外科手术的水电解质平衡.pptVIP

FLUID AND ELECTROLYTE MANAGEMENT Water Exchange Drink1000～1300 Food 700 ～ 900 Metabolic water300 Composition of Urine Water Nitrogen-containing material：urea、uric acid、creatine、creatinine、amino acid and amonia。 Organic compound：hippuric acid、glucuronate、lactic acid、ethanedioic. Electrolyte：Cl-、Na 、K and phosphate。Little protein and sugar，positive in urine pathology。 Total blood volume of human body Generally 8％of body weight， About 5000 ml for an adult。 increase23％～25％ in pregnancy women。 About 80％ of total volume in circulation Other 20% stored in liver and spleen Mechanism of Hyponatremia Water intake excess Mechanism of Hypernatremia Water intake deficient Normal Hypokalemia Hyperkalemia Phosphonium Abnormalities About 85% of phosphonium exite in bone Normal serum phosphonium level:0.96~1.62mmol/L Participate phosphorate of protein, cell membrain and acid-base balance Hypophosphatemia Cause: Hyperparathyroidism, severe burn or infection Syptom: manifestation in nervous-muscle. Treatment: administration of sodium glycerophosphate 10 ml Hyperphosphatemia Cause: acute renal failure, Hypoparathyroidism, acidosis Syptom: like hypocalcemia, ectopic calcification Treatment: treatment of hypocalcemia, dialysis Acid-base Balance Acid base: source and regulation Acid-base Balance Asid and Alkali in body volatile acid: carbonic acid（H2CO3） fixed acid：H2SO4、H2PO4、ketobodies Acid-base Balance Intracellular PH: proteins and phosphates, ECF space: bicarbonate-carbonic acid system red cell hemoglobin PH of body fluids maintained by several buffer systems and subsequently excreted by the lungs and kidneys. Acid base: source and regulation Blood buffer: Acid-base Balance 1、PH：Normal blood PH: 7.35~7.45 2、PCO2： Normal: 35-45mmHg,(40mmHg) 3、Buffuer excess（BE）: Represent ascidosis or alkolosis, Normal: +3~-3 mmol/L,(0) 4、Actual bicarbonate radical（AB）： actual HCO3- in plasma 5、Standard bicarbonate radical（SB）： HCO3- content m