水盐代谢紊乱教学课件.ppt

Case 2 72 year old male with recently diagnosed small cell lung cancer presented to the E.D. immediately following a brief seizure that occurred in the setting of worsening lethargy. Physical Exam: Confused and stuporous, unable to respond to questions; wt. 60 kg., BP 125/75 P 90; tremulous w/ twitching, lungs clear, no edema Lab Values: Plasma: Na+ 112, K+ 4.2, Cl- 76, total CO2 26, BUN 9, Cr 0.9, uric acid 2.4, Posm 234 mOsm/kg; Head CT: no focal abnormalities, but mild cerebral edema hyponatremia likely SIADH(syndrome of inappropriate antidiuretic hormone secretion) from malignancy; serious neurological signs and symptoms Case 3 A 78 year old diabetic female nursing home resident is admitted for decreased mental status following a febrile upper respiratory tract infection treated with p.o. antibiotics. Her caregiver had been withholding insulin because she had stopped eating. Physical Exam: Obtunded, wt. 50 kg. (previous normal wt. 60 kg.), BP 85/45, T 38.5°C, P 125; poor skin turgor, dry mucous membranes, foul-smelling urine Lab Values: Plasma: Na+ 170, K+ 3.9, Cl- 134, total CO2 23, BUN 45, Cr 1.6, glucose 1000 Diagnoses Hyperosmolar Hyperglycemic Non-Ketotic Coma (diabetes + infection) Effective Circulating Blood Volume Depletion (loss of total-body Na+ from glucose-induced osmotic diuresis) Hypernatremia/Dehydration (hypotonic fluid losses from osmotic diuresis + pure water losses from fever/insensible losses w/ no fluid intake) * * * * * * * * * * * * * * 2. Etiology (2) Decreased water output (1) Excessive water intake Congestive heart failure Hepatic cirrhosis Nephrotic syndrome The kidneys retain sodium and water Effective arterial blood volume ADH hypervolemic hyponatremia (3) Syndrome of inappropriate ADH secretion Water retain ? 3、Alternation of Metabolism and Function ECF?ECF osmolality? Water movement into cells serum[Na+] ? diluted blood Elevated blood pressure weight gain, edema lower serum protein concentration Swelli