Title: Disorders of Water and Electrolyte Metabolism
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Disorders of Water and Electrolyte Metabolism
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4??????????, ?????????
????(?????)
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5???????
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Cl- HCO3-
Na K Ca Mg
ECF
SO42- HPO42- ???
K
HPO42- ??
ICF
Mg Na Ca
SO42- HCO3- Cl-
ECF?ICF????????????
6Na
Na
Cl-
Cl-
HPO42- SO42- ???
HPO42- SO42- ??? ???
K Ca2 Mg2
K Ca2 Mg2
HCO3-
HCO3-
??
????
7 ?? 7 ????
0.05-0.35 ????????????? ??,??????????????????
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????
8???
9???
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10??????1.??????
2.???? 3.????
4.??????(???)?
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2.????????????????
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3.??????????????
11???????
???? ADH ??? ???
12???????????
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??????
ADH???
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??
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13??????????
14??????????????
15???????? hypovolemic hyponatremia
????? hypotonic dehydration
lt130mmol/L lt280mmol/L
16??? ??
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17?????????,?????????????
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ADH?
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18(3)??
??????????????
19(???)
?? ????,?????lt130mmol/L,
?????lt280mmol/L, ??????????,????
(1)?????
????? ????????????? ????? ???????
ADH??????????
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20(2)??
?????????????????????
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???? ???
ECF?
ECF??
????
21?? ????? ?? ????????? ???????
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22???????? hypovolemic hypernatremia ?????hypertoni
c dehydration
?? ???gt?? ?????
gt150mmol/L ?????? gt310mmol/L
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23(1)??
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?? ?????? ADH??? ????????
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24(2)??????
ECF??? ?????
ECF
??????
25?
26(3)????
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27??
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28??
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29?????????
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30????
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31 ????1
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321. ???????
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33 ?????
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342. ????????
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351. ???????
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363. ????????
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371. ???????
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384. ??????
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39???????2
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1. ???????
2. ??????????
3. ??????????????
401. ???????
- ???GFR? ??????(ECBV)?
- ?????????
41(2) ????
???
????????? ??ADH????
- ????????(filtration fraction, FF)
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4220
43???????
GFR(125)
20
FF
?????(600)
44???????
?????
???,??
?????
???,??
(300)
45???????
GFR
(100)
33
FF
?????(300)
46(No Transcript)
47?
483. ??????????????
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??????? ADH????
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49????????????
1.??????---???????
?? ??? ???????
?? ?? ?? ?? ?25g/L ?25g/L
?? ?1.015 ?1.018
??? ? ?
501.????
????(frank edema)
????(recessive edema) ?????????????, ???????,
??????10
51frank edema
522.??????????
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53???????? ??????
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54(No Transcript)
55?????????
Disorders of Water and Electrolyte Metabolism
- ??
- ??????
- ?????
- ?????
- ??????
56?? ??????
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57???????
1.????????
2.??????
581.???????(?-???) --??????????
???? ????? ???? ??? ???? ??
???? ????? ??? ???? ???
ECF
ECF
K
ICF
K
K
??
Na
Na
592.?????
???????? ?????--????????
???????? ???????????
?????? ??????
60???????
???
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??
?K????
???
K
K
Na
??
K
K
Na
61??
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H
H
???
K
K
K
K
62???? ????? ???
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63??????
1.??????
K
K
???
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2.??????
3.?????????????
64Hypokalemia(1)
Plasma K lt 3.5mmol/L
?
65 66???
67???
68ECF
ICF
K
??
?? lt3.5 mmol/L
691.????
2.????
??? ?????. ????K??????
702.????
???? ???
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????
???(??????-??)
713.????????????
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72??????
1.???????????
1)??????
(1)???????????
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73(1)???????????
???
1
2
0
3
4
74(1)???????????
30
1
2
0
0
-30
3
-60
4
-90
75(1)???????????
????
30
1
2
0
0
-30
3
-60
4
-90
76(1)???????????
77???????
4??????? ???????????
78???????
4??????? ???????????
79????
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4
???? ??????
80(1)???????????
81(2)????????????
?????????
30
0
-30
-60
P? ?? QRS???,?? ST? ??,?? T?
??,?? U? ?????
-90
82(3)???????????
832)????????
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84??
852.????????????
???????????????? ????????????
????????
863.????????--???
K?
??????
87?? ???????
??????? (lt 40-120mmol/D )
?? (lt 10-20mmol/h )
?? (lt 40 mmol/L )
?? (???? )
88Hyperkalemia(1)
Plasma K gt 5.5mmol/L
?????
89????????????????
90????????????????
ECF
ICF
??
???
911.????
????
???
K
?????
921.????
????
931.????
????
???
Et
Em
941.????
????
???
Et
Em
?????
951.????
2.????,??????
?????? 0 ?????? 2 ???? 3 ????
961.????
2.????,??????
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