• Thuemg xay ra a nhang b'enh nhan dirge truyen dich dieu tri, an qua nhieu muai ma di& nang then binh thuang se gay tang thai mu6i a thdn. Tuy nhien, khi tnlyen dich qua nhieu mu[r]
(1)TS.BS LE XUAN TRUtYNG
HOA SIKH LAM
SANG
(2)TS.BS LE XUAN TRUtYNG
c-LY).,q 771-e-t' ko& Terri -ate)
c
HOA SINH LAM SANG
TAN TAO UNIVERSITY LIBRARY
NHA XUAT BAN Y HOC Chi nhanh TP H6 Chi Minh
(3)(4)L6'1 Nol DAU
Y hoc cang tien bO va xet nghiem Haa sinh cang phat trien, co nhieu cleriu an sinh hoc mai chivy phat hien va nhieu ky thuat mai clei clwor trien khai ap dung trong lam sang
H6a sinh lam sang co mai quan he mat thiet vat cac mon hoc nine NOi, Ngogi, San, Nhi va cac chuyen nganh khac nhiim gap phan chan clam, clieu tri, tien ltro.ng, theo dot dien tien benh, tam soat benh Ong clang
The& day, mon Haa sinh lam sang chtea clwor dtra vao chwang trinh giang day chinh thirc tgi cac trtrang clgi hoc Y khoa, nhung nhang nam g ;an day no cltro.c duo vao giang day chinh thiec a nam tha tgi cac trwang dgi hoc Ykhoa ca meat
Hy vong quyen Haa sinh lam sang la tat lieu ciao two va tham khao haw ich cho sinh vien Ykhoa, hoc vien sau dgi hoc va ngtrai lam xet nghiem Hoa sinh Nha ng hieu bit trong quyen scich la ste ket hop cap nhat h6a cac kien thiec tren the giai vai ste tick lay tie thtec to mak to nhieu nam qua, ch/ic chan se mang lgi cho cac sinh vien, hoc vien, cac bac si" lam sang va can lam sang nhang kien thirc co ban ve h6a sinh lam sang de ieng dung tong tac chan down, phong va dieu tri benh
Do thai gian bien sown sach bi hgn the nen khong the trcinh khoi nhang thieu sot nhcit dinh, chac chiln clam lam hai long cac ban doc Rat mong nhan &toy six clang g6p kien cita cac ban clang nghiep, cac hoe vien sau dat hoc va sinh vien de lan tai ban sau chew hoan thien how
Thanh pita Ha Chi Minh, 09 thang nam 2013
Tic gia
(5)CHU' VIET TAT VA KY HIEU
BC Bach cAu MD Mien dich
Bili GT Bili gian tier MXV Mang xu vita Bili TT Bili tivc tiep NAHH Nhiem acid ho hdp BMV Benh dOng mach vanh NBB Nhiem base bil
BN Berth nhan NBHH Nhiem base ho hdp
BT Binh thu6ng NMCT Nh6i mau co tim CNP C.type natriuretic peptid NMCTC Nh6i mau co tim cap CRP C-reactive protein PCT Procalcitonin
CTM C6ng tithe mau NT Nu& tieu
DMP Dich mang phi TB Te bao
DNT Dich nao -lay TBTH Te bao thoai hoa
DNTB Dich ngoai bao TC Tieu cdu
DTTB Dich t6 bao TH Tudn hoan
DL Dinh luo.ng THBH Tun hoan bang he
DM Bong mau TM Tinh mach
DTD Dai thao doing TP Toan phAn
GT Gian tier, TT Tieu thily
HA Huy& ap VG Viem gan
HC H6ng cdu VGSV Viem gan sieu vi
HCMVC HOi chimg mach Vanh cap XN Xet nghiem
KN Khang nguyen XQ X-quang
(6)Chu'o'ng
CHUYEN HOA NU'&C MUOI V6 Co
MUC TIEU
1 MO &coy b'ang sa sec phan b a nu& va cac mu di vo ca co' the 2 Trinh bay citrac ca the tac dung cita mot so hormon chinh chuyen hoa
ntrac — muai vo ca
3 Neu &ro'c cac nguyen nhan chinh gay nil loan chuyen hoa nu'ac — mudi vo ca 4 Liet ke &my cac trieu chirng, hOi chirng lam sang rai loan chuyen hoa
meat — mu vo ca
5 Liet ke Avec cac xet nghiem h6a sinh quan de than doan rai loan chuyen h6a nwac — mudi vo co
1 CHUYEN HoA NU'&C
1.1 Dai cu'o'ng ye sty phan b6 nu'&c
Nuac chi6m khoang 60% luting can nang cua ca the truang thanh, 2/3 s6 dO
la dich to bao (DTTB), 1/3 lai la dich ngodi to bao (DNTB) DNTB gom dich ke (dich gian bao) chiem 15% va huyet Wong chiem 5% Vi du mot ngueri throng 70kg c6 khoang 42L neat, DTTB chiem 28L, DNTB chiem 14L, có 10,5L dich ke, chi khoang 3,5L huyet tircmg
(7)A
Huyet tu'ang 5% H2O
H2O An: lit -)
Uong: 1,2 lit) Dich nao tray Bach huyet Dich khap Dich tiet khac
NiPac oxy hoa: 0,3 lit Nutvc nhap: 2,5 lit
Ong tieu hoa
Dich ke 15%
Dich to bao 40% H2O
Oxy hea cac chat
Phan: 0,1 lit Phoi —> hai th&
1,2 lit Da -4 mo hei
Than —> nikYc tieu: 1,2 lit Thanh mao mach
Mang te bao
Nutec xuAt: 2,5 lit
Hinh 1.1 Su ph5n bó nu,ac va su, van chuyen nu,6,c ca the
Tay theo tuoi, gioi luang nix6c hien dien cac ngan dich cita ca the khac
Bang 1.1 Ph5n 136 dich co' the lien quan den tuoi va gidi Tre em (1 tuiii) Nam (40 tad) Nu (40 tali)
an nang (k
ucyng ntro.c toan Than he "ch DTT
Ngodi cac dich co the binh thuang Ice teen, met se qua trinh benh ly di the xuat hien trail dich (trail dich mang tim, Mang phoi, mang bung), dich tran co the la dich tham hay dich tiet
Dich co the co chira cac chat Ilea tan nhat dinh, do kin cc') nhang rei loan sly van chuyen cac dich co the, ailing bi mat qua nhieu hay -Cr dong, ca the se chiu nhang fei loan benh ly thir phat
(8)Dien giai DNTB (mmol/kg) DTTB (mmol/kg)
Natri damilik Ift 10
111 47mai 160
Calci a 2,7 1111r 1,0
Magie III 1,1 BMW 13
Clorua 111111116iallii■•■=r0
MEM
11.1116,1111.111rMallk
Bicarbonat
CHU'O'NG 10- CHUYEN HOA NUCIC - MUOI VC) CG
Mau &mg vai tro trung tam van chuyen nu& va cac chit hoa tan (chat dinh dtrO'ng va can ba), la not m6i cua ca the Co the luon dam bao sir hang dinh not moi, nghia cac thong so cna mau (trong c6 cac th6ng s6 h6a sinh) luon luon trang thai on dinh,(chung dao d6ng nhung giai han sinh Vi,nhat dinh) Khi co met chi so cila thong so nao vugt khoi gigi han sinh 13i (cao hay thap han) thi chi:mg pilau anh nhang trang thai benhVf nao
Thanh phan dien giai phan b6 khac gifra DNTB va DTTB Natri c6 nhieu DNTB, kali c6 nhi6u a DTTB Sir khac biet dugc tri bed barn NalCATPase
Bang 1.2 Nling TO dm mot s6 ch6t din giai cac ngan dich
Nu& ca the di chuyen qua lai giita cac ngan DTTB va DNTB vao ap lirc tham thau Ap likrc tham thau (ALTT) a DNTB chiu anh hugng cua n6ng dO Nat, K-E, Cl-, HCO3-, ure, glucose, Doi vai huyet tucmg cac phan chinh la Nat, K-F, Cr, HCO3-, ure, glucose
1.2 Ni.ro,c va nong thArn thau dich ngoai t6 bac
Nu& thuemg xuyen di chuyen qua lai giita hai khu vitt va ngodi to ban theo ap lgc tham thau, ngoai nit a thin thi ALTT va ngoai to bao luon dugc giva trang thai can bang
ALTT DNTB chiu anh huang bai n6ng dO Na+ va cac anion cna no (Cl- va HCO3-, ure, glucose) DTTB la va anion chiu yeu la protein va phosphat
(9)Cl- HCO3
Na+ uyt.t Wong
ich da day 50 IS
ich riot non IA 140 141111111.161
ich tieu chat' - 141111111.AM0 ich mang 1111111 140.211111,511111
1 1()
HOA SINN LAM SANG
Bang 1.3 Nemg dO cua mot s6 ch6t din giai mot s6 dich cCia co' th6
NOng d0 tham thau cua mot dung dich d-upc tinh bang s0 mmol chat hoa tan kg dung moi (thuemg la twat)
O nguoi, ntmg dO tham thau huy& tuong (va hault& cac dich co the khac, ngoai trir ntrac tiL) dao dOng tir 285-295 mmol/L NOng dO tham thau cua huy6t tuong có the duoc truc tip hay tinh toan dua teen cac thong s0 n0ng dO cac chit hoa tan cla ducic bi6t Ta có the tinh mot cach dcm gian bang ding thirc thu gon sau:
I■10ng di) Osmol/L = x [Nat] + [Glucose] + [Ike] (mmol/L) 1.3 Nu'o'c va vai tro cua ADH
Co quan chinh ki'ern tra su mat nuarc dm co the la than Thy theo tinh trang thira hay thiL nuac cila co the ma \Tang duai doi ti& hay khong tiet vasopressin (ADH) de tac dOng len Ong than tac dung tai hap thu ntrac tir dich loc tra vao mau Su kich thich va bai tiet ADH throe dieu hoa bai cac b0 phen 'then cam tham ap a yang clued doi va cac b0 phen nh4n cam ap a tam
Cact3i) phen nhen cam tham ap dap ung su thay doi ALTT > 2%
Cac bO phen nhen cam cam ap dap ung su thay d6i the tich nOi mach >10%
(10)NEPHRON H2O
than
Na+
Ti6u dOng mach vao—
Ti6u cAu Ong xa
Veu Ong
mach vao N H2O Na+
N
Nhanh xuemg
H2O Na+' Nhanh On
Quai Hanle
Ong gin
CHU'O'NG CHUYEN HOA NU'O'C - MUOI VO CO'
H2O Aldosteron ADH
Ong Op
H2O
Hinh 1.2 Vai tro cua ADH di6u h6a nuo'c
1.4 Roi loan chuyen hoa wen 1.4.1 AlMt weir
• Giam hrang dich ca the (tong lagng dich, chu y6u la dich ngoai bao) c6 hay khong c6 giam Na+ kern theo
• loci mat wet: ding twang, ult tnxang (mat Na+ it han H20), nhugc truang
✓ Mat nage ding truang: hrong nage va lucmg natri mau hoac huyet bi mat ding mgt dam de
✓ Mat nage tru truang: mat natri it han mat nugc.,
✓ Mat ntrac nhirgc trucmg: mat natri nhieu han mat nage
• Mat 5% la da c6 dau hieu lam sang, mat 20% de Oa nghiem tong
✓ Nguyen nhan: non, tieu chay, re 'Ong tieu hoa, but dich tieu hoa, chay mau, phong, co twang, tic met, toan ceton dai than throng, mo
✓ Trieu chung: khat, nhip tim- nhip the tang, mac tieu < 25m1/gier, thay doi hanh
vi, sang, vo nieu, de dan hoi da giam, niem mac mieng kho, mach tang, sut can
(11)HOA SINN LAM SANG
✓ Danh gia: kiem tra tinh mach (TM) ngoai vi a ban tay: cam tay cao hon vi tri tim mot thai gian ngan red xu'ang duai vi tri tim Neu the tich mau va (long mau tuan hoan binh thuemg, TM ngoai vi tay cam ditch vi tri tim se it cang yang 5-10 giay Neu TM ngoai vi khong it cang 10 giay la c6 tinh trang mat ntrac hay giam the tich mau
1.4.2 Thera mrerc
• Thuemg xay a nhang b'enh nhan dirge truyen dich dieu tri, an qua nhieu muai ma di& nang then binh thuang se gay tang thai mu6i a thdn Tuy nhien, tnlyen dich qua nhieu muai thi gay tang the tich dich ngoai bao
• Cac nguyen nhan: suy then cap, giam tong hop protein gay giam Nat, phang-viem gay phn khu tru, tac mach bach huyet gay phn, suy tim, xo gan, thuoc NSAIDs gay tang ADH ddn tai phu
• Trieu chimg: nhirc ddu, mat phuang huang, r6i loan hanh vi, 111 Ian, tang ap hrc sang, lion me, co giat, vop be, phit, tang can, tran dich cac mang Trieu chirng
a nao d u xay tinh trang thieu hay thira dich
Xet nghiem: Nat huyet giam, dO thdm thdu huyet giam, protein — albumin — Hb Hct giam, ap luc tinh mach trung tam tang han 12-15cm H20
Ca2+ Mgt +
Hu* tuang Dich ngoai to bao Dich t6 bao
Hinh 1.3 Wing dO chgt diOn giai mot s6 dich ca th6
(12)CHUCYNG IP- CHUYEN HOA NUCC - MUOI Vb CO
2 CHUYEN HOA NATRI
2.1 Dai cu'o'ng ve sty phan 136 natri
T6ng,lugng natri ca the nguai tnrang khoang 3.000mmol (55-65 mmol/ kg the trong), 70% Wang c6 the trao doi dugc, phan lai tan tai dang phirc hop xuang
Phan 16n Na+ a DNTB, n6ng dO Na+matt khoang tir 135-145mmol/L, a DTTB la 4-10 mmol/L Hau het cac mang to bao deu khong cho phep Nadi chuyen qua, Na+ di chuyen tix DTTB DNTB ngugc gradient n6ng dO nha vao bom Na+KATPase
MOt dac diem quan can luu y la tong Wang Na+ luu th6ng cac dich co the la rat lan, khoang 1000mmol bai tiet qua runt 24gi6 va dugc lac tai than khoang 25.000 mmo1/24gia Phan lan dugc tai hap thu a runt Ara than, cac qua trinh suy giam se anh hating den sly can bang not mai De dam bao hang dinh not m6i, luting dm vac) phai can bang vgi luting Na+ thai (nai thai natri la than)
Luang natri dua vao ca the thy thuOc th6i quen an tieing cua m6i nguai, trung binh 150-250 mmo1/24gia, luting that that bat buOc qua than, da va runt thuang < lOmmo1/24gia Do tieu thu mot luting lan mu6i có the gay hai cho ca the, dac biet la a nguai tang huyet tip De dam bao stir can bang not moi, thong natri dua vao phai can bang \Ted Wang natri thai ra, nai thai chinh la than, six dieu hoa cita than dugc kiem sok bad the tich not mach
2.2 Natri va dich ngoai to bao
An: 150-250mm1/24 gioe Phan: 3,5mm1/24 giey
DTH Jich
HT: 135-145mm1/L
Truy6n • Da: Ma hai: 10-20mm1/24 giCy
H2O HC
Than nutec tieu 100-200mmo1/24 giey Aldosteron
(13)HOA SINN LAM SANG
Natri la cation chinh cua DNTB nen no xac dinh ALTT DNTB, dO n6ng d6 natri thay d6i se lam thay n6ng d6 ap suit tham thau va su chuyen d6ng cua nuac giita DNTB va DTTB
Khi lugng natri o DNTB tang se lam tang n6ng d6 ap suit tham thau cua DNTB, nuac tir to bao se chuyen ngoai to bao, to bao mat nuac Ngugc lai lugng natri
a DNTB giam, se giam ap suit tham thau, nuac vao to bao gay to bao it nuac 2.3 Vai tro caa natri
Natri giu vai tro quan trong hoat dOng thAn kinh co, bum NatIC, d6 tham than dich mach va thing bang kiem toan
Gia tri binh thuang huyet Wong 135-145 meq/L, nuac tieu la 40-220 meq/L 2.4 Vai tro cua th#n di4u hoa natri
M6i c6 khoang 25.000mmol natri dugc loc qua cau than, duoi 1% lugng hien dien nuac lieu (100-200 mmo1/24gia), 75% dugc tai hap thu a 6ng hrgn gin, 20% dugc tai hap thu a nhanh len quai Henle, 5% dugc tai hap thud Ong lugn xa va 6ng
Dieu hoa su bai tiet natri dugc kiem soat bai aldosteron va ANP (atrial natri uretic peptid) Aldosteron dugc bai tiet de dap irng lai su giam the tich nOi mach theo co ch6: the tich nOi mach giam - tang tiet renin -> chuyen angiotensinogen angiotensin I
4 angiotensin II duai tic dung dia ACE (angiotensin converting enzym) Angiotensin II kith thich tuyen thugng than bai tiet aldosteron de tai hap thu natri
0 "Mat nu ,c Gam Natri Xuat huyet
® Gam the tich mau
0 Giam huyet ap •ii I 0
418inip
611uOt ap tang den tri so binh thuryng rang Renin
Gan 011.11M-
Tang ./ Tang (ACE =Angiotensin ngiotensin II Aldosteron Converting Enzym)
Hinh 1.5 Vai trO cua than diau hoa Na+
Tang Angiotensin I
đTang co bop ca tim
f )ã Tang co that mach Tang the tich mau
CrVO thuang thank '
Tang Kali/ DNTB
Tang tai hap thu
muoi-nuor tai than
(14)CHUO'NG CHUYEN HOA NU'O'C - MUOI VO CO'
2.5 ANP (peptid bai natri ni4u)
Dirge tiet dr tam nhi phai, c6 chirc nang tai hap thu natri a doan 6ng g6p, ire the bai tiet aldosteron va gay huyet dp Hai peptid c6 cau truc tuung tu la BNP (tiet bai tam that, tac deng tuning ttr ANP) va CNP (hien dien vai 'long dO cao a lap nei mac mach vanh, có tac dung gia'n mach)
2
ANP BNP
1
Gran mach -4 Ang II .010 Aldo Giam huyet ap
Giam th6 tich Giam tai hap thu mau -41- muCii - nuac Hinh 1.6 -lac dung cua ANP
2.6 IR6i loan chuyen hoa natri 2.6.1 Thigu natri
Cac nguyen nhan gay mat natri o Duamg tieu hea:
✓ Da day: non, hint dich vi, re, xuat huyet
✓ RuOt: m6 thong hed tang, re tuy, re met, tieu chay, xuat huyet, tac runt o Da: me) hoi, pheng, b'enh tang tiet a da
o Nhap vao khong du so vai nhu cau va luting mat:
✓ Cap tinh: giai doan da nieu suy then cap, sau ghep then
✓ Man tinh: han the mu6i suy then man, mat muoi cac b'enh then o Mat mu6i cac b'enh thin Oat:
✓ Tang renin hOi chirng giam aldosteron
✓ Benh Addison
✓ Giam renin hOi chirng giam aldosteron
✓ Chung gia giam aldosteron type I
(15)Loi tieu
Tang tit ADH
Ditu khee'n host thing ADH
Thiazide, frusemidelfronolactoltramiloride, triamterene
Barbiturates, morphine, chlorpropamide, tolbu-tamide, vincristine, cyclophosphamide, carbe-mazepine, clofibrate, SSRIs
Chlorpropamide, NSAIDs, paracetamol
HOA SINN LAM SANG
Thu6c va six thieu natri:
Bang 1.4 Cac thuoc gay threu natri mau
Doc diem lam sang
- Giam Na+ ket hop giam the tich ngoai bao (ECV): mu6i mat A/trot qua su mat nuorc hOi chi ng giam chile nang then nguyen Oat (benh Addison), vo thuong then bi hi:1y benh to mien, viem nhi6m hoec benh dc tinh Mat nhieu qua then: lgi nieu tham thau (tang glucose va ure mau), o'ng then giam tai hap thu Mat ngoai then: non oi, tieu chay, m6 hoi (Na+ nieu < 10)
Giam Na+ ket hop tang ECV: tang cac chat hea tan khac DNTB lam tang keo nuac kh6i to bao, kem theo natri di chuyen vao to bao nham can bang ALTT va ngoai to bap ThuOng gap nhat la tang throng huyet, met each tong quat thi vOi moi 100mg/d1 glucose tang them (voi nong de glucose > 100mg/d1) thi nong dO natri giam khoang 1,6 mmol/L Tren lam sang dieu tri bang loi tieu tham thau (manitol) cling gay hien tugng
- Giam Na+ vai ECV binh thuemg: stress (chan throng, phau thuet, bai tiet ADH cao bat thuOng), ADH tang de nhay met s6 thu6c nhu chlorpropamide, tolbutamid
- Giam Na+ gia: to dinh lugrig Na+ bang phuong phap gian flap tren benh nhan tang lipid mau hay tang protein mau
Chan &tin
mau &red 130mmol/L
- Ap tut tham thau huyet tucmg giam
- Ap luc tham thau nuov lieu > 200mosm/kg nieu > 20mmo1/L
- Chit benh nhan,khong bi mat nuac, khong benh 13'T tim mach-then-tuyen yen-chiTc nang tuyen giap, kh8ng dOng thu6c gay giam Nat, dap *rig voi giam dich truyen
(16)liang lipid m ng protein
i ii
CHU'O'NG CHUYEN HOA NU'O'C - MUOI V6 CO'
Ha natri mau gia
IA Suy giap
Threu glucocortic
Zvi tieu, nhik Vern, u ' ralocorticoid
Hinh 1.7 Sa c16 chAn doan natri mau
Dann gia qua xet nghiem: khong c6 xet nghiem dec hieu, chon xet nghiem nguyen nhan - Ure huyat: nguyen nhan then
- Na+ mau, albumin, nellig d) tham thau - Do Hct: danh gia mire clO giam DNTB
Hct binh tineerng
DNTB = 0,2 * Than * (
Hct coo
- Danh gia sir thieu but Na+
ThiL Nat = 0,6 * than trong(kg)* (140 — [Nal/mationmod - Nhu cau cung cap (trong ngO d'Oc mac cap)
(17)HOA SINH LAM SANG
2.6.2 Thipa natri
Nguyen nhan
- Thira Na+ kern theo phn: suy tim sung huyet, hOi chimg then hu, benh gan, phu nit mang thai, phn tien phat
- Thira Na+ khong kern theo phn: truyen dung dich muoi, giu natri tai then (cuamg aldosteron tien — thir phat, thira glucocorticoid benh Cushing), tang san tuyen thugng than ham sinh, chimg gia cuamg aldosteron
diem lam sang
Lien quan vai thira nuac: phu, tran dich, sung huyet tinh mach, cao huyet ap, tang can neng, kh6 Oat am
Bun non, non, hfai kho, nhip tim nhanh, cao huyet ap, lo rang, bon chon, may co., run, tang phan xa, da kho
Thuac vit su' thaw Na+
-
Corticosteroid (cortison, prednison)
Natrisalicylat, natriphosphat, natribicarbonat Thu6c ho
Khang sinh: penicillin, carbenicillin, mezlolocillin Cholestyramin, amphotericin B, propoxyphen, lactulose
Dank giti: tang Na+
Na+ man > 146mmol/L - nieu < 40 mEq/L - Ty NT < 1,025
- D them theu HT >295 mosm/kg
(18)1
1111rNgoai then * Tang hO hap
11116 hOi nhi6u o,c
Tai than * Tieu doting
* WI-1g it ntyac Natri nieu D'ang truan
hoac nhtsa truang
> 20 mmoi/L > 10 mmoi/L
Nhuvc, d I hay
u tru, Thay d6i
turang Giam luting natri
ca the Ngoai Atha
* MO h * Tieu ch
Luang natri ca the binh thubng
Phan: 100 mmo1/24 gi6
An: 50-100 mmo1/24 gity
DTH
HT 3,5-5,5 mmol/L
DNTB 1,5%
Da rn6 hoi 0-5 mmo1/24 gioe Than Nixo'c tieu
50-80 nnmo1/24 gier K+
Na+
DTTB 98,5% A Bald • ster n A: Acid
B: Base
CHUO'NG -I • CHUYEN HOA NUCYC - MUOI VC) ca
Tagibligh huyet
Met natri Va nirac (Mat natri < nuxfyc)
Tang luting natri ca the * Tang Aldosteron * Cushing
* Ding nhieu NaHCO3, NaCI
Natri niOu
Dang trulyng hoac Lru
twang < 20 mmoi/L
Hinh 1.8 Sce ch6n down tang natri mau
3 CHUYEN HOA KALI
(19)FlOA SINN LAM SANG
K± la cation chi' yeu cua DTTB, 90% tong lugng dm co the dang tg va co the trao d6i, phan lai barn vao hong ceu, xucmg va mo nao Tuy nhien chi 2% (50-60 mmol) Km hanh DNTB, la lugng to c6 the dem dugc Mang d6 mau a ngoai truang 3,5-5,5 mmol/L Wong dO mau khong phan anh chinh xac tong krcmg kali co the, nhien lugng IC lai dong vai tro quan trong viec tri sir phan cgc cua mang to bao
Luang dua vao co the toy thu6c vao the d6 an u6ng, trung binh 50-100 mmol/24gia, hau het IC dugc tai hap thu a runt, mot luting rat it theo phan bai tiet ngoai (10 mmol/L)
Sg phan b6 gitta DTTB va DNTB duce tri nher born NalCATPase nam mang to bao
3.2 Vai tro cua 1(4-
0 Mk day den truyen xung d6ng than kinh Co co ton — tim — van
0 Tham gia dieu hoa d6 th'em theu dich nOi bao
0 Tang cuong hoat dOng dm men len chuyen h6a cua to bac) Tham gia tri can bang acid — base
Ceti then loc 700mmol K±/24 gia, 95% dugc tai hap thu Ong xa va 6ng gop bai tiet duai six kiem sok cua ADH, tinh trang acid — base, lugng nhep vac., anh huang cua mot so thuoc lgi tieu
K+ nieu binh thuong 50-80mmol/L, thieu hoec met ICE ngoai then IC nieu van gift mirc 20-30mmol/L 10-20 deu Do do, nieu < lOmmol/L la thieu K± man du IC mau binh thuong
3.3 Vai tro cua thOn
Can bang kali DNTB dugc hem sok bai then va phan nao bai 6ng tieu h6a, binh thuong kali dugc loc to qua cau then m76i khoang 700mmol, heu het dugc tai hap thu tnroc den Ong lucm xa va dirge bai tiet tai 6ng 1-iron xa va 'Ong gop Sg bai tiet kali qua nu6c tieu chiu sir chi phoi bad:
0 NOng dO Na+ c6 the tai hap thu tai 6ng loon xa va 6ng gop ,
11 Moi tuong quan giita va H+ tai cac to bao 'Ong lugn xa va 'Ong gop Kha nang tiet cac to bao
Nong d6 aldosteron Tec d6 cua dich loc
Aldosteron tac dung tang tai hap thu Na+ tai eng loon xa va 'Ong gop thong qua bum
Na+K-FATPase bang each gia tang tong hop enzym —> tang thai
CO sg canh tranh gifra viec bai tiet va 1-1± tong qua trinh tai hdp thu natri
(20)CHU'O'NG ► CHUYEN HOA NU'O'C - MUOI VO CO'
Anh htrang cua tinh trang nhiem acid-base rat quan trong phan be) kali Khi nhiem acid (I-I+ cao), c6 khuynh htrang di vao to bao, K± se di chuyen theo chieu ngagc lai - tang K± mau
Khi nhiem base (11±thAp), c6 khuynh huong di khoi to bao thay ch8 cho ngoai bao giant mau Dieu giai thich vi giant mau - nhiem base: khOng dit IC de tai hdp thu Na+ nen ca the sir dung E1+4 tang bai Wet fl+
Insulin fink day qua trinh tai hdp thu qua mang to bao bang co cite kich thich born NalCATPase Six thieu but insulin dran to i tham kali khoi to bao Co the coy nghla quan trong viec dieu tri tang kali huyet Catecholamin anh htrang len six phan bo kali, (3-adrenergic gia tang qua trinh di& day kali vao to bao, a- adrenergic c6 tac dung ngtrgc lai
Sg dap irng kali nieu nhing trtrong hgp sinh benh VT c6 hieu lgc nhtmg cham Vi du nhtr tru6ng hop nhap thieu hay mast kali ngodi than (tieu chay) thi 10-20 dau, kali nieu van giir a mire 2-30 mmol, sau mai giam xu6ng lOmmol Do kali nieu < l Ommol co nghia la co the thieu but kali man mac du kali mau c6 the binh thtrang hay hai giant
3.4 R6i loan chuyen hoa kali 3.4.1.Giam kali
Nguyen nhan gay giam kali huyet o Tieu hoa:
■ Luang kali dtra vao khong du
■ R6i loan tieu hoa: non, tieu chay, re o Nhiem acid Ong than
o Nhiem base chuyen hoa o Lgi tieu
o Dung insulin
o Mineralocorticoid: chirng tang aldosteron tien-thin phat, chung gia tang aldosteron
o Thuoc: penicillin, gentamycin, cysplatin o Leukemia
o Thieu magi& Thu6c anh haang gay giam
o Thu6c x6, chit thut raa o Corticosteroid, kayexalat
o Levodopa (tang mat K±qua nuac tieu)