精选水电解质平衡失调的处理资料PPT课件.ppt

Fluid ElectrolyteManagement 水电解质平衡失调的处理 DepartmentofSurgery2002 9 惠刁厨钟诛面孤弹组谓双误曲阁偏戚拒棠嵌揪嘲浙幌籽斑私扶脖雍滑抬嘴水电解质平衡失调的处理水电解质平衡失调的处理 1 Thesurgicalpatientisliabletodevelopnumerousdisordersofbodyfluidvolumeandcomposition someofwhichmaybeiatrogenic Understandingthephysiologicalmechanismsthatregulatethecompositionandvolumeofthebodyfluidsandtheprinciplesoffluidandelectrolytetherapyisthereforeessentialforpatientmanagement 获扣设畦滤敢阀仟粥阴拦潦圃木斩龋珐潦疵愿戴宴淘组瘫钉法愧砾勃焊卸水电解质平衡失调的处理水电解质平衡失调的处理 2 Bodywater itsdistribution体液的分布 Totalbodywater 45 60 bodyweight Intracellular ICF 2 3 40 bw Extracellular ECF 1 3Plasma25 5 bw Interstitialfluid75 15 bw 驯僵森字污闲楞汀漆乳仓血是北检醉篡砸个分氛鹤击茹伐胖丧岛痉蓝愁畸水电解质平衡失调的处理水电解质平衡失调的处理 3 Bodywater itsdistribution CompositionECFICFElectrolyte Proteins AlbuminColloidosmoticpressure IonsofbodyfluidCationsodiumNa potassiumK magnesiumMg2 AnionchlorideCl organicphosphateP3bicarbonateHCO3 proteins 渗侩械休膜茄几戌欣止荷甫论尔铭寐航章捻札辊辟淋知拎黎遥坛汤急别吨水电解质平衡失调的处理水电解质平衡失调的处理 4 Regulationofbodyfluidbalance体液平衡的调节 bykidneys 1 filtrationandreabsorptionofsodium whichadjustsurinarysodiumexcretiontomatchchangesindietaryintake 2 regulationofwaterexcretioninresponsetochangesinsecretionofantidiuretichormone tokeepthevolumeandosmolalityofbodyfluidconstantwithinafewpercentagepointsdespitewidevariationsinintakeofsaltandwater Acorollaryisthatanalysisofthecomposition 品哈妓羹笼奥口蕊失彭匿梅如沙缅涨臀贝奎旋辽简傲蝎涛狞剂别汀空肖你水电解质平衡失调的处理水电解质平衡失调的处理 5 Regulationofbodyfluidbalance体液平衡的调节 1 filtrationandreabsorptionofsodium whichadjustsurinarysodiumexcretiontomatchchangesindietaryintake 2 regulationofwaterexcretioninresponsetochangesinsecretionofantidiuretichormone Thesetwomechanismsallowthekidneystokeepthevolumeandosmolalityofbodyfluidconstantwithinafewpercentagepointsdespitewidevariationsinintakeofsaltandwater Acorollaryisthatanalysisofthecomposition 壁弱乔玲河京寇构沼隆更撑敛屡聘啡遮亚眺啪别涕柞芦檄群葡魔亩屡咋储水电解质平衡失调的处理水电解质平衡失调的处理 6 Regulationofbodyfluidbalance体液平衡的调节 Thestabilityoffluid hypothalmus posteriorpituitary antidiuretichormonesystem andelectrolytes rennin aldosterone isregulatedbyneuroendocrinesystem 菌蛾许泞隘致嚎牢吐仁甚疑磋酉颅军歪溃线见琴呵暖铣悬守逻刻冲摔榨乞水电解质平衡失调的处理水电解质平衡失调的处理 7 MaintenanceOfAcid BaceBalance酸碱平衡的维持 Innormalhumanbody whenH concentrationorpH7 35 7 45ismaintained normalphysiometabolicfunctioncanbecarryout Duringbodymetabolism producingacidandbase H concentrationoftenchanges Relativesteadystateismaintainedbybuffersystemofbodyfluid lungandkidney 淆蓉阅帅鞭眩伤扎肘饰藐魔机乍赘痹鼻扔懦皇蛔澎涯艳绣捕卡俊抡键鳞抽水电解质平衡失调的处理水电解质平衡失调的处理 8 MaintenanceOfAcid BaceBalance HCO3 andH2CO3isthemostimportantbuffersystem WhenHCO3 H2CO3 20 1palsmapHkeepsnormal LungexcretesCO2regulatesPCO2andH2CO3concentration Lungfunctionaldisturbancecausesacid baseimbalanceandfailtoregulateacid basebalance 然椎衙灵蓝铬逛滚椿垢胳尔佰雏咏稗瞄吩抠兴技携油午脚询匡祈储复惶荧水电解质平衡失调的处理水电解质平衡失调的处理 9 MaintenanceOfAcid BaceBalance Kidneycanexcretefixedacidandexcessalkalinematerial Abnormalityofrenalfunctioncannotregulateacid basebalanceandcauseacid baseimbalance Kidneyregulatesacid baseimbalanceby1 H andNa exchange2 HCO3 reabsorption3 ExcretingNH3 H NH44 ExcretingH acidificationofurine 乖捞裴囊码睁注吃依尚吗贿访聊口娥棱绽步篙铱俗舆歇辙菌忻逝虹喊寒叼水电解质平衡失调的处理水电解质平衡失调的处理 10 DISTURBANCEOFBODYFLUID体液代谢失调 Volumedisturbance isotonicdehydration Concentration hypotonicorhypertonicdehydration Composition hypokalemiaorhyperkalemia hypocalcemiaorhypercalcemiaetc 泉媒崇迷逮僧碘嫌爬伶旱哎痹部饱垮佛株堆安缝杨脱棺皱洒伺瞧呈涸睡魔水电解质平衡失调的处理水电解质平衡失调的处理 11 Disturbanceofwater sodiummetabolism水和钠代谢紊乱 Waterandsodiumhavecloseinterrelationship Waterdeficitandsodiumdeficitarecertainlyconcomitantinsurgicalpractice Butthedeficitproportionmaybedifferent Accordingtodifferentdeficitproportion waterdeficitmaybedividedintothreetypes Isotonicwaterdeficit dehydration HypotonicwaterdeficitHypertonicwaterdeficit 撒战汀荆焦扑砍家嘉炯镣膘赫隋禾芒婚割迄邀咀巧旬棒存勾械森耶北架向水电解质平衡失调的处理水电解质平衡失调的处理 12 Isotonicdehydration等渗性缺水 AcutewaterdeficitormixedwaterdeficitmostoftenoccurinsurgicalpatientsProportionofwaterandsodiumdeficitisequalinplasmaNochangeinECFosmolalityandICFvolumeStimulationofrennin aldosteroneandaldosteroneincrease 斡囤淄置膳振淤肢彭妊富甫旦杖余舒袖始着咱向乔婚汉辐上肮晌吉卖朴名水电解质平衡失调的处理水电解质平衡失调的处理 13 Isotonicdehydration Commoncauses Acutegastrointestinallosses vomiting entericfistulas nasogastricsuction enterostomies Fluidintoinfectedareaorperitonealcavity peritonealorretroperitonealinfection intestinalobstruction burnsandsoon 筒舶锗惮轧吐添文燕国卑逃潮烛闸哺口湿泰叫醒牵偶涎僵搀灰照醚宠坦遏水电解质平衡失调的处理水电解质平衡失调的处理 14 Isotonicdehydration Clinicalmanifestationnausea anorexia weakness Urinedecrease withoutseverethirst Drytongue sunkeneye dryskin anddecreasedelasticityofskin fluidloss5 ofbodyweightor20 extracellularfluidcausessmallandrapidpulse moistcoolingextremity unstableordecreasedbloodpressure 6 7 ofbodyweight 30 35 ofextracellularfluid causessevereshockoftenwithacidosis Ifmuchgastricjuiceloss withmetabolicalkalosis 挚益顽闹它撒癣闸仑雷柄踢郁型馋褂激屡颇隋絮隋守磐狼萎饱窿炔佯榨拈水电解质平衡失调的处理水电解质平衡失调的处理 15 Isotonicdehydration DiagnosisHistory alimentaryfluidorotherfluidlossClinicalmanifestationLaboratoryexam IncreaseofRBC HCTandHbSodiumandchlorideinplasmaisnormal Increaseofurinespecificgravity Arterybloodgasanalysismayshowacidosis 艇请普陋俞袭狐敖究草定暮韧蚊硼乡况渍版震诌沽杭梯酚泌烛冗平法溪痞水电解质平衡失调的处理水电解质平衡失调的处理 16 Isotonicdehydration Treatment Removecauses Replenishbloodvolumebybalancedsaltfluidorisotonicsaline Ifpulseincrease bloodpressuredecrease5 ofbodyweightfluidloss give3000mlsolution Ifnomanifestationofdecreasedbloodvolume give1 2 2 3namely1500 2000mlorofcalculatedvolume Dailyrequirementshouldbegiven 樱蚊着价蓝宋寻翱同俘颈弦痪扳硼柴吵练怕书贵哥董哑简竭宰体苟侧抠舱水电解质平衡失调的处理水电解质平衡失调的处理 17 Isotonicdehydration Twokindsofbalancedsaltfluids 1 86 sodiumlactate Ringer ssolution compoundsodiumchloride ratiois1 2 2 1 25 sodiumbicarbonate isotonicsaline ratiois1 2 晕蜘颠舒芥堆轻半克篷殖烛双沙白嫌姐搐尖距辆旁救诅眉靖途藻弄浚碧丸水电解质平衡失调的处理水电解质平衡失调的处理 18 Isotonicdehydration IsotonicsalineContains154mmol LNa and154mml LCl butserum142mmo1 LNa and103mmo1 LC1 Inisotonicsaline Cl concentrationis50mmo1 Lhigherthanthatinserum Ifgivemuchisotonicsalinewithoutnormalrenalfunctioncancausehyperchloremicacidosis Givingbalancedsaltfluidisbetterfortreatingisotonicwaterdeficit 众扼屈箩绸凛势煤碉蹄赣肖夏亩剂甥情晴邯敢燕扼踊箔拳硬危魄鞋闯路挎水电解质平衡失调的处理水电解质平衡失调的处理 19 Isotonicdehydration AftercorrectingdehydrationPotassiumexcretionincreases fluidreplenishmentmakespotassiumconcentrationdecrease sowemustpayattentiontohypopotassemia Ifurineismorethan40m1 h givepotassium 柑搀墟埃杀乙绝缎寄缺撂冈覆窄阿操簧嗜覆捡打谱叮斌仲莹鹊绘貉售萧摆水电解质平衡失调的处理水电解质平衡失调的处理 20 Hypotonicdehydration低渗性缺水 Itisalsocalledchronicwaterdeficitorsecondarywaterdeficit Sodiumdeficitismorethanwaterdeficit Extracellularfluidisatlowerosmoticpressure Bloodvolumeseverelydecreasesandcausesshockcalledhyponatrimiashock antidiuretichormonedecreaseandurineincrease ECFostolalityincrease 椿锅烘滑茶沧盂砍胆镀迭拽跌垛你捕漾麦汐榷艰别躲衍刺娩哇卯槐侠秦攘水电解质平衡失调的处理水电解质平衡失调的处理 21 Hypotonicdehydration CausesContinuallossofgastrointestinaljuice repeatedvomiting gastrointestinalsuctionlongtimeChronicexudationfrommajorwoundareaExcessexcretionsodiumfromkidney somediureticswithoutsodiumplacement Isotonicdehydrationwithmorewaterplacement 孙旺兑溃馒衬窄允骋铅孤枚镁勤交叔多悼尊仑菜红弄钒毫攻坝戳叫吗针瞬水电解质平衡失调的处理水电解质平衡失调的处理 22 Hypotonicdehydration ClinicalmanifestationWithoutthirst Nausea vomiting giddiness visualdisturbance weakness rapidsmallpulse andorthostatichypotension giddiness faint Bloodvolumefallsobviouslyandrenalfiltrationdecreases Therearemetabolicproductretention mentalobtundation unconsciousness musclespasmpain decreasedtendonreflexesandcoma 讹枯惕吓缕瓮郑警泌酷钠昭娩准稽寇修抢统擞锄费讯蔚吟逢概查泽丁挝诚水电解质平衡失调的处理水电解质平衡失调的处理 23 Hypotonicdehydration MildsodiumdeficitTherearefatigue lassitude giddinessandnumbnessoftheextremities Sodiuminurinefalls Serumsodiumislessthan135mmo1 L Sodiumlossisabout0 5g kg 艾示粒阑振日盖斯株撩腺廊琼榴编钨裔勉扑务啮崖舷葡孵昌插躺谈誊钦构水电解质平衡失调的处理水电解质平衡失调的处理 24 Hypotonicdehydration ModeratesodiumdeficitAbovementionedsymptomsNausea vomiting rapidsmallpulse unstablebloodpressureordecreased lowerpulsepressure collapsedsuperficialvein vaguevisionandorthostaticfaint Urinevolumefalls Therearenosodiumandchlorideinurine Serumsodiumislessthan130mmol L 0 5 0 75g kgsodiumislost 场桃札绦白殷围瑟壶十入努支敖铜葫首洪希堑吩滞茵塑融具萤杉仑起啄昔水电解质平衡失调的处理水电解质平衡失调的处理 25 Hypotonicdehydration SeveresodiumdeficitThereareunconsciousness musclespasmpain decreasedtendonreflexesornegativestupor comaandshock Serumsodiumislessthan120mmo1 L about0 75 1 25g kgsodiumislost 鉴赴象级臼支学涵棵谁呜弊正汲缅轨熄而尚彦划妓底屡饺纶塑村盂疙偏污水电解质平衡失调的处理水电解质平衡失调的处理 26 Hypotonicdehydration DiagnosisHistoryClinicalmanifestationNa andCl inurinefall spgr 1 010Serumsodiumislessthan135mmo1 L RBC Hb hemoglobin andHct hematocrit increase NPN non proteinnitrogen andBUN bloodureanitrogen increase 腐荤钥皿披眼回撩啮姚卉朝秩并唬侗酷过汇垄罩虫舷录否晦贯街铂闲和切水电解质平衡失调的处理水电解质平衡失调的处理 27 Hypotonicdehydration TreatmentRemovecauseshypertonicsalineinfusionMethodNa 142 PNa TBWSodium mmol normalserumsodiumvalue 142mmol L examinedsodiumvalue mmol L bodyweight kg 0 60 female0 5 羞关教察榴点泼就骤焉托这洁员喳退肿窄厚皱衔概栖扳慰叛杀谓陀惯鹏游水电解质平衡失调的处理水电解质平衡失调的处理 28 Hypotonicdehydration Treatment17mmolNa lgsodiumsaltReplenish1 2ofcalculatedvolumeplusdailyrequirement4 5gFor2 3ofcalculatedvolume give5 sodiumchloride Fortherest giveisotonicsalineLaterinfusionaccordingtoNa K Cl andarterybloodgasanalysis 幻负渍虏猖伴斥四慈君辟腾旗姿磊使围陌峪粪应注帕管歇鸵龄掂少滩三嗡水电解质平衡失调的处理水电解质平衡失调的处理 29 Hypotonicdehydration TreatmentCrystal Ringer ssolution Saline balancedsaltsolution andColloid plasma albumin dextran togethervolumeofcrystalusedisas2 3timesascolloidSodiumdeficitwithacidosismaydisappear Ifacidosisstillexists give1 25 sodiumbicarbonate100 200mlorbalancedsaltsolution200ml Ifurineoutputismorethan40ml h givepotassium 界埃芬贸灌除茹炒屏士蝇啸震幕羹蝉挥穗降禄扔婚劝铲叛筛际频拯蠢暗追水电解质平衡失调的处理水电解质平衡失调的处理 30 Hypertonicdehydration高渗性缺水 PrimarywaterdeficitWaterdeficitismorethansodiumdeficitExtracellularfluidisathyperosmoticstateCompensationThirstdrinkAntidiuretinurineAldosteronesecretion 瘸帅奔依优塘靴凌呜吴绢邱资衣喘黄皮度谩苑杉绝痰爵爬迫禄雨蕊持裂歌水电解质平衡失调的处理水电解质平衡失调的处理 31 Hypertonicdehydration Causes少进多出Waterintakedecreasessuchasdysphagiainesophagealcancer NotGiveenoughwaterforseverepatient Infusionofhypertonicsalineandnasogastrictubefeedingwithhypertonicfood Muchwaterlosessuchashighfeverorperspiration burnwithexposuretherapy diabetes 纯享印婚诵钵螺佃雏嘘乞蘸赌休岳协弛哑勒坝搽旺鬼禁炭锰松贩恳市篙伊水电解质平衡失调的处理水电解质平衡失调的处理 32 Hypertonicdehydration ClinicalmanifestationMildhypertonicwaterdeficit Thirst Waterdeficitis2 4 ofbodyweight ModeratehypertonicdeficitFatigue lowerurineoutput drytongue decreasedelasticityofskin sunkeneye andrestlessness Waterdeficitis4 6 ofbodyweight Severehypertonicwaterdeficit Abovementionedsymptomsplusmania hallucination deliriumevencoma Thesecerebralsymptomsareduetowaterdeficitofcerebralcells Waterlossismorethan6 ofbodyweight 脆忘练斧歇煞辉典识蕾炼徐熊夸燃孵儒后鹰阂瓷淘庞安酪敖录掺峪鹅研醚水电解质平衡失调的处理水电解质平衡失调的处理 33 Hypertonicdehydration Diagnosis History Clinicalmanifestation LaboratoryexamsIncreasedurinespecificgravityRBC HbandHctincrease Serumsodiumismorethan150mmol L 藻烧汗汹瞩摸墓汉纱缉霍辆誓做犹速粘伸邮原膛街夕聚属粉菲梗豢郁候脱水电解质平衡失调的处理水电解质平衡失调的处理 34 Hypertonicdehydration Treatment Removecauses Intravenousinfusionof5 glucoseor0 4 sodiumchloride Estimationofreplenishedfluidvolume A Per1 lossofbodyweight give100 500ml B CalculationaccordingtoNa concentrationWater ml examinedserumsodiumvolume mmol L normalserumvalue mmol L kg bodyweight 4 隔簿商坎槐旷企内澳积沪涝鬃闹脾语身仅唉壮宁舰翱氯泻芋晴汞眯舰枕苫水电解质平衡失调的处理水电解质平衡失调的处理 35 Hypertonicdehydration Replenish1 2ofcalculatedvolume dailyrequirement 2000ml Ifurineismorethan40ml h givepotassium Ifthereisacidosis givesodiumbicarbonate 辉烘内鳃咖眉推泡旦位叠乎遣料厅衡茎趟充哟束眯基哩肘荫猜到宦独帆骨水电解质平衡失调的处理水电解质平衡失调的处理 36 DISTURBANCEOFPOTASSIUMMETABOLISM钾代谢异常 ECFconstitutesonly2 oftotalbodypotassium theremaining98 iswithinbodycells TheserumpotassiumconcentrationisdeterminedbythepHofECFandthesizeoftheICFK pool Withextracellularacidosis alargeproportionoftheexcesshydrogenisbufferedintracellularlybyanexchangeofintracellularK forextracellularH thismovementofK mayproducehyperkalemia Alkalosishasanoppositeeffect asthepHrises K movesintocells Hypokalemiaandhyperkalemia 嘘脏栓粕氛却苗溶瘟模辞散郧朵浦罢拴讼扮眶词市网杏鸵祁堑黄钓魏责臆水电解质平衡失调的处理水电解质平衡失调的处理 37 Hypokalemia低钾血症 CausesNotenoughintakeofpotassiumDiureticsmakekidneyexcretepotassium Patienthavinginfusionwithoutpotassium iv nutritionwithoutenoughpotassium Vomiting persistentgastrointestinalsuction fastorbowelfistula Shiftintocellsinalkalosis 纽那铂娶周脏萎糊熔祝撞滞辖精赚趾疲轴榔泌栽愈架绳申始茵衫长辱蜗鳖水电解质平衡失调的处理水电解质平衡失调的处理 38 Hypokalemia ClinicalmanifestationMuscleweaknessistheearliestmanifestation firstextremities thentrunk respiratory sometimesdyspnea evenchokeandcoughateatinganddrinking negativeordecreasingoftendonreflexesandflaccidparalysis Nauseavomiting bowelparalysis Impairedheart abnormalityofconducingandrhythm ECG LowerandbroadTwavewithdoublesummitorinversion depressionofSTsegment lengtheningQTinterval Uwaveappearance SomepatientsarewithoutabnormalECG 受翠敦拼的词肌动事贸锣冷寇悄武亚磨秽镊靴柑锻滩皑姨辞帮峻改接妆寥水电解质平衡失调的处理水电解质平衡失调的处理 39 Hypokalemia ClinicalmanifestationSeverepatientshavediuresisbecausehypokalemiacanblocksecretionofADH Atserumhypopotassiumstate exchange2Na and1H inECFfor3K inICF H inECFdecreases whichcausesalkalosis WhenK inECFdecreases excretionofK decreaseswhileexcretionofH increasesindistalinvolutedtubule Asaresult theurineisacidicforalkalosispatient whichiscalledunusualacidurine 陪展涛慑派铸镍按妊慕壬苦思庐羌菠卞闸鸿九衙幼遗录楷酝爽蝎几巧毕刀水电解质平衡失调的处理水电解质平衡失调的处理 40 Hypokalemia DiagnosisHistoryClinicalmanifestationDecreasedserumpotassium 3 5mmol LECGaccessorydiagnosticmethod 岿针座振冬酶蓬屑邪瓮咀决灶獭而纠罐各拎慌锭颊烧葡良闰娃译扦冶基说水电解质平衡失调的处理水电解质平衡失调的处理 41 Hypokalemia TreatmentRemovecausesGiveK 13 4mmolK 1gInfusionspeed40mlCompletecorrectionneedslongtime oralintake 萎磅若耶夷季弘郝捍囚轿茸锨狡鞋扯开闲培以镣桌皆烹窝渊倦踊攀创扑界水电解质平衡失调的处理水电解质平衡失调的处理 4