病理生理学 (15)病理生理学.pdf

Hypertonic Dehydration Case: A 62-year-old woman was admitted to the hospital because of vomiting after eating for 10 days and was diagnosed with pyloric obstruction. Her urine output was significantly decreased. The physical examination showed that her pulse is 90 times/minute, the blood pressure is 115/75mmHg, the respiratory rate is 12 times/minute. She manifested confusion and somnolence. In her laboratory tests, the urine specific gravity is 1.023 (normal range from 1.005 to 1.020) and the serum Na+ concentration is 158mmol/L (normal range from 130 to 150). Questions ： 1. What kind of fluid and electrolyte disorders did the patient experience? 2. What is the evidence of fluid and electrolyte imbalance in this patient? 3. How would you explain her confusion and somnolence? Excessive fluid loss: frequently vomiting Reduced fluid intake: vomiting after eating Decreased urine output ; Confusion; Somnolence A serum Na+ level above 150mmol/L Increased urine specific gravity Hypertonic dehydration Hypertonic dehydration refers to the decreased body fluid volume in which the loss of water is more than sodium, the serum sodium level is above 150 mmol/L and the plasma osmotic pressure is greater than 310 mOsm/L. 1. Causes of Hypertonic dehydration （1）Inadequate fluid intake Water Water shortage ：desert lost, earthquake Inability to drink water ：emesis, coma A defect of thirst ：thirst sensation damaged by brain injury 1、Causes of Hypertonic dehydration （2）Excessive water loss A defect of thirst or inability to drink water Diarrhea Fever Hyperventilation Central diabetes insipidus Vomiting Hyperthyroidism