Luthra M, Davids M R, Shafiee M A, Halperin M L
Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, Canada.
QJM. 2004 Mar;97(3):167-78. doi: 10.1093/qjmed/hch031.
Our imaginary consultant, Professor McCance, is asked to explain the basis for four major acute electrolyte abnormalities in a young woman with long-standing anorexia nervosa. She has a severe degree of hypokalaemia (2.0 mmol/l) with renal potassium wasting, a contracted extracellular fluid volume with renal NaCl wasting, hyponatraemia (118 mmol/l) while excreting hypoosmolar urine, and metabolic acidosis with a normal plasma anion gap (pH 7.20, bicarbonate 9 mmol/l). McCance begins his discussion by considering the basis for hypokalaemia, as this electrolyte disorder is potentially life-threatening. Its pathophysiology is linked to the other major findings, using principles of integrative physiology together with a deductive and quantitative analysis. Nevertheless, to reach his final diagnosis, he requires information about newer molecular discoveries. Not only is he able to suggest a likely diagnosis, but he also devises a novel long-term plan for therapy.
我们虚构的顾问麦坎斯教授被要求解释一名长期患有神经性厌食症的年轻女性出现四种主要急性电解质异常的原因。她患有严重的低钾血症（2.0毫摩尔/升）且伴有肾性钾流失，细胞外液量减少且伴有肾性氯化钠流失，低钠血症（118毫摩尔/升）同时排出低渗尿，以及代谢性酸中毒且血浆阴离子间隙正常（pH值7.20，碳酸氢盐9毫摩尔/升）。麦坎斯以考虑低钾血症的原因作为讨论的开始，因为这种电解质紊乱可能危及生命。其病理生理学与其他主要发现相关联，运用综合生理学原理以及演绎和定量分析方法。然而，为了得出最终诊断，他需要有关最新分子发现的信息。他不仅能够提出可能的诊断，还制定了一项新颖的长期治疗计划。
