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Disorder of water and sodium

Disorder of water and sodium. Section1 water and sodium in body. background. Balance in intake and removing in body per day. 1.Why are water and electrolytes so important for life? Requirement of structure

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Disorder of water and sodium

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  1. Disorder of water and sodium

  2. Section1 water and sodium in body background Balance in intake and removing in body per day

  3. 1.Why are water and electrolytes so important for life? Requirement of structure metabolism function in body

  4. So important for life Requirement of body structure 60% of body wt metabolism dissolvant function circulation / lubrication water

  5. So important for life Requirement of body structure ? metabolism ? function ? electrolytes

  6. Digestive tracts Nutrients oxidation ICF Interstitial 40% BW Plasma 15% 5% Kidney(urine) 1500ml Intestine(feces) 200ml Lung(water vapor) 400mlSkin(sweat and evaporation)400ml Water loss 2. Water balance Water balance Intake Output

  7. 3.Body fluid distributes in body and shift Interstitial 15% Plasma 5% Transcellular fluid ICF40% ECF20%

  8. Osmolality of the body fluid Acquaporin ECF ICF [Na+] 140mmol/L K+ 4.5 mmol/L K+ 150mmol/L Direction of water shifting

  9. 4. Regulation of fluid volume and osmotic pressure Regulation pathway Disturbance ADH RAAS ANP guanylin Thirst Volume Osmotic pressure Thirst ADH RAAS guanylin

  10. Mechanism for regulating body fluid and electrolyte balance (1)The sensation of thirsty (2)Hormones new hormone the guanylin family

  11. guanylin, uroguanylin, lymphoguanylin endogenous & exogenous ~

  12. Production of Guanylin Endogenous Guanylin in gastrointestinal Lymphoguanylin in kidney, myocardium and lymphoid-immune system

  13. Effect of Guanylin Pathway: Guanylin receptors with GC( guanylate cyclase) cGMP Cl- and HCO3- secretion Effect: excreting Na+, Cl- and K+

  14. 5.H2O, Na+, K+ regulated by hormones H2O, Na+, K+ ?-excreting hormones ?-sparing hormones vs maintain homeostasis of water and sodium

  15. Section 2. Types of disorders of H2O and Na+ There are 9 types of grouping and arrangement

  16. Types of disorders of H2O and Na+ metabolism

  17. Part 1 Hyponatremia [Na+] serum ↓ <130mmol/L with ECF volume↓ or ↑ hypotonic dehydration Water intoxication

  18. 1. hypotonic dehydration Definition: Salt loss > water loss serum Na+ concentration ↓ plasma crystal osmolality ↓

  19. (1) Causes Salt loss through kidney or gastrointestinal tract or skin

  20. Specially, supply only water (GS) without salt (NaCl) following hyper- or isotonic dehydration

  21. (2) Effects on body ECF ↓+ [Na+] s ↓ water shifting *orthostatic hypotension, shock *urine volume and quality？ *skin turgor↓ *CNS (metabolism disorder, cerebrocellular edema)

  22. Clinical Manifestation of Hypotonic Dehydration

  23. (3) Principle of treatment for hypotonic dehydration Fluid replacement salt first, glucose second hypertonic fluid (Na+ 0.5mmol/h →120 mmol/L. infusion velocity !) during serious ~ isotonic salt solution administered

  24. Renal water-excreting ↓（renal failure or ADH ↑ ）＋water intake ↑ （not controled ） Water retention Diluted hyponatremia Pulmonary edema or cerebral hernia * Restriction of water intake * diuresis *↓intracranial pressure 2.Water intoxication

  25. part 2. Hypernatremia [Na+] serum ↑ >150mmol/L with ECF volume↓ or ↑ hypertonic dehydration hypertonic hypervolemia

  26. 1. hypertonic dehydration (1) Definition water loss > salt loss serum Na+ concentration ↑ plasma crystal osmolality ↑

  27. (2) Causes water loss through kidney or gastrointestinal tract or skin

  28. (3) Effects on body *thirsty *urine volume and quality？ *intracellular fluid ↓ (dehydration fever) *CNS (metabolism disorder, intracranial bleeding)

  29. Clinical Manifestation of Hypertonic Dehydration ?

  30. (4)Principle of treatment for hypertonic dehydration Fluid replacement glucose first, salt second hypotonic solution(1/2~2/3 tonic)

  31. Part 3. Isotonic dehydration (1)Definition Salt loss, water loss in normal ratio serum Na+ concentration & plasma crystal osmolality are normal (2)Causes Salt and water loss through gastrointestinal tract skin kidney

  32. (3) Effects on body thirsty ( ? ) shock（？） Hormone change?

  33. THANKS!

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