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第七章 体液平衡与酸 碱平衡紊乱 PowerPoint PPT Presentation


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第七章 体液平衡与酸 碱平衡紊乱. Disturbance of Body fluid balance and acid-base balance. 倪培华. 第一节 体液平衡. body fluid balance. 生 理 学 基 础. 电解质的组成. 静水压与渗透压. 体液容量与分布. Hydrostatic pressure and Osmotic pressure. Volume and distribution of body fluid. Electrolyte. 病例 1(case 1).

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第七章 体液平衡与酸 碱平衡紊乱

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4346298

Disturbance ofBody fluid balance and acid-base balance


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body fluid balance

  • Hydrostatic pressure and Osmotic pressure

Volume and distribution of body fluid

Electrolyte


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1(case 1)

  • 1546845%1000ml

  • 37.5()(36.5-37.7)150/55/86/50mmHg(11.5/6.67KPa)

  • [Na+]125mmol/L

    [K+]3.2mmol/L


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Distribution of body fluid

(40)

Intracellular fluid (ICF)

(15

(60)

Interstitial fluid

(20)

(5)

Extracellular fluid (ECF)


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(Volume and distribution of body fluid)


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%

TBW60 65 80 52

Interstitial fluid 15 20 40 20

Plasma 5 5 5 5

(Volume and distribution of body fluid)

ICF 40 40 35 27

ECF 20 25 45 25

*Total body water,TBW; Intracellular fluid, ICF; Extracellular fluid, ECF Interstitial fluid


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(Electrolyte in body fluid)

(mEq/L)

Plasma Interstitial fluid Intracellular fluid

Positive ion Na+ 142 140 10

K + 5 5 150

Ca2+ 5 5 0.0001

Mg2+ 3 3 40

Total 155 153 200

Negative ion Cl103 112 3

HCO327 28 10

HPO422 4 142

SO421 2 5

Phosphate 6 6

Protein(Pr) 16 1 40

Total 155 153 200


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ECF:Na+Cl- HCO3-

ICF:K + Mg2 +HPO42- Pr-


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H2O

H2O

H2O

H2O

H2O

H2O

H2O

H2O

H2O

H2O

H2O

H2O

H2O

H2O

H2O

H2O

H2O

H2O

H2O

H2O

H2O

H2O

H2O

H2O

  • Hydrostatic pressure and Osmotic pressure

2

1


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H2O

Na+

Na+

H2O

H2O

H2O

Na+

H2O

H2O

(Regulation of body fluid balance)

1.

colloid osmotic pressure

hydrostatic pressure

2.


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3.(Water movement between outside-inside of body)


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(Function of body water)


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ECF

(Regulation of water balance)

1. (thirst)


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ECF

ECF

ADH

2.

(antidiuretic hormone , ADH)


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Na+H2O

ECF

Na+K+

3.(aldosterone)


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Bone 45%

ECF 45%

ICF 10%

(Regulation of sodium balance)

  • 58mmol/kg

  • 24g/d

  • 100140mmol(3g)/d >10mg/d

[Na+]: 135-145mmol/L


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(Function of sodium)


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(Potassium metabolism and

its disorders)


Normal metabolism of potassium

(Normal metabolism of potassium)

(

1. (intake)

2. (absorption):


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3. (distribution)98%(ICF)2%(ECF)serum [K+] 3.55.5mmol/L

4. (excretion) :urine 80%90(feces 10)(sweat)


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Distribution and content ofpotassium within body

(50mmol/Kg)

2%

98%

(3.5~5.5mmol/L)

(150mmol/L)


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(Regulation of potassium balance)

pump-leak)


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Na+ - K+-ATP

K+

K+

Na+

Na+

K+

K+

K+

(Regulation of potassium balance)

1.

ICF [K+]

140-160mmo1L

ECF[K+]

4.2mmol/L


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[K+]

K+

Na+

2

[H+]

Na+

K+

K+

K+

H+

H+

Na+

Na+

K+

K+

Na+

K+

ECF

K+

Na+

2


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3.


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  • (Promoting the cell metabolism)

  • (Maintenance of the resting membrane potential)

  • (Regulating the osmotic pressure and acid-base balance)


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Classification

  • (dehydration) (hypertonic)(hypotonic)(isotonic)

  • (water excess)

    (edema)


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Classification

  • hyponatremia) serum sodium <130 mmol/L

  • hypernatremia) serum sodium >150 mmol/L


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Dehydration

,(>2%)

Isotonic

Hypertonic

Hypotonic


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Hypotonic dehydration

1.(concept)

  • sodium loss water loss

  • serum[Na+] <130 mmol/L

  • plasma osmotic pressure < 280 mOsm/L


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2

1()

2

3Addison


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3

ADH


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Hypertonic dehydration

1.(concept)

  • water losssodium loss

  • serum[Na+] >150 mmol/L

  • plasma osmotic pressure 310 mOsm/L


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2

(1)

(2)


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3

CNS

()

ADH


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Isotonic dehydration

1

water loss=sodium loss

serum[Na+]130150 mmol/L

plasma osmotic pressure 280310mmol/L

2

3


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Edema

(Edema)

(concept) Accumulation of excess fluid within the interstitial spaces.


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(1)

(2)

(local edema)(anasarca)

(3)

1(Classification )


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(4)

  • frank edema)(pitting edema)

  • recessive edema)

  • (myxedema)


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Disorders of sodium metabolism

Hyponatremia

serum [Na+]<130mmol/L

Hypernatremia

serum [Na+]>150mmol/L


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  • Hyponatremia

  • normovolemic hyponatremia)

  • hypovolemic hyponatremia)

    depletional hyponatremia)

    • <10mmol/L

    • >20mmol/L

  • dilutional hyponatremia)

  • hypervolemic hyponatremia)

    ECF


  • 4346298

    Nacl

    Nacl

    orNacl

    +

    Na

    (mmol/L)

    +

    ADH

    Na

    (mmol/L)

    <10

    >20

    <10

    >20


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    • Hypernatremia

    • hypovolemic hypernatremia)

    • normovolemic hypernatremia)

    • hypervolemic hypernatremia)


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    Na+

    Na+

    Na+

    Na+

    Na+(mmul/L)

    Cushings

    <10

    >20

    UOSM(mOsm/kg)

    (UOSM >800)

    <800

    >800

    -

    -


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    1

    • 1546845%1000ml

    • 37.5()(36.5-37.7)150/55/86/50mmHg(11.5/6.67KPa)

    • Na+125mmol/LK+3.2mmol/L


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    14

    2

    3[Na+]125mmol/L(<130mmol/L)

    ??


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    Kalemia disorder

    3.55.5mmol/L

    Hypokalemia

    (concept)

    Serum [K+] < 3.5mmol/L


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    Hypokalemia

    1(Causes and mechanisms)

    1 (decreased K+ intake)


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    2(increased K+ excretion)

    • II

      HCO3-HCO3- K+

    • Cusings disease


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    H+

    K+

    [K+]

    H+

    3(Kshifts into the cells)

    • alkalosis

    • H+K+

    • Na+-H+Na+-K+

    cell


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    • insulin)

    • DM

    • Na+ -K+ -ATP


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    • (hypokalemic familial periodic paralysis)

    • Na+-K+-ATP

    4


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    (Effects)

    1

    (effects on neuromuscular excitability)


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    [K+]

    ()

    K+

    (mechanism)


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    (manifestations)

    CNS


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    2(effects on the heart)


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    (mechanism)


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    QRS

    ST

    T

    U


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    Na+

    K+

    K+

    H+

    H+

    NH3+

    H+

    H+

    NH3+

    H+

    NH3+

    3

    K+- H+

    [K+] K+H+-Na+H+ NH4+ HCO3-

    [H+]


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    Hyperkalemia

    (Concept)

    Serum [K+] > 5.5mmol/L


    Causes and mechanisms

    (Causes and mechanisms)

    (oliguria)

    Addison

    1(decreased K+ excretion)


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    2K+(K+ shifts out of cells)

    • (cell injury)

    • (metabolicacidosis)

    • (hyperkalemic periodic paralysis)

    3(increased K+ intake)


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    (Effects)

    1

    (effects on neuromuscular excitability)


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    (

    [K+]

    (

    K+

    (mechanism)


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    2(effects on the heart)


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    (mechanism)


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    3K+,T

    P-RQRS


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    (manifestations)


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    1

    • 1546845%1000ml

    • 37.5()(36.5-37.7)150/55/86/50mmHg(11.5/6.67KPa)

    • Na+125mmol/LK+3.2mmol/L


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    1-----()

    2--

    3K+3.2mmol/L(<3.5mmol/L)


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    2

    • 37BP80/64mmHg,

    • :

      :(+),(+++),(+)

    • 720.9%TK+2.0mmol/L, Na+141mmol/L

    • 1

    • 2


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    2

    1

    2


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    1

    2


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