水电解质代谢酸碱平衡的失调课件.pptVIP

(Disturbancesofwaterandelectrolytebalance)

Questionsvvvvvv

Casestudy病史：体检：治疗：Whathappenedinthepatient?

(Normalmetabolismofwaterandelectrolyte)

(Volumeanddistributionofbodyfluid)(bodyfluid)体内的水和溶解在其中的物质。

(Waterandelectrolytesbalance)vv(volume)(composition)v(osmoticpressure)v(distribution)

v40％Intracellularfluid(ICF)vExtracellularfluid(ECF)Interstitialfluid(ISF)Plasma

BodyfluidTBW(%)TBW(%)TBW(%)InfantAdultmaleAdultfemaleNormalLean607050506042708060Obeseq

(Electrolyteinbodyfluid)ECF:ICF:

平均正常值CFICF400Na+K+Cl-HCO3-HPO42-

(Osmoticpressureofbodyfluidandwatermovement)

(Osmoticpressureofbodyfluid)血浆渗透压

(Watermovement)

(watermovementbetweenoutside-insideofcell)

(watermovementbetweenoutside-insideofcapillary)

(Watermovementbetweenoutside-insideofbody)Dailyintake(ml/day)Dailyoutput(ml/day)UrineLungsDrinkingWaterinfoodWaterofoxidationSkinStoolTotalTotal

v(从尿排代谢废物35g/日最大浓度6～8g％）vv

(Physiologicfunctionofwaterandsodium)

(Functionofbodywater)v促进物质代谢v调节体温v润滑

(Physiologicfunctionofsodium)v维持体液的渗透压和酸碱平衡v参与细胞动作电位的形成

(Regulationofwaterandsodiumbalance)

(thirst)?渴中枢

(antidiuretichormone,ADH)ECF渗透压↑ECF量↑肾重吸收水↑渗透压↓有效循环血量↓

(aldosterone)有效循环血量↓低血Na+高血K+

(Disturbancesofwaterandsodiumbalance)

（Classification）v(dehydration)◆◆◆v(waterexcess)◆

v（hyponatremia)Theserumsodiumconcentration130mmol/Lv（hypernatremia)Theserumsodiumconcentration150mmol/L

(Dehydration)体液容量减少(2%)。bodywaterdeficit

(hypertonicdehydration)(concept)vwaterloss＞sodiumlossvserum[Na]150mmol/L+vplasmaosmoticpressure＞310mmol/L(hypovolemichypernatremia)

(causes)(decreaseofintake)v水源断v失口渴感v食(lostfromECF)v大量出汗v尿崩症和渗透性利尿v呼吸道蒸发

(effects)失水失Na+→皮肤蒸发↓脱水热ECF渗透压↑→渴中枢口渴↓ECF量↓↓血容量↓血↑ADH↑[Na]+血浆渗透压↑细胞内脱水↓CNS功能障碍↓肾重吸收水↑脉速,BP↓尿少比重高幻觉,躁动

(dehydrationfever)

ECF高渗ICF减少

(pathophysiologicalbasisofpreventionandtreatment)v及时补水v适当补钠

(Hypotonicdehydration)(concept)vsodiumloss＞waterlossvserum[Na]130