《生理学-机体平衡》酸碱紊乱-教学课件（非AI生成）.ppt

MetabolicAlkalosisCompensation↙↘KIDNEYLUNG↙↘urine(alkaline)suppressedbreathing(CO2retained)*MetabolicAlkalosisCauses:complex,atleast3separatefactors:(1)lossofhydrogenion,usuallyasaresultoflossofgastricsecretionswhichrichinhydrochloricacid;(2)volumedepletion,whichisoftensevere;(3)potassiumdepletion,whichalmostalwaysinpresent.*代碱临床表现一般无症状呼吸变浅变慢神经系统的症状PH值，HCO3升高*MetabolicAlkalosisSymptomsandsignsincludehypertonicityofthemuscles,tetany,anddepressedrespiration.LaboratoryfindingsincludeaurinepHof7.0,plasmabicarbonate29mEq/Linadultsand25mEq/Linchildren,aplasmapH7.45andaplasmapotassium4mEq/L.Bloodcarbondioxidepartialpressure(PCO2)isusuallyslightelevated.*代碱的治疗1积极处理原发病；2纠正脱水后一般碱中毒都可以得到缓解；3不要求完全纠正4严重时候才需要补HCL*MetabolicAlkalosisTreatment:fluidmustbegiven,usuallyassalinesolution,andshouldbeadministeredaspotassiumchloride.Example:Apatientwithametabolicalkalosis,plasmachloride=80mEq/L,Bodyweight=70kgChloridedeficit=(103-80)?0.2?70kg=322mEq(N.S2000ml)Note:103--Normalplasmachloride0.2--Extracellularfluidofbodyweight同时纠正低钾血症及低钙血症*MetabolicAlkalosis/treatmentForseverepatient,suchasHCO3-45-50mmol/L,pH7.65,dilutedhydrochloricacid(HCl)suchas0.1-0.2mol/Lcouldbeusedcautionary.*RespiratoryAcidosis通气功能下降（高碳酸血症）麻醉过深，呼吸机使用不当，气胸*Acid–BaseDisturbancesDiagnosingAcid-BaseImbalanceImbalancepHBicarbonatePCO2Metabolicacidosis↓↓Metabolicalkalosis↑↑Respiratoryacidosis↓↑Respiratoryalkalosis↑↓Summaryofchangesindirectionofbloodgasvaluesinacid-basedisturbances.Theheavyarrowsindicatetheprimaryabn