外科病人的体液失调3.pptVIP

* Metabolic Acidosis 代谢性酸中毒 Management Acid gain: identify and correct the underlying cause Lactic acidosis: restore adequate tissue perfusion Ketoacidosis: resuscitate and control glucose Renal failure: hemodialysis 治疗 产酸：判断和纠正病因 乳酸酸中毒：恢复充足的组织灌注 酮症酸中毒：控制血糖 肾衰：血液透析 * Metabolic Acidosis 代谢性酸中毒 Management (cont’) Bicarbonate loss Resuscitate with fluids similar in volume and composition to those lost Correct hyperchloremia Bicarbonate replacement pH 7.20 HCO3- 10mmol/L 治疗（续） 碳酸氢丢失 体液复苏，与容量与成份丢失的处理相同 纠正高氯血症 补充碳酸氢 pH 7.20 HCO3- 10mmol/L * 代谢性碱中毒Metabolic Alkalosis * Metabolic Alkalosis 代谢性碱中毒 Causes Loss of hydrogen ions GI losses of HCl (NG suction) Shift of hydrogen ions into the intracellular space mainly develops with hypokalemia Alkali administration Loss of bicarbonate-poor, chloride-rich extracellular fluid, as observed with thiazide diuretic or loop diuretic therapy 病因 氢离子丢失 胃肠道丢失盐酸（胃肠减压） 氢离子转移至细胞内 主要发生于低钾血症 补碱 乏碳酸氢和富氯细胞外液丢失，见于噻嗪或袢类利尿剂 * Metabolic Alkalosis 代谢性碱中毒 Clinical Manifestations Symptoms of metabolic alkalosis are not specific Because hypokalemia is usually present, the patient may experience weakness, myalgia, and polyuria Hypoventilation develops because of inhibition of the respiratory center in the medulla Symptoms of hypocalcemia may be present. 临床表现 代谢性碱中毒的症状不特异 由于通常出现低钾血症，可表现为虚弱，肌痛，多尿 由于抑制了延髓呼吸中枢，可发生通气不足 可出现低钙血症的症状 * Metabolic Alkalosis 代谢性碱中毒 Manegment Carbonic anhydrase inhibitors Acetazolamide (Diamox) - reduces reabsorption of NaHCO3 in proximal tubule IV acidic solutions Hydrochloric acid - may be indicated in severe metabolic alkalosis (pH 7.55) or when NaCl or KCl cannot be administered because of volume overload or advanced renal failure Also may be indicated if rapid correction of severe metabolic alkalosis is warranted (eg, cardiac arrhythmia, hepatic encephalopathy, digoxin toxicity) 治疗 碳酸酐酶抑制剂 乙酰唑胺-减少NaHCO3在近曲小管的重吸收 静脉注射酸溶液 盐酸-用于重度代谢性碱中毒（ pH 7.55 ），或容量超负荷或肾衰、不能给与氯化钠或氯化钾的病人 也可用于重度代谢性碱中毒需要快速纠正的病人（