最好的课件体液失调要点_第1页
最好的课件体液失调要点_第2页
最好的课件体液失调要点_第3页
最好的课件体液失调要点_第4页
最好的课件体液失调要点_第5页
已阅读5页,还剩106页未读 继续免费阅读

下载本文档

版权说明:本文档由用户提供并上传,收益归属内容提供方,若内容存在侵权,请进行举报或认领

文档简介

3/25/2019 12:32 AM,外科病人的体液失调 Fluid Disorders of Surgical Patients,3/25/2019 12:32 AM,有用的概念 Useful Concepts,3/25/2019 12:32 AM,体液,脊椎动物进化于海水 脊椎动物身体的大约2/3是水 大多数脊椎动物的细胞外液的浓度是恒定的 体液=水+电解质+蛋白质+气体,3/25/2019 12:32 AM,Body Fluid 体液,Major Factors Affecting Body Fluids Age Gender Body fat,影响体液的主要因素 年龄 性别 体脂,3/25/2019 12:32 AM,Body Fluid 体液,Birth: 75-80% of body composition 1 year: 65% After puberty 60% males 50% females Older adults 50% males 40% females,出生: 75-80% 身体成分 1岁:65% 青春期后 60% 男 50% 女 老年 50% 男 40% 女,3/25/2019 12:32 AM,Body Fluid 体液,Intracellular Fluid (ICF) 40% BW for male 35% for female) Extracellular Fluid (ECF) 20% BW Plasma 5% BW Interstital Fluid 15% BW,细胞内液 (ICF) 40%体重(男) 35%体重(女) 细胞外液 (ECF) 20%体重 血浆 5%体重 组织间液 15%体重,3/25/2019 12:32 AM,Body Fluid 体液,细胞内液 Na+ CI- , HCO3 - & Protein - 细胞外液 K +, Mg + HPO42- & Protein -,3/25/2019 12:32 AM,Homeostasis 内稳态,Homeostasis, from the Greek words for “same“ and “steady“ Defined as the dynamic constancy of the internal environment despite changes in the external environment More a dynamic state in which internal conditions vary within narrow limits,内稳态一词来自希腊文“相同的”和“稳定的” 指无论外环境如何变化,保持内环境的动态稳定 内环境的多数的动态变化仅限于很窄的范围,3/25/2019 12:32 AM,Homeostasis 内稳态,Necessary for survival Most of these mechanisms operate by negative feedback Every organ system plays a role in maintaining homeostasis Nervous and endocrine systems are major communication systems,内稳态为生存所必需 大多数以负反馈机制调节 每一器官系统对维持内稳态具有作用 神经内分泌系统是主要的信息传递系统,3/25/2019 12:32 AM,Osmotic Pressure 渗透压,The pressure required to stop osmosis through a semipermeable membrane between a solution and pure solvent It is proportional to the osmolality of the solution. Normal value 290-310 mmol/L Formula 2(Na)+K+BUN+Glu,指为维持通过半透膜所隔开的溶液与纯溶剂之间的渗透平衡而需要的压力 与重量克分子渗透压浓度一致 正常值 290-310 mmol/L 公式 2(钠)+钾+尿素氮+葡萄糖,3/25/2019 12:32 AM,Fluid Balance 体液平衡,Water balance Water intake & loss are equal Electrolyte balance Ectrolytes absorbed in small intestine = amount lost in urine Acid base balance Hydrogen ions lost = hydrogen ions produced by metabolism,水平衡 水摄入=水丢失 电解质平衡 小肠吸收电解质量=尿中丢失量 酸碱平衡 氢离子丢失=代谢产生,3/25/2019 12:32 AM,Fluid Regulation 体液调节,Thirst Kidneys ADH Aldosterone Angiotensin II Prostaglandins Glucocorticoids Atrial Natriuretic Peptide,渴感 肾脏 抗利尿激素 醛固酮 血管紧张素 前列腺素 糖皮质激素 心钠素,3/25/2019 12:32 AM,水、钠代谢紊乱 Water and Sodium Disorders,3/25/2019 12:32 AM,Water Balance 水的平衡,3/25/2019 12:32 AM,Water Balance 水的平衡,NPO (non per os ) Anorexia,摄入水(INPUT),3/25/2019 12:32 AM,Sodium 钠,Since sodium (Na) is the major osmotically active cation in the ECF compartment, changes in total body Na content are paralleled by changes in ECF volume,钠是细胞外液间隙中主要的渗透性活性阳离子,体内钠含量的变化与细胞外液容量的变化是平行的,3/25/2019 12:32 AM,Composition of GI Secretions 消化液成分,3/25/2019 12:32 AM,Dehydration 缺水,Dehydration is a condition that occurs when the loss of body fluids, exceeds the amount that is taken in Isotonic dehydration Hypotonic dehydration Hypertonic dehydration,缺水指体液丢失超过摄入 等渗性缺水 低渗性缺水 高渗性缺水,3/25/2019 12:32 AM,Dehydration 缺水,Normal RBCs,Isotonic Solution,Equal movement of water into and out of cells,Net movement of water out of cells,Net movement of water into cells,Shriveled RBCs,Swollen RBCs,Hypertonic Solution,Hypotonic Solution,3/25/2019 12:32 AM,Isotonic dehydration 等渗性缺水,Usually called fluid volume deficit, or hypovolemia in West Sodium loss = water loss Serum Na+ unchanged Plasma osmotic pressure unchanged,在西方通常称作容量缺乏或低血容量 钠丢失=水丢失 血清钠不变 血浆渗透压不变,3/25/2019 12:32 AM,Isotonic dehydration 等渗性缺水,Causes Excessive Fluid Losses Vomiting, diarrhea, GI suction, hemorrhage,intestinal fistulae, burn, intestinal obstruction, intra-abdominal infection, ect. Poor / Inadequate Fluid Intake,病因 体液丢失过多 呕吐、腹泻、胃肠减压、出血、肠瘘、肠梗阻、腹腔感染等 摄入不足,3/25/2019 12:32 AM,Isotonic dehydration 等渗性缺水,Clinical Manifestations Acute weight loss Urinary Output Anorexia Flattened neck veins Muscle weakness May not thirst Cool, clammy skin Skin turgor Weak, rapid pulse Orthostatic hypotension,临床表现 急性体重丢失 尿量减少 厌食 颈静脉萎陷 肌肉无力 可能不口渴 皮肤湿冷 皮肤弹性下降 脉搏细弱 体位性低血压,3/25/2019 12:32 AM,Isotonic dehydration 等渗性缺水,Management Replace ECF loss Address underlying cause IV route: Isotonic Solutions (Lactated Ringers, LR),处理 补充细胞外液量 去除病因 静脉补液:等渗溶液(乳酸林格氏液),3/25/2019 12:32 AM,Hypotonic Dehydration 低渗性缺水,Definition Sodium losswater loss osmotic pressure 290mmol/L Na+135mmol/L Also called hypovolemic hyponatremia,定义 钠丢失水丢失 血浆渗透压 290mmol/L 血清Na+ 135mmol/L 也称作低血容量性低钠血症,3/25/2019 12:32 AM,Hypotonic Dehydration 低渗性缺水,Causes GI losses: Vomiting and diarrhea, intestinal obstruction, fistulas, drainage and NG tubes (chronic) Renal losses: Use of diuretics Extensive wounds (burn) Third spacing (peritonitis, pancreatitis, intestinal obstruction, ascites),病因 胃肠道丢失:长期呕吐和腹泻,慢性肠梗阻,肠瘘,引流管和鼻肠管 肾脏丢失:利尿剂的应用 大面积创伤(烧伤) 第三间隙丢失:(腹膜炎,胰腺炎,肠梗阻,腹水),3/25/2019 12:32 AM,Hypotonic Dehydration 低渗性缺水,Clinical Manifestations Neurological Headache Lethargy Confusion Seizures Coma Gastrointestinal Anorexia Nausea and vomiting,临床表现 神经系统 头痛 嗜睡 意识错乱 癫痫发作 昏迷 胃肠道 厌食 恶心和呕吐,3/25/2019 12:32 AM,Hypotonic Dehydration 低渗性缺水,Severity of Illness Mild: Serum Na+135mmol/L Moderate: Serum Na+130mmol/L Severe: Serum Na+120mmol/L,分度 轻度:血清钠+ 135 mmol/L 中度:血清钠+ 130 mmol/L 重度:血清钠+ 120 mmol/L,3/25/2019 12:32 AM,Hypotonic Dehydration 低渗性缺水,Diagnosis History Clinical findings Lab Serum Na+135mmol/L RBC, Hb, Ht, BUN Urine gravity, osmolality and Na+,诊断 病史 临床表现 实验室检查 血清钠+ 135 mmol/L 红细胞计数、血红蛋白、血细胞压积、尿素氮 尿比重、渗透压、钠,3/25/2019 12:32 AM,Hypotonic Dehydration 低渗性缺水,Management Fluid replacement NaCl solutions infusion Fomula Na required (mmol/L) = desired Na (mmol/L) - actual Na (mmol/L) x Wt (kg) x 0.6 (male) /0.5(female) 17mmol Na = 1g NaCl,治疗 补液 注射含氯化钠溶液 公式 补钠量(mmol/L) = 血钠正常值(mmol/L) 血钠测得值(mmol/L) x 体重(kg) x0.6(男) /0.5(女) 17mmol 钠 = 1g 氯化钠,3/25/2019 12:32 AM,Hypotonic Dehydration 低渗性缺水,Management (cont) Mild or moderate hypovolemic hyponatremia Isotonic or Hypertonic salt solutions Severe hypovolemic hyponatremia Hypertonic salt solutions colloids,治疗(续) 轻、中度低血容量性低钠血症 等渗或高渗盐溶液 重度低血容量性低钠血症 高渗盐溶液 胶体,3/25/2019 12:32 AM,Hyponatremia 低钠血症,Hyponatremia include hypovolemic hyponatremia Hypervolemic hyponatremia Euvolemic Hyponatremia,低钠血症包括 低血容量的低钠血症 高血容量的低钠血症 正常血容量的低钠血症,3/25/2019 12:32 AM,Hyponatremia 低钠血症,Pathophysiology Hyponatremia is physiologically significant when it indicates a state of extracellular hypo-osmolarity and a tendency for free water to shift from the vascular space to the intracellular space. Although cellular edema is well tolerated by most tissues, it is not well tolerated within the rigid confines of the bony calvarium. Therefore, clinical manifestations of hyponatremia are related primarily to cerebral edema,病理生理学 低钠血症可导致细胞外低渗状态和自由水从血管间隙转移至细胞内间隙。尽管多数组织可以耐受细胞水肿,但是在坚硬的颅盖骨范围内却难以耐受。因此,低钠血症的临床表现主要与脑水肿有关,3/25/2019 12:32 AM,Pseudohyponatremia 假性低钠血症,Pseudohyponatremia is caused by an increased serum protein or lipid concentration producing a “space-occupying lesion“ in serum water It must be assessed in hyponatremic patients with, for example, paraproteinemia or hyperlipemic diabetic coma,假性低钠血症是由于血清中蛋白质和脂肪浓度增高产生的“空间占位病变”所致 在低血钠病人,合并病变蛋白血症或高脂糖尿病昏迷者,需要评估其可能性,3/25/2019 12:32 AM,Hypertonic Dehydration 高渗性缺水,Water losssodium loss Serum Na+150mmol/L Plasma osmotic pressure310mmol/L Also called hypovolemic hypernatremia,水丢失钠丢失 血清钠Na+150mmol/L 血浆渗透压310mmol/L 也称作低血容量性高钠血症,3/25/2019 12:32 AM,Hypertonic Dehydration 高渗性缺水,Causes Sodium Excess Dietary Intake Foods Medications high in sodium Water Deficit Inadequate intake Increased insensible losses (i.e. fever) Watery diarrhea Osmotic Diuresis,病因 钠过多 饮食摄入 食物 高钠药物 水缺乏 摄入不足 非显性失水增加(发热) 水样泻 渗透性利尿,3/25/2019 12:32 AM,Hypertonic Dehydration 高渗性缺水,Clinical Manifestations Neurological Restlessness Agitation Confusion Seizures Coma Other Severe thirst, dry mucous membranes, muscular twitching, hyperactive deep tendon reflexes, anorexia, nausea and vomiting,临床表现 神经系统 烦躁 兴奋 意识混乱 癫痫 昏迷 其他 重度口渴,粘膜干燥,肌肉抽搐,腱反射亢进,厌食,恶心,呕吐,3/25/2019 12:32 AM,Hypertonic Dehydration 高渗性缺水,Degree Mild: 2-4% loss BW or 6% BW or 30-40% BV Shock: 8% BW or 40% BV Lab Serum Na+150mmol/L RBC, Hb, Ht Urine gravity and osmolality,分度 轻度: 血容量2-4%体重或 6%体重或 30-40%血容量 休克: 8%体重或 40%血容量 实验室 血清钠150mmol/L 红细胞、血红蛋白、压积升高 尿比重和渗透压浓度升高,3/25/2019 12:32 AM,Hypertonic Dehydration 高渗性缺水,Management 5%glucose 0.45%NaCl,处理 5%葡萄糖 0.45%氯化钠,3/25/2019 12:32 AM,Fluid Volume Excess 体液容量过多,Clinical Manifestations Rapid weight gain Peripheral Edema Distended neck veins Shortness of breath Bounding pulse Blood pressure Crackles Orthopnea,临床表现 快速体重增加 外周水肿 颈静脉扩张 气短 洪脉 血压升高 湿罗音 端坐呼吸,3/25/2019 12:32 AM,Fluid Replacement 补液,Maintenance Deficit Actual weight loss vs estimate Give in first 8 hrs and in next 16 hrs Ongoing losses NG losses, fistulas, third space, etc,维持量 缺乏量 急性体重丢失(相对于评估) 头8小时给与1/2,后16小时给与1/2 继续丢失量 鼻胃管丢失,瘘,第三间隙等,3/25/2019 12:32 AM,Colloids to restore perfusion 胶体恢复灌注,Indications Hypotension Tachycardia Oliguria Cool peripheries Known blood loss Major surgical procedure Severe trauma Sepsis Other Critical illness,指征 低血压 心动过速 少尿 外周冷 已知血液丢失 大手术 严重创伤 脓毒症 其它危重病,3/25/2019 12:32 AM,钾的异常 Postassium Disorders,3/25/2019 12:32 AM,Postassium Disorders 钾的异常,Most abundant cation in ICF Normal serum K+: 3.55.5mmol/L Even minor variations in serum potassium levels are significant Major functions Maintaining electrical neutrality & osmolality Assists in neuromuscular transmission of impulses Assists in skeletal and cardiac muscle in contraction & electrical conductivity Maintaining acid-base balances,细胞内最多的阳离子 正常血清钾+: 3.55.5mmol/L 即使血清钾水平微小变化都可能产生显著影响 主要功能 维持电中和与渗透压浓度 促进神经肌肉冲动传播 维持酸碱平衡,3/25/2019 12:32 AM,Hypokalemia 低钾血症,Serum K+ 3.5 mmol / L Etiology Inadequate intake malnutrition IVF deficient in potassium GI Losses Vomiting, gastric suctioning and diarrhea Other: long-term abuse of laxatives or enemas GU losses Diuretics (Non-K Sparing), renal tubular acidosis Intracellular uptake with redistribution seen in acute alkalosis, insulin therapy, and anabolism,血钾 3.5 mmol / L 病因 摄入不足 营养不良 补液缺钾 胃肠道丢失 呕吐,胃肠减压,腹泻 长期泄剂滥用或灌肠 泌尿系丢失 利尿剂(非保钾),肾小管酸中毒 细胞内摄取重新分布,见于急性酸中毒,应用胰岛素和合成代谢,3/25/2019 12:32 AM,Hypokalemia 低钾血症,Clinical Manifestations Cardiac Weak, irregular pulse Dysrhythmias and EKG changes Cardiac arrest and death Neuromuscular Skeletal muscle weakness Hypoactive deep tendon reflexes Enteroparalysis Other Constipation, fatigue, anorexia & N/V,临床表现 心血管 脉搏细弱不规律 心律失常,心电图改变 心跳停止,死亡 神经肌肉 骨骼肌无力 腱反射减弱 肠麻痹 其他 便秘,乏力,厌食,恶心,呕吐,3/25/2019 12:32 AM,Hypokalemia 低钾血症,EKG low, flat T-waves, ST depression, and U waves,心电图 T波低平,ST压低,U波,3/25/2019 12:32 AM,Hypokalemia 低钾血症,Treatment Treat alkalosis IV K+ 20 mmol/hr 40 mmol/L(3gKCl) 1gKCl=13.4mmol/L,治疗 治疗碱中毒 静脉补钾 20 mmol/小时 40 mmol/L(3g氯化钾) 1g氯化钾=13.4mmol/L,3/25/2019 12:32 AM,Hyperkalemia 高钾血症,Serum K+ 5.5 mmol/L Etiology Decreased renal excretion i.e. Renal failure Increased K intake Diet / Dietary supplements Cellular death Trauma: burns,crush injuries Severe infection Chemotherapy Blood transfusions,血钾 5.5mmol/L 病因 肾排泻减少(肾衰) 钾摄入过多 细胞死亡 创伤:烧伤,积压伤 重度感染 化疗 输血,3/25/2019 12:32 AM,Hyperkalemia 高钾血症,Clinical Manifestations Cardiac Irregular pulse Dysrhythmias and EKG changes Cardiac arrest and death Neuromuscular Flaccid paralysis Paresthesias Muscle weakness Other Fatigue, irritability, anorexia and N/V,临床表现 心血管 脉搏不齐 心律失常,心电图改变 心跳停止,死亡 神经肌肉 迟缓型麻痹 感觉异常 肌无力 其他 疲乏,兴奋,厌食,恶心,呕吐,3/25/2019 12:32 AM,Hyperkalemia 高钾血症,EKG Early peaked T waves then flat P waves, prolonged QT, widened QRS progressing,心电图 早期高尖T波,P波平坦, ST段压低,QT延长,QRS增宽,3/25/2019 12:32 AM,Hyperkalemia 高钾血症,Treatment Remove iatrogenic causes Ca-gluconate Sodium bicarbonate Glucose Regular insulin Emergent dialysis Hydration and diuresis Kayexalate Sorbitol Hemodialysis,治疗 去除病因 葡萄糖酸钙 碳酸氢钠 葡萄糖 胰岛素 水化利尿 降钾树脂 山梨醇 血液透析,3/25/2019 12:32 AM,钙的异常 Calcium Abnormalities,3/25/2019 12:32 AM,Calcium Abnormalities 钙的异常,Major Functions Formation and structure of teeth and bones Assists in maintaining cell structure & function Transmission of nerve impulses Role in smooth, skeletal and cardiac muscles contraction & relaxation Role in the blood clotting processes,主要功能 牙骨构成 维持细胞结构和功能 传送神经冲动 平滑肌、骨骼肌、心肌收缩和放松 凝血,3/25/2019 12:32 AM,Calcium Abnormalities 钙的异常,Normal serum Ca2+: 2.252.75mmol/L Calcium and Phosphate Balance PTH Bones break down GI Ca2+ absorption and Vit D activation Kidneys Inc reabsorption Ca2+, dec resorption PO42- Calcitonin Deposit Ca2+ in Bone,正常钙:2.252.75mmol/L 钙磷平衡 甲状旁腺激素 骨分解 胃肠钙吸收,维生素D活性 肾钙重吸收增加,磷酸再吸收减少 降钙素 骨钙沉积,3/25/2019 12:32 AM,Hypocalcemia 低钙血症,Ca2+2.25mmol/l Causes Inadequate Dietary Intake Hypoparathyroidism Thyroid and parathyroid surgeries Vitamin D Deficiency Chronic diarrhea Pancreatitis,钙+2.25mmol/l 病因 摄入不足 甲状旁腺功能减退 甲状腺和甲状旁腺手术 维生素D缺乏 慢性腹泻 胰腺炎,3/25/2019 12:32 AM,Hypocalcemia 低钙血症,Clinical Manifestations Neuromuscular Paresthesias: Toes, fingers and around the mouth Muscle tremors, cramps, spasms or twitching Tetany +Trousseaus & + Chvosteks sign Hyperactive deep tendon reflexes Cardiac Cardiac dysrhythmias EKG changes Other Confusion, irritability, seizures, abdominal cramping, diarrhea and impaired clotting times,临床表现 神经肌肉 感觉异常:趾,指,口周 肌肉震颤痉挛抽筋抽搐 手足搐搦 束臂试验,面神经叩击征阳性 腱反射亢进 心血管 心律失常 心电图改变 其他 意识混乱,兴奋,癫痫,腹痛,腹泻,血凝损害,3/25/2019 12:32 AM,Hypocalcemia 低钙血症,Tetany 手足搐搦,3/25/2019 12:32 AM,Hypocalcemia 低钙血症,Trousseaus sign Chvosteks sign,3/25/2019 12:32 AM,Hypocalcemia 低钙血症,ECG has prolonged QT interval,心电图QT间期延长,3/25/2019 12:32 AM,Hypocalcemia 低钙血症,Management Acute: intravenous calcium gluconate or calcium chloride Chronic: oral calcium and Vitamin D Assess serum Phos,治疗 急性:静脉补充葡萄酸钙或氯化钙 慢性:口服补钙和维生素D 评估血清磷,3/25/2019 12:32 AM,Hypercalcemia 高钙血症,Ca2+2.75mmol/L Causes Excessive Intake Hyperparathyroidism Metastatic cancer Breast Lung Renal,钙 2.75mmol/L病因 摄入过多 甲状旁腺功能亢进 转移癌 乳腺 肺 肾,3/25/2019 12:32 AM,Hypercalcemia 高钙血症,Clinical Manifestations Neurological Confusion, fatigue, lethargy, acute psychotic behavior and coma Neuromuscular Muscle weakness, incoordination and hypoactive deep tendon reflexes Cardiac Dysrhythmias and ECG changes Other Anorexia, n/v, weakness, bone pain, constipation, abdominal pain,临床表现 神经系统 意识混乱,疲乏,嗜睡,精神病行为,昏迷 神经肌肉 肌肉无力,共济失调,腱反射减弱 心血管 心律失常,心电图改变 其他 厌食,恶心,呕吐,虚弱,骨痛,便秘,腹痛,3/25/2019 12:32 AM,Hypercalcemia 高钙血症,Management Rehydrate with normal saline Promote diuresis,治疗 水化 利尿,3/25/2019 12:32 AM,镁的异常 Magnesium Abnormalities,3/25/2019 12:32 AM,Magnesium Abnormalities镁的异常,Normal serum Mg2+ 0.701.10mmol/L Major functions Promotes enzyme reactions within the cell Assists in both carbohydrate and protein metabolism Assists in producing and using ATP for energy Influences vasodilation, assisting the cardiovascular system to function properly Important role in maintaining neuromuscular function,正常血镁0.701.10mmol/L 主要功能 促进细胞酶反应 促进碳水化合物和蛋白质代谢 促进ATP的生成和利用 影响血管舒张,维持心血管功能 维持神经肌肉功能,3/25/2019 12:32 AM,Hypomagnesemia 低镁血症,Causes Poor dietary intake Malnutrition Chronic ETOH abuse GI losses Prolonged diarrhea or laxative abuse GU Losses Prolonged use of loop or thiazide diuretics,病因 摄入不足 营养不良 酗酒 胃肠道丢失 长期腹泻,泻剂滥用 泌尿系丢失 长期应用襻类或噻嗪类利尿剂,3/25/2019 12:32 AM,Hypomagnesemia 低镁血症,Clinical Manifestations Symptoms the same as hypocalcemia Cardiac ventricular dysrhythmias,临床表现 症状类似低钙血症 室性心律失常,3/25/2019 12:32 AM,Hypomagnesemia 低镁血症,Management Magnesium repletion Magnesium sulfate IV,治疗 补镁 静脉注射硫酸镁,3/25/2019 12:32 AM,Hypermagnesemia 高镁血症,Causes Excessive Intake Antacids and laxatives containing Mg Impaired GU Function,病因 摄入过多 制酸剂,含镁泻剂 肾功损害,3/25/2019 12:32 AM,Hypermagnesemia 高镁血症,Clinical Manifestations Neuromuscular Hypoactive Deep Tendon Reflexes Muscle weakness & paralysis Other Drowsiness, lethargy Coma Facial flushing Respiratory depression Weak pulse, bradycardia () and cardiac arrest Hypotension,临床表现 神经肌肉 腱反射减弱 肌肉无力或麻痹 其他 嗜睡,昏迷 脸红 呼吸抑制 脉搏减弱,心动过缓,心跳停止 低血压,3/25/2019 12:32 AM,Hypermagnesemia 高镁血症,Management Protect the heart Calcium gluconate Volume resuscitate Eliminate excess magnesium Stop magnesium administration Correct acidosis Normal kidneys: loop diuretics Abnormal kidneys: hemodialysis,治疗 保护心脏 葡萄糖酸钙 容量复苏 排镁 停止镁摄入 纠正酸中毒 正常肾:利尿剂 异常肾:血液透析,3/25/2019 12:32 AM,磷的异常 Phosphate Abnormalities,3/25/2019 12:32 AM,Phosphate Abnormalities 磷的异常,Normal serum Phos: 0.961.62mol/L,正常磷:0.961.62mol/L,3/25/2019 12:32 AM,Hyperphosphatemia 高磷血症,Causes Excessive intake of Phosphorus Vitamin D Excess Renal Failure Hypoparathyroidism Chemotherapy,病因 磷摄入过多 维生素D过多 肾衰 甲状旁腺功能减退 化疗,3/25/2019 12:32 AM,Hyperphosphatemia 高磷血症,Clinical Manifestations Neuromuscular Paresthesias Muscle weakness, cramps or spasms Tetany,+ Trousseaus & + Chvosteks sign Hyperactive deep tendon reflexes Other Confusion, dysrhythmias, anorexia and n/v Reciprocal Hypocalcemia,临床表现 神经肌肉 感觉异常 肌肉无力,抽筋 手足抽搐,束臂试验,面神经叩击征阳性 腱反射亢进 其他 意识混乱,心律失常,厌食,恶心,呕吐 低钙血症,3/25/2019 12:32 AM,Hyperphosphatemia 高磷血症,Management Intravenous Ca Hemodialysis,治疗 静脉补钙 血液透析,3/25/2019 12:32 AM,Hypophosphatemia 低磷血症,Causes Intake: Loss Hyperparathyroidism GI Diarrhea Phosphate-binding antacids Requirment Glucose + insulin Anabolism,病因 摄入减少 丢失增加 甲状旁腺功能亢进 胃肠道 腹泻 磷结合制酸剂 需求增加 葡萄糖+ 胰岛素 合成代谢增加,3/25/2019 12:32 AM,Hypophosphatemia 低磷血症,Management Intravenous phos (Glyphos, FDP),治疗 静脉补磷,3/25/2019 12:32 AM,酸碱平衡的失调 Acid-base Imbalances,3/25/2019 12:32 AM,A-B Imbalances 酸碱平衡的失调,Metabolism depends on enzymes Enzymes are sensitive to pH Blood and tissue fluid normal pH = 7.35 to 7.45 HCO3- = 24 to 26 mmol/L PCO2 = 35 to 45mmHg,代谢依赖于酶 酶对pH敏感 血液和体液正常pH = 7.35 7.45 HCO3- = 24 26 mmol/L PCO2 = 35 45 mmHg,3/25/2019 12:32 AM,A-B Imbalances 酸碱平衡的失调,Compensation,代偿,3/25/2019 12:32 AM,A-B Imbalances 酸碱平衡的失调,Metabolic Acidosis Decreased pH 7. 45 PCO2 normal 35 - 45 mm Hg HCO3- Increased 26 mmol/L,代谢性酸中毒 pH降低 7. 45 PCO2 正常 35 - 45 mm Hg HCO3-升高 26 mmol/L,3/25/2019 12:32 AM,

温馨提示

  • 1. 本站所有资源如无特殊说明,都需要本地电脑安装OFFICE2007和PDF阅读器。图纸软件为CAD,CAXA,PROE,UG,SolidWorks等.压缩文件请下载最新的WinRAR软件解压。
  • 2. 本站的文档不包含任何第三方提供的附件图纸等,如果需要附件,请联系上传者。文件的所有权益归上传用户所有。
  • 3. 本站RAR压缩包中若带图纸,网页内容里面会有图纸预览,若没有图纸预览就没有图纸。
  • 4. 未经权益所有人同意不得将文件中的内容挪作商业或盈利用途。
  • 5. 人人文库网仅提供信息存储空间,仅对用户上传内容的表现方式做保护处理,对用户上传分享的文档内容本身不做任何修改或编辑,并不能对任何下载内容负责。
  • 6. 下载文件中如有侵权或不适当内容,请与我们联系,我们立即纠正。
  • 7. 本站不保证下载资源的准确性、安全性和完整性, 同时也不承担用户因使用这些下载资源对自己和他人造成任何形式的伤害或损失。

评论

0/150

提交评论