Water Intoxication急性水中毒课件.ppt

Acute Water Intoxication December 17, 2003 Bruce R. Wall, MD Good old fashioned nephrology (with a large dose of pulmonary) Most nephrologists would chose to evaluate and treat a SODIUM of 110 mEq/L rather than a BUN of 110mg% “Be careful what you ask for… you just might get it…” Lt.Col. Theodore R. Wall, USMC, Retired Patient admitted from ER with hyponatremia and respiratory failure… no problem… Today’s lecture: Chronic polydipsia – not this case Case presentation Laboratory review Brief discussion of water intoxication Pulmonary aspects @ Dr Weinmeister Input minus output equals accumulation 75 kg male 60% water = approx 45 Liters TBW Intracellular Extracellular 30 L 15 L 280mosm/kg 280mosm/kg [K+] 140mEq/l [Na+] 140mEq/l How much water was ingested? Initial TB solute: 280 X 45 =12,600 mosmol Initial ECF solute: 280 X 15 = 4,200 mosmol Initial intracellular: 12600 – 4200 = 8,400 mosmol NEW TBW : 45kg + 6 kg = 51 kg NEW TB OSM: 12,600 / 51kg = 251mosm/kg NEW ECF volume: 4200 / 251 = 16.7kg NEW intracellular volume: 8400 / 251 = 33.4kg How much water? Assume an ingestion of 6 liters: serum osmolality of 251mosmol/kg Estimated nadir [Na+] = osmolality / 2 = 125.5mEq Effective Posm is approximately 2 X [Na+] Case Presentation 21 year old AAM student at SMU CC: can not be obtained (intubation) History obtained from family members Patient was asked to drink 3 - 4 gallons of water (with hot sauce), as part of a fraternity hazing on Friday evening Post ingestion, patient was confused, and became ‘less responsive’ At 4AM, patient developed a seizure, yet was not transported to Presby ER until 7AM Hospital day:one Profound shock/hypotension – poor response to high dose pressor medications Immediate respiratory failure with severe agitation and hypoxemia; endotracheal intubation