Imbalance Of: Water ,electrolyte , Acid And Base(lecture-1)

IMBALANCE of WATER ,ELECTROLYTE , ACID and BASE(lecture-1) —— 赵高峰 Dept.of Thoracic Surgery,The First Teaching Hospital,zhengzhou University 450052

OUTLINE     

BASIC? IMPORTANT? DIFFICULT to understand? EXAMPLES case.1 M,25Y, 急性胃肠炎 Case.2 F,42Y, 风心 . 低钾 Case.3 F,70Y, 食管癌术后 . 酸中毒

Imbalance of water

Water imbalance?  Liquid imbalance?  Water and sodium imbalance(why?) 

WATER OF THE BODY Male

adult 60% ： 40% intracellular---20% extracellular ： 15% intercellular--5% plasma--Female adult 50%---Infant 80%---Questions: 1.difference why? 2.clinical significance?

INTAKE OF WATER water 1000 ～ 1500ml food water 700ml or so intrinsic water 300ml or so total: 2000 ～ 2500ml Attention:physiological volume a day/physiological/an Adult

OUTTAKE OF WATER urine stool sweat breath total:

1000 ～ 1500ml---100 ～ 200ml--500ml--400ml--2000 ～ 2500ml

Attention:(PHISIOLOGICAL VOLUME/DAY/ADULT)

Medium 

intake = outtake

Osmotic Pressure （ OP ） Normal plasma OP290 ～ 310mmol/L or mosm/L

OP Features 1.biological POWER 2.number of the particals ; No related to the physical or chemical characteristics 3.Na+ 、 K+ 、 Mg2+ 、 HCO-3/// protein 、 Gluconate 4.Crystal OP, over 90%) Colloid OP, 6%) 5. Na+→crystal OP →Total OP→warter 6. Na+→ 水

YOU MUST REALIZE 

Water imbalance →water and sodium imbalance(why?) A.hydration B.dehydration (RESULTES---DIAGNOSIS)? 1.hypertonic DH>310mmol/l 2.hypotonic DH<290mmol/l 3.isotonic DH Normal Range

1. ISOTONIC DEHYTRATION 

Concept:LOSS OF WATER AND SODIUM ---normal OP;nomal Na+

Causes ： acute loss of water （急性呕吐、腹泻、失血、大量出汗、 胸水、腹水、烧伤早期） -----feature:Acute loss of water

2: (HYPOTONIC DEHYTRATION) Concept:less loss of water;more loss of sodium----OP
3: HYPERTONIC DEHYTRATION Concept:more loss of water ;less loss of sodium --------- OP>310mosm/L Na+>145mmol/L Causes: 1more loss of sweat or urine 2 supply more Na+ feature:chronic loss of sweat Attention please:1.concepts? 2.causes---diagnosis? 

MANIFESTATIONS 

2% mild : less urine,thirsty,skin elasticity↓,deepen eyes,///bitter mouth,benumbed extremities,nausea,vomit .

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4% moderate : rapid and mild pulse,irregular heart beating,unstable or decreased BP 6% severe: coma, shock;crazy restless,cool cold. why?

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注意 :NO specific;no kind;severity-treatment

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How to know the severity 1.common—indicate the mild one 2.cardiovascular—indicate the moderate one 3.spiritual or psychological– indicate the severe one

diagnostics 1.Case History---possibility/types  2.Manifestation （ Symptoms Sign s ） -----severity  3.Lab Tests---op/Na+----confirm the diagnosis (clearly)  Attention? 

management 

Isotonic:balance water -1.25%Naco3/Nacl(1/2v)

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Hypotonic:Na

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Hypertonic:waterml=(X-140)×Kg×4

g=(140-X)×Kg×m0.6(F0.50) 17

isotonic—— 平衡液 (why?)  hypotonic—— 高渗 + 等渗 (why?)  hypertonic—— 低渗 + 等渗 (why?) 

Case reports  

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CASE.1 男 ,18M,Wt,76Kg,10AM---occurs nausea, vomiting; 3PM---went to hospital PE::BP100/60mmHg;P 120B/Min;T 37.8;R26/min; 少尿 ; 神清 et al. What happen to him? What is the correct treatment?

For treatment Isotonic: Water Balance Hypotonic: Hypertonic+isotonic Hypertonic: Hypotonic+isotonic Note: For Isotonic dehydration. to give 1000 ml solution of 0.9%Nacl is not appropriate this i.e. because….Cl of NaCl cause acidosis. So for the treatment of isotonic dehydration we have to give 1.25%NaCO3/NaCl(1/2v) This 1.25%naCO3/NaCl is balance solution. 0.9%Nacl is isotonic solution

Case report  

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CASE.2 ,46yrs M,64Kg,2003/7, got progressive vomiting after meal,he had an operation before for esophagal carcinoma. working..PE:,BP110/70mmHg,Pulse110 B/min, R 24 次 / 分 ,T 36.8, 胸部 CT 如图示 ,et al. What happen to him? What is the correct treatment?

Case report  

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CASE.3 M,36Yrs,artitecture,66Kg,2003.7,got high fever with severe sweat,patient fall down while working PE:BP110/65mmHg,R28chi/min,T38.7,P 122/min, 脉搏细速 , 少尿 , 神志模糊 ,et al. What happen to him? What is the correct treatment?

5)summary   

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1. 水 很重要 出入平衡 靠渗透压 2.OP 的特点 (5) 3. 临床 依 results 把脱水分为 three types( 等 ,低 ,高 ) 4. 三类脱水的 concept( 特点 ; 意义 ) 5. 三类脱水的 causes( 特点 ; 意义 ) 6. 三类脱水的 symptoms /signs( 要点 ; 意义 ) 7. 如何 diagnose 脱水 ( 类型 , 程度 ) 8. 脱水处理的 basic rules

Study methods