多血、血液量増加症

関: polyemia

WordNet

a blood disorder consisting of an increase in the volume of circulating blood (同)hypervolaemia

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/10/11 14:42:47」(JST)

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Hypervolemia, or fluid overload, is the medical condition where there is too much fluid in the blood. The opposite condition is hypovolemia, which is too little fluid volume in the blood. Fluid volume excess in the intravascular compartment occurs due to an increase in total body sodium content and a consequent increase in extracellular body water. The mechanism usually stems from compromised regulatory mechanisms for sodium handling as seen in congestive heart failure (CHF), kidney failure, and liver failure. It may also be caused by excessive intake of sodium from foods, intravenous (IV) solutions and blood transfusions, medications, or diagnostic contrast dyes. Treatment typically includes administration of diuretics and restriction of the intake of water, fluids, sodium, and salt.

Causes

Excessive sodium and fluid intake:

IV therapy containing sodium^[1]
As a Transfusion reaction to a rapid blood transfusion.^[1]^[2]
High intake of sodium^[1]

Sodium and water retention:

Heart failure^[1]
Liver cirrhosis^[1]
Nephrotic syndrome^[1]
Corticosteroid therapy^[1]
Hyperaldosteronism^[1]
Low protein intake^[1]

Fluid shift into the intravascular space:

Fluid remobilization after burn treatment^[1]
Administration of hypertonic fluids, e.g. mannitol^[1] or hypertonic saline solution
Administration of plasma proteins, such as albumin^[1]

Signs and symptoms

The excess fluid, primarily salt and water, builds up in various locations in the body and leads to an increase in weight, swelling in the legs and arms (peripheral edema), and/or fluid in the abdomen (ascites). Eventually, the fluid enters the air spaces in the lungs (pulmonary edema) reduces the amount of oxygen that can enter the blood, and causes shortness of breath (dyspnea) or enters pleural space by transudation (pleural effusion which also causes dyspnea), which is the best indicator of estimating central venous pressure is increased. It can also cause swelling of the face. Fluid can also collect in the lungs when lying down at night, possibly making nighttime breathing and sleeping difficult (paroxysmal nocturnal dyspnea).

Complications

Congestive heart failure is the most common result of fluid overload. Also, it may be associated with hyponatremia (hypervolemic hyponatremia).^[3]

References

^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l Page 62 (Fluid imbalances) in: Portable Fluids and Electrolytes (Portable Series). Hagerstwon, MD: Lippincott Williams & Wilkins. 2007. ISBN 1-58255-678-4.
^ "Complications of Transfusion: Transfusion Medicine: Merck Manual Professional". Retrieved 2009-02-09.
^ The MERCK MANUALS > Hyponatremia Last full review/revision May 2009 by James L. Lewis, III, MD

External links

Hypervolemia symptoms, causes, diagnosis, treatment, and general details
How Heart Failure causes fluid accumulation – An animated journey through Heart Failure
CRISP Thesaurus 00004009

UpToDate Contents

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1. 水分バランス異常（低ナトリウム血症および高ナトリウム血症）およびナトリウムバランス異常（循環血液量減少および浮腫）の一般原則 general principles of disorders of water balance hyponatremia and hypernatremia and sodium balance hypovolemia and edema
2. 腹膜透析患者における循環血液量過多の評価 evaluation of hypervolemia in peritoneal dialysis patients
3. Cardiovascular problems in the post-anesthesia care unit (PACU)
4. 術中の輸液マネージメント intraoperative fluid management
5. 小児における浮腫の評価およびマネージメント evaluation and management of edema in children

English Journal

Prevention and treatment of sepsis-induced acute kidney injury: an update.

Honore PM1, Jacobs R2, Hendrickx I3, Bagshaw SM4, Joannes-Boyau O5, Boer W6, De Waele E7, Van Gorp V8, Spapen HD9.
Annals of intensive care.Ann Intensive Care.2015 Dec;5(1):51. doi: 10.1186/s13613-015-0095-3. Epub 2015 Dec 21.
Sepsis-induced acute kidney injury (SAKI) remains an important challenge in critical care medicine. We reviewed current available evidence on prevention and treatment of SAKI with focus on some recent advances and developments. Prevention of SAKI starts with early and ample fluid resuscitation prefe
PMID 26690796

Posterior Reversible Encephalopathy Syndrome as an Overlooked Complication of Induced Hypertension for Cerebral Vasospasm: Systematic Review and Illustrative Case.

Muhammad S1, Güresir Á2, Greschus S2, Scorzin J2, Vatter H2, Güresir E2.
Stroke; a journal of cerebral circulation.Stroke.2015 Dec 1. pii: STROKEAHA.115.011697. [Epub ahead of print]
BACKGROUND AND PURPOSE: Delayed cerebral ischemia associated with cerebral vasospasm is a common cause of secondary neurological decline after aneurysmal subarachnoid hemorrhage (SAH). Triple-H therapy, induced hypertension, hypervolemia, and hemodilution, is often used to treat cerebral vasospasm.
PMID 26628389

Extracellular volume expansion and the preservation of residual renal function in Korean peritoneal dialysis patients: a long-term follow up study.

Rhee H1,2, Baek MJ3, Chung HC4, Park JM1,2, Jung WJ1,2, Park SM1,2, Lee JW1,2, Shin MJ1,2, Kim IY1, Song SH1,2, Lee DW1, Lee SB1, Kwak IS1,2, Seong EY5,6.
Clinical and experimental nephrology.Clin Exp Nephrol.2015 Nov 26. [Epub ahead of print]
INTRODUCTION: In chronic peritoneal dialysis patients, preservation of residual renal function (RRF) is a major determinant of patient survival, and maintaining sufficient intravascular volume has been hypothesized to be beneficial for the preservation of RRF. The present study aimed to test this hy
PMID 26611535

Japanese Journal

血液希釈を伴う大量輸液は動的脳血流自動調節能を障害する

小川洋二郎,岩崎賢一,青木健,柴田茂貴,加藤実,小川節郎
日大醫學雜誌 67(1), 53, 2008-02-01
NAID 10024169722

重症くも膜下出血の治療 : ニカルジピン徐放剤を用いて

糟谷英俊,恩田英明,氏家弘,山口浩司,川島明次,谷茂,比嘉隆,加藤宏一,久保田有一,岡田芳和,堀智勝
脳卒中の外科 34(4), 274-279, 2006-07-31
… Neither induced hypervolemia nor induced hypertension was used. …
NAID 110004763573

Related Pictures

★リンクテーブル★

リンク元	「低ナトリウム血症」「循環血液量過多症」「多血」「血液量増加症」「polyemia」

「低ナトリウム血症」

Hypervolemia
Classification and external resources
Specialty	endocrinology
ICD-10	E87.7
ICD-9-CM	276.6

　　[★]

英: hyponatremia
同: 低Na血症
関: ナトリウム、高ナトリウム血症、電解質異常

定義

血清ナトリウムが134mEq/L以下の病態。(正常の下限は135mEq/Lとされる)
水とナトリウムのバランスという観点で、2つに分けられる

1. 希釈性低ナトリウム血症 dilutional hyponatremia
2. ナトリウム欠乏性低ナトリウム血症 sodium depletion hyponatremia

疫学

日常臨床上最も頻度の高い水・電解質異常

入院患者の3%、集中治療室患者の30%(IMD)

分類

低ナトリウム血症

偽性低ナトリウム血症

等張性低ナトリウム血症
高張性低ナトリウム血症
低張性低ナトリウム血症：狭義の低ナトリウム血症

病型

ICU.525

循環血減少性低ナトリウム血症：下表で[2]に相当

利尿・副腎不全：　尿中Na > 20mEq
嘔吐・下痢　　　　：　尿中Na < 20mEq

等容量性低ナトリウム血症：細胞外液は増加していないが、水の方が多くなった状態。臨床的に浮腫が無い。下表で[1]に相当

SIADH　　　　：尿浸透圧 > 100 mOsm/L
心因性多飲症　：尿浸透圧 < 100 mOsm/L

循環血増加性低ナトリウム血症：細胞外液にナトリウムと水が増加しており、なおかつ水の方が多い病態：下表で[3]に相当

腎不全　　　　：　尿中Na > 20mEq
心不全・肝不全：　尿中Na < 20mEq

IMD

[1] 細胞外液量増加：組織間質に非常に多量の水と多量のナトリウムが移動。移動する原因は血液のうっ滞、膠質浸透圧の低下など

うっ血性心不全、肝硬変、末期腎不全など。

うっ血性心不全や腹水を伴う肝硬変では、圧受容器が循環血液量の減少を検出してバソプレシンを分泌する(cases.200)

[2] 細胞外液量減少：ナトリウム喪失による。

消化管からの喪失(下痢、嘔吐、腸閉塞など)、熱傷、利尿薬の過剰投与、腎疾患、副腎不全など。

[3] 細胞外液量正常：ナトリウムの摂取・排泄は変わらないが、水が異常に蓄積されるため？　←　最も多いらしい

内分泌疾患(副腎不全、抗利尿ホルモン(ADH)不適合分泌症候群(SIADH)、甲状腺機能低下症)、薬物、水中毒(心因性多飲)など。

[4] 偽性低Na血症

高浸透圧性：高血糖、マンニトール投与など。
正浸透圧性：脂質異常症(高脂血症)、高蛋白血症など。

水とナトリウムのバランスによる分類

	水	Na	体液	摂取と排出はどうなのか？				脱水所見
				IN →○		OUT 　○→
希釈性低ナトリウム血症	過剰	-	多い	[3]	⇒○→	[3]	→○→	無し
					心因性多飲症、低張輸液過多		SIADH
ナトリウム欠乏性低ナトリウム血症	-	過少	少ない		→○→	[2]	→○⇒	有り
					摂食不能		腎性(Addison病、塩類喪失性腎炎、利尿薬の使用) 腎外性(下痢・嘔吐、熱傷、腸閉塞)
	大過剰	過剰				[1]		無し
							うっ血性心不全肝硬変ネフローゼ