#1
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ïîëèóðèÿ ïðè Î×ÌÒ
Óâàæàåìûå êîëëåãè, ïðîÿâëÿþ íåäîïîíèìàíèå, íåñïîñáåí ðàçðåøèòü ñîáñòâåííûìè ñèëàìè- ó áîëüíîãî îòêðûòàÿ ×ÌÒ, 9 ñóòêè, íàðàñòàåò ïîëëèóðèÿ-ïåðâîíà÷àëüíî ñ íîðìàëüíûìè ïîêàçàòåëÿìè íàòðèÿ è êàëèÿ,íîðìàëüíîé îñìîëÿðíîñòüþ, íà 11-12 äåíü ñíèæàåòñÿ óðîâåíü íàòðèÿ äî êðèòè÷åñêèõ öèôð, ïëîòíîñòü ìî÷è 1010-1015, ãëèêåìèÿ 6,5-4,5, ââåäåíèå 4,5% ðàñòâîðà íàòðèÿ õëîðèäà íå ïðèâîäèò ê ïîâûøåíèþ óðîâíÿ â ñûâîðîòêå è îñìîëÿðíîñòè, ñîõðàíÿåòñÿ íîðìàëüíàÿ ïëîòíîñòü ìî÷è.Êîëëåãèàëüíî ðåøåíî ââåñòè ýêçîãåííî ìèíåðàëîêîðòèêîîîèäû-ñ íåáîëüøèì ïîëîæèòåëüíûì ýôôåêòîì. Ïðîøó ïîìî÷ü â ðàçúÿñíåíèè ñèòóàöèè, îòïðàâèòü ê ïåðâîèñòî÷íèêàì.
Ñ óâàæåíèåì Êóäðÿâöåâ Àíòîí. |
#2
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Äàííûõ íåäîñòàòî÷íî. Åñëè åñòü âîçìîæíîñòü, óêàæèòå îñìîëÿðíîñòü ïëàçìû è ìî÷è, íàòðèé â ïëàçìå è ìî÷å, êîëè÷åñòâî ìî÷è â ñóòêè è ÖÂÄ. Âîçìîæíî, ÷òî ó Âàøåãî ïàöèåíòà cerebral salt wasting syndrome (CSWS), îäíàêî íåëüçÿ òàêæå èñêëþ÷èòü è SIADH (ñèíäðîì íåàäåêâàòíîé ñåêðåöèè ÀÄÃ). Íåïëîõîé îáçîð â òåìó çäåñü. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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#3
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Ïîëèóðèÿ - ïàòîãíîìîíè÷íûé ïðèçíàê ãóáîêîé êîìû ñâÿçàííîé ñ âûñîêèì Â×Ä è ñìåðòè ìîçãà. Ñâÿçàíà ñ ïîðàæåíèåì ãèïîòàëàìî-ãèïîôèçàðíîé ñèñòåìû.
Êàêîé ñ÷¸ò ïî ØÊÃ? |
#4
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Öèòàòà:
D/Diagnosis of Hypotonic Hyponatremia • Hypovolemic TBW- TBNa-- » Urine Sodium: >20 mmol/L » Diagnosis: Renal Losses: Diuretic Therapy Osmotic Diuresis Salt-Wasting Nephropathy Adrenal Insufficiency (Mineralocorticoid def) Proximal Renal Tubular Acidosis Metabolic Alkalosis Pseudohypoaldosteronism Cerebral Salt-Wasting • Hypovolemic TBW- TBNa-- » Urine Sodium: <20 mmol/L » Diagnosis: Extrarenal Losses: Gastrointestinal Sweat Third Space (Burns, Ascites, Effusions) • Euvolemic TBW+ TBNa+- » Urine Sodium: >20 mmol/L » Diagnosis: Excess ADH (SIADH*, Drugs, Pain) Water Intoxication (IV Therapy, Psychogenic Water Drinking, Tap Water Enema) Reset Osmostat Glucocorticoid Deficiency Hypothyroidism • Hypervolemic TBW++ TBNa+ » Urine Sodium: <20 mmol/L » Diagnosis: Edematous Congestive Heart Failure Cirrhosis Nephrotic Syndrome • Hypervolemic TBW++ TBNa+ » Urine Sodium: >20 mmol/L » Diagnosis: Renal Failure (Acute or Chronic) TBW= Total body water; TBNa= Total body sodium |
#5
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Áîëüøîå ñïàñèáî, ÷òî óäåëèëè ìíå âðåìÿ. Îñìîëÿðíîñòü ïëàçìû ñîõðàíÿëàñü íèçêîé, ïàðàëëåëüíî óðîâíþ íàòðèÿ- ìåíåå 240 ìîñìîëü\ë, ïðè íàòðèè ïëàçìû 118-120 ìêìîëü\ë, ïîñëå íà÷àëà ââåäåíèÿ ìèíåðàëîêîðòèêîèèäîâ â òå÷åíèè 3-4 äíåé ïðèøëî â íîðìó, áåç óñèëèé. ÖÂÄ íà ïåðèîä ïîëëèóðèè -îòðèöàòåëîíîå-1-2 ñì Í2Î, ìî÷è áîîëåå 5-6 ëèòðîâ â ñóòêè.Ïîâòîðþñü-íà ìèíåðàëîêîðòèêîèäàõ -ïðèøëî ê óäîâëåòâîðèòåëüíûì âåëè÷èíàì. Îãðîìíîå ñïàñèáî çà âííèìàíèå è ññûëêó.
Ñ óâàæåíèåì Êóäðÿâöåâ Àíòîí. |
#6
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Îãðîìíîå ñïàñèáî çà âíèìàíèå è ïîíèìàíèå. Ïîñòóïàë íà 9 áàëëîâ. Íà ìîìåíò ðàçâèòèÿ ïîëèóðèè 11-12 áàëëîâ. Ïîñëå íîðìàëèçàöèè âîäíî-ýëåêòðîëèòíîãî áàëàíñà-ïðåæäå âñåãî óðîâíÿ íàòðèÿ â ïëàçìå (÷åòâåðòûå ñóòêè ïðèìåíåíèÿ ìèíåðàëîêîðòèêîèäîâ) óìåðåííîå îãëóøåíèå íà13-14 áàëëîâ, ñ âûðàæåíííîé ðå÷åâîé ïðîäóêöèåé, äèñëàëèåé è êîïðîëàëèåé.
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#7
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Öèòàòà:
Åùå îäèí îáçîð, áîëåå ïîäðîáíûé. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#8
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Öèòàòà:
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#9
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Èíòåðåñíî... Ñïàñèáî çà èíôó. Ó íàñ äîñòóïåí ïîëüñêèé ôëóäðîêîðòèçîí (êîðòèíåôô) ïî 0.1 ìã â òàáëåòêå.
Åñëè ìèíåðàëîêîðòèêîèäû ýôôåêòèâíû, òî ìîæåò è ãëþêîêîðòèêîèäû òîæå? Âî âñÿêîì ñëó÷àå ïî ãîðÿ÷èì ñëåäàì: Moro N, Katayama Y, Kojima J, Mori T, Kawamata T. Prophylactic management of excessive natriuresis with hydrocortisone for efficient hypervolemic therapy after subarachnoid hemorrhage. Stroke. 2003 Dec;34(12):2807-11. BACKGROUND AND PURPOSE: Hyponatremia caused by excessive natriuresis is common in patients with aneurysmal subarachnoid hemorrhage (SAH). Natriuresis decreases the total blood volume through osmotic diuresis and increases the risk of symptomatic cerebral vasospasm. In such patients, hypervolemic therapy is difficult to achieve without causing hyponatremia because sodium replacement provokes further natriuresis and osmotic diuresis. We examined the effects of hydrocortisone, which promotes sodium retention, in patients with SAH. METHODS: Twenty-eight SAH patients were randomized into 2 groups after direct surgery: group 1 patients without hydrocortisone treatment (n=14) and group 2 patients with hydrocortisone treatment (1200 mg/d for 10 days; n=14). Both groups underwent hypervolemic therapy by aggressive sodium and water replacement. The goal of the hypervolemic therapy was to maintain the serum sodium level >140 mEq/L and the central venous pressure (CVP) within 8 to 12 cm H2O. RESULTS: Group 2 demonstrated a lower sodium excretion (P<0.05) and higher serum sodium level (P<0.05) compared with group 1. Hyponatremia developed in 6 patients (43%) in group 1 and 0 patients in group 2 (P<0.05). Group 2 also demonstrated a lower urine volume, lower infusion volume (P<0.05) required for hypervolemic therapy, and higher CVP (P<0.05). Failure to maintain CVP was observed in 12 patients (86%) in group 1 and 3 patients (21%) in group 2 (P<0.05). Hydrocortisone caused no serious side effects. CONCLUSIONS: Hydrocortisone clearly attenuates excessive natriuresis. Prophylactic hydrocortisone administration appears to have a therapeutic value in inducing hypervolemia efficiently after SAH. |
#10
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Î÷åíü áëàãîäàðåí çà ïîìîùü è ïîäðîáíûå ññûëêè. Ïîëëèóðèÿ ïðîäîëæàëàñü â òå÷åíèè 10 äíåé, ïðè ýòîì íà ôîíå èíôóçèîííîé òåðàïèè îáùåìîçãîâàÿ ñèìïòîìàòèêà ðåãðåññèðîâàëà.Òîæå ïðèìåíÿëè êîðòèíåô.
Ñ óâàæåíèåì Êóäðÿâöåâ Àíòîí. |
#11
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Öèòàòà:
Ñ óâàæåíèåì Êóäðÿâöåâ Àíòîí |