Near Drowning

Sheila McCullough
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Abstract

causing hemodilution and possible hyponatremia and hypokalemia. The resultant change in plasma tonicity and electrolyte abnormalities can lead to secondary red cell hemolysis. This hemolysis by itself can impair oxygen delivery to the tissues. Fresh water, in addition to the hemodilution, also inactivates the surfactant within the alveoli. This alters alveolar surface tension and can result in alveolar collapse and pulmonary atelectasis. The ventilation/perfusion mismatch caused by perfused but unventilated lung regions causes hypoxemia, which can be severe. This can be potentiated by the mere presence of water in the alveoli and interstitium, acting as a diffusion barrier. This intrapulmonary shunting and barrier to oxygenation of the blood further hampers oxygenation of the tissues. In contrast, salt water pulls fluid into the alveoli because of its hypertonicity. This fluid comes from the vasculature, and if significant enough, it can cause a depletion of the intravascular fluid volume. Hypovolemia, hemoconcentration, and hypotension may result. This, in turn, can lead to decreased tissue perfusion and tissue hypoxia. Salt water does not inactivate the surfactant, so atelectasis is not typically a component of this syndrome. The electrolyte abnormalities involved in salt water aspiration are primarily hypernatremia, with a possible increase in serum calcium and magnesium based on the mineral content of the water. Despite the initiating physiology, the end pathology Peer Reviewed
靠近溺水
导致血液稀释和可能的低钠血症和低钾血症。由此引起的血浆强直性改变和电解质异常可导致继发性红细胞溶血。这种溶血本身会损害组织的氧气输送。淡水除了能稀释血液外,还能使肺泡内的表面活性剂失活。这改变了肺泡表面张力,可导致肺泡塌陷和肺不张。由灌注但不通气的肺区引起的通气/灌注错配可导致严重的低氧血症。这可以通过肺泡和间质中存在水而增强,作为扩散屏障。这种肺内分流和血液氧合障碍进一步阻碍了组织的氧合。相反,盐水由于其高渗性而将液体拉入肺泡。这种液体来自脉管系统,如果足够严重,它可以导致血管内液体体积的消耗。可能导致低血容量、血浓度和低血压。这反过来又会导致组织灌注减少和组织缺氧。盐水不会使表面活性剂失活,因此肺不张不是该综合征的典型组成部分。盐水吸入引起的电解质异常主要是高钠血症,根据水的矿物质含量,血清钙和镁可能升高。尽管最初的生理,最终病理同行评审
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