7水电平衡紊乱-2016-2[优教课堂].ppt
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1、,第三章 水、电解质代谢紊乱,主讲人 病理生理教研室 李永渝,Disorders of Water and Electrolyte Metabolism,1,课堂教育,2,课堂教育,一、体液的分布(Distribution of body fluid:water,crystalloids、colloids) (占体重%),成人(男) 儿童 新生儿 老年人 TBF(total body fluid) 60 65 80 52 Intracellular fluid 40 40 35 27 Extracellular fluid 20 25 45 25 Interstitial fluid 15 2
2、0 40 20 Plasma 5 5 5 5,ICF(24L),ECF(12L),3,课堂教育,Male(60%)Female(55%) Most concentrated in skeletal muscle TBF=0.6BW ICF=0.4BW ECF=0.2BW,影响体液量的因素:年龄、性别、胖瘦,4,课堂教育,5,- organ (tissue) water content - fat 25%30% muscle 76% bone 14%46% liver 70% skin 72% -,5,课堂教育,1.Who is having higher proportion of body
3、weight as fluid (water)? And Why? 1. Males or Females 2.Lean or Obese 3.Young or Elderly,Quiz:,2.A fatty person and a thin person with the same body weight lost the same volume of body fluid, whose condition is worse? 3. For a fatty person and a thin person with the same body weight, who is more sen
4、sitive when water is shortage?,6,课堂教育,二、体液的电解质组成(Composition of electrolyte in body fluids) Compartmental concentration (mEq/L) Plasma Interstitial fluid Intracellular fluid Positive ion Na+ 142 140 10 (Cations) K + 5 5 150 Ca2+ 5 5 0.0001 Mg2+ 3 3 40 Total 155 153 200 Negative ion Cl 103 112 3 (Ani
5、ons) HCO3 27 28 10 HPO42 2 4 142 SO42 1 2 5 Protein(Pr ) 16 1 40 Others 6 6 Total 155 153 200,7,课堂教育,8,课堂教育,Osmotic pressure in the body fluid:,Osmotic pressure of a solution depends on the amount of osmotic effective particles.,Water moves from areas of low osmolatity to areas of high osmolatity. O
6、smotic pressure of ECF is roughly equivalent to ICF.,9,课堂教育,Normal plasma osmotic pressure is 280 310 mOsm/L or mmol/L. Plasma osmotic pressure contains colloid osmotic pressure and crystal osmotic pressure.,10,课堂教育,Tonicity,11,课堂教育,四、人体水、钠的生理功能及其代谢调节(function and balance of water and sodium),1. Wat
7、er daily balance,12,课堂教育,2、水的生理功能(function of water ): water is a good solvent for many body chemicals; water is essential to metabolism; water is necessary for body temperature regulation and body fluid osmotic pressure regulation, etc.,13,课堂教育, Metabolism : 食物提供:Na 24g/ 24h,肾排出量:3g/24h, 粪便排出 10mg/
8、24h。 肾排钠特点:“多吃多排,少吃少排,不吃不排”。,3、钠的含量与分布(Content signs of dehydration; circulatory failure easily occur at early stage.,病生要点:,31,课堂教育,治疗原则: (1)治疗原发病,去除病因; (2)补液:补含钠液为主!,0.9%NaCl: Na=154 CL=154 Osm=308 pH=6.5,32,课堂教育,33,ECF,ICF,Treatment of hypotonic dehydration :,What happens ?,33,课堂教育,三、高渗性脱水低容量性高钠血症
9、 (Hypertonic dehydration) 1. Concept 失水多于失钠,血清钠浓度150mmol/L,血浆渗透压310 mmol/L,伴有ECF的减少。 The water loss is in excess of salt loss, serum Na+ is more than 150 mmol/L, and plasma osmotic pressure is more than 310 mmol/L.,34,课堂教育,丧失低渗体液: 肺失水; 皮肤失水; 肾失水(中枢性、肾性尿崩症)。 渗透性利尿; 胃肠道丧失等渗或低渗液;,2Causes and mechanism
10、机体失水或丢失低渗体液是引起高渗性脱水的主要原因。,35,课堂教育,3病理生理变化(对机体影响)(Effects on body) 代偿调节变化: 体液分布异常:其他:,36,课堂教育,水丢失 盐丢失,ECF渗透压,口渴,抗利尿激素醛固酮,ECF,饮水,水重吸收,A. 代偿过程 :,ECF增加,渗透压,ICF水流,37,课堂教育,水丢失 盐丢失,ECF渗透压,a.口渴明显,ICF水 ECF得到补充,细胞脱水,B. 临床表现,b. 中枢神经系统功能障碍,脑出血,血浆Na+,c. 脱水热,d. 尿量,抗利尿激素,38,课堂教育,mainly ICF; obvious thirst; fever;
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