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Seizure from dehydration: Dehydration Health Risks 101 | Everyday Health

Dehydration Health Risks 101 | Everyday Health

Among the most common health risks associated with dehydration is heat illness (the heat being your core temperature, not the heat outside). It frequently goes hand in hand with dehydration, particularly in hot weather. This is because losing fluid volume can affect your body’s ability to keep itself cool; and in turn, rising body temperature can lead to more fluid loss. (6)

“Our body’s primary mechanism for cooling is sweating and evaporation. That evaporation helps you to cool at the skin level,” says Sanjey Gupta, MD, the chair of emergency medicine at Southside Hospital in Bay Shore, New York. With dehydration, you actually can run out of fluid to produce sweat. “So you have lost that mechanism to cool.”

Kevin Coupe, MD, an orthopedic surgeon with Memorial Hermann Ironman Sports Medicine Institute and UT Physicians in the Woodlands, Texas, has seen numerous athletes — students, professionals, weekend warriors — suffer heat illness due to overexertion, particularly in warm weather. He points out that humid weather can also play a role in disrupting the body’s cooling mechanism.

Dr. Coupe describes the three stages that medical professionals commonly use to classify heat illness: (6,7)

Heat Cramps

This is by far the most commonly experienced stage, says Coupe. “That’s where patients who are athletes have overheated. They are sweating profusely, and they feel very hot. They start to feel cramps, and it is usually in the muscles that are associated with the activity they are involved in. For instance, with runners it is the muscles in their calves.” Other common areas for heat cramps include the arms and legs. Pausing physical activity, drinking fluid and gently stretching cramped muscles will usually address heat cramps. (6)

Heat Exhaustion

“By [this point] the person will start to get more systemic symptoms,” says Coupe. “They will get confused and light-headed, sometimes having nausea. They are still sweating profusely, but their skin is kind of cool.” If the problem isn’t addressed, it can rapidly escalate. “Your skin becomes very hot dry and red. Your body is unable to cool itself down. You can become unconscious, have seizures, and actual vomiting.”

Additional signs of heat exhaustion include excessive thirst, weakness, and headache. Your core body temperature can rise to 104 degrees F in this stage. An affected person should be moved to a cool place, fanned with cool air or have ice applied to their skin to bring their temperature down. If they’re conscious, give them fluids and get them medical attention as soon as possible. (6)

Heatstroke

“Then you pass over into the critically ill stage,” Coupe explains. “With heatstroke your core body temperature can rise it to 105 degrees F and you actually start damaging cells, your heart muscle, brain, and lungs. Your internal organs start to become damaged.” A person in this stage can slip into a coma. A call to 911 is in order for anyone suffering from heatstroke. While you’re waiting for emergency services to arrive, immerse a person with heatstroke in an ice bath or apply ice packs to the arms, neck, and groin areas. Be sure to remove his or her clothing.

Heatstroke can be fatal. But, Coupe says, “it’s pretty rare that patients get that far.” (6)

10 Dehydration Myths and Facts

Hydration is one of those things you know you should be on top of, but you may not fully understand why.

“Hydration is important because our bodies really function [best with] adequate water balance,” says Shilpi Agarwal, MD, a board-certified family medicine physician in Washington, DC, and the author of The 10-Day Total Body Transformation. “Most organ functions require water in the right proportion to work — meaning your muscles, heart, and kidneys all need water and also need the body to be adequately hydrated in order to work properly.”

And what about dehydration, to some a scary word that may be associated with health issues big and small? “Mild dehydration can lead to dizziness, fatigue, flushed skin, headache, impaired physical performance, and confusion,” explains Malina Malkani, RDN, who lives in Rye, New York, and is the creator of Solve Picky Eating, a program for parents of finicky eaters. If unaddressed, more extreme dehydration can even cause problems like labored breathing, increased body temperature, poor blood circulation, and seizures, Malkani adds. And according to the Harvard T.H. Chan School of Public Health, dehydration can contribute to urinary tract infections and kidney stones.

To clear up confusion around hydration and dehydration, here are 10 things you must know to keep your health in tip-top shape.

1. Myth: If You’re Thirsty, You’re Already Dehydrated

There is some truth to this widely repeated statement. “This can be a really helpful reminder to people, because many of us aren’t very in tune with our thirst, so once we realize we’re thirsty, our body really is calling out for water,” says Ginger Hultin, RDN, the Seattle-based owner of Champagne Nutrition and the author of Anti-Inflammatory Diet Meal Prep.

But it’s not a one-size-fits-all indicator. “Each person needs to assess if this is actually true for them, because there are a lot of reasons a person can be thirsty. It’s not 100 percent always because of dehydration,” says Hultin.

For example, something as simple as spicy food may make you thirstier than normal, according to the Cleveland Clinic. A sharp increase in thirst may also be a sign of a health problem like diabetes. It could be a side effect of a medication you’re taking; certain drugs cause dry mouth without causing dehydration per se. Regardless, it’s worth talking to your doctor if you’re much thirstier than normal to determine the underlying reason.

2. Fact: Dark Yellow Urine May Signal That You’re Dehydrated

If you’re concerned you’re not drinking enough water, try this quick trick: Check your urine color. “Urine color can be a pretty good indication of hydration status,” says Hultin.

An eight-level urine color chart lays out urine color from clear to dark yellow or brown — as posted by the U.S. Army Public Health Command. Though everyone is different, explains Hultin, the lightest four colors indicate that you’re hydrated, and the darkest four may mean that you’re dehydrated. If your pee falls in the brown range, you should seek medical attention, as Hultin advises this could mean severe dehydration.

RELATED: Genius Hacks That Can Help You Drink More Water

3. Myth: To Avoid Dehydration, Drink as Much Water as You Can

When it comes to water, some people overdo it.

“There’s a condition called hyponatremia, and it happens when the concentration of sodium in your body — which is an electrolyte — gets too low,” says Hultin. “This actually causes the cells in your body to swell, and it is a life-threatening condition.”

While anyone can develop hyponatremia (so-called water toxicity), certain groups are at an elevated risk. That includes individuals with kidney failure, congestive heart failure, liver dysfunction, chronic severe vomiting or diarrhea, Addison’s disease, and people on some medications, such as antidepressants and diuretics, according to the Cleveland Clinic and Mayo Clinic. Research has shown that endurance athletes may also be at risk for hyponatremia. Previous scientific evidence points to certain illegal drugs, like ecstasy or MDMA, which may put users at risk for hyponatremia.

If you don’t have one of these risk factors or conditions, don’t fret. “For most healthy individuals, overhydration isn’t a serious concern, because the kidneys are able to excrete any excess fluid to maintain water and electrolyte balance, Malkani says.

When severe, symptoms of hyponatremia, MedlinePlus notes, can include convulsions, confusion, fatigue, headache, nausea, and muscle weakness. Seek medical attention immediately if you have these symptoms, especially if they’re severe.

4. Fact: Some Groups Are at Higher Risk of Dehydration Than Others

Meanwhile, some people need to prioritize hydration.

“[Dehydration is] very dangerous for children, pregnant women, and some older adults,” says Hultin. “Especially if someone in these categories is sick with a fever, vomiting, or diarrhea, they may need medical attention quickly to assess their hydration status.”

According to the Mayo Clinic, severe vomiting and diarrhea is often the main cause of dehydration in children. Meanwhile, older adults can actually have a lower volume of water in the body, and certain medications and conditions can make matters worse, the Mayo Clinic also notes. And severe morning sickness in pregnant women, known as hyperemesis gravidarum, can cause vomiting and lead to dehydration, per the National Health Service.

RELATED: 6 Unusual Signs of Dehydration You Should Know About

5. Myth: You Can Get Hydrated Only by Drinking Liquids

Time to fill your grocery cart with produce — turns out, beverages aren’t the only provisions that will rehydrate you.

“While about 80 percent of our fluid intake comes from liquids, roughly 20 percent comes from the liquid found in watery foods like juicy fruits and vegetables,” explains Malkani. For example, the Mayo Clinic notes that some produce — like watermelon and spinach — is nearly 100 percent water by weight. Other hydrating foods include cucumbers, celery, radishes, watercress, grapefruit, cantaloupe, and strawberries, Malkani adds.

“On the flip side, salty foods and foods high in sodium are dehydrating because when the salt is absorbed and starts circulating in the blood, the body responds by drawing water out of the body’s cells to balance things out, causing increased thirst,” Malkani adds.

6. Fact: Too Little Sleep May Dehydrate You

Yet another reason to snooze enough: Adequate z’s may help you stay hydrated. A study published in February 2019 in the journal Sleep found that people who slept six hours each night were more dehydrated than those who regularly slept eight. A potential reason? Scientists point to the disruption of vasopressin, a hormone released at night that helps your body maintain its hydration status. If you feel off after a short night of sleep, rehydrate in the morning.

RELATED: The Top Hydrating Fruits

7. Myth: Everyone Needs 8 Glasses of Water a Day to Avoid Dehydration

Like most things in health, hydration goals vary. “There will be a range of what people need — it’s based on many factors, including physical activity, your diet and the environment that you live in, among others,” says Hultin. Other factors to consider are underlying health conditions, gender, age, and whether you are pregnant or breastfeeding.

The most recent guidelines from the National Academy of Sciences, Engineering, and Medicine, in 2006, recommend 15 cups of fluid for men and about 11 cups of fluid for women daily. But again, it depends. Ask your primary care physician what your hydration goals ought to be if you’re concerned about dehydration.

RELATED: The Best Times to Drink Water

8. Fact: Having a Respiratory Illness, Such as COVID-19, Makes Hydration Especially Important

If you develop COVID-19, be cognizant of potential dehydration.

“Any health issue that increases fluid excretion — such as vomiting, diarrhea, or increased sweating from fever — increases fluid needs,” says Malkani. As the Centers for Disease Control and Prevention notes, COVID-19 may cause those symptoms and others. If you have the respiratory illness, swig more fluid than you normally would to replace what you’ve lost, advises Johns Hopkins Medicine.

Researchers also hypothesize that drinking enough water may help prevent or improve COVID-19 outcomes, as noted in an article published in November 2020 in Medical Hypotheses. That said, more studies are needed on the possible association between inadequate hydration and COVID-19 infection and severity.

9. Myth: If You’re Dehydrated, Drinking More Water Is the Remedy

Again, it depends on the situation. According to the Mayo Clinic, it’s important to see a doctor for extra medical care if you’ve had diarrhea for 24 hours or longer, feel disoriented and more tired than normal, can’t keep liquids down, or have black or bloody stool.

More moderate cases of dehydration usually require an IV of fluids, which you can get at an urgent care center, an emergency room, or the hospital, the Cleveland Clinic notes. But if your case is severe, you may need to call 911 or visit an emergency room.

The Cleveland Clinic also notes that for mild cases of dehydration, you may benefit from a drink that contains electrolytes such as sodium, potassium, and magnesium. This is especially important if you’ve been sweating, vomiting, or experiencing diarrhea, which leads to loss of electrolytes that are also needed to maintain adequate blood pressure.

RELATED: What Are the Health Risks of Dehydration?

10. Fact: Sometimes You Can Mistake Hunger for Thirst

Are you hungry or simply craving a treat? Have a glass of water before you decide. “Sometimes, it can help you actually recognize hunger signals,” Agarwal says. After that refreshment break, you may realize you were just thirsty, and not in need of a full-on snack or meal. (On the other hand, you may realize you really do want a healthy snack!)

Bonus: Drinking water before eating may help you lose weight if that’s one of your goals. One small study found that drinking about two eight-ounce glasses of water 30 minutes before each meal of the day helped people with obesity lose almost three pounds after 12 weeks, compared with a control group who didn’t drink the H2O before each meal. Authors of a study of young adults without obesity, which was published in October 2018 in Clinical Nutrition Research, wrote that drinking water before (though not after) meals increased satiety.

Dehydration can lead to serious complications

Dehydration occurs when you use or lose more fluid than you take in, and your body doesn’t have enough water and other fluids to carry out its normal functions. If you don’t replace lost fluids, you will get dehydrated.

Common causes of dehydration include vigorous exercise, especially in hot weather; intense diarrhea; vomiting; fever or excessive sweating. Not drinking enough water during exercise or in hot weather even if you’re not exercising also may cause dehydration. Anyone may become dehydrated, but young children, older adults and people with chronic illnesses are most at risk.

You can usually reverse mild to moderate dehydration by drinking more fluids, but severe dehydration needs immediate medical treatment. The safest approach is preventing dehydration in the first place. Keep an eye on how much fluid you lose during hot weather, illness or exercise, and drink enough liquids to replace what you’ve lost.

COMPLICATIONS

– Heat injury. If you don’t drink enough fluids when you’re exercising vigorously and perspiring heavily, you may end up with a heat injury, ranging in severity from mild heat cramps to heat exhaustion or potentially life-threatening heatstroke.

– Swelling of the brain (cerebral edema). Sometimes, when you’re getting fluids again after being dehydrated, the body tries to pull too much water back into your cells. This can cause some cells to swell and rupture. The consequences are especially grave when brain cells are affected.

– Seizures. Electrolytes – such as potassium and sodium – help carry electrical signals from cell to cell. If your electrolytes are out of balance, the normal electrical messages can become mixed up, which can lead to involuntary muscle contractions and sometimes to a loss of consciousness.

– Low blood volume shock (hypovolemic shock). This is one of the most serious – and sometimes life-threatening – complications of dehydration. It occurs when low blood volume causes a drop in blood pressure and a drop in the amount of oxygen in your body.

– Kidney failure. This potentially life-threatening problem occurs when your kidneys are no longer able to remove excess fluids and waste from your blood.

– Coma and death. When not treated promptly and appropriately, severe dehydration can be fatal.


Milk better than water to rehydrate kids: study


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Relationship between Changes in Serum Sodium Level and Seizures Occurrence in Children with Hypernatremic Dehydration

Iran J Child Neurol. 2013 Autumn; 7(4): 35–40.

Farhad HEYDARIAN

1Research Center for Patient Safety, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Arezou REZAEIAN

2Pediatric Ward, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

1Research Center for Patient Safety, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2Pediatric Ward, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

Corresponding Author: Heydarian F. MD Pediatrics Ward, Ghaem Hospital, Ahmad Abad St., Mashhad, Iran Tel: +98 511-8012469 Fax: +98 511-8417451 Email: [email protected]

Received 2013 May 14; Revised 2013 May 30; Accepted 2013 Sep 14.

Copyright © 2013: Iranian Journal of Child NeurologyThis is an Open Access article distributed under the terms of the Creative Commons Attribution License, (http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.This article has been cited by other articles in PMC.

Abstract

Objective

To assess any relationship between serum sodium changes and seizure occurrence in children aged 2 months to 5 years with hypernatremic dehydration.

Materials & Methods

This cross-sectional study was performed on 63 patients aged 2 months to 5 years from 20 March 2006 to 15 March 2012 at Ghaem Hospital and Dr. Sheikh Hospital in Mashhad, Iran. Patients were divided into 2 groups: case group with hypernatremic dehydration and seizure occurrence, and control group with hypernatremic dehydration and no seizures.

Results

The mean age of patients was 10.38 (2-48) months. Thirteen patients had seizures, 11 out of them, before admission and 2 during hospital staying. Serum sodium level at admission in those 2 patients with seizure occurrence after hospitalization was 169 (158-180) mmol/L, and in 50 patients without seizure was 162.8 (148-207) mmol/l. Also, the rate of decrease of serum sodium levels in these 2 cases within the first 12 hours after admission was 1.12, and in those without seizure was 0.54 (mmol/L/hour), and it was 0.47 and 0.53 (mmol/l/ hour) after 24 hours of admission, respectively. Severe dehydration was seen in 38.5% of cases and 14% of controls.

Conclusion

There was not any relationship between changes in serum sodium level and seizure occurrence in children with hypernatremic dehydration.

Key Words: Hypernatremia, Seizure, Dehydration, Children

Introduction

Seizures occur in children commonly and some studies are performed concerning their different contributing factors (1-5).

Hypernatremic dehydration can be seen with gastroenteritis. Seizures may occur as a complication of the treatment of hypernatremic dehydration. It has been suggested that the rate of decreasing of serum sodium levels should be maintain between 10-15 mmol/L/24hr (6-8). Cerebral edema and seizure can be consequences of rapid correction of serum sodium level in these patients in whom the rate of fluid and sodium administration are inappropriate (9-11).

In one study (12), the relationship between cerebral edema occurrence and rapid rate of fluid administration were detected.

Another study (13) demonstrated that seizures occurrence is associated with rapid decrease in serum sodium levels at 24 hours after admission.

One other study (6) showed that there was no relationship between seizures occurrence during hospital staying and the rate of decreasing of sodium during treatment of patients.

Also, in another study (14), which was performed on adult patients, it was concluded that there was not any relationship between dysnatremia complications consisted of neurologic disturbances and rate of changes in serum sodium Considering the importance of seizure occurrence during hypernatremic dehydration in children and also due to some contradictory results of previous studies, we conducted this study to evaluate the relationship between seizure occurrence and serum sodium level changes in children with hypernatremic dehydration.

Materials & Methods

The present study was conducted as a cross-sectional study on 63 patients aged 2 months to 5 years from March 2006 to March 2012 at Ghaem Hospital and Dr. Sheikh Hospital, Mashhad, Iran. Patients divided into 2 groups: cases with hypernatremic dehydration and seizure occurrence before admission or after hospitalization and controls with hypernatremic dehydration without seizure. Data consisting of age, gender, severity of dehydration, serum sodium levels at admission, 12 and 24 hours after hospitalization, seizure occurrence, andthe rate of sodium and fluid administration were recorded. The amount of administered sodium included those patients who took ≤60 mEq/L or those who received>60 mEq/L in 24 hours. The administered fluid was consisted of those patients who took ≤1.5 times maintenance and those patients who received>1.5 times maintenance in 24 hours.

Hypernatremia was considered when serum sodium level was above 145 mmol/L. The inclusion criteria were patients aged 2 months to 5 years old with gastroenteritis related hypernatremic dehydration.

Exclusion criteria were severe malnutrition, meningitis, hypoglycemia, hypocalcemia, hypomagnesaemia, neurodevelopment delay, congenital heart disease, any history of epilepsy, and incomplete data in records.

This study was approved by the Ethics Committee of Mashhad University of Medical Sciences, and was performed according to the principles of the Helsinki Declaration.

Data were analyzed through SPSS software version 16. Quantitative and qualitative data were analyzed by Mann-Whitney and Chi-square tests, respectively. A value of p<0.05 was considered statistically significant for all tests.

Results

Thirty-one (49.2%) patients were male and 32 (50.8%) were female. The mean age of patients was 10.38 months (2-48). Thirty-nine (62%) patients had moderate dehydration, 12 (19 %) had mild dehydration, and 12 (19%) had severe dehydration. The mean sodium level at admission was 163.1 (148-207) mmol/L and it was 151.2 (139-177) mmol/L, 24 hours after hospitalization.

In , some data of patients with seizures and without seizures are shown.

Table1

Some Data Of Dehydrated Hypernatremic Patients With Seizures and Without Seizure

With seizures (13 patients) Without seizures (50 patients) p-value
Gender Male
female
8 (61.5%)
5 (38.5%)
22 (44%)
28 (56%)
0.32
Age (month) 9.5 9.2 0.72
Weight (gram) At admission 7323.85 7556.2 0.78
At discharge 7590 7879.6 0.73
Dehydration Severity Mild
Moderate
Severe
0 (0%)
8 (61.5%)
5 (38.5%)
12 (24%)
31 (62%)
7 (14%)
0.01
Serum sodium levels (mmol/L) At admission
12 hours post admission
24 hours post admission
164.3 (151-182)
156 (148-175)
150.7 (139-168)
162.8 (148-207)
153.1 (134-202
147.7 (139-177)
0.68
0.92
0.81
Rate of sodium drop (mmol/L/hr.) During first 12 hours
During first 24 hours
  >  >0.6 
0.69
0.59
5(41.7%)
0.55
0.53
16 (41%)
0.29
0.58
0.87
Rate of sodium administration (mmol/L) ≤60
>60
9 (69.2%)
4 (30.8%)
38 (76%)
12 (24%)
0.63

In , some data of patients with dropping of serum sodium levels below or above 0.6 mmol/L/h are shown. Two out of 13 patients with seizure had seizure occurrence after hospitalization. Comparison of serum sodium level changes between these two patients and patients without seizure are shown in .

Table 2

Comparison of Rate of Dropping of Serum Sodium Levels Below or Above 0.6 mmol/L/h

<0.6 mmol/L/h

(32 patients)
≥0.6 mmol/L/h

(21 patients)
p-value
Serum sodium level (mmol/L) At admission 159.6 (148-183) 171.4 (156-207) 0.01
24 h after admission 150.6 (139-170) 152.2 (139-177) 0.42
Mean serum sodium (mmol/L) During first 24.h 155.1 (139-183) 168.8 (139-207) 0.03
Rate of fluid administration ≤1.5 times maintenance 18 (59.4%) 10 (47.6%) 0.44
>1.5 times maintenance 13 (40.6%) 11 (52.4%)
Rate of sodium administration (mmol/L) ≤60 23 (72%) 14 (66.7%) 0.93
>60 9 (28%) 7 (33.3%)
Seizure occurrence After admission 2 (6.3%) ___ 0.97
Before admission 5 (15.6%) 5 (23.8%)
Without seizure 25 (78.1%) 16 (76.2%)

Table 3

Comparison Between Serum Sodium Level Changes in Patients with Seizures After Admission and Patients Without Any Seizure

With seizures

(2 patients)
Without seizure

(50 patients)
p-value
Serum sodium level (mmol/L) At admission 169 (158-180) 162.8 (148-207) 0.5
Mean serum sodium level (mmol/L) In 24 hours of admission 160.6 (147-180) 156.8 (134-207) 0.75
Rate of sodium drop (mmol/l/hr) In 12 hours of admission 1.12 0.54 0.09
In 24 hours of admission 0.47 0.53 0.86
Sodium administration (mmol/L) >60 1 (50%) 12 (24%) 0.80

Discussion

According to the findings of our study, there was no relationship between serum sodium level changes and seizure occurrence in patients with hypernatrmic dehydration.

In a study (13) performed on 48 patients who had hypernatremic dehydration, it was detected that mean serum sodium level at admission was 163.8 mmol/L and the mean serum sodium fall, 6 and 24 hours after admission was 0.54 and 0.52 mmol/L/h, respectively.

Also, it was revealed that 3 (6.3%) patients had seizures at hospital with dropping of serum sodium levels to 0.51 in group without seizure and to 0.63 in group with seizures (p=0.037). These 3 patients with seizures occurrence had taken more fluid as initial therapy than those patients without seizures (40 cc/kg normal saline vs. 20 cc/kg normal saline, respectively).

Seizure occurrence during first day of hospitalization can be as a result of the administration of large volume of relative hypotonic solution in patients with severe hypernatremica, and consequently rapid fall of serum sodium levels.

In another study (12) on 97 patients with hypernatremic dehydration, the mean serum sodium level was 164.5 mmol/L at admission. Cerebral edema occurred in 49 patients during hospital staying. It was detected that over-rapid rate of fluid administration consisted of initial bolus fluid therapy and severity of hypernatremia are among significant contributing factors for cerebral edema and convulsion occurrence.

Sodium is the main cation of extracellular fluid. In hypernatremia state water shifts from intracellular space to extracellular space to equal tonicity of these 2 spaces.

It results in some degree of intracellular dehydration. Rapid correction of dehydration can disturb this equilibrium between intra and extra cellular fluid and consequently brain edemas develop (15,16).

In another study (6), which was performed on 57 children with hypernatremic dehydration, the mean serum sodium level at admission was 165 mmol/L and the rate of dropping of serum sodium level was 0.6 mmol/L/h. Twenty-five percentof their patients had seizures during hospital staying. They found that the mean serum sodium level at admission in these patients was higher than others, (172 mmol/L vs. 163 mmol/L, respectively; p=0.068). Also, rate of dropping of serum sodium level was higher (0.63 mmol/L/hr vs. 0.48mmol/L/h; p=0.08). They also found that there was not any relationship between rate of serum sodium dropping and complications of hypernatremia including seizure occurrence.

In another study (14) on adult patients with dysnatremia in emergency department of a teaching hospital in Switzerland, 74 patients had severe hypernatremia, and their mean serum sodium level at admission was 152 (150-177) mm0l/L. Thirty eight percent of patients showed neurologic symptoms, and in whom serum sodium levels was significantly higher than those hypernatremic patients without any neurologic manifestations (153 vs. 151 mmol/L, respectively; p=0.02). It was revealed that rate of serum sodium level changes was not significantly different in group with neurologic manifestations and the other group without any neurologic manifestations. Also, relative slower rate of sodium correction was detected in hypernatremic patients with neurologic manifestations.

Similarly, in our study, it was revealed that the mean serum sodium level at admission was higher in the case group compared to the control group. It was 164.3 (151-182) in case group and 162.8 (148-207) in control group (p=0.68). The rate of fall in sodium level per hour was higher in case group than controls during the first 24 hours of admission (0.59 and 0.53, respectively), but it was not statistically significant (p=0.58). Also, it was detected that most of seizures occurred before hospitalization (10 patients) and only 2 patients had seizure after admission. Severe dehydration was more significantly seen among those patients who had seizures compared to those patients without seizures (38.5% vs.14%, respectively). So, it seems that in severely dehydrated patients, hypertonicity and absolute rise of serum sodium itself, can contribute to developing seizure occurrence. Also, we found that seizure occurrence after hospitalization was rare.

Rate of falling of sodium was twice higher in first 12 hours after admission in 2 patients who had seizures after hospitalization in comparison with patients without seizures (1.12 vs. 0.54, respectively). Although it was not significant statistically (p=0.09), it can be revealed that the first several hours after admission may be critical time for seizure occurrence in hypernatremic dehydrated patients.

Seizures occurrence in the first 12 hours after admission shows that possibly, high rate of fluids intake including hypotonic fluids can lead to over rapid falling of serum sodium levels during this period.

Our study had some limitations consisting of small size of our work.

In conclusion, there was not any relationship between changes in serum sodium levels and seizure occurrence in hospital in hypernatremic dehydrated children.

Most of the seizures occurred before hospitalization and severe dehydration was seen more significantly in patients who had seizure attacks.

Acknowledgments:

This work was financially supported by Vice Chancellor for Research of Mashhad University of Medical Sciences. We thank the Ethics Committee of Mashhad University of Medical Sciences.

We also appreciate Mr. Mohammad Heydarian for his assistance in this study.

References

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Acute Symptomatic Seizures Caused by Electrolyte Disturbances

Hyponatremia is defined as a serum sodium level of less than 135 mEq/L and is considered severe when the serum level is below 125 mEq/L.

Clinical features

The clinical manifestations of hypotonic hyponatremia are largely related to CNS dysfunction and are more conspicuous when the decrease in serum sodium concentrations is severe or occurs rapidly (within hours). The major clinical complications from acute hyponatremia are brain cell swelling and herniation with neurologic symptoms being evident when hyponatremia approaches 120 mEq/L. The risk of cerebral edema and neurologic manifestations is minimized if the decline in serum sodium occurs slowly and gradually (≥48 h), even in case of a marked absolute reduction of serum sodium values. Conversely, in case of a rapid decrease in serum sodium (acute hyponatremia), cerebral edema with neurologic symptoms are likely to occur.16,17

The neurological symptoms of hyponatremia therefore go in parallel with the severity of cerebral edema, and are less frequently induced by chronic than by acute hyponatremia: approximately half of the patients with chronic hyponatremia are asymptomatic, even with serum sodium concentration less than 125 mEq/L.16,17 Symptoms in these patients rarely occur until the serum sodium is less than 120 mEq/L and are more usually associated with values around 110 mEq/L or lower.3 Particularly the children are at high risk of developing symptomatic hyponatremia, because of their larger brain-to-skull size ratio. Severe and rapidly evolving hyponatremia may cause seizures, which are usually generalized tonic-clonic, and generally occur if the plasma sodium concentration rapidly decreases to <115 mEq/L.

Age and gender of the patient as well as other several factors influence the clinical outcome of neurological complications of hyponatremia. Children and women in childbearing age (rather than postmenopausal women) are the most susceptible subjects:18,19 in a retrospective study hyponatremia was the only detectable cause of seizures in 70% of infants younger than 6 months.19

Women seem to be particularly prone to develop postoperative hyponatremia.20 A case control study conducted in 65 adults with postoperative hyponatremic encephalopathy and 674 adult patients who had postoperative hyponatremia without encephalopathy showed a similar risk of developing hyponatremia and hyponatremic encephalopathy after surgery in women and men. Surprisingly, women in childbearing age had a 25-fold increased risk of death or permanent neurologic damage compared with either men or postmenopausal females.20 Consequently, it is advisable to maintain a low threshold for hyponatremia and hyponatremic encephalopathy in the event of headache, vomiting, nausea or lethargy occurring after surgery, especially in women in childbearing age.20

Hyponatremia represents a frequent cause of epileptic seizures, as shown in a recent prospective observational multicenter study where acute epileptic seizures and focal neurological deficits were identified in 5% of patients with severe (<125 mEq/L) hyponatremia.21

Several etiologies may lead to hyponatremia, some of them affecting almost exclusively adults and some mostly children and infants.

In adults, generalized seizures have been reported as the first manifestation of multihormonal pituitary hormone deficiency causing normovolemic hyponatremia.22

Administration of some drugs, such as desmopressin23,24 or thiazide diuretics,25 may also lead to hyponatremia and seizures. To date, 54 cases of hyponatremia secondary to desmopressin treatment for enuresis presenting with altered mental status or seizures have been reported. In 47 of them an intranasal formulation had been used, while excess fluid intake was documented as a contributing factor in at least 22 cases. In most cases the neurological complications developed 14 days or less after starting desmopressin.24

Thiazide diuretics may cause hyponatremia in up to 14% of patients receiving these drugs (more commonly females, elderly subjects and subjects of low body weight), and may cause confusion, falls and seizures.25

Although also tricyclic antidepressants cause frequently hyponatremia, seizures associated with hyponatremia are more frequently observed in subjects taking selective serotonin reuptake inhibitors.26,27,28

Several clinical conditions including fever (with true volume depletion) or polydipsia may also lead to hyponatremia. A study assessed the impact of fever on sodium values in children presenting with seizures during a gastroenteritis episode.29 While the presence or absence of fever did not affect seizure characteristics or duration, mild hyponatremia (sodium levels between 126 mEq/L and 134 mEq/L) was found to affect some seizure features, particularly seizure duration, with increased risk of status epilepticus. In fact, children with hyponatremia had more prolonged seizures than patients with normal serum sodium levels (6.4 minutes vs. 1.9 minutes, respectively), irrespective of body temperature. In most cases, the seizures last less than 3 minutes (range: several seconds to 20 minutes).

Polydipsia, commonly seen in patients with psychiatric disturbances, is another cause of hyponatremia with increased risk of seizures. A retrospective cross-sectional study was carried out to study the association between different levels of hyponatremia and the occurrence of epileptic seizures in patients without a prior epilepsy diagnosis.30 The authors identified from the database of a Swedish County hospital 363 in patients who were had serum sodium levels <125 mEq/L. Medical records were reviewed and 11 patients with seizures secondary to hyponatremia were identified. Seizures were the only neurologic manifestation of hyponatremia in the subjects with serum sodium levels >115 mEq/L. Marked increases in the frequency of their complex partial seizures due to hyponatremia was observed in five patients with epilepsy and polydipsia-hyponatremia with a decrease in the serum sodium level to 118-127 mEq/L.31 In all cases, patients had received antipsychotic drugs, and the serum sodium levels returned to normal through restriction of fluids with consequent decrease in seizure frequency. As this study shows, hyponatremia caused by polydipsia is a risk factor for aggravation of habitual seizures in patients with epilepsy and psychiatric disorders.

Other conditions reported to be associated with hyponatremia and seizures are the ingestion of sodium phosphate or sodium picosulfates/magnesium citrate combination, which are commonly used to evacuate the colon and rectum before colonoscopy or colorectal surgery,32 or polyethylene glycol preparation.33

Children and especially infants are particularly at risk of developing hyponatremia. A retrospective review reported 130 infants with hyponatremia (<136 mEq/L) associated with respiratory syncytial virus bronchiolitis in infants requiring intensive care. Four infants (4%) had seizures at admission (sodium 114-123 mEq/L), and were successfully managed with hypertonic saline infusions followed by fluid restriction, resulting in immediate termination of seizure activity and normalization of serum sodium values over 48 hours.34

Two infants had water intoxication associated with hyponatremic seizures (sodium levels 116 mEq/L and 121 mEq/L) after consumption of commercial bottled drinking water for infants.35

Hyponatremia should therefore be suspected in any infant less than 6 months old presenting with acute seizures and a body temperature of ≤36.5 degrees C.36 In these patients, hyponatremia needs to be promptly recognized and treated to avoid complications, although improvement in neurologic function after correction of hyponatremia is usually more rapid in children than elderly patients.37

Although the American Academy of Neurology recommends that laboratory screening tests for electrolytes should be ordered based on individual clinical circumstances such as vomiting, diarrhea or dehydratation,12 the epidemiological data show that hyponatremia is a frequent cause of acute symptomatic nonfebrile seizures in children. Consequently, laboratory tests should be systematically ordered in each child presenting with acute seizures.

Finally, it is noteworthy to mention that the antiepileptic drugs (AED) carbamazepine (CBZ), oxcarbazepine (OXC), and eslicarbazepine (ESL) may themselves represent a cause of hyponatremia due to syndrome of inappropriate antidiuretic hormone.37 Possible mechanisms for this effect are an altered sensitivity to serum osmolality by the hypothalamic osmoreceptors and an increased sensitivity of the renal tubules to antidiuretic hormone.37

AED-induced hyponatremia is usually asymptomatic, although in some cases it may result in headache, confusion, general malaise, somnolence and in exacerbation of seizures.38,39,40,41

CBZ, OXC, and ESL may lead to hyponatremia in a relevant number of patients. One comparative study showed a much higher incidence of hyponatremia (defined as sodium levels ≤134 mEq/L) in patients treated with OXC compared to those receiving CBZ (29.9% vs. 13.5%; p<0.0001). Of note, sodium levels ≤128 mEq/L were found in 12.4% of patients treated with OXC and in 2.8% of those receiving CBZ (p<0.001).42 Hyponatremia during CBZ therapy seems to be particularly common in patients with intellectual disability,43 which therefore should be considered a subset of subjects particularly at risk. A subsequent study found an incidence of severe (sodium levels ≤128 mEq/L) and symptomatic hyponatremia of 11.1% and 6.8%, respectively, in patients treated with OXC.44 Age, AED polytherapy, and the concomitant use of diuretics were found to be independent risk factors for sever hyponatremia following OXC treatment.44 Recently, also ESL (the most recent AED structurally similar to CBZ to be marketed) has been shown to be associated with hyponatremia (sodium values ≤134 mEq/L) in 12.5% of patients affected by post-stroke seizures; in 10% of these patients, hyponatremia was symptomatic and in 3% it was asymptomatic.45

The frequency of AED-induced hyponatremia is therefore particularly common after OXC administration, especially in the elderly or in patients taking diuretics. Incidence of hyponatremia following OXC appears to be dose dependent (in one study an increase of 1 mg in the dosage of OXC was shown to increase the risk of hyponatremia by 0.2% and may be prevented by a slower and lower titration-initiation schedule.46 Routine plasma sodium monitoring for patients receiving OXC is not usually necessary, except for patients receiving AED polytherapy or sodium depleting drugs (e.g., thiazide diuretics), affected by sodium-depleting disorders, or in the elderly.44,47 Conversely, monitoring of sodium serum levels are mandatory in patients under OXV therapy developing symptoms suggestive of hyponatremia (headache, confusion, general malaise, somnolence) and in those with unexplained worsening of seizures.46,47 Although no specific guidelines are available, these recommendations can be reasonably extended to patients receiving CBZ, ESL and other sodium depleting drugs.

Treatment

Hyponatremic seizures represent an ominous sign and hence a medical emergency, as they are associated with high mortality.2 Thus, a prompt recognition and treatment of acute symptomatic hyponatremia is of utmost importance as secondary brain damage may be rapid and irreversible, even in subjects with mild clinical symptoms.13 Since a small increase in the serum sodium concentration can substantially reduce cerebral edema, seizures induced by hyponatremia can be controlled by increasing the serum sodium concentration.14 However, improvement in neurologic function may occur several days after correction of the electrolyte abnormality, particularly in elderly patients.50

The most common treatment for hyponatremia consists of hypertonic saline (3%), which produces a rapid reduction in brain volume and intracranial pressure. An increase in serum sodium to values of 120 mEq/L to 125 mEq/L should be the target of therapy. Of note, more aggressive treatment of hyponatremia with hypertonic saline solution carries the risk of shrinkage of the brain leading to osmotic demyelination syndrome manifesting with severe neurologic symptoms such as quadriplegia, pseudobulbar palsy, coma, and even death.2,3,13

The sodium concentration should therefore be corrected at a rate of 0.5 mEq/L/h. Higher correction rates (a rate of 1 mEq/L to 2 mEq/L/h) have been used young patients at a risk for respiratory arrest, severe neurologic sequelae, and death14,51 and appear to be well tolerated in children.52

Hyponatremia induced by AED or other sodium-depleting drugs may be managed through water restriction, reduction of the dose and, if necessary, discontinuation.47

Evaluation of a First-Time Seizure

What is epilepsy?

Epilepsy is a brain condition that causes a person to have seizures. It is one of the most common disorders of the nervous system. It affects people of all ages, races, and ethnic backgrounds.

The brain consists of nerve cells that communicate with each other through electrical activity. A seizure occurs when one or more parts of the brain has a burst of abnormal electrical signals that interrupt normal brain signals. Anything that interrupts the normal connections between nerve cells in the brain can cause a seizure. This includes a high fever, high or low blood sugar, alcohol or drug withdrawal, or a brain concussion. But when a person has 2 or more seizures with no known cause, this is diagnosed as epilepsy.

There are different types of seizures. The type of seizure depends on which part and how much of the brain is affected and what happens during the seizure. The 2 main categories of epileptic seizures are focal (partial) seizure and generalized seizure.

Focal (partial) seizures

Focal seizures take place when abnormal electrical brain function occurs in one or more areas of one side of the brain. Before a focal seizure, you may have an aura, or signs that a seizure is about to occur. This is more common with a complex focal seizure. The most common aura involves feelings, such as deja vu, impending doom, fear, or euphoria. Or you may have visual changes, hearing abnormalities, or changes in your sense of smell. The 2 types of focal seizures include:

Simple focal seizure

The symptoms depend on which area of the brain is affected. If the abnormal electrical brain function is in the part of the brain involved with vision (occipital lobe), your sight may be altered. More often, muscles are affected. The seizure activity is limited to an isolated muscle group. For example, it may only include the fingers, or larger muscles in the arms and legs. You may also have sweating, nausea, or become pale. You don’t lose consciousness in this type of seizure.

Complex focal seizure

This type of seizure often occurs in the area of the brain that controls emotion and memory function (temporal lobe). You will likely lose consciousness. This may not mean you pass out. You may just stop being aware of what’s going on around you. You may look awake, but have a variety of unusual behaviors. These may range from gagging, lip smacking, running, screaming, crying, or laughing. You may be tired or sleepy after the seizure. This is called the postictal period.

Generalized seizure

A generalized seizure occurs in both sides of the brain. You will lose consciousness and be tired after the seizure (postictal state). Types of generalized seizures include:

Absence seizure

This is also called petit mal seizure. This seizure causes a brief changed state of consciousness and staring. You will likely maintain your posture. Your mouth or face may twitch or your eyes may blink rapidly. The seizure usually lasts no longer than 30 seconds. When the seizure is over, you may not recall what just occurred. You may go on with your activities as though nothing happened. These seizures may occur several times a day.

Atonic seizure

This is also called a drop attack. With an atonic seizure, you have a sudden loss of muscle tone and may fall from a standing position or suddenly drop your head. During the seizure, you will be limp and unresponsive.

Generalized tonic-clonic seizure (GTC)

This is also called grand mal seizure. The classic form of this kind of seizure has 5 distinct phases. Your body, arms, and legs will flex (contract), extend (straighten out), and tremor (shake). This is followed by contraction and relaxation of the muscles (clonic period) and the postictal period. During the postictal period, you may be sleepy. You may have problems with vision or speech, and may have a bad headache, fatigue, or body aches. Not all of these phases occur in everyone with this type of seizure.

Myoclonic seizure

This type of seizure causes quick movements or sudden jerking of a group of muscles. These seizures tend to occur in clusters. This means that they may occur several times a day, or for several days in a row.

What causes a seizure?

A seizure can be caused by many things. These can include:

Epilepsy may be caused by a combination of these. In most cases, the cause of epilepsy can’t be found.

What are the symptoms of a seizure?

Your symptoms depend on the type of seizure. General symptoms or warning signs of a seizure can include:

  • Staring

  • Jerking movements of the arms and legs

  • Stiffening of the body

  • Loss of consciousness

  • Breathing problems or stopping breathing

  • Loss of bowel or bladder control

  • Falling suddenly for no apparent reason, especially when associated with loss of consciousness

  • Not responding to noise or words for brief periods

  • Appearing confused or in a haze

  • Nodding your head rhythmically, when associated with loss of awareness or loss of consciousness

  • Periods of rapid eye blinking and staring

During the seizure, your lips may become tinted blue and your breathing may not be normal. After the seizure, you may be sleepy or confused.

The symptoms of a seizure may be like those of other health conditions. Make sure to talk with your healthcare provider for a diagnosis.

How are seizures diagnosed?

Your healthcare provider will ask about your symptoms and your health history. You’ll be asked about other factors that may have caused your seizure, such as:

You may also have:

  • A neurological exam

  • Blood tests to check for problems in blood sugar and other factors

  • Imaging tests of the brain, such as an MRI or CT scan

  • Electroencephalogram, to test your brain’s electrical activity

  • Lumbar puncture (spinal tap), to measure the pressure in the brain and spinal canal and test the cerebral spinal fluid for infection or other problems

How are seizures treated?

The goal of treatment is to control, stop, or reduce how often seizures occur. Treatment is most often done with medicine. There are many types of medicines used to treat epilepsy. Your healthcare provider will need to identify the type of seizure you are having. Medicines are selected based on the type of seizure, age of the person, side effects, cost, and ease of use. Medicines used at home are usually taken by mouth as capsules, tablets, sprinkles, or syrup. Some medicines can be given into the rectum. If you are in the hospital with seizures, medicine may be given by injection or intravenously by vein (IV).

It is important to take your medicine on time and as prescribed by your doctor. People’s bodies react to medicine differently so your schedule and dosage may need to be adjusted for the best seizure control. All medicines can have side effects. Talk with your healthcare provider about possible side effects. While you are taking medicine, you may need tests to see how well the medicine is working. You may have:

  • Blood tests. You may need blood tests often to check the level of medicine in your body. Based on this level, your healthcare provider may change the dose of your medicine. You may also have blood tests to check the effects of the medicine on your other organs.

  • Urine tests. Your urine may be tested to see how your body is reacting to the medicine.

  • Electroencephalogram (EEG). An EEG is a procedure that records the brain’s electrical activity. This is done by attaching electrodes to your scalp. This test is done to see how medicine is helping the electrical problems in your brain.

Other treatments

If medicine doesn’t work well enough for you, your healthcare provider may advise other types of treatment. You may have:

Vagus nerve stimulation (VNS)

This treatment sends small pulses of energy to the brain from one of the vagus nerves. This is a pair of large nerves in the neck. If you have partial seizures that are not controlled well with medicine, VNS may be an option. VNS is done by surgically placing a small battery into the chest wall. Small wires are then attached to the battery and placed under the skin and around one of the vagus nerves. The battery is then programmed to send energy impulses every few minutes to the brain. When you feel a seizure coming on, you may activate the impulses by holding a small magnet over the battery. In many cases, this will help to stop the seizure. VNS can have side effects such as hoarse voice, pain in the throat, or change in voice.

Surgery

Surgery may be done to remove the part of the brain where the seizures are occurring. Or the surgery helps to stop the spread of the bad electrical currents through the brain. Surgery may be an option if your seizures are hard to control and always start in one part of the brain that doesn’t affect speech, memory, or vision. Surgery for epilepsy seizures is very complex. It is done by a specialized surgical team. You may be awake during the surgery. The brain itself does not feel pain. If you are awake and able to follow commands, the surgeons are better able to check areas of your brain during the procedure. Surgery is not an option for everyone with seizures.

Living with epilepsy

If you have epilepsy, you can manage your health. Make sure to:

  • Take your medicine exactly as directed

  • Get enough sleep, as lack of sleep can trigger a seizure

  • Avoid anything that may trigger a seizure

  • Have tests as often as needed

  • See your healthcare provider regularly

When should I call my healthcare provider?

Call your healthcare provider if:

Key points about epilepsy and seizures

  • A seizure occurs when one or more parts of the brain has a burst of abnormal electrical signals that interrupt normal signals

  • There are many types of seizures. Each can cause different kinds of symptoms. These range from slight body movements to loss of consciousness and convulsions.

  • Epilepsy is when you have 2 or more seizures with no known cause.

  • Epilepsy is treated with medicine. In some cases, it may be treated with VNS or surgery.

  • It’s important to avoid anything that triggers seizures. This includes lack of sleep.

Too Much Water Raises Seizure Risk in Babies

Newswise — It’s a recurrent summer-time scenario in the pediatric emergency room and doctors from Johns Hopkins Children’s are sounding the alarm on it: An otherwise healthy infant is brought in by panicked parents after suffering a seizure, which turns out to be caused by drinking too much water.

Pediatricians at Hopkins Children’s see at least three or four such cases every summer, and while the seizures are benign and have no lasting effect on a child’s health, they are quite dramatic and completely preventable, doctors say.

“Babies need extra fluids in the hot weather, but straight water is not one of them,” says pediatrician Allen Walker, M.D., head of the Emergency Department at Hopkins Children’s. “A parent’s natural instinct is to give the baby water to prevent dehydration, but too much water can disrupt the delicate balance in a baby’s body, leading to water intoxication. Before you know it, the baby is seizing.”

Too much water dilutes sodium in the blood and flushes it out of the body, thus altering brain activity, which can lead to a seizure. Infants under 1 year of age may be more prone to these types of seizures than older children because a young infant’s diet does not contain enough food sources to replenish the lost sodium. Also, an infant’s immature kidneys cannot flush out excess water fast enough, causing a dangerous buildup of water in the body.

Breast milk and formula are the best way to keep a child under 1 year of age who is not eating solid foods hydrated, Walker says, and straight water should be avoided. Over-diluted formula can lead to water intoxication as well. Electrolyte-enriched pediatric drinks are not recommended for routine hydration.Symptoms of water intoxication in an infant include:

Ң changes in mental status, i.e., unusual irritability or drowsinessӢ low body temperature, usually 97 degrees or lessӢ facial swelling or puffinessӢ seizures

Though any infant who consumes too much water can suffer water intoxication, the risk is highest among children who are already dehydrated, typically after a bout with viral or bacterial infections that cause vomiting and diarrhea. Symptoms of dehydration in a young child include dry mouth, increased thirst, irritability and reduced sweating and urination. An easy way to spot dehydration is if a child has fewer than three wet diapers in 24 hours, Walker says.

In otherwise healthy infants, water intoxication is one of the leading triggers of seizures. The most common type of childhood seizures are febrile seizures, occurring in 2 to 5 percent of all children under 5 years of age, according to the American College of Emergency Physicians.

Founded in 1912 as the children’s hospital of the Johns Hopkins Medical Institutions, the Johns Hopkins Children’s Center offers one of the most comprehensive pediatric medical programs in the country, treating more than 90,000 children each year. U.S. News & World Report ranks Hopkins Children’s among the top three children’s hospitals in the nation. Hopkins Children’s is Maryland’s only state-designated Trauma Service and Burn Unit for pediatric patients. It has recognized Centers of Excellence in 20 pediatric subspecialties including cardiology, transplant, psychiatric illnesses and genetic disorders. For more information, please visit: http://www.hopkinschildrens.org

90,000 Why shakes Angela Merkel – Gazeta.Ru

German Chancellor Angela Merkel urged the world community not to worry about her health, assuring that she feels good. The politician is sure that the ailment that overcame her will pass by itself as suddenly as it appeared. However, doctors in different countries tend to disagree with the official cause of Merkel’s tremors. The shaking could not be caused by dehydration, but by more serious problems, experts say.

The world continues to monitor with fear the state of health of Angela Merkel, which has recently given several reasons for concern.So, in the second half of this month, the German Chancellor twice felt bad in public. The first time this happened on June 18, when, during a meeting with Ukrainian President Volodymyr Zelensky in Berlin, Merkel was seized with a sudden shiver. She tried to cope with the malaise by changing the position of her hands, but the ailment did not go away for about a minute. The reason for the incident was the heat. According to the doctor, the politician had a tremor due to dehydration. As Merkel herself noted in her conversation with reporters, after drinking the water she felt much better:

“After that I drank at least three glasses of water.Apparently, I missed them. Now I feel very good. ”

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President of Ukraine Volodymyr Zelenskyy and German Chancellor Angela Merkel during a meeting in Berlin, June 18, 2019

Michael Sohn / AP

The version of the harmful effects of the Berlin heat on the body of an elderly woman is adhered to by general practitioner and district chairman of the Bavarian Association of Physicians Jacob Berger.He is convinced that there is no need to worry about the Chancellor’s health. However, a physician from London Mike Fitzpatrick urged not to attribute the tremors to dehydration.

“Usually people don’t shake like that due to dehydration. From malnutrition – perhaps, but not from dehydration – told a specialist in the Daily Telegraph. – The seizures usually last a couple of minutes, and then, when the body temperature recovers, everything stops. This is probably what happened to Merkel. ”

At a meeting with the President of the Federal Republic of Germany Frank-Walter Steinmeier on June 27, Merkel again had a seizure.Now the disease could not be attributed to exposure to sunlight. The leaders of the German state were in a room in which, apparently, a comfortable air temperature was recorded.

Merkel again tried to restrain the trembling in her body with her hands, and again to no avail. True, if Zelensky chose not to notice what was happening with his colleague, now they responded promptly to problems with the head of government. They brought a glass of water to Merkel, but she refused to take even one sip with a gesture.

A repeated attack of tremor at the Chancellor leads to the conclusion about the erroneously identified causes of the first incident. Most likely, it’s not about the heat or not only about it. Experts are wondering whether Merkel’s developing ailment will force her to end her political career ahead of schedule. The chancellor herself, who is now leaving the G20 summit in Osaka, tried to reassure the public that she had no serious health problems. Like many statesmen of previous eras, she, like Leonid Brezhnev, is inclined to believe that “everything will resolve.”

“I am sure that as it appeared, it will pass by itself. I can’t tell you anything special. I feel good “,

quotes 90,020 words of Merkel DPA.

The famous German doctor Christoph Specht, who observed the legendary race car driver Michael Schumacher, identified six versions of what is happening with Merkel. The official reason – dehydration – he does not consider the main one. According to the physician, uncontrolled shaking may indicate diabetes in the patient and be a sign of low blood sugar.In addition, tremors can cause stress in the body and, for example, the use of antidepressants. Problems with blood circulation are also not excluded. An over-activity of the thyroid gland can also lead to tremors. Well, the age factor should not be discounted, the health expert emphasized.

“Improvements” or the so-called optostatic temperature has a tendency to hit people after 60 years. Drozh, as a rule, ceases when a person starts to move “,

– noted Dr. Specht, whose words are conveyed by Bild.

Professor of the Department of Nervous Diseases, Moscow Medical Academy. Sechenova Olga Vorobyova rejected the suggestion that a tremor could mean that Merkel has Parkinson’s disease.

“With dehydration, the work of the autonomic nervous system can be disrupted and cause a transient disturbance of the heart rhythm – uncontrolled tachycardia, which is often accompanied by chill-like hyperkinesis (an attack of uncontrolled tremors). A person drinks a glass of water, and the attack, as a rule, stops, ”- quotes of the medic vz.ru.

Merkel has been the Chancellor of the Federal Republic of Germany since November 22, 2005. Only Konrad Adenauer (14 years old) and Helmut Kohl (16), who, like Merkel, represented the Christian Democratic Union (CDU), held the post for longer than her in the post-war period. In addition to Merkel, of all the politicians who have headed the German government, her predecessor, Gerhard Schroeder, is still alive.

90,000 Merkel’s attacks are not like Parkinson’s disease, says Professor

https://ria.ru/201

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Merkel’s attacks are not similar to Parkinson’s disease, says professor

Merkel’s attacks are not similar to Parkinson’s disease, professor believes – RIA Novosti, 22.11.2019

Merkel’s attacks are not similar to Parkinson’s disease, says Professor

German Chancellor’s shivering attack Angela Merkel is hardly a sign of Parkinson’s disease, perhaps she has chills-like hyperkinesis, which may be … RIA Novosti, 22.11.2019

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MOSCOW, July 10 – RIA Novosti. A shivering fit of German Chancellor Angela Merkel is hardly a sign of Parkinson’s disease, perhaps she has a chill-like hyperkinesis, which can be caused by various disorders in the body, says Olga Vorobyova, professor of the Department of Nervous Diseases at the First Moscow State Medical University named after Sechenov. Earlier on Wednesday, the N-TV channel reported that Merkel experienced a shivering fit for the third time in three weeks during an official event.”It’s not like Parkinson’s disease. In Parkinson’s disease, the characteristics of tremor are different than in her. It is more like chill-like hyperkinesis,” Vorobieva told RIA Novosti. She clarified that the disease can accompany various disorders in the body, including cardiac rhythmic and metabolic. At the same time, it is very difficult to judge by one symptom and it is impossible to establish a diagnosis, Vorobyova emphasized. Shimmer-like hyperkinesis is a symptom that is most often associated with a violation of the autonomic nervous system.Such a vegetative reaction can accompany both an isolated attack of anxiety or panic, and paroxysmal organic disorders, most often cardiac rhythmic disorders, for example, supraventricular tachycardia. Chill-like hyperkinesis associated with activation of the sympathetic nervous system can be “cut off” by the intake of cold water. Drinking cold water helps to activate the vagus nerve and align the balance between the sympathetic and parasympathetic parts of the autonomic nervous system.Earlier, the N-tv channel showed footage of Merkel’s meeting with the President of Germany Frank-Walter Steinmeier, the chancellor had a fit of trembling. A similar attack occurred in Merkel during a meeting with Ukrainian President Volodymyr Zelensky. Then the chancellor explained her painful condition by dehydration. She said she felt much better after drinking the water. Another shivering attack occurred on Wednesday during a meeting between the Chancellor in Berlin and Finnish Prime Minister Antti Rinne. The video posted by the channel shows how strong tremors go through Merkel’s body.The attack lasted about a minute, but was less severe than the previous ones.

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in the world, germany, angela merkel, parkinson’s disease

MOSCOW, July 10 – RIA Novosti. An attack of shivering by German Chancellor Angela Merkel is hardly a sign of Parkinson’s disease, perhaps she has chills-like hyperkinesis, which can be caused by various disorders in the functioning of the body, says Olga Vorobyova, professor at the Department of Nervous Diseases of the First Moscow State Medical University named after Sechenov.

Earlier on Wednesday, N-tv reported that Merkel had experienced a shivering fit for the third time in three weeks during an official event.

10 July 2019, 14:54 Authors New attack. Angela Merkel is not feeling well again

“It doesn’t look like Parkinson’s disease.Parkinson’s disease has different characteristics of tremor than hers. It looks more like a chill-like hyperkinesis “, – Vorobieva told RIA Novosti. Vorobyov.

Chill-like hyperkinesis is a symptom that is most often associated with a violation of the autonomic nervous system.Such a vegetative reaction can accompany both an isolated attack of anxiety or panic, and paroxysmal organic disorders, most often cardiac rhythmic disorders, for example, supraventricular tachycardia. Chill-like hyperkinesis associated with activation of the sympathetic nervous system can be “cut off” by the intake of cold water. Drinking cold water helps to activate the vagus nerve and align the balance between the sympathetic and parasympathetic parts of the autonomic nervous system.

10 July 2019, 14:36 ​​

Merkel spoke about her condition after another tremor A similar attack occurred in Merkel during a meeting with Ukrainian President Volodymyr Zelensky. Then the chancellor explained her painful condition by dehydration. According to her, after drinking the water she felt much better.

Another tremor occurred on Wednesday during the meeting of the Chancellor in Berlin with the Prime Minister of Finland Antti Rinne.The video posted by the channel shows how strong tremors go through Merkel’s body. The attack lasted about a minute, but was less severe than the previous ones.

3 ways that work – Ozon Club

The cough is common in young children. This is due to the special structure of the larynx in the part of the vocal cords. Babies are more likely to have seizures at night. They can appear due to inflammation of the larynx, trachea, bronchi or lungs. Dry coughs are the hardest to fight.If measures are not taken in a timely manner, the child may develop stenosis, requiring immediate treatment in a hospital. All methods described below can be combined to achieve a quick effect.

Khairullina Lilia

December 7

The first way is to give a few sips of warm liquid. This can be warm milk, mineral water, or chamomile tea. These remedies help soften the mucous membrane, which means that the sore throat goes away.

During illness, there is an active evaporation of fluid from the surface of the body, so this method will help and prevent dehydration.The more the child drinks, the faster his dry cough transforms into a wet one. Alkaline drink soothes cough, promotes rapid sputum discharge.

Herbal drinks or black radish juice with honey are helpful. To get the second, you need to cut out the middle from the vegetable, leaving the bottom, add a few tablespoons of honey. When the juice is released, you can begin to heal. It is recommended to add a little vegetable oil to combat dry coughs. It will soften the throat.

The second way is to use steam. This can be inhalation using a nebulizer or creating a special microclimate in the bathroom. If the cough is stenosing, the doctor will prescribe to breathe through a nebulizer with hormonal agents (for children, Berodual or Pulmicort is often prescribed). They will not rid the body of viruses or bacteria, but they will help relieve swelling, reduce the amount of cough and increase its productivity.

The peculiarity of using the nebulizer is that the drug penetrates directly into the mucous membrane, acts locally.You can do frequent inhalations with a simple saline solution. During an attack, the method is used every 20-30 minutes. Doctors do not recommend using herbs and dietary supplements in nebulizers, since the reaction to them in a child’s body can be different.

If there is no special device at home, and the child is feeling bad, then steam in the bathroom will help. To do this, take a full bath of boiling water. Take your child in your arms and just sit in the bathroom. On the one hand, tactile contact with the mother is ensured, on the other hand, warm steam, dispersed throughout the room, will have a positive effect on the condition.Children usually fall asleep easily after the procedure.

The third way to combat cough is to take medication. There are medications that suppress the cough reflex. They should not be drunk if there is already phlegm. Usually, its appearance is associated with the removal of edema, therefore, with a wet cough, the baby’s condition becomes better. For dry cough, means based on butamirate, glaucine, libexin are used. They are all sold exclusively with a doctor’s prescription. The development of adverse reactions is possible. But they act a few minutes after application.

First aid rules for a pet in case of injuries, poisoning, seizures, diseases

First aid rules for a pet in case of injuries, poisoning, seizures, diseases

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  • F

    • Railway
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    • Korolev
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    • Kursk
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    • Lobnya
    • Lytkarino
    • Lyubertsy
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    • Moscow
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90,000 Epilepsy in children – Part 1

Seizures are common in children and adults.According to the World Health Organization, up to 10% of the world’s population will experience at least one seizure during their lifetime. Most often, seizures are noted in childhood and old age.

Epilepsy is a chronic disease with repeated convulsive and non-convulsive seizures due to excessive electrical discharges in the brain. There are many forms of epilepsy with different clinical manifestations and causes, from hereditary diseases to the consequences of brain injury.At present, a separate area dedicated to epilepsy has emerged in neurology – epileptology. A neurologist who specializes in the diagnosis and treatment of epilepsy is called an epileptologist.

What do seizures look like?

Dozens of types of seizures are described in the special literature, and even more – their combinations, so it is worth limiting ourselves to the basic concepts. The most famous are the so-called generalized tonic-clonic seizures with loss of consciousness, tension and twitching throughout the body.In addition, there are myoclonic seizures, which are short jerks throughout the body or in any part of it, often without changing consciousness – for example, jerking hands with objects falling out of them, or a sudden fall as from a blow under the knees.

Tonic seizures are manifested by sufficiently prolonged muscle tension in any part of the body.

In children, an attack can often look like tension and tremors of the arm, half of the face with speech impairment while maintaining consciousness.

At an early age, special seizures are often observed – spasms, which are short-term flinching with limb spreading, or vice versa, “squeezing into a ball”, repeated several times over a short time.

One of the most frequent types of seizures is absence, in which the child freezes and does not respond to treatment.

An important symptom during an attack is the asymmetry of movements, for example, turning the head and eyes to the side, raising and straining one arm, twitching the corner of the mouth on one side.This may indicate the focal nature of the seizure, that is, its connection with a specific limited area of ​​the brain.

It is very important to remember the patient’s appearance during the seizure, even better – to record the seizure on video – a mobile phone camera will be enough. Typical seizure patterns often provide an early assessment of prognosis and the need for and feasibility of treatment.

Are seizures always associated with epilepsy?

Not necessary at all.Seizures of various kinds – convulsive and non-convulsive – can occur in children with fever (febrile seizures), poisoning, dehydration, head injuries, and cerebrovascular accidents. In addition, outwardly it can be difficult to distinguish fainting, sleep disorders, some forms of migraine, various movement disorders, psychological disorders from seizures. An important difference between paroxysms in most of the listed disorders from epileptic seizures is the connection with a provoking factor or acute damaging effect (trauma, poisoning, overheating).In epilepsy, seizures in most cases are spontaneous or are caused by simple stimuli (flickering of light, deep forced breathing).

Risk of recurrence

For a healthy child, the risk of recurrence of a spontaneous seizure is 24% within 1 year. In the presence of previous neurological disorders (for example, cerebral palsy), the likelihood of a second seizure within a year is 37%, and if the seizures were repeated within a day – 70%.Nevertheless, if the attack was accompanied by any acute condition (overheating, infection, trauma), then the risk is usually many times less.

What to do in case of seizures?

In most cases, seizures resolve on their own within a few seconds or minutes. Regardless of the cause of the attack, first aid is only to prevent injury and ensure free breathing. During an attack, the patient should be away from heavy, unstable, stabbing and cutting objects.The patient should not be held down by force. In no case should you try to open your jaws and take out your tongue – this is useless. To ensure airway patency, it is sufficient to lay the patient on his side with the face turned downward. In this position, the tongue will not sink and block the breath. Attempts to unclench the teeth often end in injuries, tooth fragments can enter the respiratory tract and cause respiratory arrest, or even death. It is usually impossible to avoid biting the tongue after the onset of an attack, and attempts to reach the tongue only lead to additional injuries.It is useless to give a person in a convulsive attack artificial respiration and heart massage. Thus, all that is needed is to remove dangerous objects away from the patient, put him on his side face down and call an ambulance. At the same time, it is advisable to recall the recommendation for video filming of events – this can be done by an assistant.

After the end of the attack, the patient should be allowed to rest, drowsiness is possible. It is necessary to make sure that the patient has come to his senses, is oriented in the environment, there are no speech disorders and movements in the limbs are preserved (ask to answer simple questions, raise and hold arms and legs).Until the complete disappearance of impaired consciousness, nothing should be given to eat or drink in order to exclude the ingress of food, water or drugs into the respiratory tract.

For some types of seizures (eg absences and infantile spasms), emergency care at the time of the seizure is often not required.

FGBNU NCPZ. ‹Musical Exogenous Mental Disorders ››

Delirium (delirium tremens) is the most common form of

Usually delirium develops after 5 years of chronic alcoholism [Zhislin S.G., 1965]. Delirium tremens in 64% of cases develops at the age of 40-50 years, in 22% of cases – up to 40 years and in 14% of cases – over 60 years old [Salum J., 1972].

The first attack of delirium is usually preceded by a prolonged binge, the subsequent ones occur after short periods of drunkenness. In the prodrome, lasting days, weeks and even months, sleep disorders with nightmares, fears, frequent awakenings and vegetative symptoms predominate, and during the day – asthenic phenomena and changeable affect in the form of fearfulness and anxiety.Depressive disorders are constantly revealed in women. The prodromal period may be absent. Delirium develops most often (in 89% of cases) 2-4 days after the cessation of drinking, against the background of severe hangover disorders or their reverse development [Victor M., Adams R., 1953]. In 10-19% of cases [Strelchuk IV, 1970; Salum J., 1972] the development of delirium is preceded by single or multiple seizures, episodes of verbal illusions or figurative delusions are possible. The onset of delirium often coincides with the development of an acute somatic illness, trauma, and surgery.Delirium begins with influxes of images and memories that appear in the evening and intensify at night; visual illusions are not uncommon, in a number of cases, visual hallucinations devoid of dimensionality – “cinema on the wall” with the preservation of a critical attitude towards them [Zhislin SG, 1935], transient disorientation or incomplete orientation in place and time. Facial expressions and movements are lively, attention is easily distracted, mood is changeable, with a quick change of opposite affects. The last group of S.G. Zhislin attaches the greatest importance in distinguishing the hangover (withdrawal) syndrome with pronounced mental components from initial delirious disorders. For a hangover state, in contrast to a delirious state, a monotonous depressed-anxious affect is typical. In the expanded stage of delirium, complete insomnia appears, illusions become more complicated or are replaced by pareidolia, true visual hallucinations appear. Multiple and mobile micropsy hallucinations prevail – insects, small animals, snakes, as well as threads, wires, cobwebs; less often, patients see large, including fantastic animals, people, humanoid creatures – “wandering dead” [Schule H., 1886]. Visual hallucinations approach, recede, change in size, undergo transformations in front of the patient’s eyes. They are sometimes single, then multiple, sometimes they are stage-like and, reflecting certain situations (feast, spectacles, erotic scenes), can kaleidoscopically replace each other. With the deepening of delirium, auditory and among them verbal, as well as olfactory, thermal and tactile hallucinations, including those localized in the oral cavity, appear. Frequent disorders of the body scheme, sensations of changes in the position of the body in space – everything sways, rotates, falls.Behavior, affect and subject of delusional statements correspond to the content of hallucinations. Speech consists of a few, fragmentary, short phrases or words. Attention is over-distracted. Patients react to everything that happens around them with separate remarks, behavior, and facial expressions. Patients are highly suggestible Typically a rapid change in the intensity of psychopathological manifestations of delirium, especially under the influence of external stimuli (conversation with a doctor, etc.). From time to time and for a short time, the symptoms of psychosis subside spontaneously and even almost completely disappear – the so-called lucid intervals appear.The psychosis intensifies in the evening and at night. The disease is usually short-lived. Even without treatment, delirium symptoms resolve within 3-5 days. Sometimes psychosis is delayed for 1 – 1.5 weeks. According to J. Salum (1972), the duration of delirium tremens in 75% of cases is about 3 days and only in 5% of cases – more than a week. Most often, recovery occurs critically – after deep prolonged sleep, much less often – gradually (lytically), or the symptoms are reduced in waves, with alternating weakening and renewal, but in a less pronounced form.The lytic ending of psychosis is more common in women. In 90% of cases, delirium proceeds continuously, in 10% there are up to 2-3 delirious attacks, separated by “light” intervals of about a day [Salum J., 1972]. Delirium is often replaced by various intermediate syndromes. They are more frequent in the lytic ending of psychosis. Men usually have asthenic, mild hypomanic and residual delusional disorders, women are dominated by depression. In the blood, leukocytosis, a shift of the leukocyte formula to the left, increased ESR, increased cholesterol and bilirubin.

The main variants of delirium. Gu Pnagogic delirium is limited to numerous, vivid, in some cases scene-like dreams or visual hallucinations when falling asleep and closing the eyes. It is accompanied by a mild fear, less often by the affect of surprise and somatovegetative symptoms. In some cases, when hallucinations occur, patients are transferred to a different environment created by these disorders. On opening the eyes or waking up, a critical attitude to painful symptoms and orientation are sometimes not restored immediately, and in accordance with this, the behavior of patients is disturbed.Hypnagogic delirium lasts 1-2 nights and can be replaced by other delirious pictures or forms of acute metal-alcoholic psychoses.

Hypnagogic delirium of fantastic content is called hypnagogic onirism. Differs in fantastic content of abundant sensually bright visual hallucinations, scene-like hallucinatory disorders with a sequential change of one situation to another [Snezhnevsky A. V., 1941].

Delirium without delirium [Dollken A., 1901] largely corresponds to the trembling syndrome described by J. Salum (1972). It arises sharply. Fussy excitement predominates with marked tremors and sweating. Sensory and delusional disorders are absent or rudimentary. There is a transient disorientation in the environment. Delirium lasts 1-3 days. A transition to expanded delirious states is possible.

Abortive delirium is determined by the development of non-abundant, and in some cases, single visual illusions and micropsic hallucinations that do not create the impression of certain, and even more complete situations, as in advanced forms of delirium. Acoasms and phonemes are encountered.The monotonous affect of anxiety or fear prevails [Strelchuk I. V., 1970] Rudimentary delusional disorders (distrust, suspicion, apprehension) in some cases are accompanied by delusional defense. There is a short motor excitement. Time orientation can be violated. Duration does not exceed 1 day.

Systematic delirium . Multiple, scene-like (with a consistently developing plot or in the form of separate situations) visual hallucinations prevail.Their content is determined mainly by various scenes of pursuit, often adventurous, with flight or pursuit, in which routes, modes of transport, and shelter change. The pronounced affect of fear predominates.

Delirium with severe verbal hallucinations . Along with intense visual, tactile, thermal hallucinations, disorders of the body scheme, visual illusions, verbal hallucinations are constantly present. They then recede into the background, then sharply intensify, in connection with which we can talk about the development of verbal hallucinosis in the structure of delirium.Both visual and especially verbal hallucinatory disorders have a frightening or life-threatening content of the patient.In delusional statements, ideas of physical destruction prevail Despite the relatively small scope of delusion, delusional statements can be sufficiently developed in separate details, which creates the impression of systematized delusion. However, unlike him, who always has a system of evidence, delusional statements are not supported by arguments. In addition, in such cases, one can always identify distinct symptoms of figurative delirium (confusion, delusional ideas of staging, a symptom of a positive double that spreads to many people around).Affect, especially at the onset of psychosis, is determined by pronounced fear or intense anxiety, interspersed with attacks of fear. Orientation in place and time usually suffers little or not at all, that is, the depth of the clouding of consciousness, despite the abundance of productive disorders, is insignificant. The severity of autonomic and neurological disorders is often moderate and even insignificant. The duration of psychosis ranges from several days to several weeks. In the latter case, painful disorders disappear lytically.

Atypical forms of delirium. Symptoms characteristic of delirium tremens are determined by fantastic content – oneiric confusion or combined with mental automatisms [GS Vorontsova, I960; Gofman A. G., 1974].

Delirium with fantastic content (fantastic delirium, alcoholic oneiroid) , as a rule, is noted with repeated alcoholic psychoses. It is preceded by other delirious states in structure [Snezhnevsky A.V., Schneider VT., 1966; Goffman A.G., 1974; Strelchuk I. V., 1974]. In the development of psychosis, a sequential change of disorders occurs. In the initial period, multiple photopsies or elementary visual hallucinations prevail (dust, smoke, hair, cobwebs, rings, spirals, threads, often shiny or sparkling), as well as acoasms. Less commonly, psychosis begins with ordinary or fantastic hypnagogic delirium. During the day, there are episodes of figurative delirium. The state of altered consciousness, as in typical delirium, is accompanied by a changeable affect with a predominance of fear, motor excitement, and periodic lucid intervals.After 2-3 days at night, a distinct complication of the clinical picture occurs: scene-like visual and verbal auditory hallucinations appear, elements of figurative delirium, accompanied by delusional orientation and a symptom of a positive double (the surrounding persons are perceived as relatives, acquaintances or colleagues), intense motor excitement with complex coordinated actions … After 1-2 days, against the background of increasing and becoming more and more erratic motor excitement, episodes of immobility with drowsiness periodically occur, or severe immobility occurs acutely.In a state of inhibition, patients answer questions succinctly, after repeated repetition of the question. A false orientation in place and time is revealed, while the consciousness of one’s self is preserved. Some statements testify to delusional disorders of fantastic content.

The mimicry of patients is characteristic: a dull, frozen expression is replaced by a frightened, surprised, anxious. Patients try to get up, tend to go somewhere, but usually they easily give in to persuasion or a little coercion.More often, psychosis ends in a critically deep sleep after a few days, less often it lasts a week or more. Patients report sufficiently detailed information about its content, including during the period of inhibition, both immediately after psychosis and after various periods of time. Patients talk about fantastic and everyday scenes that were replaced without any sequence or connection. Pictures of concentration camps, torture, battles involving various types of troops, extraordinary adventures in various parts of the world up to space flights and world cataclysms are interspersed with pictures of family and office celebrations, festivities, meetings or scenes related to professional activities.With their eyes closed, patients become participants in the listed events, objects of torture and various experiments, they feel burning, heat, cold, pain, heaviness, pressure, then relatively pleasant effects that patients often associate with rays, current, ultrasound, etc. There is always a sensation fast movement in space. With their eyes open, the patients no longer directly participate in the unfolding events, but passively observe them. Despite the unusualness of what is happening or the experience of a direct threat to life, the affect of fear that was at the beginning of psychosis sharply decreases.Surprise, curiosity, even indifference begin to prevail. The patient feels that time is lengthening significantly. The duration of oneiroid stupefaction ranges from several hours to 2-3 days. Described psychoses lasting up to 1 week. The disappearance of painful disorders is usually critical, after deep sleep. Residual delusions may persist.

Delirium with oniric disorders (alcoholic onirism). Indications of this form can be found in E. Bleuler (1920), A.V. Snezhnevsky (1941), V. G. Schneider (1965, 1970). The most complete description of such delirium is M.G. Gulyamov, I.R.Khasanov (1973).

It differs from fantastic delirium by the predominance from the very beginning of sensually vivid hallucinations, symptoms of substupor or stupor, a much smaller illusory-delusional component of psychosis and the severity of stage-like visual pseudohallucinosis.

Deliriums with psychic automatisms . Mental automatisms arise with the complication of typical or at the height of systematized delirium with a combination of delirium with pronounced verbal hallucinations or with delirious-oneiroid states [Vorontsova G.S., 1959, 1960; Shneider V.G., 1968; Strelchuk I. V., 1970; Shapkin Yu. A., 1974]. In all cases, mental automatisms in delirium are transient, they disappear before the symptoms, against the background of which they appeared, begin to decrease. All the main variants of mental automatism can arise – ideatorial, sensory, motor, but all three are never encountered at the same time. Ideatorial psychic automatisms are most often noted. Sometimes there are two options at once – ideator and sensory or sensory and motor.Of ideatorial automatisms, visual pseudo-hallucinations projected outward are more common. Sometimes visual pseudo-hallucinations are accompanied by a feeling of being done – “they show it, like in a movie,” sometimes patients talk about the effect of certain equipment. Visual pseudo-hallucinations can coexist with true ones or be interspersed with them. From other associative automatisms, the feeling of mastery and openness most often arises. Sensory automatisms can represent the interpretation of real pathological sensations associated with autonomic and neurological (polyneuropathy) disorders, which patients interpret as specially caused.With the deepening of the symptoms of psychosis, in particular, with the appearance of oneiric disorders, pathological sensations are associated with the effects of rays, waves, hypnosis, but without explanation and clarification of their origin and purposes of application (i.e., without delusional development). Motor automatism arises against the background of oneiric clouding of consciousness and is manifested primarily by object sensations of transformations occurring with the patient’s body or its parts (limbs, internal organs, etc. disappear or change).P.). Patients explain their interventions by means of specific objects (for example, a saw) or external influences (rays, etc.). At the same time, patients not only feel the impact, but also see its results. Simultaneously, the surrounding animate and inanimate objects are exposed to physical influence and transformation, that is, disorders resembling motor automatism arise not only with a dreamy clouding of consciousness, but also with the simultaneous development of metamorphosis delirium [Shapkin Yu A., 1971].The intensity of psychic automatisms fluctuates greatly. The psychosis lasts 1-2 weeks.

Prolonged (protracted, chronic) delirium . With a slow reverse development of some forms of delirium (systematic delirium, delirium with a predominance of severe variable hallucinations, delirium with oneiric disorders or with mental automatisms) for weeks, and occasionally months, symptoms of hypnagogic delirium may remain. Along with visual hallucinations, tactile and much rarer and less intense auditory hallucinations – acoasms and phonemes – are possible.Delusional disorders are limited to mild diffuse paranoia, and affective disorders are limited to mild anxiety and, much less often, transitory and mild fear. Behavior during this period does not change significantly. All types of orientation are saved. During the day, a low-tearful or low-dysphoric mood prevails in combination with symptoms of asthenia. Patients are critical of mental disorders that arise at night.

Delirium with occupational delirium (occupational delirium, delirium with occupational delirium).Psychosis can begin as typical delirium with subsequent transformation of the clinical picture. The intensity of hallucinatory-illusory and affective disorders is significantly reduced, the figurative delirium of persecution weakens or disappears. At the same time, excitement changes, in which there are fewer and fewer actions associated with protection, flight, that is, actions that require dexterity, strength, considerable space, accompanied by reactions of panic fear. Typically, the prevalence of relatively simple, stereotypical motor acts occurring in a limited space, reflecting individual everyday actions – dressing and undressing, picking up or unfolding bed linen, counting money, lighting matches, individual movements during drinking, etc.etc., less often there are actions reflecting some kind of episode associated with professional activity. Characterized by the reduction, and then the complete disappearance of the lucid intervals, or they are absent from the very onset of psychosis. In other cases, already at the onset of delirium, attention is drawn to the poverty of sensory disorders (they are static, few, without stage-like hallucinations), the monotony of affect, in which anxiety predominates. At the same time, somatoneurological disorders and motor excitement are quite intense.Distraction by external stimuli in this state is clearly weakened and may disappear altogether. This is usually silent arousal or arousal with very few spontaneous cues. Speech contact with patients is difficult, although sometimes it is possible to get monosyllabic answers. In the initial period of delirium with professional delirium, as a rule, there are multiple, variable false recognitions of the surrounding persons and constantly changing false orientation in the situation. The content of both symptoms is commonplace – relatives, co-workers, drinking companions, really past or possible situations.Consciousness of my Self is always preserved. With the aggravation of the condition, false recognition disappears, the movements become more automated and simple, contact with the patient is impossible. An aggravation of the condition is indicated by the appearance of symptoms of stunning during the day. Psychosis is accompanied by complete amnesia, less often fragmentary memories are preserved. With an aggravation of the condition, professional delirium can be replaced by exaggerated delirium.

Delirium with mumbling (exaggerating, “muttering” delirium), as a rule, replaces other delirious syndromes, most often delirious syndrome with professional delusions and typical delirious syndrome with autochthonous unfavorable course or complication of intercurrent diseases; often occurs with alcoholic encephalopathy of the Gaie-Wernicke type.Delirium is characterized by a combination of deep stupefaction and special motor and speech disorders with severe neurological and somatic symptoms. Patients do not react at all to their surroundings, verbal communication with them is impossible. Motor excitement occurs in an extremely limited space – “within the bed” (feeling, smoothing, grasping, pulling or, on the contrary, pulling on a blanket or sheet, the so-called picking – carphology, finger-fingering), i.e.That is, it is manifested by rudimentary movements without the simplest integral motor acts. In this regard, the excitement has a distinct “neurological” appearance. Such a definition of motor excitement is justified by its frequent combination with myoclonic twitchings of various muscle groups and choreiform hyperkinesis, which can also occur in isolation, without symptoms of “robbing”. Speech excitement is a set of one and the same, then different syllables, interjections, individual sounds, occasionally short words, pronounced in a quiet voice devoid of modulations.At times, both motor and speech arousal disappears. Of the neurological disorders, the most important are symptoms of oral automatism and oculomotor disorders in the form of strabismus, nystagmus, ptosis, and of somatic disorders, hyperthermia, severe hypotension, hyperhidrosis, and symptoms of dehydration. When the condition aggravates, delirium with muttering is replaced by severe stunning. Upon recovery, the entire period of the illness is completely amnestied.

According to various authors, death in alcoholic delirium occurs in 2-5% of cases.In connection with the success of active therapy of alcoholic psychoses, mortality in them decreased from 8% in the 20s of the XX century to 2% in the 50s [Achte K. et al., 1969]. The history of patients with severe, including death-ending, deliriums noted a high tolerance to alcohol, a rarity of previous psychoses, severe and prolonged binge drinking on the eve of psychosis [Salum J., 1972]. Other authors [Smirnova IN, Ruzhansky MI, Urakov IG, 1971], on the contrary, in almost 30% of cases noted a history of patients with delirium, including severe ones.Severe delirium is often preceded by severe dyspeptic disorders, in particular repeated vomiting.

They indicate a greater than usual frequency of epileptic seizures (in 41% of patients), especially before the onset of psychosis, as well as during its development [Salum J., 1972]. Symptoms of stunning and massive autonomic-neurological disorders are quickly added to the clinical picture of such deliriums. Hyperthermia is constant, reaching 40-42 ° C. In 72% of patients J. Salum noted frequent subcutaneous hematomas, and in 84% – a significant increase in the liver.

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        • Visit of Professor Janita Abeyvikrem Liyanage, Ambassador Extraordinary and Plenipotentiary of the Democratic Socialist Republic of Sri Lanka
        • Regional stage of the competition “Student of the Year-2021”
        • Republican online conference dedicated to the 60th anniversary of the Department of Obstetrics and Gynecology
        • Alma Mater-2021 (PF, MDF)
        • GRSMU awarded certificates to students of the personnel reserve school
        • Otorhinolaryngological readings
        • Alma Mater-2021 (LF, MPF)
        • Dialogue platform with the deputy of the House of Representatives Oleg Sergeevich Gaidukevich
        • Visit of the expert group of the Leader of the Year business award
        • Deputy Prime Minister of the Republic of Belarus Igor Viktorovich Petrishenko met with students of the State Medical University
        • Delegation of the University of Baghdad on a visit to the State Medical University
        • Student Festival of National Cultures-2021
        • Student of the Year 2021
        • Classes in the simulation center of the State Medical University, imitating the “red zone”
        • Refresher graduation ceremony
        • Festive concert dedicated to Mother’s Day
        • The ceremony of signing an agreement on cooperation between the university and the Grodno Orthodox diocese
        • Dialogue platform with the Chairman of the Grodno Regional Executive Committee Vladimir Stepanovich Karanik
        • Exhibition-presentation of institutions of higher education “Education of the future”
        • Friendly futsal tournament
        • Conference “Modern Problems of Radiation and Environmental Medicine, Radiation Diagnostics and Therapy”
        • Initiation into freshmen-2021
        • Meeting of the Deputy Minister of Health D.V. Cherednichenko with students
        • Open dialogue dedicated to the 19th anniversary of the Belarusian Republican Youth Union
        • Retraining group in the specialty “Health Organization”
        • Freshmen Faculty Meetings 2021
        • Knowledge Day – 2021
        • University Council
        • Students of the Military Department of the Grodno State Medical University took the oath
        • Liberation Day Grodno-2021
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        • Independence Day-2021
        • Students of the military department of the State Medical University: final practice-2021
        • Graduation from the Faculty of General Medicine-2021
        • Graduation from medical-psychological and medical-diagnostic faculties-2021
        • Graduation of the Faculty of Pediatrics-2021
        • International Students Faculty Graduation 2021
        • Graduation ceremony-2021
        • Requiem meeting dedicated to the 80th anniversary of the beginning of the Great Patriotic War
        • Action “Memory” dedicated to the 80th anniversary of the beginning of the Great Patriotic War
        • Republican student track and field race “At the start, youth!”
        • Current issues of food hygiene
        • Solemn event for the Day of Medical Workers-2021
        • University Council
        • Visiting meeting of the Republican Council of Rectors
        • Ceremony for awarding medals and special certificates to graduates of 2021
        • Prevention of destructive manifestations in the student environment and the influence of aggressive information content on the Internet
        • Online exhibition “Remember so as not to repeat”
        • Regional interuniversity conference “The feat of the people is immortal”
        • Final of the first Republican intellectual tournament ScienceQuiz
        • Conference “Topical issues of comorbidity of diseases in outpatient practice: from prevention to treatment”
        • Family Day 2021
        • Dialogue platform with the chairman of the Grodno Regional Council of Deputies
        • Festive city events for Victory Day
        • Regional stage of the competition “Queen of Students-2021”
        • Festive concert by May 9, 2021
        • IV Republican civil-patriotic marathon “Together – for a strong and prosperous Belarus!”
        • University Cup KVN-2021
        • Musical planet of students (completion of FIU Days-2021)
        • Youth round table “We are different, but we are together”
        • FIU Days 2021.Intellectual game “What? Where? When?”
        • Donation week at GrSMU
        • Creative living room. FIU Days 2021
        • Opening of the XVIII Student Festival of National Cultures
        • Mobile multimedia exhibition “Partisans of Belarus”
        • Republican subbotnik-2021
        • Seminar “The Man Within Himself”
        • International competition “Healthy lifestyle through the eyes of different generations”
        • Presentation of the badge “Border Guard’s Wife”
        • Meeting with representatives of the Medical University of St.Lublin
        • Queen of Students of GrSMU – 2021
        • Open Doors Day 2021
        • Personal finance management (meeting with representatives of BPS-Sberbank)
        • Spring “Melotrek”
        • Festive concert for March 8
        • Dialogue platform with the chairman of the Grodno Regional Executive Committee
        • Extended meeting of the university council
        • Grodno – Youth Capital of the Republic of Belarus-2021
        • A solemn meeting timed to coincide with the Defender of the Fatherland Day
        • Presentation of a certificate of a full member of the Belarusian Chamber of Commerce and Industry
        • New Year’s ScienceQuiz
        • Final IV of the ScienseQuiz Tournament
        • Regional stage of the competition “Student of the Year 2020”
        • Distance learning seminar for university staff from Belarus “Quality assurance of medical education and education in the field of public health and health care”
        • Student of the Year – 2020
        • Knowledge Day – 2020
        • Awarding ceremony for the Government Prize for Quality
        • Military oath
        • Graduation from the Faculty of General Medicine-2020
        • Graduation from the Faculty of Medicine and Psychology-2020
        • Graduation of the Faculty of Pediatrics-2020
        • Graduation from the Faculty of Foreign Students 2020
        • Distribution – 2020
        • Stop coronavirus!
        • Towards spring – 2020
        • Career guidance – 18th International Specialized Exhibition “Education and Career”
        • Spartakiad among employees “Health 2020”
        • Conference “Actual problems of medicine”
        • Opening of the hostel number 4
        • Meeting of the President of Belarus with students and teachers of medical universities
        • New Year’s party at GrSMU
        • XIX Republican student conference “Language.Society. The medicine”
        • Alma mater – love from the first year
        • Topical issues of comorbidity of cardiovascular and musculoskeletal diseases in outpatient practice
        • Regional stage “Student of the Year-2019”
        • Final Science Qiuz
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        • Dedication to FIU students
        • Mothers Day
        • Open Doors Day – 2019
        • Visit to Azerbaijan Medical University
        • Seminar-training with international participation “Modern aspects of nursing education”
        • Autumn Athletics Cross-Country – 2019
        • 40 years of pediatrics
        • Knowledge Day – 2019
        • Initiation into freshmen
        • Action for World Suicide Prevention Day
        • Tourslet-2019
        • Agreement on the establishment of a branch of the Department of General Surgery on the basis of the Brest Regional Hospital
        • Independence Day
        • Conference “Modern technologies of diagnostics, therapy and rehabilitation in pulmonology”
        • Graduation from medical diagnostic, pediatric faculties and faculty of foreign students – 2019
        • Graduation from the Faculty of Medicine and Psychology – 2019
        • Graduation from the Faculty of General Medicine – 2019
        • Good luck, graduates!
        • Distribution by subordination profiles
        • State exams
        • Intellectual game “What? Where? When?”
        • Mister and Miss Faculty of Foreign Students 2019
        • Victory Day
        • IV Republican student military-scientific conference “These days will not cease glory”
        • Republican civil-patriotic marathon “Together – for a strong and prosperous Belarus!”
        • Literary and artistic marathon “On the praises of Mayoi spadchyny”
        • Open Doors Day-2019
        • Their names will remain in our hearts
        • Regional stage of the competition “Queen of Spring – 2019”
        • Queen of Spring Grodno State Medical University – 2019
        • Career guidance “Applicant – 2019” (St.Baranovichi)
        • Event “Career starts with education!” (city of Lida)
        • Final distribution of graduates – 2019
        • “Towards Spring – 2019”
        • Solemn ceremony dedicated to the Defender of the Fatherland Day
        • Solemn meeting for the Defender of the Fatherland Day – 2019
        • Mister GrSMU – 2019
        • Pre-distribution of 2019 graduates
        • Meeting-requiem at the monument to soldiers-internationalists
        • Vocational guidance “Education and Career” (c.Minsk)
        • The final board of the Main Department of Health of the Grodno Regional Executive Committee
        • Spartakiad “Health – 2019”
        • Final scientific-practical conference “Actual problems of medicine”.
        • Extended meeting of the University Council.
        • Scientific-practical conference “Simulation technologies of teaching in the training of medical workers: relevance, problematic issues of implementation and prospects”
        • Freshmen competition “Alma mater – love from the first year”
        • XVI Congress of Surgeons of the Republic of Belarus
        • Final practice
        • Competition “Student of the Year-2018”
        • University Council
        • 1st Congress of the Eurasian Arrhythmological Association (14.09.2018 y.)
        • 1st Congress of the Eurasian Arrhythmological Association (09/13/2018)
        • Knowledge day
        • Independence Day of the Republic of Belarus
        • Awarding ceremony for the winners of the competition for the CIS Prize
        • Day of the coat of arms and flag of the Republic of Belarus
        • “Become a donor – give the opportunity to live”
        • VIII International Interuniversity Festival of Contemporary Dance “Take a Step Forward”
        • Competition of grace and artistic skills “Queen of Spring of the State Medical University – 2018”
        • Final distribution of graduates 2018
        • Requiem meeting timed to coincide with the 75th anniversary of the Khatyn tragedy
        • Regional meeting “Results of the work of the therapeutic and cardiological services of the Grodno region in 2017 and tasks for 2018”
        • Competitive show performance “Mister GrSMU-2018”
        • Pre-allocation of 2018 graduates
        • Final scientific-practical conference “Actual problems of medicine”
        • II Congress of Scientists of the Republic of Belarus
        • Round table of the Faculty of Foreign Students
        • “Youth of the world: identity, solidarity, cooperation”
        • Meeting of the visiting session of the Grodno Regional Council of Deputies
        • Regional stage of the republican competition “Student of the Year-2017”
        • Meeting with the Chairman of the Belaya Rus RPA, Alexander Mikhailovich Radkov
        • Conference “Topical issues of infectious pathology”, 27.10.2017
        • XIX World Festival of Students and Youth
        • Republican scientific and practical conference “II Grodno arrhythmological readings”
        • Regional scientific-practical conference “V Grodno gastroenterological readings”
        • Celebration dedicated to the 889th anniversary of the city of Grodno
        • Round table on the topic “The place and role of the RPO” Belaya Rus “in the political system of the Republic of Belarus” (22.09.2017)
        • GRSMU and the University of Medicine and Pharmacy (Tyrgu-Mures, Romania) signed a Cooperation Agreement
        • 1 September is the day of knowledge
        • Final practice at the Department of Military and Extreme Medicine
        • Qualification exam for medical interns
        • Meeting with the Commission for Awarding the Prize of the Government of the Republic of Belarus
        • Scientific-practical conference “Outpatient therapy and surgery of diseases of ENT organs and associated pathology of other organs and systems”
        • National Flag and Coat of Arms Day
        • May 9
        • Republican scientific and practical conference with international participation “V Belarusian-Polish dermatological conference: dermatology without borders”
        • “Become a donor – give the opportunity to live”
        • “Round table” of the Standing Committee of the Council of the Republic of Belarus of the National Assembly of the Republic of Belarus on Education, Science, Culture and Social Development
        • Spring Cup of KVN “Humor is a Science”
        • Miss GRSMU-2017
        • 2017 distribution
        • Citywide career guidance day for students of gymnasiums, lyceums and schools
        • Festive concert dedicated to the Day of March 8
        • Competitive show performance “Mister GrSMU-2017”
        • “Maslenitsa-2017”
        • A festive meeting and a festive concert dedicated to the Defender of the Fatherland Day
        • Lecture by professor, d.M.Sc. O.O. Rummo
        • Final scientific-practical conference “Actual problems of medicine”
        • Memorandum of cooperation between the regional organization of the Belarusian Red Cross Society and the regional organization of the Red Cross of the Chinese province of Henan
        • Visit of the delegation of the Moscow State University of Economics HELL. Sakharov BSU at GrSMU
        • “Student of the Year 2016”
        • Visit of the Ambassador Extraordinary and Plenipotentiary of the Kingdom of Sweden to the Republic of Belarus Mr. Martin Oberg to the State Medical University
        • Freshmen competition “Alma mater – love from the first year”
        • Mother’s Day at GrSMU
        • Final practice-2016
        • Knowledge day
        • Visit of the Chinese delegation to the State Medical University
        • Visit of a foreign delegation from Wroclaw Medical University (Republic of Poland)
        • Solemn event dedicated to the professional holiday – the Day of the medical worker
        • Visit of the Rector of the State Medical University Viktor Snezhitsky to India
        • Republican University Saturday-2016
        • Republican action “Belarus against tobacco”
        • Meeting with the poetess Yanina Bokiy
        • May 9 – Victory Day
        • Meeting dedicated to the Day of the State Emblem and State Flag of the Republic of Belarus
        • Regional interuniversity student scientific-practical conference “1941: tragedy, heroism, memory”
        • “Flowers of the Great Victory”
        • Concert of the folk ensemble of Polish song and dance “Khabry”
        • Subotnik ў Muravantsy
        • “Miss Grodno State Medical University-2016”
        • Visit of the academician of the Russian Academy of Medical Sciences, Professor Razumov Alexander Nikolaevich to the educational establishment “GrSMU”
        • Visit of a foreign delegation from the Medical Council of the Republic of Maldives
        • “Cup of the Rector of Grodno State Medical University in Judo”
        • “Friendship Cup-2016” on mini-football among men’s and women’s teams of medical educational institutions of the Republic of Belarus
        • Distribution of graduates 2016
        • Visit of the Minister of Defense of the Republic of Belarus to the military department of the State Medical University
        • Visit of the First Secretary of the Embassy of Israel Anna Keinan and Director of the Israeli Cultural Center at the Embassy of Israel Ray Keinan
        • Visit of a foreign delegation from the Gansu province of the People’s Republic of China to the State Medical University
        • The opening of the photo exhibition “In the footsteps of the Bible”
        • “Dean’s Cup” of the Medical and Diagnostic Faculty of Climbing
        • Mister GRSMU-2016
        • Reception of the First Secretary of the Israeli Embassy Anna Keinan at the State Medical University
        • Spartakiad “Health” UO “GrSMU” among employees of the 2015-2016 academic year
        • Visit of the Ambassador of the Republic of India to the UO “GrSMU”
        • Solemn meeting and concert dedicated to the Defender of the Fatherland Day
        • Meeting-requiem dedicated to the Day of Remembrance of the soldiers-internationalists
        • The final meeting of the board of the main department of ideological work, culture and youth affairs of the Grodno regional executive committee
        • Final scientific and practical conference of Grodno State Medical University
        • New Year’s concert
        • Opening of the professorial advisory center
        • Concert-action “Youth against AIDS”
        • “Student of the Year 2015”
        • Open lectures by Professor, Academician of the National Academy of Sciences of Belarus Yuri Petrovich Ostrovsky
        • “Alma mater – love from the first year”
        • Open lecture by WHO Regional Director Ms Zsuzsanna Jakab
        • “Open Cup for cycling orienteering RCFViS”
        • Joint meeting of the University CouncilsGrodno
        • Meeting with the Minister of Health of the Republic of Belarus V.I. Hot
        • Day of the city
        • Debate “Physician – the choice of life”
        • Day of the city
        • Festive concert “For you, freshmen!”
        • Promotion “Our year is our choice”
        • Knowledge day
        • Open admission of applicants to the educational establishment “Grodno State Medical University”
        • Taking the military oath by students of the GrSMU
        • Independence Day of the Republic of Belarus
        • Graduation ceremony for 2015 graduates
        • Republican Olympiad for Students in Pediatrics
        • Opening of a memorial sign in honor of the fallen defenders
        • May 9
        • “The second Belarusian-Polish dermatological conference: dermatology without borders”
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        • Grodno State Medical University
        • Honoring our veterans
        • 1st of May
        • Joint cleanup
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