论文部分内容阅读
患者男,42岁.因发热,头痛、腰痛.尿少1周转入本院.体检:体温、脉搏、呼吸均正常,BP24/14kPa.洒醉貌,球结膜轻度充血.心肺听诊正常.肝肋下1.0cm,两肾区叩击痛.下肢轻度水肿.实验室检查:血WBC12×10~9/L,中性0.80,淋巴0.20,异型淋巴细胞0.07.尿蛋白十十,红细胞十十.血肌酐675μmol/L,尿素氮23mmol/L.血pH7.22,血Na~+130mmol/L,K~+4.0mmol/L,CI~-90mmol/L.Ca~(2+)2.0mmol/L,Mg~(2+)0.69mmol/L.诊断为流行性出血热(EHF),急性肾功能衰竭(ARF)少尿期,代谢性酸中毒.入院第2天开始血液透析,连续3天,每天4小时.第5天开始尿量增至1000ml以上.第7天再透析,此时病情明显好转,血电解质除钙偏低外均在正常值范围内.第8天开始常规补钾.在每500m15%葡萄糖液体中加氯化钾1g,当天输液2000ml,以后3天均为2500ml.翌日血钾即达6.2mmol/L、由于当天尿量在3000ml以上,未引起足够重视,继续补钾3天.血钾高达7.5mmol/L.患者胸闷,疲乏,肌酸痛.ECG示高钾.立即予高渗葡萄糖和碳酸氢钠等
Male patient, age 42, due to fever, headache, back pain. Less urine 1 week transferred to our hospital. Physical examination: body temperature, pulse, respiration are normal, spilled drunk, bulbar conjunctiva mild hyperemia. Cardiopulmonary auscultation normal. Hepatic ribs 1.0cm, two kidney area percussion pain .Lower limbs mild edema .Laboratory examination: blood WBC12 × 10 ~ 9 / L, neutral 0.80, lymph 0.20, atypical lymphocytes 0.07. Urine protein ten, red blood cells ten Serum creatinine 675μmol / L, urea nitrogen 23mmol / L. Blood pH7.22, blood Na ~ + 130mmol / L, K ~ + 4.0mmol / L, CI ~ -90mmol / L.Ca ~ (2+) /L,Mg((2+)0.69mmol/L. Diagnosis of epidemic hemorrhagic fever (EHF), acute renal failure (ARF) oliguria, metabolic acidosis .2 days after hemodialysis on admission, continuous 3 Day, 4 hours a day .First day 5 urine volume increased to more than 1000ml .Dialysis on the 7th day, when the condition was significantly improved, blood electrolytes except calcium lower outside the normal range.On the 8th day routine potassium In each 500m15% glucose solution plus 1g of potassium chloride, the day of infusion 2000ml, 3 days after the average of 2500ml. The next day that potassium is up to 6.2mmol / L, because the day the amount of urine in more than 3000ml, did not pay enough attention to continue to make up Potassium 3 days. Potassium up to 7.5mmol / L. Patients with chest tightness, fatigue, creatine .ECG shown potassium. Now I hypertonic glucose and sodium hydrogencarbonate