Drink 10L of water a day, pee after drinking, and increase the blood sodium to 175mmol/L within 3 hours.

!---- remember siline elevator has an ad phrase: "Up and down feeling.""It's not about the Mitsubishi Elevator, it's about a case of sodium in the blood of a urinary crash patient, like a roller coaster ridean 18-year-old boy who was transferred from abroad for medical treatmenthear the child's mother say that the child has been "loving to drink water" since she was five years old, drinking 5-10 L of water a daydrink on urine, to say less a day also have to pee a dozen or twenty times, one can pee a saltwater bottlethe last three years, the child walking gradually unstable, has been to many large hospitals to see, also did not see a so comeDrWang, whothe neurology department, is a hospital-level figure, and not the kind of nerd who can only read bookswhile listening to the child's mother's rambling, DrWang carefully examined the patient, trying to find some cluespatient's cranial MRI suggests that the two-sided cerebellum is white-haired, and the cerebellum is managed to balance movement, which may be associated with the patient's movement disorders for nearly three yearspatients with slow development, 18 years old, like 134 junior high school students, but no intelligence problemssome scoliosis in the spinebarely find a complete tooth in its mouth, and the loose remaining teeth are like suspended on gumsspecialist body found a typical common disorder gait, the double ball vertical, horizontal two directions have a large tremor, tendon reflection, two-sided pathological positiveheard the child's mother say that the child's right eye protruded somewhat before the age of ten, but then it became less obviousDrWang quickly extracted several key words: urinary collapse, diffuse microcephaly, one side of the convex eye, suspended teethdiagnosis is not clear for a while, DrWang instructed junior doctors to do routine examination and treatment, the patient's information sent to the professional Internet to search for similar caseswas quickly diagnosed: Han Xueke syndrome! This is a relatively rare childhood Langehans tissue cell hyperplasia, typically characterized by one-sided convex eye, urinary collapse, and osteopathythe suspended teeth of the patient are caused by bone-soluble lesions in the jaw bonepatients' urinary collapse is caused by damage to the droolingl, which secretes antiddd diuretic hormones (AHD)then for urinary collapse, the pituitary later foliatin and double gram were addedsurprise, the morning after the addition of pituitary folly, the patient suddenly had a persistent seizure with breathing difficultiesemergency treatment of anti-epileptic drugs such as diazepam, phenybarbitol, lidocain, etcwas ineffective, and DrWang referred the patient to the ICUwell, after tracheostomy and mechanical ventilation patients breathing improved, and under the action of the sedative propofol, epilepsy also quickly easedAfterbreathed a sigh of relief, the electrolyte results of the emergency check came back: sodium 120 mmol/L, chlorine 77 mmol/L, potassium 1.9 mmol/L, calcium 1.98 mmol/L, potassium sodium chlorcalcium all green! Table 1Blood sodium blood chlorine change graph note: 25 plus pituitary after leaf, 26 pm deactivation, 28th afternoon again added, 29th deactivation table 2 Blood potassium calcium change curve can be in two days ago the patient's electrolyte is still in the normal level! The most deadly thing is that the potassium of blood reaches the level that can cause the heart to stall at any time The atmosphere that had just eased was immediately tense again taking into account the main role of pituitin is to promote the reabsorption of water by the renal tube, re-absorption of a large amount of water due to dilution to further aggravate hyponatremia, ICU discontinued the pituitary pre-leaf, and strictly restrict water intake given that the blood sodium level is not particularly low, and in order to avoid too fast correction of low sodium brought about by the central nerve demyelin, so there is no addition of high sodium, but the regular supplement of physiological saline, but focus on the treatment of severe hypokalemia patients with urinary collapse, so don't worry about the amount of urine so the gastric tube, central venous catheter waiting, oral, static droplets, micro-pump together, the effect is indeed also forced a day later, the potassium was restored to 3.3 mmol/L and the sodium blood to 132 mmol/L the next morning to review the electrolyte again, let us silly is that the blood sodium like a roller coaster ride, from a low point, suddenly rushed to the peak: sodium 160 mmol/L, chlorine 122 mmol/L !!! Immediately deactivate all sodium-containing liquids and fill the gastric tube with fresh water, which is still no use three hours later, it was a hundred feet further, sodium 175 mmol/L, chlorine 133 mmol/L!!! It felt like a sudden rush from the North Pole to Hainan Island dizzy, finally think of starting from scratch to the patient: the patient urinary collapse is due to the lack of ADH, resulting in a large number of low seepage "fresh water" from the urine loss, and sodium has not been eliminated, so that the body becomes a "salt pool", sodium will be higher and higher to solve this problem, patients will stop drinking water to dilute the body's higher and higher sodium salts patients do not turn themselves into saltfish when adequate fresh water supplies are guaranteed the role of foliatin, a special drug for the treatment of urinary collapse, is to supplement ADH, which is like closing the floodgates of a reservoir problem is to supplement the pituitary after leaf, but not to control the patient's mouth, the patient or inertia under the action of a large amount of drinking water it's like closing the floodgates, but failing to stop the huge amount of fresh water coming upstream the consequences of open source throttle is that a large amount of low-permeable water accumulates in the body, leading to dilution of hyponatremia, also known as acute water poisoning water poisoning further induces seizures, which are caused by hyposodium hyperemia and the discontinuation of precipitate fothutomy, while limiting drinking water intake actually caused the blood sodium to climb from the bottom of the valley to the top of the mountain in two days pain, the only option is to return then re-applyed a piece of pituitary endothefoinafter after the sodium climbed to sodium 175 mmol/L 5 hours later, the blood sodium finally began to slide from the peak, 159 mmol/L! After 1 day, the sodium blood dropped to near-normal 146 mmol/L, the blood potassium also returned to normal, the patient successfully unplugged offline, transferred out of the ICU in view of the difficulty of controlling the patient's drinking water, in order to avoid another roller coaster, we stopped the pituitary after leaf, all turned around and helplessback back to the original point: urine collapse on the urinary collapse bar, buy a few more buckets of water than live ICU stronger .. After this case of patients in a short period of time electrolyte, especially blood sodium chloride roller coaster changes in the key to urinary collapse special pathological characteristics it is difficult the average patient to see such drastic changes in a short period of time introduced the case to everyone in order to avoid the mistake from happening again every patient is our teacher, that's always true Baiding Source: The End of the !-- Content Presentation in the Medical Community -- !-- Determine whether the login ends.