韩春茂水电解质和酸碱平衡失调的处理.pptxVIP

第一节 概述：Total body water 50%-70% of total body weightdeuteriun oxide or tritiated water: 60% for male adult and 50% for female adult, both normal variation ±15%.(lean body mass and age) 52% and 47% with elder and 75%-80%for newborn infants, at 1 year of age, 65%题外话我的学、教经历我的困惑我的体会Interstitial fluid: Functioning components (90%) Nonfunctioning components(10%) connective tissue water and transcellular water, which includes cerebrospinal and joint fluids.Osmotic PressureThe physiologic and chemical activity of electrolytes depends on the number of particles (present per unit volume (moles or millimoles per liter), the number of electrical charges per unit volume( equivalents or milliequvalents per liter),and the number of osmoles or milliosmoles per liter)A Mole =the molecular weight of that substance in grams Eg:a mole of NaCl:58 grams(Na,23; Cl, 35)An Equivalent of an ion =its atomic weight expressed in grams divided by the valence.Eg:Ca++ 1 millimole equals 2 milliequivalentsOsmole refers to the actual number of osmotically active particals present in solution. 1mmol NaCl, 2mOsm;1mmol Na2SO4,3 mOs; 1 mmol glucose,1mOsm.In each compartment the total number of osmotically active particles is 290 to 310 mOsm.The effective osmotic pressure depends on those substances that fail to pass through the pores of the semipermeable membrane. Such as sodium , glucose.The cell membranes are completely permeable to water. Any condition that alters the effective osmotic pressure in either compartment causes redistribution of water between the compartments. 体液平衡和渗透压的调节—— 神经-内分泌系统渗透压：下丘脑-垂体后叶-抗利尿激素系统（敏感而弱）血容量：肾素-醛固酮系统（强）共同作用于肾二. 酸碱平衡的维持血液缓冲 HCO3-/H2CO3肺：CO2肾: 排出固定酸、保留碱性物质 Case:男，42岁。柴油烧伤60% ，2-3度休克期平稳，伤后第3天行气管切开，四肢削痂生物敷料覆盖、并行悬浮床治疗术后4天：有一过性烦躁，嗜睡术后5天：昏迷，Na 158 , Cl 119 血糖：704mg% BUN82, Cr3.36 进量 出量术后第1天5250 4370术后第2天5250 4670术后第3天6560 3950术后第4天5270 4800结果： 抢救3天，死亡！！每天生理需要量5%氯化钠溶液500ml5-10%葡萄糖溶液1500-2000ml10%氯化钾溶液30ml第二节 体液代谢的