Cerebrospinal fluid inorganic phosphorus

The total amount of phosphorus in adults is 400-800g, accounting for about 1% of adult body weight, accounting for 1/4 of total minerals in the body. The human body consumes 1.0 to 1.5 g of phosphorus per day. The phosphorus that can be absorbed and utilized by the human body is an organic phosphate compound such as a phosphate ester or a phospholipid. Phosphorus is excreted by the intestines and kidneys, and the amount of renal excretion accounts for about 60% of the total excretion. Basic Information Specialist classification: examination classification: cerebrospinal fluid examination Applicable gender: whether men and women apply fasting: fasting Analysis results: Below normal: 1 In hyperparathyroidism, renal tubular reabsorption of phosphorus is inhibited, urinary phosphorus excretion is more, and cerebrospinal fluid phosphorus is reduced. 2 rickets or rickets associated with secondary hyperparathyroidism, increased urinary phosphorus excretion and decreased phosphorus in the cerebrospinal fluid. 3 increased sugar utilization, such as continuous intravenous infusion of glucose and simultaneous injection of insulin and pancreatic tumor with hyperinsulinemia, the use of sugar increased, both of which require a large amount of inorganic phosphate to participate in phosphorylation, and reduce the phosphorus in the cerebrospinal fluid. 4 renal tubular degeneration, renal tubular reabsorption of phosphorus function disorders, cerebrospinal fluid phosphorus is low, such as Fanconi syndrome. (3) increased urinary phosphorus excretion in hyperparathyroidism, Fang syndrome, metabolic alkalosis and so on. (4) The reduction of urinary phosphorus excretion is seen in hypoparathyroidism, rickets, celiac disease, renal failure, nephritis with acidosis, and increased sugar utilization. Normal value: Cerebrospinal fluid inorganic phosphorus: 0.9-2.0mg/dl Above normal: 1 hypoparathyroidism, due to reduced hormone secretion, so that the reabsorption of phosphorus by the renal tubules increased the cerebrospinal fluid phosphorus. Pseudohypoparathyroidism is also associated with increased phosphorus in the cerebrospinal fluid. 2 in the late stage of chronic nephritis, renal insufficiency or renal failure, phosphate excretion disorder and blood phosphorus retention. 3 excessive vitamin D, promote the absorption of calcium and phosphorus in the intestine, so that the serum calcium and phosphorus content increased, and the calcium and phosphorus in the cerebrospinal fluid increased. 4 multiple myeloma and fracture healing period. negative: Positive: Tips: Some drugs can affect the blood phosphorus concentration, such as aluminum-containing antacids inhibit the absorption of phosphorus in the intestines, so that the blood phosphorus is reduced, and the blood phosphorus is reduced when taking synthetic estrogen, contraceptives and phenobarbital. When using androgen, synthetic hormones and certain diuretic drugs, blood phosphorus is elevated. Normal value 0.9 to 2.0 mg/dl. Clinical significance (1) Increased inorganic phosphorus in cerebrospinal fluid 1 hypoparathyroidism, due to reduced hormone secretion, so that the reabsorption of phosphorus by the renal tubules increased the cerebrospinal fluid phosphorus. Pseudohypoparathyroidism is also associated with increased phosphorus in the cerebrospinal fluid. 2 in the late stage of chronic nephritis, renal insufficiency or renal failure, phosphate excretion disorder and blood phosphorus retention. 3 excessive vitamin D, promote the absorption of calcium and phosphorus in the intestine, so that the serum calcium and phosphorus content increased, and the calcium and phosphorus in the cerebrospinal fluid increased. 4 multiple myeloma and fracture healing period. (2) Reduced inorganic phosphorus in cerebrospinal fluid 1 In hyperparathyroidism, renal tubular reabsorption of phosphorus is inhibited, urinary phosphorus excretion is more, and cerebrospinal fluid phosphorus is reduced. 2 rickets or rickets associated with secondary hyperparathyroidism, increased urinary phosphorus excretion and decreased phosphorus in the cerebrospinal fluid. 3 increased sugar utilization, such as continuous intravenous infusion of glucose and simultaneous injection of insulin and pancreatic tumor with hyperinsulinemia, the use of sugar increased, both of which require a large amount of inorganic phosphate to participate in phosphorylation, and reduce the phosphorus in the cerebrospinal fluid. 4 renal tubular degeneration, renal tubular reabsorption of phosphorus function disorders, cerebrospinal fluid phosphorus is low, such as Fanconi syndrome. (3) increased urinary phosphorus excretion in hyperparathyroidism, Fang syndrome, metabolic alkalosis and so on. (4) The reduction of urinary phosphorus excretion is seen in hypoparathyroidism, rickets, celiac disease, renal failure, nephritis with acidosis, and increased sugar utilization. Low results may be diseases: hyperthyroidism, rickets, high results may be diseases: chronic nephritis precautions Clinically, the determination of inorganic phosphorus is mostly based on serum or plasma samples. Because of the determination of phosphate by lysis of whole blood, the result is high. The method for determination of urinary phosphorus and cerebrospinal fluid phosphorus is the same as serum phosphorus. Some drugs can affect the blood phosphorus concentration. For example, aluminum-containing antacids inhibit the absorption of phosphorus in the intestines and reduce blood phosphorus. When taking synthetic estrogen, contraceptives and phenobarbital, blood phosphorus is reduced. When using androgen, synthetic hormones and certain diuretic drugs, blood phosphorus is elevated. Inspection process 1. The patient lies on the hard board bed, the back is perpendicular to the table top, the head is bent as far as possible to the chest, the knees are tightly attached to the abdomen with both hands, so that the trunk is as arched as possible; or the assistant is used to hold the patient's head opposite the surgeon. The other hand pulls the lower limbs of the armpits and holds them tightly, so that the spine is as convex as possible to widen the intervertebral space, which is convenient for needle insertion. 2, determine the puncture point, usually the junction point of the highest point of the bilateral iliac spine and the posterior median line as the puncture point, here is equivalent to the third to fourth lumbar spine process, sometimes in the upper or lower lumbar spine The gap is carried out. 3, routine disinfection of the skin after wearing sterile gloves, cover the hole towel, with 2% lidocaine from the skin to the interspinous ligament for layer-by-layer local anesthesia. 4, the surgeon uses the left hand to fix the puncture point skin, the right hand holding puncture needle to the vertical back, the needle tip slightly obliquely to the direction of the head, the adult needle depth is about 4 ~ 6cm, children about 2 ~ 4cm. When the needle passes through the ligament and the dura mater, there is a sudden loss of resistance. At this point, the needle core can be slowly withdrawn (to prevent the cerebrospinal fluid from flowing out quickly, causing cerebral palsy), and the cerebrospinal fluid can be seen to flow out. 5. Connect the pressure measuring tube to measure the pressure before draining. The cerebrospinal fluid pressure in the normal lateral position is 70-180 mmH2O (0.098 Kpa=10 mmH2O) or 40-50 d/min. If you continue to do the queckstedt test, you can see if there is any obstruction in the subarachnoid space. That is, after the initial pressure is measured, the assistant first compresses one side of the carotid artery for about 10 s, then presses the other side, and finally presses both sides of the carotid artery. When the carotid artery is compressed at normal time, the pressure of the cerebrospinal fluid immediately increases by about one time, and after 10 to 20 seconds after the pressure is released, it rapidly drops to the original level, which is called negative in the obstruction test, indicating that the subarachnoid space is unobstructed; if the carotid artery is compressed, it cannot be When the pressure of the cerebrospinal fluid is raised, the obstruction test is positive, indicating that the subarachnoid space is completely blocked. If it rises slowly after applying pressure, it will slowly fall after relaxation, indicating incomplete obstruction. but. Those with increased intracranial pressure are forbidden to do this test. 6. Remove the pressure measuring tube and collect 2~5ml of cerebrospinal fluid for examination. If it is needed for cultivation, use sterile tube to keep the specimen. 7. After the operation, insert the needle core and pull out the puncture needle together, cover the sterile gauze, and fix it with tape. 8, go to the pillow for 4 to 6 hours, so as not to cause postoperative low intracranial pressure headache. Determined by Mitol colorimetry. Not suitable for the crowd 1. If there is obvious papilledema or cerebral palsy, contraindications are contraindicated. 2. Patients who are in shock, exhaustion or endangered state and local skin inflammation, and lesions in the posterior cranial fossa are contraindicated. Adverse reactions and risks If the patient has symptoms such as breathing, pulse, or abnormal color during puncture, stop the operation immediately and deal with it accordingly.