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פיזיולוגיה של התייבשות
פיזיולוגיה של התייבשות

ביולוגיה (עברית):פיזיולוגיה השוואתית - מערכת הנשימה, חלק ב (מאי 2024)

ביולוגיה (עברית):פיזיולוגיה השוואתית - מערכת הנשימה, חלק ב (מאי 2024)
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התייבשות, אובדן מים מהגוף; כמעט תמיד זה קשור לאובדן מלח (נתרן כלורי). הטיפול בכל סוג של התייבשות, לפיכך, מחייב לא רק את החלפת המים שאבדו מהגוף אלא גם את שחזור הריכוז הרגיל של המלח בנוזל הגוף.

מחלת תזונה: מחסור במים (התייבשות)

מים הם המרכיב הגדול ביותר בגוף, ומהווים יותר ממחצית ממשקל הגוף. כדי להחליף אבידות נוזלים, מבוגרים זקוקים לרוב

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סיבות

התייבשות עלולה להיגרם כתוצאה מצריכת מים מוגבלת, איבוד מים מוגזם או משניהם. הגורם השכיח ביותר להתייבשות הוא אי שתיית נוזלים. חסך של מים הוא הרבה יותר חמור ממחסור באוכל. האדם הממוצע מאבד כ -2.5 אחוז מכלל מי הגוף ביום (כ -1,200 מיליליטר [1.25 ליטר]) בשתן, באוויר שפג תוקפו, על ידי זיעה בלתי ניתנת לטיפול, ומדרכי העיכול. אם בנוסף לאובדן זה, האובדן בזיעה מוגבר מאוד - כפי שמודגם במקרה של הספן הרוס הספינות בים טרופי או המטייל שאבד במדבר - התייבשות עלולה לגרום לזעזוע ומוות תוך שעות ספורות בלבד. כאשר הבליעה קשה אצל אנשים חולים במיוחד, או כאשר אנשים אינם יכולים להגיב לתחושת צמא בגלל גיל או מחלה או עמום בתודעה,אי הפיצוי על אובדן היומי של מי הגוף יביא במהירות להתייבשות והשלכותיה. כמויות גדולות של מים עלולות גם לאבד מהגוף על ידי הקאות או שלשול.

Symptoms and progression

The symptoms of dehydration depend in part on the cause and in part on whether there is associated salt deprivation as well. When loss of water is disproportionately greater than loss of electrolytes (salt), the osmotic pressure of the extracellular fluids becomes higher than in the cells. Since water passes from a region of lower to a region of higher osmotic pressure, water flows out of the cells into the extracellular fluid, tending to lower its osmotic pressure and increase its volume toward normal. As a result of the flow of water out of the cells, they become dehydrated. This results in the thirst that always accompanies “pure” water depletion.

In those diseases in which there is loss of salt in excess of water loss, the decreased concentration of sodium in the extracellular fluid and in the blood serum results in decreased osmotic pressure, and water therefore enters the cells to equalize the osmotic pressure. Thus there is extracellular dehydration and intercellular hydration—and no thirst.

Water deprivation produces distinctive symptoms in humans. Weight loss, amounting to two to three pounds per day, occurs. Thirst is the most prominent symptom, with the dryness of mouth, decreased production of saliva, and impaired swallowing that accompany it. It is probable that thirst is the result of this subsequent intracellular dehydration and increased intracellular osmotic pressure. Experimentally, thirst can be produced when the cells have lost about 1 percent of their intracellular water.

As dehydration progresses, the tissues tend to shrink, the skin becomes dry and wrinkled, and the eyes become sunken and the eyeballs soft. Fever develops, possibly from mild to marked, as dehydration progresses. Dehydration itself probably affects the temperature regulatory centres in the brain. As dehydration and salt loss progress, however, the plasma volume and heart output decrease, with a consequent decrease in blood supply to the skin. Sweating decreases and may stop completely, and the main avenue for heat loss is closed. The body temperature may then rise precipitously.

There are marked changes in the volume of the extracellular and intracellular fluids, but the blood plasma volume changes the last and the least. The plasma volume is maintained more or less constant at the expense of the tissue fluids. If, however, the plasma volume does fall, the output of the heart also falls, and the pulse rate climbs, all of which indicates a dangerous physical state.

The renal (kidney) changes that occur in humans during prolonged water depletion similarly tend to maintain a normal balance. If water deprivation continues and the plasma volume falls, however, the output of urine will be drastically reduced. As long as urine output of more than 30 millilitres (1 ounce) per hour is maintained, the kidney can excrete nitrogenous and nonnitrogenous solids with maximum efficiency. Once the urine flow is decreased below this level, the kidney is unable to function efficiently, the substances are retained in the body, and their concentration in the blood rises.

The final result of prolonged dehydration is now apparent. The normal distribution of salt and water in the body is destroyed, the plasma volume decreases, and the blood viscosity increases. As a result of these changes renal function is impaired, the urinary output falls, and waste products accumulate. Far more life-threatening, however, is decreased loss of moisture from the skin, with the subsequent rise in temperature, and the fall in cardiac output with the attendant irreversible shock.

Once renal failure occurs, about 8 percent of the total body water has been lost (4 litres [about 4.25 quarts]). When 5 to 10 litres (about 5.25 to 10.5 quarts) of body water have been lost, a person is acutely and severely ill, with contracted plasma volume, increased concentration and viscosity of the blood, renal failure and excessive urea in the blood, and falling blood pressure. In a previously healthy adult, death follows the loss of 12 to 15 litres (about 12.5 to 15.8 quarts) of body water. In the very young, the very old, or the debilitated, death occurs at a lower level of dehydration.

Treatment

The treatment of any form of dehydration depends not only on restoring the depleted water but also on reestablishing normal levels of body electrolytes and limiting the production of nitrogenous waste products. Before any of these therapeutic measures can be applied, however, the initiating cause must be removed. The sailor or the desert traveler must be rescued, the vomiting infant must be cured, or the underlying disease must be treated. Then, after accurate biochemical determinations of the levels of various electrolytes and other blood components have been made and the plasma volume has been measured, the physician may give measured quantities of the appropriate mixtures of salt and water. Given the right amounts of salt and water, the human body will gradually restore the normal relationships between the cells, the extracellular fluid, and the plasma volume. That done, the complicated functions of the kidney will clear the circulating blood of the retained waste products, and the body will have restored its own normal balance.