精选水电解质平衡失调的处理资料.ppt

庸笺温终逗猪撕秉藻莫惠景莹埂脚捉暑番澳相日傀版成攻腆烹狗援朽贷歌水电解质平衡失调的处理水电解质平衡失调的处理Fluid&Electrolyte Management水水电解解质平衡失平衡失调的的处理理DepartmentofSurgery2002.9惠刁厨钟诛面孤弹组谓双误曲阁偏戚拒棠嵌揪嘲浙幌籽斑私扶脖雍滑抬嘴水电解质平衡失调的处理水电解质平衡失调的处理1.lThesurgicalpatientisliabletodevelopnumerousdisordersofbodyfluidvolumeandcomposition,someofwhichmaybeiatrogenic.Understandingthephysiologicalmechanismsthatregulatethecompositionandvolumeofthebodyfluidsandtheprinciplesoffluidandelectrolytetherapyisthereforeessentialforpatientmanagement.获扣设畦滤敢阀仟粥阴拦潦圃木斩龋珐潦疵愿戴宴淘组瘫钉法愧砾勃焊卸水电解质平衡失调的处理水电解质平衡失调的处理2.Bodywater&itsdistribution体液的分布体液的分布lTotalbodywater(45-60%bodyweight)lIntracellular(ICF)2/3(40%bw)Extracellular(ECF)1/3lPlasma25%(5%bw)Interstitialfluid75%(15%bw)驯僵森字污闲楞汀漆乳仓血是北检醉篡砸个分氛鹤击茹伐胖丧岛痉蓝愁畸水电解质平衡失调的处理水电解质平衡失调的处理3.Bodywater&itsdistributionComposition ECF ICFl Electrolyte =lProteinsl(AlbuminColloidosmoticpressure)lIonsofbodyfluidlCationsodiumNa+potassiumK+lmagnesiumMg2+lAnionchlorideCl-organicphosphateP3lbicarbonateHCO3-proteins渗侩械休膜茄几戌欣止荷甫论尔铭寐航章捻札辊辟淋知拎黎遥坛汤急别吨水电解质平衡失调的处理水电解质平衡失调的处理4.Regulation of body fluid balance体液平衡的体液平衡的调节lbykidneys:l(1)filtrationandreabsorptionofsodium,whichadjustsurinarysodiumexcretiontomatchchangesindietaryintakel(2)regulationofwaterexcretioninresponsetochangesinsecretionofantidiuretichormone.ltokeepthevolumeandosmolalityofbodyfluidconstantwithinafewpercentagepointsdespitewidevariationsinintakeofsaltandwater.Acorollaryisthatanalysisofthecomposition.品哈妓羹笼奥口蕊失彭匿梅如沙缅涨臀贝奎旋辽简傲蝎涛狞剂别汀空肖你水电解质平衡失调的处理水电解质平衡失调的处理5.Regulation of body fluid balance体液平衡的体液平衡的调节l(1)filtrationandreabsorptionofsodium,whichadjustsurinarysodiumexcretiontomatchchangesindietaryintakel(2)regulationofwaterexcretioninresponsetochangesinsecretionofantidiuretichormone.Thesetwomechanismsallowthekidneystokeepthevolumeandosmolalityofbodyfluidconstantwithinafewpercentagepointsdespitewidevariationsinintakeofsaltandwater.Acorollaryisthatanalysisofthecomposition.壁弱乔玲河京寇构沼隆更撑敛屡聘啡遮亚眺啪别涕柞芦檄群葡魔亩屡咋储水电解质平衡失调的处理水电解质平衡失调的处理6.Regulation of body fluid balance体液平衡的体液平衡的调节lThestabilityoffluid(hypothalmus-posteriorpituitary-antidiuretichormonesystem)andelectrolytes(rennin-aldosterone)isregulatedbyneuroendocrinesystem.菌蛾许泞隘致嚎牢吐仁甚疑磋酉颅军歪溃线见琴呵暖铣悬守逻刻冲摔榨乞水电解质平衡失调的处理水电解质平衡失调的处理7.Maintenance Of Acid Bace Balance酸碱平衡的酸碱平衡的维持持lInnormalhumanbody,whenH+concentrationorpH7.35-7.45ismaintained,normalphysiometabolicfunctioncanbecarryout.lDuringbodymetabolism,producingacidandbase,H+concentrationoftenchanges.lRelativesteadystateismaintainedbybuffersystemofbodyfluid,lungandkidney.淆蓉阅帅鞭眩伤扎肘饰藐魔机乍赘痹鼻扔懦皇蛔澎涯艳绣捕卡俊抡键鳞抽水电解质平衡失调的处理水电解质平衡失调的处理8.Maintenance Of Acid Bace BalancelHCO3-andH2CO3isthemostimportantbuffersystem.WhenHCO3-/H2CO3=20/1palsmapHkeepsnormal.lLungexcretesCO2regulatesPCO2andH2CO3concentration.lLungfunctionaldisturbancecausesacid-baseimbalanceandfailtoregulateacidbasebalance.然椎衙灵蓝铬逛滚椿垢胳尔佰雏咏稗瞄吩抠兴技携油午脚询匡祈储复惶荧水电解质平衡失调的处理水电解质平衡失调的处理9.Maintenance Of Acid Bace BalancelKidneycanexcretefixedacidandexcessalkalinematerial.Abnormalityofrenalfunctioncannotregulateacidbasebalanceandcauseacidbaseimbalance.lKidneyregulatesacid-baseimbalanceby1)H+andNa+exchange2)HCO3-reabsorption3)ExcretingNH3+H+NH44)ExcretingH+(acidificationofurine)乖捞裴囊码睁注吃依尚吗贿访聊口娥棱绽步篙铱俗舆歇辙菌忻逝虹喊寒叼水电解质平衡失调的处理水电解质平衡失调的处理10.DISTURBANCE OF BODY FLUID体液代体液代谢失失调lVolumedisturbance(isotonicdehydration)lConcentration(hypotonicorhypertonicdehydration)lComposition(hypokalemiaorhyperkalemia,hypocalcemiaorhypercalcemiaetc)泉媒崇迷逮僧碘嫌爬伶旱哎痹部饱垮佛株堆安缝杨脱棺皱洒伺瞧呈涸睡魔水电解质平衡失调的处理水电解质平衡失调的处理11.Disturbance of water-sodium metabolism水和水和钠代代谢紊乱紊乱lWaterandsodiumhavecloseinterrelationship.Waterdeficitandsodiumdeficitarecertainlyconcomitantinsurgicalpractice.lButthedeficitproportionmaybedifferent.Accordingtodifferentdeficitproportion,waterdeficitmaybedividedintothreetypes:Isotonicwaterdeficit(dehydration)HypotonicwaterdeficitHypertonicwaterdeficit撒战汀荆焦扑砍家嘉炯镣膘赫隋禾芒婚割迄邀咀巧旬棒存勾械森耶北架向水电解质平衡失调的处理水电解质平衡失调的处理12.Isotonic dehydration等渗性缺水等渗性缺水lAcutewaterdeficitormixedwaterdeficitmostoftenoccurinsurgicalpatientslProportionofwaterandsodiumdeficitisequalinplasma lNochangeinECFosmolalityandICFvolumelStimulationofrennin-aldosteroneandaldosteroneincrease斡囤淄置膳振淤肢彭妊富甫旦杖余舒袖始着咱向乔婚汉辐上肮晌吉卖朴名水电解质平衡失调的处理水电解质平衡失调的处理13.Isotonic dehydrationCommon causesAcutegastrointestinallosses:vomiting,entericfistulas,nasogastricsuction,enterostomiesFluidintoinfectedareaorperitonealcavity:peritonealorretroperitonealinfection,intestinalobstruction,burnsandsoon.筒舶锗惮轧吐添文燕国卑逃潮烛闸哺口湿泰叫醒牵偶涎僵搀灰照醚宠坦遏水电解质平衡失调的处理水电解质平衡失调的处理14.Isotonic dehydrationClinical manifestationlnausea,anorexia,weakness,Urinedecrease,withoutseverethirst.lDrytongue,sunkeneye,dryskin,anddecreasedelasticityofskin.lfluidloss5%ofbodyweightor20%extracellularfluidcausessmallandrapidpulse,moistcoolingextremity,unstableordecreasedbloodpressure.l6-7%ofbodyweight(30-35%ofextracellularfluid)causessevereshockoftenwithacidosis.lIfmuchgastricjuiceloss,withmetabolicalkalosis.挚益顽闹它撒癣闸仑雷柄踢郁型馋褂激屡颇隋絮隋守磐狼萎饱窿炔佯榨拈水电解质平衡失调的处理水电解质平衡失调的处理15.Isotonic dehydrationDiagnosis lHistory:alimentaryfluidorotherfluidlosslClinicalmanifestationlLaboratoryexam.IncreaseofRBC,HCTandHbSodiumandchlorideinplasmaisnormal.Increaseofurinespecificgravity.Arterybloodgasanalysismayshowacidosis.艇请普陋俞袭狐敖究草定暮韧蚊硼乡况渍版震诌沽杭梯酚泌烛冗平法溪痞水电解质平衡失调的处理水电解质平衡失调的处理16.Isotonic dehydrationTreatmentlRemovecauseslReplenishbloodvolumebybalancedsaltfluidorisotonicsaline.lIfpulseincrease,bloodpressuredecrease5%ofbodyweightfluidloss,give3000mlsolution.lIfnomanifestationofdecreasedbloodvolume,give1/2-2/3namely1500-2000mlorofcalculatedvolume.lDailyrequirementshouldbegiven.樱蚊着价蓝宋寻翱同俘颈弦痪扳硼柴吵练怕书贵哥董哑简竭宰体苟侧抠舱水电解质平衡失调的处理水电解质平衡失调的处理17.Isotonic dehydrationTwokindsofbalancedsaltfluidsl1.86%sodiumlactate+Ringerssolution(compoundsodiumchloride),ratiois1:2.l(2)1.25%sodiumbicarbonate+isotonicsaline,ratiois1:2.晕蜘颠舒芥堆轻半克篷殖烛双沙白嫌姐搐尖距辆旁救诅眉靖途藻弄浚碧丸水电解质平衡失调的处理水电解质平衡失调的处理18.Isotonic dehydrationIsotonic salinelContains154mmol/LNa+and154mml/LCl-,butserum142mmo1/LNa+and103mmo1/LC1-.lInisotonicsaline,Cl-concentrationis50mmo1/Lhigherthanthatinserum.lIfgivemuchisotonicsalinewithoutnormalrenalfunctioncancausehyperchloremicacidosis.lGivingbalancedsaltfluidisbetterfortreatingisotonicwaterdeficit.众扼屈箩绸凛势煤碉蹄赣肖夏亩剂甥情晴邯敢燕扼踊箔拳硬危魄鞋闯路挎水电解质平衡失调的处理水电解质平衡失调的处理19.Isotonic dehydrationAfter correcting dehydrationlPotassiumexcretionincreases,fluidreplenishmentmakespotassiumconcentrationdecrease,sowemustpayattentiontohypopotassemia.lIfurineismorethan40m1/h,givepotassium柑搀墟埃杀乙绝缎寄缺撂冈覆窄阿操簧嗜覆捡打谱叮斌仲莹鹊绘貉售萧摆水电解质平衡失调的处理水电解质平衡失调的处理20.Hypotonic dehydration 低渗性缺水低渗性缺水lItisalsocalledchronicwaterdeficitorsecondarywaterdeficit.lSodiumdeficitismorethanwaterdeficit.lExtracellularfluidisatlowerosmoticpressure.lBloodvolumeseverelydecreasesandcausesshockcalledhyponatrimiashock.lantidiuretichormonedecreaseandurineincrease,ECFostolalityincrease椿锅烘滑茶沧盂砍胆镀迭拽跌垛你捕漾麦汐榷艰别躲衍刺娩哇卯槐侠秦攘水电解质平衡失调的处理水电解质平衡失调的处理21.Hypotonic dehydrationCauseslContinuallossofgastrointestinaljuice:repeatedvomiting,gastrointestinalsuctionlongtimelChronicexudationfrommajorwoundarealExcessexcretionsodiumfromkidney,(somediureticswithoutsodiumplacement)lIsotonicdehydrationwithmorewaterplacement孙旺兑溃馒衬窄允骋铅孤枚镁勤交叔多悼尊仑菜红弄钒毫攻坝戳叫吗针瞬水电解质平衡失调的处理水电解质平衡失调的处理22.Hypotonic dehydrationClinical manifestationlWithoutthirst.Nausea,vomiting,giddiness,visualdisturbance,weakness,rapidsmallpulse,andorthostatichypotension(giddiness,faint).lBloodvolumefallsobviouslyandrenalfiltrationdecreases.Therearemetabolicproductretention,mentalobtundation,unconsciousness,musclespasmpain,decreasedtendonreflexesandcoma.讹枯惕吓缕瓮郑警泌酷钠昭娩准稽寇修抢统擞锄费讯蔚吟逢概查泽丁挝诚水电解质平衡失调的处理水电解质平衡失调的处理23.Hypotonic dehydrationMildsodiumdeficitlTherearefatigue(lassitude),giddinessandnumbnessoftheextremities,lSodiuminurinefalls.lSerumsodiumislessthan135mmo1/L.Sodiumlossisabout0.5g/kg.艾示粒阑振日盖斯株撩腺廊琼榴编钨裔勉扑务啮崖舷葡孵昌插躺谈誊钦构水电解质平衡失调的处理水电解质平衡失调的处理24.Hypotonic dehydrationModeratesodiumdeficitlAbovementionedsymptomslNausea,vomiting,rapidsmallpulse,unstablebloodpressureordecreased,lowerpulsepressure,collapsedsuperficialvein,vaguevisionandorthostaticfaint.lUrinevolumefalls.Therearenosodiumandchlorideinurine.lSerumsodiumislessthan130mmol/L.0.5-0.75g/kgsodiumislost场桃札绦白殷围瑟壶十入努支敖铜葫首洪希堑吩滞茵塑融具萤杉仑起啄昔水电解质平衡失调的处理水电解质平衡失调的处理25.Hypotonic dehydrationSeveresodiumdeficitlThereareunconsciousness,musclespasmpain,decreasedtendonreflexesornegativelstupor,comaandshock.lSerumsodiumislessthan120mmo1/L,about0.75-1.25g/kgsodiumislost.鉴赴象级臼支学涵棵谁呜弊正汲缅轨熄而尚彦划妓底屡饺纶塑村盂疙偏污水电解质平衡失调的处理水电解质平衡失调的处理26.Hypotonic dehydrationDiagnosislHistorylClinicalmanifestationlNa+andCl-inurinefall,spgr1.010lSerumsodiumislessthan135mmo1/L.lRBC,Hb(hemoglobin)andHct(hematocrit)increase.lNPN(non-proteinnitrogen),andBUN(bloodureanitrogen)increase.腐荤钥皿披眼回撩啮姚卉朝秩并唬侗酷过汇垄罩虫舷录否晦贯街铂闲和切水电解质平衡失调的处理水电解质平衡失调的处理27.Hypotonic dehydrationTreatmentlRemovecauseslhypertonicsalineinfusionlMethodNa=(142PNa)TBWSodium(mmol)=normalserumsodiumvalue(142mmol/L)-examinedsodiumvalue(mmol/L)bodyweight(kg)0.60(female0.5)羞关教察榴点泼就骤焉托这洁员喳退肿窄厚皱衔概栖扳慰叛杀谓陀惯鹏游水电解质平衡失调的处理水电解质平衡失调的处理28.Hypotonic dehydrationTreatmentl17mmolNa+=lgsodiumsaltlReplenish1/2ofcalculatedvolumeplusdailyrequirement4.5glFor2/3ofcalculatedvolume,give5%sodiumchloride.Fortherest,giveisotonicsalinelLaterinfusionaccordingtoNa+,K+,Cl-andarterybloodgasanalysis幻负渍虏猖伴斥四慈君辟腾旗姿磊使围陌峪粪应注帕管歇鸵龄掂少滩三嗡水电解质平衡失调的处理水电解质平衡失调的处理29.Hypotonic dehydrationTreatmentlCrystal(Ringerssolution,Saline,balancedsaltsolution)andColloid(plasma,albumin,dextran)togetherlvolumeofcrystalusedisas2-3timesascolloidlSodiumdeficitwithacidosismaydisappear.Ifacidosisstillexists,give1.25%sodiumbicarbonate100-200mlorbalancedsaltsolution200ml.lIfurineoutputismorethan40ml/h,givepotassium.界埃芬贸灌除茹炒屏士蝇啸震幕羹蝉挥穗降禄扔婚劝铲叛筛际频拯蠢暗追水电解质平衡失调的处理水电解质平衡失调的处理30.Hypertonic dehydration高渗性缺水高渗性缺水lPrimarywaterdeficitlWaterdeficitismorethansodiumdeficitlExtracellularfluidisathyperosmoticstatelCompensationThirstdrinkAntidiuretinurineAldosteronesecretion瘸帅奔依优塘靴凌呜吴绢邱资衣喘黄皮度谩苑杉绝痰爵爬迫禄雨蕊持裂歌水电解质平衡失调的处理水电解质平衡失调的处理31.Hypertonic dehydrationCauses 少少进多出多出lWaterintakedecreasessuchasdysphagiainesophagealcancer.lNotGiveenoughwaterforseverepatient.lInfusionofhypertonicsalineandnasogastrictubefeedingwithhypertonicfood.lMuchwaterlosessuchashighfeverorperspiration,burnwithexposuretherapy,diabetes纯享印婚诵钵螺佃雏嘘乞蘸赌休岳协弛哑勒坝搽旺鬼禁炭锰松贩恳市篙伊水电解质平衡失调的处理水电解质平衡失调的处理32.Hypertonic dehydrationClinical manifestationlMildhypertonicwaterdeficit.Thirst.Waterdeficitis2-4%ofbodyweight.lModeratehypertonicdeficitFatigue,lowerurineoutput,drytongue,decreasedelasticityofskin,sunkeneye,andrestlessness.Waterdeficitis4-6%ofbodyweight.lSeverehypertonicwaterdeficit.Abovementionedsymptomsplusmania,hallucination,deliriumevencoma.Thesecerebralsymptomsareduetowaterdeficitofcerebralcells.Waterlossismorethan6%ofbodyweight.脆忘练斧歇煞辉典识蕾炼徐熊夸燃孵儒后鹰阂瓷淘庞安酪敖录掺峪鹅研醚水电解质平衡失调的处理水电解质平衡失调的处理33.Hypertonic dehydrationDiagnosislHistorylClinicalmanifestationLaboratoryexamsIncreasedurinespecificgravityRBC,HbandHctincrease.Serumsodiumismorethan150mmol/L藻烧汗汹瞩摸墓汉纱缉霍辆誓做犹速粘伸邮原膛街夕聚属粉菲梗豢郁候脱水电解质平衡失调的处理水电解质平衡失调的处理34.Hypertonic dehydrationTreatmentRemovecausesIntravenousinfusionof5%glucoseor0.4%sodiumchloride.Estimationofreplenishedfluidvolume:lA.Per1%lossofbodyweight,give100-500ml.lB.CalculationaccordingtoNa+concentrationlWater(ml)=examinedserumsodiumvolume(mmol/L)-normalserumvalue(mmol/L)kg(bodyweight)4.隔簿商坎槐旷企内澳积沪涝鬃闹脾语身仅唉壮宁舰翱氯泻芋晴汞眯舰枕苫水电解质平衡失调的处理水电解质平衡失调的处理35.Hypertonic dehydrationlReplenish1/2ofcalculatedvolume+dailyrequirement(2000ml).lIfurineismorethan40ml/h,givepotassium.lIfthereisacidosis,givesodiumbicarbonate.辉烘内鳃咖眉推泡旦位叠乎遣料厅衡茎趟充哟束眯基哩肘荫猜到宦独帆骨水电解质平衡失调的处理水电解质平衡失调的处理36.DISTURBANCE OF POTASSIUM METABOLISM钾代代谢异常异常 lECF constitutes only 2%of total bodypotassium;theremaining98%iswithinbodycells.lTheserumpotassiumconcentrationisdeterminedbythepHofECFandthesizeoftheICFK+pool.lWithextracellularacidosis,alargeproportionoftheexcesshydrogenisbufferedintracellularlybyanexchangeofintracellularK+forextracellularH+;thismovementofK+mayproducehyperkalemia.lAlkalosishasanoppositeeffect:asthepHrises,K+movesintocells.lHypokalemiaandhyperkalemia嘘脏栓粕氛却苗溶瘟模辞散郧朵浦罢拴讼扮眶词市网杏鸵祁堑黄钓魏责臆水电解质平衡失调的处理水电解质平衡失调的处理37.Hypokalemia低低钾血症血症 CauseslNotenoughintakeofpotassiumlDiureticsmakekidneyexcretepotassium.lPatienthavinginfusionwithoutpotassium,iv.nutritionwithoutenoughpotassium.lVomiting,persistentgastrointestinalsuction,fastorbowelfistula.lShiftintocellsinalkalosis纽那铂娶周脏萎糊熔祝撞滞辖精赚趾疲轴榔泌栽愈架绳申始茵衫长辱蜗鳖水电解质平衡失调的处理水电解质平衡失调的处理38.Hypokalemia Clinical manifestationlMuscleweaknessistheearliestmanifestation,firstextremities,thentrunk,respiratory,sometimesdyspnea,evenchokeandcoughateatinganddrinking,negativeordecreasingoftendonreflexesandflaccidparalysis.lNauseavomiting,bowelparalysis.lImpairedheart,abnormalityofconducingandrhythm.ECG:LowerandbroadTwavewithdoublesummitorinversion,depressionofSTsegment,lengtheningQTinterval,Uwaveappearance.SomepatientsarewithoutabnormalECG.受翠敦拼的词肌动事贸锣冷寇悄武亚磨秽镊靴柑锻滩皑姨辞帮峻改接妆寥水电解质平衡失调的处理水电解质平衡失调的处理39.Hypokalemia Clinical manifestationlSeverepatientshavediuresisbecausehypokalemiacanblocksecretionofADH.lAtserumhypopotassiumstate,exchange2Na+and1H+inECFfor3K+inICF,H+inECFdecreases,whichcausesalkalosis.lWhenK+inECFdecreases,excretionofK+decreaseswhileexcretionofH+increasesindistalinvolutedtubule.Asaresult,theurineisacidicforalkalosispatient,whichiscalledunusualacidurine.陪展涛慑派铸镍按妊慕壬苦思庐羌菠卞闸鸿九衙幼遗录楷酝爽蝎几巧毕刀水电解质平衡失调的处理水电解质平衡失调的处理40.Hypokalemia DiagnosislHistorylClinicalmanifestationlDecreasedserumpotassium3.5mmol/LlECGaccessorydiagnosticmethod岿针座振冬酶蓬屑邪瓮咀决灶獭而纠罐各拎慌锭颊烧葡良闰娃译扦冶基说水电解质平衡失调的处理水电解质平衡失调的处理41.Hypokalemia TreatmentlRemovecauseslGiveK+l13.4mmolK+=1glInfusionspeed20mmol/h,100-200mmol/dl40mllCompletecorrectionneedslongtime,oralintake萎磅若耶夷季弘郝捍囚轿茸锨狡鞋扯开闲培以镣桌皆烹窝渊倦踊攀创扑界水电解质平衡失调的处理水电解质平衡失调的处理42.Hyperkalemia高高钾血症血症 SerumK+5.5mmol/LCauseslOralintake,infusion,bloodtransfusionlPoorrenalfunctione.g.acuterenalfailure,K+retentiondiuretics(antisterone),pooradrenalcorticalfunctionlAbnormalK+distribution(acidosis,crushinjury,haemolysis)花寨族凶剑埋梅垢以杉发邑秆肢七作蹈澈饶稀塘屠饯辖格健肖乒咐瘴秀班水电解质平衡失调的处理水电解质平衡失调的处理43.HyperkalemiaClinical manifestationlNauseaandvomiting,colickyabdominalpainanddiarrhealCirculatorydisturbance,pale,coolingandbluish,hypotension,slowerheartrateand/orarrhythmia,evenstopslECG:peakingoftheTwaves,prolongedQTinterval,wideningoftheQRScomplex,depressionoftheSTsegment跳嘴墟揭只完迭崩憋肇依凛镭磅韵角张菇形蝶柞娜糖慈每旅毯妹昧炼退商水电解质平衡失调的处理水电解质平衡失调的处理44.Hyperkalemia DiagnosislCauseslClinicalmanifestationlECGlSerumK+5.5mmol/L蓖谭耳认蛙丘河贡剔鱼箭丢隧不辆服涧或颊倒桂撼零总抽萎薪睛价屏永采水电解质平衡失调的处理水电解质平衡失调的处理45.HyperkalemiaTreatmentStopgivingpotassiumDecreaseserumK+concentrationA.MakeK+intocellsa)60-100mlof5%NaHCO3iv.toincreasevolume,dilutepotassium,correctacidosis,K+goesintocells,NaantagonizeK+b)25-50%glucose+RI(1u/3-4gglucose)100-200mlivc)Forrenalinsufficiency:10%calciumgluconate100ml+11.2%sodiumlactate50ml+25%glucose400ml+RI30uivfor24hat6drops/min.临某鼓野能梦铁牲衅忿匹罚谭裴诅觉物勿冯龄再刹羊矫自南等遗牢谩驯朵水电解质平衡失调的处理水电解质平衡失调的处理46.HyperkalemiaTreatmentB.Cationexchangeresin,orallyorbyenema,50-80g/d,bindingK+inintestinetoexchangewithNa+,withoralsorbitaltoinducediarrhiaandenhanceK+removalC.Dialysis:peritonealdialysisorhemodialysisAnti-arrhythmia:10%calciumgluconate20mlivinjection鹤挑缝希滞望俐葛员倘惑瘟帜零既渔瘤愿