Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st year (First Year) Biochemistry ppt lectures Topic 58 Water Electrolytes Notes. - biochemistry notes pdf, biochemistry mbbs 1st year notes pdf, biochemistry mbbs notes pdf, biochemistry lecture notes, paramedical biochemistry notes, medical biochemistry pdf, biochemistry lecture notes 2022 ppt, biochemistry pdf.
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