? A 55-year-old man was brought to the emergency with severe
multiple injuries in a road traffic accident and crush injuries, fractures
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of the legs and scalp lacerations. He was conscious and breathing
spontaneously. Pulse 130/min, BP 60/40 mm Hg, serum sodium 142
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mmol/L, potassium 7.9 mmol/L, chloride 110 mmol/L, Blood urea 40mg/dL, and serum creatinine 1.2 mg/dL.
? Interpret the laboratory data?
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? What is the basis of the changes?The body water compartments
? During oxidation of foodstuffs,
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? 1 g carbohydrate produces? 0.6 mL of water,
? 1 g protein releases
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? 0.4 mL water and
? 1 g fat generates
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? 1.1 mL of water.? major factors control ing the intake :
? thirst and
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? the rate of metabolism.
Wate r balance in the body
? Osmolarity means osmotic pressure exerted by the
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? number of moles per liter of solution.
? Osmolality is the osmotic pressure exerted by the
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? number of moles per kg of solvent.? osmotic balance is mainly maintained by
? Albumin
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? the major determinant factor of osmolality is
? the sodium
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? The osmolality of plasma varies from? 285 to 295 mosm/kg
Gamblegrams showing composition of fluid
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compartmentsElectrolyte and Water Composition of Body Fluid Compartments
Components
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Plasma
Interstitial fluid
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Intracel ular fluidVolume, H2O (TBW 3.5 L
10.5 L
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28 L
= 42 L)
Na+
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142
145
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12K+
4
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4
156
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Ca+22.4
2-3
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2.3
Mg2+
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21-2
26
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Trace elements
1
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--
Total cations
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155
Cl-
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103114
4
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HCO-
27
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3112
Protein-
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16
-
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55Organic acids-
5
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HPO2 -
2
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SO2 -1
Total anions
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154
Regulation of Sodium and Wate r balance
? ADH
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? Renin-Angiotensin system
? Autoregulation
Disturbances in Fluid and Electrolyte balance
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? Isotonic contraction- Loss of fluid that is isotonic with plasma--Loss of
GI fluid
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? Hypotonic contraction--Predominant Na loss? Infusion of fluids withlow sodium content like dextrose
? Hypertonic contraction ---Predominantly water depletion---Diarrhoea
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? Isotonic expansion---Secondary to hypertension
? Hypotonic expansion---ADH excess
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? Hypertonic expansion---Conns syndrome & Cushings syndrome_Excess mineralocorticoid- sodium retention
Reference interval of Sodium:
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136-145 mmol/L (Adult)128-148 mmol/L (New born at 48 h)
Approx 127 mmol/L (From Umbilical cord)
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Urinary sodium excretion = 120-240 mmol/day with large diurnal variation
At night = 20% of the peak
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Hyponatremia typical y manifests clinical y as(1) nausea,
(2) generalize weakness, and
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(3) mental confusion.
<120 mmol/L: mental confusion
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<110 mmol/L : Ocular palsy90-105 mmol/L: Severe mental impairment
Algorithm for the differential diagnosis of hyponatremia.
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Hypernatremia Plasma sodium > 150 mmol/LSymptoms are primarily neurologic
(because of neuronal cell loss of H2O into the ECF)
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1. Tremors
2. Irritability
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3. Ataxia4. Confusion
5. coma
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HypernatremiaHYPOKALEMIA
Reference interval of K+:
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1.Muscle weakness
Serum=3.5-5.0 mmol/L (Adult)
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2.Irritability3.Paralysis
Plasma= 3.4-4.8 mmol/L (Adult)
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4.Tachycardia
3.7-5.9 mmol/L ( Newborn)
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5.Cardiac conduction defectCSF= 70% that of plasma
6.Flattened T wave
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7.Cardiac arrest
Hypokalemia
Hypokalemia (continued)
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Metabolic Alkalosis
HYPERKALEMIA
1. Mental confusion
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2. Weakness
3. Tingling
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4. Flaccid paralysis of the extremities5. Weakness of the respiratory muscles
6. Bradicardia
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7. Conduction defects
8. Peripheral vascular collapse : Prolonged severe hyperkalemia >7 mmol/L
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9. Cardiac arrestHyperkalemia
MCQ 1
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? A patient with diarrhoea may have all the following abnormalitiesexcept:
? A. Metabolic acidosis
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? B. Hypertonic contraction of ECF
? C. Urine with a high specific gravity
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? D. Isotonic contraction of ECFMCQ 2
? Which of the following is the major intracellular cation?
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? A. Magnesium? B. Sodium
? C. Calcium
? D. Potassium
MCQ 3
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? All 5the following hormones affect fluid and electrolyte balance
except:
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? A. Aldosterone? B. ADH
? C. Cortisone
? D. Thyroxine
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