钾代谢障碍酸碱平衡紊乱

DisordersofPotassiumMetabolism钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第1页!Outline

NormalpotassiummetabolismandregulationHypokalemiaHyperlalemiaCasediscussion钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第2页!1.thetotalpotassium

ofbody:

intracellular:98％（140-160mmol/L）

extracellular：2％（3.5-4.5mmol/L）Normalpotassiummetabolism钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第3页!2.potassiumpresentsinthefood,suchasmilk,peanutpotatoes,saltsubstitute.Potassiumexcretepathway:kidneythroughurine:90％

Stool(feces):10％Sweatnormalserumpotassium:3.5-5.5mmol/Lbalancebetweenintra-andextracellularK+

normal:15h钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第4页!(1)PotassiumtranscellulartransferPump-leakmechanismfactors:PotassiumconcentrationinECFAcid-basebalanceInsulinCatecholamineOsmolarityExerciseTotalbodypotassium钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第5页!Sodium-potassiumATPasePermeabilityofluminalmembraneforpotassiumReabsorptionincollectingtubulesHydrogen-potassiumATPase-protonpumpMechanismofpotassiumexcretionindistalandcollectingtubules:钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第6页!4.physiologicalfunctionofpotassiummaintaincellularmetabolismmaintaincellularrestingmembranepotentialregulatetheosmolarityandacid-basebalance钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第7页!5.influencingfacterofpotassiumhomeostasisacidosisalkalosishypoxiaseruminsulinserum

damageofcells[K+]ADS[K+]catabolismanabolism

distalflowratedistalflowrate钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第8页!2.causes(1).intake↓(2).discharge↑①digestivetract②kidneys：③skin钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第9页!(3).AbnormalitydistributionofpotassiummoveintocellsacutealkalosisinsulinoverdoseBariumpoisoningBeta-receptorexcitomotoryhypokalemicperiodicparalysis钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第10页!

Effectsonbody

(1).nervesandmusclesacutehypokalemiaexcitability

0mv

serum[K+]-30mvAP-60mvTP(Et)-90mvRP(Em)

hyperpolarization钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第11页!Excitability:[K+]ECF

K+permeabilitydepolarizationrepolarizationexcitabilityECGTwaveConductivity:RP0phaseofAP

conductivityconductiveblockunidirectionalblockECGP-R

钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第12页!(3).Renalpolyuria(sensitivityofADH)(4).GIsmoothmusclesHyperpolarization(5).acid-basebalancemetabolicalkalosisparadoxicalaciduria钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第13页!1.definition:hyperkalemiaisdefinedasserumpotassiumexceeding5.5mmol/L.Ⅲ.hyperkalemia钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第14页!(3).abnormalpotassiumtranscellularditribution①acuteacidosis②hypoxia→ATP↓③tissuedamage④hyperkalemicperiodicparalysis⑤Diabetes⑥Beta-receptorinhibbitor钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第15页!

skeletalmuscle

＜8mmol/LRP(depolarization)excitabilitystabbing;tremor

＞8mmol/LRPinactivationofNa+channeldepolarizationparalysis钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第16页!

Autorhythmicity:

K+outwardofphase4

SpontaneousdepolarizationheartrateConductivity:RPNa+inwardofphase0conductivityconductiveblock

unidirectionalblockContractility:inhibitionofCa2+inwardflowcontractilityacid-basebalanceacidosisparadoxicalalkalineurine钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第17页!SummaryNormalpotassiummetabolismandregulationHypokalemiahyperkalemiadefinitioncausesalterationsofmetabolismandfunctionprinciplesofpreventionandtreatmentCasepresentation钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第18页!I.Acid-basehomeostasis

1.Theacidsandbasesintheblood

1)Acids

钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第19页!

②Metabolicacid

Theproductofmetabolismofaminoacid:

phosphophoryn,nuclericacid→phosphoricacid

methionine,cysteine→sulfuricacid

purine→uricacid(gout)

Lacticacid(TheliverremovesandconvertstoG)

Ketoacids(pyruvicacid,acetoaceticacid,

β–hydroxybutyricacid)钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第20页!2.ControlofpH

1)Thebuffersystems

BuffersarethefirstdefenseagainstpHdisorders,andactimmediately.

Alkalisaltoftheacid

Buffersystem:————————————————

Weakacid

钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第21页!2)Respiratorycontribution

TherespiratorysystemistheseconddefenseagainstpHdisorders,andneedsseveralminutes.

↑H2CO3┑

┃

↑Therateanddepth↓H2CO3

↑[H+]┛

ButwhenPaCO2>80mmHg,↓therateanddepth.

↓H2CO3┑

┃

↓Therateanddepth↑H2CO3

↓[H+]┛钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第22页!

Thekidneyscanpensatefor

respiratoryacidimbalancesby

excretionofmetabolicacids.(Indirectly)

↑H2CO3→↑Excretionofmetabolicacid

↓H2CO3→↓Excretionofmetabolicacid

钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第23页!

4)EffectsofK+andCl-onpHregulation

Acidosiscancausehyperkalemia,

andalkalosiscancausehypokalemia.

H+

K+

HCO3-

Cl-钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第24页!4.Themainindicatorsoflaboratoryaboutacid-basebalance

1)pH:Thenormalrangeis7.35~7.45

AnormalrangeofpHrepresents

①Nodisturbanceinacid-basebalance

②Acid-baseimbalancewithpletepensation

③AmixedacidosisandalkalosiswhichhaveoppositeeffectonpHandoffseteachother.3situations:钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第25页!

3)HCO3-:Thenormalrangeis24~33mmol/L.Itisanindicatoroftherenalexcretionofmetabolicacid.

↓HCO3-meansanexcessofmetabolicacids(metabolicacidosisorrespiratoryalkalosisafterpensation).

↑HCO3-meansadeficitofmetabolicacidsoranexcessofbase(metabolicalkalosisorrespiratoryacidosisafterpensation).钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第26页!

4)AG(aniongap):AGdescribesthedifferencebetweenunmeasuredanion(UA)andunmeasuredcation(UC).

AG=Na+-(Cl-+HCO3-).

Thenormalrangeis10~

14mmol/L(12mmol/L).

钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第27页!2)Causes:

(1)Increaseinmetabolicacids

①Excessproductionofmetabolicacids

E.g.fastingandstarvation,diabeticketoacidosis,lacticacidosis(shock,hypoxia,heartfailure,anemia).

②Decreasedlossofmetabolicacids

E.g.renalfailure,renaltubularacidosis-I

③

Overdoseofacidicmedicine(aspirin).

AGisincreased.钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第28页!3)Compensation:

(1)Buffersystemandcell

(2)Signsofpensation

①

Kussmaulbreathing

②

Acidurine钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第29页!4)Laboratoryfindings

↓pH,↓HCO3-,

↓PaCO2ifthereispensationofrespiratorysystem.

钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第30页!(1)A36-year-oldmanwashospitalizedwitha3-dayhistoryoffeverandwaterydiarrhea.Thebloodpressureis90/60mmHg,thepulseis112/minute,therespiratoryrateis24/minute,andthetemperatureis37.5ºC.Thelaboratoryresultswereobtained.

钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第31页!2)Causes

Respiratoryacidosiscanoccurasanacuteorachronicdisorder.

(1)Acuterespiratoryacidosis

E.g.acuterespiratoryinfections,chestinjuries,pulmonaryedema.

(2)Chronicrespiratoryacidosis

E.g.chronicobstructivelungdisease,chronicbronchitis.钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第32页!

(1)CO2crossestheblood-brainbarrierrelativelyeasily,andcandilatethebloodvesselsinthebrainandleadtobrainedema.

(2)CO2canalsodecreasethepHofthecerebrospinalfluid,andmakedepressionofneuralfunction,likeweakness,confusion,paralysis,stuporanda.钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第33页!3.Metabolicalkalosis

1)Concept:Metabolicalkalosisreferstoaprimaryincreaseinbasebicarbonate,thepHelevates.

2)Causes:

(1)DecreaseofacidE.g.vomiting

(Ileus:intestinalobstruction).

(2)IncreaseofbaseE.g.antacids,transfusionwithcitratedblood,hyperaldosteronism.

Saline-responsivealkalosisandsaline-resistantalkalosis钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第34页!5)Laboratoryfindings

↑pH,↑HCO3-,

↑PaCO2

ifthereispensationofrespiratorysystem.钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第35页!3)Compensation

4)Manifestations

Tetany

5)Laboratoryfindings

↑pH,↓PaCO2,

↓HCO3-(dependonthenormalrenalfunction).钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第36页!

Bacterialpneumonia→respiratoryacidosis

Patient

Diarrhea→metabolicacidosis

Inthismixedimbalance,thepHislikelytobeverylow.

Pneumonia→respiratoryacidosis

Patient

Vomiting→metabolicalkalosis

Inthismixedimbalance,thepHwillchangeslightlyorinnormalrange.

钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第37页!

(2)A32-year-oldmalepresentedwithvomitingofoneweek'sduration.Onexamination,hehadabloodpressureof90/60mmHgandapulseof116/minute.Seethelaboratoryresults.

钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第38页!(3)A52-year-oldmanwithchronicobstructivelungdiseaseisadmittedtothehospitalwithworseningdyspnea.Heappearscyanosisandinrespiratorydistress.Thelaboratorydatafollow.钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第39页!(4)A48-year-oldfemalepresentedwithseverevomiting.Onexamination,T38℃,HR89/min,R26/min,Bp150/100mmHg.Sheappearsgeneraledema.Thelaboratoryresults钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第40页!3.regulationofpotassiumhomeostasis

TranscellulartransferRenalregulation钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第41页!(2).RenalregulationforpotassiumexcretionGlomerularfiltrationReabsorptionbytheproximaltubuleandtheloopofHenleRegulationofpotassiumexcretioninthedistalandcollectingtubules钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第42页!Influencingfactorsofpotassiumexcretionindistalandcollectingtubules:PotassiumconcentrationinECFAldosteroneDistalflowrateAcid-basebalance(3)PotassiumexcretionincolonThesameastheexcretioninkidney钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第43页!DisorderofpotassiummetabolismNormalserumpotassium:3.5-5.5mmol/LHypokalemiaHyperkalemia钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第44页!1.Definition:Hypokalemiaisdefinedasadecreaseinserumpotassiumlevellessthan3.5mmol/L.Ⅱ.hypokalemia钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第45页!GI:vomiting;diarrhea;GastrointestinalsuctionSkin:excessivesweatsfurosemidediureticlossesdiamoxdiureticphaseofARFrenal:

primaryhyperaldosteronismlackofmagnesiumrenaltubularacidosis

osmoticdiuresis

钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第46页!3.alterationsofmetabolismandfunctionNervecellsskeletalmusclesgastrointestinalsmoothmuscleMyocardialcells钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第47页!(2).Heartarrhythmia

0mv

serum[K+]-30mv-60mv-90mv

depolarization

钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第48页!Autorhythmicity:Contractility:acute;chroniceffectsonheartcardiacexcitability↑cardiacconductivity↓cardiacautomaticity↑cardiaccontractibility↑→↓钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第49页!4.principlesofpreventionandtreatment1.treatmentofprimarydisease2.principlesofpotassiumpensationoralapplicationisbetterGivepotassiumaccordingtotheurineconcentration40mmol/L，slowly10-20mmol/htoobserve：heartratecardiacrhythmconsciousnessacidbase钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第50页!2.causes(1).increasedintakeofpotassium(2).Impairedrenalpotassiumexcretion：①renaldysfunction②ALD↓③potassium-sparingdiuretics钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第51页!3.alterationsofmetabolismandfunction(1).effectonneuromuscularexcitability:(2).effectsonheartcardiacexcitability↑→↓cardiacconductivity↓cardiacautomaticity↓cardiaccontractibility↓(3).effectontheacid-basebalanceacidosisparadoxicalalkalineurine钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第52页!heart(hyperkalemiaK+permeability)5.5-7mmol/L→RP→Eexcitability

7-9mmol/L→RP→ETwave;QTshortcardiacarrestPR

QT钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第53页!4.principlesofpreventionandtreatmenttreatmentofprimarydiseasedecreaseuptakeofK+cutdowntotalamountofbodypotassiumdialysision-exchangeresininduceK+uptakebycells.applicationofcalciumandsodium钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第54页!

ThepHoftheECFismaintainedwithinthenarrowrangeof7.35~7.45

<6.9or>7.8

!!!钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第55页!①Respiratoryacid(Volatileacid)

—H2CO3

CO2+H2O

H2CO3

H++HCO3-

钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第56页!

2)Base

Thefruitsandvegetablesarerichinalkalisalt,e.g.sodiumcitrate,potassiumcitrate.

钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第57页!NaHCO3

————Bicarbonatebufferpair

H2CO3

Tobuffermetabolicacid

and

base

in

ECF

Hbbufferpairs

in

RBC

tobuffer

respiratoryacid.

HPO42-

————

Phosphatebufferpair

H2PO4-TobufferinICF

钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第58页!3)Renalcontribution

Thekidneyisthethirddefenseagainstacid-basedisorders.

↑Metabolicacid→↑Excretionofacid

↑Reabsorptionofbase

↓Metabolicacid→↓Excretionofacid

↓Reabsorptionofbase

↑Base→↓Excretionofacid

↑Excretionofbase

钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第59页!

Therenalpensationrequiresseveraldaystobefullyeffective.

钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第60页!3.ThedeterminationofpH

pH=pKa+log[HCO3-]

/[H2CO3]

Iftheratiois20:1,thepHwillbe7.4

钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第61页!

2)PaCO2:Normalrangeis38~42mmHg(40mmHg).

(33~46mmHg)

PaCO2isanindicatoroftheeffectivenessofrespiratoryexcretingofcarbonicacid.

If↑PaCO2,meanshypoventilation

ormetabolicalkalosisafterpensation

↓PaCO2,meanshyperventilation

ormetabolicacidosisafterpensation钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第62页!①StandardbicarbonateSB

(22～27mmol/L)②ActualbicarbonateAB

AB>SB,hypoventilation;AB<SB,hyperventilation

③BufferbaseBB

④

BaseexcessBE⑤CO2

binepower（CO2CP）钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第63页!II.Acid-baseimbalances

1.Metabolicacidosis

1)Concept:Metabolicacidosisreferstoaprimarydeficitinbasebicarbonate,thepHfalls.钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第64页!

(2)Increaseinbicarbonateloss

E.g.

①Severediarrhea,intestinalfistulas

②

Renaltubularacidosis-II.

③OverdoseofNH4+,releasesHCl

AGisnormal.

钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第65页!4)Manifestations

(1)Heartfailure:

①Hyperkalemia__cardiacarrhythmia

②Impairmyocardialcontraction

(2)Decreasedresponseofcapillarytocatecholamines__Shock

(3)Depressionofneuralfunction

Lethargy,disorderofconsciousness,a.

(4)Changesofosseoussystem

Renalrickets肾性佝偻病,osteomalacia骨软化症钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第66页!Casestudy:

Arterialblood:

pH7.21

PaCO226mmHg

PaO2108mmHg

HCO3-12mmol/L

Na+135mmol/L

K+2.0mmol/L

Cl-110mmol/L

Urine:

pH5.0钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第67页!2.Respiratoryacidosis

1)Concept:RespiratoryacidosisisdefinedasadecreaseofpHinducedbyprimaryincreaseinplasma[H2CO3].钾代谢障碍酸碱平衡紊乱共77页，您现在浏览的是第68页!3)Compensation:

Buffersystemandcell

4)Manifesta