第八版病理生理学 第三章 水和电解质代谢紊乱.pptxVIP

(Disturbances of water and electrolyte balance);(Normal metabolism of water and electrolyte);一、体液的容量和分布(Volume and distribution of body fluid);(Water and electrolytes balance);Total body water (TBW) 60%;影响体液容量的因素;二、体液的电解质 (Electrolyte in body fluid);血[Na＋] 140 mmol/L 血[Cl－] 104 mmol/L 血[HCO3－] 24 mmol/L ; 三、体液的渗透压 和水的交换(Osmotic pressure of body  fluid and water movement);(一)体液的渗透压(Osmotic pressure of body fluid) ; (二) 水的交换(Water movement ) ;1.细胞内外水的运动(water movement between outside-inside of cell) ;2.血管内外水的运动(water movement between outside-inside of capillary) ;Daily intake (ml/day);每日最低尿量500ml;三、水和钠的生理功能(Physiologic function of water and sodium);(一)水的生理功能(Function of body water);(二)钠的生理功能(Physiologic function of sodium); 四、水与钠平衡的调节(Regulation of water and sodium balance) ;1.渴感(thirst) ;2.抗利尿激素 (antidiuretic hormone , ADH);3.醛固酮(aldosterone);42岁男性，因恶心、呕吐、腹胀和腹部 绞痛3天入院。 既往史：20岁做过阑尾切除术。 体检： T 38.7?C，脉搏104 beat/min BP 115/70 mmHg 腹胀，有压痛和反跳痛。 皮肤和舌干燥，尿量5ml/h 化验：血[Na＋]152mmol/L, [Cl-]108mmol/L, [K+] 5.4mmol/L， 尿比重1.038;woman 38 ， 2-day history of weakness and postural dizziness（直立性眩晕 ）History：laxative（泻药）abuse with  multiple bowel movements each day Physical examination： BP 110/60 mmHg falls to 80/50 mmHg  HR 100 beats/min and regular Skin turgor is poor  The mucous membrane is dry;Laboratory test[Na+] = 140 mmol/L[K+] = 3.3 mmol/L[Cl-] ＝ 116 mmol/LUrine [Na+] = 9 mmol/LBUN = 40 mg/dL Arterial pH = 7.25[HCO3-] = 12 mmol/L PaCO2 = 28 mmHg ;(Disturbances of water and sodium balance) ;脱水(dehydration)  ◆高渗性  ◆低渗性  ◆等渗性 水过多(water excess) ◆水中毒 ◆水 肿;低钠血症（hyponatremia)  The serum sodiu