Mental disorders associated with water and electrolyte disturbances

Introduction to mental disorders associated with water and electrolyte disorders Water and electrolyte disorders caused by various reasons are often encountered in clinical departments of general hospitals. The body water accounts for about 60%, and the brain water content can reach 75% to 80%. Water metabolism is closely related to sodium metabolism, and water is insufficient. Can cause dehydration, and too much water can cause water poisoning, electrolytes high or low, there will be physical and mental disorders. basic knowledge The proportion of illness: 0.01% - 0.05% Susceptible people: no special people Mode of infection: non-infectious complication:

Causes of mental disorders associated with water and electrolyte disorders

(1) Causes of the disease

Common water and electrolyte disorders are as follows:

1. Dehydration (hypertonic syndrome) Dehydration is a physical and mental disorder that occurs due to lack of water in the body. There are three reasons for this: 1) Insufficient water intake, such as disturbance of consciousness, when swallowing, 2 excessive water discharge, Such as high fever, vomiting during gastrointestinal diseases, diarrhea, kidney, liver, lungs and other diseases and long-term use of diuretics, 3, in the case of high concentrations of sugar, salt, protein, etc., causing water deficiency.

2. Water poisoning (hypotonic syndrome) refers to serum sodium as a solute in the body fluid is more serious than water, so it is also called hyponatremia (blood sodium is less than 120mmoL / L), causing hypotonic syndrome There are many reasons: 1 excessive secretion of vasopressin can be seen after surgery, anterior pituitary dysfunction, adrenal insufficiency, excessive drinking of mental patients, 2 sodium ion reduction, clinically common in patients with chronic nephritis or pyelonephritis Long-term use of diuretics, chronic acidosis in diabetes, adrenal insufficiency, severe or persistent vomiting, diarrhea, excessive sweating, etc., excessive sodium loss, and even sodium ions can be moved from the outside of the cell due to potassium deficiency Intracellular and so on.

3. Hyperkalemia Potassium ion, like sodium ion, is one of the important electrolytes in the body's environment. It maintains intracellular enzyme activity, myocardial function, neuromuscular stress, and maintains body fluid tension and acid and alkali. Balance and other plays an important role, the normal serum potassium concentration is 3.5 ~ 5.0nmol / L, the blood potassium concentration is more than 5.5nmoL / L called hyperkalemia, when renal failure, oliguria or anuria when serum potassium Can be significantly elevated, input too much or too fast potassium-containing solution, trauma, hyperkinesia, wasting disease, adrenal insufficiency and hemolysis reaction, heart failure, cardiomyopathy and diabetic acidosis can make potassium Tolerance is reduced, causing potassium poisoning.

4. Common causes of hypokalemia are insufficient intake, fasting, anorexia, and a large amount of fluid replacement in patients with disturbance of consciousness; followed by digestive tract diseases, intestinal obstruction, liver, stomach, and kidneys, resulting in a large loss of digestive juice; renal function Depletion, respiratory or metabolic alkalosis and a large number of long-term use of diuretics and hormones; hypokalemia can also occur during the use of antipsychotic drugs; clinically, a hypokalemia can not be found.

5. Abnormal calcium ion metabolism The concentration of blood calcium is related to the concentration of protein, vitamin D, parathyroid hormone, etc., and calcium is mainly involved in osteogenesis and regulation of neuromuscular excitability. The nerve excitation threshold rises and the nerve conduction velocity slows down.

6. Magnesium ion metabolism abnormality Magnesium ion is one of the main elements in the body. It is related to the secretion of acetylcholine in the nerve interstitial and sympathetic ganglia, inhibiting nerves and muscles, sedating, and neuromuscular excitability when magnesium ions are deficient. Abnormal, generally due to insufficient intake of magnesium, reabsorption of renal tubules, endocrine disorders, long-term fasting, malabsorption, chronic alcoholism, pancreatitis, hypoparathyroidism, hyperaldosteronism, diabetic coma, long-term use Diuretics, blood chlorosis, etc., hypomagnesemia is often accompanied by high blood calcium, water, electrolyte disorders accompanied by mental symptoms are often not a single factor, a variety of factors are common brain function, and in the patient's own personality, Under the influence of psychological stress and other factors, mental symptoms appear.

(two) pathogenesis

The pathogenesis of water and electrolyte disorders accompanied by psychiatric symptoms or disturbance of consciousness is complex, often not a single factor, the main factor of mental disorders in water-electrolyte disorders, and other factors related to the occurrence of mental disorders, such as other biological factors, Including the patient's gender, age, genetic factors, personality characteristics, and past neuropsychiatric history; psychological factors include stress, long-term psychological contradiction; environmental factors, such as residential congestion, environmental pollution, humidity, air pollution, etc. Can be a trigger for mental disorders, which can be summarized as follows:

1. Insufficient energy supply Due to water and electrolyte imbalance, the body's metabolic disorder leads to insufficient energy supply, which causes the normal physiological function of the brain to be disordered. This is the main mechanism for the occurrence of such mental disorders.

2. Cerebral hypoxia can cause microcirculatory disturbances due to water and electrolyte imbalance, which can lead to blood supply to the brain, and insufficient brain oxygenation, which is also an important mechanism for mental disorders.

3. The body's metabolic disorder water, electrolyte imbalance, fluid metabolism and acid-base balance disorder acidosis, alkalosis, hypokalemia, etc., will inevitably affect brain function and neuropsychiatric disorders.

4. Stress reaction water, electrolyte imbalance, exogenous stressors and psychological stressors act on the body, through physiological, neurochemical, neuroendocrine and immune mechanisms, produce a series of physiological and biochemical reactions, in these reactions In the middle, the brain is directly or intermittently affected, causing its normal physiological function to be affected, leading to the occurrence of mental disorders.

5. Individual susceptibility This may be related to genetic factors and individual quality or personality defects. For example, family history of mental disorders caused by physical illness accounts for 2% to 8%, higher than the general group; introverted, impatience, stubborn, willful Physical disorders are prone to mental disorders; those with poor brain function, such as the elderly and children with physical illnesses are prone to paralysis.

Prevention of mental disorders associated with water and electrolyte disorders

The first is the prevention of primary diseases, the prevention and control of water and electrolyte metabolism and the imbalance of acid-base balance. The imbalance of body fluid metabolism and acid-base balance is often the accompanying finding or result of a primary disease. Measures should be taken to prevent such disorders. Occurrence, generally daily intravenous infusion of 5% ~ 10% glucose solution about 1500ml, 5% glucose saline about 500ml, 10% KCl 30 ~ 40ml, supplement daily water and glucose, to save protein catabolism, avoid excessive Ketoacidosis that may occur during fat burning. For patients with fever, generally increase the amount of replenishment from the skin by about 3 to 5 ml/kg for every 1 °C increase in body temperature, and patients with moderate sweating. Loss of body fluid about 500 ~ 1000ml (including NaCl 1.25 ~ 2.50g); a large amount of sweating, loss of body fluid about 1000 ~ 1500ml, tracheotomy patients, the daily evaporation of water from the breath is 2 to 3 times more than normal, About 1000ml, both need to increase replenishment during rehydration. The treatment of body fluid metabolism and acid-base balance imbalance should be determined according to the type of disorder. The general treatment principle is to relieve the cause, supplement blood volume and electrolysis, and correct acid and alkali. Balance imbalance, etc., should be added to the daily demand, the amount of extra loss in the previous day and the previous loss, but the previous loss should not be replenished within 1 day, but should be divided in 2 to 3 days, or even longer Replenishment, so as to avoid excessive liquid entering the body, causing adverse consequences. It must be emphasized that various infusions, electrolyte supplements or adjustment formulas for acid and alkali are only used as a reference for determining the amount and quality of rehydration, and should not be regarded as An absolute rule, as long as the primary disease can be relieved, the continued loss of body fluids is controlled or compensated, and the liquid can be replenished to restore the blood volume and the osmotic pressure of the body fluids. The body's own regulatory capacity can cause body fluid metabolism. And the acid-base balance gradually recovers. Therefore, during the treatment, the changes of the condition should be closely observed, and the type of medication, the speed of infusion and the total amount of infusion should be adjusted in time. At the same time, a scientific and reasonable lifestyle, eating habits can help prevent this disease. Occurrence, better personality, psychology will help to reduce the occurrence of mental symptoms after illness.

Complications of mental disorders associated with water and electrolyte disorders Complication

1. Isotonic water shortage: water and sodium are lost in proportion, so serum sodium is still in the normal range, and extracellular fluid can remain normal. Isotonic water shortage can cause a rapid decrease in extracellular fluid volume. Since the lost fluid is isotonic, the osmotic pressure of the extracellular fluid is substantially unchanged, and the intracellular fluid does not transfer to the extracellular space without compensatory.

2. Hypotonic water shortage: At this time, water and sodium are missing at the same time, but the sodium loss is more than the lack of water, the serum sodium is lower than the normal range, and the extracellular fluid is in a hypotonic state.

3. Hypertonic water shortage: water and sodium are lost at the same time, but water shortage is more, serum sodium is higher than the normal range, and the osmotic pressure of extracellular fluid is increased. Severe water shortage can move the intracellular fluid to the extracellular fluid space, resulting in a decrease in the amount of fluid inside and outside the cell.

Symptoms of mental disorders associated with water and electrolyte disorders Common symptoms Expressions of apathy and psychoactive substances... Directional dysfunction Walking, gastrointestinal numbness, nausea, forgetfulness, irritability, depression

1. Dehydration (hypertonic syndrome) The level of blood sodium in normal humans depends on the ratio of water to solute. High serum sodium concentration can cause hyperosmotic dehydration. Therefore, hypernatremia is usually a manifestation of dehydration. Increased blood sodium (150mmol / L or more), can produce hyperfunction of stress, clinical manifestations of excitatory state, hallucinations, etc., in severe cases, there may be disturbance of consciousness, causing hyperosmolar syndrome and non-ketotic hyperosmolar diabetes And high mannitolemia, its clinical manifestations are mainly excitatory state, hallucinations or disturbances of consciousness, even coma, physical symptoms have thirst, dry mouth, oliguria, but in the elderly or disturbance of consciousness, the above symptoms are active statements Less, should pay special attention to the treatment should be supplemented with liquids that do not cause increased blood sugar or increased blood sodium, such as 0.45% saline or moderate amount of insulin, it is also important to maintain blood circulation and kidney function.

2. Intoxication of water (hypotonic syndrome) Clinical manifestations: mental disorders are often acute onset, mild mental activity, weakness, fatigue, and other inhibition states, indifferent emotions, low speech, slow movement, stupor state, There have also been reports of hallucinatory delusions, severe disturbances of consciousness, lethargy, lethargy, confusion, convulsions, and coma. Most of the nervous system symptoms are caused by cerebral edema or high intracranial pressure or cerebral palsy, such as headache, nausea, and vomiting. , blurred vision, limb muscle strength and muscle tone decline, tendon reflex decline, pathological reflex positive, etc., severe cases may occur seizures, myoclonus, hernia, medullary paralysis and other symptoms, treatment according to clinical symptoms and hyponatremia The reason is to increase the extracellular osmotic pressure, and the mental symptoms do not require special treatment.

3. The clinical symptoms of hyperkalemia are manifested in three aspects: 1 physical symptoms, slow pulse, mild early blood pressure, lower blood pressure, irregular breathing, arrhythmia, etc. 2 neuromuscular symptoms, early manifestation of muscle pain, weakness It is obvious at the end of the extremities, and there are autonomic symptoms such as abnormal numbness and dampness at the end of the extremities. There are tenderness of the gastrocnemius, decreased muscle tone, weakened or disappeared tendon reflexes, and delayed sputum. In severe cases, respiratory muscle paralysis may occur, and 3 mental symptoms may occur. The early manifestations are indifferent expressions, slow response to the outside world, and excitement, emotional instability, restlessness, etc., when severe, there are disturbances of consciousness, lethargy, coma, etc. In addition to the cause of the disease, it is necessary to fight against potassium poisoning and promote potassium. Excretion of ions protects myocardial function.

4. The clinical manifestations of hypokalemia are not only related to the concentration of serum potassium, but also closely related to the rate of hypokalemia. Therefore, in patients with slow onset, although hypokalemia is severe, the clinical symptoms are not necessarily obvious; In acute cases, hypokalemia is not heavy, but the clinical symptoms can be significant. Clinical symptoms can also be divided into 3 aspects. 1 Physical symptoms, lack of appetite, bloating, thirst, nausea, vomiting, chest tightness, palpitation, severe myocardial involvement can lead to Heart failure, 2 neuromuscular symptoms are the most prominent symptoms of hypokalemia, the important manifestations are muscle weakness in the limbs, weakness, weakness, and stagnation and periodic paralysis. 3 Early symptoms of mental symptoms are fatigue, emotional apathy, memory loss, In the state of depression, stupor can also occur. In severe cases, disturbance of consciousness, drowsiness, paralysis, coma, treatment principle, removal of hypokalemia, prevention of hyperkalemia during potassium supplementation, generally with potassium supplementation, clinical symptoms Also recover, such as combined convulsions should pay attention to whether there are other electrolyte changes, especially the regulation of blood calcium, use antipsychotic drugs with caution to prevent hair loss A disturbance of life.

5. The neuropsychiatric symptoms of hypercalcemia are unresponsive, not concerned about the outside world, emotional apathy and memory disorders; there may also be hallucinations, delusions, depression and other symptoms; severe cases may have sleepiness, coma and other disturbances of consciousness.

6. Common neuropsychiatric symptoms of low blood calcium, hand and foot convulsions, epileptic seizures, paresthesia, increased muscle tone, hyperreflexia, muscle tenderness, disturbance of consciousness, etc.

7. Hypomagnesemia can clinically manifest dizziness, muscle weakness, tremors, convulsions, hypersensitivity, nystagmus, movement disorders, hand and foot, coma and other symptoms, but also irritability, depression or excitement, hallucinations, orientation Force disorder, forgetfulness- syndrome.

8. Hypermagnesemia often occurs in renal insufficiency, before treatment of diabetic acidosis, mucus edema, etc., neurological symptoms are mainly inhibitory, central or peripheral nerves are inhibited, paralysis and respiratory paralysis occur, quadriplegia reflexes are slow or disappear Often an important indicator of early hypermagnesemia, mental disorders can also appear drowsiness or coma.

Examination of mental disorders associated with water and electrolyte disorders

A laboratory-positive test result that meets water and electrolyte disturbances.

Auxiliary examination changes in accordance with water and electrolyte disturbances.

Diagnosis and diagnosis of mental disorders associated with water and electrolyte disorders

Diagnose based on

1. There is evidence of water and electrolyte imbalance.

2. There are water, electrolyte disorders leading to the symptoms and signs of the corresponding functional abnormalities.

3. Psychiatric symptoms change with the development of water and electrolyte imbalance symptoms, that is, mental symptoms appear in water, electrolytes are disordered, and developmental changes are parallel with water and electrolyte disorders.

4. Give relevant water, electrolyte treatment has a significant effect.

5. It should be differentiated from other functional declines associated with mental disorders and other functional psychosis such as schizophrenia, snoring and depression.

Differential diagnosis

According to the absence of water, the history of electrolyte disturbances and related symptoms and signs are not difficult to distinguish from other physical diseases associated with mental disorders, schizophrenia and depression.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.