肾内泌尿
词汇介绍
拓展阅读
解析
metabolic 英 /ˌmetəˈbɒlɪk/ 美 /ˌmetəˈbɑːlɪk/
释 义 adj. 变化的；新陈代谢的
同根词 metabolism n. [生理] 新陈代谢
metabolize vi. 新陈代谢
metabolize vt. 使新陈代谢；使变形
例 句 Phospholipids is the basic composition of membrane material, its synthesis and metabolic activity not only play an important physiological role in the cells.磷脂作为生物膜的基本组成物质，其合成和代谢不仅在细胞生理活动中发挥重要的角色。
alkalosis 英 /,ælkə'ləʊsɪs/ 美 /,ælkə'losɪs/
释 义 n. 碱中毒，碱毒症
例 句 Graph of changed scope of compliance about renal participating in compensatory adjustment were drawn out in chronic respiratory acidosis and alkalosis separately.分别绘制了慢性呼吸性酸、碱中毒时，肾参与代偿调节顺应性的变化范围曲线图。
概述
概述
代谢性碱中毒是一种代谢性疾病，其中组织的pH升高至正常范围（7.35-7.45）以上。这是氢离子浓度降低导致碳酸氢根浓度升高的结果，或者是碳酸氢根浓度升高的直接结果。如果肾脏功能正常，该病通常不能持续很长时间。
病理生理学
氢离子的损失-最常见的是通过呕吐或肾脏两种机制引起的。呕吐导致胃内容物损失盐酸（氢和氯离子），剧烈呕吐会导致钾（低血钾）和钠（低钠血症）的流失。肾脏通过将钠保留在收集管中以弥补氢离子的损失来弥补这些损失（保留钠/钾泵以防止钾的进一步损失），从而导致代谢性碱中毒。先天性氯化物腹泻-罕见的是引起碱中毒而不是酸中毒的腹泻。收缩性碱中毒-这是由于细胞外空间中水分的流失，例如脱水引起的。细胞外体液的减少会触发肾素-血管紧张素-醛固酮系统，随后醛固酮会刺激肾脏肾单位内钠（进而水）的重吸收。但是，醛固酮的第二个作用是刺激肾脏排出氢离子（同时保留碳酸氢盐），正是这种氢离子的损失提高了血液的pH值。利尿剂疗法-利尿剂和噻嗪类药物起初都可能导致氯化物增加，但是一旦存储耗尽，尿液排泄量将低于25 mEq/ L，钠排泄引起的体液流失会引起收缩性碱中毒。碱性物质-过量施用的碱性物质，例如碳酸氢盐（在消化性溃疡或胃酸过多的情况下使用）或抗酸剂会导致碱中毒。
临床表现
轻度的代谢性碱中毒病例通常不会引起任何症状，中度至重度代谢性碱中毒的典型表现包括感觉异常，神经肌肉易激动，手足抽搐，心律异常（通常是由于伴随的电解质异常，例如血液中钾水平较低），昏迷，癫痫发作等。
治疗方法
找出根本致病原因（例如幽门梗阻，利尿剂的使用等）；纠正损害肾脏碳酸氢盐排泄的缺陷（即给予氯化物，水和K +）；用生理盐水扩大ECF量（如果缺乏钾离子，则增加KCl）；如果诊断不明显，则可采用氯化尿液，低浓度表明氯离子耗尽，需要更换，高水平提示肾上腺皮质过量，需要更换钾离子；罕见的辅助措施：输注HCl，乙酰唑胺，口服赖氨酸盐酸盐。
An Unusual Cause of Metabolic Alkalosis and Hypocalcemia in Childhood
复制标题
儿童代谢性碱中毒和低钙血症的罕见原因
发表时间：2019-04-01
影响指数：6.9
作者： Tony Huynh
期刊：Clin Chem
In the pediatric population, hypokalemic, hypochloremic metabolic alkalosis is seen in the neonatal period as a result of idiopathic hypertrophic pyloric stenosis leading to chronic gastric outlet obstruction. Less common causes of pediatric gastric outlet obstruction include malrotation, midgut volvulus, and antral webs in the first year of life and Crohn disease and hiatus hernia in later childhood. Neoplasia, although rare in childhood, should be considered in the differential diagnosis. In addition to primary gastric lymphoma and adenocarcinoma, external compression can result from a wide range of tumors, including hepatoblastoma, hepatocellular carcinoma, pancreatoblastomas, and soft-tissue sarcomas of the mesentery or abdominal viscera. Before the recognition of the pathophysiological role of Helicobacter pylori and the subsequent adherence to targeted Helicobacter pylori eradication protocols, peptic ulcer disease was thought to be responsible for up to 90% of cases of gastric outlet obstruction in adults. It is infrequently seen in childhood. Obstruction results from acute peptic ulcers due to inflammation-induced edema and tissue deformation, whereas chronic peptic ulcer disease leads to scarring and tissue remodeling as part of the healing process. The vomiting in gastric outlet obstruction is forceful and often described as “projectile.” It occurs predominantly as a result of mechanical obstruction with repetitive gastric contractions generating a pressure gradient leading to evacuation of accumulated gastric contents. Helicobacter pylori infection is commonly associated with dyspepsia and nausea, which may exacerbate the vomiting.
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