(黄巧冰).pptVIP

1. In cellular level: The hyposmolal ECV leads to a tendency for free water to shift from the extracellular to the intracellular compartments. It could cause cerebral edema, brainstem herniation. 2. In vascular level: The fluid lost in vascular space leads to a trend of shock. 3. In total body level: Due to the significant low interstitial fluid, there would be remarkable dehydration signs, oliguria, changed urine natrium (decreased or absent). Consequence: Dehydration signs: 脱(失)水体征：由于血容量减少，组织间液向血管内转移，组织间液减少更明显，病人出现 皮肤弹性减退，眼窝和婴幼儿囟门凹陷。 C. Isosmolal (isotonic) dehydration 等渗性脱水 Equal lost of water and sodium in proportion Serum sodium concentration 130~150 mmol/L Plasma osmolality 280~320 mOsm/L Section 1. Dehydration Part 3. Disorder of water and electrolytes metabolisms Characteristics: Causes : Consequence: Common dehydration (most of time from gastrointestinal) Thirst Oliguria Dehydration signs Exacerbate to Hyperosmolal (increased insensible loss of water) Hyposmolal (inappropriate water replacement) Section 1. Dehydration Part 3. Disorder of water and electrolytes metabolisms 三型脱水的比较 ? 高渗性脱水（低容量性高钠血症） 低渗性脱水(低容量性低钠血症） 等渗性脱水 发病原因 水摄入不足 或丧失过多 体液丧失 而单纯补水 水和钠等比例丧失而未予补充 发病原理 细胞外液高渗， 细胞内液丧失为主 细胞外液低渗， 细胞外液丧失为主 细胞外液等渗，以后高渗，细胞内外液均有丧失 主要表现和影响 口渴、尿少、 脑细胞脱水 脱水体征、休克、 脑细胞水肿 口渴、尿少、 脱水体征、休克 血清钠(mmol/L) 150以上 130以下 130～150 尿氯化钠 有 减少或无 减少 治疗 补充水分为主 补充生理盐水或3%氯化钠溶液 补充低渗盐水 Section 1. Dehydration Part 3. Disorder of water and electrolytes metabolisms Water Intoxication Characteristics: Causes : Consequence: Hypervolemic hyponatriumia Over water retention Excessive ADH secretion (primary: Syndrome of inappropriate ADH secretion，SIADH secondary: Medication) Renal failure Intracellular overhydration (edema) Cerebral edema, brainstem herniation About natriuretic hormone Different opinions: 1. Atrial natriuretic hormone = ANP 2. Natriuretic hormone is a Na+ , K+