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1、水、電解質(zhì)代謝紊亂WaterandElectrolyteImbalance生理學(xué)基礎(chǔ)體液容量與分布Volume&distribution水與電解質(zhì)代謝平衡調(diào)節(jié)Balanceofwaterandelectrolytemetabolism體液的電解質(zhì)組成Compositionofelectrolytes（Waterandelectrolytesbalance）一、水、電解質(zhì)代謝水、電解質(zhì)紊亂1、體液容量及其分布（Totalfluidvolumeanddistribution）Table1Approximatevolumeofbodyflui
2、dcompartments（/體重）成人（男）成人（女）新生兒老年人TBW6050-558052*Totalbodywater,TBW;Intracellularfluid,ICF;Extracellularfluid,ECF水、電解質(zhì)紊亂Interstitialfluid15144020Plasma5455ICF40353527ECF201845252、體液的電解質(zhì)組成（Compositionofelectrolyteinbodyfluids）Table2ElectrolytecompositionofbodyfluidsCompar
3、tmentalconcentration(mEq/L)PlasmaInterstitialfluidIntracellularfluidPositiveionNa+14214010K+55150Ca2+550.0001Mg2+3340Total155153200NegativeionCl?1031123HCO3?272810HPO42?24142SO42?125Organicacid66—Protein(Pr?)16140Total155153200水、電解質(zhì)紊亂滲透壓高滲透壓低⊙⊙⊙⊙⊙⊙⊙⊙⊙⊙⊙⊙⊙⊙⊙⊙⊙⊙⊙H2OH2OH2OH
4、2OH2OH2OH2OH2O滲透壓H2O如相鄰兩個(gè)體液腔隙的靜水壓相等，而體液中溶質(zhì)的濃度不同，那么水將由溶質(zhì)濃度低的腔隙向溶質(zhì)濃度高的腔隙轉(zhuǎn)移，推動(dòng)水滲透的力稱為滲透壓。水、電解質(zhì)紊亂【滲透壓】（Osmoticpressure）Osmosisisthenetdiffusionofwateracrossaselectivelypermeablemembranefromaregionofhighwaterconcentrationtoonethathasalowerwaterconcentration.AB概念:指溶液具有的吸引水分子透過
5、半透膜的力量。影響因素：滲透壓的大小與溶質(zhì)顆粒數(shù)目的多少呈正變，而與溶質(zhì)的種類和顆粒的大小無關(guān)。血漿滲透壓（280～310mmol/L）水、電解質(zhì)紊亂【滲透壓】（Osmoticpressure）IsotonicHypertonicHypotonic水、電解質(zhì)紊亂細(xì)胞內(nèi)外液體調(diào)節(jié)血漿與組織間液調(diào)節(jié)體內(nèi)外液體交換調(diào)節(jié)3、水與電解質(zhì)代謝平衡調(diào)節(jié)Balanceofwaterandelectrolytemetabolism水、電解質(zhì)紊亂水、電解質(zhì)紊亂?血漿與組織間液的交換調(diào)節(jié)Hydrostaticpressureandosmoticpressur
6、earetheforcesthatdeterminetransportoffluidinandoutofcapillaries.?細(xì)胞內(nèi)外液體的交換調(diào)節(jié)Exchangeoffluidbetweenthecytoplasmandtheinterstitialspaceisdrivenbyosmoticgradients.H2OH2OH2OH2OH2OH2OH2ONa+Na+Na+?體內(nèi)外液體的交換調(diào)節(jié)(Regulationofbodyfluidandelectrolytebalance)水、電解質(zhì)紊亂【水的攝入與排除】成年人每天攝入水量：
7、2500ml；每天排出水量：2500ml。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)水、電解質(zhì)紊亂▲抗利尿激素（Antidiuretichormone，ADH）Serumosmolality↑(>280mmol/L)Osmoreceptor（+）Bloodvolume↓Baroreceptor（+）Stress,Pang,Nausea,ATII↑ADHoutput↑Reabsorptionofwaterfromrenaldistaltubularfluid↑血清鈉濃度↑口渴中樞（+）Thirst有效循環(huán)血量↓、ATII
8、↑Waterintake↑ECF↑▲渴感(Thirst)水、電解質(zhì)紊亂■血漿滲透壓調(diào)節(jié)（Regulationofplasmaosmolality）【ADH作用下遠(yuǎn)曲小管、集合管對(duì)水重吸收】ADH+V2受體（
