Dezechil acido bazic si hidro-elec
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dezechilibrul acidobazic si hidroelectrolitic
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Dezechil acido bazic si hidro-elec
- 1. DEZECHILIBRE HIDRO – ELECTROLITICE SI ACIDO - BAZICE
- 3. APA CORPORALA TOTALA ( 42 L ) 50 - 60 % din G corp APA INTRACELULARA 66 % din apa totala ( 28 L ) APA EXTRACELULARA 34 % din apa totala ( 14 L ) APA INTERSTI TIALA 75 % din apa ex. cel ( 10 , 5 L ) APA INTRAVASCULARA 25 % din apa ex. cel ( 3 , 5 L ) Na 10 mEq/L 136 140 K 150 mEq/L 5 5
- 5. DISTRIBUTIA LICHIDELOR INFUZATE 42 43 43 43 42,1 3,6 3,8 4,6 3,6 4,05 10,6 11,2 12,9 10,5 10,05 28,8 28 25,5 28 1000 G 5% 100 ml 100 ml + 800 ml 1000 Ringer 300 ml 700 ml 1000 NaCl 3% 1000 + 100ml 2400 ml - 2500 ml 1oo Albumina 25% 100 + 450 ml - 450 ml APA TOTALA INTRAVASCULAR INTERSTITIAL INTRACELULAR 3,5 30 min 10,5 28
- 6. BALANTA APEI IN ORGANISM SETE OSMO-RECEPTORI DESHIDRATARE CELULARA BARO-RECEPTORI HIPOVOLEMIE APORT H2O ADH REABSORBTIA DE H20 FG H2O NaCl NaCl H2O
- 23. DEZECHILIBRE ACIDO - BAZICE
- 26. ACIDOZA METABOLICA - CAUZE PRODUCTIE / RETENTIE H+ PIERDERI HCO3 DIGESTIVE / RENALE GAURA ANIONICA SERICA Na – ( Cl + HCO3 ) = 12 mEq / l CRESCUTA 1 . Ac. LACTICA ( SOC , ENDOTOXEMIE ADRENALINA iv , I HEPATICA ) 2 . CETOACIDOZA DZ , ALCOOL, FOAME 3 . I. RENALA ( RFG < 20 ml / min 4 . TOXINE : METANOL , ETILENGLICOL, PARALDEHIDA NORMALA ( Ac. M. HIPERCLOREMICA ) 1 . DIAREE 2 . FISTULA PANCREATICA 3 . URETEROSIGMOIDOSTOMIE 4 . ACIDOZA TUBULARA RENALA 5 . SUBST. ACIDIFIANTE ( ARGININA , CaCl2 , MgSO4 )
- 36. Pacient 1 ICC , DIGOXIN , FUROSEMID 39 C , TUSE PRODUCTIVA FR = 30 /min FR = 42 / min TA = 140 / 84 TA = 110 / 64 86 / 40 AV = 100 / min 12 ore 120 / min 2 ore Ph = 7 , 59 7 , 40 7 , 24 HCO3 = 29 mEq / l 16 mEq / l PCO2 = 31 mmHg 48 mmHg 38 mmHg PO2 = 51 mmHg 44 mmHg 84 mmHg GA = 23 mEq/ l LACTAT 8 mMol/L ALCALOZA METABOLICA ACIDOZA RESPIRAT ACIDOZA LACTICA + ALCALOZA RESPIRATORIE
- 37. Pacient 2 - Neoplasm gastric mica curbura . Carcinomatoza peritoneala pH = 7,97 7, 64 7,58 7,47 pCO2 = 58 mmHg 56 46 35 pO2 = 76 mmHg 80 140 150 HCO3 =88,4 mEq/L 8 ore 60 24 ore 44,3 36 ore 24,7 EB = + 70 , 4 + 39,2 + 19,7 + 1,7 Na = 112 mEq/L 119 128 134 K = 1,7 mEq/L 1,9 2,2 3,1 HCL 0,1N : 5 – 7 - 10 ml / ora ( total 50 ml ) Arginina Ederen NaCl 7,45% : 10 ml/ora KCl 5,85% : 10 - 15 ml/ora Repletie volemica ( SF , RINGER )