Balance{ Water}

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Balance{ Water}

  1. 1. BALANCE WATER ACID-BASE ELECTROLYTE
  2. 2. WATER BALANCE <ul><li>NORMAL WATER CONTENT OF BODY </li></ul><ul><li>75% AT BIRTH </li></ul><ul><li>55-60% YOUNG ADULTS </li></ul><ul><ul><li>MEN SLIGHTLY HIGHER THAN WOMEN </li></ul></ul><ul><ul><li>(MORE FAT, LESS WATER) </li></ul></ul><ul><li>45% IN ELDERLY, OBESE </li></ul>
  3. 3. WATER BALANCE <ul><li>TOTAL BODY WATER </li></ul><ul><li>~40 LITERS </li></ul><ul><li>SEVERAL FLUID COMPARTMENTS </li></ul><ul><ul><li>65% INTRACELLULAR FLUID (ICF) </li></ul></ul><ul><ul><li>35% EXTRACELLULAR FLUID (ECF) </li></ul></ul><ul><ul><ul><li>25% INTERSTITIAL FLUID (TISSUE FLUID) </li></ul></ul></ul><ul><ul><ul><li>8% BLOOD PLASMA AND LYMPH </li></ul></ul></ul><ul><ul><ul><li>2% TRANSCELLULAR FLUID </li></ul></ul></ul><ul><ul><ul><ul><li>SYNOVIAL, PLEURAL, PERICARDIAL, ETC. </li></ul></ul></ul></ul>
  4. 4. WATER BALANCE <ul><li>TOTAL BODY WATER </li></ul><ul><li>ENTERS BODY </li></ul><ul><ul><li>OSMOSIS FROM DIGESTIVE TRACT </li></ul></ul><ul><ul><ul><li>ALSO PRODUCED BY AEROBIC RESPIRATION </li></ul></ul></ul><ul><ul><ul><li>ALSO PRODUCED BY CONDENSATION REACTIONS </li></ul></ul></ul><ul><li>EXITS BODY </li></ul><ul><ul><li>URINARY, DIGESTIVE, RESPIRATORY, & INTEGUMENTARY SYSTEMS </li></ul></ul>
  5. 5. WATER BALANCE <ul><li>TOTAL BODY WATER </li></ul><ul><li>FLUID EXCHANGED BETWEEN COMPARTMENTS </li></ul><ul><ul><li>CAPILLARY WALLS, PLASMA MEMBRANES </li></ul></ul><ul><ul><li>DRIVEN BY TRANSIENT OSMOTIC GRADIENTS </li></ul></ul><ul><ul><li>OSMOTIC GRADIENTS DEPENDENT ON SOLUTE MOLECULES </li></ul></ul><ul><ul><li>MOST ABUNDANT SOLUTES ARE ELECTROLYTES </li></ul></ul><ul><ul><li>WATER BALANCE AND ELECTROLYTE BALANCE ARE CLOSELY RELATED </li></ul></ul>
  6. 7. WATER BALANCE <ul><li>WATER BALANCE </li></ul><ul><li>FLUID GAIN = FLUID LOSS </li></ul><ul><li>BOTH TYPICALLY ~2500 ML / DAY </li></ul>
  7. 8. WATER BALANCE <ul><li>WATER GAIN </li></ul><ul><li>TYPICALLY ~2500 ML / DAY </li></ul><ul><li>1600 ML FROM DRINK </li></ul><ul><li>700 ML FROM FOOD </li></ul><ul><li>200 ML FROM METABOLISM </li></ul><ul><ul><li>AEROBIC RESPIRATION </li></ul></ul><ul><ul><li>CONDENSATION REACTIONS </li></ul></ul><ul><ul><ul><li>A.K.A. DEHYDRATION REACTIONS </li></ul></ul></ul>
  8. 9. WATER BALANCE <ul><li>WATER LOSS </li></ul><ul><li>TYPICALLY ~2500 ML / DAY </li></ul><ul><li>1500 ML EXCRETED AS URINE </li></ul><ul><li>200 ML ELIMINATED IN FECES </li></ul><ul><li>300 ML EXPIRED IN BREATH </li></ul><ul><li>100 ML SECRETED AS SWEAT </li></ul><ul><li>400 ML LOST AS CUTANEOUS TRANSPIRATION </li></ul><ul><ul><li>DIFFUSES THROUGH EPIDERMIS, EVAPORATES </li></ul></ul>
  9. 12. WATER BALANCE <ul><li>WATER LOSS </li></ul><ul><li>CAN VARY GREATLY </li></ul><ul><ul><li>INCREASED RESPIRATORY LOSS IN COLD WEATHER </li></ul></ul><ul><ul><li>INCREASED SWEAT LOSS IN WARM WEATHER </li></ul></ul><ul><ul><li>INCREASED RESPIRATORY AND SWEAT LOSS, DECREASED URINE OUTPUT DURING PHYSICAL EXERTION </li></ul></ul>
  10. 13. WATER BALANCE <ul><li>WATER LOSS </li></ul><ul><li>OBLIGATORY WATER LOSS </li></ul><ul><ul><li>RELATIVELY UNAVOIDABLE </li></ul></ul><ul><ul><li>EXPIRED AIR, CUTANEOUS TRANSPIRATION, SWEAT, FECAL MOISTURE, MINIMUM URINE OUTPUT (~400 ML/DAY) </li></ul></ul>
  11. 14. WATER BALANCE <ul><li>REGULATION OF WATER INTAKE </li></ul><ul><li>GOVERNED BY THIRST </li></ul><ul><ul><li>PROVOKED BY INCREASED PLASMA OSMOLARITY </li></ul></ul><ul><ul><li>PROVOKED BY BLOOD LOSS </li></ul></ul><ul><li>THIRST CENTER IN HYPOTHALAMUS </li></ul><ul><ul><li>RESPONDS TO SIGNS OF DEHYDRATION </li></ul></ul><ul><ul><ul><li>ANGIOTENSIN II </li></ul></ul></ul><ul><ul><ul><li>ANTIDIURETIC HORMONE (ADH) </li></ul></ul></ul><ul><ul><ul><li>SIGNALS FROM OSMOCENTERS </li></ul></ul></ul><ul><ul><li>INHIBITS SALIVATION </li></ul></ul>
  12. 15. WATER BALANCE <ul><li>REGULATION OF WATER INTAKE </li></ul><ul><li>INHIBITED SALIVATION </li></ul><ul><ul><li>DRY MOUTH </li></ul></ul><ul><ul><li>SENSE OF THIRST </li></ul></ul><ul><ul><li>INGESTION OF WATER </li></ul></ul><ul><ul><ul><li>COOLS AND MOISTENS MOUTH </li></ul></ul></ul><ul><ul><ul><li>DISTENDS STOMACH AND INTESTINES </li></ul></ul></ul><ul><ul><ul><li>REHYDRATES BLOOD </li></ul></ul></ul><ul><ul><li>THIRST INHIBITED </li></ul></ul>
  13. 17. WATER BALANCE <ul><li>REGULATION OF WATER OUTPUT </li></ul><ul><li>CONTROLLED VIA ALTERATIONS IN URINE VOLUME </li></ul><ul><li>URINE VOLUME AFFECTED BY </li></ul><ul><ul><li>SODIUM REABSORPTION </li></ul></ul><ul><ul><ul><li>WATER FOLLOWS SODIUM REABSORPTION </li></ul></ul></ul><ul><ul><ul><li>MORE LATER </li></ul></ul></ul><ul><ul><li>ANTIDIURETIC HORMONE (ADH) </li></ul></ul><ul><ul><ul><li>BLOOD VOLUME  , [Na+]  , OSMORECEPTORS STIMULATED, PITUITARY RELEASES ADH </li></ul></ul></ul><ul><ul><ul><li>AQUAPORINS PRODUCED IN KIDNEY’S COLLECTING DUCTS </li></ul></ul></ul><ul><ul><ul><li>FACILITATE REABSORPTION </li></ul></ul></ul><ul><ul><ul><li>ALSO WORKS IN REVERSE </li></ul></ul></ul>
  14. 19. WATER BALANCE <ul><li>WATER BALANCE DISORDERS </li></ul><ul><li>FLUID DEFICIENCY </li></ul><ul><ul><li>VOLUME DEPLETION (HYOVOLEMIA) </li></ul></ul><ul><ul><li>DEHYDRATION </li></ul></ul><ul><li>FLUID EXCESS </li></ul><ul><ul><li>VOLUME EXCESS </li></ul></ul><ul><ul><li>HYPOTONIC HYDRATION </li></ul></ul><ul><li>FLUID SEQUESTRATION </li></ul>
  15. 20. WATER BALANCE <ul><li>WATER BALANCE DISORDERS </li></ul><ul><li>FLUID DEFICIENCY: HYPOVOLEMIA </li></ul><ul><li>CAUSED BY PROPORTIONATE LOSS OF WATER AND SODIUM WITHOUT REPLACEMENT </li></ul><ul><li>TOTAL BODY WATER DECREASED </li></ul><ul><li>OSMOLARITY UNCHANGED </li></ul><ul><li>CAUSES </li></ul><ul><ul><li>HEMORRHAGE </li></ul></ul><ul><ul><li>SEVERE BURNS </li></ul></ul><ul><ul><li>CHRONIC VOMITING OR DIARRHEA </li></ul></ul><ul><ul><ul><li>MAJOR CAUSE OF INFANT MORTALITY </li></ul></ul></ul>
  16. 21. WATER BALANCE <ul><li>WATER BALANCE DISORDERS </li></ul><ul><li>FLUID DEFICIENCY: DEHYDRATION </li></ul><ul><li>CAUSED BY LOSS OF MORE WATER THAN Na + </li></ul><ul><li>TOTAL BODY WATER DECREASED </li></ul><ul><li>ECF OSMOLARITY INCREASES </li></ul><ul><li>CAUSES </li></ul><ul><ul><li>LACK OF DRINKING WATER </li></ul></ul><ul><ul><li>DIABETES MELLITUS </li></ul></ul><ul><ul><li>ADH HYPOSECRETION </li></ul></ul><ul><ul><li>PROFUSE SWEATING </li></ul></ul><ul><ul><li>OVERUSE OF DIURETICS </li></ul></ul>
  17. 22. WATER BALANCE <ul><li>WATER BALANCE DISORDERS </li></ul><ul><li>FLUID DEFICIENCY: DEHYDRATION </li></ul><ul><li>AFFECTS ALL FLUID COMPARTMENTS </li></ul><ul><li>INFANTS MORE VULNERABLE THAN ADULTS </li></ul><ul><ul><li>HIGHER METABOLISM  MORE WASTES </li></ul></ul><ul><ul><ul><li>MORE WASTES  MORE URINE VOLUME </li></ul></ul></ul><ul><ul><li>IMMATURE KIDNEYS </li></ul></ul><ul><ul><ul><li>URINE LESS CONCENTRATED </li></ul></ul></ul><ul><ul><li>GREATER SURFACE AREA-TO-VOLUME RATIO </li></ul></ul><ul><ul><ul><li>GREATER WATER LOSS BY EVAPORATION </li></ul></ul></ul>
  18. 23. WATER BALANCE <ul><li>WATER BALANCE DISORDERS </li></ul><ul><li>EFFECTS OF FLUID DEFICIENCY </li></ul><ul><li>CIRCULATORY SHOCK </li></ul><ul><ul><li>DUE TO LOSS OF BLOOD VOLUME </li></ul></ul><ul><li>NEUROLOGICAL DYSFUNCTION </li></ul><ul><ul><li>DUE TO DEHYDRATION OF BRAIN CELLS </li></ul></ul>
  19. 24. WATER BALANCE <ul><li>WATER BALANCE DISORDERS </li></ul><ul><li>FLUID EXCESS </li></ul><ul><li>LESS COMMON THAN FLUID DEFICIENCY </li></ul><ul><ul><li>KIDNEYS ARE TYPICALLY ABLE TO EXCRETE MORE URINE </li></ul></ul>
  20. 25. WATER BALANCE <ul><li>WATER BALANCE DISORDERS </li></ul><ul><li>FLUID EXCESS: VOLUME EXCESS </li></ul><ul><li>CAUSED BY PROPORTIONATE RETENTION OF EXCESS WATER AND SODIUM </li></ul><ul><li>TOTAL BODY WATER INCREASED </li></ul><ul><li>OSMOLARITY UNCHANGED </li></ul><ul><li>CAUSES </li></ul><ul><ul><li>ALDOSTERONE HYPERSECRETION </li></ul></ul><ul><ul><li>RENAL FAILURE </li></ul></ul>
  21. 26. WATER BALANCE <ul><li>WATER BALANCE DISORDERS </li></ul><ul><li>FLUID EXCESS: HYPOTONIC HYDRATION </li></ul><ul><li>“ WATER INTOXICATION”, “POS H 2 0 BALANCE” </li></ul><ul><li>CAUSED BY RETENTION OF MORE WATER THAN SODIUM </li></ul><ul><li>TOTAL BODY WATER INCREASED </li></ul><ul><li>ECF OSMOLARITY DECREASES </li></ul><ul><li>CAUSES </li></ul><ul><ul><li>REPLACEMENT OF WATER AND SALT WITH WATER </li></ul></ul><ul><ul><ul><li>LACK OF PROPORTIONATE INTAKE OF ELECTROLYTES </li></ul></ul></ul><ul><ul><li>ADH HYERSECRETION </li></ul></ul>
  22. 27. WATER BALANCE <ul><li>WATER BALANCE DISORDERS </li></ul><ul><li>EFFECTS OF FLUID EXCESS </li></ul><ul><li>PULMONARY EDEMA </li></ul><ul><li>CEREBRAL EDEMA </li></ul>
  23. 28. WATER BALANCE <ul><li>WATER BALANCE DISORDERS </li></ul><ul><li>FLUID SEQUESTRATION </li></ul><ul><li>EXCESS FLUID ACCUMULATES IN A PARTICULAR LOCATION </li></ul><ul><li>TOTAL BODY WATER MAY BE NORMAL </li></ul><ul><li>CIRCULATING VOLUME MAY DROP </li></ul><ul><li>EXAMPLES </li></ul><ul><ul><li>EDEMA (IN INTERSTITIAL SPACES) </li></ul></ul><ul><ul><li>HEMORRHAGE (LOST TO CIRCULATION) </li></ul></ul><ul><ul><li>PLEURAL EFFUSION (IN PLEURAL CAVITY) </li></ul></ul>
  24. 29. ELECTROLYTE BALANCE <ul><li>IMPORTANCE OF ELECTROLYTES </li></ul><ul><li>SALTS </li></ul><ul><ul><li>E.G. NaCl, Ca 3 (PO 4 ) 2 , ETC. </li></ul></ul><ul><ul><li>INCLUDE IONS IN DEFINITION </li></ul></ul><ul><li>MANY ROLES </li></ul><ul><ul><li>INVOLVED IN METABOLISM </li></ul></ul><ul><ul><li>DETERMINE ELECTRICAL MEMBRANE POTENTIALS </li></ul></ul><ul><ul><li>AFFECT OSMOLARITY OF BODY FLUIDS </li></ul></ul><ul><ul><li>AFFECT WATER CONTENT AND DISTRIBUTION </li></ul></ul><ul><ul><li>ETC. </li></ul></ul>
  25. 30. ELECTROLYTE BALANCE <ul><li>SODIUM </li></ul><ul><li>PRINCIPAL EXTRACELLULAR CATION </li></ul><ul><ul><li>90 – 95% OF OSMOLARITY FROM SODIUM SALTS </li></ul></ul><ul><li>ROLES </li></ul><ul><ul><li>DEPOLARIZATION </li></ul></ul><ul><ul><ul><li>MUSCLES, NERVES </li></ul></ul></ul><ul><ul><li>AFFECT TOTAL BODY WATER </li></ul></ul><ul><ul><li>AFFECT WATER DISTRIBUTION </li></ul></ul><ul><ul><li>COTRANSPORT </li></ul></ul><ul><ul><ul><li>GLUCOSE, AMINO ACIDS, CALCIUM, ETC. </li></ul></ul></ul><ul><ul><li>ETC. </li></ul></ul>
  26. 31. ELECTROLYTE BALANCE <ul><li>SODIUM HOMEOSTASIS </li></ul><ul><li>0.5 G / DAY DIETARY REQUIREMENT </li></ul><ul><li>RECEIVE 3 – 7 G / DAY FROM OUR DIET </li></ul><ul><li>KIDNEYS EXCRETE EXCESS (~5 G / DAY) </li></ul><ul><li>EXCRETION REGULATED BY 3 HORMONES </li></ul><ul><ul><li>ALDOSTERONE </li></ul></ul><ul><ul><li>ANTIDIURETIC HORMONE (ADH) </li></ul></ul><ul><ul><li>ATRIAL NATRIURETIC FACTOR (ANF) </li></ul></ul>
  27. 32. ELECTROLYTE BALANCE <ul><li>SODIUM HOMEOSTASIS </li></ul><ul><li>REGULATION BY ALDOSTERONE </li></ul><ul><li>“SALT-RETAINING HORMONE” </li></ul><ul><li>STEROID HORMONE </li></ul><ul><li>ALDOSTERONE SECRETION STIMULATED BY: </li></ul><ul><ul><li>HYPONATREMIA </li></ul></ul><ul><ul><li>HYPERKALEMIA </li></ul></ul><ul><ul><li>HYPOTENSION </li></ul></ul>
  28. 33. ELECTROLYTE BALANCE <ul><li>SODIUM HOMEOSTASIS </li></ul><ul><li>REGULATION BY ALDOSTERONE </li></ul><ul><li>TARGET CELLS </li></ul><ul><ul><li>DISTAL CONVOLUTED TUBULE </li></ul></ul><ul><ul><li>COLLECTING DUCT </li></ul></ul><ul><li>TRANSCRIBE GENE FOR Na + -K + PUMP </li></ul><ul><ul><li>SODIUM REABSORPTION INCREASES </li></ul></ul><ul><ul><li>H + AND K + SECRETION INCREASES </li></ul></ul><ul><ul><li>URINE pH DROPS </li></ul></ul>
  29. 34. ELECTROLYTE BALANCE <ul><li>SODIUM HOMEOSTASIS </li></ul><ul><li>REGULATION BY ALDOSTERONE </li></ul><ul><li>AVERAGE Na + EXCRETION 5 G / DAY </li></ul><ul><li>ALDOSTERONE REDUCES TO ~0 </li></ul><ul><li>WATER REABSRBED PROPORTIONALLY </li></ul><ul><li>SODIUM CONCENTRATION IN BODY UNCHANGED </li></ul>
  30. 35. ELECTROLYTE BALANCE <ul><li>SODIUM HOMEOSTASIS </li></ul><ul><li>REGULATION BY ALDOSTERONE </li></ul><ul><li>INHIBITED BY HYPERTENSION </li></ul><ul><li>KIDNEYS THEN REABSORB LITTLE Na + </li></ul><ul><li>EXCRETION INCREASED TO ~30 G / DAY </li></ul>
  31. 37. ELECTROLYTE BALANCE <ul><li>SODIUM HOMEOSTASIS </li></ul><ul><li>REGULATION BY ADH </li></ul><ul><li>INDEPENDENTLY MODIFIES SODIUM AND WATER EXCRETION </li></ul><ul><ul><li>CAN CHANGE SODIUM CONCENTRATION </li></ul></ul><ul><li>HIGH BLOOD [Na + ]  ADH SECRETION </li></ul><ul><ul><li>INCREASES WATER REABSORPTION </li></ul></ul><ul><ul><ul><li>SODIUM CONCENTRATION DECREASED </li></ul></ul></ul><ul><ul><li>ADH ALSO STIMULATES THIRST </li></ul></ul><ul><li>ALSO HAPPENS IN REVERSE </li></ul>
  32. 38. ELECTROLYTE BALANCE <ul><li>SODIUM HOMEOSTASIS </li></ul><ul><li>REGULATION BY ANF </li></ul><ul><li>HYPERTENSION  ANF SECRETION </li></ul><ul><ul><li>INHIBITS ADH AND RENIN SECRETION </li></ul></ul><ul><ul><li>INHIBITS SODIUM & WATER REABSORPTION </li></ul></ul><ul><ul><li>MORE SODIUM AND WATER EXCRETED </li></ul></ul><ul><ul><li>BLOOD PRESSURE DECREASED </li></ul></ul>
  33. 39. ELECTROLYTE BALANCE <ul><li>SODIUM HOMEOSTASIS </li></ul><ul><li>REGULATION BY OTHER HORMONES </li></ul><ul><li>ESTROGENS MIMIC ALDOSTERONE </li></ul><ul><ul><li>WATER RETENTION DURING PREGNANCY </li></ul></ul><ul><ul><li>MENSTRUAL WATER RETENTION </li></ul></ul><ul><li>PROGESTERONE </li></ul><ul><ul><li>REDUCES SODIUM REABSORPTION </li></ul></ul><ul><ul><li>DIURETIC AEFFECT </li></ul></ul><ul><li>GLUCOCORTICOIDS </li></ul><ul><ul><li>PROMOTE SODIUM REABSORPTION, EDEMA </li></ul></ul>
  34. 40. ELECTROLYTE BALANCE <ul><li>SODIUM HOMEOSTASIS: IMBALANCES </li></ul><ul><li>RELATIVELY RARE </li></ul><ul><li>HYPERNATREMIA </li></ul><ul><ul><li>CAN RESULT FROM IV SALINE </li></ul></ul><ul><ul><li>CAUSES WATER RETENTION, HYPERTENSION, EDEMA </li></ul></ul><ul><li>HYPONATREMIA </li></ul><ul><ul><li>GENERALLY FROM WATER EXCESS </li></ul></ul><ul><ul><li>HYPOTONIC HYDRATION </li></ul></ul><ul><ul><li>CORRECTED BY EXCRETION OF EXCESS WATER </li></ul></ul>
  35. 41. ELECTROLYTE BALANCE <ul><li>POTASSIUM </li></ul><ul><li>PRINCIPAL INTRACELLULAR CATION </li></ul><ul><li>AFFECTS INTRACELLULAR OSMOLARITY </li></ul><ul><li>AFFECTS CELL VOLUME </li></ul><ul><li>ROLES </li></ul><ul><ul><li>PRODUCES RESTING & ACTION POTENTIALS </li></ul></ul><ul><ul><li>COTRANSPORT </li></ul></ul><ul><ul><li>THERMOGENESIS </li></ul></ul><ul><ul><li>COFACTOR FOR PROTEIN SYNTHESIS </li></ul></ul>
  36. 42. ELECTROLYTE BALANCE <ul><li>POTASSIUM HOMEOSTASIS </li></ul><ul><li>HOMEOSTASIS LINKED TO THAT OF Na + </li></ul><ul><ul><li>K + AND Na + COREGULATED BY ALDOSTERONE </li></ul></ul><ul><li>90% OF K + REABSORBED IN PCT </li></ul><ul><ul><li>REMAINDER EXCRETED IN URINE </li></ul></ul><ul><li>CONTROL IMPARTED IN DCT & COLLECTING DUCT (CD) </li></ul><ul><ul><li>HIGH [K + ]  SECRETE MORE INTO FILTRATE </li></ul></ul><ul><ul><li>LOW [K + ]  SECRETE LESS INTO FILTRATE </li></ul></ul><ul><ul><li>EXCHANGED FOR Na + </li></ul></ul>
  37. 43. ELECTROLYTE BALANCE <ul><li>POTASSIUM HOMEOSTASIS </li></ul><ul><li>REGULATION BY ALDOSTERONE </li></ul><ul><li>HIGH [K + ]  ALDOSTERONE PRODUCTION </li></ul><ul><ul><li>Na + -K + PUMP PRODUCED </li></ul></ul><ul><ul><li>Na + AND K + COREGULATED </li></ul></ul><ul><ul><li>INCREASE K + SECRETION </li></ul></ul><ul><ul><li>DECREASE Na + SECRETION </li></ul></ul>
  38. 44. ELECTROLYTE BALANCE <ul><li>POTASSIUM HOMEOSTASIS: IMBALANCES </li></ul><ul><li>MOST DANGEROUS ELECTROLYTE IMBALANCES </li></ul><ul><li>HYPERKALEMIA </li></ul><ul><ul><li>EFFECTS DEPEND ON SPEED OF CONC RISE </li></ul></ul><ul><ul><li>QUICK RISE  NERVE/MUSCLE CELLS VERY EXCITABLE </li></ul></ul><ul><ul><li> CARDIAC ARREST </li></ul></ul><ul><ul><ul><li>E.G., K+ RELEASED FROM INJURED CELLS </li></ul></ul></ul><ul><ul><ul><li>E.G., TRANSFUSION WITH OLD BLOOD </li></ul></ul></ul><ul><ul><ul><li>E.G., EUTHANASIA, CAPITAL PUNISHMENT LETHAL INJECTION </li></ul></ul></ul><ul><ul><ul><ul><li>K+ HAS LEAKED FROM ERYTHROCYTES </li></ul></ul></ul></ul><ul><ul><li>SLOW RISE  NERVE/MUSCLE CELLS LESS EXCITABLE </li></ul></ul><ul><ul><li>(Na+ CHANNELS INACTIVATED) </li></ul></ul><ul><ul><ul><li>E.G., ALDOSTERONE HYPOSECRETION, RENAL FAILURE, ACIDOSIS </li></ul></ul></ul><ul><ul><ul><li>E.G., SUPPLEMENTAL K+ TO RELIEVE MUSCLE CRAMPS </li></ul></ul></ul>
  39. 45. ELECTROLYTE BALANCE <ul><li>POTASSIUM HOMEOSTASIS: IMBALANCES </li></ul><ul><li>HYPOKALEMIA </li></ul><ul><ul><li>NERVE/MUSCLE CELLS LESS EXCITABLE </li></ul></ul><ul><ul><li>MUSCLE WEAKNESS, LOSS OF MUSCLE TONE, DEPRESSED REFLEXES, IRREGULAR HEART ACTIVITY </li></ul></ul><ul><ul><li>E.G., HEAVY SWEATING, CHRONIC VOMITING OR DIARRHEA, EXCESSIVE LAXATIVES, ALDOSTERONE HYPERSECRETION, ALKALOSIS </li></ul></ul><ul><ul><li>E.G., DEPRESSED APPETITE, BUT RARELY FROM DIETARY INSUFFICIENCY </li></ul></ul>
  40. 47. ELECTROLYTE BALANCE <ul><li>CHLORIDE </li></ul><ul><li>MOST ABUNDANT ANION IN ECF </li></ul><ul><ul><li>MAJOR CONTRIBUTION TO OSMOLARITY </li></ul></ul><ul><li>ROLES </li></ul><ul><ul><li>FORMATION OF HCl </li></ul></ul><ul><ul><li>CHLORIDE SHIFT </li></ul></ul><ul><ul><ul><li>CO 2 LOADING/UNLOADING </li></ul></ul></ul><ul><ul><li>REGULATION OF BODY pH </li></ul></ul>
  41. 48. ELECTROLYTE BALANCE <ul><li>CHLORIDE HOMEOSTASIS </li></ul><ul><li>Cl - STRONGLY ATTRACTED TO SOME CATIONS (E.G., Na + , K + , Ca 2+ ) </li></ul><ul><ul><li>CANNOT KEEP THEM APART </li></ul></ul><ul><li>HOMEOSTASIS ACHIEVED AS AN EFFECT OF Na + HOMEOSTASIS </li></ul><ul><ul><li>Cl - PASSIVELY FOLLOWS Na + </li></ul></ul>
  42. 49. ELECTROLYTE BALANCE <ul><li>CHLORIDE IMBALANCES </li></ul><ul><li>HYPERCHLOREMIA </li></ul><ul><ul><li>RESULTS FROM DIETARY EXCESS </li></ul></ul><ul><ul><li>RESULTS FROM INTERVENOUS SALINE ADMINISTRATION </li></ul></ul><ul><li>HYPOCHLOREMIA </li></ul><ul><ul><li>SIDE EFFECT OF HYPONATREMIA </li></ul></ul><ul><ul><li>SIDE EFFECT OF HYPOKALEMIA </li></ul></ul><ul><ul><ul><li>KIDNEYS RETAIN K+ BY SECRETING Na+, Cl- FOLLOWS </li></ul></ul></ul><ul><li>EFFECTS </li></ul><ul><ul><li>ALTERED ACID-BASE BALANCE </li></ul></ul>
  43. 50. ELECTROLYTE BALANCE <ul><li>CALCIUM </li></ul><ul><li>ROLES </li></ul><ul><ul><li>STRENGTHENS BONE </li></ul></ul><ul><ul><li>MUSCLE CONTRACTION </li></ul></ul><ul><ul><li>SECOND MESSENGER FOR HORMONES </li></ul></ul><ul><ul><li>ACTIVATES EXOCYTOSIS </li></ul></ul><ul><ul><li>BLOOD CLOTTING </li></ul></ul>
  44. 51. ELECTROLYTE BALANCE <ul><li>CALCIUM </li></ul><ul><li>BINDS TO PHOSPHATE ION </li></ul><ul><ul><li>CAN FORM Ca 3 (PO 4 ) 2 </li></ul></ul><ul><ul><li>HIGH CONCENTRATIONS OF BOTH IONS WILL FORM PRECIPITATE CRYSTALS </li></ul></ul><ul><ul><li>INTRACELLULAR [Ca 2+ ] MUST BE KEPT LOW </li></ul></ul><ul><ul><li>Ca 2+ PUMPED OUT & INTO E.R. </li></ul></ul>
  45. 52. ELECTROLYTE BALANCE <ul><li>CALCIUM HOMEOSTASIS </li></ul><ul><li>REGULATED BY PTH & CALCITROL </li></ul><ul><ul><li>ALSO BY CALCITONIN IN CHILDREN </li></ul></ul><ul><li>BLOOD [Ca 2+ ] REGULATED VIA </li></ul><ul><ul><li>BONE DEPOSITION & REABSORPTION </li></ul></ul><ul><ul><li>INTESTINAL ABSORPTION </li></ul></ul><ul><ul><li>URINARY EXCRETION </li></ul></ul>
  46. 53. ELECTROLYTE BALANCE <ul><li>CALCIUM IMBALANCES </li></ul><ul><li>HYPERCALCEMIA </li></ul><ul><ul><li>REDUCES EMBRANE PERMEABILITY TO Na+ </li></ul></ul><ul><ul><li>INHIBITS DEPOLARIZATION OF NERVES/MUSCLES </li></ul></ul><ul><ul><li> MUSCULAR WEAKNESS, CARDIAC ARRHYTHMI, ETC. </li></ul></ul><ul><ul><li>RESULTS FROM </li></ul></ul><ul><ul><ul><li>ALKALOSIS </li></ul></ul></ul><ul><ul><ul><li>HYPERPARATHYROIDISM </li></ul></ul></ul><ul><ul><ul><li>HYPOTHYROIDISM </li></ul></ul></ul>
  47. 54. ELECTROLYTE BALANCE <ul><li>CALCIUM IMBALANCES </li></ul><ul><li>HYPOCALCEMIA </li></ul><ul><ul><li>INCREASES EMBRANE PERMEABILITY TO Na+ </li></ul></ul><ul><ul><li>NERVES/MUSCLES OVERLY EXCITABLE </li></ul></ul><ul><ul><li> TETANUS IF CONCENTRATION DROPS TO LOW </li></ul></ul><ul><ul><li>RESULTS FROM </li></ul></ul><ul><ul><ul><li>ACIDOSIS </li></ul></ul></ul><ul><ul><ul><li>VITAMIN D DEFICIECY </li></ul></ul></ul><ul><ul><ul><li>DIARRHEA </li></ul></ul></ul><ul><ul><ul><li>PREGNANCY OR LACTATION </li></ul></ul></ul><ul><ul><ul><li>HYPOPARATHYROIDISM </li></ul></ul></ul><ul><ul><ul><li>HYPERTHYROIDISM </li></ul></ul></ul>
  48. 55. ELECTROLYTE BALANCE <ul><li>PHOSPHATES </li></ul><ul><li>RELATIVELY CONCENTRATED IN ICF </li></ul><ul><li>ROLES </li></ul><ul><ul><li>COMPONENTS OF BONES </li></ul></ul><ul><ul><li>COMPONENTS OF DNA & RNA </li></ul></ul><ul><ul><li>COMPONENTS OF PHOSPHOLIPIDS </li></ul></ul><ul><ul><li>ACTIVATE / DEACTIVATE ENZYMES </li></ul></ul><ul><ul><li>BUFFER pH OF BODY FLUIDS </li></ul></ul>
  49. 56. ELECTROLYTE BALANCE <ul><li>PHOSPHATES </li></ul><ul><li>COMPONENTS OF </li></ul><ul><ul><li>NUCLEIC ACIDS (DNA, RNA) </li></ul></ul><ul><ul><li>NTPs AND dNTPs (ATP, dATP, GTP, dGTP, etc) </li></ul></ul><ul><ul><li>cAMP </li></ul></ul><ul><ul><li>PHOSPHOLIPIDS </li></ul></ul><ul><ul><li>VARIOUS OTHER PHOSPHORYLATED MOLECULES </li></ul></ul><ul><li>GENERATED VIA ATP HYDROLYSIS, ETC. </li></ul><ul><li>EXIST AS MIXTURE OF THREE FORMS </li></ul><ul><ul><li>PO 4 3- (PHOSPHATE ION) </li></ul></ul><ul><ul><li>HPO 4 2- (MONOHYDROGEN PHOSPHATE ION) </li></ul></ul><ul><ul><li>H 2 PO 4 - (DIHYDROGEN PHOSPHATE ION) </li></ul></ul>
  50. 57. ELECTROLYTE BALANCE <ul><li>PHOSPHATE HOMEOSTASIS </li></ul><ul><li>DIET PROVIDES AMPLE PHOSPHATE </li></ul><ul><li>READILY ABSORBED BY SMALL INTESTINE </li></ul><ul><li>REGULATION </li></ul><ul><ul><li>RENAL TUBULES SITE OF REGULATION </li></ul></ul><ul><ul><li>PTH INCREASES PHOSPHATE EXCRETION </li></ul></ul><ul><ul><li>EXCRETION RATE AFFECTED BY URINE pH </li></ul></ul>
  51. 58. ELECTROLYTE BALANCE <ul><li>PHOSPHATE IMBALANCES </li></ul><ul><li>PHOSPHATE HOMEOSTASIS NOT VERY CRITICAL </li></ul><ul><li>BODY CAN TOLERATE WIDE VARIATIONS OF PHOSPHATEE CONCENTRATION WITH LITTLE EFFECT </li></ul>
  52. 59. ACID-BASE BALANCE <ul><li>ACIDS, BASES, AND pH </li></ul><ul><li>ACID </li></ul><ul><ul><li>ANY SUBSTANCE RELEASING H + </li></ul></ul><ul><ul><li>[H+] INCREASES (pH DECREASES) </li></ul></ul><ul><li>BASE </li></ul><ul><ul><li>ANY SUBSTANCE ACCEPTING H + </li></ul></ul><ul><ul><li>[H+] DECREASES (pH INCREASES) </li></ul></ul><ul><li>pH </li></ul><ul><ul><li>A MEASURE OF [H + ] </li></ul></ul><ul><ul><li>-LOG [H + ] </li></ul></ul><ul><ul><li>SCALE 0 – 14, 7 IS NEUTRAL </li></ul></ul>
  53. 60. ACID-BASE BALANCE <ul><li>WHY IS ACID-BASE BALANCE IMPORTANT? </li></ul><ul><li>METABOLISM REQUIRES NUMEROUS ENZYMES </li></ul><ul><li>ENZYMES ARE PROTEINS </li></ul><ul><li>pH AFFECTS PROTEIN STRUCTURE </li></ul><ul><li>PROTEIN STRUCTURE AFFECTS FUNCTION </li></ul><ul><li>DEVIATIONS FROM NORMAL pH CAN INACTIVATE ENZYMES AND SHUT DOWN METABOLIC PATHWAYS </li></ul>
  54. 62. ACID-BASE BALANCE <ul><li>BLOOD pH </li></ul><ul><li>BLOOD AND TISSUE pH 7.35 – 7.45 </li></ul><ul><ul><li>ENZYMES FUNCTION WELL WITHIN THIS RANGE </li></ul></ul><ul><ul><li>ENZYMES FUNCTION POORLY (OR NOT AT ALL) WHEN SIGNIFICANTLY OUTSIDE OF THIS RANGE </li></ul></ul><ul><ul><li>THIS RANGE MUST BE MAINTAINED </li></ul></ul><ul><ul><ul><li>ACID-BASE BALANCE </li></ul></ul></ul>
  55. 63. ACID-BASE BALANCE <ul><li>BUFFERS </li></ul><ul><li>ANY MECHANISM OF RESISTING SIGNIFICANT CHANGES IN pH </li></ul><ul><li>ACCOMPLISHED BY CONVERTING: </li></ul><ul><ul><li>STRONG ACID  WEAK ACID </li></ul></ul><ul><ul><li>STRONG BASE  WEAK BASE </li></ul></ul>
  56. 64. ACID-BASE BALANCE <ul><li>BUFFERS </li></ul><ul><li>PHYSIOLOGICAL BUFFER </li></ul><ul><ul><li>SYSTEM STABILIZING pH BY CONTROLLING BODY’S OUTPUT OF ACIDS, BASES, OR CO 2 </li></ul></ul><ul><ul><ul><li>URINARY SYSTEM </li></ul></ul></ul><ul><ul><ul><ul><li>BUFFERS GREATEST QUANTITY </li></ul></ul></ul></ul><ul><ul><ul><ul><li>REQUIRES HOURS OR DAYS TO EXERT EFFECT </li></ul></ul></ul></ul><ul><ul><ul><li>RESPIRATORY SYSTEM </li></ul></ul></ul><ul><ul><ul><ul><li>SMALLER EFFECT </li></ul></ul></ul></ul><ul><ul><ul><ul><li>EXERTS EFFECT WITHIN MINUTES </li></ul></ul></ul></ul>
  57. 65. ACID-BASE BALANCE <ul><li>BUFFERS </li></ul><ul><li>CHEMICAL BUFFER SYSTEM </li></ul><ul><ul><li>COMBINATION OF WEAK ACID AND WEAK BASE </li></ul></ul><ul><ul><li>BINDS TO H + AS [H + ] RISES, AND </li></ul></ul><ul><ul><li>RELEASES H + AS [H + ] FALLS </li></ul></ul><ul><ul><li>CAN RESTORE NORMAL pH ALMOST IMMEDIATELY </li></ul></ul><ul><ul><li>THREE MAJOR CHEMICAL BUFFER SYSTEMS </li></ul></ul><ul><ul><ul><li>BICARBONATE SYSTEM </li></ul></ul></ul><ul><ul><ul><li>PHOSPHATE SYSTEM </li></ul></ul></ul><ul><ul><ul><li>PROTEIN SYSTEM </li></ul></ul></ul>
  58. 66. ACID-BASE BALANCE <ul><li>BICARBONATE BUFFER SYSTEM </li></ul><ul><li>CARBONIC ACID (H 2 CO 3 ) </li></ul><ul><ul><li>WEAK ACID </li></ul></ul><ul><li>BICARBONATE ION (HCO 3 - ) </li></ul><ul><ul><li>WEAK BASE </li></ul></ul><ul><li>CO 2 + H 2 0  H 2 CO 3  H + + HCO 3 - </li></ul><ul><li>WORKS IN CONCERT WITH RESPIRATORY AND URINARY SYSTEM </li></ul><ul><ul><li>THESE SYSTEMS REMOVE CO 2 OR HCO 3 - </li></ul></ul>
  59. 67. ACID-BASE BALANCE <ul><li>PHOSPHATE BUFFER SYSTEM </li></ul><ul><li>DIHYDROGEN PHOSPHATE ION(H 2 PO 4 - ) </li></ul><ul><ul><li>WEAK ACID </li></ul></ul><ul><li>MONOHYDROGEN PHOSPHATE ION (HPO 4 2- ) </li></ul><ul><ul><li>WEAK BASE </li></ul></ul><ul><li>H 2 PO 4 -  H + + HPO 4 2- </li></ul><ul><li>STRONGER THAN BICARBONATE BUFFERING SYSTEM </li></ul><ul><li>MORE IMPARTANT IN BUFFERING ICF AND RENAL TUBULES THAN IN ECF </li></ul>
  60. 68. ACID-BASE BALANCE <ul><li>PROTEIN BUFFER SYSTEM </li></ul><ul><li>PROTEINS ARE MORE CONCENTRATED THAN BICARBONATE AND PHOSPHATE BUFFERS </li></ul><ul><li>ACCOUNTS FOR ~75% OF ALL CHEMICAL BUFFERING OF BODY FLUIDS </li></ul><ul><li>BUFFERING ABILITY DUE TO CERTAIN FUNCTIONAL GROUPS OF AMINO ACID RESIDUES </li></ul><ul><ul><li>CARBOXYL GROUPS </li></ul></ul><ul><ul><ul><li>--COOH  -COO - + H + </li></ul></ul></ul><ul><ul><li>AMINO GROUPS </li></ul></ul><ul><ul><ul><li>--NH 3 +  -NH 2 + H + </li></ul></ul></ul>
  61. 69. ACID-BASE BALANCE <ul><li>RESPIRATORY CONTROL OF pH </li></ul><ul><li>CO 2 + H 2 0  H 2 CO 3  H + + HCO 3 - </li></ul><ul><li>ADDITION OF CO 2 INCREASES [H + ] </li></ul><ul><li>REMOVAL OF CO 2 DECREASES [H + ] </li></ul><ul><li>CAN NEUTRALIZE 2-3 X MORE ACID AS CHEMICAL BUFFERS </li></ul>
  62. 70. ACID-BASE BALANCE <ul><li>RENAL CONTROL OF pH </li></ul><ul><li>CAN NEUTRALIZE MORE ACID OR BASE THAN BOTH RESPIRATORY SYSTEM AND CHEMICAL BUFFERS </li></ul><ul><li>RENAL TUBULES SECRETE H + </li></ul><ul><ul><li>H + EXCRETED IN URINE </li></ul></ul><ul><ul><li>EXCHANGED FOR SODIUM ION (Na + ) </li></ul></ul><ul><ul><li>ONLY POSSIBLE WHEN [H + ] INSIDE TUBULE CELLS IS > [H + ] IN TUBULAR FLUID </li></ul></ul>
  63. 72. ACID-BASE BALANCE <ul><li>ACID-BASE BALANCE DISORDERS </li></ul><ul><li>AT pH 7.4, 20:1 HCO 3 - :H 2 CO 3 RATIO </li></ul><ul><li>IF [H 2 CO 3 ] INCREASES, pH DROPS </li></ul><ul><ul><li>pH BELOW 7.35 = ACIDOSIS </li></ul></ul><ul><li>IF [HCO 3 - ] INCREASES, pH INCREASES </li></ul><ul><ul><li>pH ABOVE 7.45 = ALKALOSIS </li></ul></ul>
  64. 73. ACID-BASE BALANCE <ul><li>ACID-BASE BALANCE DISORDERS </li></ul><ul><li>RESPIRATORY ACIDOSIS </li></ul><ul><ul><li>CO 2 PRODUCTION EXCEEDS RESPIRATORY CO 2 ELIMINATION </li></ul></ul><ul><ul><li>CO 2 ACCUMULATES IN ECF </li></ul></ul><ul><ul><li>pH DROPS </li></ul></ul><ul><li>RESPIRATORY ALKALOSIS </li></ul><ul><ul><li>RESPIRATORY CO 2 ELIMINATION EXCEEDS CO 2 PRODUCTION </li></ul></ul><ul><ul><li>EXCESSIVE VENTILATION (HYPERVENTILATION) </li></ul></ul><ul><ul><li>pH RISES </li></ul></ul>
  65. 74. ACID-BASE BALANCE <ul><li>ACID-BASE BALANCE DISORDERS </li></ul><ul><li>METABOLIC ACIDOSIS </li></ul><ul><ul><li>INCREASED PRODUCTION OF ORGANIC ACIDS </li></ul></ul><ul><ul><ul><li>E.G., FERMENTATION  LACTIC ACID </li></ul></ul></ul><ul><ul><ul><li>E.G., ALCOHOLISM, DIABETES MELLITUS  KETONE BODIES </li></ul></ul></ul><ul><ul><li>INGESTION OF ACIDIC DRUGS </li></ul></ul><ul><ul><ul><li>E.G., ASPIRIN </li></ul></ul></ul><ul><ul><li>LOSS OF BASE </li></ul></ul><ul><ul><ul><li>E.G., CHRONIC DIARRHEA, OVERUSE OF LAXITIVES </li></ul></ul></ul><ul><li>METABOLIC ALKALOSIS </li></ul><ul><ul><li>RARE </li></ul></ul><ul><ul><li>OVERUSE OF BICARBONATES </li></ul></ul><ul><ul><ul><li>E.G., ANTACIDS </li></ul></ul></ul><ul><ul><li>LOSS OF STOMACH ACID FROM CHRONIC VOMITING </li></ul></ul>
  66. 76. ACID-BASE BALANCE <ul><li>ACID-BASE BALANCE DISORDERS </li></ul><ul><li>ACIDOSIS </li></ul><ul><li>H + PASSIVELY DIFFUSES INTO CELLS </li></ul><ul><li>K + DIFFUSES OUT </li></ul><ul><ul><li>ELECTRICAL BALANCE MAINTAINED </li></ul></ul><ul><li>H + BUFFERED BY INTRACELLULAR PROTEINS </li></ul><ul><li>NET LOSS OF CATIONS FROM CELL </li></ul><ul><li>MEMBRANE IS NOW HYPERPOLARIZED </li></ul><ul><li>NERVE & MUSCLE CELLS DIFFICULT TO STIMULATE </li></ul><ul><ul><li>CENTRAL NERVOUS SYSTEM DEPRESSED </li></ul></ul><ul><ul><ul><li>CONFUSION, DISORIENTATION, COMA </li></ul></ul></ul>
  67. 78. ACID-BASE BALANCE <ul><li>ACID-BASE BALANCE DISORDERS </li></ul><ul><li>ALKALOSIS </li></ul><ul><li>H + PASSIVELY DIFFUSES OUT OF CELLS </li></ul><ul><li>K + DIFFUSES INTO CELLS </li></ul><ul><ul><li>GAIN IN POSITIVE INTRACELLULAR CHARGE </li></ul></ul><ul><li>MEMBRANE POTENTIAL SHIFTED </li></ul><ul><li>NERVOUS SYSTEM HYPEREXCITABLE </li></ul><ul><ul><li>NEURONS FIRE SPONTANEOUSLY </li></ul></ul><ul><ul><li>SKELETAL MUSCLES OVERSTIMULATED </li></ul></ul><ul><ul><ul><li>MUSCLE SPASMS, TETANY, CONVULSIONS, RESPIRATORY PARALYSIS </li></ul></ul></ul>
  68. 79. ACID-BASE BALANCE <ul><li>ACID-BASE IMBALANCE COMPENSATION </li></ul><ul><li>RESPIRATORY SYSTEM COMPENSATION </li></ul><ul><li>ADJUSTS P CO 2 IN ECF </li></ul><ul><ul><li>CO 2 EXCESS  INCREASED VENTILATION </li></ul></ul><ul><ul><li>CO 2 DEFICIENCY  DECREASED VENTILATION </li></ul></ul><ul><li>EFFECTIVE VS RESPIRATORY ACIDOSIS AND ALKALOSIS </li></ul><ul><li>NOT VERY EFFECTIVE VS METABOLIC ACIDOSIS AND ALKALOSIS </li></ul><ul><ul><li>I.E., CANNOT RID BODY OF KETONE BODIES </li></ul></ul><ul><li>CAN CORRECT pH 7.0 TO 7.2 OR 7.3 </li></ul><ul><ul><li>NOT ALL THE WAY TO 7.4 </li></ul></ul>
  69. 80. ACID-BASE BALANCE <ul><li>ACID-BASE IMBALANCE COMPENSATION </li></ul><ul><li>RENAL SYSTEM COMPENSATION </li></ul><ul><li>SLOWER TO RESPOND </li></ul><ul><li>CAN FULLY RESTORE NORMAL pH </li></ul><ul><li>URINE pH NORMALLY 5 – 6 </li></ul><ul><ul><li>MAY DROP TO 4.5 WITH EXCESS H + </li></ul></ul><ul><ul><ul><li>RESPONSE TO ACIDOSIS </li></ul></ul></ul><ul><ul><ul><li>RENAL TUBULES INCREASE H + SECRETION </li></ul></ul></ul><ul><ul><ul><li>H + IN URINE IS BUFFERED </li></ul></ul></ul><ul><ul><li>MAY RISE TO 8.2 WITH EXCESS HCO 3 - </li></ul></ul><ul><ul><ul><li>RESPONSE TO ALKALOSIS </li></ul></ul></ul><ul><ul><ul><li>HCO 3 - CONCENTRATION IN URINE ELEVATED </li></ul></ul></ul>

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