英文班水电解质授课.pptxVIP

病 例 分 析 男性 29岁，王XX,因急性上腹部疼痛 12小时，急诊收住入院。诊断为重症急性胰腺炎。入院后病人主诉上腹部胀痛和极度口渴。HR 150次/分，R 38次/分，BP 170/98mmHg，无尿。腹部体征示，压痛、反跳痛、严重的腹胀，后背部有凹陷性水肿。诊断性穿刺游离腹腔内有棕褐色腹腔渗液， CT发现肠腔内有大量的液体积聚。 伴有水、电和酸、碱紊乱的程度1 存在严重的脱水,如何补液？2 第三间隙的液体急剧积聚，何为第三间隙？3 Na+ 155mmol/l, Cl- 115mmol/l, K + 6.5mmol/l, Ca 1.0mmmol/l，如何纠正？4 伴有代谢性酸中毒、呼吸性碱中毒，如何处理？Fluid & Electrolyte and Acid-base disturbancesEnqiang Mao Ph.D.Department of Surgery, Ruijin Hospital ,Shanghai5% Body Weight15％Body Weight2+MgNa +Anatomy of Body Fluids Compartments proteinPlasmaKHCOCINa- - ++3（ECF）Interstitial Fluid (ISF)+HCOCI- - NaK+3Extracellular FluidIntracellular FluidNa+ K+ ATPase（ICF）ProteinKPO+-440％Body WeightIntracellular Fluid (ICF) （Female 35％）FigHow to differentiate function and non-function interstitial fluidsFunction:Taking part in modulating the balance of body fluids.Non-function: Fluids in cavity in normal status.Including cerebrospinal ,joint,pericardium and abdominal cavity fluids.Third SpaceDefinition: Pathophysiologicly,relatively nonfunctional extracellular fluid.Mainly for the change of quantity of nonfunctional ECF. Distribution:exudates in burns; ascites; soft tissue injuries. bowel wall;peritoneum;infected lesions. Attention: not confused with the nonfunctioning components from interstitial fluid. The Concept of Osmotic PressurePressure leading to the shift of water through semi-permeable membrane Semi-permeable membranewaterwaterAnion and Cation as well as non-electrolyte particlesDefinition the number of osmotically active particles or ions per unit volume.Unit : milliosmoles per liter （mOsm / L） Plasma Osmotic PressureNormal Range =290~310mOsm/LRelation between Osmotic pressure and distribution of body fluidOsmotic Pressure：Crystal OP and Colloid OPPlasma Crystal OP :[Na+] contributes a major portion of OP Plasmatic Colloid OP：Plasma protein contributes a force leading to distribution of ECF Interstitial Crystal OP：Contributes to the shift of extracellular and intracellular wate