WordNet

dryness resulting from the removal of water (同)desiccation
the process of extracting moisture (同)desiccation, drying up, evaporation
depletion of bodily fluids
preserve by removing all water and liquids from; "carry dehydrated food on your camping trip" (同)desiccate
remove water from; "All this exercise and sweating has dehydrated me" (同)desiccate

PrepTutorEJDIC

脱水,乾燥;〈体の〉脱水状態
…'を'脱水する,脱水状態にする / 水分を失う,〈体が〉脱水状態になる

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/11/08 06:12:19」(JST)

wiki en

In physiology and medicine, dehydration (hypohydration) is the excessive loss of body water,^[1] with an accompanying disruption of metabolic processes. The term dehydration may be used loosely to refer to any condition where fluid volume is reduced; most commonly, it refers to hypernatremia (loss of free water and the attendant excess concentration of salt), but is also used to refer to hypovolemia (loss of blood volume, particularly plasma).

Dehydration occurs when water loss exceeds water intake, usually due to exercise or disease. Most people can tolerate a three to four percent decrease in body water without difficulty. A five to eight percent decrease can cause fatigue and dizziness. Over ten percent can cause physical and mental deterioration, accompanied by severe thirst. A decrease more than fifteen to twenty-five percent of the body water is invariably fatal.^[2] Mild dehydration is characterised by thirst and general discomfort and usually resolves with oral rehydration.

Definition

Dehydration occurs when water intake is insufficient to replace free water lost due to normal physiologic processes (e.g. breathing or urination) and other causes (e.g. diarrhea or vomiting). Hypovolemia is specifically a decrease in volume of blood plasma - isotonic intravascular volume depletion, whereas the loss of intracellular pure water in dehydration results in an increase in salt concentration, hypernatremia.^[3]^[4] Some authors have reported three types of dehydration based on serum sodium levels: hypotonic or hyponatremic (referring to this as primarily a loss of electrolytes, sodium in particular), hypertonic or hypernatremic (referring to this as primarily a loss of water), and isotonic or isonatremic (referring to this as equal loss of water and electrolytes).^[5] The terms hyponatremic and eunatremic dehydration refer to hypovolemia. In humans, it is thought that the most commonly seen type of dehydration by far is isotonic (isonatraemic) dehydration, but this effectively refers to hypovolemia. Dehydration, is thus a term that has loosely been used to mean loss of water, regardless of whether it is as water and solutes (mainly sodium) or as free water. Hypotonic dehydration refers to solute loss, and thus loss of intravascular volume, but in the presence of exaggerated intravascular volume depletion for a given amount of total body water gain. Neurological complications can occur in hypotonic and hypertonic states. The former can lead to seizures, while the latter can lead to osmotic cerebral edema upon rapid rehydration.^[6]

Signs and symptoms

Symptoms of dehydration include thirst, headache, general discomfort, loss of appetite, dry skin, decreased urine volume, confusion, unexplained tiredness, and irritability.^[7]^[8]^[9] More prolonged or severe dehydration leads to abnormally dark urine, rapid breathing, constipation, decreased blood pressure (hypotension), dizziness or fainting when standing up due to orthostatic hypotension, listlessness, insomnia, and loss of skin elasticity.^[7] Athletes may suffer a loss of performance^[10] and experience flushing, low endurance, rapid heart rates, elevated body temperatures, and rapid onset of fatigue. Untreated dehydration generally results in delirium, extreme lethargy, seizures, sunken fontanelle ("soft spot" of the skull) in infants, fainting, sunken eyes, unconsciousness, swelling of the tongue and, in extreme cases, death.^[7]^[11] Blood tests may show hyperalbuminemia, an overabundance of protein in the blood plasma, poor kidney function, or excess concentration hemoglobin; urinalysis may show concentrated urine.^[7]^[11] Dehydration symptoms generally become noticeable after 2% of normal euhydration water volume has been lost.^[12]

The symptoms of dehydration become increasingly severe with greater water loss. Heart and respiration rates begin to increase to compensate for decreased plasma volume and blood pressure, while body temperature may rise because of decreased sweating. At around 5% to 6% water loss, grogginess or sleepiness, severe headaches or nausea, and a tingling in the limbs (paresthesia) may all be experienced. With 10% to 15% fluid loss, muscles may become spastic, skin may shrivel and wrinkle (decreased skin turgor), vision may dim, urination will be greatly reduced and may become painful, and delirium may begin. Losses greater than 15% are usually fatal as organs fail, starting with the kidneys.^[2]

In people over age 50, the body’s thirst sensation diminishes and continues diminishing with age. Many senior citizens suffer symptoms of dehydration. Dehydration along with hyperthermia results in the elderly dying suddenly during extreme hot weather.

In studies of terminally ill patients who have chosen to die, deaths by terminal dehydration are generally peaceful and are not associated with suffering when supplemented with adequate pain medication.^[13]^[14]

Cause

Water leaves the body in many ways, categorized into either “sensible” water loss or “insensible" water loss depending on whether the loss can be perceived by the senses. “Sensible” water loss includes such processes as sweating and vomiting. “Insensible" water loss occurs mainly through the skin and respiratory tract.^[15] In humans, dehydration can be caused by a wide range of diseases and states that impair water homeostasis in the body. These include the following:

External or stress-related causes
- Prolonged physical activity with sweating without consuming adequate water, especially in a hot or dry environment
- Prolonged exposure to dry air, e.g. in high-flying airplanes (5%–12% relative humidity)
- Blood loss or hypotension due to physical trauma
- Loss of fluid through weeping burns or other injury
- Crying
- Diarrhea
- Fever
- Hyperthermia
- Shock (hypovolemic)
- Vomiting or nausea

Infectious diseases
- Cholera
- Gastroenteritis
- Shigellosis
- Yellow fever

Malnutrition
- Electrolyte disturbance
  - Hypernatremia (also caused by dehydration)
  - Hyponatremia
- Fasting
- Recent rapid weight loss
- Patient refusal of nutrition and hydration
- Inability to swallow (obstruction of the esophagus)

Other causes of obligate water loss

Severe hyperglycemia, especially in diabetes mellitus
- Glycosuria
- Uremia
Diabetes insipidus
Acute emergency dehydration event
Foodborne illness
Crohn's disease

Likelihood of dehydration increases with consumption of diuretics, including caffeinated or alcoholic beverages.^[12]

Prevention

Dehydration is avoided by drinking sufficient water; adults require 2–3 L of fluid per day (including water content of food).^[11] Drinking water beyond the needs of the body entails little risk when done in moderation, since the kidneys will efficiently remove excess water through the urine with a large margin of safety.^{[citation needed]}

For routine activities, thirst is normally an adequate guide to maintain proper hydration. With exercise, exposure to hot environments, or a decreased thirst response, additional water may be required. An accurate determination of fluid volume lost during a workout can be made by performing weight measurements before and after a typical exercise session.^[16]^[17]^[18]^[19]^[20]

Normal water loss occurs through the lungs as water vapor (about 350ml), through the skin by perspiration (100ml) and by diffusion through the skin (350ml), or through the kidneys as urine (1000–2000ml, about 900ml of which is obligatory water excretion that gets rid of solutes). Some water (about 150–200ml, in the absence of diarrhea) is also lost through the feces.^[21] In warm or humid weather or during heavy exertion, however, the water loss can increase by a factor of 10 or more^{[citation needed]} through perspiration; all of which must be promptly replaced. In extreme cases, the losses may be great enough to exceed the body's ability to absorb water from the gastrointestinal tract; in these cases, it is not possible to drink enough water to stay hydrated, and the only way to avoid dehydration is to either pre-hydrate^[18] or find ways to reduce perspiration (through rest, a move to a cooler environment, etc.)

When large amounts of water are being lost through perspiration and concurrently replaced by drinking, maintaining proper electrolyte balance becomes an issue. Drinking fluids that are hypertonic or hypotonic with respect to perspiration may have grave consequences (hyponatremia or hypernatremia, principally) as the total volume of water turnover increases.

Treatment

The treatment for minor dehydration, often considered the most effective, is drinking water and stopping fluid loss. Plain water restores only the volume of the blood plasma, inhibiting the thirst mechanism before solute levels can be replenished.^[22] Solid foods can contribute to fluid loss from vomiting and diarrhea.^[23] Urine concentration and frequency will customarily return to normal as dehydration resolves.^[11]

In more severe cases, correction of a dehydrated state is accomplished by the replenishment of necessary water and electrolytes (through oral rehydration therapy or fluid replacement by intravenous therapy). As oral rehydration is less painful, less invasive, less expensive, and easier to provide, it is the treatment of choice for mild dehydration. Solutions used for intravenous rehydration must be isotonic or hypotonic. Pure water injected into the veins will cause the breakdown (lysis) of red blood cells (erythrocytes).

When fresh water is unavailable (e.g. at sea or in a desert), seawater and alcohol will worsen the condition. Urine contains a similar solute concentration to seawater, and numerous guides advise against its consumption in survival situations.^[24]^[25]^[26]^[27]

For severe cases of dehydration where fainting, unconsciousness, or other severely inhibiting symptom is present (the patient is incapable of standing or thinking clearly), emergency attention is required. Fluids containing a proper balance of replacement electrolytes are given orally or intravenously with continuing assessment of electrolyte status; complete resolution is the norm in all but the most extreme cases.

Some research indicates that artificial hydration to alleviate symptoms of dry mouth and thirst in the dying patient may be futile.^[28]

Notes

^ "Definition of dehydration" at medicine net
^ ^a ^b Ashcroft F, Life Without Water in Life at the Extremes. Berkeley and Los Angeles, 2000, 134-138.
^ MedicineNet > Definition of Hypovolemia Retrieved on July 2, 2009
^ TheFreeDictionary.com --> hypovolemia Citing Saunders Comprehensive Veterinary Dictionary, 3 ed. Retrieved on July 2, 2009
^ Fleisher, Gary Robert; Ludwig, Stephen (2010). Textbook of Pediatric Emergency Medicine. Lippincott Williams & Wilkins. p. 811. ISBN 978-1-60547-159-4.
^ Dehydration at eMedicine
^ ^a ^b ^c ^d Kaneshiro, Neil K. "Dehydration". National Library of Medicine. Retrieved 10 June 2014.
^ Shirreffs SM, Merson SJ, Fraser SM, Archer DT; Merson; Fraser; Archer (June 2004). "The effects of fluid restriction on hydration status and subjective feelings in man". Br. J. Nutr. 91 (6): 951–8. doi:10.1079/BJN20041149. PMID 15182398.
^ "Dehydration Affects Mood, Not Just Motor Skills / November 23, 2009 / News from the USDA Agricultural Research Service". Ars.usda.gov. Retrieved 2012-11-09.
^ Bean, Anita (2006). The Complete Guide to Sports Nutrition. A & C Black Publishers Ltd. pp. 81–83. ISBN 0-7136-7558-6.
^ ^a ^b ^c ^d Wedro, Benjamin. "Dehydration". MedicineNet. Retrieved 10 June 2014.
^ ^a ^b Kleiner, SM (February 1999). "Water: an essential but overlooked nutrient". Journal of the American Dietetic Association 99 (2): 200 Extra |pages= or |at= (help). doi:10.1016/S0002-8223(99)00048-6. PMID 9972188.
^ Printz LA (April 1992). "Terminal dehydration, a compassionate treatment". Archives of Internal Medicine 152 (4): 697–700. doi:10.1001/archinte.152.4.697. PMID 1373053.
^ Sullivan RJ (April 1993). "Accepting death without artificial nutrition or hydration". Journal of General Internal Medicine 8 (4): 220–224. doi:10.1007/BF02599271. PMID 8515334.
^ Alok K. Maintenance Fluid Therapy in Children [Online]. University of Texas Medical Branch. http://www.utmb.edu/pedi_ed/CORE/Fluids&Electyrolytes/page_02.htm[16 March,2014]
^ "Water, Water, Everywhere". WebMD.
^ Naomi Tupper. "Should you be drinking water while exercising?". Calorie Secrets.
^ ^a ^b Sawka MN, Burke LM, Eichner ER, Maughan RJ, Montain SJ, Stachenfeld NS; Sawka; Burke; Eichner; Maughan; Montain; Stachenfeld (February 2007). "American College of Sports Medicine position stand. Exercise and fluid replacement". Med Sci Sports Exerc 39 (2): 377–90. doi:10.1249/mss.0b013e31802ca597. PMID 17277604.
^ Nancy Cordes (April 2, 2008). "Busting The 8-Glasses-A-Day Myth". CBS.
^ ""Drink at Least 8 Glasses of Water a Day" — Really?". Dartmouth Medical School.
^ "Major Minerals". SparkNotes.
^ "." Murray, R. & , J. (2001)Stofan, John; Murray (2001). "Ch. 8: Formulating carbohydrate-electrolyte drinks for optimal efficacy". In Maughan, Ron J.; Murray, Robert. Sports Drinks: Basic Science and Practical Aspects. CRC Press. pp. 197–224. ISBN 978-0-8493-7008-3. Missing |last1= in Authors list (help)
^ "Healthwise Handbook," Healthwise, Inc. 1999
^ water
^ Tracker Trail - Mother Earth News - Issue #72
^ EQUIPPED TO SURVIVE (tm) - A Survival Primer
^ Five Basic Survival Skills in the Wilderness
^ Ellershaw JE, Sutcliffe JM, Saunders CM; Sutcliffe; Saunders (April 1995). "Dehydration and the dying patient". J Pain Symptom Manage 10 (3): 192–7. doi:10.1016/0885-3924(94)00123-3. PMID 7629413.

References

Ira R. Byock, M.D., "Patient Refusal of Nutrition and Hydration: Walking the Ever-Finer Line." American Journal Hospice & Palliative Care, pp. 8–13. (March/April 1995)

External links

Look up dehydration in Wiktionary, the free dictionary.

Definition of dehydration by the U.S. National Institutes of Health's MedlinePlus medical encyclopedia
Rehydration Project at rehydrate.org
Steiner, MJ; DeWalt, DA; Byerley, JS (Jun 9, 2004). "Is this child dehydrated?". JAMA: the Journal of the American Medical Association 291 (22): 2746–54. doi:10.1001/jama.291.22.2746. PMID 15187057.

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 小児における血液量減少症（脱水）の臨床的評価および診断 clinical assessment and diagnosis of hypovolemia dehydration in children
2. 小児における循環血液量減少症（脱水）の治療 treatment of hypovolemia dehydration in children
3. 成人における体液量減少の病因、臨床症状、および診断 etiology clinical manifestations and diagnosis of volume depletion in adults
4. 経口補水療法 oral rehydration therapy
5. Responding to requests for physician-assisted dying

English Journal

Evolution of colour and phenolic compounds during Garnacha Tintorera grape raisining.

Figueiredo-González M, Cancho-Grande B, Simal-Gándara J.SourceNutrition and Bromatology Group, Analytical and Food Chemistry Department, Faculty of Food Science and Technology, University of Vigo, Ourense Campus, E-32004 Ourense, Spain.
Food chemistry.Food Chem.2013 Dec 1;141(3):3230-40. doi: 10.1016/j.foodchem.2013.05.142. Epub 2013 Jun 10.
The off-vine drying is one of the most important steps in the production of a high quality naturally sweet wine. However, only few studies have analyzed the changes in colour and phenolic compounds of the grapes throughout the process. In this work, UV/Vis spectrophotometry and HPLC/DAD-ESI/MS were
PMID 23871082

ESR spectroscopic properties of irradiated gum Arabic.

Leonor SJ, Gómez JA, Kinoshita A, Calandreli I, Tfouni E, Baffa O.SourceDepartamento de Física, Faculdade de Filosofia Ciências e Letras, Universidade de São Paulo, Av. Bandeirantes 3900, 14040-901 Ribeirão Preto, SP, Brazil.
Food chemistry.Food Chem.2013 Dec 1;141(3):1860-4. doi: 10.1016/j.foodchem.2013.04.095. Epub 2013 May 10.
Electron spin resonance (ESR) spectra of irradiated gum Arabic with doses between 0.5 and 5kGy were studied. A linear relationship between the absorbed dose and the intensities of the ESR spectra was observed. ESR spectra of irradiated gum Arabic showed a decay of relative concentrations of free rad
PMID 23870902

Interactions of dietary fibre and omega-3-rich oil with protein in surimi gels developed with salt substitute.

Debusca A, Tahergorabi R, Beamer SK, Partington S, Jaczynski J.SourceWest Virginia University, Division of Animal and Nutritional Sciences, P.O. Box 6108, Morgantown, WV 26506, USA.
Food chemistry.Food Chem.2013 Nov 1;141(1):201-8. doi: 10.1016/j.foodchem.2013.02.111. Epub 2013 Mar 7.
Most Western populations have insufficient intake of fibre and ω-3 polyunsaturated fatty acids (PUFAs), while sodium intake greatly exceeds the recommended maximum. Surimi seafood is not currently fortified with these nutraceutical ingredients. Alaska pollock surimi seafood was developed with salt
PMID 23768348

Designer cathinones-An emerging class of novel recreational drugs.

Zawilska JB, Wojcieszak J.SourceDepartment of Pharmacodynamics, Medical University of Lodz, 1 Muszynskiego St., 90-151 Lodz, Poland. Electronic address: jolanta.zawilska@umed.lodz.pl.
Forensic science international.Forensic Sci Int.2013 Sep 10;231(1-3):42-53. doi: 10.1016/j.forsciint.2013.04.015. Epub 2013 May 10.
A new group of recreational drugs, popularly known as "bath salts", "plant feeders" or "plant food", has recently emerged in numerous countries. Although various products are labeled with warnings "not for human consumption" or "not tested for hazards or toxicity", they are intended to produce a hig
PMID 23890615

Japanese Journal

Preparation and optimization of mordenite nanocrystal-layered membrane for dehydration by pervaporation

Zhang Yaqi,Nakasaka Yuta,Tago Teruoki,Hirata Aya,Sato Yuki,Masuda Takao
Microporous and mesoporous materials 207, 39-45, 2015-05-01
Mordenite nanocrystal-layered membranes consisting of a mordenite nanocrystal layer and protection layer were successfully prepared. The obtained mordenite membranes were applied to the separation of …
NAID 120005602511

食品技術講座(6)食品の安全・品質に関する技術講座(第34回)糖-水の相互作用による耐凍結乾燥特性の究明

白神慧一郎,足立絢,小川雄一
冷凍 90(1051), 362-367, 2015-05
NAID 40020487293

特発性側弯症における術前後の頚椎椎間板に関する検討 (東海脊椎脊髄病研究会特集号)

瀧村浩介,小原徹哉,辻太一 [他]
Journal of spine research : official journal of the Japanese Society for Spine Surgery and Related Research 6(4), 849-853, 2015-04
NAID 40020463554

CEU Quiz関連記事競技中の筋痙攣 : 脱水を超えた考察

Buskard Andrew N. L.
Strength & conditioning journal : 日本ストレングス&コンディショニング協会機関誌 22(3), 19-28, 2015-04
NAID 40020415169

Related Pictures

★リンクテーブル★

国試過去問	「106C011」
リンク元	「100Cases 60」「脱水症」「dehydrate」「脱水状態」「water deprivation」

「106C011」

Dehydration
	Classification and external resources
	Nurses encourage a patient to drink an oral rehydration solution to reduce dehydration he acquired from cholera.
ICD-10	E86
ICD-9	276.5
MedlinePlus	000982
eMedicine	article/801012

　　[★]

症候と英語表記の組合せで誤っているのはどれか。

a　黄疸　－　jaundice
b　けいれん　－　convulsion
c　不整脈　－　anorexia
d　脱水　－　dehydration
e　便秘　－　constipation

[正答]

※国試ナビ4※　［106C010］←［国試_106］→［106C012］

「100Cases 60」

　　[★]

attend

vt.

～に出席/参列する、(学校に)行く(go toより堅い語)

The normal ECG and chest X-ray when he attended hospital after an episode do not rule out an intermittent conduction problem.

(結果として)～に伴う

～に同行/同伴する、付き添う、仕える。往診する。～の世話をする、～に気をつける、見張る

vi.

出席/参列/出勤する(at)

留意/注目/傾聴する(to)。身を入れる、勢力を注ぐ、心を傾注する(to)。世話をする、気を配る(to)

仕える、付きそう(on)。(危険・困難などが)伴う(on)

productive

adj

生産的な、生産力を有する(⇔unproductive
(擦過が)他作の。(土地などが)多産の、豊富に算出する
[叙述](～を)引き起こす、もたらす(of)
(事業などが)利益をもたらす、営利的な。良い結果をもたらす、実りの多い
(言語)(接辞などが)生産性のある
(医学)(咳が)喀痰を伴う。(炎症が)増殖性の

outflow

n.

流出/流出物。流出量

vi.

流出する

obstruction

n.

妨害、障害、支障、差し障り(to)。妨害物、

obstruction to outflow

the clinical picture suggests obstruction to outflow from the stomach.(この臨床像は胃流出障害を示唆している)

閉塞、閉塞症。

obstruction to outflow

流出障害

ex.

the clinical picture suggests obstruction to outflow from the stomach.(この臨床像は胃流出障害を示唆している)

aqueous outflow from the eye (眼球からの房水流出)

retain

re + tent (tineo=teneo) = to hold back

vt.

保持する、保有する、保留する、持ち続ける、維持する。(使用のために)確保しておく
(ある場所に)保つ、保持する。(熱などを)保っている、失わないでいる
忘れないでいる、覚えている
(弁護士・気腫・召使いなどを)雇っておく、抱える
使用/実行し続ける。(廃止しないで)そのままにしておく

palliation

n.

寛解、緩和

n.

強く揺り動かすこと、強く揺れること

splash

n.

はね返し、はねかけ。はねかす音。

どっと流れる水。

□unit

1 unit = 10 ml of ethanol

□350ml アルコール5%

350x0.05/10=1.75 unit

http://pohwa.adam.ne.jp/you/hobby/ryori/sake2.ht ml

1unitの量が国によって違う。純エタノール換算で、1英unitは8g=10ml（英糖尿病協会採用の数値）、1米unitは15g（20ml弱：1drinkとも）で、日本では10～14g程度（代謝熱量80Kcalが基準：食品成分表5訂版,2002）や20ないし23g（日本酒1合分）を1unitとしている。日本の医学界では1unit=20g（体積に換算すると25ml）を採用することが多いので、ここでもそれに従う。この基準（1unit=20g=25ml）で計算すると、40度のウィスキー1ショット（＝1オンス：英液量オンスで28.41ml、米液量オンスで29.57ml、日本の1ショットで30ml）が約0.5unitとなる。5度のビールなら500mlでだいたい1unit（この、日本酒1合≒ウィスキーダブル≒ビール500cc≒1unitという関係は、覚えておくと便利かもしれない：ワインなどは日本酒に準じるので、1本750mlがだいたい4unit強である）。

主訴：体重減少

(主訴にまつわる症状)

　・4ヶ月で10kg減少、食欲の減少、嘔吐(頻度：次第に増えてきている。嘔吐物と量：何時間も前に食べたものを多量に嘔吐する)

(主訴以外の症状)

　・一ヶ月前から脱力感(部位：特に下肢で著しい(丘に登ったり、階段を上ったりするとき))

嗜好歴：喫煙 20/day、飲酒 10units/week (ビール 6本弱)

家族歴：なし

既往歴：高血圧(2年間β遮断薬で治療、4ヶ月前に服薬中止)

身体所見 examination

バイタル：82/分、血圧 148/86 mmHg

全身：やせ、体調が悪そう(unwell)。

呼吸器、心血管系に異常なし

腹部：腫瘤触知せず、圧痛なし、振盪音/振水音を認める

検査所見 investigations

低値：ナトリウム、カリウム、クロライド、尿素

高値：重炭酸

Q

1. これらの所見の説明は？

2. もっともな診断は？

A

★

　胃流出路の閉塞　＝　食後の嘔吐　＋　胃の振水音

　高BUN　＋　低CRE　→　脱水

　低Na,Cl,H+　→　嘔吐

　HClの喪失　→　代謝性アルカローシス

　　H：細胞内→外

　　K：細胞外→内

　　従って、低カリウム血症　→　筋力低下・脱力

★

　胃流出路の閉塞の原因：胃癌とか胃潰瘍による瘢痕

　診断には上部消化管内視鏡・生検(組織診)、その後にCT(局所浸潤、転移巣検索)

　治療法：腫瘍だったら腹腔鏡による腫瘍の摘出術。その他の場合は手術をしたり、薬物療法をしたり、、、

学習ポイント

・嘔吐・嘔気 nausea and vomiting DIF.321, vomitus DIF.449 IMD.351

解剖で考えよう。縦に解剖、横に病因

鼻咽頭　扁桃、外来異物

食道　アカラシア、逆流性食道炎、食道癌　・・・嚥下困難があるはず

胃　胃炎、消化性潰瘍、胃癌、幽門部の病変(ポリープ、癌、潰瘍；胃の出口を閉塞させる)。子供だったら幽門狭窄症

十二指腸：潰瘍、十二指腸炎、Billroth II法による輸出脚の閉塞、Billroth I/II法によるダンピング症候群。胆汁性胃炎も原因となる。

小腸：小腸閉塞(腸重積、腸回転異常症、胃石症、癌腫、限局性回腸炎)

結腸：潰瘍性大腸炎、アメーバ症、腫瘍男。腸間膜動脈血栓症、

消化管全体：Strongyloides, Ascaris, Taenia solium

・β遮断薬の服用中止で何が起こる？

　狭心症や発作性の高血圧。

　なんでやめたんだろう？　→　副作用：(1%程度に)めまい、全身倦怠感、頭痛、徐脈が出現

・振盪音

　腹水や胃内容物の貯留によって聴取される。

・BUN 高値、Cre 低値

suggest a degree of dehydration

・BUN

==検査値の異常 (異常値の出るメカニズム第5版 p.144)==

===BUN 上昇===

1. 組織の異化亢進

外科的大手術、体内への出血、異型輸血、悪性腫瘍、飢餓時、高熱、高度熱傷、アジソン病のクリーゼ、糖尿病性アシドーシス、甲状腺機能亢進症、膵臓壊死、重症感染症

2. 蛋白摂取量の増加
3. 消化管出血

赤血球・血漿蛋白が腸管内で分解　→　分解されて生成するNH<sub>3</sub>が小腸で吸収される　→ BUN↑

4. 腎血流量の減少

重症心不全、ショック

5. 腎障害

尿素排泄機能が低下

6. 尿路の閉塞

腎後性に尿排泄が阻害されると尿素が血液中にうっ滞する。

「脱水症」

　　[★]

英: dehydration, anhydration
同: (国試)脱水
関

病態

水喪失とNa喪失による循環血液量の低下

(病態によって体液の浸透圧と量に変化が生じる)→循環血液量の低下

身体所見

体重減少、血圧・脈拍の変化、起立性低血圧、皮膚乾燥感と緊張度の低下、口腔粘膜の乾燥、静脈虚脱。

検査所見

血液：中心静脈圧↓、Ht・BUN・UA↑、血液浸透圧↑

脱水状態では近位尿細管でNa・水と共に尿素の再吸収が亢進するため(NEL.313)

尿：尿比重1.020↑、尿の浸透圧↑、尿中Na排泄↓(10 mEq/l以下)
ホルモン：ADHの上昇
神経系：RA系と交感神経の亢進。

脱水の分類

高張性脱水：喪失が　Na　＜　水　→　血清浸透圧↑

→細胞内から細胞外に水が移動→循環血液量わずか↓。細胞内液は著名↓

等張性脱水：細胞外液から等張の体液喪失

血清浸透圧は不変→水の移動は起こらない。

低張性脱水：喪失が　Na　＞　水　→　血清浸透圧↓

→細胞外から細胞内に水が移動→循環血液量著名↓減。細胞内液↑

	低張性脱水	等張性脱水	高張性脱水
細胞外液浸透圧	↓↓		↑↑
病態	Na喪失		水喪失
水の動き	細胞外→細胞内		細胞内→細胞外
血管内のvolume	減少する		比較的保たれる
疾患	熱傷、利尿薬、アジソン病		発熱、発汗過多、下痢、急性腎不全回復期
皮膚ツルゴール	↓↓	↓	↓
脈拍	↑↑	↑	↑
ショック	＋＋	＋	±
ヘマトクリット	↑	↑	↑
尿量	→↓	→↓	↓↓↓ 一次的な血漿浸透圧低下のためにADHが分泌され尿濃縮を来す
意識障害	＋(傾眠→昏睡)	様々	＋(興奮→昏睡)
口渇感	±	－	＋＋
粘膜乾燥	＋	＋＋	＋＋
深部腱反射	↓↓	様々	↑↑
嘔気・嘔吐	＋(脳浮腫)	－	±
頭痛	＋(脳浮腫)	－	－
体温	↓(循環不全)	↓(循環不全)	↑(筋痙攣、　熱中枢異常)

体重あたりの必要水分量

乳児：150 ml/kg/day
小児：100 ml/kg/day
学童： 80 ml/kg/day
成人： 50 ml/kg/day

乳児の脱水

		軽症	中等症	重症
脱水徴候	体準減少	3-5%	6-9%	10%以上
	皮膚ツルゴール低下	－	＋	＋＋
	更新粘膜乾燥	±	＋	＋＋
	大泉門陥凹	－	＋	＋＋
	眼球陥凹	－	＋	＋＋
	尿量	やや乏尿	乏尿	著明乏尿
末梢循環不全	皮膚色	やや蒼白	蒼白	チアノーゼ
	脈拍減弱	－	＋	＋＋
	血圧低下	－	±	＋
中枢神経症状	意識障害	－	＋	＋＋
中枢神経症状	痙攣	－	±	＋

体温　：脱水が重症になるにつれて四肢の体温が低下　→　循環血液量減少　→　交感神経緊張　→　末梢血管収縮

呼吸数：軽度～中程度の脱水では変化しない。高度の脱水では代謝性アシドーシス　→　代償的な頻呼吸

乳児・年長児の脱水症状

SPE.195改変

等級

体重減少

皮膚

粘膜

循環

尿量

口渇感

啼泣時の涙

大泉門

症状のまとめ

乳児

年長児

緊張度

色調

末梢体温

脈拍

血圧

軽度

＜5％

＜3％

良好

青白い

少しひんやり

乾燥

正常

軽度低下

軽度

出る

平坦

濃縮尿

中等度

＜10％

＜6％

｜

速脈を触れる

正常か低下

｜

末梢循環不全

重度

＜15％

＜9％

かなり低下

斑点状

冷たい

カラカラに乾燥

速脈、わずかに触れる

低下

無尿

強度

出ない

明らかに陥没

血圧低下・ショック・意識障害

脱水の種類と症候・検査値

QB.O-50

高張性脱水：Na ≧150 mEq/L
等張性脱水：Na 130～150 mEq/L
低張性脱水：Na ≦130 mEq/L

国試

100H013、096F020、101D008、098I011、097F021、095E045

「dehydrate」

　　[★]

vt.

(化)脱水する。(野菜など)から水分を抜く、乾燥させる。(fig)ひからびさせる、つまらなくする

the patient looks unwell and dehydrated.

vi.

水分/湿気が抜ける、脱水/無水状態になる

関: dehydration, water deprivation

「脱水状態」

　　[★]

英: dehydration
関: 脱水、脱水症、脱水症状

「water deprivation」

　　[★]

水分欠乏、脱水

関: dehydrate、dehydration

[1] "Definition of dehydration" at medicine net

[Ashcroft-2] Ashcroft F, Life Without Water in Life at the Extremes. Berkeley and Los Angeles, 2000, 134-138.

[3] MedicineNet > Definition of Hypovolemia Retrieved on July 2, 2009

[4] TheFreeDictionary.com --> hypovolemia Citing Saunders Comprehensive Veterinary Dictionary, 3 ed. Retrieved on July 2, 2009

[5] Fleisher, Gary Robert; Ludwig, Stephen (2010). Textbook of Pediatric Emergency Medicine. Lippincott Williams & Wilkins. p. 811. ISBN 978-1-60547-159-4.

[6] Dehydration at eMedicine

[nlm-7] Kaneshiro, Neil K. "Dehydration". National Library of Medicine. Retrieved 10 June 2014.

[8] Shirreffs SM, Merson SJ, Fraser SM, Archer DT; Merson; Fraser; Archer (June 2004). "The effects of fluid restriction on hydration status and subjective feelings in man". Br. J. Nutr. 91 (6): 951–8. doi:10.1079/BJN20041149. PMID 15182398.

[9] "Dehydration Affects Mood, Not Just Motor Skills / November 23, 2009 / News from the USDA Agricultural Research Service". Ars.usda.gov. Retrieved 2012-11-09.

[10] Bean, Anita (2006). The Complete Guide to Sports Nutrition. A & C Black Publishers Ltd. pp. 81–83. ISBN 0-7136-7558-6.

[mednet-11] Wedro, Benjamin. "Dehydration". MedicineNet. Retrieved 10 June 2014.

[Kleiner-12] Kleiner, SM (February 1999). "Water: an essential but overlooked nutrient". Journal of the American Dietetic Association 99 (2): 200 Extra |pages= or |at= (help). doi:10.1016/S0002-8223(99)00048-6. PMID 9972188.

[13] Printz LA (April 1992). "Terminal dehydration, a compassionate treatment". Archives of Internal Medicine 152 (4): 697–700. doi:10.1001/archinte.152.4.697. PMID 1373053.

[14] Sullivan RJ (April 1993). "Accepting death without artificial nutrition or hydration". Journal of General Internal Medicine 8 (4): 220–224. doi:10.1007/BF02599271. PMID 8515334.

[15] Alok K. Maintenance Fluid Therapy in Children [Online]. University of Texas Medical Branch. http://www.utmb.edu/pedi_ed/CORE/Fluids&Electyrolytes/page_02.htm[16 March,2014]

[16] "Water, Water, Everywhere". WebMD.

[17] Naomi Tupper. "Should you be drinking water while exercising?". Calorie Secrets.

[Exercise_and_Fluid_Replacement-18] Sawka MN, Burke LM, Eichner ER, Maughan RJ, Montain SJ, Stachenfeld NS; Sawka; Burke; Eichner; Maughan; Montain; Stachenfeld (February 2007). "American College of Sports Medicine position stand. Exercise and fluid replacement". Med Sci Sports Exerc 39 (2): 377–90. doi:10.1249/mss.0b013e31802ca597. PMID 17277604.

[19] Nancy Cordes (April 2, 2008). "Busting The 8-Glasses-A-Day Myth". CBS.

[20] ""Drink at Least 8 Glasses of Water a Day" — Really?". Dartmouth Medical School.

[21] "Major Minerals". SparkNotes.

[22] "." Murray, R. & , J. (2001)Stofan, John; Murray (2001). "Ch. 8: Formulating carbohydrate-electrolyte drinks for optimal efficacy". In Maughan, Ron J.; Murray, Robert. Sports Drinks: Basic Science and Practical Aspects. CRC Press. pp. 197–224. ISBN 978-0-8493-7008-3. Missing |last1= in Authors list (help)

[23] "Healthwise Handbook," Healthwise, Inc. 1999

[24] water

[25] Tracker Trail - Mother Earth News - Issue #72

[26] EQUIPPED TO SURVIVE (tm) - A Survival Primer

[27] Five Basic Survival Skills in the Wilderness

[28] Ellershaw JE, Sutcliffe JM, Saunders CM; Sutcliffe; Saunders (April 1995). "Dehydration and the dying patient". J Pain Symptom Manage 10 (3): 192–7. doi:10.1016/0885-3924(94)00123-3. PMID 7629413.

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dehydration