新水电平衡.ppt

Fluid and Electrolyte Management of the Surgical Patient References: 克氏外科学（第15版） Maxwell,M.H. Etal: Clinical disorders of fluid and electrolyte metabolism 4th ed. New York, McGraw-Hill,1987. SCHWARTZ‘S PRINCIPLES OF SURGERY - 8th Ed. (2005) 可下载 体现在各个章节\疾病中 原发和继发 联系疾病的发病\发展机理 基础的基础(最基本的内环境平衡) 上课讲的少,自学的不是不重要! 美国没有教课书,但最后要求比较严! 第一节 概述：Total body water  50%-70% of total body weight deuteriun oxide or tritiated water: 60% for male adult and 50% for female adult, both normal variation ±15%.(lean body mass and age) 52% and 47% with elder and 75%-80%for newborn infants, at 1 year of age, 65% Interstitial fluid:  Functioning components (90%) Nonfunctioning components(10%) connective tissue water and transcellular  water, which includes cerebrospinal and  joint fluids. Osmotic PressureThe physiologic and chemical activity of electrolytes depends on the number of particles (present per unit volume (moles or millimoles per liter), the number of electrical charges per unit volume( equivalents or milliequvalents per liter),and the number of osmoles or milliosmoles per liter) A Mole =the molecular weight of that substance in grams Eg:a mole of NaCl:58 grams(Na,23; Cl, 35) An Equivalent of an ion =its atomic weight expressed in grams divided by the valence.Eg:Ca++ 1 millimole equals 2 milliequivalents Osmole refers to the actual number of osmotically active particals present in solution. 1mmol NaCl, 2mOsm;1mmol Na2SO4,3 mOs; 1 mmol glucose,1mOsm. In each compartment the total number of osmotically active particles is 290 to 310 mOsm. The effective osmotic pressure depends on those substances that fail to pass through the pores of the semipermeable membrane. Such as sodium , glucose. The cell membranes are completely permeable to water. Any condition that alters the effective osmotic pressure in either compartment causes redistribution of water between the compartments. Quiz 4. About hypovolemic patient (isotonic dehydr