
nirjjaleekaranam

shareerashaasthrathil, nirjjaleekaranam ennathu shareerathile motham jalathinte abhaavamaan, athodoppam upapachayam prakriyakal thadassappedunnu. saadhaaranayaayi vyayaamam, rogam allengil uyarnna paaristhithika thaapanila enniva kaaranam soujanya jalakshamam soujanya jala upabhogathe kaviyumbozhaanu ithu sambhavikkunnath. mungal vidagtharil decompression rogathinulla saadhyatha vardhippikkunna immersion diuresis moolavum neriya nirjjaleekaranam undakam.
mikka aalukalkkum budhimuttukalo prathikoola aarogya prathyaaghaathangalo illaathe shareerathile motham jalathinte 3-4% kuravu sahikkaan kazhiyum. oru <aii. dii. 1> kuravu ksheenathinum thalakarakkathinum kaaranamakum. shareerathile motham jalathinte 10 sathamaanathiladhikam nashtappedunnathu kadinamaaya daahathodoppam shaareerikavum maanasikavumaya kshayam undaakkum. shareerathile jalathinte 15-25% nashtappedumbozhaanu maranam sambhavikkunnath. neriya nirjjaleekaranam daaham, pothuvaaya aswasthatha ennivayaal savisheshamaan, ithu saadhaaranayaayi vaayile rehydration vazhi pariharikkappedunnu.
nirjjaleekaranam hypernatremiaykk (rakthathile uyarnna alavil soodiyam ionukal) kaaranamakum, ithu hypovolamiayil ninnu (rakthathinte alavu, prathyekichu raktha plasmayude nashtam) vyathyasthamaan.
adayaalangalum lakshanangalum.
thalavedana, pothuvaaya aswasthatha, vishapp nashtappedal, ookkaanam, moothrathinte alavu kurayal (polyuriya nirjjaleekaranathinu kaaranamallengil), ashayakkuzhappam, vishadeekarikkappedaatha ksheenam, purple viralthumbukal, pidichedukkal thudangiya daaham, neurological mattangal nirjjaleekaranathinte mukhamudrakalil ulppedunnu. shareerathile motham jalakshaamathode nirjjaleekaranathinte lakshanagal kooduthal kadinamaakunnu. neriya nirjjaleekaranam ennu kanakkaakkappedunna 1-2% enna shareerathile jalakshayam vaijnjaanika prakadanatthe durbalappeduthunnathaayi kaanikkunnu. 50 vayassinu mukalilullavaril, shareerathinte daaham praayathinanusarichu kurayumbol, cheruppakkaarum praayamaayavarum thammilulla draavaka upabhogathil vyathyaasamillenn oru patanam kandethi. prayamaaya palarkkum nirjjaleekaranathinte lakshanangalund. nirjjaleekaranam praayamaayavaril rogaavasthaykku kaaranamaakunnu, prathyekichu choodulla kaalavastha polulla bodhamillaatha soujanya jalanashtam prothsaahippikkunna saahacharyangalil. eee vishayathekkurichulla oru cochrain avalokanam jalakshaamathe nirjjaleekaranam ennu nirvachichathu "serem ausmolaality 295 mosmo/kiloyo athil kooduthalo ulla aalukal" ennum praayamaayavaril (65 vayassinu mukalilullavar) pradhana lakshnam sheenamaanennum kandethi.
kaaranam.
nirjjaleekaranathinulla apakada gadakangalil iva ulppedunnu, ennaal ivayil maathram parimithappedunnilla choodullathum eerppamullathumaaya kaalaavasthayil svayam parisramikkuka, uyarnna uyarangalil thamasam, sahishnutha athlattiks, prayamaayavar, sisukkal, kuttikal, vittumaaraatha rogangalumaayi jeevikkunna aalukal.
nirjjaleekaranam palatharam marunnukalil ninnum marunnukalil ninnum oru paarshwafalamaayum varaam.
praayamaayavaril, adhika soujanya jalanashtam (prathyekichu hyper glycemiayumaayi bandhapetta) undaakumbol daaham allengil soujanya vellam labhikkanulla aparyapthamaaya kazhivu ennivaykkulla mangiya prathikaranamaanu nirjjaleekaranathinte pradhana kaaranagal. adhika soujanya vellamo hypotonic vellamo shareerathil ninnu rund tharatthil puratthupokum-ausmotic diuresis, vearp, chharddi, vayarilakkam thudangiya "sensible" nashtam, pradhaanamaayum charmmatthiloodeyum shwasananaalathiloodeyum sambhavikkunna "insensible" jalakshamam. manushyaril, nirjjaleekaranam undaakunnath shareerathile vaattar homeostasis thakararilakkunna vaividhyamaarnna rogangalum avasthakalum moolamaanu. iva pradhaanamaayum sambhavikkunnath onnukil daaham/jala labhyatha allengil soodiyam adikamaayathiloodeyaanu.
roganirnayam.
nirvachanam.
shwaasam, moothramozhikkal, vearp allengil vayarilakkam, chharddi ennivayulppedeyulla mattu kaaranangalal saadhaarana physiological prakriyakal moolam nashtappetta soujanya vellathinu pakaram vellam kazhikkathirikkunnathaanu nirjjaleekaranam. nirjjaleekaranam kadinamaakumbol jeevanu bheeshaniyaakukayum apasmaarangalilekko shwaasakosha sthambhanathilekko nayikkukayum cheiyunnu, koodaathe rehydration amithamaayi vegathilaanenkil ausmotic cerebral edimaykkulla saadhyathayum vahikkunnu.
rakthathile plasmayude alavu kurayunnathine prathyekamaayi soochippikkunna hypovolamiyayude prathyekavum anubandhavumaaya avasthayude proxiyayi "nirjjaleekaranam" enna padam chilappol thettayi upayogichittundu. iva randum manushyarile swatantra samvidaanangaliloode niyanthrikkappedunnu; chikitsa nayikkunnathil vyathyasam pradhaanamaan.
prathirodham.
pathiv pravarthanangalkku, sariyaaya jalamsham nilanirthunnathinulla mathiyaya maarganirddeshamaanu daaham. sareerabhaaram, oorjja chelavu, praayam, lingam, shaareerika pravartthanangal, paristhithi, bhakshanakramam, janithakashasthram ennivaye aashrayich kuranja jala upabhogam vyakthigathamayi vyathyaasappedum. vyayaamam, choodulla anthareekshathil edapedal, allengil daaham kuranja prathikaranam ennivaykku adhika vellam aavashyamaayi vannekkaam. malsarangalil pankedukkunna kaayikathaarangalil, sareerabhaaram kurachittum, daaham vare kudikkunnath prakadanavum surakshyum opttimais cheiyunnu, 2010 leeii kanakkanusarichu, daaham ozhivaakkunnathum vyayaama samayat bharam nilanirthunnathum prayojanakaramaanennu kaanikkunna shaasthreeya padanangalonnum undaayirunnilla.
choodullatho eerppamullatho aaya kaalaavasthayilo kadinamaaya adhwaanathilo jalakshamam ganyamaayi vardhikkum, kaaranam manushyarkk viyarppinulla valuthum vyaapakamaayi maaravunnathumaaya sheshiyund. malsaraadhishtitha kaayika enangalil purushanmaarude muzhuvan shareera vearp nashtappedunnathu manikkooril 2 littar kavian saadhyathayund, kuranja samayadairkhyamulla, uyarnna theevrathayulla choodil vyayaamam cheyyumbol manikkooril 3 muthal 4 littar vare nirakk nireekshikkappedunnu. viyarppiloode ithrayum valia alavil vellam nashtappedumbol, electrolyteukalum, prathyekichu soodiyam nashtappedunnu.
mikka kaayikathaarangalilum 5-5 manikkoor vyayaamam cheyyukayum viyarkkukayum cheiyunnathil 50 emol/lill kuravu vearp soodiyam saandrata ullappol, motham soodiyam nashtappedunnathu motham body storukalude 10 sathamaanathil thaazheyaan (motham storukal ekadesham 2,500 emol allengil 70 kilogram vyakthiyude 58 gram). eee nashtangal mikka aalukalum nannayi sahikkunnathayi thonnunnu. draavakam maattisthaapikkunna paaneeyangalil soodiyam ulppeduthunnathu chila saidhaanthika gunangal nalkunnu, eee draavakangal hypotonic aayirikkunnidatholam kaalam apakadasaadhyatha kuravo illayo cheiyunnu (nirjjaleekaranam thadayunnathinulla pradhana adisthaanam soujanya jalanashtam maattisthaapikkuka ennathaanu).
chikitsa.
cheria nirjjaleekaranathinulla ettavum phalapradamaaya chikitsa kudivellam, draavaka nashtam kuraykkuka ennivayaanu. draavakathinte alavu niraykkunnathinu munbu daaham prakriya thadayunna playin vaattar rakthathile plasmayude alavu maathrame punasthaapikkunnulloo. soolid bhakshanagal chharddiyum vayarilakkavum moolam draavakam nashtappedaan kaaranamakum. nirjjaleekaranam pariharikkappedumbol moothrathinte saandrathayum aavruthiyum saadhaarana nilayilekku madangum.
chila sandarbhangalil, aavashyamaaya vellavum electrolyteukalum (ooral rehydration therapy allengil intravinus therapy vazhi draavakam mattisthaapikkunnathiloo) niraykkunnathiloodeyaanu nirjjaleekaranam sambhavikkunna avasthayude thiruthal saadhyamaakunnath. vaayile rehydration vedana kuravum aakramanaathmakamallaathathum chelavukuranjathum nalkaan eluppamullathumaayathinaal, ithu neriya nirjjaleekaranathinulla chikilsayaanu. intravinus rehydrationaayi upayogikkunna laayanikal isotonic allengil hypertonic aayirikkanam. sirakalilekku kuthivaykkunna shudhajalam chuvanna rakthaanukkalude (erithrosaittukal) thakarchaykku (lysis) kaaranamakum.
shudhajalam labhyamallaathappol (udha.jii. kadalilo marubhoomiyilo), kadaljalamo ganyamaaya alavil madya saandrathayulla paaneeyangalo nirjjaleekaranam vashalaakkum. moothrathil kadaljalathekkaal kuranja laayaniyude saandrata adangiyirikkunnu; ithinu adhika uppu neekkam cheiyunnathinu vrukkakal kooduthal moothram srishtikkendathundu, ithu kadaljalathil ninnu upayogikkunnathinekkaal kooduthal vellam nashtappedaan kaaranamaakunnu. oru vyakthi nirjjaleekaranam neridukayum oru medical kendrathilekku kondupookukayum cheythaal, IVs upayogikkaam.
nirjjaleekaranam, bodhakshayam, allengil mattu gurutharamaaya lakshanagal enniva undaakunna gurutharamaaya nirjjaleekaranam ennivaykku (rogikk nilcano vyakthamaayi chinthikkaano kazhivilla), adiyanthira shradha aavasyamaanu. electrolyte nilayude thudarchayaaya vilayiruthaliloode sariyaaya maattisthaapikkal electrolyteukal adangiya draavakangal vaamozhiyilo intravinasilo nalkunnu; ettavum theevramaaya kesukalilozhike matellaa kesukalilum poornnamaaya resolution saadhaaranamaanu.

