鉀代謝障礙酸堿平衡紊亂-資料下載頁
2025-05-13 12:02本頁面
【正文】 c abnormalities. Neurologic manifestations may be more prominent in respiratory acidosis than in metabolic acidosis. ―CO2 narcosis‖ The mechanism: (1) CO2 crosses the bloodbrain barrier relatively easily, and can dilate the blood vessels in the brain and lead to brain edema. (2) CO2 can also decrease the pH of the cerebrospinal fluid, and make depression of neural function, like weakness, confusion, paralysis, stupor and a. 5) Laboratory findings ↓pH, ↑ PaCO2, ↑HCO3 if there is pensation of kidneys (chronic). 3. Metabolic alkalosis 1) Concept: Metabolic alkalosis refers to a primary increase in base bicarbonate, the pH elevates. 2) Causes: (1) Decrease of acid . vomiting (Ileus: intestinal obstruction). (2) Increase of base . antacids, transfusion with citrated blood, hyperaldosteronism. Salineresponsive alkalosis and salineresistant alkalosis 3) Compensation 4) Manifestations Alkalosis can cause increased excitability of nervous system, like hyperactive reflexes, muscle hypertonicity, tetany etc. 5) Laboratory findings ↑pH, ↑HCO3, ↑ PaCO2 if there is pensation of respiratory system. 4. Respiratory alkalosis 1) Concept: Respiratory alkalosis is defined as an increase of pH induced by primary decrease in plasma [H2CO3]. 2) Causes: Hyperventilation . anxiety, hysteria, fever, early salicylate (aspirin) toxicity, misuse of mechanical ventilation. 3) Compensation 4) Manifestations Tetany 5) Laboratory findings ↑pH, ↓PaCO2, ↓HCO3 (depend on the normal renal function). 5. Mixed acidbase imbalances Concept: Two or more primary acidbase imbalances exist at the same time. Bacterial pneumonia→ respiratory acidosis Patient Diarrhea→ metabolic acidosis In this mixed imbalance, the pH is likely to be very low. Pneumonia→ respiratory acidosis Patient Vomiting→ metabolic alkalosis In this mixed imbalance, the pH will change slightly or in normal range. Acidosis + acidosis, or alkalosis + alkalosis, the pH will change a lot。 acidosis + alkalosis, the pH will change slightly or in normal range. Respiratory acidosis and respiratory alkalosis can not exist at the same time. (2) A 32yearold male presented with vomiting of one week39。s duration. On examination, he had a blood pressure of 90/60 mmHg and a pulse of 116/minute. See the laboratory results. Arterial blood : pH PaCO2 46 mmHg HCO3 39 mmol/L Na+ 143 mmol/L K+ mmol/L Cl 72 mmol/L Urine pH (3) A 52yearold man with chronic obstructive lung disease is admitted to the hospital with worsening dyspnea. He appears cyanosis and in respiratory distress. The laboratory data follow. Arterial blood pH PaCO2 60 mmHg PaO2 50 mm Hg HCO3 35 mmol/L Na+ 136mmol/L K+ mmol/L Cl 96 mmol/L (4) A 48yearold female presented with severe vomiting. On examination, T 38℃ , HR 89/min, R 26/min, Bp 150/100 mmHg. She appears general edema. The laboratory results Arterial blood pH PaCO2 43 mmHg PaO2 95 mm Hg HCO3 26 mmol/L Na+ 142mmol/L K+ mmol/L Cl 98 mmol/L
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