【正文】 Massive blood transfusions Gastric drainage Parenteral nutrition Chloridewasting diarrhea(villous adenoma) Plasma volume expanders After diuretic use Sodium lactate(Ringer’s solution) After hypercapnea Other Chloride unresponsive(urine Cl20mmol/L) Severe deficiency of intracellular cations Mineralocorticoid excess Magnesium, potassium Primary hyperaldosteronism(Conn’s syndrome) Secondary hyperaldosteronism Cushing’s syndrome Liddle’s syndrome Bartter’s syndrome Exogenous corticoids Excessive licorice intake Ongoing diuretic use From William C, Shoemaker, Stephen M. Ayres, Ale Grenvik, Peter R, Holbrook:Textbook of Critical Care, 4th Edition,847 Treatment of Metabolic Alkalosis Primary aldosteronism: Spironolactone ； Restriction of sodium intake and potassium supplementation ； Surgery ； Dexamethasone is effective in longterm therapy of familial dexamethasoneresponive aldosteronism. Secondary aldosteronism: Angiotensinconverting enzyme inhibitors Cushing’s syndrome: Caused by pituitary oversecretion of ACTH: surgery or radiation Caused by adrenal adenoma or carcinoma: adrenalectomy Caused by secondary or ectopic ACTH production: address the underlying malignancy Treatment of Metabolic Alkalosis Liddle’s syndrome: Triamterence Bartter’s syndrome: Postssiumsparing diuretics, potassium and magnesium supplementation, angiotensinconverting enzyme inhibitors, and cyclooxygenase inhibitors Exogenous corticoids: Discontiunation of the offending agent or agents and vigorous initial potassium replacement. Severe potassium or magnesium depletion: Replacement of these electrolytes(may require very large amounts). 呼吸性酸中毒 respiratory acidosis Acute respiratory acidosis causes: CNS suppression neuromuscular disease or impairment airway and parenchymal lung disease permissive hypercapnia Chronic respiratory acidosis causes: chronic lung disease chest wall disease central hypoventilation chronic neuromuscular disease Treatment of Respiratory Acidosis Treat the underlying causes Supplemental Oxygen Noninvasive/Invasive Ventilation CO2排出綜合征 BP↓,HR↑,心律失常 ,甚至心跳停止 . (1)應(yīng)激消失 (2)回心血減少 (3)冠狀血管 ,腦血管收縮 ,心腦供血不足 . overventilation to chronic hypercapnia has two undesirable consequences: lifethreatening alkalemia difficulty to wean the patient from mechanical ventilation. 慢性呼酸治療就注意的幾個問題 一般不需應(yīng)用堿性藥物糾正酸血癥 避免過多給氧 避免應(yīng)用鎮(zhèn)靜藥物 綜合治療 呼吸中樞興奮劑一般無效 黃體酮可能有效 機械通氣 呼吸性堿中毒 Respiratory Alkalosis reside at high altitude pathologic conditions: salicylate intoxication early sepsis hepatic failure hypoxic respiratory disorders pregnancy pain or anxiety Hypocapnia appears to be a particularly bad prognostic indicator in patients with critical illness. Treatment of Respiratory Alkalosis Treat the underlying causes Nacrotics Mechanical ventilation Supplemental Oxygen 復(fù)習(xí)思考題 反映氣體交換效率的指標 反映氧供需平衡的指標 常見的低氧血癥的原因 氧合指數(shù)的計算 主要的酸堿平衡調(diào)節(jié)機制 代償?shù)臅r間、極限、最大幅度 酸堿平衡失常的診斷 酸堿平衡失常的治療原則 謝 謝