Batcheller J
AACN Clin Issues Crit Care Nurs. 1992 May;3(2):370-8. doi: 10.4037/15597768-1992-2009.
Depending upon the age and sex of a human, water constitutes 55% to 80% of the body's weight and provides a milieu vital for survival. Water imbalance is common among the critically ill. Excessive increases or decreases in body water can be lethal. There are numerous pathologic and iatrogenic causes for water imbalance, the most troublesome being disorders of antidiuretic hormone (ADH) secretion. Antidiuretic hormone plays a pivotal role in conserving water by increasing reabsorption of water by the kidney. Without the influence of ADH (as is seen in diabetes insipidus), a person would be required to ingest between 5 and 15 L of water daily to match urinary losses. Conversely, excessive ADH secretion would reduce urine output in adults to as little as 500 mL per day, dangerously diluting blood volume and expanding intracellular volume. This is what causes the symptoms of the syndrome of inappropriate ADH (SIADH). The care of patients who are critically ill and have disorders of ADH secretion can be challenging. The challenge lies in the recognition and treatment of the disorder. A collaborative team approach helps patients achieve and maintain the delicate balance of body fluids.
根据人的年龄和性别，水占体重的55%至80%，并提供了生存所必需的环境。水失衡在重症患者中很常见。体内水分的过度增加或减少都可能致命。水失衡有许多病理和医源性原因，最麻烦的是抗利尿激素（ADH）分泌紊乱。抗利尿激素通过增加肾脏对水的重吸收在保水方面起关键作用。如果没有抗利尿激素的影响（如在尿崩症中所见），一个人每天需要摄入5至15升水才能与尿流失相匹配。相反，抗利尿激素分泌过多会使成年人的尿量减少至每天仅500毫升，危险地稀释血容量并扩大细胞内体积。这就是抗利尿激素分泌不当综合征（SIADH）症状的成因。对患有抗利尿激素分泌紊乱的重症患者的护理可能具有挑战性。挑战在于识别和治疗该疾病。采用协作团队方法有助于患者实现并维持体液的微妙平衡。
