水、鈉代謝紊亂

1、 生生 理理 學(xué)學(xué) 基基 礎(chǔ)礎(chǔ) H2OH2OH2OH2OH2OH2OH2OH2OH2O體內(nèi)外液體交換調(diào)節(jié)體內(nèi)外液體交換調(diào)節(jié)三、水與電解質(zhì)代謝平衡調(diào)節(jié)三、水與電解質(zhì)代謝平衡調(diào)節(jié)Balance H2OH2OH2OH2OH2OH2OH2ONa+Na+Na+包含機(jī)體對(duì)水、電解質(zhì)平衡調(diào)節(jié)血漿滲透壓的調(diào)節(jié)血容量的維持調(diào)節(jié)血漿滲透壓調(diào)節(jié)（Regulation of plasma osmolality）血容量的維持調(diào)節(jié)（Regulation of Blood volume）ECF 45%ICF 10%Bone 45%Regulation 缺鈉性低鈉 治療：補(bǔ)鈉量可參考以下公式1.補(bǔ)鈉量=（125mmol實(shí)測(cè)血

2、鈉值mmol）體重kg 0.6，2.補(bǔ)鈉量=（142mmol實(shí)測(cè)血鈉值mmol）體重kg 0.2，對(duì)于無癥狀的輕度低鈉血癥，可參考上述公式，先給計(jì)算量的1/2，一般在24-48小時(shí)補(bǔ)足。若同時(shí)存在脫水和異常繼續(xù)損失（如腹瀉、嘔吐等），可將糾正脫水和補(bǔ)充正常及異常繼續(xù)損失所需溶液分別計(jì)算共同給予。中重度脫水伴循環(huán)障礙者需先擴(kuò)容，抗休克，然后給予高滲鹽水、一般3%鈉鹽100-150ml/h靜脈輸注，血清鈉恢復(fù)到125-130mmol/L,一般每小時(shí)提高1mmol/L,還需糾正酸中毒和補(bǔ)鉀。 治療： 第一小時(shí) ： 150ml3%鈉鹽 靜脈輸注20min以上，20min后復(fù)測(cè)血鈉 可重復(fù)輸注 至血鈉升

3、高超過5mmol/l 1h后癥狀改善： 0.9%NS靜滴直至開始病因治療， 第一個(gè)24h血鈉上升10mmol/l 隨后每日血鈉上升8mmol/l 目標(biāo)：血鈉130mmol/l 復(fù)測(cè)血鈉：6h 12h qd 治療：1h后癥狀無改善： 繼續(xù)輸注3%鈉鹽或使血鈉上升1mmol/l/h 停止輸注3%鈉鹽： 癥狀改善 血鈉增加10mmol/l 血鈉130mmol/l 輸注3%鈉鹽期間每4小時(shí)復(fù)測(cè)血鈉 治療：1h后癥狀無改善： 繼續(xù)輸注3%鈉鹽或使血鈉上升1mmol/l/h 停止輸注3%鈉鹽： 癥狀改善 血鈉增加10mmol/l 血鈉130mmol/l 輸注3%鈉鹽期間每4小時(shí)復(fù)測(cè)血鈉 治療： 單次靜脈輸

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