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📢 | [Urgent recommendations from medical professionals] Medical collapse is imminent!The risk of death and sequelae of heat stroke is higher than usual!


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[Urgent recommendations from medical professionals] Medical collapse is imminent!The risk of death and sequelae of heat stroke is higher than usual!

 
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Be sure to keep a few bottles of oral rehydration solution in the refrigerator in the summer.
 

Increased burden with emergency transportation for heat stroke, which has similar symptoms to the new corona!Remember how to deal with mild heat stroke that you can do yourself ... → Continue reading

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Oral rehydration solution

Oral rehydration solution(Keikou Hosuiki,British: Oral Rehydration Solution, ORS) IsSaltとGlucoseWas mixed and dissolved in water at an appropriate concentration.fresh waterIt ’s better to drink this than to drinkSmall intestineMainly because the absorption of water indiarrhea-Vomiting-Fever-sweatingbyDehydrationUsed for the treatment of.In addition, the one in the state before being dissolved in waterOral rehydration salt(Keikou Hosuien,Oral Rehydration Salts).

Overview

Dehydration occurs when symptoms such as diarrhea, vomiting, and fever occur for a long period of time or occur frequently, especially in children and the elderly.deadEasy to reach.To prevent this, in hospitals in developed countriesIntravenous dripHydration is performed by.However, the oral rehydration solution can be administered orally, and since it is inexpensive, safe, and the procedure is simple, treatment with the oral rehydration solution is possible.世界Popularized in.

In particularDeveloping countryThen, due to poor hygiene,diarrheaLike to causeInfectionIn addition, even if dehydration occurs due to such an infectious disease, intravenous drip infusion may not be possible because there are not enough medical facilities nearby.For this reasonWHO,UNICEFDistributes oral rehydration solution and promotes educational activities on rehydration treatment in the early stage of onset.And, in fact, the oral administration of oral rehydration solution to dehydrated people had a life-saving effect, so it spread rapidly in developing countries.[1].

On the contrary,Developed countryIn medical treatment, oral rehydration solution was not often used and its spread was delayed because dehydration was treated by intravenous drip infusion.However, especially in developed countries乳 幼 児On the other hand, it is difficult to perform intravenous drip infusion for a long time, and in such a case, hydration with an oral rehydration solution is desirable.

In addition, even if you do not have an intravenous drip infusion kit, you can use an oral rehydration solution, so even if you are dehydrated, you will not be unconscious and you can treat patients who can take it orally.Doctor,nurseEven if it is not, there is an advantage that it can be done on the spot.For exampleheatstrokeThis feature is useful when there is a high degree of urgency, such as the treatment of.Oral rehydration solution is relatively upper in the gastrointestinal tractSmall intestineSince it absorbs water efficiently, the effect is fast.

However, when dehydration becomes severe and unconsciousness, treatment with oral rehydration solution becomes difficult and the risk of aspiration increases. I have to.Therefore, oral rehydration solutions should be started before oral ingestion becomes difficult.

development of

If you have diarrheacolonIt does not absorb enough water, andElectrolyteLoss also occurs.However,Small intestineでSodium ionWhen glucose is absorbed, a mechanism (cotransporter system) is discovered in which water is also absorbed, and if glucose and salt are given at the same time, it is not from the large intestine, which is responsible for most of the normal water absorption, but from the small intestine. It was found that water could be replenished efficiently, which led to the invention of the oral rehydration solution.

An oral rehydration solution made by dissolving appropriate concentrations of glucose and salt in water was able to rehydrate the small intestine even if the large intestine did not function well and diarrhea occurred and water was drained.choleraEven for dehydration caused in the above, it has a life-saving effect as a silver bullet just by giving the patient an oral rehydration solution using a spoon etc., and it has spread rapidly in developing countries.[2].

In addition, it has been regarded as a sick food for a long time.Heavy waterIt is,Starch(GlucosePolymer) Is includedriceIt can be said that it was a food that was boiled and added with a small amount of salt, and that it made sense in terms of hydration.However, in order for starch to be digested by glucose, it is in the digestive tract.digestive enzymeIt differs from oral rehydration solutions in this respect because it must be sufficiently secreted.

composition

Basic

Oral rehydration solutions are basically made of water, glucose and salt.At that time, a glucose concentration of about 1.35 to 4% is suitable.[3]..With glucosesodium TheMoleBecause it is absorbed at a ratio of 1: 1[4]The water absorption efficiency associated with this is also optimized at this molar ratio.[5]. AlsoOsmotic pressureIt is,bloodThe osmotic pressure of 270 (mOsm / L) should be less than[6]..This is because if the osmotic pressure is too high, water is sucked out from the blood, which worsens dehydration.

application

For example, even if you don't have glucose at handsugarSubstitute with water 1literAgainst sugarTbsp 41⁄2(40G), SaltTeaspoon1⁄2By adding (3 grams), a simple oral rehydration solution can be made.In some developing countries, it is popular to put a pinch of salt and a handful of sugar in a glass of boiling water.LGS(lobon-gur solution) Called.

In addition, various compositions have been devised in order to adjust the oral rehydration solution according to the patient's condition.

For example, in vomiting and diarrhea, potassium is lost as much as sodium, so potassium supplementation is also performed at the same time.Potassium chlorideMay be added.If potassium chloride is absent, substitute fruits and vegetables such as apples, bananas, and tomatoes.

Also, for oral rehydration solutionBicarbonateTaking advantage of the fact that the water absorption efficiency is further increased by addingsodium hydrogen carbonateMay be added.It is a precursor of bicarbonatecitric acidMay be added.

Furthermore, while improving the absorption rate and speed from the digestive tract, sugar is added for the purpose of administering calories, and the osmotic salt content is reduced to cope with the evaporation of pure water and sweating during long-term administration. There is also an idea that a product with an increased proportion of pure water is used as an oral rehydration solution.

Recipes

The following is an example of a recipe.

  1. 2003 revised edition of WHO / UNICEF[7]
    • 1 g of glucose + 13.5 g of trisodium citrate dihydrate + 2.9 g of salt + 2.6 g of potassium chloride per liter of water
    In addition, there can be various recipes, but the range is as follows.
    • All: 200-310 mmol / L
    • Glucose: equal to or greater than sodium, but not greater than 111 mmol / L.
    • Sodium: 60-90 mEq / L
    • Potassium: 15-25 mEq / L
    • Citric acid: 8-12 mmol / L
    • Chlorine: 50-80 mEq / L
  2. 1 g of glucose per liter of water,Sodium chlorideDissolved in a ratio of 3.5 g (salt), 2.5 g of sodium hydrogen carbonate (baking soda), and 1.5 g of potassium chloride.
  3. 700 mL of water, 300 mL of unsalted tomato juice (supplementation of potassium, fiber content affects in case of diarrhea), 3 g of salt (1/2 teaspoon), 40 g of sugar (4 and 1/2 tablespoon of white sugar)[8]
  4. For 1 liter of watersugar 40 g, sodium chloride (salt) 3 g
  5. 1 mL of sugar (15 tablespoon), 1 mL of salt (half a teaspoon) for 2 liter of water[9]
    • It cannot be confirmed because there is no primary information, but this is considered to be a mistranslation. WHO's simple recipe states "1 teaspoons of sugar and half a teaspoon of salt for 6 liter of water"[10].

Source

  1. ^ Reducing deaths from diarrhea through oral rehydration therapyBulletin of the World Health Organization, 2000, 78: 1246–1255
  2. ^ Reducing deaths from diarrhea through oral rehydration therapyBulletin of the World Health Organization, 2000, 78: 1246–1255
  3. ^ American Centers for Disease Control and Prevention (CDC), Treatment of Acute Gastroenteritis in Children: Oral Rehydration, Maintenance and Nutritional Therapy MMWR 2003; 52 (No.RR-16): p. 12
  4. ^ Toshinori Hongo et al. (Edit) Standard Physiology (1987) Igaku-Shoin p.683
  5. ^ Toshinori Hongo et al. (Edit) Standard Physiology (1987) Igaku-Shoin p.690
  6. ^ ENAcute_Diarrhoea_reprint.pdf p.6 (2004)
  7. ^ WHO Drug Information Vol. 16, No. 2, 2002
  8. ^ "Let's make delicious ORS" "First aid kit for water" Oral rehydration solution (ORS) story that can be done at home "2006 Health and Cooking Company
  9. ^ Oral rehydration therapy: dehydration and infusion therapy --Merck Manual 18th Edition Japanese Edition
  10. ^ WHO position paper on Oral Rehydration Salts to reduce mortality from cholera

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