Unfavorable for expressed ...

Unfavorable change over expressed in a typical hyperkinetic delirium, mussitiruyuschim, hyperthermia occurs sopor and coma. Death occurs during the collapse, which may arise during mussitiruyuschego delirium. Case-fatality rate reaches 1,015%. Usually have to deal with two variants tyazheloprotekayuschego delirium. For the first characterized by progressive dehydration and hypovolemia. Having decompensated metabolic acidosis, hypovolemia politsitemicheskaya, the concentration of sodium in blood plasma and decreases its concentration in red blood cells, drops of potassium in plasma and erythrocytes. The second option is accompanied by hyperhydration, increased politsitemicheskoy hypervolemia. There is decompensated metabolic acidosis. Increased potassium content in blood plasma and sodium in erythrocytes decreases the concentration of potassium in erythrocytes and plasma sodium levels. On the severity of the condition can be judged not only by the depth of confusion and progression of neurologic symptoms, but the content of sodium and potassium ions. In a typical delirium tremens sodium content was 2024 umol / L, potassium 6580 micromoles per liter. In severe delirium tremens sodium content (erythrocyte) above 24 micromol / l and potassium 3.5 mmol / liter. With such a violation of hypokalemia and the ratio of potassium and sodium, edema of the brain. When dehydration and hypovolemia skin is dry, hot, facial features, sharp, there is cyanosis of lips, noted wears neck veins, inhibition of reflexes. Arises serchechnososudistaya and respiratory failure. Necessary to conduct rehydration. Introduced more fluid than urine. Treatment is effective if the urine output increased to 400,500 ml. Used 5% glucose, Ringer's solution, isotonic sodium chloride solution, gemodez, reopoliglyukin, dextran. Blood volume filled by the introduction of 14 liters of fluid. Be sure to introduce the ions of potassium, sodium, and tachyarrhythmias, magnesium sulfate, sodium chloride, propranolol, novokainamid. When hyperhydration overcrowding neck veins, peripheral edema, signs of cerebral edema. Used by 1,020% glucose with insulin, 30% solution of potassium chloride, furosemide, mannitol. Woo to the amount of urine on 10% higher than the amount of fluid infused. To combat the metabolic acidosis arising during that and the other variant tyazheloprotekayuschego delirium on the basis of laboratory parameters are introduced 5% sodium bicarbonate, Cocarboxylase, disol, potassium chloride. To increase the level of blood pressure and normalization of vascular permeability using hydrocortisone and prednisolone. With the trend towards lower blood pressure dose of prednisolone is 80 mg, when a kollaptoidnyh states simultaneously introduced no less than 120 mg prednisolone. Of particular importance is the introduction of vitamins complex B. It is believed that in many developed severe delirium tremens, as well as acute encephalopathy GayeVernike due to deficiency of vitamin B1.