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5/21/2018 .pdf
1/101
,
,RN,MA
-135-145 meq/l - - -":ADH, Renin-Angiotensin-
Aldosteron system
>135meq/l :
-
,-
:),(' 1.2.:'3. - - -SIADH
)
):>48
5/21/2018 .pdf
2/102
,3. ,4.,5. 6. 7.
:
!!! !!!
: PO,PZ,IV1. -
IV NaCl 0.9%, Ringers Lactated sol
.2 12 meq/l-( )Demyelination
:IV NaCl 3.
)"800(4..5SIADH:, +fusid.6AVP antagonist- IV Conivaptane
(Vaprisol)
-
( )
5/21/2018 .pdf
3/103
:.1 2.
: 1..2
:1. (
) 2.3. 4..5Diabetes Insipidus
.6 , (IVNaBicarbonat(
:1. 2.: 3.--- - -
:Na > 145 meq/l
Osm (bl) > 300 mosm/lOsm (ur)
: !!!
)(1.
(IV Glu 5%)
2.
3. 0.5-1 meq/h
.4Desmopressin (Minirin)Diabetes Insipidus
5/21/2018 .pdf
4/104
:1.2. 3. 4.5.
DI - SIADH
Na/Osm (Ur)
Na/Osm (Bl)
DISIADH
- :3.5-5.0 meq/l- -- -
) )-"-RAAS
>3.5 meq/l:1..2 :,,,('- )-((Cushing dis - -
:,1. ,2. 3.4.
TU
5/21/2018 .pdf
5/105
:1.2. PO/IV.3 ) , , (-
:+1.2.3.
:IV1. IM ,2.
.3 : 20 meq/100 cc/h: 4. ,20 meq/100 cc 5.
5/21/2018 .pdf
6/106
)(1. Kayexalate2.
:1. )(2. .3IV Calcium gluconate.4IV NaBicarbonate.5IV Reg Insulin + glucose.6IV Fusid.7Inh Ventoline.8Kayxalate9.
:1. 2. 3. 4.
99 %1 % - '
( ) 8.6-10.2 mg/dl -++ Ca
1.1-1.3 mmol/l
.1PTH hormone.2Calcitonin
: 1. 2. ) ( 3.4.D 5.
5/21/2018 .pdf
7/107
:1. , 2..3Trousseaus , Chvosteks signs
4.
,, 5.
6.
,7.
8.
) :().(IV Calcium1. 2.
_____________________________
: .1Vit. D
2.
3.
4.
:1.)( 2. 3. Calcium 4.
50%
: 1. 2. 3.
:1. - ) ( 2., ,3. 4.: 5.-6.
:1. ) +(NaCl 0.9%2. 3. .4IM Calcitonin
5.
.6Mithrhtramycin
7.
8.
5/21/2018 .pdf
8/108
:1. 2. 3.4. 5.
-- :1.51.51.51.5----2.5 meq/L2.5 meq/L2.5 meq/L2.5 meq/L
>1.5
:'
: ),
) , ,
:
IVIVIVIV ( )
2.5
:- )OTCOTCOTCOTC (MaaloxMaaloxMaaloxMaalox
:
' -
5/21/2018 .pdf
9/109
:
IV CalciumIV CalciumIV CalciumIV Calcium
:2.52.52.52.5----4.5 mg/4.5 mg/4.5 mg/4.5 mg/dLdLdLdL
ATPATPATPATP - ) ) -
:
-
: ) IVIVIVIV)IVIVIVIVPOPOPOPO
:
- : ,:,:
,,CSF :96-106meq/L
:, ' :, ,:
5/21/2018 .pdf
10/1010
: :, ,
: ,- , , , -