【正文】 crynic acid利尿酸 , which block the reabsorption of Na+ and Cl in proximal tubule and Henle’s loop, then deliver more Na+ and Cl to the distal tubules. More K+ are exchanged with Na+ and the loss of potassium will increase. ? Acetazolamide 乙酰唑胺 inhabits the activaty of CA in proximal tubule, H+Na+ exchange decreases, More Na+ arrive at distal tubules, K+Na+ exchange increases, K excretion increases. ? All diuretics including increase osmotic diuretics mannitol甘露醇 ,can increase the urine volume. ③ Type I of Renal Tubular Acidosis ? There are two kinds of ion exchanges in tubular cells: ? Na+ K+ ? Na+H+ ? Failure of hydrogen excretion is the character of this disease, so more K+ is excreted to exchange for Na+. ④ Increased negative charges in distal tubular fluid More βhydroxybutyric acid and acetoacetic acid (ketone bodies) in distal tubular fluid of patients with ketosis (diabetes). 3) More K+ moves into cell (a) In alkalosis, H+ moves out of the cells, at the same time, K+ moves into the cells. For each unit increase of pH in ECF, the [K+] of serum decreases mmol/L. (b) Insulin stimulates glycogen synthesis in the liver and skeletal muscle cells, at the same time, K+ moves into cells. Insulin stimulates Na+K+ ATPase. (c) Familiar hypokalemia periodic paralysis is a rare disease, there is a acute shift of K+ from ECF to ICF, the [K+]e will reduce, which causes paralysis of the limb and trunk. (d) Hyperthyroidism 甲亢 : Overdose thyroxin stimulates Na+K+ ATPase. (e) Barium poisoning 鋇中毒 : Brium ion is a K+ channel block in cell membrane. (e) Barium poisoning 鋇中毒 : Brium ion is a K+ channel block in cell membrane. ? 據(jù) 2020年 6月 26日中央電視臺(tái) 《 每周質(zhì)量報(bào)告 》 節(jié)目報(bào)道， 5月 31日江西省上饒市發(fā)生多起咸蛋中毒事件，鉛山縣鵝湖鎮(zhèn)羅溪村一黑窩點(diǎn)用工業(yè)鹽下腳料，用來(lái)加工生產(chǎn)咸蛋生產(chǎn)出的咸蛋鋇超標(biāo)達(dá) 30～ 80倍。治療：抗菌素，輸入生理鹽水1200ml。伴煩躁、煩渴。 2人死亡 . 東瓦窯村 69歲的吳賢水，在午飯吃過(guò)咸蛋后3小時(shí)發(fā)病，先是嘔吐、腹瀉，后氣管切開(kāi)，上了呼吸機(jī)，最后死亡。次日病情加重，極煩渴，呼吸深，驚厥，昏迷，并發(fā)腸麻痹死亡。嘔吐，水樣便每日 20余次。 4) Blood dilution ? The concentration of potassium in plasma will reduce in dilute blood. ? Multiple factors in diabetes with ketosis and a. ? (3) Effect on the body ? 1) Effect on neuromuscular irritability ? 2) Effect on heart ? 3) Effect on the acidbase balance ? 4) Effect on the kidney 1) Effect on neuromuscular irritability Neuromuscular irritability (excitability) indicates the degree of difficulty or easy to start AP. High excitability means easy to start AP. Excitability is determined by the distance between the RMP and TMP. The less distance (difference) , the higher of excitability. (a) Decrease the n