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Condition analysis:
Renal tubular acidosis, the clinical manifestations the distal tubule H secretion disorder, decreased plasma HCO-3, the recovery of cl-increasing, and because hyperaldosteronism, sodium retention but also in retaining cl-, leaving the blood chloride increased, causing high acidosis , showed weakness, anorexia, nausea, vomiting, breathing fast or deep perception of slow; the same time reduce the renal tubular secretion of H, resulting in H and Na exchange, the loss of a large number of K Erzhi hypokalemia, can be expressed as muscle weakness, severe appears periodic paralysis; K also caused substantial loss of the increase in N Na excretion, instead of the last Ca2 K, Na excretion, causing hyponatremia, hypocalcemia. The former patients may have headache, facial expressions indifferent, low blood pressure, etc.; The latter patients may have tetany and renal bone disease.
distal renal tubular secretion of H barriers can lead to acidification of the urine, urine 6.0; urine concentration is reduced, causing polydipsia, polydipsia and polyuria.
Other: patient may hematuria, renal colic, urinary tract infections and pyelonephritis secondary to severe glomerular damage caused when uremia.
(2) proximal renal tubular acidosis: the proximal tubular absorption of HCO-3 back to a lot of barriers to discharge, the renin - angiotensin - aldosterone system activity was enhanced stimulation of secondary aldosteronism Na-K exchange , resulting in a


n increase in K excretion, causing hypokalemia: while glucose, amino acids from the urine, uric acid and phosphate excretion, resulting in lower blood concentrations of uric acid and phosphate, causing acidosis, the main symptoms are fatigue, weakness, nausea, anorexia and so on. and proximal renal tubular acidosis remains a typical example of high chloride acidosis.
3, the diagnosis of renal tubular acidosis
(1) distal poisoning: clinical manifestations and the above plasma HCO-3 decreased, CO2 binding is reduced, blood K, Ca2, PO3-4, Na low Cl-increased blood and urine 6.0,24 hours urinary Na, K, Ca2, PO3-4 emission increased and so can be confirmed; feasible ammonium chloride loading test. the first day of basic drugs stop the next day, three times after the oral administration of 0.1g/kg given ammonium chloride for 3 days in urine PH, such as urine PH can not be reduced to 5.5 below, which have diagnostic significance, regular use of atypical clinical cases, such as urine PH at 6.0, while the other symptoms not obvious, if the patient has liver disease, can not be applied chloride ammonia, calcium chloride can be used instead.
(2) proximal tubular toxicity: According to the typical clinical symptoms and laboratory tests, blood HCO-3 reduction in carbon dioxide combining power decreased, hypokalemia, increased blood Cl-; urinary HCO3 content increased, accompanied by amino acids in urine, diabetes and so on. systemic acidosis, urine PH of 5.5 can be reduced to below the amount of fractional excretion of filtered bicarbonate, etc. greater than 15% can be confirmed.
Suggestion:
Renal tubular acidosis, treatment and care
Mainly to correct the acidosis, the principle of treating the primary disease.
(1) distal renal tubular acidosis: first correct the acidosis with sodium bicarbonate 3 ~ 10g / day orally or by injection several times; followed to correct electrolyte imbalance, hypokalemia if potassium were added in time, can be taken orally 10% Gouchuan Potassium 10ml 3 times a day; a calcium supplement calcium are; the bone disease of vitamin D were available agents, protein synthesis agent.
(2) proximal renal tubular acidosis: its treatment of basic and type similar, but with a larger dose of sodium bicarbonate a day, about 5 ~ 10mmol/kg, potassium also should be noted, caution diuretics, such as fast urine, the urine hydrochlorothiazide thiophene and so on. severe renal tubular acidosis required bed rest. And be high-calorie, high protein, vitamins of the light diet;
wards shall maintain appropriate temperature and humidity, ventilation time, doing all kinds of care operation, it is necessary to strictly aseptic operation, and should pay attention to the patient warm and avoid cold, cold.
accurate records of intake and output should be and do the laboratory tests. Out of the body reflects the amount of water, electrolyte, acid-base balance of the important indicators, a direct response to changes in patient condition, and various laboratory tests and diagnosis for the condition to provide a good basis, it should be properly collected urine and other specimens, and timely submission.
Renal tubular acidosis in patients with acid-base imbalance, electrolyte disorders, low immunity, urea can be excreted from the salivary glands, and calm the skin, causing bad breath, mouth ulcers, skin itching, so strengthening the oral and skin care at the same time, should be Good hygiene education, attention to personal hygiene.
Closely observe the patient mind, body temperature, pulse, respiration, blood pressure, urine and the reaction after administration. Because they can suggest disease progression but also conducive to abnormal circumstances, such as renal tubular acidosis caused by many, and kidney disease can also lead to high blood pressure, high blood pressure and renal vascular lesions continue to increase, so that further deterioration of renal function, so by observing the changes in blood pressure can understand the patient's condition changes.
Recurrent renal tubular acidosis and easy to make hygiene education and discharge instructions. Reasonable arrangements to enable patients to their daily life, to avoid infection and other parts of the upper respiratory tract infection, and strengthen the training, enhance the body resistance.



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