Melaranci C, Giammaria P, Graziani M C
IIa Divisione, Ospedale Bambino Gesu, Roma, Italia.
Pediatr Med Chir. 1991 Mar-Apr;13(2):161-4.
Dehydration, in childhood as in adulthood, may origin from an inadequate water ingestion or an excessive water elimination. Causes may be found in fever, vomiting, scalds, pulmonary hyperventilation, diabetes. Water loss during acute diarrhea in children can be even 6-7 times higher in comparison with an healthy child. Together with water, electrolytes are lost. We differentiate dehydration in isonatremic d. (70% of cases), hyponatremic d. (10%) and hypernatremic d. (20%) basing on Sodium loss. Important dehydration causes severe clinical symptoms as shock, renal and cardiocirculatory failure, convulsion, coma. Symptoms at the central nervous system level derivate both from hyperosmolarity in brain cells and from thrombosis or hemorrhages in subdural sites. Dehydration, following acute diarrhea, is slight when weight loss is lower than 5%. The child health conditions still remain good. Dehydration become moderate if weight loss reaches 5% and the child starts suffering. When the weight loss reaches 10%, dehydration is now severe and circulatory deficiency becomes evident. When it is higher than 10%, prognosis is very severe and shock and coma may be observed. In the present work, we illustrate the different ways of rehydration after acute diarrhea. Initially, oral rehydration must be established with one of the oral solutions, differing each other for amount of electrolytes and glucose. Recently, a new solution, "supersolution", has been presented differing from the other ones for electrolytes concentration and for the presence of rice starch instead of glucose. In most cases of diarrhea, oral rehydration appears adequate but sometimes an intravenous rehydration becomes necessary, e.g. in case of vomiting, CNS depression and in any case of severe gastroenteric symptomatology.(ABSTRACT TRUNCATED AT 250 WORDS)
儿童期的脱水与成人期一样,可能源于水摄入不足或水排出过多。病因可见于发热、呕吐、烫伤、肺部过度换气、糖尿病。与健康儿童相比,儿童急性腹泻期间的失水量甚至可能高出6至7倍。电解质会随水一同流失。根据钠的丢失情况,我们将脱水分为等渗性脱水(70%的病例)、低渗性脱水(10%)和高渗性脱水(20%)。严重脱水会引发休克、肾和心血管循环衰竭、惊厥、昏迷等严重临床症状。中枢神经系统层面的症状既源于脑细胞的高渗状态,也源于硬膜下部位的血栓形成或出血。急性腹泻后的脱水若体重减轻低于5%则为轻度,儿童健康状况仍良好。若体重减轻达到5%且儿童开始出现不适,脱水则为中度。当体重减轻达到10%时,脱水即为重度,循环功能不足变得明显。若高于10%,预后非常严重,可能会出现休克和昏迷。在本研究中,我们阐述了急性腹泻后不同的补液方法。首先,必须用其中一种口服溶液进行口服补液,这些溶液在电解质和葡萄糖含量上有所不同。最近,一种新的溶液“超级溶液”问世,它在电解质浓度以及用大米淀粉替代葡萄糖方面与其他溶液不同。在大多数腹泻病例中,口服补液似乎就足够了,但有时静脉补液是必要的,例如在呕吐、中枢神经系统抑制以及任何严重胃肠道症状的情况下。(摘要截选至250词)