Section II: Liquid Balance
Sufficient fluid intake is a basic physiological requirement. No food person can survive for several weeks, but no water can survive for a few days. Fluid balance refers to the balance between loss (through the kidneys, skin and lungs or other channels) and intake (through digested fluids and foods). If fluid intake is below and lost due to illness, fluid balance may become a key issue. Loss of fluids due to diarrhea kills two to three million children each year in developing countries.
Normal-sized adults lose 1,500 cc to 2000 cc of water per day. Excretion of one to two liters of water per day through the kidneys is a “dominant (perceivable) loss;†in addition, it is tempered by perspiration (even in cold weather) and the evaporation of moisture in the lungs (moistening the air inhaling the lungs). The loss in the climate and low-altitude environment has risen to half a liter of water, and this loss is known as "hidden loss." In hot weather or when a patient has a fever, you can lose a few liters of water through excessive sweating. At high altitudes, the daily loss of water through the lungs can be as high as 4 liters.
Salts (sodium chloride), potassium and sodium bicarbonate (collectively referred to as electrolytes) are the key elements in body fluids. These elements, like water, need to maintain the balance of intake and loss. The average daily salt requirement for adults is 3 grams. When salt is lost through massive perspiration, the body needs more salt to maintain balance.
In general, the kidneys are very sensitive to changes in fluid balance in the body and can be quickly adjusted by retention or excretion. Urine volume and color are very reliable indicators of body fluid balance. 24-hour urine output below 500 cc or dark yellow or orange urine shows a serious loss of fluid; while urine output of 2000 cc and very light color indicate high fluid intake.
These moisture and electrolyte requirements reflect the physical needs of healthy adults. Patients with heart or kidney disease who cannot rule out excess salt and moisture may have very different index requirements. To give water and salt to such patients according to the standards of normal adults can have serious consequences.
When certain diseases, such as dysentery, cholera, vomiting, or diarrhea cause massive loss of fluids, it is necessary to correctly estimate and supply the appropriate intake. The "hidden loss" part must also be taken into account, including fever, ambient temperature and high altitude. Recording the patient's flow quality can help ensure that enough intake is planned. These data should be recorded in order to calculate the patient's fluid quality requirements.
Although urine volume and color are good indicators of fluid balance in the body, it is the response that has already occurred. Through the timely intake and loss records, you can more accurately grasp the status of patients with fluid imbalance.
High altitude dehydration
The increase in altitude and the decrease in ambient temperature linearly aggravate the body's tendency to dehydrate. Above 5,500 meters, almost all walkers and climbers are dehydrated! Some medical researchers believe that many high-altitude symptoms such as depression, depression, poor judgment, and other psychological and mental changes that were originally thought to be due to tissue hypoxia are actually due to dehydration.
The main reason for high altitude dehydration is that the human body breathes colder air faster and deeper. When passing through the upper respiratory tract, the air is heated to body temperature and saturated. The relative humidity reaches 100% when the air reaches the lungs. The cold air contains almost no water (the saturated vapor pressure of air at -15 degrees Celsius is only 1.24 millimeters of mercury), and the human respiratory tract needs more moisture to moisturize. Most of the heat and moisture consumed by this process is lost with exhaled exhaust gas (the upper respiratory tract can recover part of the moisture when exhaling the exhaust gas, but most of the gas is exhaled through the oral cavity not through the upper respiratory tract). In addition, losing a lot of heat by evaporating moisture and inhaling air by heating is an important factor in the loss of temperature at high altitudes.
If the climber ignores the need to adjust the clothing to minimize perspiration, especially when ignoring the need to add warm clothing in a timely manner at high altitudes, the body fluid may be lost more unnecessarily.
Loss of fluid intake at high altitudes often leads to dehydration. In addition, the suppression of thirst feeling due to the need to carry fuel, snow to obtain drinking water, and the acute mountain sickness such as loss of appetite, nausea and even vomiting all lead to a decrease in fluid intake.
At high altitudes, climbers must consciously force themselves to drink plenty of water. It is not reliable to rely on whether you feel thirsty or not! Between 4600 and 4900 meters above sea level, the body's demand for fluids often exceeds 4 litres per day. Urine volume and color accurately show whether the body is dehydrated. Dark dark urine - orange snowflakes instead of light yellow - and no morning urine feeling are signs of severe dehydration.
Supplementary fluids
Drinking more water is the simplest and most reliable way to supplement fluids. Almost all non-alcoholic liquids are OK, but juices, soft drinks, soups, and similar liquids are better because of the lack of electrolytes in pure water. (Coffee, tea, and hot chocolate are less suitable because they contain caffeine, and caffeine has a diuretic effect that speeds up fluid discharge in the kidneys.)
Tip: Non-alcoholic, decaffeinated juices, beverages, and soups provide better fluids than pure water!
Seriously injured patients often refuse to drink fluids and eat because of loss of appetite. However, they can still be convinced to drink a small amount, even if it sucks two or three every 15 to 20 minutes. If persisted, peers continue to encourage, these wounded patients may be convinced a few liters of liquid for 24 hours.
Some patients, especially malignant vomiting or coma, cannot take fluids through the esophagus. If they can get medical care within a day or two, the loss of fluids will not be exacerbated. Short-term water shortages are not particularly serious. However, if it takes longer and other functional disorders increase fluid loss, severe dehydration may result. In the absence of rectal suppositories that control vomiting, such as Compazine or Phenergan, fluids must be added intravenously.
Intravenous injection must be given by a person with relevant knowledge and operating experience! Intravenous fluids cannot be temporarily prepared, so they are usually carried by only a few expeditions. However, such flow agents are left behind by the expeditionary team and are often easily found in areas frequented by some teams. Although the flow agent labels are different in different countries, the basic ingredients are usually marked with chemical symbols or English.
The quality of intravenous fluids needs to be determined on a daily basis. There must be sufficient dose to supplement normal or abnormal fluid loss. Without abnormal fluid loss, 2 litres of glucose at a concentration of 5 per cent and 500 ml of saline-containing electrolytes (preferably balanced salt solution, which can be saved without ordinary salt) can meet the daily needs of the injured. . Loss of fluid due to vomiting, dysentery or excessive perspiration should be supplemented with electrolyte solution. Hyperventilation caused by high levels of excess fluid in the lungs should be replenished with glucose fluid because the body's electrolytes are not lost through exhalation. In other words, at high altitudes, unless there is a lot of perspiration, it is the best way to supplement fluids by drinking water and giving glucose fluids to injured people.
The potassium content of most electrolyte solutions is very low. People with kidney disease cannot excrete excess potassium on their own, and the potassium concentration in the victim's body may rapidly accumulate to a fatal degree. However, people with normal kidney function can excrete excess potassium through the urine. If potassium is not added in a timely manner during prolonged intravenous treatment, the potassium content of the injured blood may be reduced to dangerous levels. Therefore, potassium should be added to the flower at 15 to 20 mEq per liter for wounds that have been administered intravenously for more than two to three days, or if the diarrhoea is deprived of much water but the function of the kidneys is normal. (It is difficult to obtain such potassium salt additives outdoors; such potassium salts are usually supplied as a solution and can be added directly to the electrolyte flow agent).
If you have a healthy heart and a functioning kidney, supplement with enough water (such as glucose) and electrolytes (balanced salt solution), the body itself can compensate for imbalances in the regulation of fluids; it can also automatically adjust for errors in fluids that are unavoidable in diagnosis and treatment. However, if you have a history of heart disease, especially congestive heart failure, kidney disease, or injury caused by acute kidney failure due to illness, you may only be referred by a medical professional or hospital. For these types of injuries, errors in diagnosis and treatment all exist in the flow agent that cannot be confirmed enough to measure.
Experience with Everest climbers: Drink 1 to 2 liters of water 1 to 2 hours before departure. You will feel the difference in your climbing status! (From "The Everest Survival Handbook" by explorersweb.com A LittleCute-it-All)
[Tips]: High-altitude climbers drink water on a day (4 to 5 litres for extremely high altitude climbers). Arrangements: 1 to 2 liters of water in the morning before departure, 1 litre in action, and 1 litre after camping. Dinner is supplemented with 1 litre before going to bed. Pay attention to your own urine output and color changes! Timely replenishment of adequate fluids, prevention of dehydration and warmth are the top two survival rules of the mountain!
Basic Medical Care and First Aid in "Yangye Medical" - Medical Care
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