シチュエーションで学ぶ　輸液レッスン　第3版

出版社： メジカルビュー社
著者：
発行日： 2021-03-20
分野： 臨床医学：一般  >  栄養/食事/輸血
ISBN： 9784758317825
電子書籍版： 2021-03-20 （第3版第1刷）
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「読みやすさ」「理解しやすさ」にさらにこだわった充実の第3版！

目次

  • プレテスト　あなたの輸液の実力は?

    第１章　輸液の基本・輸液の実際
    【輸液の基本】
    　総体液量は体重の60％ , 血液量は体重の約7.5%
    　輸液の目的はNaと水の補充
    　輸液製剤の代表選手は生理食塩液と自由水（5%ブドウ糖液）
    　1Lの生理食塩液を投与すると250mLが血管内に残る。
    　　5％ブドウ糖液なら83mLしか血管内に残らない
    　1Lの自由水を投与してもわずか83mLしか血管内に残らない！
    　低張液（ソリタ®-T3）1L投与後の体内分布を考えよう
    　1価のイオン1mmolは1mE（q メック），2価のイオン1mmol は
    　　2mEqになることを覚えておこう
    【輸液の実際】
    　高ナトリウム血症があれば脱水，なければ細胞外液量欠乏とよぶ
    「脱水」（細胞外液量欠乏）状態かをみたければ患者さんの
    　　脇，舌，爪など身体をくまなく診察する！
    　輸液療法の基本は，初期アセスメントとモニタリング
    　輸液の投与量と投与速度を決めるには？−1日当たりの投与量をイメージしよう
    　Advance
    　有効循環血液量減少，有効動脈血液容量，細胞外液量欠乏，脱水について
    　生理食塩液の浸透圧は308でなく286mOsm/kg・H2Oなのはなぜ？

    第２章　電解質，酸塩基平衡
    【Na・水バランス】
    　腎臓でのNaと水調節メカニズムを理解する
    　浮腫の原因は，(1)静水圧上昇，(2)膠質浸透圧低下，(3)血管透過性亢進，
    　　　(4)リンパ灌流不全
    　全身性浮腫の治療では，まず食塩を制限する
    　利尿薬は尿細管でのNa再吸収を阻害し，Naと水の排泄を促進する
    　ループ利尿薬はヘンレループ太い上行脚で作用する最強の利尿薬
    　サイアザイド系は遠位曲尿細管で作用するマイルドな降圧利尿薬
    　鉱質コルチコイド受容体拮抗薬（K保持性利尿薬）はループ利尿薬や
    　　サイアザイド系利尿薬との併用で効果が増強する
    　急性重症低ナトリウム血症は致死的な病態！
    　　慢性低ナトリウム血症はQOL低下を生じる！
    　低ナトリウム血症をみたら，まずは本物か偽物かを見極める！
    　低浸透圧性低ナトリウム血症であれば，まずは水中毒を除外！
    　水中毒を除外したら，細胞外液量に注目する！
    　術後患者にみられる低ナトリウム血症は医原性ともいえる
    　　―漫然と維持輸液を処方し続けてはならない
    　下痢にみられる低ナトリウム血症―原因はNa喪失といってよいのだろうか
    　SIADHの診断をマスターしよう
    　低ナトリウム血症の治療にあたっての考え方
    　重篤な神経症状がある高度低ナトリウム血症に対する緊急補正
    　症状が軽微な慢性低ナトリウム血症に対する治療の進め方
    　　―細胞外液量欠乏を伴う低ナトリウム血症
    　SIADHの低ナトリウム血症をどのように治療するか（正攻法）
    　高ナトリウム血症の原因は口渇中枢の異常，尿濃縮力障害，水分摂取量低下である
    　高ナトリウム血症の診断
    　高ナトリウム血症の治療法をマスターしよう
    　Advance
    　トルバプタンは集合管に作用する「水利尿薬」
    　SGLT2阻害薬は近位尿細管に作用し利尿作用を伴う新規経口血糖降下薬！
    　グリコカリックスと改訂Starlingの法則
    　脱塩現象（desalination）　生食を投与すればするほど低Na血症が進行する!?
    【Kバランス】
    　血漿K濃度は(1)食事や輸液からのK摂取（intake），(2)細胞内外のK移動，
    　　(3)腎臓からのK排泄（output）のバランスによって調整されている
    　腎臓のK排泄量は，Naの摂取量に影響される
    　利尿薬を服用中の患者さんでは低カリウム血症に注意
    　低カリウム血症の鑑別診断の進め方
    　K補充は経口投与が原則。点滴補充は適応を十分に検討すること
    　高カリウム血症は，(1)K摂取過剰，(2)K排泄障害，(3)細胞外への
    　　K移動のどれかで起こっている
    　高カリウム血症をみたら，(1)K再検査，(2)心電図モニター，
    　　(3)治療の緊急性を判断
    　高カリウム血症の治療法
    　Advance
    　腎臓のK調節機序
    　RAA系阻害薬服用患者にみられる高カリウム血症の管理
    【酸塩基平衡】
    　酸塩基平衡を理解する
    　Henderson-Hasselbalchの式を理解しよう
    　動脈血ガスはステップワイズ法で読む！　練習あるのみ！
    　動脈血ガスの代償性変化を予測する
    　3つのSTEPで血液ガスを解釈する
    　AGの増加は代謝性アシドーシスの存在を示している。
    　　高AGアシドーシスの鑑別はKUSSMAL-P
    　補正HCO3 − を計算して隠れた代謝性アルカローシスをみつける
    　　（ステップワイズの3）
    　代謝性アシドーシスの原因を理解しよう
    　代謝性アシドーシスの治療法 −安易にメイロンを使用してはいけない
    　Advance
    　酸塩基平衡異常の解釈法：Boston学派，Copenhagen学派，Stewart法
    　静脈血液ガス，静脈血［HCO3 − ］，総CO2含量
    　尿アニオンギャップ
    【そのほか（Ca，P，Mg）のバランス】
    　Caは生体にかかすことのできない重要なミネラルである
    　低リン血症は，心不全，呼吸不全の原因になる！
    　意外に見落とすMg欠乏―Mgはルーチンに測定するべき必須元素！　微量元素ではない！
    　Case Review
    　電解質異常の初期治療
    　　低ナトリウム血症／高ナトリウム血症／低カリウム血症／
    　　高カリウム血症／高カルシウム血症

    第３章　特殊な病態のマネジメント
    【心不全の輸液】
    　体液過剰のある心不全患者に輸液をしてもよいのでしょうか？
    　左室駆出率が保たれている心不全（HFpEF）に気をつける
    【腎不全の輸液】
    　腎不全患者では尿量に応じて輸液処方を調整する
    　腎不全患者では過剰投与にならないよう注意する
    　Advance
    　急性心不全の初期輸液　−病態評価を通じて治療（輸液）の方針を考えよう
    　造影剤腎症予防
    　終末期患者に対する輸液
    　輸液スチュワードシップ：適正な輸液療法をめざす質改善活動
    　医療の質と安全

この書籍の参考文献

参考文献のリンクは、リンク先の都合等により正しく表示されない場合がありますので、あらかじめご了承下さい。

本参考文献は電子書籍掲載内容を元にしております。

第1章 輸液の基本・輸液の実際

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第2章 電解質, 酸塩基平衡

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第3章 特殊な病態のマネジメント

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