病理生理学 (17)病理生理学.pdf

Hypotonic dehydration Case: A 42-year-old woman was hospitalized due to diarrhea, vomiting, fever, thirst and decreased urine output for 3 days. After intravenous infusion of 5% glucose solution for 2 days, the patient developed symptom of hollow socket, poor skin elasticity, dizziness, anorexia and weakness of muscles. Physical examination showed her pulse is 110 times/min, blood pressure is 70/50mmhg. Laboratory examination indicated serum Na+ level is 115mmol/L (130-150). Questions ： 1. What kind of fluid and electrolyte disorders did the patient have and what is the evidence? 2. Why did the patients heart rate increase and blood pressure decrease? 1. Definition of hypotonic dehydration Excessive body fluid loss: diarrhea, vomiting Manifestations including hollow sockets, poor skin elasticity, dizziness, fast pulse and hypotension Serum sodium 130mmol / L Hypotonic dehydration Hypotonic dehydration is defined as a decrease in body fluid volume with more sodium loss than water loss, sodium concentration of lower than 130 mmol/L and plasma osmolality of less than 280 mOsm/L. 2. Etiology of Hypotonic Dehydration （1) Body fluid losses in the gastrointestinal tract （2）Excessive sweating （3）Severe burn 2. Etiology of Hypotonic Dehydration Loop or thiazide diuretics use Thiazide （4）Body fluid Polyuria phase of diuretics losses in the kidneys acute renal failure Addison’s disease Aldosterone