体液失调英文版

Fluid-Electrolyte-Acid-baseManagement,GeneralsurgerydepartmentThefirstaffiliatedhospitaltoSoochowUniversity,overview,compositionsofbodyfluid,regulationsoffluidbalance,acid-basebalance,importanceoffluidbalance,Contentsofdiscuss,fluid-electrolyte-acid-basemanagementcatalog,adjustoffluidmetabolism,demonstratecharts,basicprinciplesoftreatments,Normalbodyfluid,osmoticpressureandelectrolytearethebasisofbodymetabolismandorganfunctions.Trauma,operationandmanyclinicaldisordersleadtofluid,electrolyteandacid-baseimbalance,managementoftheseproblemsisaveryimportantmatterinthesurgicaltherapy.-1,fluid-electrolyte-acid-basemanagementoverview,Maincomponentsofthebodyfluidarewaterandelectrolytes.Bodyfluidisdividedintointracellularfluidandextracellularfluid.Musclecontainsmuchwater.(75-80)Fatcontainslesswater.(10-30),fluid-electrolyte-acid-basemanagementcompositionsofbodyfluid,About60ofweightofadultmaleisbodyfluid；about55ofweightofadultfemaleisbodyfluid；about80ofweightofinfantisbodyfluid；after14yearsold,childrenareneartomanhood.,fluid-electrolyte-acid-basemanagementcompositionsofbodyfluid,Mostintracellularfluidisinskeletalmuscle;intracellularfluidaccount40%ofbodyweightformale,forfemaleis35%.Extracellularfluidaccount20%ofbodyweightforbothofmaleandfemale.Extracellularfluidisfurtherdividedintoplasmaandinterstitialfluid;plasmaoccupy5%ofbodyweight;Interstitialfluidoccupy15%ofbodyweight.,fluid-electrolyte-acid-basemanagementcompositionsofbodyfluid,Mostofinterstitialfluidcanexchangewithplasmaorintracellularfluidquickly,andgettobalance,whichisveryimportantinfluidandelectrolytemanagement,calledfunctionalextracellularfluid.,fluid-electrolyte-acid-basemanagementcompositionsofbodyfluid,Otherinterstitialfluidcanonlyexchangeandgettobalanceslowly,theyhavedifferentfunctions,buttheyarelessimportantinthemaintainofbodyfluidbalance,callednonfunctionalextracelluarfluid.Connectivetissuefluidandpenetrablefluidofcell,e.g.cerebrospinalfluid,synovialfluidanddigestivejuice,andsoon,areallcallednonfunctionalextracelluarfluid.,fluid-electrolyte-acid-basemanagementcompositionsofbodyfluid,Thechangesofsomenonfunctionalextracelluarfluidcanleadtoimbalanceofbodyfluid,electrolyteandacid-baseobviously.Themostfamiliarexampleisagreatdeallossofdigestivejuice,itcanleadtomarkedchangeofbodyfluidvolumeandelements.-2Nonfunctionalextracelluarfluidoccupies1%-2%ofbodyweight,andabout10%ofinterstitialfluid.,fluid-electrolyte-acid-basemanagementcompositionsofbodyfluid,ThemostimportantcationinextracelluarfluidisNa+,andthemainanionareCl-,HCO3-andprotein.ThemaincationinintracelluarfluidareK+andMg2+,themainanionareHPO42-andprotein.Theosmolalityofextracelluarfluidandintracelluarfluidareequal,theosmolalityofplasmais290-310mmolL.,fluid-electrolyte-acid-basemanagementcompositionsofbodyfluid,Thestabilityofbodyfluidandosmoticpressureisadjustedbynerve-incretionsystem.Thenormalosmoticpressureofbodyfluidisresumedandmaintainedbythalamo-posthypophysis-antidiureticsystem.Thevolumeofbloodisresumedandmaintainedbyrenin-aldosteronesystem.,fluid-electrolyte-acid-basemanagementfluidbalanceandosmoticpressureadjust,extracellularosmoticpressure,thalamo-posthypophysis-antidiureticsystem,antidiuretichormoneisverysensitivetothechangesofextracellularosmoticpressure,evenoverstep2,extra-cellularosmoticpressurefalltonormal,waterlose,thirst，drinkmore,waterresorburinereduce,waterisreserved,keephomeostasis,fluid-electrolyte-acid-basemanagementfluidbalanceandosmoticpressureadjust,stimulaterenin,adrenalaldosterone,withincreasedresorptionofnatrium,morewaterisresorb,extra-cellularosmoticpressurefalltonormal,bloodvolumebloodpressure,Na+resorb,K+drainage,H+drainage,keephomeostasis,fluid-electrolyte-acid-basemanagementfluidbalanceandosmoticpressureadjust,Bothofthetwosystemsallactonkidneytoadjusttheabsorptionanddrainageofelectrolyteaswaterandnatriumandsoon,togetthebodyfluidbalanceandinternalenvironmentstability.Thebloodvolumeismoreimportantthanosmoticpressureforbody.,fluid-electrolyte-acid-basemanagementfluidbalanceandosmoticpressureadjust,Soasthebloodvolumereducedgreatlyandinthesametimetheplasmaosmoticpressurereduced,theaccelerationforantidiuretichormonebyformerplayamuchmoreimportantrolethanthedepressionforthehormonebylatter.-3Thepurposeisatfirsttokeepandresumebloodvolume,ensuretheenoughbloodforvitals,maintainthesafeofpatientslife.,fluid-electrolyte-acid-basemanagementfluidbalanceandosmoticpressureadjust,Thenormalphysiologicalandmetabolismfunctionneednormalbodyfluidwithproperhydrogen.UsuallythebodyfluidmaintainacertainconcentrationofH+,alsomaintainacertainpH(arterialplasmaspHbetween7.400.05).Butintheprocessofmetabolism,bodypersistentlyproduceacidandalkalisubstance,inthisway,theconcentrationofH+alsochangesregularly.,fluid-electrolyte-acid-basemanagementmanagementofacid-basebalance,InordertokeepthefluctuationofconcentrationofH+inasmallrange,thebodyadjusttheacidandalklaibybuffersystem,breathingwithlungandexcretionwithkidney.ThemostimportantbuffersysteminbloodisHCO3-/H2CO3.,fluid-electrolyte-acid-basemanagementmanagementofacid-basebalance,ThenormalmeanvalueofHCO3-is24mmolL,H2CO3is1.2mmolL,theratioofHCO3-/H2CO3=241.2=20:1.nomatterhowhigherorlowertheHCO3-andH2CO3are,theratioofHCO3-/H2CO3stillkeepsin20:1,pHofplasmaisremaining7.40.-4e.g.H+HCO3-=H2CO3=H2OCO2,fluid-electrolyte-acid-basemanagementmanagementofacid-basebalance,Breathoflungadjusttheacid-basebalancebydischargingCO2fromlung,thiscanreducePaCO2inblood,inthesametime,alsoadjustH2CO3inblood.Ifrespiratoryisinsufficiency,itwillleadacid-basedisorder,anditwillalsodepressitscompensatorycapacityofacid-basebalance.,fluid-electrolyte-acid-basemanagementmanagementofacid-basebalance,Kidneyplaythemostimpotantmanangementroleintheacid-basebalancesystem,kidneymaintainnormalconcentrationofHCO3-inplasmabychangingoutputoffixedacidandalkalitokeeppHofplasmainnormalrange.Ifkidneyisabnormal,itnotonlyeffectthenormaladjustofacid-basebalance,butalsoleadacid-baseimbalance.,fluid-electrolyte-acid-basemanagementmanagementofacid-basebalance,Intheclinicalwork,wemaymeetmanyproblemsaboutwater,electrolyteandacid-basebalancewithdifferentcharactersanddegrees.Manysuddenandserioussicknessesoftheinternalmedicineandsurgery,e.g.shock,massivehemorrhageofdigestivetract,largeareaburns,digestivetractfistula,intestinalobstructionandseriousperitonitis,allthesecanleadbadlyinternalenvironmentdisordersfordehydration,hypovolemia,hypokalemiaandacidosis.,fluid-electrolyte-acid-basemanagementimportance,Recognizingintimeandactivelycorrectingtheseabnormalitiesisthefirstjobinourtherapies,becausetheaggravationforeachofwater,electrolyteandacid-baseimbalancewillleadthepatientsdeath.Whenthethepatientswithelectrolytedisorderoracidosis,thedangerforoperationwillincreaseobviously.-5Eventheoperationissuccessful,Ifweignorethemaintenanceofinternalenvironment,itwillresulttothefailureoftherapyatlast.,fluid-electrolyte-acid-basemanagementimportance,Therearemanydifferentclinicalmanifestationsofbodyfluid,electrolyteandacid-baseimbalance.Thereareusuallymixedabnormalitiesinthesametime,notonlybodyfluidandelectrolytedisorder,butalsoacid-baseimbalance.Soweshouldcorrectthemoverall,anddonnotmissanyone.,fluid-electrolyte-acid-basemanagementimportance,VolumeDisorders:isotonicbodyfluiddecreaseorincrease.Itonlycausesextracellularfluidvaried,andintracellularfluidisusuallynormal.,fluid-electrolyte-acid-basemanagementmaladjustmentoffluidmetabolism,ConcentrationDisorders:thewaterofextracellularfluiddecreaseorincrease,itleadingthechangesofconcentrationofinfiltrationparticulates,sotheosmoticpressurealsochanges.Because90infiltratingparticulatesofextracellularfluidareconstitutedbyNa+，sothattheconcentrationdisordersdisplayashyponatremiaorhypernatremia.,fluid-electrolyte-acid-basemanagementmaladjustmentoffluidmetabolism,CompositionsDisorders:thechangeofconcentrationofotherionsinextracellularfluid,exceptNa+.Althoughtheseionscancausesomephysio-pathologicaleffect,theamountofpenetrableparticulatesaresolittle,theironlyhaveslightinfluencetoextracelluarfluid.Forexample:hypopotassaemiaorhyperpotassaemia,hypocalcemiaorhypercalcemia,andacidosisoralkalosis,andsoon.,fluid-electrolyte-acid-basemanagementmaladjustmentoffluidmetabolism,hypertonicdehydrationbodyfluiddecreaseintracellularfluidwaterlosssaltlossosmoticpressurethirstextracellularfluidintracellularfluidMoveintracellularintoextracellularfluidfluidsweatglandsecreteosmoticpressureskinevaporationseriouscerebrocellulardehydrationcentralnervoussystemADHsecretcoma,fluid-electrolyte-acid-basemanagementchangesandeffectofhypertonicdehydration,ADHsecretextracellularfluiddehydrationslightlyBPslightlychangelittlerenaltubulereabsorbwaterandnatriumALDexcretenormalhypourocriniaearlyperiodUNanotdecrease,fluid-electrolyte-acid-basemanagementchangesandeffectofhypertonicdehydration,fluid-electrolyte-acid-basemanagementchangesandeffectofhypotonicdehydration,hypotonicdehydrationbodyfluiddecreasesaltlosswaterlossinterstitialeyeholeintrocessionfluidSkinelasticityECFosmoticECFintocellECFdecreasepressurepachemiabloodvolumeveincollapsedecreaseBPdecreaseADHsecreteSeverityshockICFdecreasenotobviouslyALDsecreterenaltubulereabsorbrenaltubulereabsorbwaterandnatrumwaterandnatrumearlierperiodurinaryUNadecreaseorabolitionvolumenotdecrease,fluid-electrolyte-acid-basemanagementcomparison,fluid-electrolyte-acid-basemanagementcomparison,fluid-electrolyte-acid-basemanagementcauseandeffectofhypokalemia,fluid-electrolyte-acid-basemanagementcauseandeffectofhyperkalemia,fluid-electrolyte-acid-basemanagementECGofhypokalemiaandhyperkalemia,NormalECGPwaveQRSintervalTwaveQTintervalS-Tstage,fluid-electrolyte-acid-basemanagementECGofhypokalemiaandhyperkalemia,ECGofHypokalemiaS-TlowerQTprolongUwave,fluid-electrolyte-acid-basemanagementECGofhypokalemiaandhyperkalemia,ECGofHyperkalemiaQRSprolongTwaveQTprolong,fluid-electrolyte-acid-basemanagementexaminationofacid-baseimbalance,ArterialbloodgasanalysisPH:7.35-7.45actualbicarbonate(AB)&standbicarbonate(SB):AB=SB=21-27mmol/LnormalABSBrespiratoryacidosisABSBrespiratoryalkalosisABSBmetabolicacidosisABSBmetabolicalkalosisbufferbase(BB)(includeHCO3-):45-55mmol/Lbufferexcess(BE):-3-+3mmol/LPCO2:4.67-6.0kPa(35-45mmHg)PO2:8.0kPa(60mmHg),fluid-electrolyte-acid-basemanagementcauseandeffectofmetabolicacidosis,fluid-electrolyte-acid-basemanagementcauseandeffectofmetabolicalkalosis,fluid-electrolyte-acid-basemanagementcomparisonofacid-baseimbalance,bodyfluid,electrolyteandacid-baseimbalanceisaverycommonpathophysiologicchangeclinically,nomatterwhichkindofimbalance,itcanleaddisordersofmetabolism,ifitfurtheraggravate,willcauseorganfailure,evendeath.followsarethebasicprinciplesofmanagementforbodyfluid,electrolyteandacid-baseimbalance.,fluid-electrolyte-acid-basemanagementbasicprinciplesofclinicaltherapy,Mastermedicalhistorythoroughly,andexaminethepatientssignssufficiently,inmostcondition,wecangetvalueableinformationandmakeoutinitialdiagnosis.Findoutcauseswhichmayleadbodyfluidimbalance,e.g.severevomit,diarrhea,intakelessforlongtime,severeinfectionorsepticemia,Findoutthesymptomsorsignsofbodyfluidimbalance,e.g.dehydration,hypourocrinia,tachypnea,insanity,andsoon.,fluid-electrolyte-acid-basemanagementbasicprinciplesofclinicaltherapy,1.bloodandurineroutine,hematocrit,liver-renalfunction,bloodglucose,2.bloodserumK+,Na+,CI-,Ca2+,Mg2+andPi,3.arterialbloodgasanalysis,4.determinbloodurineosmoticpressure,p.r.n.,Laboratoryexamination,fluid-electrolyte-acid-basemanagementbasicprinciplesofclinicaltherapy,Comprehendingthecasehistoryandabove-mentionedlaboratorydata,wecandeterminethetypeanddegreeofwater,electrolytesandacid-basedisorders.Weshoulda