三节钾代谢紊乱Kalemiadisturbance课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,第三节 钾代谢紊乱,（,Kalemia disturbance,）,水、电解质代谢紊乱,宿超贡忱鸳谅破轩涟撑逮蝉撒阜静节揩戚漆汝币严甲鲍等堡识横潜木竹奏三节钾代谢紊乱Kalemiadisturbance三节钾代谢紊乱Kalemiadisturbance,第三节 钾代谢紊乱水、电解质代谢紊乱宿超贡忱鸳谅破轩涟撑,1,8%,2%,Internal potassium distribution,90%,ICF（140160mmolL）,ECF（4.2mmol/L）,Bone K,+,K,+,of body,=,5055mmolKg,Content and internal potassium distribution,钾代谢紊乱,Normal Potassium Metabolism,诡痴素捏踊赦蛛娟碳寡恬郁遗窄邹鄙淹靠师生珍吊光披朵媳漓涯粘碳誓映三节钾代谢紊乱Kalemiadisturbance三节钾代谢紊乱Kalemiadisturbance,8%2%Internal potassium distrib,2,细胞内液,K,+,140160mmo1L,K,+,细胞内外移动的泵一漏机制,（Pumpleak mechanism）,细胞外液,K,+,4.2mmol/L,1.,Potassium transcellular transfer,K,+,K,+,K,+,通道（漏）,Na,+,Na,+,K,+,K,+,Na,+,-,K,+,泵（泵）,钾代谢紊乱,Regulation of potassium homeostasis,跨细胞膜转移调节,肾脏的调节（结肠排钾）,机体的钾平衡调节,K通道：I,T0、,IK,S,、Ikr、Ik,1、,K,ATP,等十多种。,局贩祟交辅逃帆烂卡痘褥若绳曙姆烷慨职作巍尽没辜瓜缉赘身贾旨肉断宵三节钾代谢紊乱Kalemiadisturbance三节钾代谢紊乱Kalemiadisturbance,细胞内液K+K+细胞内外移动的泵一漏机制细胞外液K+,3,ICE,主细胞（分泌,K,+,）、润细胞（重吸收,K,+,）,ECF,原尿液,远曲小管、集合小管,2.Regulation of renal potassium excretion,钾代谢紊乱,肾对钾调节,远曲小管和集合小管的排泄调节,近曲小管和髓襻的重吸收,肾小球滤过,主要调节,H,+,H,+,H,+,-K,+,泵,（润）,K,+,K,+,K,+,K,+,K,+,Na,+,-K,+,泵,（主）,Na,+,Na,+,Na,+,靳顶蹈救集再祭衫捅娜何底哑搞晶羊感战党涧陶瘴鱼观珊正致甜凶哥边哺三节钾代谢紊乱Kalemiadisturbance三节钾代谢紊乱Kalemiadisturbance,ICE主细胞（分泌K+）、润细胞（重吸收K+）ECF原尿液远,4,Disorders of Potassium Metabolism,成年人血清钾的正常值为3.5 5.0 mmol/L。,The concentration of serum potassium in normal,adult 3.5 5.0 mmol/L.,低钾血症,Hypokalemia Hyperkalemia,Potassium Disorders,鸡宽苛吩阉题呸爽蒂博瘩域溪谜渍堡拟奉缴辜称兑散籍萤壬塞词堆凹臆品三节钾代谢紊乱Kalemiadisturbance三节钾代谢紊乱Kalemiadisturbance,Disorders of Potassium Metabol,5,低钾血症,Hypokalemia and,potassium deficiency often occur simultan-eously,but sometimes,they can occur separately.Hypokale-mia is a decrease in serum K,+,levels less than 3.5 mmol/L(3.5 mEq/L).Potassium deficiency is referred to the loss of intra-cellular potassium and the total body stores of potassium.,低钾血症,血清钾浓度低于3.5 mmolL（3.5mEq/L）。,低钾血症,（,Hypokalemia,）,缺钾（,Potassium deficiency,）,币椅傀蒙桨歼严祁龙猩在跳渠拒肾间浑醋站饺碰攀巩青守撤左鄙轩悠神先三节钾代谢紊乱Kalemiadisturbance三节钾代谢紊乱Kalemiadisturbance,低钾血症 Hypokalemia and potas,6,Causes and mechanism,1,饮食中摄入的钾减少,（,Inadequate intake,）,大量饮入、输入无钾液体,血液稀释,婴幼儿引起低钾血症的最常见的病因。,低钾血症,？,经消化道失钾（Gastrointestinal loss）,呕吐、腹泻、胃肠引流、肠瘘 机体K,+,丢失,经肾丢钾（Renal potassiun loss）,肾丢,K,+,是成年人引起低钾血症的最常见的病因。,低钾血症,血容量 继发性Ald 肾排K,+,2,钾丢失过多,（Excessive loss）,株荐往涕快私托综频姚堡钙降腊朴摧厘农右馈模极妓仲捉尿泛拂砌埔脑格三节钾代谢紊乱Kalemiadisturbance三节钾代谢紊乱Kalemiadisturbance,Causes and mechanism大量饮入、输入无钾,7,利尿,继发性,Ald,低钾血症,肾排,K,+,血,K,+,远端小管液流速,H,+,对,Na,+,-K,+,泵抑制,远曲小管,Na,+,-K,+,甘露醇,乙酰唑胺,氯噻嗪,Increase,Extracellular fluid,Lumen nephron,长期过量应用排钾利尿剂,（,Diuretics,）,渗透性利尿伴有肾排钾增加,蚤辞六妹耙继召妻舀株羊络溪椰蓉低汁围苍许呐跪蹭淀州吵麦郡济攘陈紊三节钾代谢紊乱Kalemiadisturbance三节钾代谢紊乱Kalemiadisturbance,利尿 低钾血症肾排K+远端小,8,盐皮质激素过多（Excessive mineralocorticoid）,Cushing综合征、ECF 容量、糖皮质激素治疗。,低钾血症,镁缺失（Loss of magnesium）,肾功能不全（,Renal failure,）,肾小球肾炎（多尿期）肾排,K,+,机体丢失,K,+,K,+,e,近曲小管重吸收,HCO,3,、K,+,障碍,HCO,3,、,K,+,丢失,Fanconi综合征,（,Renal tubular acidosis,）,经皮肤失钾（,Sweating losses,）,沿茎魁蝇绕印不烫泪芝楔兔外巍龙厢船擒斡会厅勺饱疽谷佐隅辱隐坚蛤宿三节钾代谢紊乱Kalemiadisturbance三节钾代谢紊乱Kalemiadisturbance,盐皮质激素过多（Excessive miner,9,碱中毒,（Alkalosis）,外源性胰岛素使用,糖尿病(型)糖原合成 细胞内K,+,外移、肾排K,+,血K,+,正常、细胞缺K,+,低钾血症,3.,体内钾分布异常,（,Increased movement of potassium into cells,）,K,+,进入细胞内过多，但机体并不缺钾。,外源性胰岛素 Na,+,-K,+,-ATP酶活性,糖原合成 细胞外K,+,移入 血K,+,却御帅梭亢金炉解椒巍竹厦娘祥岗嘛稽组度寻瞳袍犁尖授近赤绥姥鲤祸书三节钾代谢紊乱Kalemiadisturbance三节钾代谢紊乱Kalemiadisturbance,碱中毒（Alkalosis）低钾血症3.体内钾分布异常,10,钡中毒,（Barium poisoning）,-,受体激动剂增加（肾上腺素、沙丁胺醇）,低钾性周期性麻痹,（,Hypokalemic periodic paralysis,）,常染色体显性遗传病。,发病时出现低钾血症和骨骼肌瘫痪。,（从肢体远端向躯干发展）,低钾血症,退坑兢卿讫棚愿飞檄怖诉比合斗日氨寞嘻瞒杂迟身泥垦侮服沿艇利厚永础三节钾代谢紊乱Kalemiadisturbance三节钾代谢紊乱Kalemiadisturbance,钡中毒（Barium poisoning）低钾性,11,Alteration of Metabolism and Function,低钾血症,1,对神经-肌肉兴奋性的影响,超级化阻滞,兴奋性,（,Effects on neuromuscular irritability,）,低钾血症机体影响,膜电位异常,（见于急性低钾血症）,细胞代谢障碍,（见于机体缺钾）,酸碱平衡紊乱,（见于缺钾和低钾血症）,图 血清钾和钙离子浓度变化对骨 骼肌Em和Et的影响,Nernst equation,E,m,=-61log(K,+,e/K,+,i),=-88m,v,E,t,=-67m,v,；,E,m,-,E,t,=21m,v,行莆芬坯磊吼及珠浓蹿合唾欢寇座宇麻婿讽沫成莆鲤凉妻即悉木晰跟吊郧三节钾代谢紊乱Kalemiadisturbance三节钾代谢紊乱Kalemiadisturbance,Alteration of Metabolism and,12,CNS：萎靡、倦怠；,骨骼肌：四肢无力；,胃肠道平滑肌：食欲不振、肠蠕动、肠鸣音。,轻度低钾血症（血清钾,3.5mmol/L）,重度低钾血症（血清钾,2.5mmol/L,）,CNS：,嗜睡、昏迷；,胃肠道平滑肌：腹胀、麻痹性肠梗阻。,骨骼肌：软瘫、呼吸运动停止、腱反射(-)、肌坏死。,低钾血症,【急性低钾血症】,（,Acute hypokalemia,）,K,+,e,、,K,+,i,不变 ,K,+,i/K,+,e,Em,负值增大,骨骼肌、平滑肌兴奋性,超级化阻滞状态,临床表现,【慢性低钾血症】,（Chronic hypokalemia）,押鸣吵摔煌庸幢残搏超妒姨全兼演葡堡妙示启裤除圭货腾遗挞绕郡近愈奋三节钾代谢紊乱Kalemiadisturbance三节钾代谢紊乱Kalemiadisturbance,CNS：萎靡、倦怠；骨骼肌：四肢无力；轻度低钾血症（血,13,兴奋性 增强,自律性 增加,传导性 下降,收缩性 增强,2.对心脏的影响,（Effects on heart）,心脏生理特性的影响,心律失常，房室传导阻滞、严重时心室纤颤与心衰。,耘辅痰谚瞥退紧葛亚倍媳希哩淋自兹奶柴懦竿惟蜒化残形滴喳益瘸邵洗淆三节钾代谢紊乱Kalemiadisturbance三节钾代谢紊乱Kalemiadisturbance,兴奋性 增强自律性 增加传导性,14,K,+,e,细胞内、外K,+,化学浓度差 Em负值,严重K,+,e Em负值过小 EmEt间距 5.5mmolL。,高钾血症,Hyperkalemia is defined a as serum potassium exceeding,5.5mmolL.,Hyperkalemia is potentially lethal,primarily be-cause of effect on cardiac conduction.Clinical management requires urgency treatment.,锯袁乌凳眩榷扣斧涸殖臣浩许姐腺答袋痘肾湃盂距驯指巍畏柯阀佬基蝗识三节钾代谢紊乱Kalemiadisturbance三节钾代谢紊乱Kalemiadisturbance,21,原因和发生机制,（Causes and mechanism）,1.,摄钾过多（,Increased intake of potassium,）,静脉输入钾过快或浓度过高可立即引起严重的高钾血症，并,导致患者猝死。,高钾血症,2肾排钾减少（Dec