SINH L

DCH C TH
1. Phn bit c cc ngn dch ca c
th.
2. Trnh by c KN v ni mi v hng tnh ni
mi.
3. Xc nh c TC v CN ca cc loi dch c
th.

4. Phn tch c cc c ch H V dch v TBKT

 LNG NC XUT NHP HNG NGY

Hai ngun nhp nc chnh: 2300ml/d

- Tiu ha: 2100ml/d
- Chuyn ha: 200ml/d
Bn ng mt nc: 2300ml/d
- Urine: 1200- 1500 ml/d
- Phn: 200ml/d
- H hp: 300- 400 ml/d
- M hi: 300- 400 ml/d
 HAI KHOANG DCH

Phn b
Ngi trng thnh: 50kg
Dch c th (30lt # 60%)

ICF(20 l # 40%) ECF(10 l # 20%)

Plasma Dch k
Hai nhm: (3,3 l # 6,6%)
(6,7 l # 13,3%)
- Cht khng in gii: u th
- Cht gii:qnh tnh thm thu/dch b
 NNG THM THU CA ICF V
ECF

NTT /ECF l: 285 mosmol.10L= 2850 mo

NTT /ICF l: 285 mosmol.20L= 5700 mos

C s cn bng v NTT / ICF v ECF

Khi c s NTT/ ECF NTT/ ICF

Cn bng mi c thit lp
 EX: BN mt 6 L nc

VICF mt: VECF mt:

20l - (2/3 x 6) (10 l (1/3 x 6)

= 16 lt = 8 lt
NTT 2 ngn t gi tr mi:

5700 2850
C ICF C ECF 350mosmol / L
16 8

Tm li: duy tr tnh hng nh/ NTT

ICF, phi c c ch .ha V, NTT/ ECF.
 TRUNG HA V IN CA ICF V ECF
in tch anions = in tch cations tng ng
Thnh phn Plasma Dch k
(mOsmol/l) (mOsmol/l)
Na+ 142 136
K+ 4 4,5
Ca++ 2,4 2,4
Mg++ 1,2 2
TNG CNG 149 145
Cl- 103 111
HCO3- 27 28
PO4- - 1,8 1,8
 NI MI

Khi nim: dch ngoi bo cn c gi l l

mi trng bn trong c th hay ni mi.

Hng tnh ni mi: duy tr cc trng thi hoc

iu kin hng nh trong ni mi.
 CC H THNG THAM GIA IU HA
HNG TNH NI MI
H thng tip nhn cht DD, tiu ha v chuyn ha cht DD
- H h hp
- H tiu ha
- Gan
- Cc m khc: m m, nm ng t/ha, thn v tuyn ni tit

H thng vn chuyn cht dinh dng: tim v mch mu

H thng bi tit cc sn phm chuyn ha

- H h hp
- H niu
- H tiu ha
- Da
CC KHOANG DCH NGOI BO

Huyt tng: 5% trng lng c th

CN ca huyt tng:
+ Protein/ht > gp ba ln ca dch k, c HMW, khng
thm qua cc l nh ca thnh mao mch, to ra mt
lc thm thu vo khong 28mmHg, gi l p sut keo.
+ H TBTK, ng mu, bo v c th, vn chuyn cc
cht
CC KHOANG DCH NGOI BO

Dch k: chim khong 15% tng BW.

Chc nng ca dch k
CC KHOANG DCH NGOI BO
DCH BCH HUYT

VC ddng (Chylomicron) t TH

L con ng BC lympho ti tun hon

a tr li sys t.hon 1 lng protein v

t khoang k

Kim sot [protein], V v P / khoang k

CC KHOANG DCH NGOI BO
DCH NO
TY
- khng mu, t trng khong 1.005
- khng protein ( 20- 30 mg/dl )
- khng t bo ( 5 BC L/ mm3 ).
- Na+ # huyt tng
- Cl- cao hn 15%
- K+ thp hn 40%
- Glucose thp hn 30%
 DCH NO TY (tt)

- m cho no trong hp s cng

- VDNT thch nghi vi nhng V ca hp s
DCH NHN CU

nm trong mt v gi cho mt lun c

Cn bng bi tit & hp thu / thy tinh

dch
V v P/ dch nhn cu lun n nh (15 mm
IU HA HOT NG C TH
BNG C CH TH DCH
H hot ng c th bng c ch th dch l H thng
qua hng tnh ni mi (homeostasis).
Gia ni mi v cc c quan c mi quan h qua li rt
cht ch
Ni mi l dch ngoi bo vi hai thnh phn chnh gm
nc v cc cht ha tan. Duy tr hng tnh ni mi l
duy tr s n nh ca hai thnh phn ny, ni cch khc
l iu ha thng qua dch v nng cc cht c trong
dch.
IU HA TH TCH DCH
IU HA Cosmol/ECF
 IU HA TH TCH DCH
QU TRNH XUT NHP NC

NTT K0 ung thi n

Kht ADH Ht kht ADH

Ung gi nc NTT
 IU HA VECF

- ANP (Atrial Natriuretic peptid)

- Renin Angiotensin system = RAS

Td/ ANP
 Decreased
effective
Angiotensinogen
VASODILATION
Arterial Renin
blood
volume
(-) Angi I PG Nitric oxide
Bradykinin
Tanatril(-) CE
Endotheliu
Inactive
Normal Angi II peptid m
Thirst

Vasoconstrictio Aldostero ADH NA H 2O

n n Intake
Blood
presure Na+ H2O
reabsorption reabsorption

The renin- angiotensin system helps maintain

 TI PHN B NC GIA CC NGN
DCH V CC VNG

Nc c th khuch tn qua li gia cc ngn

dch mt cch d dng v nhanh chng do
mi s thay i v th tch mt ngn s dn
n s chia u cho cc ngn cn li.
Cc p sut ch yu nh hng ln s di
chuyn ca nc l p sut thy tnh v p sut
thm thu.
MM U TIU MM U TIU TM
M

KHOANG K
9/1
0

H BCH HUYT 1/10

MM U Pk HT MM U
TIU M Pk dch P m dch TIU TM
Ptt mm k k
 CC P SUT HAI U MAO
MCH
Cc p Tc dng Mao mch Mao mch
sut vi lng u M u TM
mch
P thy tnh y dch ra 30mmHg 10mmHg
mm
P keo dch Ko dch ra 8mmHg 8mmHg
k
P m dch Ko dch ra -3mmHg -3mmHg
k
P keo HT Ht dch 28mmHg 28mmHg
vo
Chnh lch Lc y v Lc ht v
lc lc y:
IU HA THNG BNG TOAN KIM

pH ca cc dch c th t thay i l nh
c th t duy tr pH bng cc h m
trong v ngoi t bo, s o thi acid
ca phi v thn.
 KHI NIM pH v ion H +

Theo khi nim ca Bronstedt:

+ Acid l mt cht c th gii phng ion H+
+ Base l cht c th tip nhn ion H+.
+ acid ca mt dd: pH = - logH+
Dd trung tnh: lng ion H+ v OH- tng ng nhau
v bng 10-7. Ch s nng ion H+ v OH- trong dung
pH mu = - log [H+]= -(log 4.10-8) = 7,398
Hay theo phng trnh Henderson-Haselbach:
pH = pK + log [HCO3-/H2CO3] = 6,1 + log 20/1 7,4
 CC H THNG IU HA pH
H do h thng m: mt acid yu v mt mui ca
base mnh hoc mt base yu vi mui ca n vi mt
acid mnh.

H do h hp: c th ng nhiu CO2, s lm pH

gim, pH gim ti 7,33 s lm TTHH b kt mnh dn ti
tng thng kh, nh vy CO2 c o thi ra ngoi.
Ngc li, khi H2CO3 gim hoc NaHCO3 tng, pH s c
xu hng tng th trung tm h hp s b c ch dn ti
th chm, CO2 tch t li.

H do thn: o thi H+, HCO3-

Ex1: HCl + NaHCO3 H2CO3 + NaC
H+ + HCO3
Nhp th
CO2 H2O
bi tit H+

Ex2: NaOH + H2CO3 NaHCO3 + H

Thn
Ex1: HCl + Na2HPO4 NaH2PO4 + NaCl
Thn

Ex2: NaOH + NaH2PO4 Na2 HPO4 + H2O

Thn
 TM TT QU TRNH H TBTK

Khi tng H+ trong c th:

Bc 1: H+ c m bi h thng m trong c th.

Bc 2: C ch b tr ca h hp, thi tt c CO 2 sinh

ra qua phi.
Bc cui cng: l c ch b tr ca thn khi phc
li "kho d tr" m trong c th, bi tit cc H+ cn
tha trong c th.
H NNG CC CHT C TRONG DCH

Cc cht kh.
Cc ion.
Cc hormon.