Download MBBS Biochemistry PPT 58 Water Electrolytes Lecture Notes

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Water And Electrolytes

Balance

And

Imbalance

In Human Body

Body Water
? Water is the chief

constituent of human body.

? Water is the chief solvent of

body.

?Water comprises 60-70%

of total body weight

?Human body cannot exist

without Water the.
Sources Of Body Water

Exogenous Sources Of Water

?Drinking Water

,Beverages -1000-1500 ml

?Water from Cooked

Foods
? Water intake through mouth is

highly variable 1-5 Litres this

depend on :

?Social habits
?Climatic condition

Endogenous Sources Of Water

? Metabolic Water - 400 ml

? Produced during

metabolism oxidation of

food substances.

(At end of ETC Process)


Distribution Of Body Water


? In an adult of 70 kg body

? Total Body Water -60- 70% /36-49 Lt
? Intracel ular Fluid -65 % - 35 L
? Extracel ular Fluid -35% -14 L

?Interstitial Tissue Fluid -25% -11L
?Plasma /Intra Vascular Fluid -8% -3L
?Transcel ular Fluid- 2%

12

19/10/2009

12



15

? Body water content in percentage

of a body weight is lowest in.

(A)Well built man
(B) Fat woman
(C)Well nourished child
(D) Fat Man
Functions Of Body Water

? Involved in Biochemical reactions

?Water act as reactant in many hydration

Hydrolytic reactions of metabolic

pathways.

? Transporting media of body:

?Transportation of nutrients and waste

metabolites through aqueous media of

blood and tissue floods.

? Regulates body temperature
? Water transports Hormones, Enzymes,

blood platelets, and red and white

blood cel s

? Water act as a solvent for Electrolytes

and Non electrolytes

? Water Facilitates Digestion and

promoting Elimination of ingested

food

? Water serve as a tissue Lubricant

Body Water Input and Output
Body Water Input

? Body can gain water by

?Ingestion of liquids and moist

foods (2300mL/day)

?Metabolic synthesis of water

during cellular respiration

(200mL/day)

Body Water Output

? Body losses water through:

?Kidneys (1500mL/day)
?Evaporation from Skin (600mL/day)
?Exhalation from Lungs (300mL/day)
?Feces (100mL/day)


23

BODY ELECTROLYTES
What Are Electrolytes?

?Substance when dissolved

in solution dissociates into

ions

?These ions are able to

carry an electrical current

?An Electrolyte is a

substance

?Which develops an

electrical charge when

dissolved in water
Body Electrolytes

? Salts like NaCl and KCl in aqueous

solutions gets dissociated to

? Charged ions Na+ and Cl- cal ed as

Electrolytes.

? The concentration of these

Electrolytes is expressed as mEq/L.

Types Of Electrolytes

? CATION - Positively

charged Electrolyte

? ANION - Negatively

charged Electrolyte
?Water molecules

completely surround

these dissociated ions


?These prevents union of

Cations and Anions.

Distribution Of Body

Electrolytes In ECF and ICF
ELECTROLYTES IN

BODY FLUID COMPARTMENTS

INTRACELLULAR

EXTRACELLULAR

Electrolytes

Electrolytes

POTASSIUM

SODIUM

MAGNESIUM

CHLORIDE

PHOSPHOROUS

BICARBONATE

31

To Maintain Electrical Neutrality In

Each Fluid Compartments

Number Cations =Number Anions
ECF Cations

ECF Anions

Na+ ( 140 mEq/L) Cl- (103 mEq/L)
K+

HCO3-

Ca+

HPO4--

Mg+

SO4--

Total Cations

Total Anions

155 mEq/L

155 mEq/L

?Predominant Cations

and Anions of ECF:

?Na+ and Cl-

respectively.
ICF Cations

ICF Anions

Na+

Cl-

K+ (150 mEq/L)

HCO3-

Ca+

HPO4- - (140 mEq/L)

Mg+

SO4--

Total Cations

Total Anions

195 mEq/L

195 mEq/L

?Thus the

predominant Cations

and Anions of ICF

?K+ and HPO4--

respectively.


Electrolyte and protein anion concentrations

Copyright 2009, John Wiley & Sons, Inc.
Functions Of Body Electrolytes

? Electrolytes are wel

distributed in the body

compartments.

? Electrolytes in the

medium/compartments

produce osmotic pressure.

? This osmotic pressure helps in

maintaining water balance.
ELECTROLYTES

? Na+: Most abundant electrolyte in

the ECF.

? K+: Essential for normal membrane

excitability for nerve impulse

? Cl-: Regulates osmotic pressure and

assists in regulating acid-base

balance

? Ca2+: Promotes nerve impulse and

muscle contraction/relaxation

? Mg2+: Plays role in carbohydrate and

protein metabolism, storage and use

of intracellular energy and neural

transmission. Important in the

functioning of the heart, nerves, and

muscles
?For more detail functions

of Electrolytes

?Refer Minerals Chapter.

Movement of Water and Electrolytes


Diffusion ? movement of

particles down a concentration

gradient.
Diffusion: the random

movement of particles in all

directions through a solution

? Osmosis: movement of water

across a membrane from a less

concentrated solution to a more

concentrated solution

? Osmosis ? diffusion of water

across a selectively permeable

membrane
? Osmolarity: The number of

moles per liter of solution

? Osmolality: The number of

moles per Kg of Solvent.

? Sodium and its associated

ions in plasma make the

largest contribution (90%) for

plasma Osmolality.

? Osmolality is measured by

Osmometer
? Plasma Osmolality = 2 x Plasma Na +



mmol/L

? Osmolality: concentration

of a solution determined by

the number of dissolved

particles per kilogram of

water.

? Osmolality controls water

movement and distribution

in body fluid compartments
? Active transport: Movement

of solutes across

membranes;

? Requires transporters and

expenditure of energy

? Movement of particles is up

a concentration gradient

?Filtration: transfer of

water and solutes

through a membrane

?From a region of high

pressure to a region of

low pressure
Normal Fluid and Electrolytes

Exchanges In Body

Water And Electrolytes Movement

INN and OUT of Cel s.

Remember

?Normally in a healthy body

there is osmotic

equilibrium maintained in

each compartment.
? In a healthy body the

semipermeable cell membrane


? Al ows only passage of Water

but not Electrolytes through it.

? Disturbance in osmotic equilibrium

of compartments

? Draws water from the compartment

with lower osmotic pressure

(Hypotonic)

? Into the compartment with higher

osmotic pressure (Hypertonic)

? Until equilibrium is restored.
?In the concentration

gradient of K+ and Cl-

?K+ tends to diffuse out of

the cells and Cl -enters into

cells.

? During difference in electrical

potential

? For example in relative

negativity inside the cells

? There tend to keep Cl - out and

K + inn.
Remember

? Cells do not allow accumulation

of Na +

? Na rapidly enters in the cel s
? By the Sodium pump, Na is

effectively extrudes out from ICF

? By active transport of Na out of

cel s.

?However in case of Na +

diffusion into cells

?It is favored by both the

concentration gradient

and electrical potential.
Remember

?Where Sodium goes,

Water fol ows.

Homeostasis Of Body Water

OR

Regulation Of Body Water
Water Balance

? An healthy adult individual

always try

? To maintain water balance by

the homeostatic mechanisms.

? Since Water balance is vital for

human body

? A body is said to be in water

balance In a day

? When the amount of water

intake in the body is equal

? To the amount of water

output by that body.


?A healthy body tries to

regulate the body water

?Proportionately

distribute the water in

ICF and ECF
Water Input = Water Out put

2100ml

2100 ml

Sensible loss

? Drinking Water 1000 ml Urine 1000 ml

? Cooked Foods 700 ml Feces 100 ml

? Metabolic Water 400 ml

Insensible loss

Skin 600 ml

Lungs 400 ml



Electrolyte Balance

? Healthy body obeys the law of

electrical neutrality.

? Fluid in any body compartment

contain, equal number of

Cations and Anions.
? Specific concentrations of

Electrolytes in the body

compartments are of most

important

? In distribution and retention

of body water.

? In healthy state the Osmotic

pressure due to Cations is equal

to the osmotic pressure due to

Anions.

? Which is predominantly due to

equal concentrations of Cations

and Anions in each compartment.
Factors Regulating

Water

And

Electrolyte Balance

? In human body Water and

Electrolytes go togetherly.

? That means the osmotic

equilibrium created by

Electrolytes help in maintaining

water balance.

? If there is imbalance in

Electrolytes it directly affects

Water balance.
? Since the Electrolytes and

Water balance go hand in

hand in human body.

? Hence factors regulating the

water and electrolytes are

same.

Homeostasis of

Water And Electrolytes

Is Maintained By

74


Solute Homeostasis Maintained by:

?Ion transport
?Water movement
?Kidney function

These functions act to keep body fluids:

?Electrical y neutral
?Osmotical y stable

76


Fluid Exchanges

? A body consume fluids and food

items variably depending upon

habits and climatic condition.

? Intake of water and electrolytes

is rarely proportional.
? Kidneys play a predominant

role

? In regulating water and

electrolyte balance in the

body normal y.

?Kidneys play role to excrete

?Excess water through urine

(Dilute form of Urine)

OR

?Excess Electrolytes through

urine

(Concentrated form of Urine)
Biochemical Factors

Regulating

Water And Electrolyte

Balance

1. Neural Mechanism- Thirst

Mechanism

2. Antidiuretic Hormone/Vasopressin

3. Renin Angiotensin System

4. Aldosterone

5. Atrial Natriuretic Peptide(ANP)

6. Kinins ( Increases Salt and Water

excretion)
1.Neural Mechanism/Thirst Mechanism

Regulate Low Body Water

? When the body water is lowered

due to:

?No intake of fluids
?Body fluids lost through obligatory

losses (Urine and Feces).

? This leads to decrease in volume of

body fluids with respect to solutes

and rise in osmotic pressure.


85

? The ECF volume decreases

and becomes hypertonic.

? This tends to draw water from

ICF causing cellular

dehydration.
? The cellular dehydration

stimulates

? The thirst centre located in

hypothalamus.

? In response to the stimulus to

thirst center

? There occurs dryness of mouth

and Pharynx .

? Feeling of thirst makes drink water


? Water ingested oral y quench the

thirst to regulate the body water.
2. Antidiuretic Hormone/Vasopressin



Antidiuretic Hormone/Vasopressin

?Anti Diuretic

Hormone(ADH) is produced

in Hypothalamus

?Stored in posterior

pituitary gland
? The action of Peptide

Hormone ,ADH is via cyclic

AMP.

?An increase in Osmolality

(Na+ conc) of plasma

?Promotes ADH secretion

and vice versa.
? ADH is water conservation

hormone

? It acts on renal col ecting

tubule

? For reabsorption of water

by renal tubules.

Role Of Anti Diuretic Hormone (ADH)

?When the body water

is depleted

?ADH exerts

Antidiuretic effect.
? ADH affects renal tubules

? Provides for the facultative

reabsorption of water from

distal tubules.

?Urine output wil be lower

?Urine concentration wil be

increased

?Body water wil be

maintained

3. RENIN ANGIOTENSIN MECHANISM
? Renin-Angiotensin System

works when the:

?Blood volume is low
?Blood pressure is low

?Kidney, Liver and

Lungs are involved in

Renin Angiotensin

System.


?Renin is released by

kidneys in response to

decreased blood

volume
? Renin causes

Angiotensinogen (plasma

protein formed in Liver) to

split & produce

Angiotensin I

?Lungs convert

Angiotensin I to

Angiotensin II

?By Angiotensin

Converting Enzyme.
? Angiotensin II then stimulates

adrenal gland to release

Aldosterone

? Aldosterone then increase the

peripheral vasoconstriction

? Renin Angiotensin System

regulates Aldosterone

hormone from Adrenal gland

? During homeostatic

mechanism of Water and

Electrolyte Balance.
? Fall in E.C.F volume
? Decreases blood pressure
? Sensed by Juxtaglomerular apparatus

of Nephrons of Kidneys to secrete

Renin

? Renin then stimulate Liver

Angiotensinogen to produce

Angiotensin ?I

?Angiotensin I is converted to

Angiotensin

?By Lung produced enzyme

Angiotensin Converting

Enzyme(ACE).


?Angiotensin I stimulates

the release of

Aldosterone from Adrenal

gland.
4. Role Of Aldosterone

Aldosterone

? Aldosterone is a Steroid Hormone.
? It is a Mineralocorticoid produced

by Zona Glomerulus of Adrenal

Cortex.

? It has most important effect on

Mineral Metabolism.
ALDOSTERONE

? Aldosterone is released as

part of Renin Angiotensin

mechanism

? Acts on renal distal

convoluted tubule

? The hormone Aldosterone by

its action:

?Increases the rate of

reabsorption of Na+ (95 %)

and Cl-

?Increases K+ loss through

Urine
Role Of Aldosterone

? Aldosterone increases Sodium

uptake from the tubular fluid

? Regulates water reabsorption by

renal tubules and add into the

blood

? Makes excretion of Potassium

? Thus Aldosterone maintain

Water and Electrolyte Balance by

its action on renal tubules:

?Reabsorbs Sodium
?Retains Water
?Looses Potassium
Factors Affecting Aldosterone Secretion

5. Atrial Natriuretic Peptide or Factor

(ANP)/ (ANF)
Atrial Natriuretic Peptide or Factor

(ANP)/ (ANF)

?ANP is a Cardiac hormone

?Secreted by right Atrium of

Heart.

? Chemical y ANP is a

Polypeptide hormone

ANP

?ANP is released in response to

increased blood pressure in the

atria ( due to increased blood

volume)

?ANP opposes the Renin-

Angiotensin-Aldosterone system
vANP suppresses Renin level
vDecreases the release of

Aldosterone

vDecreases ADH release
vANP stimulates excretion of Na

and H2O

vReduces vascular resistance by

causing vasodilation.

Role Of Atrial Natriuretic Peptide

(ANP)

?ANP increases the

urinary excretion of Na+

and regulates the

electrolytes balance.
6. Role of Kinins

? Kinins are proteins in the

blood

? Kinins cause inflammation

and affect blood pressure

(especial y lowers the blood

pressure).

? Kinins increases Salt and

Water excretion.
Osmolarity of a Solutions

Osmolarity of Solutions

? Isotonic Solution-- Same concentration

of solutes as plasma

? Hypertonic Solution-- Greater

concentration of solutes than plasma

? Hypotonic Solution-- Lesser

concentration of solutes than plasma
Example Of

ISOTONIC SOLUTIONS

? 0.9% Sodium Chloride Solution / Normal Saline

? Ringer's Solution typical y contains

?Sodium Chloride

?Potassium Chloride

?Calcium Chloride

?Sodium Bicarbonate

?Lactate Ringer's Solution

? Contains additional y Lactate

? 1 mol NaCl weighs 58.44g NaCl
? 1 mmol NaCl weighs 0.058 g

NaCl

? One mmol of NaCl contains

?58.3 mg NaCl


127

HYPOTONIC SOLUTIONS

?5% DEXTROSE & WATER
?0.45% SODIUM CHLORIDE
?0.33% SODIUM CHLORIDE


Cel in a

hypotonic

solution

129

HYPERTONIC SOLUTIONS

?3% SODIUM CHLORIDE
?5% SODIUM CHLORIDE
?WHOLE BLOOD
?ALBUMIN
?TOTAL PARENTERAL NUTRITION
?TUBE FEEDINGS
?CONCENTRATED DEXTROSE (>10%)


Cel in a

hypertonic

solution

131

Water And Electrolyte

Imbalances
?In a human body water

distribution in compartments

?Is due to osmotic pressure

produced by Electrolytes

? Since Water and Electrolytes

balance in the body go together

? Hence imbalance in any one of it

,affects both.

? In simple words if there is

Electrolyte imbalance, it directly

affects and causes Water Imbalance.
What Conditions Leads To

Water And Electrolyte Imbalance?

Factors Involved In Water and

Electrolyte Balance

? Water intake

? Electrolyte intake

? Organs and Mechanisms

? Hypothalamus

? Pituitary Gland

? Kidneys

? Liver

? Lung

? Adrenal glands

? Cardiac tissue

? Related Genes

? Cholesterol

? Amino acids
REGULATION OF FLUID VOLUME

? Any defect in the organs

associated to factor

regulating Water and

Electrolyte balance

? May lead to Water and

Electrolyte imbalance.
?Anything that alters

the concentrations of

Electrolytes

?Wil alter the

concentration of

water, and vice versa.

Remember

? In condition of Water and

Electrolyte imbalances


? Care should be taken to

manage both the entities

simultaneously.
Conditions Of Water and Electrolyte

Imbalances

Water Electrolyte Imbalance

Conditions

?Dehydration
?Over hydration
Dehydration

? Dehydration is a condition of

Water imbalance.

? Dehydration is characterized

by disturbance of Water and

electrolyte balance.

?In a dehydrated body

the output of water

exceeds the water

intake.

?This causes reduction of

body water below the

normal level.
Basic Cause Of Dehydration

?No Ingestion of water

?Excessive Loss of body

fluids

Features Of Dehydration

? Water Deficiency Condition
? Low body water
? Low blood volume
? Disturbance in body Electrolytes.
Types Of Dehydration

Types Of Dehydration

? Primary Dehydration /Due to pure water

depletion

? Mixed Type Dehydration /Due to both

Water and Salt depletion

? Secondary dehydration/Due to pure salt

depletion
Primary Dehydration

OR

Pure Water Depletion

Causes Of Primary Dehydration

? Very weak or very il patients

unable to ingest Water.

? Mental Patients who refuses to

drink water

? In Coma Condition
? Person lost in desert or

Shipwrecked
? Defect to hypothalamus
? Patients with renal tubular

disorder

? Diabetes insipidus-ADH

insufficiency.

Biochemical Alterations

? Pure Water depletion occurs

almost always:

?Because of lack of Water intake
?Rather than because of excess

looses from the body.
? Body water stores get depleted

because of:

? Continuing obligatory losses of

water through

? Urine and Feces to excrete

metabolic waste.

? The only source of water

supply in this condition is

? Metabolic water obtained

from oxidation of food

stuffs.
? The volume of ECF is

maintained almost to normal

in this condition.

? At the expense of I.C.F which

is grossly reduced in volume

? Causing intracellular

dehydration.

?Neural mechanism is

activated

?But if this is not responded

?By oral Water ingestion

?Causes water depletion in

body.
Clinical Manifestations

? Dry tongue and pinched facies

(Due to intense thirst)

? Oligouria- ADH secreted causes

reabsorption of water from kidney

tubules

? Causing a gradual diminution of

Urine volume.

Management

? Give water to drink by mouth
? 5% Glucose by I.V (Hypotonic Soln)
? To correct intracellular dehydration.
? Note: Never give Isotonic Saline.
(0.9 % w/v NaCl solution).
Mixed Type Of Dehydration

Water and Salt Depletion

?This is the most common

type of dehydration

condition.
Causes of Mixed Type

Dehydration

?Severe Vomiting
?Severe Diarrhea

Biochemical Alterations

? Mixed dehydration has both low

volume of both water and

electrolytes.

? Here the volume of fluids in both

E.C.F and I.C.F is reduced.

? The patient appears dehydrated

and complains of thirst.
Manifestations

? Feeling of thirst
? Low BP
? Increased blood Urea
? Urinary out put is diminished

Management

? Administering Mixture of

Saline and 5 % Glucose in 1:1

proportion.
Secondary Dehydration

Pure Salt Depletion

Pure Salt Depletion

Secondary Dehydration

? This occurs when fluids of

high Na/Cl content are lost

from the body

? And body is replaced by

Salt deficient fluids.
Causes

? Excessive Sweating
? GIT loss of fluids during vomiting and

diarrhea

? Continuous aspirations of G.I fluids
? In Addisons disease (Insufficiency of

Adrenal Cortex)

? Vigorous use of diuretics

Biochemical Alterations

? The loss of body water and

electrolytes

? Replaced with water

without salts leads to

pure salt depletion
? In pure salt depletion E.C.F becomes

hypotonic.

? The lowered osmotic pressure

inhibits the release of ADH

? In this response Kidneys excrete

water in an attempt to maintain

normal extracel ular Na

concentration

? This decreases plasma and

interstitial fluids .

? The water from ECF (hypotonic)

flows into the I.C.F of cells

(hypertonic soln).

? This further reduces the volume

of ECF.


? In this condition there is no

cellular dehydration.

? No response to thirst

centre.

Series of Events in Secondary Dehydration

Copyright 2009, John Wiley & Sons, Inc.
Manifestations Of Secondary

Dehydration

? Absence of Thirst (No intracellular dehydration)
? Patient is apathetic, listless
? Hallucinations and Confusions are common
? Anorexia and Nausea
? Cramps in thigh, abdominal and respiratory muscles.
? Sunken eyes, inelastic skin
? Low BP, decreased GFR and excretion

Management of Secondary

Dehydration

? By administering Isotonic

solution 0.9% NaCl.
Differences In Primary And Secondary

Dehydration

Primary Dehydration

Secondary Dehydration

Caused due to pure

Caused due to pure Salt depletion

Water Depletion

when fluids of high salt content

when water in take is lost and replaced by salt deficient

stopped.

fluids

Noted in patients with Patients with excessive

dysphagia

sweating,vomiting ,diarrhea in

Comatose and Mental CCF, with no electrolytes

patients, Lost in deserts replenished.

Feels Thirst , Cramps Thirst absent , cramps present,

absent ,Pulse and B.P rapid and thready

normal.

pulse with low B.P.


Primary Dehydration

Secondary Dehydration

Scanty Urine

Normal or increased Urine

ECF Hypertonic

ECF Hypotonic

Cellular Dehydration

Cellular Edema present

present

Management by Water

By infusing Isotonic

intake and Hypotonic soln solution


Over Hydration /Water Excess
Over hydration /Water Excess

?Here there is excess of

body water.

Over Hydration / Water Intoxication

?Due to excess water intake
?Due to water retention
Causes Of Water Excess

? Excessive administration of parenteral

fluids.

? Renal Failure (No/Less excretion of Urine)
? Hypersecretion of ADH
? Administration of Narcotics ,Anaesthesia

causes secretion of ADH

? Excess of Aldosterone (Conn's Syndrome)

Manifestations

? Headache
? Nausea
? Incoordination of Movements
? Delirium
Management

? Withholding drinking of

fluids.

? Administration of 3-5%

Hypertonic Saline

intravenously.

ELECTROLYTE IMBALANCES
ELECTROLYTE IMBALANCES

? Hyponatremia (sodium deficit < 130mEq/L)
? Hypernatremia (sodium excess >145mEq/L)
? Hypokalemia (Potassium deficit <3.5mEq/L)
? Hyperkalemia (Potassium excess >5.1mEq/L)
? Chloride imbalance (<98mEq/L or >107mEq/L)
? Magnesium imbalance (<1.5mEq/L or

>2.5mEq/L)

Common Conditions And Disorders

Associated

With Water And Electrolyte Imbalances


Edema

Edema/Swel ing

? Condition in which excess fluid accumulates in

the interstitial compartment.

? It is a response to inflammation and injury
Common Conditions Of Edema

?Inflammation
?Infections
?Pregnancy
?Medications

Causes Of Edema

? Increased Hydrostatic Pressure

? Smal blood vessels become leaky and releases

fluid into nearby tissues.

? Venous obstruction, Lymphedema, CHF, Renal

failure

? Lowered Plasma Osmotic pressure (Protein loss)

? Liver failure, Malnutrition, Burns

? Increased capil ary membrane permeability

? Inflammation, Sepsis


Types Of Edema

? Generalized Edema
? Organ specific Edema
[cerebral, ascites , pleural)
? Cutaneous Pitting Edema
? Non Pitting Edema
Consequences Of Edema

? Imbalance in Water and Electrolyte

distribution.

? Impaired blood flow

? Slow healing

? Increased risk of infections

? Pressure sores over bony prominences

? Impaired organ function

(Brain, Liver, Gut, Kidney)

Treatment Of Edema

? Treat the underlying cause of

Edema.

? Defect in heart/Lungs/Liver

/Kidney should be treated

? Reducing amount of salt
Diabetes insipidus

Diabetes insipidus

? Endocrine Disorder

? ADH insufficiency

? Affecting Water and

Electrolyte imbalance of

the body.
Diabetes insipidus

? Diabetes insipidus (DI) is

a condition characterized by:

?Excretion of large amounts

of severely dilute urine

?With excessive thirst

Incidence Of DI

? 3 in 100,000 individuals of

general population.
Causes And Types of DI

Central Diabetes Insipidus

? Central Diabetes insipidus

(CDI)

?Involves a deficiency of

Vasopressin /

Antidiuretic hormone
Nephrogenic Diabetes insipidus

? The second common type of DI

is Nephrogenic Diabetes insipidus

(NDI),

? Is due to kidney or nephron

dysfunction

? Caused by an insensitivity of

the Kidneys or nephrons to ADH.

Manifestations Of DI

? Polyuria with dilute urine.

? Due to osmotic diuresis

? Excessive thirst(Polydypsia)

? Dehydration

? Electrolyte imbalance
Diagnosis

? Urine Osmolarity
? Urine Specific gravity
? Electrolyte concentrations in

serum and urine

? Fluid Deprivation test

Treatment

? Central DI respond

to Desmopressin which is

given as intranasal or oral

tablets
Addisons Disease

Hypoadrenocorticism

Addisons Disease

? Thomas Addison first discoverer

(1849)

? Autoimmune disease
? Endocrine disorder
Cause

? Defect in Adrenal glands
? Adrenal gland insufficiency
? Deficient Aldosterone and

Cortisol

Incidence Of DI

?1 in 100,000
Biochemical Alterations

? Hypoglycemia (reduced level of blood glucose)
? Hyponatremia (low sodium level in the blood)
? Hyperkalemia (elevated potassium level in the

blood)

? Hypercalcemia (elevated calcium level in the blood)

Manifestations

? Low blood pressure
? Syncope (loss of consciousness and

inability to stand)

? Confusion, Psychosis, slurred speech
? Severe Lethargy
? Convulsions
Diagnosis

?Blood Electrolytes
(Na and K)
?Blood Glucose
?Blood Calcium

? Blood Cortisol levels

? ACTH Stimulation Test

? Uses synthetic pituitary ACTH

hormone Tetracosactide used

for diagnosis
Management

? Standard therapy involves intravenous

injections of Glucocorticoids

? of Hydrocortisone tablets,

Prednisone tablets

? Large volumes of intravenous saline

solution with Dextrose/Glucose.

? Oral doses of Fludrocortisone Acetate

Cushings Syndrome

Hyperadrenocorticism
Cause

? Over activity of Adrenal

glands

? Excess of Aldosterone and

Cortisol

Incidence

?1 in 100,000
Biochemical Alterations

? Hyperglycemia (Increased level of blood glucose)
? Hypernatremia (High Sodium level in the blood)
? Hypokalemia (Low potassium level in the blood)
? Hypocalcemia (Low Calcium level in the blood)

Manifestations

? High blood pressure
? Weight gain ,Central obesity. Buffalo

Hump and Moon Face

? Insomnia
? Excessive Sweating
? Depression
? Anxiety
Diagnosis

?Blood Electrolytes

(Na+ and K+)

?Blood Glucose

?Blood Calcium

?Blood Cortisol levels

Management

? In adrenal Adenomas surgical removal.
? Ketoconazole, Metyrapone inhibit

Cortisol biosynthesis.

? Mifepristone is a powerful

Glucocorticoid type I receptor

antagonist
Effects of Stress on Water And

Electrolyte Balance

? The Hypothalamus and

Pituitary gland

? Integrate communication

between nervous and

endocrine systems

? Stress severely affect this

coordination and affect Water

and Electrolyte balance
Diagnostic Tests

To Check for Fluid and Electrolytes

Balance And Imbalance

Blood Investigations

? Serum Electrolytes
? Serum Creatinine = 0.6 ? 1.5 mg/dl
? Blood Urea and BUN = 8-20 mg/dL
? Serum Osmolality
? Serum Albumin ? 3.5-5.5 g/dL
? Serum Hematocrit = 40-54%/men, 38-47% for

women (Decreased in Dehydration)
Urine Investigations

?Urine pH

?Urine specific gravity

?Urine Osmolarity

?Urine Creatinine Clearance

?Urine Sodium

?Urine Potassium

Questions
? Distribution & functions of

Water in human body.

? What are Electrolytes? Give

its distribution & functions

related to human body.

? What is water electrolyte

balance? Explain the factors

involved in water electrolyte

balance.

? What are disorders of Water

and Electrolyte imbalances?
? Dehydration- types, causes &

management.

? Differentiate between Primary and

Secondary Dehydration

? Over hydration/Water Toxicity/Water

Intoxication.

? Edema

? Diabetes Insipidus.

? Addison's & Cushing Syndrome.

Thank You

This post was last modified on 05 April 2022