order to correct the lack of sodium. If there is potassium deficiency correction at the same time, potassium supplementation should be done after the urine volume exceeds 40ml/h to avoid causing excessive blood potassium. After rehydration treatment, the acidosis is still not corrected can be supplemented with sodium bicarbonate solution.