?

&

ECF, ICF,

0

40

80

120

160

Na+ K+ Cl- HCO3- HPO42-

m

m

o

l

/

L

++

(50-55 mmol/kg)ECF ECF 2%

ICF 98%98%(1(1440mmol/L)0mmol/L)

[[++] ] 3.5~5.5mmol/L3.5~5.5mmol/L

[+] &

Na+-K+-ATPase

2 K+

3 Na+

Doucet A. Kidney Int 1988;34:749

Brown RS. Kidney Int 1986;30:116

+ : +

+ ECF & ICF +

+ +

Sterns RH et al. Medicine 1981;60:339

Knochel JP. Am J Med 1982;72:521

&

&

Na+-K+-ATPase +

pH 9 9 Tumor lysis syndrome

Rose BD & Post TW. Clinical Physiology of acid base and electrolyte disorders 5th edition;2001

Na+- K+- ATPase

3 Na+

2 K+

9 9

9 9

Reza MJ et al. N Engl J Med 1974:291:777Kaji D et al. Am J Physiol 1987;252:F785

Cox M et al. N Engl J Med 1978;299:525

:(Na+-K+-ATPase & )

2 - + - +

( Na+-K+-ATPase / Glc)

+ (, )

&

+ + 2.0 mmol/L

2 K+

3 Na+ . +

. +

*Tourniquet /

Lindinger M et al. Am J Physiol 1992;262:R126

&

Na+K+

+

+

+

+, + Na+

&

[K+][K+]:: KK+ + ICF ICF ECFECF KK++

[K[K++]] H+ ECF

K+ & Na+ ( ) [K[K++]] K+

Adrogue HJ et al. Am J Med 1981;71:456Graber M. Am J Kidney Dis 1993;22:436

&

HH22O O KK++

..

Conte G et al. Kidney Int 1990;38:301Nicolis GL et al. Arch Intern Med 1981;41:49

/&

Drakos P et al. Am J Clin Oncol 1994;17:502Lawson DH et al. Q J Med 1972;41:1

(( ++ )) / / crash syndromecrash syndrome

(( ++ ))

( 12)

((GMGM--CSF)CSF)

1

+ :

ECFECF && ICFICF

[K+]

9 9 9

Stanton BA. Am J Physiol 1989;257:R989Kaufman JS et al. Am J Physiol 1985;248:F228

: :

+ + HenleHenle = = >>90% 90% KK++

..

:: (( NaNa++&H&H++).).

&

Okusa MD et al. Am J Physiol 1992;262:F488

H

+

-

K

+

-

A

T

P

a

s

e

Giebisch G et al. Kidney Int 1996;49:1624

K+( K+)

+( K+):

( )

( )

Na/K Na/K ATPaseATPase

KK++

NaNa++

NaNa++

--50 mV50 mVKK++

Aldo-Rec Aldo

+-Cl-

Himathongam T et al. Clin Endocrinol Metab 1975;41:153

:: ZonaeZonae GlomerulosaGlomerulosa

:: //::

, ,

KK++

:: NaNa++ KK++ HH++ KK++ && NaNa++

()

Himathongam T et al. Clin Endocrinol Metab 1975;41:153Rabinowitz L. Kidney Int 1996;49:1738

:: / /

KK++..

Giebisch G et al. Kidney Int 1996;49:1624

+ : () K+

& & KK++

& & KK++

Young DB et al. Am J Physiol 1983;244:F28

Na/K Na/K ATPaseATPase

KK++

NaNa++

NaNa++

--50 mV50 mV

KK++

Aldo-Rec Aldo

+-Cl-

< 4 mmol/L

4 mmol/L

100 mmol/L

Na/K Na/K ATPaseATPase

KK++

NaNa++

NaNa++

--50 mV50 mVKK++

Aldo-Rec Aldo

+-Cl- :- - SO42-

X

+

99 99

Na+

3Na+2K+

Malnic G et al. Am J Physiol 1989;256:F932

& & KK++

0.10

0.20

0.30

0.40

0.50

10 20 30Distal tubular flow rate, nanoL/min

D

i

s

t

a

l

K

+

s

e

c

r

e

t

i

o

n

,

n

a

n

o

m

o

l

/

m

i

n

Khuri RM et al. Am J Physiol 1975;228:1249

High K+ diet

Control diet

Low K+ diet

+

+

+

: &

+ ( )

: & + : ,

? & [+] & & & Na+- K+- ATPase & & & & / & 1 & () & K+ & K+