沒事多喝水 小心水中毒

[TC]

沒事多喝水 小心水中毒

記者曾芳蘭／新竹報導

一名有 20多年精神分裂症病史的 47歲男性患者，不久前才剛從精神病房出院返家，因患者認為大量喝水可以沖掉人體吃太多藥物的副作用，免於洗腎的恐懼，於是從五月底起拚命喝水，一個早上可以喝 6至 7瓶 700c.c.礦泉水，一天下來可以喝下 8,000~ 9,000c.c.的水。

日前患者家人因覺得患者走路不太穩定，全身倦怠，講話變得遲緩，好像大舌頭，於是緊急送往衛生署新竹醫院急診室，醫師擔心是患者腦部病灶的問題，安排頭部電腦斷層，沒想到竟然在電腦斷層室內痙攣發作且發紺，臉部瞬間變黑，呼吸困難，血壓心跳曾一度量不到，經醫師施以緊急心肺復甦術後，送至加護病房照顧。後來經詢問病史、詳細理學檢查及實驗室檢查，證實為喝水喝太多所引起的低血鈉導致痙攣發作合併呼吸衰竭，還好急救得宜，鈉離子已矯正回來，目前已拔管並轉至一般病房照顧。

衛生署新竹醫院加護病房陳憲青醫師指出，低血鈉的定義為小於 135mEq/L，這位病人的低血鈉為 119 mEq/L，低於標準甚多，根據教科書記載，神經學症狀嚴重程度與血中鈉離子降低速度有關，也就是短時間喝太多水，引起血中鈉離子降太快，也就俗稱”水中毒”，一般而言，急性低血鈉症（發展二天左右），病人會有噁心、無力感，此時鈉離子度約 125 mEq/L，然而隨著鈉離子往下掉，症狀會更嚴重，包括頭痛、疲倦、意識混淆、走路不穩，當鈉離子小於 115 mEq/L，會產生痙攣昏迷甚至死亡，所以不可輕忽。

醫師表示，精神分裂症者大量飲水行為的成因，至今仍未有定論，早期認為是鉀鹽或抗精神藥物引起口渴之副作用，也有學者指出可能是下視丘或海馬迴的功能障礙所引起，像此病患大量飲水是受到聽幻覺及妄想所影響，在精神症狀改善後，其大量飲水也跟著減少，因此，精神病人按時服藥，有問題至精神醫師詢問及調整是非常重要的。

[千言萬語]

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