1 水电解质代谢紊乱1 disorders of water and electrolyte metabolism.docx
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1 水电解质代谢紊乱1 disorders of water and electrolyte metabolism.docx
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1水电解质代谢紊乱1disordersofwaterandelectrolytemetabolism
1水、电解质代谢紊乱(1disordersofwaterandelectrolytemetabolism)
1水、电解质代谢紊乱(1disordersofwaterandelectrolytemetabolism)1水、电解质代谢紊乱(1disordersofwaterandelectrolytemetabolism)Dehydration(dehydration)\hypotonicdehydration(Hypotonicdehydration)\dehydrationsymptoms(Dehydrate,symptom)\[hypertonicdehydration(Hypertonic,dehydration)/isotonicdehydration(Isotonic,dehydration)/waterintoxication(Water,intoxication)\hyponatremia(hyponatremia)\hypernatremia(hypernatremia)AdisorderofwaterandsodiummetabolismDehydration(dehydration):
adecreaseinbodyfluidvolume(morethan2%ofbodyweight)andaseriesofpathologicaldisordersoffunctionandmetabolism.Thewaterofthebodyismainlythelossofextracellularfluid,whilesodiumionsarethemostimportantcationsintheextracellularfluid,sodehydrationisoftenassociatedwiththelossofsodium(I)hypotonicdehydration(Hypotonic,dehydration);Hypotonicdehydration:
lossofsodium,morethanwaterloss,serumsodiumconcentration135mmol/L,plasmaosmoticpressure280mmol/L,andaccompaniedbydecreasedextracellularfluidvolume,knownashypotonicdehydration.AlsocalledhyponatremiaoflowvolumeTheetiologyandpathogenesisof****Mainlythelossofisotonicorhypotonicfluid.1)extrarenalcausesA.digestivejuicesarelostinlargeamounts,B.fluidsaccumulateinlargeamountsinthebodycavity,andC.accumulateslargeamountsofsweatorburnsinlargeareas2)renalcausesAlargenumberoflong-termuseofsodiumintakeornatriureticdruglimitA.(hydrochlorothiazideandfurosemideandethacrynicacidetc.)B.chronicrenalinterstitialdisease,ascendinglimbofHenleandNawithrenaldysfunctionincreasedlostC.acuterenalfailurepolyuriaperiod,GFRincrease,tubularfunctiondidnotrecover,sodiumandwaterexcretionincreasedD.saltlosingnephritis,tubularepithelialcelllesionsofAld(aldosterone)responsetothedecreaseinsodiumreabsorptioninrenalsodiumexcretion,reduceexcessiveTheadrenalcortexande.,suchasAddisondisease,AldsecretionofNa,thedecreaseintubularreabsorptionanddecreaserenalsodiumexcretionanddrainageincreasedF.excessiveosmoticdiuresisandrenalexcretionofNaandH2Oincrease2.oftheimpactofthebodyThebasicchangeswereobviousdecreaseofextracellularfluidanddecreaseofosmoticpressureLossofsodiumandwaterloss,theosmoticpressureofextracellularfluid,thedecreaseinextracellulartointracellularwatertransfertointracellularwateruptocelledema,extracellularfluiddecreasedmoreobviouslyClinicalmanifestation1)circulatoryfailure(Symptomof,circulatory,failure)Thewaterfromthecelltocelloutwardtransferofextracellularfluidandbloodvolumedowndowndowndowndowndown,bloodpressure,shock2)dehydrationsymptoms(Dehydrate,symptom)Lowerskinelasticity,sunkensocket,andthreeconcavesignsininfants.(3)otherclinicalmanifestations(Other,manifestation);-thirsty:
earlywithoutthirst;inlate,therewillbethirsty.CNS-symptoms:
severehypotonicdehydrationwithhaziness,drowsiness,coma.-urinarysodium:
:
urinarysodiumorno10mmol/L.Accordingtotheclinicalsymptomsoftheseverityofclinicalhypotonicdehydrationofthreedegrees(two)hypertonicdehydration(Hypertonic,dehydration);Hypertonicdehydration:
dehydrationmorethansodiumloss,serumsodiumconcentration145mmol/L,plasmaosmoticpressure310mmol/L,andaccompaniedbydecreasedextracellularfluidvolume,Hypertonicdehydration.Alsocalledlowvolumehypernatremia.1.etiologyandpathogenesisDehydrationorlossoflowosmoticfluidisthemaincauseofhypertonicdehydration1)simpledehydrationA.isC.throughthelung,B.bytheskin,andbythekidneys
(2)lossofhypotonicfluidC.lossofhypotonicfluidthroughthegastrointestinaltract,B.profusesweating,andrepeatedosmoticdiuresiscausedbyrepeateduseofmannitolorhypertonicglucoseinthea.2.,theimpactonthebody1)compensatoryresponseoforganism-drink(exceptforthirstthirstdisorder)Plasmaosmoticpressureincreases,osmoreceptor(+)-(+)-thirstythirstHere,AGTIIrelax,thirstycentralbloodvolume(+)-thirstyHypertonicdehydration,saliva,throatdrydownWhiletheproportionofhigh-oliguria(excludingdiabetesinsipiduspatients)InthewaterfromthecellwithintheextracellulartransfertotheosmoticpressureofextracellularfluiddecreasedsomewhatThesethreeaspectsmaketheextracellularfluidosmoticpressurefallback,sothattheearlybloodvolumeofdehydrationisnoteasytodroptothedegreeofshock2)theclinicalmanifestationvarieswiththedegree-urinarysodiumMildhypertonicdehydration(earlystage)Theosmoticpressureofextracellularfluid,increasebloodvolumedecreaseisnotobvious,thereabsorptionofwaterandsodium,highurinesodium.Mediumandseverehypertonicdehydration(late)Bloodvolumeandrenalbloodflowwassignificantlylower,Ald(aldosterone)secretion,increaseurinarysodiumdown-CNSsymptomsSeverehyperosmolardehydration,intracellularfluid,braincelldehydrationandsignificantlydecreasebrainpressuredecreases,theseverityofthesymptomsofCNS-thermaldehydrationHere,thebodytemperaturedowntoincreaseheatdissipationfunction,sweatglandsecretorycells:
liquid-shock,renalfailureAccordingtotheseverityofclinicalsymptoms,thehypertonicdehydrationwasthreedegrees(three)isotonicdehydration(Isotonic,dehydration);Isotonicdehydration:
whenwaterandsodiumarelostinproportionorafterlosingfluid,theplasmaosmoticpressureisstillwithinnormalrange,theserumsodiumconcentrationis135~145mmol/L,andtheplasmaosmoticpressureis280~310mmol/L.1.etiologyandpathogenesisVomitinganddiarrhea,alargenumberofpleuralandascitesformation,extensiveburnsandseveretrauma,suchasplasmaloss.2.,theimpactonthebodyIsotonicdehydrationoftenhasclinicalmanifestationsofhypotonicandhypertonicdehydration.Amassivelossofisotonicfluid,extracellularfluid,bloodvolume,bloodpressuredown,downtothedecreaseinurinevolume,bodytemperature,dehydrationobviousappearanceIsotonicdehydrationcanonlybeconvertedintohypotonicdehydrationifonlywaterisaddedtothetreatmentwithoutattentiontosodiumsupplementation.WaterintoxicationWaterintoxication(Waterintoxication):
whenthewaterintake,overregulatingnerveendocrinesystemandkidneydrainageability,makealotofwaterretentioninthebody,resultinginvolumeofintracellularfluidandextracellularfluidexpansion,andtheemergenceofaseriesofdiseasesincludinghyponatremia,physicalandphysiologicalchanges.1.etiologyandpathogenesis1)takeinorentertoomuchelectrolytefreeliquid2)acuteorchronicrenalinsufficiency3)excessivesecretionofADHExcessivesecretionofADHisdefinedasabnormalsecretionofADHundercertainpathologicalconditions.(a)ADHabnormalgrowthsyndrome(SIADH):
Hypothalamicdiseases(encephalitis,braintumors)andectopicADHsecretion(lung,oatcellcarcinoma)B)otherreasonsInpain,nauseaandemotionalstress:
relax,ADHsecretionofwaterintoxicationInthecaseofadrenocorticalfunction:
GC(glucocorticoid),inhibitionofhypothalamicADHsecretionfunctiondowndown-exogenousADHinput(vasopressinandoxytocin)4)certainspecialpathologicalstatesA)heartfailure,hepaticascites,effectivecirculatingbloodvolumedown,downtothewaterloadincreaserenaldrainageandwaterpoisoning(b)hypotonicdehydration-alargeamountofelectrolytefreewaterintoxication2.,theimpactonthebodyProminentmanifestation:
increasedintracellularfluidvolumeorcelledemaWhenwaterpoisoningoccurs,theextracellularfluidincreasesobviously,andthelowpermeabilityofextracellularfluidcausesalargeamountofwatertoenterthecellMildwaterintoxication,theincreaseofintracellularandexternalfluidisnotobvious,thesymptomsarenotobvious,maybeweak,dizzinessandsoonAcutepoisoningwithwaterintoxicationcancausebraincelledemaandincreasedintracranialpressure,whichcanbelife-threateningtestquestions1.thebalanceofosmoticpressureinsideandoutsidecellsmainlydependsonthemovementofthefollowingsubstancesA.,Na+,B.,K+,C.,Cl-,D.,H2O,Ca++,E.2.,alargeamountofwaterisaddedtothepatientswithseverehypotonicdehydration,whilenosodiumsaltisaddedA.hypertonicdehydration,B.isotonicdehydration,C.poisoning,D.hypokalemia,E.edema3.whatarethemajorcharacteristicsofhypotonicdehydration?
4.whyishypertonicdehydrationlesspronetocirculatoryfailureintheearlystage?
5.,wecomparedthesimilaritiesanddifferencesbetweenhypotonicdehydrationandhypertonicdehydration.CaseanalysisMalepatients,2yearsold,diarrhea2days,6-7timesaday,waterystools;vomiting3times,vomitingisthemilkconsumed,cannoteat.Accompaniedbythirst,oliguriaandbloating.Physicalexamination:
thespiritofmalaise,T37oC,BP11.5/6.67KPa(86/50mmHg),skinelasticity,eyessag,bregmaticsubsidence,fastheartbeatandweak,noabnormallung,abdominaldistension,abdominalreflex,decreasedbowelsounds,kneereflex,coldextremities.Laboratorytests:
serumK+3.3mmol/L,Na+140mmol/L.Whatkindofwaterandelectrolytedisorderoccurinthechild?
Onthebasisofwhat?
ComparisonofthreekindsofdehydrationDisturbanceofsodiummetabolism1.hyponatremiaHyponatremia(hyponatremia)referstoserumsodiumconcentrationsbelow135mol/l.Plasmaosmolalitymainlydependsontheconcentrationofserumsodiumions,sohyponatremiaisusuallyassociatedwithlowosmolarity.(I)hypotonichypon
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