hypokalemiaandpotassiumdeficit-資料下載頁
2024-10-18 02:02本頁面
【導(dǎo)讀】(1)Concept. (2)Causesandmechanism. (3)Effectonthebody. plasmais<mmol/L.movementofK+fromECFtoICF,1)Decreasedintake. 2)ExcessivelossofK+. 3)MoremovingofK+intocells. 4)Blooddilution. Atthesametime,thereisstilllossof. least).(b)Excessiverenalloss. potassium.potassiumdirectly.Renallossisthemain. ①Hyperaldosteronism. syndrome.kidneys.hypokalemia.尿andethacrynicacid利尿酸,tubules.Acetazolamide乙酰唑胺。exchangedecreases,increases.Therearetwokinds. Na+-K+. Na+-H+. Failureofhydrogen. forNa+.
【正文】 When [K+]e of ECF reduce, the K+ of ICF moves out of the cells, at the same time, H+ moves into the cells for electric neutrality. Then the [H+] in ECF will be reduced, which is called metabolic alkalosis. ? (Depending on the primary disease) There are two kinds of ion exchange in renal tubules: K+ Na+ H+ Na+ ,. In hypokalemia, the K+Na+ exchange is reduced, the H+Na+ exchange will increase, so the excretion of H+ from kidneys is increased, which leads to acidic urine. ? Usually in alkalosis, the elimination of H+ is reduced from kidneys, and the urine should be alkaline. ? But in the alkalosis caused by hypokalemia, the urine is acidic, it is unusual, so it is called unusual aciduria. 4) Effect on the kidney ? Pathologic study found the swelling, proliferation, vacuolation in proximal tubular cells, the renal tubular cells can not produce sufficient cAMP, which is necessary for ADH to work, so the tubules lose the concentrating ability to urine. ? The volume of urine is increased and the specific gravity will reduce. ? Thirst may occur in patients with hypokalemia. 4. Principle of treatment ? 1) Etiological treatment is to correct the underlying diseases. ? 2) The major problem of replacement of potassium is to produce the hyperkalemia ? Replacement of potassium salts slowly after urination (no oliguria).見尿補鉀 ? Oral potassium chloride is better than intravenous administration. ? We must pay attention to the rate of intravenous administration and the potassium concentration of potassium chloride solution. ? ? (a) When K deficiency and oliguria, the [K+]e may not be severely reduced because of dehydration and acidosis at the same time. ? (b) It will take 1~2 days to get the balance of [K+]I and [K+]e. (10~15 days) ? Replenish KCl may correct both hypokalemia and metabolic alkalosis. ? Replenish KHCO3 may correct both hypokalemia and metabolic acidosis. . Case Discussion ? 1. A 36yearold man was hospitalized with a 3day history of fever and watery diarrhea. His blood pressure was 90/60 mmHg, the pulse was 112/min, temperature is ℃ . The abdomen was distended with low skin elasticity. The laboratory results were: Arterial blood: pH=, PaCO2=26 mmHg PaO2= 108 mmHg. [Na+]=135 mmol/L [K+] = mmol/L [HCO3] = 16 mmol/L Urine: pH=, Specific gravity= ? The patient’s problems were: ? (1)isotonic dehydration ? (2)metabolic acidosis ? (3)hypokalemia. ? 病例分析 ? 1．患嬰， 3個月，入院前 1天開始發(fā)熱。嘔吐，水樣便每日 20余次。伴煩躁、煩渴。查體： ℃ , 嗜睡，醒后煩躁，皮膚干熱，明顯腹脹。治療：抗菌素，輸入生理鹽水1200ml。次日病情加重，極煩渴，呼吸深，驚厥，昏迷，并發(fā)腸麻痹死亡。
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