ICU如何保持水电解质和酸碱平衡.ppt

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2016-01-11 发布于山西
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ICU如何保持水电解质和酸碱平衡.ppt

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ICU如何保持水电解质和酸碱平衡

Respiratory Alkalosis And Metabolic Acidosis ABG pH 7.50, PCO2 20 mmHg, HCO3 15 mmol/L, Na 140 mmol/L, Cl 103 mmol/L Interpretation Alkalemic with low PCO2 and low bicarbonate concentration Low PCO2 as a primary disorder – respiratory alkalosis AG = 140 – (103 + 15) = 22 20 – anion gap metabolic acidosis Excess AG = 22 – 12 = 10 mmol/L Excess AG + HCO3 = 25 mmol/L – no further primary abnormalities Metabolic Alkalosis And Metabolic Acidosis ABG pH 7.40, PCO2 40 mmHg, HCO3 24 mmol/L, Na 145 mmol/L, Cl 100 mmol/L Interpretation Normal ABG AG = 145 – (100 + 24) = 21 20 – anion gap metabolic acidosis Excess AG = 21 – 12 = 9 mmol/L Excess AG + HCO3 = 33 mmol/L 30 – metabolic alkalosis Respiratory Alkalosis, Metabolic Acidosis and Metabolic Alkalosis ABG pH 7.50, PCO2 20 mmHg, HCO3 15 mmol/L, Na 145 mmol/L, Cl 100 mmol/L Interpretation Alkalemic with low PCO2 and low bicarbonate concentration Low PCO2 as a primary disorder – respiratory alkalosis AG = 145 – (100 + 15) = 30 20 – anion gap metabolic acidosis Excess AG = 30 – 12 = 18 mmol/L Excess AG + HCO3 = 33 mmol/L – metabolic alkalosis Vomitting，renal failure and severe pneumonia Respiratory Acidosis, Metabolic Acidosis and Metabolic Alkalosis ABG pH 7.10, PCO2 50 mmHg, HCO3 15 mmol/L, Na 145 mmol/L, Cl 100 mmol/L Interpretation Acidemic with elevated PCO2 and low bicarbonate concentration Increased PCO2 and decreased bicarbonate both as primary disorders – respiratory acidosis and metabolic acidosis AG = 145 – (100 + 15) = 30 20 – anion gap metabolic acidosis Excess AG = 30 – 12 = 18 mmol/L Excess AG + HCO3 = 33 mmol/L – metabolic alkalosis Anion Gap and Nonanion Gap Metabolic Acidosis ABG pH 7.15, PCO2 15 mmHg, HCO3 5 mmol/L, Na 140 mmol/L, Cl 110 mmol/L Interpretation Acidemic with low PCO2 and low bicarbonate concentration Low bicarbonate as a primary disorder – metabolic acidosis with respiratory compensation? AG = 140 – (110 + 5) = 25 20 – anion gap metabolic acidosis Excess AG = 25 – 12 = 13 mmol/L Excess A