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Fluids, Electrolytes, and Acid-Base Disturbances：液体，电解质，酸碱失衡
glutamine * Decrease minute ventilation * Calcium Hypercalcemia Primary hyperparathyroidism, malignancy (bone metastasis, PTHr) Neurologic impairment, muscle weakness/pain, renal dysfunction, n/v, abdominal pain, worsening of Digitalis toxicity, short QT interval, flat T waves, AV block Hypocalcemia Pancreatitis, soft tissue infection, renal failure, small bowel fistulas, hypoparathyroidism, TSS, abnormal magnesium, tumor lysis syndrome, post-parathyroidectomy, breast/prostate cancer, alkalosis Parastheias of face, muscle cramps, carpopedal spasm, stridor, tetany, seizures, hyperreflexia, heart block, prolonged QT Vitamin Deficiency Deficiency Effect Chromium Hyperglycemia, encephalopathy, neuropathy Selenium Cardiomyopathy, weakness, hair loss Copper Pancytopenia Zinc Hair loss, poor healing, rash Trace elements Poor wound healing Phosphate Weakness (fail to wean vent), encephalopathy, decreased phagocytosis Thiamine (B1) Wernicke’s, cardiomyopathy, peripheral neuropathy Pyridoxine (B6) Sideroblastic anemia, glossitis, peripheral neuropathy Cobalamin (B12) Megaloblastic anemia, peripheral neuropathy, beefy tongue Folate Megaloblastic anemia Niacin Pellagra (diarrhea, dermatitis, dementia) Essential Fatty Acids Dermatitis, hair loss, thrombocytopenia Vitamin A Night Blindness Vitamin K Coagulopathy Vitamin D Rickets, Osteomalacia Vitamin E Neuropathy Acid-Base Disorder Disorder of balance between HCO3- and H+ Blood pH: 7.35 – 7.45 Arterial PCO2: 35 – 45mmHg Plasma HCO3-: 22 – 26mEq/L Lungs compensate for metabolic abnormalities Quick Kidneys compensate for respiratory abnormalities Delayed, up to 6 hours Acute – before compensation Chronic – after compensation Respiratory Acidosis pH 7.35, pCO2 45 Decreased ventilation BiPAP, intubation to increase minute ventilation Chronic form: pCO2 remains constant and HCO3 increases as compensation occurs Narcotics, Atelectasis, Mucus plug, pleural effusion, pain, limited diaphragmatic excursion Respiratory Alkalosis pH 7.4
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