Download MBBS Biochemistry PPT 58 Water Electrolytes Lecture Notes

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And

Imbalance

In Human Body

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Body Water
? Water is the chief

constituent of human body.

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? Water is the chief solvent of

body.

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?Water comprises 60-70%

of total body weight

?Human body cannot exist

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without Water the.
Sources Of Body Water

Exogenous Sources Of Water

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?Drinking Water

,Beverages -1000-1500 ml

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?Water from Cooked

Foods
? Water intake through mouth is

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highly variable 1-5 Litres this

depend on :

?Social habits

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?Climatic condition

Endogenous Sources Of Water

? Metabolic Water - 400 ml

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? Produced during

metabolism oxidation of

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food substances.

(At end of ETC Process)

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Distribution Of Body Water


? In an adult of 70 kg body

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? 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

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?Plasma /Intra Vascular Fluid -8% -3L
?Transcel ular Fluid- 2%

12

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19/10/2009

12

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15

? Body water content in percentage

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of a body weight is lowest in.

(A)Well built man
(B) Fat woman
(C)Well nourished child

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(D) Fat Man
Functions Of Body Water

? Involved in Biochemical reactions

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?Water act as reactant in many hydration

Hydrolytic reactions of metabolic

pathways.

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? Transporting media of body:

?Transportation of nutrients and waste

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metabolites through aqueous media of

blood and tissue floods.

? Regulates body temperature

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? Water transports Hormones, Enzymes,

blood platelets, and red and white

blood cel s

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? Water act as a solvent for Electrolytes

and Non electrolytes

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? Water Facilitates Digestion and

promoting Elimination of ingested

food

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? Water serve as a tissue Lubricant

Body Water Input and Output
Body Water Input

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? Body can gain water by

?Ingestion of liquids and moist

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foods (2300mL/day)

?Metabolic synthesis of water

during cellular respiration

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(200mL/day)

Body Water Output

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? Body losses water through:

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

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?Feces (100mL/day)


23

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BODY ELECTROLYTES
What Are Electrolytes?

?Substance when dissolved

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in solution dissociates into

ions

?These ions are able to

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carry an electrical current

?An Electrolyte is a

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substance

?Which develops an

electrical charge when

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dissolved in water
Body Electrolytes

? Salts like NaCl and KCl in aqueous

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solutions gets dissociated to

? Charged ions Na+ and Cl- cal ed as

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Electrolytes.

? The concentration of these

Electrolytes is expressed as mEq/L.

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Types Of Electrolytes

? CATION - Positively

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charged Electrolyte

? ANION - Negatively

charged Electrolyte

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?Water molecules

completely surround

these dissociated ions

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?These prevents union of

Cations and Anions.

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Distribution Of Body

Electrolytes In ECF and ICF
ELECTROLYTES IN

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BODY FLUID COMPARTMENTS

INTRACELLULAR

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EXTRACELLULAR

Electrolytes

Electrolytes

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POTASSIUM

SODIUM

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MAGNESIUM

CHLORIDE

PHOSPHOROUS

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BICARBONATE

31

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To Maintain Electrical Neutrality In

Each Fluid Compartments

Number Cations =Number Anions

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ECF Cations

ECF Anions

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

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K+

HCO3-

Ca+

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HPO4--

Mg+

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SO4--

Total Cations

Total Anions

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155 mEq/L

155 mEq/L

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?Predominant Cations

and Anions of ECF:

?Na+ and Cl-

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respectively.
ICF Cations

ICF Anions

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Na+

Cl-

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K+ (150 mEq/L)

HCO3-

Ca+

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HPO4- - (140 mEq/L)

Mg+

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SO4--

Total Cations

Total Anions

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195 mEq/L

195 mEq/L

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?Thus the

predominant Cations

and Anions of ICF

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?K+ and HPO4--

respectively.

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Electrolyte and protein anion concentrations

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

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? Electrolytes are wel

distributed in the body

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compartments.

? Electrolytes in the

medium/compartments

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produce osmotic pressure.

? This osmotic pressure helps in

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maintaining water balance.
ELECTROLYTES

? Na+: Most abundant electrolyte in

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the ECF.

? K+: Essential for normal membrane

excitability for nerve impulse

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? Cl-: Regulates osmotic pressure and

assists in regulating acid-base

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balance

? Ca2+: Promotes nerve impulse and

muscle contraction/relaxation

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? Mg2+: Plays role in carbohydrate and

protein metabolism, storage and use

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of intracellular energy and neural

transmission. Important in the

functioning of the heart, nerves, and

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muscles
?For more detail functions

of Electrolytes

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?Refer Minerals Chapter.

Movement of Water and Electrolytes

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Diffusion ? movement of

particles down a concentration

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gradient.
Diffusion: the random

movement of particles in all

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directions through a solution

? Osmosis: movement of water

across a membrane from a less

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concentrated solution to a more

concentrated solution

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? Osmosis ? diffusion of water

across a selectively permeable

membrane

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? Osmolarity: The number of

moles per liter of solution

? Osmolality: The number of

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moles per Kg of Solvent.

? Sodium and its associated

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ions in plasma make the

largest contribution (90%) for

plasma Osmolality.

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? Osmolality is measured by

Osmometer
? Plasma Osmolality = 2 x Plasma Na +

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mmol/L

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? Osmolality: concentration

of a solution determined by

the number of dissolved

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particles per kilogram of

water.

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? Osmolality controls water

movement and distribution

in body fluid compartments

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? Active transport: Movement

of solutes across

membranes;

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? Requires transporters and

expenditure of energy

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? Movement of particles is up

a concentration gradient

?Filtration: transfer of

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water and solutes

through a membrane

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?From a region of high

pressure to a region of

low pressure

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Normal Fluid and Electrolytes

Exchanges In Body

Water And Electrolytes Movement

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INN and OUT of Cel s.

Remember

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?Normally in a healthy body

there is osmotic

equilibrium maintained in

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each compartment.
? In a healthy body the

semipermeable cell membrane

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? Al ows only passage of Water

but not Electrolytes through it.

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? Disturbance in osmotic equilibrium

of compartments

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? Draws water from the compartment

with lower osmotic pressure

(Hypotonic)

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? Into the compartment with higher

osmotic pressure (Hypertonic)

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? Until equilibrium is restored.
?In the concentration

gradient of K+ and Cl-

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?K+ tends to diffuse out of

the cells and Cl -enters into

cells.

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? During difference in electrical

potential

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? For example in relative

negativity inside the cells

? There tend to keep Cl - out and

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K + inn.
Remember

? Cells do not allow accumulation

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of Na +

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

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effectively extrudes out from ICF

? By active transport of Na out of

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cel s.

?However in case of Na +

diffusion into cells

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?It is favored by both the

concentration gradient

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and electrical potential.
Remember

?Where Sodium goes,

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Water fol ows.

Homeostasis Of Body Water

OR

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Regulation Of Body Water
Water Balance

? An healthy adult individual

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always try

? To maintain water balance by

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the homeostatic mechanisms.

? Since Water balance is vital for

human body

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? A body is said to be in water

balance In a day

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? When the amount of water

intake in the body is equal

? To the amount of water

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output by that body.


?A healthy body tries to

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regulate the body water

?Proportionately

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distribute the water in

ICF and ECF
Water Input = Water Out put

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2100ml

2100 ml

Sensible loss

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? Drinking Water 1000 ml Urine 1000 ml

? Cooked Foods 700 ml Feces 100 ml

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? Metabolic Water 400 ml

Insensible loss

Skin 600 ml

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Lungs 400 ml

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Electrolyte Balance

? Healthy body obeys the law of

electrical neutrality.

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? Fluid in any body compartment

contain, equal number of

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Cations and Anions.
? Specific concentrations of

Electrolytes in the body

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compartments are of most

important

? In distribution and retention

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of body water.

? In healthy state the Osmotic

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pressure due to Cations is equal

to the osmotic pressure due to

Anions.

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? Which is predominantly due to

equal concentrations of Cations

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and Anions in each compartment.
Factors Regulating

Water

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And

Electrolyte Balance

? In human body Water and

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Electrolytes go togetherly.

? That means the osmotic

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equilibrium created by

Electrolytes help in maintaining

water balance.

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? If there is imbalance in

Electrolytes it directly affects

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Water balance.
? Since the Electrolytes and

Water balance go hand in

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hand in human body.

? Hence factors regulating the

water and electrolytes are

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same.

Homeostasis of

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Water And Electrolytes

Is Maintained By

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Solute Homeostasis Maintained by:

?Ion transport

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?Water movement
?Kidney function

These functions act to keep body fluids:

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?Electrical y neutral
?Osmotical y stable

76

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Fluid Exchanges

? A body consume fluids and food

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items variably depending upon

habits and climatic condition.

? Intake of water and electrolytes

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is rarely proportional.
? Kidneys play a predominant

role

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? In regulating water and

electrolyte balance in the

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body normal y.

?Kidneys play role to excrete

?Excess water through urine

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(Dilute form of Urine)

OR

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?Excess Electrolytes through

urine

(Concentrated form of Urine)

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Biochemical Factors

Regulating

Water And Electrolyte

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Balance

1. Neural Mechanism- Thirst

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Mechanism

2. Antidiuretic Hormone/Vasopressin

3. Renin Angiotensin System

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4. Aldosterone

5. Atrial Natriuretic Peptide(ANP)

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6. Kinins ( Increases Salt and Water

excretion)
1.Neural Mechanism/Thirst Mechanism

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Regulate Low Body Water

? When the body water is lowered

due to:

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?No intake of fluids
?Body fluids lost through obligatory

losses (Urine and Feces).

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? This leads to decrease in volume of

body fluids with respect to solutes

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and rise in osmotic pressure.


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? The ECF volume decreases

and becomes hypertonic.

? This tends to draw water from

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ICF causing cellular

dehydration.
? The cellular dehydration

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stimulates

? The thirst centre located in

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hypothalamus.

? In response to the stimulus to

thirst center

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? There occurs dryness of mouth

and Pharynx .

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? Feeling of thirst makes drink water


? Water ingested oral y quench the

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

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Antidiuretic Hormone/Vasopressin

?Anti Diuretic

Hormone(ADH) is produced

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in Hypothalamus

?Stored in posterior

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pituitary gland
? The action of Peptide

Hormone ,ADH is via cyclic

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AMP.

?An increase in Osmolality

(Na+ conc) of plasma

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?Promotes ADH secretion

and vice versa.
? ADH is water conservation

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hormone

? It acts on renal col ecting

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tubule

? For reabsorption of water

by renal tubules.

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Role Of Anti Diuretic Hormone (ADH)

?When the body water

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is depleted

?ADH exerts

Antidiuretic effect.

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? ADH affects renal tubules

? Provides for the facultative

reabsorption of water from

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distal tubules.

?Urine output wil be lower

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?Urine concentration wil be

increased

?Body water wil be

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maintained

3. RENIN ANGIOTENSIN MECHANISM
? Renin-Angiotensin System

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works when the:

?Blood volume is low
?Blood pressure is low

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?Kidney, Liver and

Lungs are involved in

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Renin Angiotensin

System.

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?Renin is released by

kidneys in response to

decreased blood

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volume
? Renin causes

Angiotensinogen (plasma

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protein formed in Liver) to

split & produce

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Angiotensin I

?Lungs convert

Angiotensin I to

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Angiotensin II

?By Angiotensin

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Converting Enzyme.
? Angiotensin II then stimulates

adrenal gland to release

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Aldosterone

? Aldosterone then increase the

peripheral vasoconstriction

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? Renin Angiotensin System

regulates Aldosterone

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hormone from Adrenal gland

? During homeostatic

mechanism of Water and

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

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of Nephrons of Kidneys to secrete

Renin

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? Renin then stimulate Liver

Angiotensinogen to produce

Angiotensin ?I

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?Angiotensin I is converted to

Angiotensin

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?By Lung produced enzyme

Angiotensin Converting

Enzyme(ACE).

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?Angiotensin I stimulates

the release of

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Aldosterone from Adrenal

gland.
4. Role Of Aldosterone

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Aldosterone

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

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by Zona Glomerulus of Adrenal

Cortex.

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? It has most important effect on

Mineral Metabolism.
ALDOSTERONE

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? Aldosterone is released as

part of Renin Angiotensin

mechanism

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? Acts on renal distal

convoluted tubule

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? The hormone Aldosterone by

its action:

?Increases the rate of

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reabsorption of Na+ (95 %)

and Cl-

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?Increases K+ loss through

Urine
Role Of Aldosterone

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? Aldosterone increases Sodium

uptake from the tubular fluid

? Regulates water reabsorption by

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renal tubules and add into the

blood

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? Makes excretion of Potassium

? Thus Aldosterone maintain

Water and Electrolyte Balance by

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its action on renal tubules:

?Reabsorbs Sodium
?Retains Water

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?Looses Potassium
Factors Affecting Aldosterone Secretion

5. Atrial Natriuretic Peptide or Factor

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

(ANP)/ (ANF)

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?ANP is a Cardiac hormone

?Secreted by right Atrium of

Heart.

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? Chemical y ANP is a

Polypeptide hormone

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ANP

?ANP is released in response to

increased blood pressure in the

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atria ( due to increased blood

volume)

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?ANP opposes the Renin-

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

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Aldosterone

vDecreases ADH release
vANP stimulates excretion of Na

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and H2O

vReduces vascular resistance by

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causing vasodilation.

Role Of Atrial Natriuretic Peptide

(ANP)

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?ANP increases the

urinary excretion of Na+

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and regulates the

electrolytes balance.
6. Role of Kinins

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? Kinins are proteins in the

blood

? Kinins cause inflammation

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and affect blood pressure

(especial y lowers the blood

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pressure).

? Kinins increases Salt and

Water excretion.

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Osmolarity of a Solutions

Osmolarity of Solutions

? Isotonic Solution-- Same concentration

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of solutes as plasma

? Hypertonic Solution-- Greater

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concentration of solutes than plasma

? Hypotonic Solution-- Lesser

concentration of solutes than plasma

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Example Of

ISOTONIC SOLUTIONS

? 0.9% Sodium Chloride Solution / Normal Saline

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? Ringer's Solution typical y contains

?Sodium Chloride

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?Potassium Chloride

?Calcium Chloride

?Sodium Bicarbonate

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?Lactate Ringer's Solution

? Contains additional y Lactate

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

NaCl

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? One mmol of NaCl contains

?58.3 mg NaCl

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127

HYPOTONIC SOLUTIONS

?5% DEXTROSE & WATER

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?0.45% SODIUM CHLORIDE
?0.33% SODIUM CHLORIDE


Cel in a

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hypotonic

solution

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129

HYPERTONIC SOLUTIONS

?3% SODIUM CHLORIDE

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?5% SODIUM CHLORIDE
?WHOLE BLOOD
?ALBUMIN
?TOTAL PARENTERAL NUTRITION
?TUBE FEEDINGS

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?CONCENTRATED DEXTROSE (>10%)


Cel in a

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hypertonic

solution

131

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Water And Electrolyte

Imbalances
?In a human body water

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distribution in compartments

?Is due to osmotic pressure

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produced by Electrolytes

? Since Water and Electrolytes

balance in the body go together

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? Hence imbalance in any one of it

,affects both.

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? In simple words if there is

Electrolyte imbalance, it directly

affects and causes Water Imbalance.

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What Conditions Leads To

Water And Electrolyte Imbalance?

Factors Involved In Water and

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Electrolyte Balance

? Water intake

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? Electrolyte intake

? Organs and Mechanisms

? Hypothalamus

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? Pituitary Gland

? Kidneys

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? Liver

? Lung

? Adrenal glands

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? Cardiac tissue

? Related Genes

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? Cholesterol

? Amino acids
REGULATION OF FLUID VOLUME

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? Any defect in the organs

associated to factor

regulating Water and

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Electrolyte balance

? May lead to Water and

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Electrolyte imbalance.
?Anything that alters

the concentrations of

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Electrolytes

?Wil alter the

concentration of

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water, and vice versa.

Remember

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? In condition of Water and

Electrolyte imbalances

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? Care should be taken to

manage both the entities

simultaneously.

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Conditions Of Water and Electrolyte

Imbalances

Water Electrolyte Imbalance

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Conditions

?Dehydration
?Over hydration

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Dehydration

? Dehydration is a condition of

Water imbalance.

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? Dehydration is characterized

by disturbance of Water and

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electrolyte balance.

?In a dehydrated body

the output of water

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exceeds the water

intake.

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?This causes reduction of

body water below the

normal level.

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Basic Cause Of Dehydration

?No Ingestion of water

?Excessive Loss of body

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fluids

Features Of Dehydration

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

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Types Of Dehydration

? Primary Dehydration /Due to pure water

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depletion

? Mixed Type Dehydration /Due to both

Water and Salt depletion

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? Secondary dehydration/Due to pure salt

depletion
Primary Dehydration

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OR

Pure Water Depletion

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Causes Of Primary Dehydration

? Very weak or very il patients

unable to ingest Water.

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? Mental Patients who refuses to

drink water

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? In Coma Condition
? Person lost in desert or

Shipwrecked
? Defect to hypothalamus

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? Patients with renal tubular

disorder

? Diabetes insipidus-ADH

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insufficiency.

Biochemical Alterations

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? Pure Water depletion occurs

almost always:

?Because of lack of Water intake

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?Rather than because of excess

looses from the body.
? Body water stores get depleted

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because of:

? Continuing obligatory losses of

water through

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? Urine and Feces to excrete

metabolic waste.

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? The only source of water

supply in this condition is

? Metabolic water obtained

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from oxidation of food

stuffs.
? The volume of ECF is

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maintained almost to normal

in this condition.

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? At the expense of I.C.F which

is grossly reduced in volume

? Causing intracellular

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dehydration.

?Neural mechanism is

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activated

?But if this is not responded

?By oral Water ingestion

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?Causes water depletion in

body.
Clinical Manifestations

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? Dry tongue and pinched facies

(Due to intense thirst)

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? Oligouria- ADH secreted causes

reabsorption of water from kidney

tubules

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? Causing a gradual diminution of

Urine volume.

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Management

? Give water to drink by mouth
? 5% Glucose by I.V (Hypotonic Soln)
? To correct intracellular dehydration.

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? Note: Never give Isotonic Saline.
(0.9 % w/v NaCl solution).
Mixed Type Of Dehydration

Water and Salt Depletion

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?This is the most common

type of dehydration

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condition.
Causes of Mixed Type

Dehydration

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?Severe Vomiting
?Severe Diarrhea

Biochemical Alterations

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? Mixed dehydration has both low

volume of both water and

electrolytes.

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? Here the volume of fluids in both

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

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? The patient appears dehydrated

and complains of thirst.
Manifestations

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

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Management

? Administering Mixture of

Saline and 5 % Glucose in 1:1

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proportion.
Secondary Dehydration

Pure Salt Depletion

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Pure Salt Depletion

Secondary Dehydration

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? This occurs when fluids of

high Na/Cl content are lost

from the body

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? And body is replaced by

Salt deficient fluids.
Causes

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? Excessive Sweating
? GIT loss of fluids during vomiting and

diarrhea

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

Adrenal Cortex)

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? Vigorous use of diuretics

Biochemical Alterations

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? The loss of body water and

electrolytes

? Replaced with water

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without salts leads to

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

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hypotonic.

? The lowered osmotic pressure

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inhibits the release of ADH

? In this response Kidneys excrete

water in an attempt to maintain

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normal extracel ular Na

concentration

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? This decreases plasma and

interstitial fluids .

? The water from ECF (hypotonic)

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flows into the I.C.F of cells

(hypertonic soln).

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? This further reduces the volume

of ECF.

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? In this condition there is no

cellular dehydration.

? No response to thirst

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centre.

Series of Events in Secondary Dehydration

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

Dehydration

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? 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.

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? Sunken eyes, inelastic skin
? Low BP, decreased GFR and excretion

Management of Secondary

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Dehydration

? By administering Isotonic

solution 0.9% NaCl.

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Differences In Primary And Secondary

Dehydration

Primary Dehydration

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Secondary Dehydration

Caused due to pure

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Caused due to pure Salt depletion

Water Depletion

when fluids of high salt content

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when water in take is lost and replaced by salt deficient

stopped.

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fluids

Noted in patients with Patients with excessive

dysphagia

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sweating,vomiting ,diarrhea in

Comatose and Mental CCF, with no electrolytes

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patients, Lost in deserts replenished.

Feels Thirst , Cramps Thirst absent , cramps present,

absent ,Pulse and B.P rapid and thready

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normal.

pulse with low B.P.

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Primary Dehydration

Secondary Dehydration

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Scanty Urine

Normal or increased Urine

ECF Hypertonic

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ECF Hypotonic

Cellular Dehydration

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Cellular Edema present

present

Management by Water

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By infusing Isotonic

intake and Hypotonic soln solution

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Over Hydration /Water Excess
Over hydration /Water Excess

?Here there is excess of

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body water.

Over Hydration / Water Intoxication

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

? Excessive administration of parenteral

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fluids.

? Renal Failure (No/Less excretion of Urine)
? Hypersecretion of ADH

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? Administration of Narcotics ,Anaesthesia

causes secretion of ADH

? Excess of Aldosterone (Conn's Syndrome)

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Manifestations

? Headache
? Nausea

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? Incoordination of Movements
? Delirium
Management

? Withholding drinking of

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fluids.

? Administration of 3-5%

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Hypertonic Saline

intravenously.

ELECTROLYTE IMBALANCES

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ELECTROLYTE IMBALANCES

? Hyponatremia (sodium deficit < 130mEq/L)
? Hypernatremia (sodium excess >145mEq/L)
? Hypokalemia (Potassium deficit <3.5mEq/L)

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? Hyperkalemia (Potassium excess >5.1mEq/L)
? Chloride imbalance (<98mEq/L or >107mEq/L)
? Magnesium imbalance (<1.5mEq/L or

>2.5mEq/L)

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Common Conditions And Disorders

Associated

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With Water And Electrolyte Imbalances


Edema

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Edema/Swel ing

? Condition in which excess fluid accumulates in

the interstitial compartment.

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

?Inflammation

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?Infections
?Pregnancy
?Medications

Causes Of Edema

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? Increased Hydrostatic Pressure

? Smal blood vessels become leaky and releases

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fluid into nearby tissues.

? Venous obstruction, Lymphedema, CHF, Renal

failure

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? Lowered Plasma Osmotic pressure (Protein loss)

? Liver failure, Malnutrition, Burns

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? Increased capil ary membrane permeability

? Inflammation, Sepsis

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Types Of Edema

? Generalized Edema
? Organ specific Edema
[cerebral, ascites , pleural)

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? Cutaneous Pitting Edema
? Non Pitting Edema
Consequences Of Edema

? Imbalance in Water and Electrolyte

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distribution.

? Impaired blood flow

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? Slow healing

? Increased risk of infections

? Pressure sores over bony prominences

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? Impaired organ function

(Brain, Liver, Gut, Kidney)

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Treatment Of Edema

? Treat the underlying cause of

Edema.

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? Defect in heart/Lungs/Liver

/Kidney should be treated

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? Reducing amount of salt
Diabetes insipidus

Diabetes insipidus

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? Endocrine Disorder

? ADH insufficiency

? Affecting Water and

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Electrolyte imbalance of

the body.
Diabetes insipidus

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? Diabetes insipidus (DI) is

a condition characterized by:

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?Excretion of large amounts

of severely dilute urine

?With excessive thirst

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Incidence Of DI

? 3 in 100,000 individuals of

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general population.
Causes And Types of DI

Central Diabetes Insipidus

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? Central Diabetes insipidus

(CDI)

?Involves a deficiency of

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Vasopressin /

Antidiuretic hormone
Nephrogenic Diabetes insipidus

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? The second common type of DI

is Nephrogenic Diabetes insipidus

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(NDI),

? Is due to kidney or nephron

dysfunction

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? Caused by an insensitivity of

the Kidneys or nephrons to ADH.

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Manifestations Of DI

? Polyuria with dilute urine.

? Due to osmotic diuresis

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? Excessive thirst(Polydypsia)

? Dehydration

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? Electrolyte imbalance
Diagnosis

? Urine Osmolarity
? Urine Specific gravity

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? Electrolyte concentrations in

serum and urine

? Fluid Deprivation test

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Treatment

? Central DI respond

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to Desmopressin which is

given as intranasal or oral

tablets

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Addisons Disease

Hypoadrenocorticism

Addisons Disease

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? Thomas Addison first discoverer

(1849)

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? Autoimmune disease
? Endocrine disorder
Cause

? Defect in Adrenal glands

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? Adrenal gland insufficiency
? Deficient Aldosterone and

Cortisol

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Incidence Of DI

?1 in 100,000
Biochemical Alterations

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

blood)

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? Hypercalcemia (elevated calcium level in the blood)

Manifestations

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? Low blood pressure
? Syncope (loss of consciousness and

inability to stand)

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

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

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? Blood Cortisol levels

? ACTH Stimulation Test

? Uses synthetic pituitary ACTH

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hormone Tetracosactide used

for diagnosis
Management

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? Standard therapy involves intravenous

injections of Glucocorticoids

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? of Hydrocortisone tablets,

Prednisone tablets

? Large volumes of intravenous saline

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solution with Dextrose/Glucose.

? Oral doses of Fludrocortisone Acetate

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Cushings Syndrome

Hyperadrenocorticism
Cause

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? Over activity of Adrenal

glands

? Excess of Aldosterone and

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Cortisol

Incidence

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?1 in 100,000
Biochemical Alterations

? Hyperglycemia (Increased level of blood glucose)
? Hypernatremia (High Sodium level in the blood)

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? Hypokalemia (Low potassium level in the blood)
? Hypocalcemia (Low Calcium level in the blood)

Manifestations

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

Hump and Moon Face

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? Insomnia
? Excessive Sweating
? Depression
? Anxiety
Diagnosis

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?Blood Electrolytes

(Na+ and K+)

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?Blood Glucose

?Blood Calcium

?Blood Cortisol levels

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Management

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

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Cortisol biosynthesis.

? Mifepristone is a powerful

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Glucocorticoid type I receptor

antagonist
Effects of Stress on Water And

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Electrolyte Balance

? The Hypothalamus and

Pituitary gland

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? Integrate communication

between nervous and

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endocrine systems

? Stress severely affect this

coordination and affect Water

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and Electrolyte balance
Diagnostic Tests

To Check for Fluid and Electrolytes

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Balance And Imbalance

Blood Investigations

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? 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

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? Serum Hematocrit = 40-54%/men, 38-47% for

women (Decreased in Dehydration)
Urine Investigations

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?Urine pH

?Urine specific gravity

?Urine Osmolarity

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?Urine Creatinine Clearance

?Urine Sodium

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?Urine Potassium

Questions
? Distribution & functions of

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Water in human body.

? What are Electrolytes? Give

its distribution & functions

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related to human body.

? What is water electrolyte

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balance? Explain the factors

involved in water electrolyte

balance.

--- Content provided by​ FirstRanker.com ---

? What are disorders of Water

and Electrolyte imbalances?
? Dehydration- types, causes &

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management.

? Differentiate between Primary and

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Secondary Dehydration

? Over hydration/Water Toxicity/Water

Intoxication.

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? Edema

? Diabetes Insipidus.

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? Addison's & Cushing Syndrome.

Thank You