practical session 2 实操部分

1、ESAVSPractical session 实操部分Filippo FerriDVM, Dipl ECVIM-CA (Internal Medicine)Istituto Veterinario di Novara ItalyESAVS“Minnie”Domestic shorthair cat家养短毛猫 Neutered female 绝育母犬15 years 15岁ESAVSHistory 病史Three weeks history of 近三周病史Progressive weight loss 渐进性消瘦Acute onset of lethargy 倦怠急性发作Anorexia 厌食

2、Vomiting 呕吐ESAVSPhysical examination 体格检查Dehydration 7% 脱水7%Weakness 虚弱Neck ventroflexion 头颈腹弯HR 200 bpm心率 200 bpmSystemic blood pressure 100/50 mmHb 血压100/50 mmHbESAVSProblem list 问题列表Hypotension 低血压 Dehydration 7% 脱水7%Neck ventroflexion 头颈腹弯Weakness 虚弱 Vomiting 呕吐 Anorexia 厌食Weight loss 体重减轻List o

3、f differential diagnosis 鉴别诊断列表ESAVSHypotension 低血压List of differential diagnosis 鉴别诊断列表ESAVSHypotension 低血压ESAVSList of differential diagnosis 鉴别诊断列表Hypotension 低血压Decreased preload前负荷降低 Decreased cardiac function心功能减弱 Decreased vascular tone血管紧张度降低 ESAVSList of differential diagnosis 鉴别诊断列表Hypoten

4、sion 低血压Decreased cardiac function心功能减弱 Decreased vascular tone血管紧张度降低 Decreased preload前负荷降低 Hypovolemia血容量减少 Decreased venous return静脉回心血量减少 ESAVSList of differential diagnosis 鉴别诊断列表Hypotension 低血压Decreased preload前负荷降低 Hypovolemia血容量减少Blood loss 失血Gastrointestinal losses胃肠道丢失Hypoadrenocorticism

5、肾上腺皮质机能减退Effusion 渗出液Polyuria 多 尿Burns 烧伤 Heart stroke 心脏病发作Decreased cardiac function心功能减弱 Decreased vascular tone血管紧张度降低 Decreased venous return静脉回心血量减少 List of differential diagnosis 鉴别诊断列表Hypotension 低血压 ESAVSDecreased preload前负荷降低 Hypovolemia血容量减少 Blood loss 失血 Decreased cardiac function心功能减弱 D

6、ecreased vascular tone血管紧张度降低 Gastrointestinal losses 胃肠道丢失Hypoadrenocorticism 肾上腺皮质机能减退Effusion 渗出液Polyuria 多尿Burns 烧伤 Heart stroke 心脏病发作 Decreased venous return 静脉回心血量减少Cardiac tamponade心包填塞Restrictive pericarditis 限制性心包炎Severepneumothorax严重气胸Pos. pressure ventilation 正压通气 GDV 胃扭转 Caval syndrome 腔

7、静脉症候群List of differential diagnosis 鉴别诊断列表Hypotension 低血压 ESAVSDecreased preload前负荷降低 Hypovolemia血容量减少Blood loss 失血Gastrointestinal losses 胃肠道丢失 Hypoadrenocorticism肾上腺皮质机能减退Effusion 渗出液Polyuria 多 尿Burns 烧伤 Heart stroke 心脏病发作Decreased cardiac function心 功能减弱 Cardiomyopathy心肌 病 Adult-onset valvular dis

8、ease成年发作型心瓣膜病Congenital heart disease先 天 性 心 脏 病 Arrhythmias心律不齐Electrolytes abnormalities电解质异常 Decreased vascular tone血管紧张度降低 Severe hypoxemia 严重低氧血症SIRS/Sepsis SIRS/败血症Decreased venous return 静脉回心血量减少Cardiac tamponade心包填塞Restrictive pericarditis 限制性心包炎Severe pneumothorax严重气胸Pos. pressure ventilati

9、on 正压通气GDV 胃扭转 Caval syndrome 腔静脉综合征 List of differential diagnosis 鉴别诊断列表Hypotension 低血压 ESAVSDecreased preload前负荷降低 Hypovolemia血容量减少Blood loss 失血Gastrointestinal losses 胃肠道丢失Hypoadrenocorticism 肾上腺皮质机能减退Effusion 渗出液Polyuria 多尿 Burns 烧伤 Heart stroke 心脏病发作Decreased vascular tone血管紧张度降低 Decreased car

10、diac function 心功能减弱 Cardiomyopathy心肌病 Adult-onset valvular disease 成年发作型心瓣膜病Congenital heart disease先 天 性 心 脏 病 Arrhythmias心律不齐Electrolytes abnormalities 电解质异常 Severe hypoxemia严重低氧血症SIRS/Sepsis全身炎症反应综合征/败血症Sepsis/SIRS败血症/全身炎症反应综合征Anaphylaxis 过敏反应Neurogenic 神经性 Drug-induced药物诱导性Electrolytes/pH abnorm

11、al. 电解质/pH异常 Severe hypoxemia严重低氧血症 Decreased venous return静脉回心血量减少 Cardiac tamponade 心包填塞Restrictive pericarditis 限制性心包炎Severe pneumothorax严重气胸Pos. pressure ventilation 正压通气GDV 胃扭转 Caval syndrome 腔静脉综合征 List of differential diagnosis 鉴别诊断列表 ESAVSDehydration脱水Increased loss of fluid液体丢失增加 Reduced in

12、take of fluid液体摄入减少 ESAVSList of differential diagnosis鉴别诊断列表Dehydration脱水Enophtalmia, dry mucous membranes, mildly/moderately decreased skin turgor 眼球凹陷，黏膜干燥，轻度/中度皮肤弹性降低3-5%6-8%Stupor, coma, death 神志不清，昏迷，死亡 No specific abnormalities, history of fluid(diarrhea, vomiting)loss10-12%无特定异常，有液体丢失病史（腹泻，呕

13、吐）Enophtalmia, dry mucous membranes, weak peripheral pulses, depression, markedly decreased skin turgor眼球凹陷，黏膜干燥，外周脉搏虚弱，沉郁皮肤弹性显著降低 15%ESAVSList of differential diagnosis鉴别诊断列表Dehydration脱水Enophtalmia, dry mucous membranes, mildly/moderately decreased skin turgor 眼球凹陷，黏膜干燥，轻度/中度皮肤弹性降低3-5%6-8%Stupor,

14、coma, death 神志不清，昏迷，死亡 No specific abnormalities, history of fluid(diarrhea, vomiting)loss10-12%无特定异常，有液体丢失病史（腹泻，呕吐）Enophtalmia, dry mucous membranes, weak peripheral pulses, depression, markedly decreased skin turgor眼球凹陷，黏膜干燥，外周脉搏虚弱，沉郁皮肤弹性显著降低 15%ESAVSList of differential diagnosis鉴别诊断列表Dehydration

15、脱水Enophtalmia, dry mucous membranes, mildly/moderately decreased skin turgor 眼球凹陷，黏膜干燥，轻度/中度皮肤弹性降低3-5%6-8%Stupor, coma, death 神志不清，昏迷，死亡 No specific abnormalities, history of fluid(diarrhea, vomiting)loss10-12%无特定异常，有液体丢失病史（腹泻，呕吐）Enophtalmia, dry mucous membranes, weak peripheral pulses, depression,

16、 markedly decreased skin turgor眼球凹陷，黏膜干燥，外周脉搏虚弱，沉郁皮肤弹性显著降低 15%ESAVSList of differential diagnosis鉴别诊断列表Dehydration脱水Enophtalmia, dry mucous membranes, mildly/moderately decreased skin turgor 眼球凹陷，黏膜干燥，轻度/中度皮肤弹性降低3-5%6-8%Stupor, coma, death 神志不清，昏迷，死亡 No specific abnormalities, history of fluid(diarr

17、hea, vomiting)loss10-12%无特定异常，有液体丢失病史（腹泻，呕吐）Enophtalmia, dry mucous membranes, weak peripheral pulses, depression, markedly decreased skin turgor眼球凹陷，黏膜干燥，外周脉搏虚弱，沉郁皮肤弹性显著降低 15%ESAVSList of differential diagnosis鉴别诊断列表Dehydration脱水Enophtalmia, dry mucous membranes, mildly/moderately decreased skin tu

18、rgor 眼球凹陷，黏膜干燥，轻度/中度皮肤弹性降低3-5%6-8%Stupor, coma, death 神志不清，昏迷，死亡 No specific abnormalities, history of fluid(diarrhea, vomiting)loss10-12%无特定异常，有液体丢失病史（腹泻，呕吐）Enophtalmia, dry mucous membranes, weak peripheral pulses, depression, markedly decreased skin turgor眼球凹陷，黏膜干燥，外周脉搏虚弱，抑郁皮肤弹性显著降低 15%ESAVSList

19、of differential diagnosis鉴别诊断列表Dehydration脱水No specific abnormalities, history of fluid loss (diarrhea, vomiting)无特定异常，有液体丢失病史（腹泻，呕吐） 3-5%Enophtalmia, dry mucous membranes, mildly/moderately decreased skin turgor 眼球凹陷，黏膜干燥，轻度/中度皮肤弹性降低Enophtalmia, dry mucous membranes, weak peripheral pulses, depress

20、ion, markedly decreased skin turgor眼球凹陷，黏膜干燥，外周脉搏虚弱，沉郁皮肤弹性显著降低 Stupor, coma, death 木神志不清，昏迷，死亡 6-8%10-12%15%ESAVSProblem list 问题列表 Hypotension 低血压 Dehydration 7% 脱水7%Neck ventroflexion 头颈腹弯Weakness 虚弱 Vomiting 呕吐 Anorexia 厌食Weight loss 体重减轻ESAVSWeakness and hyporexia 虚弱和食欲减退List of differential diag

21、nosis鉴别诊断列表 ESAVSList of differential diagnosis鉴别诊断列表Vomiting 呕吐Gastrointestinal causes胃肠道原因 Extra-gastrointestinal causes胃肠道外原因 ESAVSList of differential diagnosis鉴别诊断列表Vomiting 呕吐Gastrointestinal causes胃肠道原因 Extra-gastrointestinal causes胃肠道外原因 Motility disordersDietary 饮食性Infective 传染性Neoplastic 肿

22、瘤性Inflammatory 炎症性ESAVSList of differential diagnosis鉴别诊断列表Vomiting 呕吐Extra-gastrointestinal causes胃肠道外原因 Gastrointestinal causes胃肠道原因 Motility disorders 动力障碍 obstruction, GDV, electrolytes阻塞，胃扭转，电解质紊乱 Dietary 饮食性 allergy, indiscretion,intolerance过敏，乱吃东西，不耐受 Infective 传染性 parasites, bacteria, fungi寄

23、生虫，细菌，真菌 Neoplastic 肿瘤性 gastric, enteric tumors胃、肠肿瘤 Inflammatory 炎症性 gastritis, enteritis 胃炎，肠炎ESAVSList of differential diagnosis鉴别诊断列表Vomiting 呕吐Extra-gastrointestinal causes胃肠道外病因 Gastrointestinal causes胃肠道病因 Motility disorders 动力障碍 obstruction, GDV, electrolytes阻塞，胃扭转，电解质紊乱 Dietary 饮食性 allergy,

24、 indiscretion,intolerance过敏，乱吃东西，不耐受 Infective 传染性 parasites, bacteria, fungi寄生虫，细菌，真菌 Neoplastic 肿瘤性 gastric, enteric tumors胃、肠肿瘤 Inflammatory 炎症性 gastritis, enteritis 胃炎，肠炎Metabolic 代谢性Endocrine 内分泌Neurologic 神经性Vascular 血管性Inflammatory 炎症性List of differential diagnosis鉴别诊断列表ESAVSVomiting 呕吐Extra-

25、gastrointestinal causes胃肠道外病因 Gastrointestinal causes胃肠道病因 Motility disorders 动力障碍obstruction, GDV, electrolytes阻塞，胃扭转，电解质紊乱 Dietary 饮食 allergy, indiscretion,intolerance过敏，乱吃东西，不耐受 Infective 传染性 parasites, bacteria, fungi寄生虫，细菌，真菌 Neoplastic 肿瘤性gastric, enteric tumors 胃、肠肿瘤 Inflammatory 炎症性 gastriti

26、s, enteritis 胃炎，肠炎Metabolic 代谢性 renal, hepatobiliary disease肾脏、肝脏疾病Endocrine 内分泌性 hyperthyroidism,甲状腺机能亢进，Neurologic 神经性 vestibular syndrome,.前庭综合征，.Vascular 血管性 portal hypertension,门静脉高压 Inflammatory 炎症性 pancreatitis, peritonitis,.胰腺炎，腹膜炎，.ESAVSList of differential diagnosis鉴别诊断列表Weight loss 体重减轻Ad

27、equate food intake 食物摄入足够 Inadequate food intake食物摄入不足 ESAVSList of differential diagnosis鉴别诊断列表Weight loss 体重减轻Inadequate food intake食物摄入不足Adequate food intake 食物摄入足够Decreased caloric intake 热量摄取减少Starvation 饥饿Inability to utilize digested food无法利用被消化的食物 Underfeeding 饲喂不足Poor quality of food 食物质量差P

28、rotein-losing disease 蛋白丢失性疾病Inappetence 食欲不振Increased metabolic demand代谢需求增加Accelerated energy loss 能量丢失加速ESAVSNeck ventroflexion 头颈腹弯ESAVSDiagnostic plan 诊断方案Neurological examination神经学检查Blood gas analysis血气分析Cervical CT and MRI颈部CT和MRINeck XRays 颈部X光ESAVSList of differential diagnosis鉴别诊断列表Neck v

29、entroflexion头颈腹弯Hypokalemic myopathy 低血钾性肌病Thiamine deificiency 硫胺素缺乏Hyperthyroidism 甲状腺机能亢进Hypophosphatemia 低磷血症Neuromuscular disorders 神经肌肉疾病Intoxications 中毒ESAVSDiagnostic plan诊断方案Neurological examination神经学检查Blood gas analysis血气分析Cervical CT and MRI颈部CT和MRINeck XRays 颈部X光ESAVSDiagnostic plan 诊断方

30、案Neurological examination神经学检查 Blood gas analysis Blood gas analysis 血气分析Cervical CT and MRI颈部CT和MRINeck XRays 颈部X光Blood gas analysis 血气分析ESAVSTotal solid 总固形物 5limpid7.3832.638.263.3%309.6151.62.581181.130.57891.5210.86.326.223.8296.95.9-8.7g/dlSerum pH pCO2pO2 SO2 PCVHb Na+ K+Cl- Ca2+ Mg2+GluLat B

31、UNCrea SBE SBC HCO3 -Osmcolor血清颜色7.26-7.3628-3840-55mmHg mmHg32-40%10.7-13.5148-1543.8-4.5115-120g/dl mmol/L mmol/L mmol/L1,15-1,25 mmol/L0.57-1.03 mmol/L80-120mg/dL0.8-2 mmol/L9-19 mg/dL0.8-1.3 mg/dL-6 / -216-23 mmol/L16-23 mmol/L288-298 mOsm/kESAVSBlood gas analysis血气分析Total solid总固形量物5limpid7.383

32、2.638.263.3%309.6151.62.581181.130.57891.5210.86.326.223.8296.95.9-8.7g/dlSerum pH pCO2pO2 SO2 PCVHb Na+ K+Cl- Ca2+ Mg2+GluLat BUNCrea SBE SBC HCO3 -Osmcolor血清颜色7.26-7.3628-3840-55mmHg mmHg32-40%10.7-13.5148-1543.8-4.5115-120g/dl mmol/L mmol/L mmol/L1,15-1,25 mmol/L0.57-1.03 mmol/L80-120mg/dL0.8-2 m

33、mol/L9-19 mg/dL0.8-1.3 mg/dL-6 / -216-23 mmol/L16-23 mmol/L288-298 mOsm/kESAVSBlood gas analysis血气分析 Total solid总固体量5limpid7.3832.638.263.3%309.6151.62.581181.130.57891.5210.86.326.223.8296.95.9-8.7g/dlSerum pH pCO2pO2 SO2 PCVHb Na+ K+Cl- Ca2+ Mg2+GluLat BUNCrea SBE SBC HCO3 -Osmcolor血清颜色7.26-7.3628

34、-3840-55mmHg mmHg32-40%10.7-13.5148-1543.8-4.5115-120g/dl mmol/L mmol/L mmol/L1,15-1,25 mmol/L0.57-1.03 mmol/L80-120mg/dL0.8-2 mmol/L9-19 mg/dL0.8-1.3 mg/dL-6 / -216-23 mmol/L16-23 mmol/L288-298 mOsm/kESAVSList of differential diagnosis鉴别诊断列表Neck ventroflexion头颈腹弯Hypokalemic myopathy 低血钾性肌病Thiamine

35、deificiency 硫胺素缺乏Hyperthyroidism 甲状腺机能亢进Hypophosphatemia 低磷血症Neuromuscular disorders 神经肌肉疾病Intoxications 中毒 ESAVSList of differential diagnosis鉴别诊断列表Neck ventroflexion弓背前驱Hypokalemic myopathy 低血钾性肌病Thiamine deificiency 硫胺素缺乏Hyperthyroidism 甲状腺机能亢进Hypophosphatemia 低磷血症Neuromuscular disorders 神经肌肉失调In

36、toxications 中毒ESAVSESAVSHypokalemia低钾血症Potassium integration 钾加入Do not exceed 0.5 mEq/kg/h 不要超过0.5 mEq/kg/hserum K+ (mEq/L)血清K+(mEq/L)Suppl K+/L补钾K+/L5Wait观察 4.0-5.5103.5-4.0203.0-3.5302.5-3.0402.0-2.5605Wait观察 4.0-5.5103.5-4.0203.0-3.5302.5-3.0402.0-2.5602.080ESAVSList of differential diagnosis鉴别诊断

37、列表Hypokalemia低钾血症Diet饮食Endocrine内分泌 Increased loss丢失增加 Translocation转移 Drug药物ESAVSList of differential diagnosis鉴别诊断列表Hypokalemia低钾血症 Endocrine内分泌 Diet饮食Increased loss丢失增加 Translocation转移 Drug药物Diabetes mel.糖尿病 CKD慢性肾病Alkalosis碱中毒Hypothermia体温过低Diabete mel.糖尿病Hyperadren.肾上腺皮质机能 Diuretic therapy利尿治疗

38、Idiopathic/Burmese亢进特发性/缅甸猫GI loss胃肠道丢失Hyperaldo.醛固酮增多症Post obstructive diuresis去梗阻后利尿 Renal tubular acidosis肾小管酸中毒 ESAVSList of differential diagnosis鉴别诊断列表Metabolic alkalosis 代谢性碱中毒Hyperadrenocorticism 肾上腺皮质机能亢进Primary hyperaldosteronism 原发性醛固酮增多症Vomiting 呕吐Post hypercapnia 高碳酸血症后Drugs 药物ESAVSDiag

39、nostic plan 诊断方案FIV, FeLV serology FIV， FeLV血清学检查CBC, biochemical profile, CT CBC，生化指标，CTCBC, biochemical profile, TT4, and urinalysisCBC，生化指标， TT4，尿液分析 CBC, urinalysis, Thoracic Rays CBC，尿液分析，胸X光片ESAVSDiagnostic plan 诊断方案FIV, FeLV serology FIV, FeLV serology FIV， FeLV血清学检查CBC, biochemical profile,

40、CT CBC，生化指标，CTCBC, biochemical profile, TT4,CBC,and urinalysisTT4, biochemical profile,CBC，生化指标， and urinalysis TT4，尿液分析CBC, urinalysis, Thoracic Rays CBC，尿液分析，胸X光片Complete blood count全血细胞计E数SAVSLeukocytesNeutrophils白细胞中性粒细胞27.16-11 K/l-11666379802711000-60000-5000-3000-600/l/l/l/lLymphocytes 淋巴细胞Mo

41、nocytes 单核细胞Basophils 嗜碱性粒细胞Eosinophils 嗜酸性粒细胞Erythrocytes 红细胞5274115345-10 T/l28-45 %40-55 fl13-17 pg31-34 g/dlHematocrit MCVMCH MCHC红细胞压积375150-500 G/lPlatelets 血小板Reticulocytes14000/l网织红细胞Complete blood count全血细胞计E数SAVSLeukocytesNeutrophils白细胞中性粒细胞27.16-11 K/l-11666379802711000-60000-5000-3000-60

42、0/l/l/l/lLymphocytes 淋巴细胞Monocytes 单核细胞Basophils 嗜碱性粒细胞Eosinophils 嗜酸性粒细胞Erythrocytes 红细胞5274115345-10 T/l28-45 %40-55 fl13-17 pg31-34 g/dlHematocrit MCVMCH MCHC红细胞压积375150-500 G/lPlatelets 血小板Reticulocytes14000/lleukocytosis网织红细胞Neutrophilic, lymphocytic, and monocytic中性粒细胞，淋巴细胞，和单核细胞增多 Mild normoc

43、hromic, normochromic non regenerative anemia轻度素性，素性非再生性贫血 Biochemical profile生化指标 ESAVSKidney 肾 脏 Urea尿素氮Creatinine肌酐Sodium钠Clorum 氯Potassium钾Phosphates 磷 Liver 肝脏 Total bilirubine 总胆红素ALT ALP GGTTotal protein总蛋白Albumin白蛋白Globulin 球蛋白 Pancreas 胰脏1021.61511092.54.716-362.4147-159109-1293.3-5.82.7-5.2

44、mg/dl mg/dl mg/dl mg/dl mg/dl mg/dl0.41589607629470.9130111157-8923-3928-51mg/dl U/l U/l U/l g/l g/l g/l12971-159150014002257.8-11.3mg/dl U/l U/l mg/dlmmol/lGlucose血糖Amylase淀粉酶Lipase脂肪酶Cholesterol胆固醇Calcium钙 108410331279.7ESAVSBiochemicalprofile生化指标Kidney 肾 脏 Urea尿素氮Creatinine肌酐Sodium钠Clorum 氯Potass

45、ium钾Phosphates 磷 Liver 肝脏 Total bilirubine 总胆红素ALT ALP GGTTotal protein总蛋白Albumin白蛋白Globulin 球蛋白 Pancreas 胰脏1021.61511092.54.716-362.4147-159109-1293.3-5.82.7-5.2mg/dl mg/dl mg/dl mg/dl mg/dl mg/dl0.41589607629470.9130111157-8923-3928-51mg/dl U/l U/l U/l g/l g/l g/lHypokalemia低钾血症Mild increased ALT

46、ALT轻度升高 12971-159150014001035Nitrates硝酸盐pHProtein蛋白质Glucose葡萄糖Ketone bodies酮体Bilirubine胆红素 Blood/Hgb/Mgb 血液/血红蛋白/肌红蛋白Urinary specific gravity 尿比重1050Sediment 尿沉渣Erythrocytes红细胞Leukocytes白细胞Epithelial cells上皮细胞Crystals结晶 Casts管型Bacteria细菌Yeasts酵母菌Hyphae菌丝 Protein/creatinine ratio蛋白/肌酐比值Urinary total

47、protein尿总蛋白Urinary creatinine000neg neg neg neg neg 0.724.132.70-10-50-5neg neg neg neg neg1035Nitrates硝酸盐pHProtein蛋白质Glucose葡萄糖Ketone bodies酮体Bilirubine胆红素 Blood/Hgb/Mgb 血液/血红蛋白/肌红蛋白Urinary specific gravity 尿比重1050Mild proteinuria轻度蛋白尿 Sediment 尿沉渣Erythrocytes红细胞Leukocytes白细胞Epithelial cells上皮细胞Cry

48、stals结晶 Casts管型Bacteria细菌Yeasts酵母菌Hyphae菌丝 Protein/creatinine ratio蛋白/肌酐比值Urinary total protein尿总蛋白Urinary creatinine000neg neg neg neg neg 0.724.132.70-10-50-5neg neg neg neg neg0.332-63ESAVSTotal T4 总T4Total T4总T41.81.80.8-4.7 g/dl0.8-4.7 g/dlFIVnegativeFIVFeLVnegativeFeLVESAVSDiagnostic plan诊断方案C

49、TMRIThoracic XRays胸X光片Abdominal ultrasound腹部超声ESAVSDiagnostic plan诊断方案CTMRIThoracic XRays胸X光片Abdominal ultrasound Abdominal ultrasound 腹部超声ESAVSAbdominal ultrasound腹部超声Report:报告：Both adrenal glands appear slightly increased (maximal width of 6.2mm)Intestinal muscularis propria is diffusely thickened双侧肾上腺均轻微增大（最大宽度为6.2mm） 肠固有肌层弥漫性增厚 ESAVS快速回顾Neutrophilic, lymphocytic, and monocytic leukocytosis中性粒细胞，淋巴细胞，和单核细胞增多 Mild normochromic, normochromic non regenerative anemia轻度素性，素性非再生性贫血 Hypokalemia 低钾血症Metabolic alkalosis 代谢性碱中毒Mild increased ALT ALT轻度升高Mild proteinuria轻度蛋白尿 Hypotension低