【正文】 Treatment of Gastrointestinal Acidosis Lactated Ringer’s solution instead of Saline. 代酸 所需堿性藥物的 mmol = BE * * Kg（ 體重 ） 所需 5% 碳酸氫鈉的 ml = BE * * Kg （ 體重 ） 糾酸時注意補(bǔ)鉀 注意補(bǔ)堿速度 代謝性堿中毒 metabolic alkalosis ChlorideResponsive Disorders ChlorideResistant Disorders Other causes of Metabolic alkalosis 表：代謝性堿中毒的病因 H+丟失： 經(jīng)消化道丟失： 胃液丟失：嘔吐或胃管引流 抗酸治療：尤其是用陽離子交換樹脂 失氯性腹瀉 經(jīng)腎丟失： 髓袢或噻嗪類利尿藥 鹽皮質(zhì)激素過多 慢性高碳酸血癥恢復(fù)后 氯攝入不足 大量羧芐青霉素或其它青霉素衍生物 H+移入細(xì)胞內(nèi)：低鉀血癥 HCO3過多 大量輸血 碳酸氫鈉輸入過多 乳 堿綜合征 Potential clinical effects of Metabolic alkalosis Cardiovascular Metabolic Effect Increased inotropy(Ca++entry) Hypokalemia Altered coronary blood flow* Hypocalcemia Digoxin toxicity Hypophosphatemia Impaired enzyme function Oxygen Delivery Neuromuscular Increased oxyhemoglobin affinity Neuromuscular excitability Increased 2,3DPG(delayed) Encephalopathy Seizures From William C, Shoemaker, Stephen M. Ayres, Ale Grenvik, Peter R, Holbrook:Textbook of Critical Care, 4th Edition,841 Differential Diagnosis of Metabolic Alkalosis(increased strong ion difference) Chloride responsive(urine Cl ＜ 10mmol/L) Exogenous Sodium Loadchloride Gastrointestinal losses sodium salt administration(acetate, citrate) Vomiting 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