五年制教学稿3医.ppt

水、电解质代谢 肾内科 赵素梅 Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 内容 水、钠代谢失常 失水 水过多和水中毒 低钠血症 高钠血症 钾代谢失常 钾缺乏和低钾血症 高钾血症 Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 3 体液(body fluid)构成 Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 体液成分 Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 5 水、电解质代谢 血浆渗透压＝2 （Na＋＋K＋)＋葡萄糖＋尿素氮 280～310mOsm/Kg.H2O 细胞内外液渗透压保持相等，不平衡时由水的移动来调节 6 Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 渗透压 Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 水平衡(water balance) 水摄入(water intake) 饮水：500-1200mL 食物水：700-1000mL 内生水：300mL 总计：1500-2500mL 水排出(water output) 肾脏*: 650--1600mL 皮肤: 500mL 肺脏: 300mL 肠道: 50-100mL 总计：1500-2500mL 渴觉中枢 AVP Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 8 水的调节 （水多）水的排泄由肾脏完成，主要受血管加 压素的调节 （水少）渗透压上升或循环血容量下降 10% 1 .感受器→刺激AVP分泌→远端小管和集 合管重吸收水增加； 2.作用于口渴中枢→水摄入↑ 11 Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 钠平衡(sodium balance) 钠摄入(Na intake) 食盐 （4~6g/d) 食物（很少） 钠排出(Na output) 肾脏*（尿钠130~260mmol/d,3~5g/d) 皮肤（汗液NaCl浓度约0.3%,50mmol/d） 肠道：极少，粪便钠1~2mmol/d Na排泄：主要受醛固酮调节 Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 10 钠的调