Teaching Experience with Hyponatremia in Burn Patients: Early shock management involves administering a large amount of sodium chloride solution. Students immediately question this, noting that the normal sodium replacement is 5-10g, so why do 50%-100% of patients with burns, such as a 60kg woman, need to be replenished with 3-6 liters of 0.9% sodium chloride? For late-stage hospitalized patients with infections, why is saline still required when they need more calories? Educators should guide students to review the etiology of hyponatremia: (1) continuous loss of gastrointestinal digestive juices, leading to sodium loss along with a lot of digestive fluids; (2) chronic wound exudates; (3) renal excretion of excessive water and sodium. In severely burned patients, circulation permeates into tissue spaces or seeps from the surface. Within 48 hours post-injury, for every 1% burn area per kilogram of body weight, there is a loss of 0.5-0.6 mmol/L. Additionally, about 0.02 mmol of sodium is lost daily through the nose via wounds. Vascular permeability changes simultaneously with the original tissue. Burn areas and surrounding tissues experience changes in cell membrane function, causing Na-K pump failure, which leads to sodium entering cells from the extracellular space, resulting in severe cerebral edema and pulmonary edema. This increases water and electrolyte metabolism imbalance. Sodium's primary physiological function is maintaining extracellular fluid volume. Correcting hypovolemic shock requires a large amount of normal saline to maintain effective circulating blood volume, with fluid volume increasing proportionally to the burn area and sodium exudation. After systemic infections occur, infected burns result in double the sodium loss from wounds. High temperature, vomiting, and reduced food intake due to wound pain increase natriuresis, making hyponatremia more likely, necessitating saline supplementation to meet physical needs.
Clinical manifestations of hyponatremia include fatigue, drowsiness, nausea, vomiting, hand and foot cramps, lack of facial expression, atheism, blurred vision, muscle twitching, weakening or disappearance of tendon reflexes, increased pulse rate, and fainting upon standing. This is because sodium deficiency reduces extracellular fluid osmotic pressure and volume, stimulating increased secretion of antidiuretic hormone by the posterior pituitary, enhancing water absorption and potentially causing oliguria. As circulating blood volume continues to decline, metabolites accumulate in the body, leading to acidosis, azotemia, and organ dysfunction, especially affecting the brain. Symptoms may include confusion, muscle spasm pain, weak alkaline muscle Arab Spring reflection, and coma. The sodium method involves using a formula to complement the mmol of sodium, supplying 17 mmol of sodium chloride = 1g sodium severely. It is necessary to use 3%-5% sodium chloride solution. Remind students that daily supply should only be half of the demand, approximately 4.5g, without being overly anxious, as it is difficult to correct hyponatremia within one week. Rapid correction of hyponatremia can cause neurological diseases like central pontine demyelination, manifesting as paralysis. Using hypertonic 10% sodium chloride plus 5% glucose diluted to 3% is safer. Hyponatremia involves clinical subjects that interns must master. New ways to grasp the context effects are essential in foreign language teaching.
Keywords: relevance theory; contextual effects; communication; circle words in foreign language teaching: G420 Document code: A Article ID: 1008-7702 (2OO2) 02-0173 - 03
Context is a psychological construct involving not just specific contextual factors but also including real-time object environments and knowledge factors, such as known facts, assumptions, beliefs, and a person’s cognitive abilities. Therefore, in language communication, understanding the speaker’s intent goes beyond language itself and depends on communication-specific scenario factors and each individual’s potential income. Example: (in a store, a salesperson) "We are about to close."