低钾血症临床诊断思路培训课件.ppt

外院检查结果 某医院（1月19日-1月23日） 钾0.84-2.71mM，钠137mM，钙1.9mM，磷0.76mM，镁0.61mM 尿蛋白0.75-0.25g CK 2604U/L、CK-MB 486U/L、LDH 1621U/L、羟丁酸脱氢酶 856U/L、ALT 289U/L、AST 529U/L。 腹部B超：双肾体积增大，双肾弥漫性病变。 肾上腺CT（当地医院）：双侧肾上腺增生，左侧肾上腺体部结节样增生。 Copyright Alcohol Medical Scholars Program * 入院后检查结果——电解质 K (3.5-5.5mmol/l) Na (130-150mmol/l) Ca (2.25-2.75mmol/l) P (0.97-1.62mmol/l) Mg (0.6-1.4mmol/l) Cl (94-110mmol/l) 07-1-23 16:40 1.86 140.7 2.09 0.62 0.82 106.1 07-1-24 06:30 2.56 143.9 2.15 0.82 0.76 110.1 07-1-24 16:00 1.80 140.1 2.10 0.64 0.74 105.8 07-1-25 06:30 2.73 144.6 2.14 0.90 0.74 111.2 07-1-25 16:00 2.60 139.7 2.10 0.61 0.74 105.8 07-1-26 06:30 3.13 149.3 2.12 1.02 0.82 109.3 07-1-26 16:00 2.67 139.7 2.16 0.80 0.78 102.7 07-1-27 06:30 3.10 142.5 2.10 0.97 0.72 104.3 07-1-28 14:00 3.83 139.7 2.38 1.36 0.84 106.0 07-1-29 06:30 4.22 142.7 2.14 1.52 0.86 106.1 Copyright Alcohol Medical Scholars Program * 肌酶变化 CK (2-100U/L) CK-MB (0-16U/L) LDH (40-250U/L) AKP (0-130U/L) ALT (0-40U/L) AST (0-40U/L) 07-1-23 16:40 12430.0 135.8 675.0 77.0 155.0 178.0 07-1-24 06:30 6048.1 117.8 611.4 82.0 152.1 178.2 07-1-24 16:00 10765.0 142.4 973.0 198.0 244.0 570.0 07-1-25 06:30 5420.5 102.2 601.7 193.6 241.2 301.5 07-1-25 16:00 8330.0 123.4 534.0 152.0 173.0 196.0 07-1-26 06:30 5009.5 94.7 549.2 156.0 167.5 147.7 07-1-26 16:00 3253.0 90.0 438.0 116.0 121.0 106.0 07-1-27 06:30 3372.6 60.6 514.1 142.5 115.3 90.0 07-1-28 14:00 1542.0 84.0 397.0 114.0 78.0 57.0 07-1-29 06:30 1478.7 68.0 467.5 127.4 80.2 62.7 Copyright Alcohol Medical Scholars Program * 血钾与肌酶变化关系 26,16 0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 14000 12000 10000 8000 6000 4000 0 2000 23,16 24,06 24,16 25,06 25,16 26,06 27,06 28,14 29,06 CK(U/L) 血钾(mmol/l) 时间 Copyright Alcohol Medical Scholars Program * 血气分析 PH (7.35-7.45) PO2 (69-116mmHg) PCO2 (32-45mmHg) HCO3- (20-26mM) BE (-3-3mM) SO2 (95-99%) 07-1-23 7.489 120.0 34.4 25.6 2.44 98.7 07-1-24 7.450 96.4 39.7 26.9 2.8 98.0 07-1-28 7.448 87.4 46.3 31.4 6.5 97.5 Copyright Alcohol Medical Scholars Program * 24