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:https://www.slideshare.net/secret/1ed62HSkwSsmzw
25/02/2016
!, , ! : ! , !
: ; ; ; .
?
: 83%
,
%
45% 1 30% 20%
+ + Hall JE. Medical Physiology. Saunders, 2011
(/) 6055 8085 160130 300270
, , , , , . , , t , ,
Na I
II
Na ( Na);
-
, ,
--
, . . , . . , . , . 3-4 .
! (% ) 3-4 380-400 (10%)1 10 800 (8%)7-10 25-30 1250-1300 (5-3%)
50-70 1200-1400 (2,5%) (2%)
! !
. .
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.. , .. - . 2015
.. , .. - . 2015
.. , .. - . 2015
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Markus Weiss, Zrich, 2014
10 N : 6 10 N . 4 .
/ ( , 2013) 4R:1- R: Resuscitation 2- R: Routine maintenance3-
R: Replacement 4- R: Redistribution
5- R Reassessment .
, / / , , -, , /
, / / , , -, , / 4R ?
= 1 //. 2 - 2,5 , , .
,
= 1 3 // (25 75 //). 5 //.
2 482-6 446-12 3912-18 3418-24 3224-30 3030-36 273 244-6 227-12
1813-18 12-16
1 0.542-3 0.5354-8 0.5259-13 0.4914-60 0423-5 0.366-11 0.3551
0.353 0.364-5 0.3710-15 0.39
. MM Wintrobe (1962)
I = . II = 80% . III = 50% (10% ).
= + (25 //), 1,2 //. = ( ).
? !
1 =100 (3 ) = //. , .
Holliday-Segar : 100 , , 100 .
10 (0-10 )100 // 10 (11-20 )1000 + 50 //>20 1500 + 20 //
, 2400 /Holliday-Segar
4 - 2 -1
, 100 /Holliday-Segar 10 (0-10 )4 // 10 (11-20 )40 / + 2
//>20 60 / + 1 //
1- 60 //2- 90 //3- 120 //4- 150 //5- 3- 150 //3-6 . 140 //6-12 .
120 //1-3 100 //3-6 90 //6-10 70 // 10 40 //
, /, /1- 00 2- 2 4 2 4
? . : 5-10-20% . , : 2-30 //, .
, , , . 1 , , , , , , , , ( , ).
2- ) ( 10 / )
Deficit therapy
(/) : 200 250350 1 150170200-2205 10015017510 80110130 10
5075100
K = (4,5 ) 0,6
Na = (140 Na) 0,3
I-II , - III . - . 2 :1- : 4-6 - . I 30-50 /, II 100 /.
1 : ; ; ; ; ; . 1 4-6 2 , . 50-100 / 10 / .
, : 60 /; 20 /; 10 /; 110 /; 250 /. , , . 200-250 /.
III , , - . , - . - , . (5% , ) .
(Na=135-145 /) 5% 0,9% - 2 : 1. , .
- , , , , .
(Na>145 /) 5% 0,9% (3:1).
, 2-3 /.
140-150 /, , , ; > 150 / , , .
.
. 1 / 8% . 15-20 , , .
(5% + 0,2%NaCl + 20-30 / KCl) : =10 , 10% = 1 . = 1000 1 - 20 /,
200 (20 /)
2 24-48 , + 800 + 1000 = 1800 1800 : 24 = 75 / 10-12 //.
3 + 1000 : 24 = 42 / +
0,9% NaCl: 20 / 20 . ( ) , :[Na]: 145-157 /: 24 [Na]: 158-170 /:
48 [Na]: 171-183 /: 72 [Na]: 184-196 /: 84 : : 5% + 0,2% NaCl 5% +
0,45% NaCl ( 20 / KCl, ) : 1.25-1.5 , .
(Na
