体液失调英文版.ppt

Fluid-Electrolyte-Acid-base Management,General surgery department The first affiliated hospital to Soochow University,overview,compositions of body fluid,regulations of fluid balance,acid-basebalance,importance of fluid balance,Contents of discuss,fluid-electrolyte-acid-base management catalog,adjust of fluid metabolism,demonstratecharts,basic principles of treatments,Normal body fluid,osmotic pressure and electrolyte are the basis of body metabolism and organ functions.Trauma,operation and many clinical disorders lead to fluid,electrolyte and acid-base imbalance,management of these problems is a very important matter in the surgical therapy.-1,fluid-electrolyte-acid-base management overview,Main components of the body fluid are water and electrolytes.Body fluid is divided into intracellular fluid and extracellular fluid.Muscle contains much water.(75-80)Fat contains less water.(10-30),fluid-electrolyte-acid-base management compositions of body fluid,About 60 of weight of adult male is body fluid；about 55 of weight of adult female is body fluid；about 80 of weight of infant is body fluid；after 14 years old,children are near to manhood.,fluid-electrolyte-acid-base management compositions of body fluid,Most intracellular fluid is in skeletal muscle;intracellular fluid account 40%of body weight for male,for female is 35%.Extracellular fluid account 20%of body weight for both of male and female.Extracellular fluid is further divided into plasma and interstitial fluid;plasma occupy 5%of body weight;Interstitial fluid occupy 15%of body weight.,fluid-electrolyte-acid-base management compositions of body fluid,Most of interstitial fluid can exchange with plasma or intracellular fluid quickly,and get to balance,which is very important in fluid and electrolyte management,called functional extracellular fluid.,fluid-electrolyte-acid-base management compositions of body fluid,Other interstitial fluid can only exchange and get to balance slowly,they have different functions,but they are less important in the maintain of body fluid balance,called nonfunctional extracelluar fluid.Connective tissue fluid and penetrable fluid of cell,e.g.cerebrospinal fluid,synovial fluid and digestive juice,and so on,are all called nonfunctional extracelluar fluid.,fluid-electrolyte-acid-base management compositions of body fluid,The changes of some nonfunctional extracelluar fluid can lead to imbalance of body fluid,electrolyte and acid-base obviously.The most familiar example is a great deal loss of digestive juice,it can lead to marked change of body fluid volume and elements.-2Nonfunctional extracelluar fluid occupies 1%-2%of body weight,and about 10%of interstitial fluid.,fluid-electrolyte-acid-base management compositions of body fluid,The most important cation in extracelluar fluid is Na+,and the main anion are Cl-,HCO3-and protein.The main cation in intracelluar fluid are K+and Mg2+,the main anion are HPO42-and protein.The osmolality of extracelluar fluid and intracelluar fluid are equal,the osmolality of plasma is 290-310mmolL.,fluid-electrolyte-acid-base management compositions of body fluid,The stability of body fluid and osmotic pressure is adjusted by nerve-incretion system.The normal osmotic pressure of body fluid is resumed and maintained by thalamo-posthypophysis-antidiuretic system.The volume of blood is resumed and maintained by renin-aldosterone system.,fluid-electrolyte-acid-base management fluid balance and osmotic pressure adjust,extracellular osmotic pressure,thalamo-posthypophysis-antidiuretic system,antidiuretic hormone is verysensitive to the changes ofextracellular osmotic pressure,even overstep 2,extra-cellular osmotic pressure fall to normal,water lose,thirst，drink more,water resorb urine reduce,water is reserved,keep homeostasis,fluid-electrolyte-acid-base management fluid balance and osmotic pressure adjust,stimulate renin,adrenal aldosterone,with increased resorption ofnatrium,more water is resorb,extra-cellular osmotic pressure fall to normal,blood volume blood pressure,Na+resorb,K+drainage,H+drainage,keep homeostasis,fluid-electrolyte-acid-base management fluid balance and osmotic pressure adjust,Both of the two systems all act on kidney to adjust the absorption and drainage of electrolyte as water and natrium and so on,to get the body fluid balance and internal environment stability.The blood volume is more important than osmotic pressure for body.,fluid-electrolyte-acid-base management fluid balance and osmotic pressure adjust,So as the blood volume reduced greatly and in the same time the plasma osmotic pressure reduced,the acceleration for antidiuretic hormone by former play a much more important role than the depression for the hormone by latter.-3The purpose is at first to keep and resume blood volume,ensure the enough blood for vitals,maintain the safe of patients life.,fluid-electrolyte-acid-base management fluid balance and osmotic pressure adjust,The normal physiological and metabolism function need normal body fluid with proper hydrogen.Usually the body fluid maintain a certain concentration of H+,also maintain a certain pH(arterial plasmas pH between 7.40 0.05).But in the process of metabolism,body persistently produce acid and alkali substance,in this way,the concentration of H+also changes regularly.,fluid-electrolyte-acid-base management management of acid-base balance,In order to keep the fluctuation of concentration of H+in a small range,the body adjust the acid and alklai by buffer system,breathing with lung and excretion with kidney.The most important buffer system in blood is HCO3-/H2CO3.,fluid-electrolyte-acid-base management management of acid-base balance,The normal mean value of HCO3-is 24mmolL,H2CO3 is 1.2mmolL,the ratio of HCO3-/H2CO3=241.2=20:1.no matter how higher or lower the HCO3-and H2CO3 are,the ratio of HCO3-/H2CO3 still keeps in 20:1,pH of plasma is remaining 7.40.-4e.g.H+HCO3-=H2CO3=H2O CO2,fluid-electrolyte-acid-base management management of acid-base balance,Breath of lung adjust the acid-base balance by discharging CO2 from lung,this can reduce PaCO2 in blood,in the same time,also adjust H2CO3 in blood.If respiratory is insufficiency,it will lead acid-base disorder,and it will also depress its compensatory capacity of acid-base balance.,fluid-electrolyte-acid-base management management of acid-base balance,Kidney play the most impotant manangement role in the acid-base balance system,kidney maintain normal concentration of HCO3-in plasma by changing output of fixed acid and alkali to keep pH of plasma in normal range.If kidney is abnormal,it not only effect the normal adjust of acid-base balance,but also lead acid-base imbalance.,fluid-electrolyte-acid-base management management of acid-base balance,In the clinical work,we may meet many problems about water,electrolyte and acid-base balance with different characters and degrees.Many sudden and serious sicknesses of the internal medicine and surgery,e.g.shock,massive hemorrhage of digestive tract,large area burns,digestive tract fistula,intestinal obstruction and serious peritonitis,all these can lead badly internal environment disorders for dehydration,hypovolemia,hypokalemia and acidosis.,fluid-electrolyte-acid-base management importance,Recognizing in time and actively correcting these abnormalities is the first job in our therapies,because the aggravation for each of water,electrolyte and acid-base imbalance will lead the patients death.When the the patients with electrolyte disorder or acidosis,the danger for operation will increase obviously.-5 Even the operation is successful,If we ignore the maintenance of internal environment,it will result to the failure of therapy at last.,fluid-electrolyte-acid-base management importance,There are many different clinical manifestations of body fluid,electrolyte and acid-base imbalance.There are usually mixed abnormalities in the same time,not only body fluid and electrolyte disorder,but also acid-base imbalance.So we should correct them overall,and don not miss anyone.,fluid-electrolyte-acid-base management importance,Volume Disorders:isotonic body fluid decrease or increase.It only causes extracellular fluid varied,and intracellular fluid is usually normal.,fluid-electrolyte-acid-base management maladjustment of fluid metabolism,Concentration Disorders:the water of extracellular fluid decrease or increase,it leading the changes of concentration of infiltration particulates,so the osmotic pressure also changes.Because 90 infiltrating particulates of extracellular fluid are constituted by Na+，so that the concentration disorders display as hyponatremia or hypernatremia.,fluid-electrolyte-acid-base management maladjustment of fluid metabolism,Compositions Disorders:the change of concentration of other ions in extracellular fluid,except Na+.Although these ions can cause some physio-pathological effect,the amount of penetrable particulates are so little,their only have slight influence to extracelluar fluid.For example:hypopotassaemia or hyperpotassaemia,hypocalcemia or hypercalcemia,and acidosis or alkalosis,and so on.,fluid-electrolyte-acid-base management maladjustment of fluid metabolism,hypertonic dehydration body fluid decrease intracellular fluid water loss salt loss osmotic pressure thirst extracellular fluid intracellular fluid Moveintracellular into extracellular fluid fluid sweat gland secrete osmotic pressure skin evaporation serious cerebrocellular dehydration central nervous system ADH secret coma,fluid-electrolyte-acid-base management changes and effect of hypertonic dehydration,ADH secret extracellular fluid dehydration slightly BP slightly change little renal tubule reabsorb water and natrium ALD excrete normal hypourocrinia early period UNa not decrease,fluid-electrolyte-acid-base management changes and effect of hypertonic dehydration,fluid-electrolyte-acid-base management changes and effect of hypotonic dehydration,hypotonic dehydration body fluid decrease salt loss water loss interstitial eyehole introcession fluid Skin elasticity ECF osmotic ECF into cell ECF decreasepressure pachemia blood volume vein collapse decrease BP decreaseADH secrete Severity shock ICF decrease not obviously ALD secrete renal tubule reabsorb renal tubule reabsorb water and natrum water and natrum earlier period urinary UNa decrease or abolitionvolume not decrease,fluid-electrolyte-acid-base management comparison,fluid-electrolyte-acid-base management comparison,fluid-electrolyte-acid-base management cause and effect of hypokalemia,fluid-electrolyte-acid-base management cause and effect of hyperkalemia,fluid-electrolyte-acid-base management ECG of hypokalemia and hyperkalemia,Normal ECGP waveQRS intervalT waveQT intervalS-T stage,fluid-electrolyte-acid-base management ECG of hypokalemia and hyperkalemia,ECG of HypokalemiaS-T lowerQT prolongU wave,fluid-electrolyte-acid-base management ECG of hypokalemia and hyperkalemia,ECG of HyperkalemiaQRS prolongT waveQT prolong,fluid-electrolyte-acid-base management examination of acid-base imbalance,Arterial blood gas analysisPH:7.35-7.45 actual bicarbonate(AB)&stand bicarbonate(SB):AB=SB=21-27 mmol/L normal ABSB respiratory acidosis ABSB respiratory alkalosis ABSB metabolic acidosis ABSB metabolic alkalosisbuffer base(BB)(include HCO3-):45-55 mmol/Lbuffer excess(BE):-3-+3 mmol/L PCO2 kPa(35-45mmHg)PO2:8.0 kPa(60mmHg),fluid-electrolyte-acid-base management cause and effect of metabolic acidosis,fluid-electrolyte-acid-base management cause and effect of metabolic alkalosis,fluid-electrolyte-acid-base management comparison of acid-base imbalance,body fluid,electrolyte and acid-base imbalance is a very common pathophysiologic change clinically,no matter which kind of imbalance,it can lead disorders of metabolism,if it further aggravate,will cause organ failure,even death.follows are the basic principles of management for body fluid,electrolyte and acid-base imbalance.,fluid-electrolyte-acid-base management basic principles of clinical therapy,Master medical history thoroughly,and examine the patients signs sufficiently,in most condition,we can get valueable information and make out initial diagnosis.Find out causes which may lead body fluid imbalance,e.g.severe vomit,diarrhea,intake less for long time,severe infection or septicemia,Find out the symptoms or signs of body fluid imbalance,e.g.dehydration,hypourocrinia,tachypnea,insanity,and so on.,fluid-electrolyte-acid-base management basic principles of clinical therapy,1.blood and urine routine,hematocrit,liver-renal function,blood glucose,2.blood serum K+,Na+,CI-,Ca2+,Mg2+and Pi,3.arterial bloodgas analysis,4.determinblood urine osmotic pressure,p.r.n.,Laboratory examination,fluid-electrolyte-acid-base management basic principles of clinical therapy,Comprehending the case history and above-mentioned laboratory data,we can determine the type and degree of water,electrolytes and acid-base disorders.We should actively treat the primary disease,in the same time make the plan correcting water,electrolytes and acid-base disorders.If the mixed disorders are exist,we should according to the order of importance and urgency,regulate and correct them one by one.,fluid-electrolyte-acid-base management basic principles of clinical therapy,1 recover blood volume,ensure circulation in good condition,2 actively correct oxygen deficiency,3 retrieve severeacidosis or alkalosis,4 treat hyperkalemia,Chiefly measures,fluid-electrolyte-acid-base management basic principles of clinical therapy,fluid-electrolyte-acid-base management review and summary,thalamo-posthypophysis-antidiureticsystem,fluid-electrolyte-acid-base management review and summary,renin-Aldosteronesystem,fluid-electrolyte-acid-base management review and summary,Fluid consist of：,fluid-electrolyte-acid-base management review and summary,Electrolytes consist of：,fluid-electrolyte-acid-base management review and summary,Every Day Fluid Metabolism,Every Day,for a fasting patient,need:1、Water 2500ml 2、Na 3、K:3.0g 4、glucose,lipid,amino acid,fluid-electrolyte-acid-base management review and summary,Every Day fluid replacement1、5%GNS 500ml 3、NS 500ml 10%KCL 10ml 10%KCL 10ml2、5%GS 500ml 4、Intralipid 500ml Vit.C 2.0 5、amino acid 500ml Vit.B6 0.2 10%KCL 10ml 15 iv gtt qd,fluid-electrolyte-acid-base management review and summary,共同努力，勇攀医学高峰!,Thank you！,