In surgical patientsAnd principles of infusion therapy

Acute violations of the water and electrolyte balance are one of the most frequent complications of surgical pathology - peritonitis, intestinal obstruction, pancreatitis, injuries, shock, diseases accompanied by fever, vomiting and diarrhea.

9.1. The main causes of violations of the water and electrolyte balance

The main reasons for disorders include:

external fluid losses and electrolytes and pathological redistribution between the main liquid media due to the pathological activation of natural processes in the body - with polyuria, diarrhea, excessive sweating, with abundant vomiting, through various drains and fistula or from the surface of the Russian Academy of Sciences and burns;

internal movement of fluids in the edema of injured and infected tissues (fractures, crushing syndrome); cluster of fluid in the pleural (pleurisy) and abdominal (peritonitis) cavities;

changes in osmolarity of liquid media and moving excess water into a cell or from it.

Moving and accumulation of fluid in the gastrointestinal tract,reaching several liters (with intestinal obstruction, intestinal infarction, as well as with severe postoperative paresis) in terms of the severity of the pathological process. external lossesfluids, since in both cases large volumes of liquid are lost with high electrolyte and protein content. No less significant external losses of fluid, identical plasma from the surface of the Russian Academy of Sciences and burns (in the cavity of a small pelvis), as well as with extensive gynecological, proctological and thoracic (in the pleural cavity) operations.

The inner and external loss of fluid determine the clinical picture of the deficiency of fluid and disorders of the water and electrolyte balance: ge-mooconcentration, plasma deficiency, protein loss and general dehydration. In all cases, these violations require a targeted correction of a water and electrolyte balance. Being unrecognized and confused, they worsen the results of the treatment of patients.

The whole water supply of the body is in two spaces - intracellular (30-40% body weight) and extracellular (20-27% body weight).

Extracellular volumeit is distributed among interstitial water (water ligaments, cartilage, bones, connective tissue, lymphs, plasma) and water, not actively participating in metabolic processes (cerebrospinal, intra-articular fluid, and gastrointestinal contents).

Intracellular sectorcontains water in three types (constitutional, protoplasm and colloidal micelles) and the electrolytes dissolved in it. Cellular water is distributed in various fabrics unevenly, and the more hydrophilica, those vulnerable to water exchange disorders. Some of the cellular water is formed as a result of metabolic processes.

The daily volume of metabolic water with "combustion" of 100 g of proteins, fats and carbohydrates is 200-300 ml.

The volume of extracellular fluid may increase during injury, starvation, sepsis, severe infectious diseases, i.e., with those states that are accompanied by a significant loss of muscle mass. An increase in the volume of extracellular fluid occurs during edema (cardiac, uncooked, inflammatory, kidney, etc.).

The volume of extracellular fluid decreases with all forms of dehydration, especially with loss of salts. Significant disorders are observed in critical states in surgical patients - peritonitis, pancreatitis, hemorrhagic shock, intestinal obstruction, blood loss, severe injury. The ultimate goal of regulating the water and electrolyte balance in such patients is to maintain and normalize vascular and in-terrastic volumes, their electrolyte and protein composition.

Maintaining and normalizing the volume and composition of extracellular fluid are the basis for the regulation of arterial and central venous pressure, heart Emission, organ blood flow, microcirculation and biochemical homeostasis.

The preservation of the body's water balance is normal due to adequate water intake in accordance with its losses; Daily "turnover" is about 6% of the water of the body. An adult man consumes about 2500 ml of water in a day, including 300 ml of water formed as a result of metabolic processes. Water losses are about 2500 ml / day, of which 1500 ml is released with urine, 800 ml evaporates (400 ml through the respiratory tract and 400 ml through the skin), 100 ml is released from then with 100 ml with a feet. When conducting corrective infusion-transfusion therapy and parenteral nutrition, the mechanisms regulating the flow and consumption of fluid are shunting, thirst. Therefore, to restore and maintain the normal state of hydration, careful monitoring of clinical and laboratory data, body weight and daily diuresis are required. It should be noted that physiological fluctuations of water loss can be rather significant. With increasing body temperature, the amount of endogenous water increases and the loss of water is increasing through the skin when breathing. Breathing disorders, especially hyperventilation at low humidity, increase the needs of the body in water by 500-1000 ml. Losses of fluid from extensive wound surfaces or during long-term operational interventions on abdominal and chest cavity organs, more than 3 hours increase the need for water up to 2500 ml / day.

If water flow prevails over its release, the water balance is considered positive;against the background of functional disorders from the separation authorities, it is accompanied by the development of edema.

With the predominance of water release over the admission, balance is considered negative- In this case, the dehydration signal is a feeling of thirst.

Invoyed dehydration correction can lead to a collapse or dehydration shock.

The main body regulating water-electrolyte equilibrium are kidneys. The volume of the separated urine is determined by the amount of substances that must be derived from the body and the ability of the kidney to concentrate urine.

During the day with urine allocated from 300 to 1500 mmol of finite metabolic products. With a lack of water and electrolytes, Oliguria and Anuria

we look at the physiological response associated with the stimulation of ADG and Aldosterone. The correction of water and electrolyte losses leads to the restoration of the diurea.

Normally, the regulation of the water balance is carried out by activating or oppressing the osimoricceptors of the hypothalamus, which react to changes in the osmolarity of the plasma, arises or oppresses the feeling of thirst and the secretion of the antidiuretic hormone (ADG) is changed accordingly. ADG increases the reabsorption of water in the distal tubules and collective tubes of the kidneys and reduces the urination. On the contrary, with a decrease in the secretion of ADG, urination increases, urinary osmolar decreases. The formation of an ADG is naturally increasing with a decrease in fluid volumes in the interstitial and intravascular sectors. With increasing the BCC, the adg secretion decreases.

In pathological conditions, such factors such as hypovolemia, pain, traumatic damage to tissues, vomiting, drugs affecting the central mechanisms of the nervous regulation of the aqueous-electrolyte balance are found in the pathological states.

There is a close relationship between the amount of fluid in various sectors of the body, the state of peripheral blood circulation, the permeability of the capillaries and the ratio of colloid-osmotic and hydrostatic pressures.

Normally, the exchange of liquid between the vascular channel and the interstitial space is strictly balanced. In pathological processes, primarily due to loss of the plasma loss in the plasma protein (acute blood loss, hepatic insufficiency), the plasma code is reduced, as a result of which the liquid from the microcirculation system in excess passes in interstics. Blood thickening occurs, its rheological properties are disturbed.

9.2. Electrolyte exchange

The state of water exchange is normal and pathology is closely interconnected with the exchange of electrolytes - Na +, K +, Ca 2+, Mg 2+, CS, NS0 3, H 2 P0 4 ~, SOF, as well as proteins and organic acids.

The concentration of electrolytes in the liquid spaces of the organism is not the same; Plasma and interstitial fluid differ significantly only by protein content.

The content of electrolytes in outside and intracellular liquid spaces is not the same: in the extracellular one is mainly contained by Na +, SG, NSO ^; in intracellular - K +, Mg + and H 2 P0 4; Almost the concentration S0 4 2 and proteins are also high. The differences in the concentration of some electrolytes form the bioelectric potential of rest, performing nervous, muscle and sectoral cells by excitability.

Preservation of electrochemical potential cell and extracellularspaceprovided by the work of Na + -, K + -ATPAZ pump, due to which Na + is constantly "ran out" from the cell, and K + - "rushes" into it against the gradients of their concentration.

In violation of this pump, due to the deficiency of oxygen or as a result of metabolic disorders, the cellular space becomes available for sodium and chlorine. The concomitant increase in osmotic pressure in the cell enhances the movement of water in it, causes swelling,

and in the subsequent disorder of the membrane, right up to lysis. Thus, the dominant cation in the intercellular space is sodium, and in a cage - potassium.

9.2.1. Sodium exchange

Sodium - the main extracellular cation; The most important cation of an inter-stothy space is the main osmotically active substance of plasma; Participates in the generation of the potential of action, affects the volume of extracellular and intracellular spaces.

With a decrease in the concentration of Na +, osmotic pressure with a simultaneous decrease in the volume of interstitial space is reduced. An increase in sodium concentration causes a reverse process. Sodium deficiency cannot be replenished by any other cation. The daily need for a sodium of an adult is 5-10 g.

Sodium is allocated from the body mainly by the kidneys; Minor part - from then. Its level in the blood increases with prolonged treatment with corticosteroids, long-term IVL in hyperventilation mode, nonachon diabetes, with hyperaldosteroneism; Decreases due to the long-term use of diuretics, against the background of prolonged heparinotherapy, in the presence of chronic heart failure, hyperglycemia, liver cirrhosis. Sodium content in urine is normal 60 mmol / l. Surgical aggression associated with activation of antidiuretic mechanisms leads to sodium delay at the kidney level, so its content in the urine can decrease.

Hypernamentia(Plasma sodium more than 147 mmol / l) occurs with an elevated sodium content in an interstitial space, as a result of dehydration in water exhaustion, salt overload of the body, inexpensive diabetes. Hypernamentia is accompanied by the redistribution of fluid from the intracellular in the extracellular sector, which causes cell dehydration. In clinical practice, this state arises due to an increased sweating, intravenous infusion of a hypertensive solution of sodium chloride, as well as in connection with the development of acute renal failure.

Hyponatremia(plasma sodium less than 136 mmol / l) develops under the excessive secretion of ADG in response to pain factor, with pathological losses of fluid through the gastrointestinal tract, excessive intravenous administration of abolving solutions or glucose solutions, excessive water intake against the background of limited food intake; accompanied by cell hypershydration while simultaneously decreasing the BCC.

Sodium deficiency is determined by the formula:

For deficiency (mmol) \u003d (Na Hopma - the number actual) body weight (kg) 0.2.

9.2.2. Caliya's exchange

Potassium -the main intracellular cation. The daily need for potassium is 2.3-3.1 g. Potassium (along with sodium) takes an active part in all metabolic processes of the body. Kalia, as well as sodium, owns a leading role in the formation of membrane potentials; It affects the pH and the utilization of glucose, is necessary for protein synthesis.

In the postoperative period, during critical states, potassium losses may exceed its receipt; They are also characteristic of long starvation, accompanied by the loss of cell mass of the body - the main "depot" of potassium. A certain role in increasing the losses of potassium plays the metabolism of hepatic glycogen. In seriously ill (without relevant compensation) for 1 weeks from cellular space in extracellular moves to 300 mmol potassium. In the early post-traumatic period, potassium leaves the cell together with metabolic nitrogen, the excess of which is formed as a result of cellular protein catabolism (on average 1 g of nitrogen "takes" 5-6 MEKV potassium).

I. Inok.temy(plasma potassium less than 3.8 mmol / l) can develop with an excess of sodium, against the background of metabolic alkalosis, in hypoxia, pronounced catabolism of protein, diarrhea, long vomiting, etc. With intracellular potassium deficiency in the cell, Na + and H + are increasing in the cell. What causes intracellular acidosis and hyperhymitation against the background of extracellular metabolic alkalosis. The clinically given state is manifested by arrhythmia, arterial hypotension, a decrease in the tone of skeletal muscles, the intestinal paresis, impaired psyche. The ECG appear characteristic changes: tachycardia, narrowing complex QRS., flooding and Inversion of Tissue T,increase the amplitude of the prong. U.. Treatment of hypokalemia begin, eliminating the etiological factor and reimbursement of potassium deficiency, using the formula:

Potassium deficiency (mmol / l) \u003d K + patient plasma, mmol / l 0.2 body weight, kg.

The rapid introduction of a large number of potassium preparations can cause complications from cardiac activity, up to the heart stop, therefore the total daily dose should not exceed 3 mmol / kg / day, and the infusion rate is not more than 10 mmol / h.

Used potassium preparations should be dissolved (up to 40 mmol per 1 liter of the injected solution); The optimal is their introduction in the form of a polarity mixture (glucose + potassium + insulin). Treatment of potassium preparations are produced under daily laboratory control.

Hypercalemia(plasma potassium more than 5.2 mmol / l) most often occurs when the potassium is disturbed from the body (acute renal failure) or with a massive output of it from damaged cells due to extensive injury, hemolysis of erythrocytes, burn, positional compression syndrome, etc. , Hypercalemia is characteristic of hyperthermia, convulsive syndrome and accompanies the use of a number of drugs - heparin, aminocaproic acid, etc.

Diagnosticshypercalemia is based on the presence of etiological factors (injury, OPN), the appearance of characteristic changes in cardiac activity: sinus bradycardia (up to a heart stop) in combination with ventricular extrasystole, pronounced slowdown in-ventricular and atrioventricular conductivity and characteristic laboratory data (plasma potassium more than 5, 5 mmol / l). High Pointed Teeth is recorded on ECG T,expansion of the complex QRS., reducing the amplitude of the priest R.

Treatmenthypercalemia begins to eliminate the etiological factor and the correction of acidosis. Prescribe calcium preparations; To transfer an excess of plasma potassium inside the cell, the glucose solution (10-15%) with insulin (1 unbend to every 3-4 g of glucose) is administered intravenously. If these methods do not bring due effect, hemodialysis is shown.

9.2.3. Calcium exchange

Calcium this is approximate 2 % body masses, of which 99% are in the bound state in the bones and under normal conditions in electrolyte exchange participation are not accepted. The ionized calcium form is actively involved in the neuromuscular transmission of excitation, blood coagulation processes, the operation of the heart muscle, the formation of the electrical potential of cell membranes and the production of a number of enzymes. The daily need is 700-800 mg. In the body of calcium comes with food, stands out through the tract and urine. Calcium exchange is closely interrelated with phosphorus exchange, plasma protein level and blood pH.

Hypocalcemia(plasma calcium less than 2.1 mmol / l) develops with hypoalbuminemia, pancreatitis, overflowing large quantities of citrate blood, long-term bile fistulas, vitamin D deficiency, impaired absorption in the small intestine, after highly assemble operations. Clinically manifested by increasing neuromuscular excitability, paresthesias, paroxysmal tachycardia, Tetania. Correction of hypocalcemia is carried out after laboratory determination of its level in the blood plasma intravenous administration of drugs containing ionized calcium (gluconate, lactate, chloride or calcium carbonate). The effectiveness of corrective therapy of hypocalcemia depends on the normalization of the level of albumin.

Hypercalcemia(plasma calcium more than 2.6 mmol / l) occurs with all processes accompanied by enhanced bone destruction (tumor, osteomyelitis), parasite diseases (adenoma or pa-rattyroid), excessive administration of calcium preparations after transfusion of citrate blood and other clinically condition It is manifested by increased fatigue, intensity, muscle weakness. At the increasing of hypercalcemia, symptoms of atony TBCT: nausea, vomiting, constipation, meteorism. The ECG appears the characteristic shortening of the interval (2-7; there is a violation of rhythm and conductivity, sinus bradycar-diya, slowing the anntrifricular conductivity; the teeth of r can become negative, two-phase, reduced, rounded.

Treatmentlies in the effects on the pathogenetic factor. With pronounced hypercalcemia (more than 3.75 mmol / l), targeted correction is required - 2 g of the disodium salt of ethylenediaminetetrauxous acid (EDTA), divorced in 500 ml of 5% glucose solution, intravenously slowly, drip 2-4 times a day, under Control of calcium content in blood plasma.

9.2.4. Magnesium exchange

Magnesium is an intracellular cation; Its plasma concentration is 2.15 times less than inside erythrocytes. The trace element reduces the neuromuscular excitability and the reduction of myocardium, causes depression of the central nervous system. Magnesium plays a huge role in the assimilation of oxygen cells, energy production, etc. The body comes with food and stands out through the gastrointestinal tract and with urine.

Gipicomagnia(plasma magnesium less than 0.8 mmol / l) is observed in cirrhosis of the liver, chronic alcoholism, acute pancreatitis, polyururic stage of OPN, intestinal fistulas, unbalanced infusion therapy. Clinically hypomagnemia is manifested by an increased neuro-

muscle excitability, hyperreflexia, convulsive cuts of various muscle groups; The appearance of spastic pain in the gastrointestinal bodies, vomiting, diarrhea. Treatmentit is a targeted effect on the etiological factor and appointment under laboratory control of magnesium salts.

Hypermagnias(Magnesium plasma more than 1.2 mmol / l) develops with KE-Taucidosis, increased catabolism, OPN. Clinically manifested by drowsiness and intensity, hypotension and bradycardia, resignation of breathing with the advent of signs of hypoventilation. Treatment- targeted effects on the etiological factor and the purpose of the antagonist of magnesium - salts of calcium.

9.2.5. Exchange chlorine

Chlorine -the main anion of the extracellular space; Located in equivalent ratios with sodium. The organism comes in the form of sodium chloride, which dissociates in the Na + and C1 stomach. When entering into a compound with hydrogen, chlorine forms hydrochloric acid.

Hypochloremia(Plasma chlorine less than 95 mmol / l) develops with long vomiting, peritonitis, stenosis of gatekeeper, high intestinal obstruction, reinforced sweating. The development of hypochlorinemia is accompanied by an increase in the hydrocarbonate buffer and the appearance of alkalosis. Clinically manifested by dehydration, respiratory impairment and cardiac activity. The occurrence of a convulsive or comatose state with a fatal outcome is possible. Treatmentit is a focused impact on the pathogenetic factor and under the laboratory control of infusion therapy with chlorides (primarily preparations of sodium chloride).

Hyperchloremia(Plasma chlorine is more in mmol / l) develops with general dehydration, violation of the removal of fluid from an interstitial space (for example, OPN), an increased fluid transition from the vascular channel in interstics (for hypoproteinemia), the introduction of large volumes of liquids containing excess chlorine. The development of hyper-chloremia is accompanied by a decrease in the buffer capacity of the blood and the appearance of metabolic acidosis. Clinically, it is manifested by the development of edema. The basic principle treatment- Impact on the pathogenetic factor in combination with syndromic therapy.

9.3. The main types of disorders of the water and electrolyte exchange

▲ Isotonic dehydration(Plasma sodium within the norm: 135-145 mmol / l) arises due to the loss of fluid of interstitial space. Since on the electrolyte composition, the interstitial fluid is close to the blood plasma, then a uniform loss of fluid and sodium occurs. Most often, isotonic dehydration develops with prolonged vomiting and diarrhea, acute and chronic diseases of the gastrointestinal tract, intestinal obstruction, peritonitis, pancreatitis, extensive burns, poly-uria, uncontrolled destination of diuretics, polytrame. Dehydration is accompanied by loss of electrolytes without a significant change in plasma osmolarity, therefore, there is no significant redistribution of water between sectors, but hypovolemia is formed. Clinically

there are violations by central hemodynamics. The turgor of the skin is reduced, the language is dry, Oliguria right up to Anuria. Treatmentpathogenetic; Replacement therapy with isotonic sodium chloride solution (35-70 ml / kg / day). Infusion therapy should be carried out under the control of the CVD and hourly diurea. If the correction of hypotonic dehydration is carried out against the background of metabolic acidosis, sodium is administered as a hydrocarbonate; With metabolic alkalosis - in the form of chloride.

▲ Hypotonic dehydration(Plasma sodium less than 130 mmol / l) times in cases where sodium loss exceeds the loss of water. WHO NOTES in massive losses of liquids containing a large amount of electrolytes - multiple vomiting, profuse diarrhea, abundant puming division, polyuria. The decrease in the content of sodium in the plasma is accompanied by a decrease in its osmolarity, as a result of which the water from the plasma begins to redistribute into the cells, causing their edema (intracellular hyperhydrium) and creating a lack of water in an interstitial space.

Clinicallythis condition is manifested by a decrease in the turgore of the skin and eyeballs, impaired hemodynamics and volienia, azotemia, impaired kidney function, brain, hemokoncentration. Treatmentit is a focused impact on the pathogenetic factor and conducting active rehydration with solutions containing sodium, potassium, magnesium (Ace-salt). During hypercalemia, a dish is prescribed.

▲ Hypertonic dehydration(Plasma sodium more than 150 mmol / l) WHO is no exceeding water loss over sodium loss. It occurs at a polyuric stage of OPN, a long-term forced diurea without timely replenishment of water deficiency, with a fever, insufficient injection of water during parenteral nutrition. Excess water loss over the sodium causes an increase in plasma osmolarity, as a result of which the intracellular fluid begins to move into the vascular channel. Intracellular dehydration (cell dehydration, excicosis) are formated.

Clinical symptoms- Thirst, weakness, apathy, drowsiness, and with severe lesions - psychosis, hallucination, dry language, body temperature, oliguria with high relative urine density, azotemia. The dehydration of the cells of the brain causes the appearance of non-specific neurological symptoms: psychomotor excitation, confusion, convulsions, the development of a comatose state.

Treatmentit is a targeted effect on the pathogenetic factor and liquidation of intracellular dehydration by appointing infusion glucose solution with insulin and potassium. The introduction of hypertensive solutions of salts, glucose, albumin, diurendic, is contraindicated. It is necessary to control the level of sodium in plasma and osmolarity.

▲ Hyperciforation isotonic(Plasma sodium within the rate of 135-145 mmol / l) Most often arises against the background of diseases, accompanied by eating syndrome (chronic heart failure, toxicosis of pregnancy), as a result of excessive administration of isotonic salt solutions. The occurrence of this syndrome is possible against the background of the liver cirrhosis, kidney diseases (nephrosis, glomerulonephritis). The main mechanism for the development of isotonic hyperhydration is an excess of water and salts with normal plasma osmolarity. The fluid delay occurs mainly in the interstitial space.

Clinicallythis form of hypershydration is manifested by the appearance of arterial hypertension, a rapid increase in body weight, the development of edema syndrome, anasarki, a decrease in blood concentration indicators. Against the background of hyper hydrating, there is a shortage of free fluid.

Treatmentit is to apply diuretics aimed at reducing the volume of interstitial space. In addition, 10% albumin is administered intravenously in order to increase the oncotic pressure plasma pressure, as a result of which the interstitial fluid begins to move into the vascular channel. If this treatment does not give proper effect, resort to hemodialysis with ultrafiltration of blood.

Hypotonic hyperhydration(plasma sodium less than 130 mmol / l), or "water poisoning", can occur with the one-time reception of very large amounts of water, with long-term intravenous administration of abolving solutions, edema against the background of chronic heart failure, liver cirrhors, OPN,hyperproduction ADG. The main mechanism is a decrease in plasma osmolarity and the transition of fluid inside the cells.

Clinical pictureit is manifested by vomiting, a frequent liquid watery chair, polyuria. Signs of the TSN defeat are joined: weakness, drierness, fast fatigue, sleep disorder, delirium, violation of consciousness, convulsions, coma.

Treatmentit is possible to more quickly eliminate excess water from the body: diuretic drugs are prescribed with simultaneous intravenous administration Sodium chloride, vitamins. A high calorie diet is needed. If necessary, hemodialysis with ultrafiltration of blood is carried out.

j. Hypertension hypertensive(Plasma sodium more 150 mmol / l) occurs when the introduction of large quantities of hypertensive solutions in the body against the background of the preserved excretory function of the kidneys or isotonic solutions - patients with impaired excretory function of the kidneys. The condition is accompanied by an increase in the osmolarity of the fluid of the interstitial space, followed by the dehydration of the cell sector and the strengthened output of potassium from it.

Clinical pictureit is characterized by thirst, redness of the skin, an increase in body temperature, Hell and FVD. When progressing the process, signs of damage to the CNS are joined: violation of the psyche, convulsions, coma.

Treatment- Infusion therapy with inclusion 5 % glucose and albumin solution on the background of diurea stimulation by osmodiuretics and saluretics. According to the testimony - hemodialysis.

9.4. Escort

Escort(Kos) is one of the most important components of the biochemical constancy of the liquid media of the body as the basis of normal metabolic processes, the activity of which depends on the chemical reaction of the electrolyte.

Kos characterize the concentration of hydrogen ions and denote the symbol of the pH. Acid solutions are pH from 1.0 to 7.0, the main - from 7.0 to 14.0. Acidosis- The pH shift in the acidic side arises due to the accumulation of acids or the lack of foundations. Alkalosis- The pH shift in the alkaline side is due to an excess of bases or a decrease in acid content. The constancy of the pH is the indispensable human life condition. The pH is a finite, the total reflection of the equilibrium of the concentration of hydrogen ions (H +) and buffer systems of the body. Preservation of the equilibrium of KS.

it is carried out by two systems that prevent blood pH shift. These include buffer (physico-chemical) and physiological systems regulation of Kos.

9.4.1. Physico-chemical buffer systems

Four physico-chemical buffer systems of the body are known - bicarbonate, phosphate, buffer system of blood proteins, hemoglobino-water.

Bicarbonate system the amount of 10% of the entire buffer blood capacity is the ratio of bicarbonates (NS0 3) and carbon dioxide (H 2 C0 3). Normally it is 20: 1. The final product of the interaction of bicarbonates and acid is carbon dioxide (C0 2), which exhales. The bicarbonate system is the most fast-acting and works both in plasma and in extracellular fluid.

Phosphate system it takes a small place in the buffer containers (1%), acts slower, and the final product - potassium sulfate - is excreted by the kidneys.

Plasma proteins depending on the level of pH, both acids and as grounds can act.

Hemoglobin buffer system it occupies the main place in maintaining the acid-base state (about 70% of the buffer container). The hemoglobin of erythrocytes binds 20% of the blood flow, carbon dioxide (C0 2), as well as hydrogen ions, resulting from carbon dioxide dissociation (H 2 C0 3).

The hydrocarbonate buffer is mainly represented in the blood and in all departments of extracellular fluid; in plasma - hydrocarbonate, phosphate and protein buffers; in red blood cells - hydrocarbonate, protein, phosphate, hemoglobine; In the urine - phosphate.

9.4.2. Physiological buffer systems

Lungscontrol the content of C0 2, which is the product of the decomposition of coalic acid. The accumulation of C0 2 leads to hyperventilation and shortness of breath, and thus excess carbon dioxide is removed. If there is an excess of bases, the reverse process takes place - pulmonary ventilation decreases, bradypuna occurs. Along with C0 2, strong irritants of the respiratory center are pH of the blood and oxygen concentration. PH shift and changes in oxygen concentration lead to an increase in pulmonary ventilation. In a similar way, potassium salts are also valid, but with a rapid increase in concentration K + in blood plasma, the activity of chemoreceptors is suppressed and the pulmonary ventilation decreases. The respiratory regulation of the COP refers to the rapid response system.

Kidneysupport braids with several ways. Under the influence of carbonichidrase enzyme contained in large quantities in the renal tissue, the C0 2 and H 2 0 compound occurs to the formation of coalic acid. Coalic acid dissociates to bicarbonate (NS0 3 ~) and H +, which is connected to the phosphate buffer and is removed from the urine. Bicarbonates are reab-sorbed in the tubules. However, with an excess of bases, reabsorption decreases, which leads to an increased removal of bases with urine and a decrease in alkalosis. Each Millimol N +, excreted in the form of titratable acids or ammonium ions, adds 1 mmol to the blood plasma

NS0 3. Thus, the excretion of H + is closely connected with the synthesis of NS0 3. The kidney regulation of Kos flows slowly and requires many hours or even a day for complete compensation.

Liverregulates the brain, metabolizing the non-composite exchange products coming from the gastrointestinal tract, forming urea from nitrogen slags and withdrawing acidic radicals with bile.

Gastrointestinalit takes an important place in maintaining the constancy of the COB due to the large intensity of the proceedings and suction of fluids, food and electrolytes. Violation of any digestion link causes violation of Kos.

Chemical and physiological buffer systems are powerful and efficient CBS compensation mechanisms. In this regard, even the most minor braid shifts indicate severe metabolic disorders and dictate the need for timely and targeted corrective therapy. The general directions of the normalization of KS are the elimination of the etiological factor (pathology of the respiratory and cardiovascular system, organs of the abdominal cavity, etc.), the normalization of hemodynamics is the correction of hypovolemia, the restoration of microcirculation, improving the rheological properties of blood, treatment of respiratory failure, up to the translation of the patient to the IVL , Correction of water and electrolyte and protein metabolism.

SKU indicators defined by an equilibration micrometeode of the ASTR-PA (with an interpolation calculation of PC0 2) or methods with direct oxidation C0 2. Modern microanalysts All variables of KOS and the partial tension of blood gases are automatically determined. The main indicators of KS are presented in Table. 9.1.

Table 9.1.SPE indicators normal

To assess the type of violation of the CB in conventional practical work, pH indicators, PC0 2, P0 2, BE use.

9.4.3. Types of disorders of the acid-base state

There are 4 main types of disorders of Kos: metabolic acidosis and alkalosis; Respiratory acidosis and alkalosis; Possible their combinations.

but Metabolic acidosis- Base deficit, leading to a decrease in pH. Causes: Acute renal failure, noncompensated diabetes (ketoacidosis), shock, heart failure (acidic acid acid), poisoning (salicylates, ethylene glycol, methyl alcohol), subfickered (duodenal, pancreatic) fistula, diarrhea, adrenal insufficiency. Cleaning indicators: pH 7.4-7.29, RC0 2 40-28 RT. Art., BE 0-9 mmol / l.

Clinical symptoms- Nausea, vomiting, weakness, violation of consciousness, Tahipne. Clinically moderate acidosis (BE up to -10 mmol / l) can proceed asymptomatic. When the pH decreases to 7.2 (the state of subcompensation, then the decompression) is increasing shortness of breath. With a further decrease in the pH, respiratory and heart failure increases, hypochest encephalopathy is developing up to coma.

Treatment of metabolic acidosis:

Strengthening of the hydrocarbonate buffer system - the introduction of 4.2% sodium bicarbonate solution (Contraindication- hypokalemia, metabolic alkalosis, hypernatremia) intravenously through peripheral or central vein: undiluted, diluted with 5% glucose solution in a 1: 1 ratio. The infusion rate of the solution is 200 ml in 30 minutes. The required amount of sodium bicarbonate can be calculated by the formula:

The amount of sodium bicarbonate mmol \u003d BE body weight, kg 0.3.

Without laboratory control apply no more than 200 ml / day, drip, slowly. The solution should not be administered simultaneously with solutions containing calcium, magnesium and not mix with phosphate-containing solutions. Transfusion of lactasol according to the mechanism of action is similar to the use of sodium bicarbonate.

but Metabolic alkalosis- The state of the deficiency of H + ions in the blood in combination with an excess of bases. Metabolic alkalosis is difficult to treat, as it is the result of both external losses of electrolytes and disorders of cellular and extracellular ion relations. Such violations are characteristic of massive blood loss, refractory shock, sepsis, pronounced losses of water and electrolytes with intestinal obstruction, peritonitis, pancreonecrose, long functioning intestinal fistulas. It is often precisely metabolic alkalosis as the final phase of metabolic disorders incompatible with life in this category of patients becomes the immediate cause of death.

Principles for the correction of metabolic alkalosis.Metabolic alkalosis is easier to prevent than treat. TO preventive measures The adequate administration of potassium in conducting hemotransphusion therapy and the replenishment of potassium cellular deficiency, timely and full correction of voluble and hemodynamic disorders. In the treatment of developing metabolic alkalosis, paramount imports

elimination of the main pathological factor of this state. Conduct targeted normalization of all types of exchange. The relief of alkalosis is achieved by intravenous administration of protein preparations, glucose solutions in combination with potassium chloride, large number of vitamins. Isotonic sodium chloride solution is used to reduce the OSM-Frying of the extracellular fluid and eliminate cell dehydration.

▲ Respiratory (respiratory) acidosisit is characterized by an increase in the blood concentration of H + diaons (pH< 7,38), рС0 2 (> 40 mm RT. Art.), Be (\u003d 3.5 + 12 mmol / l).

The causes of respiratory acidosis may be hypoventilation as a result of obstructive forms of emphysema of light, bronchial asthma, impaired pulmonary ventilation in weakened patients, extensive atelectasis, pneumonia, acute pulmonary damage syndrome.

The main compensation of the respiratory acidosis is carried out by the kidneys by the forced removal of H + and SG, increase the reabsorption of NS0 3.

IN clinical picturethe respiratory acidosis is dominated by the symptoms of intracranial hypertension, which arise due to cerebral va-zodilatia caused by excess C0 2. Progressive respiratory acidosis leads to a brain ebony, the severity of which corresponds to the degree of hypercap. Often develops copor with the transition to whom. The first signs of hypercapinia and increasing hypoxia are the concern of the patient, motor excitement, arterial hypertension, tachycardia, followed by the transition to hypotension and tachyarithmia.

Treatment of respiratory accidefirst of all, it is to improve alveolar ventilation, eliminating the atelectasis, pneumatic or hydrotorax, the rehabilitation of the tracheobronchial tree and translating the patient to the IVL. Treatment must be carried out urgently to the development of hypoxia as a result of hypoventilation.

j. Respiratory (respiratory) alkalosisit is characterized by a decrease in the level of PC0 2 below 38 mm RT. Art. and a pH climb above 7.45-7.50 as a result of enhancing the ventilation of the lungs both in frequency and in depth (alveolar hyperventilation).

The leading pathogenetic ring of respiratory alkalosis is the decrease in volumetric cerebral blood flow as a result of increasing the tone of the brain vessels, which is a consequence of the deficiency of C0 2 in the blood. At the initial stages, the patient may have parrestesia of the leather limbs and around the mouth, muscle spasms in the limbs, light, or severe drowsiness, headache, sometimes deeper disorders of consciousness, up to coma.

Prevention and treatmentthe respiratory alkalosis is primarily aimed at normalizing the external respiration and the impact on the pathogenetic factor that caused hyperventilation and hypocris. The testimony for the translation of the patient on the IVL is oppressed or lack of spontaneous breathing, as well as shortness of breath and hyperventilation.

9.5. Infusion therapy of water-electrolyte disorders and acid-base state

Infusion therapyit is one of the main methods in the treatment and prevention of violations of the functions of vital organs and systems in patients of surgical profile. Infusion efficiency

noy therapy depends on the validity of its program, the characteristics of infusion media, pharmacological properties and pharmacokinetics of the drug.

For diagnostics voluble violations and construction infusion therapy programsin the pre-and postoperative period, the skin of the skin, humidity of the mucous membranes, the filling of the pulse on the peripheral artery, heart rate and blood pressure. During operational intervention, the filling of the peripheral pulse, hourly diuresis, the dynamics of hell is most often assessed.

Manifestations of hypervolemiathere are tachycardia, shortness of breath, wet wipes in the lungs, cyanosis, foaming sputum. The degree of voluble violations reflect the data of laboratory studies - hematocrit, pH of arterial blood, relative density and osmolarity of urine, sodium concentration and chlorine in the urine, sodium in plasma.

To laboratory signs dehydrationthe increase in hematok-rita, progressive metabolic acidosis, the relative density of urine more than 1010, decreased by the concentration of Na + in the urine of less than 20 MEKV / L, urine-perosolarness. There are no laboratory characteristic of hypervolemia. Hypervolemia can be diagnosed according to lung radiography - enhancement of vascular pulmonary pattern, interstitial and alveolar lung edema. FLOLD is estimated in accordance with a specific clinical situation. The most significant is the test with the bulk load. A slight increase (1-2 mm Hg. Art.) FED after a quick infusion of a crystalloid solution (250-300 ml) indicates the hypo-volley and the need to increase the amount of infusion therapy. And vice versa, if, after the test, the growth of the CCLD exceeds 5 mm RT. Art., It is necessary to reduce the pace of infusion therapy and limit its volume. Infusion therapy implies intravenous administration of colloidal and crystalloid solutions.

but Crystaloid solutions - the aqueous solutions of low molecular weight ions (salts) quickly penetrate through the vascular wall and are distributed in extracellular space. The choice of solution depends on the nature of the fluid loss, which should be filled. Water loss is reimbursed by hypotonic solutions, which are called solutions of a support type. The deficiency of water and electrolytes is replenished with isotonic electrolyte solutions, which are called solutions of a substitution type.

▲ Colloid solutions based on gelatin, dextran, hydroxyethyl starch and polyethylene glycol, the colloid-osmotic plasma pressure is maintained and circulated in vascular bed, having a voluce-sky, hemodynamic and reality effect.

In the peripheral period, with the help of infusion therapy, physiological fluid needs (maintenance therapy) are replenished, accompanying fluid deficit, loss through an operating wound. The choice of an infusion solution depends on the composition and nature of the lost liquid - the sweat, the contents of the gastrointestinal tract. The intraoperative loss of water and electrolytes is caused by evaporation from the surface of the operating wound with extensive surgical interventions and depends on the area of \u200b\u200bthe wound surface and the duration of the operation. Accordingly, intraoperative infusion therapy includes the replenishment of the main physiological needs for fluid, eliminating the preoperative deficit and operational losses.

Table 9.2.The content of electrolytes in the media of the gastrointestinal tract

The need for waterdetermine on the basis of an accurate estimate of the resulting liquid deficiency, taking into account the renal and abandoned losses.

For this purpose, the volume of daily diuresis is summed: V, - proper value of 1 ml / kg / h; V 2 - loss with vomiting, chair and gastrointestinal content; V 3 - separated by drainage; P - loss by extracting through the skin and light (10-15 ml / kg / day), taking into account the constant T - loss with a fever (with an increase in body temperature by 1 ° C above 37 ° losses amount to 500 ml per day). Thus, the total daily water deficit is calculated by the formula:

E \u003d V, + V 2 + V 3 + P + T (ml).

To prevent hypoxium or hyperifying, control over the amount of fluid in the body, in particular, in the extracellular space:

OUP \u003d body weight, kg 0,2, Hematocrit recalculation coefficient - hematocrit

Deficiency \u003d true proper body weight, kg hematocrit due 5

Calculation of the deficit of the main electrolytes(K +, Na +) are carried out by volume of their losses with the urine, the contents of the gastrointestinal tract (gastrointestinal tract) and drainage environments; Definitions of concentration indicators - according to generally accepted biochemical methods. With the impossibility of determining potassium, sodium, chlorine in the gastric loss contents can be estimated primarily taking into account the oscillations of the concentrations of indicators within the following limits: Na + 75-90 mmol / l; K + 15-25 mmol / l, SG up to 130 mmol / l, total nitrogen 3-5.5 g / l.

Thus, the total loss of electrolytes per day is:

E \u003d V, C, + V 2 C 2 + V 3 with 3 g,

where v] - dairy diuresis; V 2 - the volume of the discharge gastrointestinal tract during vomiting, with a chair, by the probe, as well as fistula losses; V 3 - separated by drainage from the abdominal cavity; C, C 2, C 3 - concentration indicators in these environments, respectively. When calculating, you can refer to Table data. 9.2.

When translating the magnitude of losses from mmol / l (system SI) in grams, the following recalculations must be performed:

K +, r \u003d mmol / l 0.0391.

Na +, r \u003d mmol / l 0.0223.

9.5.1. Characterization of crystaloid solutions

Tools regulating the aqueous-electrolyte and acid-base-mineostasis include electrolyte solutions and osmodietics. Electrolytic solutionsapply to correct disorders of water exchange, electrolyte metabolism, water and electrolyte metabolism, acid-base state (metabolic acidosis), water and electrolyte metabolic metabolic metabolic metabolic and acidic state (metabolic acidosis). The composition of the electrolytic solutions determines their properties - osmolarity, isotonic, ion, backup alkalinity. In relation to the osmolarity of electrolyte solutions to the blood, they show iso-, hypo-or hyperosmolar effect.

Isosmolar Effect -water introduced with isosmolarium solution (Ringer's solution, ringer-acetate) is distributed between intrasociry and output spaces as 25%: 75% (the voluble effect will be 25% and will last about 30 minutes). These solutions are shown in isotonic dehydration.

Hyposmoly effect -more than 75% of the water introduced with the electrolytic solution (the disol, acel, 5% solution of glucose) will pass into a subordinate space. These solutions are shown in hypertensive dehydration.

Hyperosmolar effect -water from the output space will flow into the vascular channel until the hyperosmolarity of the solution to the osmolarity of blood. These solutions are shown in hypotonic dehydration (10% sodium solution of chloride) and hyper hydrating (10% and 20% Man-nitol).

Depending on the electrolyte content in the solution, they can be isotonic (0.9% solution of chloride sodium, 5% glucose solution), hypotonic (disol, azesol) and hypertonic (4% solution of chloride potassium, 10% sodium chloride, 4.2% and 8.4% sodium hydrocarbonate solution). The latter are called electrolyte concentrates and are used as an additive to infusion solutions (5% glucose solution, ringer-acetate solution) immediately before administration.

Depending on the number of ions, monoion (sodium solution of chloride) and polyionic (Ringer's solution, etc.) differ in the solution.

Introduction to the electrolytic solutions of reserve baseliness (hydrocarbonate, acetate, lactate and fumarate) allows you to correlate and violations of Kos metabolic acidosis.

▲ Sodium chloride solution 0.9 % enter intravenously through the peripheral or central vein. Introduction speed 180 drops / min, or about 550 ml / 70 kg / h. Average dose for an adult patient 1000 ml / day.

Indications:hypotonic dehydration; ensuring the need for Na + and O; hypochlorinemic metabolic alkalosis; Hypercalcemia.

Contraindications:hypertensive dehydration; hypernemia; hy-perchloremia; hypokalemia; hypoglycemia; Hyperchloremic metabolic acidosis.

Possible complications:

hypernemia;

hyperchloremia (hyperchloremic metabolic acidosis);

hypershydration (pulmonary edema).

j Ringer-acetate- isotonic and isoion solution, administered intravenously. Introduction speed of 70-80 drops / min or 30 ml / kg / h;

if necessary, up to 35 ml / min. Average dose for an adult patient 500-1000 ml / day; If necessary, up to 3000 ml / day.

Indications:loss of water and electrolytes from the gastrointestinal tract (vomiting, diarrhea, fistula, drainage, intestinal obstruction, peritonitis, pancreatitis, etc.); with urine (polyuria, isostenuria, forced diuresis);

Isotonic dehydration S. metabolic acidosis - Delayed the correction of acidosis (blood loss, burns).

Contraindications:

hypertensive hyperhyrastation;

• hypernemia;

  hyperchloremia;

  hypercalcemia.

Complications:

hyper hydrating;

• hypernemia;

  hyperchloremia.

but Jonosteril- isotonic and isoion electrolyte solution is administered intravenously through the peripheral or central vein. Introduction speed 3 ml / kg of body weight or 60 drops / min or 210 ml / 70 kg / h; If necessary, up to 500 ml / 15 min. The average dose for an adult 500-1000 ml / day. In severe or urgent cases up to 500 ml in 15 minutes.

Indications:

extracellular (isotonic) dehydration of various origins (vomiting, diarrhea, fistula, drainage, intestinal obstruction, peritonitis, pancreatitis, etc.); Polyuria, Isostenuria, forced diuresis;

Primary plasma substitution with plasma losses and burns. Contraindications:hypertensive hyperhyrastation; swelling; Heavy

renal failure.

Complications:hypershydration.

▲ Lakosol.- isotonic and isoion electrolyte solution VVO is intravenously through peripheral or central vein. The rate of administration of 70-80 drops / min, or about 210 ml / 70 kg / h; If necessary, up to 500 ml / 15 min. Average dose for adult 500-1000 ml / day; For options for up to 3000 ml / day.

Indications:

loss of water and electrolytes from the gastrointestinal tract (vomiting, diarrhea, fistula, drainage, intestinal obstruction, peritonitis, pancreatitis, etc.); with urine (polyuria, isostenuria, forced diuresis);

isotonic dehydration with metabolic acidosis (fast and delayed absidosis correction) - blood loss, burns.

Contraindications:hypertensive hyperhyrastation; alkalosis; hypernemia; hyperchloremia; hypercalcemia; Hyperlactatemia.

Complications:hyper hydrating; alkalosis; hypernemia; hyperchloremia; Hyperlactatemia.

▲ Azesol- The hyposmolar solution contains Na +, C1 ions "and acetate. Enter intravenously through the peripheral or central vein (inkjano

or drip). The daily dose for an adult is equal to the daily need for water and electrolytes plus "/ 2 water deficit plus continuing pathological losses.

Indications:hypertensive dehydration in combination with hypercalemi-it and metabolic acidosis (delayed absidation correction).

Contraindications:hypotonic dehydration; hypokalemia; Hypershydration.

Complication:hypercalemia.

but Sodium hydrocarbonate solution 4.2% For rapid correction of metabolic acidosis. Introduced intravenously undiluted or diluted 5 % glucose solution in a 1: 1 ratio, the dosage depends on the data of the ionogram and the COP. In the absence of laboratory control slowly, no more than 200 ml / day are injected drip. Sodium hydrocarbonate solution 4.2% should not be administered simultaneously with solutions containing calcium, magnesium, as well as not mix with phosphate-containing solutions. Dose of the drug can be calculated by the formula:

1 ml of 4.2% solution (0.5 molar) \u003d BE body weight (kg) 0.6.

Indications -metabolic acidosis.

Contraindications- hypokalemia, metabolic alkalosis, hypernat-ramia.

▲ Osmodiuretics(Mannitol). 75-100 ml of 20% of mannitol intravenously introduced for 5 minutes. If the amount of urine is less than 50 ml / h, then the next 50 ml is introduced intravenously.

9.5.2. The main directions of infusion therapy hypo-and hyperhydration

1. Infusion therapy with dehydrationit must take into account its appearance (hypo pertonic, isotonic, hypotonic), as well as:

the volume of the "third space"; Forcing diuresis; Hyperthermia; hyperventilation, open wounds; Hypovolemia.

2. Infusion therapy with hyperhydrationit must take into account its appearance (hypertensive, isotonic, hypotonic), as well as:

physiological daily need for water and electrolytes;

preceding deficiency of water and electrolytes;

continuing pathological loss of fluid with secrets;

the volume of the "third space"; Forcing diuresis; hyperthermia, hyperventilation; open wounds; Hypovolemia.

But due to improper nutrition, abundant or insufficient drinking and other factors, this balance may violate. If the salts becomes more, then dehydration occurs, the pressure rises and the blood is increasing, and when their disadvantage is observed, the renal failure is developing, the pressure drops, the body quickly loses fluid. How to restore the water-salt balance of body fluids and maintain it correctly? Answers to these questions and some recommendations read in the article.

Salt Balance Restoration

Independently disturbing the composition of the body of the body is difficult to detect, so suspicions need to consult a doctor, but if there is no such possibility, then pay attention to the following symptoms:

• too frequent / rare visit toilet;
• pressure jumps;
• constant feeling of thirst;
• concentrated urine of a saturated yellow color;
• yellowish tint of leather and nails;
• dry epidermis, hair loss.

If these symptoms are present, the water-salt balance can be broken, so it must be restored. You can do this in various ways:

Detailed information about each of them is presented below, but it is best to combine somewhat to achieve an optimal result.

Drug

The essence of the method is to adopt vitamin and mineral or simply mineral complexes that contain calcium, magnesium, sodium, potassium, silicia - metals responsible for the water-salt balance inside the body.

It is best to visit the doctor who correctly select a complex depending on the needs of the body, but you can also consult with a pharmacologist in the pharmacy. Often to restore the water-salt balance accept:

• "Duuk", which includes 8 necessary minerals and 12 vitamins;
• "Vitrum", in which more than 10 minerals are present;
• Biotech Vitabolik, containing only minerals in the required quantity.

There are also other drugs, but before they are used, it is necessary to consult with a specialist, as well as to pass compulsory tests to determine the needs of the body. The complex needs to take a month, and then take a break for a few weeks.

Chemical

The chemical method is different from drugs that do not need non-colored pills, but a special solution. Each pharmacy sells special packages that contain various salts. Initially, similar means were used during diseases such as cholera, dysentery, poisoning, because then a person quickly loses fluid with diarrhea and vomiting, and the salt solution helps to delay water in the body.

Before using such packages, it is necessary to consult with the attending physician, this method cannot be used at:

• renal failure;
• diabetes;
• liver diseases;
• infections of the urogenital system.

To restore it is enough to drink a weekly packet course. Take them worth an hour after lunch, and the next meal should be no earlier than in an hour and a half. At the time of treatment, it is necessary to abandon the addition of salt to food, in order not to be excessive.

Diet

In order to establish the water-salt balance, it is not necessary to take various medicines. Without harm to the body, it is possible to make a correct diet with the calculation of salt. Every day, a person must consume about 7 grams of this substance (with the exception of patients who are shown a partial or complete exception to it from the diet).

Keep track of how much salt add to various dishes. In the 3 liter pan of soup, it is enough to put 1-1.5 tablespoons of the salt (this is about 10 grams). Accordingly, 300 ml of the product contains 1 gram of chemical. But in one portion of fast food or semi-finished products can be contained up to 12 grams of salt!

Calculate the consumption of this chemical and do not go beyond 5-8 grams per day, then the water-salt balance will be saved.

1. Instead of a regular cook salt, use sea, because it contains more necessary minerals.
2. If it is not possible to use sea salt, add iodized cooking.
3. Do not solit "on the eye", but use spoons. 5 grams are placed in the teaspoon, and in the dining room without a slide of 7 grams.

It should also be forgotten that the balance of water-salt, and, it means, water is of great importance. It is necessary to consume depending on the body weight. Every kilogram mass accounts for 30 grams of water, but the use should not exceed 3 liters per day.

Outpatient

Hospitalization due to violation of the water-salt balance is rarely appointed, but it happens. In this case, the patient under the supervision of the doctor takes special minerals and saline solutions. Strict drink mode is also assigned, and all food is prepared for the patient's need. In emergency cases, droppers are prescribed with isotonic solution.

For restoration of the water-salt balance, the following recommendations are performed daily.

1. Drink ordinary water, because juices, broths or cooks will not quit the needs of the body.
2. The daily volume of fluid is easy to calculate itself: per 1 kg of weight - 30 grams of salt.
3. On a liter of drilled water, 2-2.3 g of salt is necessary.
4. Watch out for your urine color - it should be light yellow, almost transparent.
5. In various diseases of the kidneys or liver, consult your doctor in front of any actions to restore salt balance.

Water-salt balance inside the fluids of the body can be restored at home, but before that it is necessary to visit the doctor and pass the tests. It is not necessary to independently assign various vitamin and mineral complexes or salt packages, better limit to the diet and support of the recommendations.

Why does the water and salt balance occur?

What causes impaired water-salt balance in the body, and what consequences can this imbalance cause?

Two phenomena - one problem

Water-electrolyte (water-salt) balance can be broken in two directions:

1. Hypershydration - excessive accumulation of fluid in the body, slowing down the latter. It accumulates in the intercellular space, its level inside the cells increases, the last swell. When involving the nerve cells, nerve centers are excited and convulsions arise;
2. Dehydration - the phenomenon opposite to the previous one. Blood begins to thicken, the risk of blood formation increases, the blood flow in the tissues and organs is disturbed. With a deficit, death comes more than 20%.

Violation of the water-salt balance manifests weight loss, dry skin and cornea. With a strong moisture deficit, the subcutaneous fatty tissue resembles the dough consistency, the eyes are seized, the volume of circulating blood is reduced.

Dehydration is accompanied by exacerbation of the features of the face, cyanosis of lips and nails, reduced pressure, weak and frequent pulse, hypofunction of kidneys, an increase in the concentration of nitrogen bases due to the violation of protein metabolism. Also, a person is frozen the upper and lower limbs.

There is such a diagnosis as isotonic dehydration - water loss and sodium in equal amounts. This occurs during acute poisoning when the electrolytes and the volume of the liquid medium is lost in diarrhea and vomiting.

Why there is a disadvantage or excess in the body of water

The main causes of pathology are the external loss of fluid and the redistribution of water in the body. The level of calcium in the blood is reduced in the pathologies of the thyroid gland or after it is removed; When the drugs of radioactive iodine are used (for treatment); With pseudogopoparatyosis.

Sodium decreases with long-term diseases accompanied by a decrease in urine release; in the postoperative period; With self-treatment and uncontrolled diuretic drugs.

Potassium decreases as a result of its intracellular movement; with alkalosis; aldosteroneism; Corticosteroid therapy; alcoholism; liver pathologies; after operations on thin intestines; with insulin injections; Hypophunction thyroid. The reason for its increase is the increase in cataton and the delay of its compounds, cell damage and potassium output from them.

Symptoms and signs of violation of the water-salt balance

The first disturbing signals depend on what is happening in the body - hyper hydration or dehydration. This includes swelling, vomiting, diarrhea, severe thirst. It often changes the acid-alkaline balance, blood pressure decreases, an arhydrammy heartbeat is observed. It is impossible to ignore these symptoms, since the progressive pathology leads to a stop of the heart and death.

Calcium deficiency entails a smooth muscles convulsions. The spasm of large vessels and larynx is especially dangerous. In the excess of this element, pain in the stomach, severe thirst, vomiting, urination rapid, poor blood circulation occurs.

Potassium deficiency is accompanied by alkalosis, atonium, CPN, intestinal obstruction, brain pathologies, heart ventricles fibrillation and other changes in its rhythm.

With an increase in its concentration in the body, ascending paralysis, nausea, vomiting occurs. This condition is very dangerous, as the fibrillation of heart ventricles is developing very quickly, that is, the probability of the atrium stop is high.

Excess magnesium occurs in the abuse of antacids and kidney dysfunction. This condition is accompanied by nausea, reducing to vomiting, increased temperature, slowing down cardiac rhythm.

The role of the kidneys and the urinary system in the regulation of the water-salt balance

The function of this pair of the organ is aimed at maintaining the constancy of various processes. They are responsible for the ion exchange that occurs on both sides of the tubular membrane, extinguishing the excess cation and anions from the body by adequate reabsorption and the excretion of potassium, sodium and water. The role of the kidneys is very large, since their functions allow you to preserve the stable volume of the intercellular fluid and the optimal level of substances dissolved in it.

On a day, a healthy person needs about 2.5 liters of liquid. Approximately 2 liters he gets through food and drink, 1/2 l is formed in the very organism as a result of metabolic processes. One and a half liters remove the kidney, 100 ml - intestines, 900 ml - leather and lungs.

The amount of fluid that the kidney is derived depends on the state and the needs of the organism itself. With a maximum diuresis, this organ of the urinary system can derive to 15 liters of fluid, and with antidioresis - up to 250 ml.

Sharp fluctuations of these indicators depend on the intensity and nature of the tubing reabsorption.

Diagnosis of disorders of the water-salt balance

In the primary inspection, it is an estimated conclusion, further therapy depends on the patient's reaction to the introduction of anti-shock tools and electrolytes.

The doctor puts the diagnosis based on the complaints of the patient, history, research results:

1. Anamnesis. If the patient is conscious, its survey is carried out, the information on violations of the water and electrolyte balance (diarrhea, ascites, ulcerative disease, narrowing of the gatekeeper, heavy intestinal infections, some types of ulcerative colitis, dehydration of different etiology, short-term salt diet in the menu) ;
2. Setting the degree of pathology, carrying out measures to eliminate and prevent complications;
3. General, bacteriological and serological blood test to identify the cause of deviation. Additional laboratory and instrumental research can be appointed.

Modern diagnostic methods make it possible to establish the cause of pathology, its degree, as well as in a timely manner to start the relief of symptoms and the restoration of human health.

How can I restore the water and salt balance in the body

Therapy implies the following activities:

1. Conduct states that may be a threat to life;
2. The bleeding and sharp blood loss are eliminated;
3. Hypovolemia is eliminated;
4. Hyper or hypercalemia is eliminated;
5. It is necessary to apply measures to regulate normal-variant exchange. Most often prescribed a solution of glucose, polyionic solutions (Hartman, lactasol, ring meter), erythrocyte mass, polyglyukin, soda;
6. It is also necessary to prevent the development of possible complications - epilepsy, heart failure, in particular with therapy with sodium preparations;
7. During the restoration, with the help of intravenous administration of saline solutions, hemodynamics, kidney function, the level of Kos, NDO should be controlled.

Preparations that are used to restore the water-salt balance

Potassium and magnesium asparaginat - required with myocardial infarction, heart failure, artimiyami, hypokalemia and hypomagniasia. The drug is well absorbed during oral administration, excreted by the kidneys, tolerates magnesium and potassium ions, contributes to their entry into the intercellular space.

Sodium Hydrocarbonate - is often used for ulcerative disease, gastritis with increased acidity, acidosis (with intoxication, infection, diabetes mellitus), as well as with kidney stones, breathing organs and oral cavity.

Sodium chloride - applied with a lack of an intercellular fluid or its large loss, for example, with toxic dyspepsia, cholera, diarrhea, indomitable vomiting, strong burns. The drug has a rehydrating and disintellation effect, allows you to restore water-electrolyte metabolism with different pathologies.

Sodium citrate - allows you to restore normal blood indicators. This agent increases sodium concentration.

Hydroxyethyl stroke (Reohales) is used in surgical interventions, acute blood losses, burns, infections as the prevention of shock and hypovolemia. It is also used with the deviation of microcirculation, as it contributes to the propagation of oxygen in the body, restores the walls of the capillaries.

Compliance with natural water-salt balance

This parameter may violate not only with serious pathologies, but also with abundant sweating, overheating, uncontrolled diuretic, long-lasting diet.

Compliance with Drink Mode - important condition Prevention. It is necessary to control the existing diseases, chronic pathologies, not to take without the appointment of a doctor of any medicines.

Restoration of electrolyte balance

What do you think can be found in common between the products below:

cabbage saunas in Russian,

beans in Tomat

tomatoes and cucumbers salty? Combines their high content of potassium microelement, vital for full work nervous and muscular Systems - Its content in tissues and in blood plasma is sharply reduced against the background of alcohol excesses.

In the classic picture of the Russian wings, sauerkraut (with ice), daily soup and brine from under the cucumbers are not attended by chance. The people were noticed that it was these products that are not bad for a good feeling of a hangover state - depression, muscle weakness, heart interruptions, and so on.

Today, when the body's electrolyte composition is well studied (we recall that, except potassium, the electrolytes include magnesium, calcium, sodium chlorine and inorganic phosphates), you can appreciate the need for the body in these substances for any condition of the soul and body. In the clinic, for this purpose, a so-called blood plasma ionogram is drawn up, where the content of the main electrolytes is indicated and the deficit of any of them is calculated by special formulas.

But what to do in domestic conditions, when the laboratory analysis is not available, and the state of the "patient" does not cause special optimism? Does it make sense to purposefully replenish the electrolyte losses?

Of course, it has - especially if in the near future you are going to return to active intellectual or physical activity. The replenishment of the losses of magnesium and potassium (in the state of abstinence, the deficit of these trace elements determines the heaviness of a firmy malaise) allows you to normalize the work of the heart, the activities of the central nervous system - we mean the return of the ability to read, think, talk, understand what is written, and getting rid of emotional tension.

In our practice, it was repeatedly faced with complaints about unpleasant sensations and pain in the heart of the heart, arising after alcohol excesses. Note that for a healthy person who has never had a heart problem, such a state is carried very hard - any cardialgia (literally translates as "pain in the heart") is accompanied by feeling fear and confusion.

We will reveal a little professional secret: most of those who turn to expensive drug treatment at home (these proposals are many in any advertising edition) are concerned about the condition of their heart and often truly frightened with their own feelings. Naturally, such sufferers primarily makes the deficiency of potassium and magnesium - there is Panangin preparation containing both of these electrolytes in the form of aspartic salts and actively used in cardiology. Potassium rather quickly normalizes the processes of excitation and conducting electrical pulses in myocardium, and magnesium, in addition, has a pronounced positive effect on metabolic processes in the heart muscle. By the way, magnesium has a number and other important properties: it eliminates the feeling of depression, removes emotional tension and has an anticonvulsant action.

Let's consider uncomplicated calculations.

The daily need of the body in potassium (again, for a person with an average weight of 70 kg) is 1.0 mmol / kg of mass: 1.0 mmol / kg x 70 kg x 16.0 grams / mol (molar mass) \u003d 1.12 grams per day. After the alcohol excesse, accompanied by the reinforced conclusion of potassium from the blood plasma cells and then with the urine from the body in general, the daily need for this electrolyte will increase at least 50%.

In addition, according to our scheme (see below), a large amount of fluid is assigned and diuretics drugs causing active urinations are used: a certain amount of potassium leaves with urine; We assign drugs in the form of tablets "through the mouth", in connection with which the total number of potassium can be increased by at least 50%.

Total: 1.12 g + 0.56 g + 0.56 g \u003d 2.24 g of potassium / day.

How to fill the resulting deficit?

In almost every pharmacy, there are two popular and inexpensive drugs - asparks and Panangin, which are constantly accepted by core patients. In one tablet of the miraculous means, it contains: asparks - 40.3 mg of potassium, Panangin - 36.2 mg of potassium.

Use drugs as follows: Several tablets are crushed and taken, pre-soluble at 0.5 glasses of warm water. The effect is assessed as follows - if the unpleasant feelings in the heart area disappeared, then enough for the day to take twice 1 tablet asparkama or Pangin and after that they forget about them. From practice it is known that the beneficial WHO occurs no earlier than 1-1.5 hours after receiving the first dose of the drug.

You can find specific information about the use of Asparkama and Pangina in the subsequent sections of our benefit. Note that not all recommendations can be used by patients with chronic diseases Hearts, heart rate impaired and chronic renal failure, although potassium compounds are an ordinary salt, the abuse of them is far from harmless.

A reasonable question: the calculated daily number of potassium is 2.24 grams, and when using Pangen or Aslakama per day, at best, no potassium becolemag is recruited. Where is the rest? The case is that a significant amount of this trace element comes in a completely natural way with food and drinks. For example, 100 grams of ordinary potatoes contain approximately 500 mg of potassium; Beef, low-fat pork or fish contain potassium in an amount of from 250 to 400 mg per 100 grams of edible part of the product, although some part it is not absorbed and stands out in the composition kALOV MASS.. Excess electrolytes is automatically excreted from the body with urine using a row of hormones.

In general, the idea of \u200b\u200bthe method is as follows: after subjective improvement in the reception of electrolytes, it is sharply reduced - then the body itself will adjust their equilibrium. But undoubtedly one (and it shows daily practices): a positive "electrolyte" push aimed at restoring the lost balance, favorable In the first hours of abstinence, affecting not only the cardiovascular system, but also on the overall tone of the body - potassium and magnesium participate in more than 300 thin biochemical reactions.

What to do in the event that potassium preparations are not available, and the unfortunate abstinee is bothering pain, rhythm disruption and other unpleasant sensations in the heart of the heart? Here it is necessary to resort to folk practice: fried potato dish with beef, beans in tomato, utered peas, brine or sauerkraut.

Many years ago, in the Far East, local alcohol professionals turned our attention to the food product, occupying a modest place among other exotic. It was used in combination with a fried bow, some of the sea products (such as squid, trumpeter, scallop, or just fish), successfully replacing a Russian brine. This product is nothing but a sea cabbage.

Interested in, we turned to the appropriate literature and found out that the content of potassium and magnesium, sea cabbage does not have equal among food, known in our region (close to it, perhaps, are dried and prunes).

The fact is that the tonic effects of naval cabbage on the human body, known not one millennium, has been used widely and is used in Japanese, Korean and Chinese medicine. One of the latest innovations is the ability of sea cabbage to increase the body's stability to the effects of various stressors up to ionizing radiation (as doctors say, high adaptogenic qualities of this maritime product). By the way, we will talk about the use of adaptogens in the relevant section of our benefit - this is an extremely interesting topic!

In conclusion, we note that the canned sea cabbage is replaced by all the number of potassium, which was calculated by us. The only thing that disrupts the situation somewhat is not very pleasant taste quality of the product, although everything is in your hands here. Sometimes a fairly good tomato sauce.

Water-salt balance in the body: violation, restoration, maintenance

Water salt man balance

Under the water-salt balance of a person means the processes of distribution, assimilation and removal from the body of water and mineral salts. Man for the most part consists of water. Thus, in the body of a newborn baby, it is about 75%, in adult men, its content is about 60%, and in women - 55%. Over the course of life, this indicator gradually decreases.

The importance of the balance of salts and water in the body

The water-salt exchange is included in the process of receipt of water and salts in the body, their absorption, distribution between different tissues, organs and liquids and the elimination of the body. It is one of the most important mechanisms for maintaining human vital activity.

Water participates in almost all exchange processes. It is contained in all tissues, cells and organs. The importance of fluid for the body is difficult to overestimate.

Salt exchange is necessary to perform such functions as the movement of vessels in vessels, maintenance of metabolism, blood coagulation, saving normal level Sugar in the blood, removal of toxins and so on. The main electrolytes are considered to be calcium, magnesium, sodium, chlorine and potassium.

Regulation mechanism

Regulation of the water-salt balance is made by several systems. Special receptors send signals to the brain when the content of electrolytes, ions and water changes. After that, consumption, distribution and removal from the body of liquid and salts changes.

The removal of water and electrolytes occurs through the kidneys under the control of the central nervous system. The mechanism for regulating the water-salt metabolism is as follows. The central nervous system comes to the violation of the normal balance of the liquid or any of the salts. This leads to the development of certain hormones or physiologically active substances. They, in turn, affect the removal of salts from the body.

Features of water and salt metabolism

It is believed that a day, a person should receive approximately 30 ml of water for every kilogram of its weight. This quantity is enough to supply the body with minerals, fluid flow in tissue, cells and organs, dissolving and eliminating the outward products of life. An ordinary person rarely uses more than 2.5 liters of water per day, of which, near the liter accounts for a liquid contained in food, and another 1.5 liters - on the water drunk during the day.

The balance of fluid depends on the ratio of its receipt and selection in one period of time. The removal of water is made through the urinary system, together with the feces, through the sweat, and also together with the exhaled air.

Violation of the Water-Salt Balance

There are two directions of disorders of the water-salt balance: hypershydration and dehydration. The first of them is an increased cluster of water in the body. The liquid can accumulate in tissues, intercellular space or inside the cells. Dehydration is a lack of water. It leads to a thickening of blood, the formation of blood clots, violation of normal blood supply. If the water deficit is more than 20%, the person dies.

Causes of phenomena

The cause of the violation of the water-salt balance becomes the redistribution of fluid in the body and its loss. Thus, hyperhyrapping occurs when the water delay in the tissues and the difficulty of its excretion, for example, in kidney pathologies. Dehydration is often developing with intestinal infections, under which there is a strong diarrhea and vomiting.

Reducing the level of salts may occur for the following reasons:

Symptoms

Symptoms of violation of water exchange depend on its type. In hypershydration, swelling, nausea, weakness are noted. With a lack of fluid in the body, a strong thirst appears, the skin and mucous membranes become dry, the pallor and coldness of the limbs are also observed, a decrease in the amount of urine and reduced skin elasticity. Such states require mandatory medical care.

The disadvantage and oversupplication of mineral tools is more complicated. With a lack of calcium in the body, cramps may arise, the largest dangers are represented by vessels and larynx spasms. Increased content The salts of this mineral leads to vomiting, feeling thirst, strengthening the selection of urine and pain in the stomach.

The symptoms of the deficiency of potassium becomes: atony, brain pathology, alkalosis, intestinal obstruction, changes in the heart rhythm. With its excessive content in the body, vomiting and nausea may be observed. This condition can lead to the development of heart ventricles fibrillation and stopping its atrium.

An excess of magnesium in the blood can lead to the appearance of nausea and vomiting, climb temperature and slowing the work of the heart.

Measures to restore water-salt balance

Preparations

To restore the water-salt balance, drugs can be used, the action of which is directed to the control of the content in the body of salts and liquid. These funds include:

1. Magnesium and potassium asparaginat. It is prescribed with heart attacks, impairment of the heart, heart failure arising from a shortage of potassium or magnesium.
2. Sodium bicarbonate. This drug can prescribe with high acidity gastritis, ulcers, acidosis, intoxications, infections and other cases. It has an antacid effect, increases the production of gastrin.
3. Sodium chloride. It is used in loss of fluid and its insufficient flow as a result of indoorable vomiting, acute diarrhea, extensive burns. Also, this drug is prescribed with chlorine and sodium deficiency arising against the background of dehydration.
4. Sodium citrate. The drug is used to normalize blood composition. It binds calcium, increases sodium levels and inhibits hemokoagulation.
5. Hydroxyethyl starch. It is prescribed with strong blood loss, extensive burns, infections, as well as during operations and in the postoperative period.

Preparations for water balance restoration:

Solutions

Chemical solutions are used to combat dehydration of the body with diseases such as dysentery, cholera, acute poisoning and other pathologies accompanied by vomiting and diarrhea. It is not recommended to use such solutions with diabetes, renal failure, liver diseases and infectious diseases urogenital organs.

To restore the water-salt balance, it should take solutions for 5-7 days. It is necessary to do it in the afternoon, about an hour after eating. Over the next 1.5-2 hours, it is better to refrain from food. At the same time, during the treatment period, it is worth reduce or completely eliminate the salt from the diet to prevent it up.

With acute rapid dehydration of the body, solutions start taking immediately. At the same time, with severe vomit, you should drink them little, but every 5-10 minutes. This will help to avoid repeating attacks of vomiting. Continue treatment before the disappearance of all symptoms of dehydration.

Additional information on solutions:

Hospital treatment

Hospitalization with violations of water-salt metabolism is rarely produced. It is shown in strong dehydrations, signs of water deficit in young children or old people, serious pathologies and in other similar cases. Treatment in hospital conditions is carried out under the control of specialists. It consists in specialized therapy of the underlying disease, as well as in the reception of saline solutions and drugs containing minerals. In addition, the diet of the patient and its drinking mode is required. In particularly severe cases, drip infusion in the vein isotonic solution is prescribed.

Regulation by folk remedies

Use folk remedies for regulating the water-salt balance should be very careful. It is advisable to conduct such treatment only under the control of the doctor. The bulk of folk recipes is aimed at preventing the dehydration of the body, as well as the fight against it.

At home, you can prepare a saline solution, similar to the action with pharmaceutical means. To do this, you need to dissolve in clean water on one large spoon of sugar and salt.

Dehydration, most often, becomes the result of diarrhea and vomiting. To get rid of them, it is also possible to use folk remedies, such as tightly boiled tea, a solution of potato starch, infusion of pomegranate crusts, rice decoction and others.

When restoring and maintaining the water-salt metabolism, the doctor, except for the purpose of drugs, and in easy cases instead, gives recommendations for nutrition.

A mandatory factor is the daily counting of the amount of salt in food, it must be no more than 7 grams. The exceptions are patients who are spelled out full or partial refusal from it. Especially a lot of salt contains in store semi-finished products and fast food dishes, they can be present in them. It is recommended to replace the usual salt onto marine or iodized, as they are more minerals.

It is worth paying attention to the amount of water consumed during the day. Normal is considered 1.5-2.5 liters per day. At the same time, it is desirable to drink more in the first half of the day, otherwise the appearance of edema.

Narcosis Somubrevin, sodium oxybutirate.

The most prominent representatives of domestic surgery, the largest surgical schools.

Venous insufficiency. Varicose and trophic ulcers.

Somubrevin - the drug is a narcotic agent that does not contain barbiturates. It is introduced in / in slowly, the action manifests itself 20-40 seconds after administration and lasts 3-4 minutes. Consciousness of patients after anesthesia quickly enlightened: the reaction, concentration and critical ability are restored after 20-30 minutes. Indications: short-term operations in surgery, traumatology, obstetrics, otolaryngology. Doses for adults - 5-10 mg / kg of weight; Elderly and weakened - 3-4 mg / kg of weight. Complications: Sometimes hyperventilation is sometimes observed at the beginning of anesthesia, and then depression of breathing, tachycardia and the drop of blood pressure (small). Symptoms are independently disappearing for 1 minute.

Oxybutirate sodium. It is characterized by extremely low toxicity, the ability to potentiate the effect of other anesthetics,

№80. Anaerobic infection (pathogens, clinic, treatment, prevention).

Anaerobic infection RAS is caused by microbes from the genus Clostridium: Ci. Perfringens, Ci. Septicum, Ci. Oedematiens, Ci. Histolyticum. The causative agents of anaerobic infection are characterized by the following features.
Ci. Perfringens. - The most frequent pathogen of gas infection in humans. The microbe is very common in nature. It is in large quantities in the intestines of man, animals and in the ground. The microbe is immobile, forms disputes and toxin, consisting of hemolysin, miotoxin and necromethin. The impact of this toxin on live tissues leads to the formation of bloody exudate and gas, swelling and tissue necrosis, especially muscles. The muscles under the influence of toxin become pale, "colors of boiled meat", contain many gas bubbles. Large doses of toxin lead to death.
Ci. Oedematiens. - Mobile sporing microbe containing hemolysin and exotoxin. The toxins of this microbe are characterized by high activity and the ability to quickly form swelling of subcutaneous, intermushkin tissue and muscles. Toxin also has a constant and specific hemolytic effect. Disputes for boiling die only after 60 minutes (E. V. Glotova, 1935).
Ci. septicum - A movable sporing microbe, an open with a Pasteur in 1861. Its toxin is hemolyutic, causes a rapidly propagating blood-seated-serous edema, serous-hemorrhagic impregnation of subcutaneous tissue, muscle tissue, in more rare cases - muscle death. Toxin, falling into the blood, leads to a rapid drop in blood pressure, paralysis of blood vessels and the damage to the heart muscle. The microbe is in the soil, the intestines of man and animals. Disputes withstand boiling from 8 to 20 minutes.
Ci. Histolyticum. - Sporied, movable microbe. Opened in 1916. The toxin of this microbe contains a propalytic enzyme fibroleasing, under the action of which comes the rapid melting of muscles, subcutaneous tissue, connective tissue and leather. The molten tissues are converted into an amorphous mass resembling crimson jelly. Gas formation is absent.
The toxins of the causative agents of the gas infection are complexes of various enzymes of protein origin (letizinase, hyaluronidase, deoxyribonucleosis, hemolyns, etc.). These enzymes, as well as product cleavage products with them, sucking in blood, have a generalization effect on the body as a whole and contribute to the distribution (development) of microbes.
The main sources of pollution of Ran anaerobic pathogens are the Earth and the clothes polluted. In crops from fresh wounds Ci. Perfringens occurs in 60-80%; Ci. Oedematiens - at 37-64%;
Ci. septicum - at 10-20%; Ci. Histolyticum - in 1-9% (A. V. Smoliannikov, 1960). Along with the listed microbes in a fresh firearm, other types of anaerobic and aerobic microorganisms are found (Ci. Sperogenes, Ci. Terticum, Ci. Oerofoctidus, anaerobic and aerobic streptococci, staphylococcus, intestinal wand, protest, etc.). The aerobic microorganisms developing in the wound, especially streptococci and staphylococci, can be anaerobov activators "group of four", reinforcing their reproduction, pathogenicity, hemolytic and necrotic properties. Consequently, the flora of gas infection is usually polyimicrobna. However, the leading importance in this disease belongs to anaerobic microbes.
Despite the greater frequency of pollution of gunshot wounds anaerobic microorganisms, an anaerobic infection in them develops relatively rarely (0.5-2%), with a combination of certain local and general factors. Local factors include primarily extensive tissue damage, which is most often observed in fragmentation wounds, especially with damage to the bones.
The experience of the Great Patriotic War confirmed that for firearm fractures, followed by significant damage to the soft tissues, an anaerobic infection occurs 3.5 times more often than when limb injuries without damage to the bone. The view of the injury also affects the frequency of the anaerobic infection: with fragmentation wounds of complications, the anaerobic infection was observed in 1.5 times more often than at bulletin, and at blind injuries - twice as more often than with end-to-end (O. P. Levin, 1951) .
In the emergence of anaerobic infection, the localization of injuries plays a latter role.
In most cases (75%), the anaerobic process developed with the injuries of the lower limb, it is explained, apparently, the presence of large muscular arrays enclosed in dense aponeurotic cases. The traumatic edema developing after injury leads to the squeezing of muscles and feed their blood vessels in the aponeurotic cases and the development of muscle tissue ischemia, which, as is known, favors the development of anaerobic infection. Perhaps playing a certain role and the fact that the lower limbs are easier to pollute.
The factors predisposing to the development of anaerobic infection are: local circulatory disorders due to damage to the main vessels, the use of harness, tight wound tamponade, grinding tissue, shock and blood loss, etc.
A certain effect on the incidence of anaerobic infection is provided by meteorological conditions and seasonality. It has been reliably established that the frequency of the anaerobic complications of the Russian Academy of Sciences is increasing during rainy weather, more often in spring and autumn, as well as with significant soil contamination with manure and feces on the part of the fighting.
These facts can be explained by the fact that in the spring and autumn combat operations are often conducted on the soaked soil and there are massive pollution of clothing and wound grounds.
Promotes the development of anaerobic infection. The overall weakening of the body caused by fatigue, cooling, malnutrition.
Anaerobic infection is studied with a late takeaway of victims from the battlefield (from the hearth), with unsatisfactory and late medical care and first medical care, with evacuation of the wounded roads and in non-adapted evacuation vehicles. During evacuation with fractures of limbs, the quality of transport immobilization is of paramount importance.
However, the main role in the development of anaerobic infection is played by the late and technically imperfect primary surgical processing of the wound or the refusal of this operation in the presence of indications.
The danger of the occurrence of anaerobic infection increases, if after the primary surgical treatment of the wound is heated tightly.

Anaerobic infection clinic

The most dangerous period for the development of anaerobic infection is 6 days after injury. It is during this period that favorable conditions are most often created in the wound for the development and life of pathogenic anaerobes. In classical cases, the incubation period with this complication is short - about 24 hours, therefore it is necessary to recognize this complication. Belaced diagnosis, as a rule, leads to an adverse outcome, due to the features of the flow of anaerobic infection: its clinical manifestations Develop a rapid, increasing rates, which is not observed with other types of wound infection.
Sometimes the course of anaerobic infection takes a lightning nature. Fabric necrosis, swelling develops in front. Proteolisis muscles and erythrocytes leads to the formation of gases - hydrogen, hydrogen sulfide, ammonia, coalic acid, in subcutaneous tissue, the hemorrhagic nature of the exudate, hemolytic spots on the skin, etc. intoxication of the body. Its main features: Early manifestation, rapid progression and increasing severity.
Anaerobic infection is characterized by diversity and dynamic of clinical manifestations. At the increase in pathological processes, the symptomology of anaerobic infection is also changing, but from a practical point of view, the earliest symptoms are most important.
1. Acute, unbearable, unnecessary pain involved pain. After injury, the pain has a certain dynamics. The initial pain associated with the injury.
The period of rest (the period of incubation of anaerobic flora). With the development of anaerobic infection, pain is sharply enhanced and quickly taken by an unbearable character. With the formation of a large array of the necrosis of soft tissues and the gain of intoxication, the pain decreases again or disappears. In a state of severe toxicoinfection, wounded at all do not complain (late stage).
2. Burly progressive edema of limb tissue. He raises complaints about the feeling of completeness or cutting limb. To determine the rate of increasing edema, A. V. Melnikov (1938) proposed to impose a ligature around the limb to 8-10 cm above the wound ("symptom of ligature"). The symptom is considered positive if the ligature, tightly superimposed the wounds, starts to crash. According to A. V. Melnikova (1945), if the ligature is 2-3 hours after overlaying it cuts into a depth of 1-2 mm, amputation is necessary.
When two specified symptoms appear, immediately remove the bandage from the wound and carefully examine it and the entire damaged limb.
3. Changes in the wound. Dryness, a small amount of wound separated - bleeding ("lacquer blood"). Muscles have a gray color, remind of type boiled meat. As a result of developing edema and impregnation of tissue with gas, muscle tissue rolls out of the wound hole, muscle fibers are not reduced and not bleed, it is easy to rush. With late diagnosis of anaerobic infection, dead muscles are dark gray. Often, characteristic bubbles filled with or bleeding, or transparent, or muddy liquid are formed on the skin of the affected segment. The skin acquires the "bronze", "saffron", brown or blue color. This is due to the red blood cell diapection, which is rapidly destroyed by the enzymes allocated by microorganisms; Hemoglobin disintegrates with the formation of a dirty-brown pigment, which gives tissues a specific color.
Often, wounds with a developed anaerobic infection are published by an unpleasant, reel smell, resembling the smell of mice, "heavy hay" or "acid cabbage".
4. The gas in the soft tissues of the affected segment is a symptom of the development of anaerobic infection. Gas formation, as a rule, arises after the development of edema and testifies to tissue destruction as a result of the vital activity of anaerobic microbes, primarily Ci. Perfringens. The presence of gas is determined by percussion: a tympanic sound is detected in the gas propagation area. In subcutaneous tissue, the presence of gas can be established by palpation - according to the "dry snow" (symptom of bubbles of gas bubbles). When shaving hair on the skin surrounding the wound, there is a light crackle - a resonance over the impregnated gas plot ("Symptom of the razor"). Pinzeti branches of pinches gives a characteristic box.
The French surgeon lemet recommends that the circle of the wound is described with the diagnostic goal - the characteristic resonant sound is obtained.
5. No sensitivity and motor function in distal departments The limbs - the early and terrible symptom of the development of anaerobic infection. These violations appear even with externally small changes from the wound and limb and are very important: they help to identify anaerobic infection, when, at first glance, there are still no other symptoms. Therefore, the doctors of the receiving and sorting offices should always have a pin to determine the sensitivity of the distal limbs and fingers.
6. X-ray studies - auxiliary method of determining gas in tissues. During the propagation of gas on muscle tissue on a radiograph, "Curish clouds" or "Christmas trees" are noted, and if there is a gas in subcutaneous tissue, the image resembles "bee honeycombs", sometimes separate gas bubbles or gas bands are visible on the radiograph. Anaerobic infection toxins are affected by many organs and all wounded systems. This develops a number of general symptoms.
7. Temperature is most often within 38-38.9 °. 8. The pulse at the fourth part of the wounded does not exceed 100 blows per minute, almost 70% are 120 blows per minute (O. A. Levin, 1951). A formidable symptom is the divergence of the pulse and temperature, the so-called "scissors": the pulse rate is growing, and the temperature curve is lowered down.
9. Arterial pressure at an increase in anaerobic infection is progressively reduced.
10. Changes in the blood: High neutrophilic leukocytosis, shift of the formula to the left, lymphopenia, eosinopenia.
11. Scler characteristic due to the hemolysis of red blood cells.
12. The state of the gastrointestinal tract is a dry language, covered (in 36% wounded wet language). The wounded feel the feeling of the neatoly thirst and dryness in the mouth - it is possible to complicate the wound process anaerobic infection. The appearance of nausea and vomiting undoubtedly indicates a large intricensication of the body.
13. Facial expression. Anaerobic infection leads to a change in the appearance of the wounded. The skin of the face becomes pale, in the earthy tint, the features of the face are sharpened, the eyes are wade. There is a characteristic appearance and the expression of the face of the wounded - "Fades HipPocratica". fourteen. Nervous Various from light euphoria to sharp excitement, from the state of indifference, inhibition to severe depression. Often marked incorrect orientation and evaluation of your own sensations and conditions. However, consciousness is preserved up to the deadly outcome.

Depending on the features clinical flow The following forms of anaerobic infection are distinguished:
1) Lightning - a few hours after injury;
2) rapidly progressive - after 1-2 days after injury;
3) Slow progressive - with a large incubation period.
Depending on the nature of the pathological process, an anaerobic infection is divided into the following forms:
1) with a predominance of gas - gas form;
2) with the predominance of edema - malignant swelling;
3) Mixed forms.
Depending on the depth of the lesion of the tissues, it is distinguished:
1) Deep - subfascial
2) Surface - epiphascial forms.
It should be remembered that an anaerobic infection does not always proceed from the very beginning with an extremely serious general condition of the patient. Absolutization of such ideas may cause late diagnosis. Only attentive observation of the wounded will make it possible to recognize in a timely manner, on a general well-being background, perhaps the only symptom characteristic of anaerobic infection. For example, changing from the wound and surrounding skin - self-cleaning muscles, swelling, tissue voltage, pain in the course of large nerves and vessels, pale skin, the appearance of hemorrhagic stains, etc. In other cases it can be the appearance of pain in the wound, complaints squeezing the limb to the bandage, the appearance of anxiety or thirst, an increase in temperature.
Knowledge of an anaerobic infection clinic in all its manifestations, attentive inspection of each wounded is a guarantee of early detection of anaerobic infection.
Firearms with a large number of swiss and dead fabrics can be soil for the development of a rotten infection. Due to the fact that some manifestations of a putrefactive infection are similar to those observed in gas gangrene, you need to know the general and distinctive features of these two types of wound infection.
The causative agents of a putrefactory infection are V. Coli, V. Rosuanes, V. Putrificum, Streptococus Fecalis, V. Proteus vulgaris. V. Eraphysematicus, Escherichia coli and many other anaerobic and aerobic microorganisms. The vital activity of these microbes causes a rotten decay of dead and non-visual fabrics. This is accompanied by the processes of rotary fermentation, the release of hemorrhagic exudate and a large number of silent gas. The absorption of protein decay products causes intoxication, fever, octvinations, and the presence of gas in the tissues suggests an anaerobic infection. Differential diagnosis with anaerobic infection: at a rotary infection general state The wounded does not suffer as if anaerobic infection. In particular, despite the high temperature, leukocytosis and changes from leukocyte formula Blood, the general view of the wounded leaves a favorable impression: the face is not loose, skin covers do not differ in paleness, the look is alive and calm. The pulse is although more participating, but satisfactory filling and tension, and, most importantly, corresponds to the temperature reaction. The language of the wounded wet may be slightly covered. Feelings of thirst, nausea and vomiting there. In other words, sharply pronounced intoxication is not inherent in an isolated, clean form of a grinding infection.
Local changes in the wound, as well as from the limb as a whole, with a rotary infection, have their own characteristics. For wounds, a sharp, bad, illuminated smell is characteristic of the presence of a rotten decay. In the wound detected a brownish color of the fetid pus. The edges of the wound edema, hyperemic, painful. In the wound there are always areas of dead fabrics, the fiber is saturated with serous-purulent exudate with gas bubbles (symptom of attitudes) and at the same time, healthy, well-supplied muscles, well-supplied muscles are always preserved. The edema of the limb is although it is expressed, but growing slowly, not malignant. There is no sensitivity disorders in the distal limbs.

Prevention of anaerobic infection

Timely and sufficient operation is provided by an acceleration effect, and the further course of the wound process becomes a favorable nature.
The prevention of the wound infection is consigned from the set of events. In the military area, it begins with simple, but exceptionally important first-medical care activities on the battlefield, which include timely wanted list of injuries, the imposition on the wound aseptic dressing, the rapid and correct imposition of the harness in order to stop bleeding, transport immobilization of limbs during fractures, introducing an anesthetic From the syringe tube, the cottage of the tablet antibiotics, the careful removal and gentle evacuation of the wounded.
At the subsequent stages of medical evacuation, preventive measures are expanded, complemented (including the parenteral administration of antibiotics) and ends with primary surgical treatment of the wound, which is the main means of preventing anaerobic infection.
Application with the prophylactic target of antichangrenous serums (passive immunization) in the Great Patriotic War did not justify hopes. Any convincing data indicating its effectiveness, and currently not. Therefore, antichangrenous serum as a prophylactic means of anaerobic infection is now not applicable.

Treatment of anaerobic infection

Treatment of wounded with anaerobic infection is carried out in OMEDB (OMO), in VPHG and in SVPHG for wounded in the thigh and large joints. It is composed of a complex of events, the basis of this complex is an emergency operational intervention. Considering the contagiousness of anaerobic infection, the wounded G of this disease must be isolated and focused in the tent or separated for this mel.
In Omhedb (OMO), the anaerobic is usually deployed in the tent of the cabin-56. Anaerobic provides not only accommodation and inpatient treatment of wounded, but also carrying out operational interventions: wide cuts, amputations, excuting limbs. In this regard, the tent with the help of a curtain from the sheets is divided into two halves, one of which is a dressing (operating room), and the second is the hospital for three or four beds. Equipment and equipment of this tent should provide the necessary assistance to this wounded: operating table, table for sterile tools, instrumental tables, table for sterile solutions, dressings and medicines, stand for pelvis, enameled and galvanized basin, care, washbasin, stand for Stretch, bottle holder. On the table for medicines, in addition to conventional agents, in sufficient quantities there must be solutions of potassium hypermanganate, hydrogen peroxide, hypertopic sodium chloride solution, polyvalent serum. The toolkit is selected so that we can produce wide cuts and excision, blending, amputation and exercice.
In military field surgical hospitals, special anaerobic compartments are created for injured in limbs: chambers for placing patients with anaerobic infection and surgery with all necessary equipment, tools and materials. The service personnel and doctors are obliged to strictly observe anti-epidemic regime and personal hygiene rules (careful washing of hands, change of bathrobes after each dressing or operation). Operational interventions and dressings are carried out necessarily in surgical gloves. Polluted underwear, blankets and bathrobes are soaked in a 2% solution of soda and boil for an hour in the same solution, and then erased. Used dressing material, drainage, wooden tires are burned, metal tires are burned on fire. Surgical gloves used during operations and dressings are subjected to mechanical cleaning (washing in warm water with soap), and then sterilize in the autoclave. Tools used in operations and dressings, after mechanical cleaning are sterilized for an hour in 2% solution of soda. Dressing table, padlines, stands, etc. are treated with solutions (2-3%) carbolic acid, 1-3% solution of lizola, etc.
Operational intervention in anaerobic infection is made in an emergency at the very first signs of the anaerobic process. It should take the minimum time and be as radical.
Depending on the localization, the nature and distribution of anaerobic infection, operations of 3 types are used:
1) wide "lamps" cuts on the damaged segment of the limb;
2) cuts combined with excision of affected fabrics;
3) amputation (examination).
The wounded in front of surgery needs in short (30-40 min) preoperative preparation: the use of heartfers, blood transfusion, polyglyukin, intravenous glucose administrations. Drip blood transfuses or polyglyukine should be produced during the operation. These events increase the vascular tone and prevent operational shock to which the wounded with anaerobic infection. Preoperative preparation - paranefral or wagosympootic blockade (on the side of the lesion) and intravenous administration of sodium salt, penicillin - 1,000,000 units and ristomycin - 1,000,000 units (A.V. Vishnevsky and M. I. Schreiber, 1975).
With operational intervention about the anaerobic infection, the choice of anesthesia means is very important.
Gas anesthesia controlled nitrogen nitrogen with oxygen is less dangerous for anaerobic infection than other types of anesthesia, according to American surgeons, which have been treated with the victims of victims in Korea and Vietnam (Fisher, 1968).
General principles Operational methods of excision of tissues during anaerobic infection. The wound is disseminated wide and bred with hooks. Then, in the longitudinal direction, the Z-shaped section is revealed by aponeurotic cases, in which with a deep anaerobic process due to the accumulation of gas and the eduction fluid, as a rule, muscle tissue is squeezed. After that, necrotic muscles excised are widely excised within visually disabouted tissues throughout the edge channel - from the inlet to the outlet. Remove foreign bodies and freely lying bone fragments, open all the blind pockets and recesses going away from the wound canal. The wound should be widely gaping, lyady shape. Seam imposition is contraindicated. Wound leave wide open. Fabrics around the wound infiltrate antibiotics (penicillin, streptomycin). Irrigator tubes are inserted into the wound for the subsequent introduction of antibiotics and the loosely grinding gauze, moistened with a solution of potassium permanganate or a solution of hydrogen peroxide.
After the operation, the limb should be well immobilized by plaster tires or gypsum flares - to the subsistress of acute phenomena, after which the testimony may be imposed a deaf gypsum bandage.
Indications for amputation limbs for anaerobic infection:
lightning forms of anaerobic infection;
gangrene limbs;
extensive lesions by the pathological process of muscular arrays of the limb, in which there is no exhaustive operational intervention;
the far-closed anaerobic infection when the process extends to the hip (shoulder) on the torso;
extensive destruction of limbs complicated by anaerobic process;
the spread of the pathological process with the phenomena of severe toxemia and the rapid development of gas phlegmon;
intra-articular fractures of thighs or legs complicated by gas phlegmon or persistence;
gunshot injuries of hip or shoulder joints complicated by gas gangrey;
common forms of anaerobic infection, emanating from the multi-blocks, especially intra-articular firearms complicated by damage to the main vessels;
continued anaerobic process after the dissection of fabrics;
The course of anaerobic infection on the background of radial illness or other combined lesions.
The level of amputation during anaerobic infection is of great importance for outcomes: the clipping line should be higher than the focus of the infection - within the limits of healthy tissues. "It must be remembered that amputation through tissues affected by anaerobic infection, not only causes the shock phenomena, but always enhances the inxication phenomena from which the wounded and dies. Sometimes shock and intoxication are so significant that the wounded dies on the operating table or shortly after the operation. "(A. V. Melnikov, 1961).
Determining the level of amputation, proceed from the muscular fabric state: gray, flabby, non-durable and disgraining muscles are included in the zone, the clipping line is located above.
However, when localizing the focus of infection (wounds) in the upper third of the thigh or shoulder, the truncation of the limb is always made through tissues affected by the anaerobic process. In these cases, it is necessary to dissemble the culture of 2-3 longitudinal deep cuts and excised fabrics affected by an anaerobic infection.
Ammputation should be made without a harness, a circular or patchwork. Suts on the cult do not impose. Secondary seams for the closure of amputation crust are permissible only with the full stop of the anaerobic infection. The cult is covered with wet tampons moistened in a solution of furaciline (1: 5000) or hydrogen peroxide. Circled skin-fascial flap is placed on top of the tampons. The cult is immobilized by a gypsum U-shaped Longeta.
As well as surgical treatment Anaerobic infection, for neutralization (binding) of specific toxins incoming to the blood, it is necessary to use antitoxic anti-hyangenous serum. Therapeutic dose of serum 150 LLC ME. It can be administered intramuscularly and intravenously in the form of a polyvalent mixture of 50 ooo serum antipersion, antipethens and antiseptic.
The serum for intravenous administration is divorced in 5-10 times in the warm isotonic solution of the table salt and after pre-desensitization by challenge is poured by a drip method.
Simultaneously with intravenous administration, antitoxic serum is introduced intramuscularly to create a depot (V. N. Stolovkov, 1957; D. A. Arapov, 1972; A. N. Berkutov, 1972, etc.). With any method of serum administration, careful monitoring is needed. With a decrease in blood pressure, the appearance of anxiety, chills or the occurrence of rash, which indicates an anaphylactic shock, the administration of serum is stopped and used ephedrine, calcium chloride, a concentrated glucose solution, the transfusion of one -road blood.
IN postoperative period Patients with anaerobic infection It is necessary to introduce antibiotics.

So that our body function normally, the most complex complex of internal processes is involved. Maintaining in the norm of water-salt exchange refers to one of them. When he is in order, a person does not have health problems, but his violation leads to complex and noticeable deviations. So what is a water and salt balance? Violation, symptoms will also be considered.

general information

The water-salt balance is considered to be interacting with each other processes in the body of water and salts, their absorption and distribution in internal organs and fabrics, as well as ways of their elimination.

Everyone knows that a person more than half consists of water, the amount of which in the body may be different. It depends on many factors, such as fat mass and age. The newborn is 77% consists of water, in adult men, this indicator is 61%, and in women - 54%. Such a small amount of fluid in the female organism is explained by the presence of numerous fat cells. To the old age, such an indicator becomes even lower.

How is water distributed in the human body?

The distribution of the fluid is carried out in this way:

• 2/3 of the total number falls on intracellular fluid;
• 1/3 of the total number is represented by extracellular fluid.

IN human organism Water is in a free state, it is holding it with colloids or it is involved in the formation and decay of molecules of fats, proteins and carbohydrates.

Compared to the intercellular fluid and plasma of blood, the tissue fluid in the cells is characterized by a higher concentration of magnesium ions, potassium and phosphates and low content of chlorine ions, sodium, calcium and hydrocarbonate ions. This difference is explained by the fact that the capillary wall for proteins has low permeability. Normal in a healthy person contributes to the support of not only a constant composition, but also the volume of fluid.

Regulation of the water-salt balance by the kidneys and the urinary system

The kidneys are needed to maintain constant processes. They are responsible for the ion exchange, remove the amount of cations and anions from the body by reabsorption and sodium excretion, potassium and water. The role of the kidneys is extremely important, since, due to them, the required volume of the intercellular fluid and the optimal amount of substances dissolved in it are preserved.

On a day, a person must consume 2.5 liters of fluids. About 2 liters come through drink and food, and the rest of the volume is formed in the body due to metabolic processes. The kidneys are derived 1.5 liters, intestines - 100 ml, leather and light - 900 ml. Thus, it regulates the water-salt balance is not one body, but their totality.

The volume of the resulting kidney fluid depends on the needs and conditions of the body. The maximum amount of urine, which is able to derive this organ per day, is 15 liters of fluids, and with antidioresis it is 250 ml.

Such different indicators depend on the nature and intensity of the tubular reabsorption.

Why is the balance of water and salt in the body violates?

Violation of the water-salt balance occurs in the following cases:

• Cutting in the body of fluid in large quantities and slowing down its elimination. It occurs to accumulate in the intercellular space, its volume inside the cells increases, resulting in swelling the latter. If nerve cells are involved in the process, nervous centers are excited, contributing to the occurrence of convulsion.
• Also in the body can occur completely opposite processes. Due to excessive removal of fluid from the body, blood is begins to thicken, the risk of blood clots increases, the blood flow in organs and tissues is disturbed. If the lack of water is more than 20% - the person dies.

Violation of the water-salt balance of the body leads to weight loss, dry skin and cornea. In the case of a strong moisture deficit, the subcutaneous fatty tissue begins to resemble the dough on the consistency, the eye is blown, and the volume of circulating blood decreases. In addition, the features of the face become acute, cyanosis of nails and lips, kidney pituitary, decreases blood pressure, the pulse is rapidly and weakens, and due to the violation of protein metabolism, the concentration of nitrous bases increases. A person starts

In addition, the balance of the balance may occur due to equal loss of water and salts. Typically, this happens during acute poisoning when the liquid and electrolytes are lost during vomiting and diarrhea.

Why is the lack of and excess water in the body?

Most often, such a pathological process occurs due to the external loss of fluid and its redistribution in the body.

Reducing the level of calcium in the blood takes place:

• for diseases of the thyroid gland;
• when using radioactive iodine preparations;
• with pseudogopoparatyosis.

Sodium decreases as a result of long-term diseases in which urine is very bad; after operation; Due to self-medication and uncontrolled diuretic reception.

To reduce potassium, lead:

• its movement inside the cells;
• alkalosis;
• corticosteroid therapy;
• liver pathology;
• injection insulin;
• aldosteronism;
• alcoholism;
• operation on the small intestine;
• hypophunction of the thyroid gland.

Symptoms of Water Balance Disorders and Salt in the Body

If the water-salt balance in the body is broken, then symptoms such as vomiting, severe thirst, swelling, diarrhea occur. It begins to change the acid-alkaline balance, blood pressure decreases, arrhythmia appears. Such symptoms in no way should be ignored, since the progressive pathology can lead to a stop of the heart and death.

Calcium deficiency is dangerous to the emergence of a smooth muscles cramps, especially if the larynx spasm occurs. If this element in the body, on the contrary, is very much, a strong thirst appears, pain in the stomach, vomiting, stripped urination.

When potassium deficiency, alkalosis occurs, chronic renal failure, atony, intestinal obstruction, heart, brain pathology. With its increase, vomiting appears, nausea, ascending paralysis. This state is dangerous in that it very quickly arises for the fibrillation of cardiac ventricles, leading to the atrium stop.

Excess magnesium appears due to kidney dysfunction and antacid abuse. In this case, there is nausea, reaching vomiting, the body temperature rises, the heart rate slows down.

How to restore the water-salt balance in the body?

It is quite difficult to determine the presence of such pathology yourself, and in the event of suspicious symptoms, you should consult a doctor. It can offer the following treatment methods in order to ensure the restoration of the water-salt balance:

• drug;
• outpatient;
• chemical;
• diet.

Medical treatment method

This method is that the patient must take mineral or vitamin and mineral complexes containing calcium, sodium, silicia, magnesium, potassium, i.e. such elements that are responsible for the water-salt balance in the body.

These drugs include:

• "Duovit";
• "Vitrum";
• Biotech Vitabolik.

The course of treatment is a month, then take a break in a few weeks.

Chemical method of treatment

In this case, it is necessary to take a special solution. In any pharmacy, you can purchase special packages containing various salts. Such remedies used to be used in poisoning, cholera, dysentery, which are accompanied by diarrhea and vomiting, resulting in a rapid and such saline solution contributes to the water delay in the body.

Before using such a means, you must consult with your doctor, because it is contraindicated with:

• diabetes;
• renal failure;
• infections of the urogenital system;
• liver diseases.

How to restore the water-salt balance in this way? To do this, you need to drink a week. Take salt solution one hour after meals, and the next reception is carried out no earlier than 1.5 hours. During treatment, it is worth abandoning the use of salt.

Outpatient treatment method

It is very rare, but such a situation happens that the patient has to be hospitalized due to disruption of the water-salt balance. In this case, the patient takes saline solutions and special mineral drugs under the supervision of the doctor. In addition, the strict drink mode is recommended, and food is prepared for the needs of the patient. In extreme cases, the droppers are prescribed with

Diet

To bring the water-salt balance to normal, it is not necessary to take medicines for this. In this case, the patient is prescribed a special diet with the calculation of the amount of salt. It should be limited to 7 g per day.

• instead of a cook salt, it is better to use sea, because in it more content useful minerals;
• if it is not possible to use sea salt, you can add iodized cooking dishes;
• it is not necessary to salt "on the eye", but to use a spoon for this (5 g of salts are placed in the tea room, and in the dining room - 7 g).

In addition, it is necessary to consume water, depending on body weight. Per 1 kg of mass accounts for 30 g of water.

Output

Thus, the water-salt balance can be put on their own normal, but before that, it is still necessary to consult a doctor and pass all the necessary analyzes. It is not necessary to appoint various mineral and vitamin complexes or salt packages to itself, better adhere to a special diet and useful recommendations.

Description:

Hyponatremia is a decrease in sodium concentration in the blood to 135 mmol / l and below, with hyposmolaur and isosmolar hyphydration means true Na deficiency in the body. In the case of hyposmolar hyperifying, it may not mean a general sodium deficiency, although in this case it is often observed. (Calcium content in the blood is higher than 2.63 mmol / l).
- Reducing the concentration of potassium in the blood below 3.5 mmol / l.
- an increase in potassium concentration above 5.5 mmol / l.
- Reduced magnesium levels below 0.5 mmol / l.

Symptoms:

In the clinical picture - an increase in neuromuscane excitability, spastic manifestations of the gastrointestinal tract, coronary vessels.

In acute calcium poisoning (hypercalcemia), it may develop, which is manifested by acute pain in the epigastria, thirst, nausea, indomitable vomiting, polyuria leading to and then to oliganuria, hyperthermia, acute circulatory disorders, up to its stop.

The main manifestations of hypokalemia: muscle weakness that can cause hypoventilation, the development of CPN, a decrease in carbohydrate tolerance, dynamic, violation of the heart rhythm (fibrillation possible). The SEC interval decreases to the ECG, the RT is lengthened, the T. T. with a decrease in Caliamia to 1.5 mmol / l develops an atrioventricular blockade, an enlarged amplitude of the Tusque U without elongation Qt. Increases sensitivity to cardiac glycosides.

Major clinical manifestations of hypercalemia: symptoms of neuromuscular lesions (weakness, ascending, quadriplegia,), intestinal obstruction.

The danger of hypercalemia is determined by the violation of the function of myocardium. With hypercalemia, 5-7 mmol / l accelerates the conduct of pulses in the myocardium, at 8 mmol / l there are livelihoods. At the ECG, it first observed a high pointed teeth of T, then the elongation of the PQ interval, the disappearance of the prong P and the stop of the atrium. It is possible to broaden the QRS complex, the occurrence of ventricular with the development of ventricular fibrillation.
(Over 0.75-1 mmol / l) and hypermagging are observed with reducing the release of its kidneys, excessive administration, using antacids, especially on the background of CPN.

Clinical manifestations: for magnesium 1.25-2.5 mmol / l there are nausea, vomiting, feeling of heat and thirst. When the concentration is exceeded to 3.5 mmol / l, drowsiness, hypoxy appear, the pulses in myocardium is disturbed. Upon exceeding the magnesium content above 6 mmol / l - coma, stop breathing ,.

Causes of occurrence:

The main causes of violations of the water and electrolyte balance are the external losses of fluids and the pathological redistribution between the main liquid media.
The main causes of hypocalcemia are:
- injury of parachitoid glasses;
- therapy with radioactive iodine;
- removal of parachitoid glands;
- .

The most common cause of hypercalcemia is primary or secondary.

The main reasons of hyponatremia include:
- severe exhausting diseases accompanied by a decrease in diuresis;
- post-traumatic and postoperative states;
- Extras of sodium loss;
- excessive flow of water into the antidiuretic phase of post-traumatic or postoperative state;
- uncontrolled application of diuretics.

The causes of hypokalemia are:
- the displacement of potassium into the cells;
- exceeding the losses of potassium over its intake is accompanied by hypokaliagistry;
- the combination of the above factors;
- alkalosis (respiratory, metabolic);
- aldosteronism;
- periodic hypokalemic paralysis;
- Application of corticosteroids.

The main causes of hypercalemia are:
- the output of potassium from the cell due to its damage;
- delay in potassium in the body, most often due to the redundant arrival of the caaton in the patient's body.

The causes of the hypomagnemiology may be: