HOMEOSTASIS IMBALANCES PHARMACOLOGY

1. HOMEOSTASIS
IMBALANCES

2. Objectives
Review the physiological mechanism responsible for the
movement of fluid and electrolyte in the following body
compartments. Between ICF & ECF Between
Intravascular & interstitial.
Discuss the Starling‟s Hypothesis to describe the
movement of fluid across the capillary wall. Discussthe
classification of fluid electrolyte imbalance in termsof:
Isotonic imbalance Osmotic imbalance Compositional
imbalance

3. Objectives
Discuss the causes manifestation,and Pathophysiology
of following isotonic imbalance: Hypovolemia
Hypervolemia.
Discuss the causes, Pathophysiology and clinical
manifestation of the following osmoticimbalance:
Hyponateremia Hypernateremia

4. Objectives
Discuss the causes, Pathophysiology and clinical
manifestation of compositional imbalance:Hypokalemia
Hyperkalemia

5. HOMEOSTASIS IMBALANCES
Homeotic imbalance is the disability of the internal
environment to remain in equilibrium in the face of
internal , external and environmental influences.
Homeostatic imbalance occurs when cells in the body
experience a deficiency, such as nutritional deficiencies
resulting from an unhealthy diet or when cells are
exposed to toxins.

6. HOMEOSTASIS IMBALANCES
Homeostatic imbalances may result from three main
influences -
1) Internal influences such as aging and genetics.
2)External influences such as nutrition deficiencies,
physical activity, mental health , drug and alcohol
abuse.
3) Environmental influences such as exposure to toxins.

7. ICF & ECF
Extracellular fluid (ECF) is the fluid in the body that is
outside of cells. Intracellular fluid (ICF) is the fluid in
the body that is inside of cells.

8. Body Water Content

9. ICF & ECF
Human beings are mostly water, ranging from about 75
percent of body mass in infants to about 50–60 percent
in adult men and women, to as low as 45 percent in old
age.

10. Intracellular Fluid
The ICF makes up about 60 percent of the total water in
the human body, and in an average-size adult male, the
ICF accounts for about 25 liters (seven gallons) of fluid.
This fluid volume tends to be very stable, because the
amount of water in living cells is closely regulated.
If the amount of water inside a cell falls to a valuethat
is too low, the cytosol becomes too concentrated with
solutes to carry on normal cellular activities; if too
much water enters a cell, the cell may burst and be
destroyed.

12. Extracellular Fluid
Approximately 20 percent of the ECF is found in plasma.
Plasma travels through the body in blood vessels and
transports a range of materials, including blood cells,
proteins (including clotting factors and antibodies),
electrolytes, nutrients, gases, and wastes.

13. Extracellular Fluid
The body has other water-based ECF
. These include the
cerebrospinal fluid that bathes the brain and spinal
cord, lymph, the synovial fluid in joints, the pleural
fluid in the pleural cavities, the pericardial fluid in the
cardiac sac, the peritoneal fluid in the peritoneal
cavity, and the aqueous humor of the eye.
Because these fluids are outside of cells, these fluids
are also considered components of the ECF
compartment.

15. Intravascular & interstitial
the interstitial compartment (also called "tissuespace")
surrounds tissue cells. It is filled with interstitialfluid.
Interstitial fluid provides the
immediate microenvironment that allows for movement
of ions, proteins and nutrients across the cell barrier.
This fluid is not static, but is continually being
refreshed by the blood capillaries and recollected
by lymphatic capillaries.

16. Intravascular & interstitial
The main intravascular fluid is blood, a
complex mixture with elements of a suspension (blood
cells), colloid (globulins),
and solutes (glucose and ions).
The blood represents both the intracellular
compartment (the fluid inside the blood cells) and the
extracellular compartment (the blood plasma). The
other intravascular fluid is lymph.

18. Isotonic imbalance Osmotic
imbalance Compositional
imbalance
Isotonic imbalance:
Intracellular fluid volume remains constant
External loss: vomiting, diarrhoea, haemorrhage,
burning
Internal loss: ileus, ascites, pleural effusion
Therapy: volume replacement wiht isotonic solution

19. Osmotic imbalance
Osmoregulation is the process of maintenance of salt
and water balance (osmotic balance) acrossmembranes
within the body’s fluids, which are composed of water,
plus electrolytes and non-electrolytes.

20. Compositional imbalance
Fluid imbalance can arise due to hypovolemia,
normovolemia with maldistribution of fluid, and
hypervolemia.
Trauma is among the most frequent causes of
hypovolemia, with its often profuse attendant blood
loss.
Another common cause is dehydration, which primarily
entails loss of plasma rather than whole blood.

21. Hypovolemia Hypervolemia
Hypovolemia, also known as volume
depletion or volume contraction, is a state of
decreased intravascular volume.
This may be due to either a loss of both salt and water
or a decrease in blood volume

22. Signs and symptoms
Hypovolemia
Early symptoms of hypovolemia include headache,
fatigue, weakness, thirst, and dizziness.
The more severe signs and symptoms are often
associated with hypovolemicshock

23. Causes
Loss of body sodium and consequent intravascular water
(due to impaired reabsorption of salt and water in the
tubules of the kidneys)
Loss of bodily fluids due to:Gastrointestinal losses; e.g.
vomiting and diarrhea
Skin losses; e.g. excessive sweating andburns

24. Pathophysiology
A decrease in circulating volume can lead to adecrease
in blood perfusion to the brain, resulting in headache
and dizziness. Altered mental status progresses as
hypovolemia continues.

25. Diagnosis
full blood count, glucose, Urine output measurements
(via urinary catheter)
Blood pressure,SpO2 oxygen saturation monitoring

26. Treatment
The following interventions are carried out:
IV access
Oxygen as required
Fresh frozen plasma or blood transfusion
Surgical repair at sites of bleeding

27. Hypervolemia
also known as fluid overload, is the medical condition
where there is too much fluid in the blood.

28. Signs and symptoms
increase in weight
swelling in the legs and arms (peripheral edema)

29. Complications
Congestive heart failure is the most common result of
fluid overload.

30. Causes
Excessive sodium and/or fluid intake
Sodium and water retention.

31. Treatment
One of the mostn
common treatments for hypervolemia isdiuretics

32. Hyponateremia
Hypernateremia
Two different disorders, known as hyponatremia and
hypernatremia, may result from changes in the balance
of water in the body and levels of sodium in the blood

33. Hyponatremia
Hyponatremia occurs when blood sodium goes below
normal levels, which is 135 milliequivalents/liter
(mEq/L).
When sodium levels in the blood are too low, extra
water goes into body cells causing them to swell.This
swelling can be especially dangerous for brain cells,
resulting in neurological symptoms such as headache,
confusion, irritability, seizures or even coma.

34. symptoms of the disorder include muscle cramps or
weakness, nausea, vomiting, tiredness and a lack of
energy.

35. causes
some of the causes may include:
Severe vomiting or diarrhea.
Excessive fluid intake, such as during endurance
activities or from excessive thirst.
Taking diuretics, medications that help flush excess
water and sodium from the body.
Kidney failure, a condition in which the kidneys have
difficulty eliminating extra fluid from the body.

36. Hypernatremia
Hypernatremia is a common electrolyte problem that is
defined as a rise in serum sodium concentration to a
value exceeding 145 mmol/L.

37. Signs and symptoms
confusion, muscle twitching or spasms. Withsevere
elevations, seizures and comas may occur

38. Cause
nadequate intake of free water associated withtotal
body sodium depletion.
Intake of a hypertonic fluid (a fluid with a higher
concentration of solutes than the remainder of the
body) with restricted free water intake.

39. Diagnosis
Hypernatremia is diagnosed when a basic metabolic
panel blood test demonstrates a sodium concentration
higher than 145 mmol/l.

40. Treatment
thiazide diuretics (e.g., chlorthalidone) in congestive
heart failure or corticosteroids in nephropathy also can
be used.

41. Hypokalemia Hyperkalemia
Hypokalemia and hyperkalemia are common
electrolyte disorders caused by changes in potassium
intake, altered excretion, or transcellular shifts.
Diuretic use and gastrointestinal losses are common
causes of hypokalemia, whereas kidney disease,
hyperglycemia, and medication use are common causes
of hyperkalemi