外科手术的水电解质平衡PPT.ppt

Six-Step to the Interpretation of Arterial Blood Gas With Serum Sodium, Potassium, and Chloride Concentrations OBSERVATION INTERPRETATION INTERVENTION pH other than 7.40? Acidosis if 7.35 Clinical evaluation for causal disease Alkalosis if 7.45 pH 7.20 or 7.55? Severe disorder Prompt correction required Paco2 other than 40 mm Hg? Ventilation compensates disorder Change ventilation Paco2 compensates base deficit other than zero? Bicarbonate loss/gain compensates or contributes to disorder NaCO3 or HCl correct proton concentration urine pH reflect acidosis/alkalosis? Acid/alkaline urine indicates renal function compensates or contributes Renal-active drugs or electrolyte replacement anion gap 12 mmol/L? Value12 mmol/L suggest lactic or ketoacidosis Correct the primary metabolic problem Simple type H2CO3 (1) HCO3 (20) － pH ∝ Metab(Alk) Resp.(aci) Metab. alkalosis Metab.acidosis Resp. acidosis Resp. alkalosis The four types of acid-base disturbances The four types of acid-base disturbances Acute Chronic pH PCO2 HCO3ˉ pH PCO2 HCO3ˉ Resp acid N Resp alka N Meta acid N Meta alka N ? Acidosis and Alkalosis Defect Cause Resp acid Retention of CO2 Depression of respiratory Resp alka Excessive loss of CO2 Hyperventilation Meta acid Retention of fixed acids Diabetes, diarrhea Loss of base bicarbonate Lactic acid accumulation Meta alka Loss of fixed acids Vomiting or gastric suction Gain of base bicarbonate Excessive intake of Potassium depletion bicarbonate Respiratory Acidosis: Hypoventilation PCO2 is elevated and plas