水电酸碱紊乱诊治

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1、FLUID,ELECTROLYTE,ANDACID-BASEDISORDERS外科水电紊乱与酸碱失衡CaseReport78ys,female平时一般状态良好，自行料理家务，活动近月来纳差，近5天进食后呕吐，乏力、懒言、嗜睡，入院前一天未排尿入院Bp96/58mmHg,P106bpm,R28tpm心肺查体无明显异常；腹部稍隆，未见胃肠型及逆蠕动波，胃区振水音未闻及；肝、胆、脾未触及，全腹未及肿物，无压痛、反跳痛区；膀胱区叩浊，移动性浊音阴性。留置导尿，膀胱潴留尿液3200ml，导尿后尿量30ml/hrs。CaseReport(c

2、ont)BloodRTHb152g/LRBC452×1012/LHct45.2%WBC107×109/LN71%ElectrolytesNa128mEq/LK2.8mEq/LCa1.83mEq/LCl87mEq/LTCO232.8mEq/LLiverFunctionAlb28g/LGlu26g/LOthersnormalKidneyFunctionBUN7.1mg/LCr218mg/LBloodSugar4.6mEq/LUrineRTDensity1.030KET+++OthersnormalOutlineIntroductio

3、nPhysiology&PathophysiologyDehydrationDisordersofCompositionAcidosisandAlkalosisBodyFluidsTotalbodywateriscontainedin2compartments.IntracellularExtracellularExtracellularisdividedinto2spaces.IntravascularInterstitialTheintravascularspacecontainstheplasmavolume.25%oft

4、heextracellularfluid8%ofthetotalbodywater5%ofbodyweightThesecompartmentsareindynamicequilibrium,andalterationsinoneultimatelyleadstocompensatorychangesintheothers.体液的构成BodyWaterTotalBodyWaterBodyWeightMaleFemaleTotal1006050Intracellular67(2/3)4030Extracellular33(1/3)

5、2020Intravascular(plasma)855Interstitial251515BODYFLUIDCONSTITUTION(%)LeanBodyWeight体液的成份BODYFLUIDCOMPOSITION(mEq/L)ExtracellularFluidIntracellularfluidPlasmaInterstitialFluidCATIONSNa+14014612K+44150Ca2+5310-7Mg2+217ANIONSCl-1031143HCO3-242710SO42-11—HPO43-22116Prot

6、ein16540OrganicAnions55—WaterTranscompartmentalMovement晶体渗透压CELLBLOODVESSELINTERSTITIALSPACE胶体渗透压细胞膜半透作用Osmolalitycrystalcolloid细胞间紧密连接semipermeablemembraneHomeostasisTheThirdSpaceAnadditionalECFcompartment,thetranscellularcompartment,consistsofwaterthatispoorlyexcha

7、ngeableundernormalcircumstances.Thisfluidisseparatedfromothercompartmentsbybothendothelialandepithelialbarriers.Includedinthiscategoryarecerebrospinalfluid,synovialfluid,waterincartilageandbone,fluidsoftheeye,andthelubricatingfluidsoftheserousmembranes.Gastrointestin

8、aljuicealsobelongstothiscategory.Together,thesefluidsconstituteapproximately4%ofTBW.(1%----2%BW)Non-functionalECFELECTROLYTECONCENT