顾勇－水电解介碱平衡.pptVIP

Disorders of Fluid and eletrolyte Metabolism 2005-3-10 Huashan Hospital,Fudan University Water and Sodium Metabolism Control of water excretion Control of sodium excretion Hyponatremia and hypernatremia Control of Water Excretion Regulation of thirst Antidiuretic hormone Control of Sodium Excretion Nephron segmental reabsorption Regulation of sodium balance Nephron Segmental reabsorption Glomerulotubular balance Proximal tubule Henle’s loop Distal convoluted tubule Collecting tubule Regulation of Sodium Balance Extrarenal mechanisms intrarenal mechanisms Extrarenal mechanisms Renal nerves Renin-angiotensin System Atrial natriuretic peptide Vasopressin Endogenous Na-K-ATPase inhibitors intrarenal mechanisms Renal hemodynamics Physical factors Prostaglandins Kallikrein-kinin system Endothelium-derived factors Hyponatremia Etiology and classification Clinical features Treatment Etiology and Classification Isotonic hyponatremia Hypertonic hyponatremia hypotonic hyponatremia Isotonic hyponatremia Pseudo-hyponatremia Hyperlipidemia hyperproteinemia Hypertonic hyponatremia Hyperglycemia Hypertonic infusion hypotonic hyponatremia Hypovolemic hyponatremia Hypervolemic hyponatremia Isovolemic hyponatremia Hypovolemic hyponatremia GI loss Skin loss 3rd space Renal loss Adrenal insufficiency Hypervolemic hyponatremia CHF Liver damage nephrosis Isovolemic hyponatremia Water intox Renal failure SIADH Reset osmostat Clinical Features Neurologic manifestation Headache Nausea Vomiting Weakness Seizures coma Treatment Increase serum sodium by 1-2mM/h Diuretic--people unable to excrete dilute urine hypernatremia Etiology and classification Clinical features Treatment Etiology and Classification Hypovolemic hypernatremia Hypervolemic hypernatremia Isovolemic hypernatremia Renal Potassium Handling Potassium-aldosterone feedback system Plasma pH Volume expansion-increased urinary flow rate Antidiuretic hormone Extrarenal Control of Potassium Insulin Catecholamines Aldosterone Para