This document provides an overview of body fluids and electrolytes. It discusses daily fluid intake and output, body fluid compartments, blood volume, compositions of extracellular and intracellular fluid, types of fluids used for fluid replacement, and key electrolytes including sodium, potassium, and calcium. For each electrolyte, it covers normal levels, causes and symptoms of hypo- and hyper- conditions, and general treatment approaches. The document contains detailed but concise explanations of fluid and electrolyte physiology.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
3. INTRODUCTION
• Surgical illness and operative intervention
disrupt homeostasis and lead to changes in
fluid, electrolyte and acid– base balance.
• A grasp of the surgical physiology involved is
vital for understanding the principles of
preoperative and postoperative care.
24-May-23 Body Fluids 3
4. COUNT….
The monitoring and alteration of fluid and
acid–base status comprise the principal aspects
of the care of surgical patients.
24-May-23 Body Fluids 4
6. FLUID INTAKE AND OUTPUT
During steady state conditions
Total amount of body fluids and the
concentration of solutes remain relatively
constant
There is continuous exchange of fluids and
solutes with
External environment
Different compartments of body
24-May-23 Body Fluids 6
7. Daily Water Intake
Two major sources
Ingested in form of Liquid & Water in food
about = 2200 ml/day
Synthesized in the body by Oxidation of
carbohydrates about = 300 ml/day
–Total intake = 2500 ml/day
24-May-23 Body Fluids 7
8. Daily Water Intake
Water intake very variable
From person to person
In the same individual
• Depends on Climate, habits, level of
physical activity
24-May-23 Body Fluids 8
9. Daily Loss of Body Water
Insensible fluid loss
Evaporation
In respiratory tract = 400 ml/day
Through the skin = 400 ml/day
–Total insensible loss = 800 ml/day
24-May-23 Body Fluids 9
10. Daily Loss of Body Water..
Insensible loss via skin
Independent of sweating
Minimized by cornified layer of the skin
Burns : rate of evaporation increases
24-May-23 Body Fluids 10
11. Daily Loss of Body Water…
Fluid loss in sweat.
Highly variable depend on
Environmental temperature(hot weather)
Level of physical activity(exercise)
Normally = 100 ml/day
24-May-23 Body Fluids 11
12. Daily Loss of Body Water
Water loss in faeces
Small amount = 100 ml/day
But amount lost increases tremendously in
severe diarrhea
Water loss by kidneys
Variable
As low as 0.5l/day in dehydration
As high as 20 l/day in a person with
excessive fluid intake
Normally about =1500 ml/day
24-May-23 Body Fluids 12
13. Daily Water Balance
Water input (ml/day) Water output (ml/day)
Fluid intake 1,200
Insensible loss
(lungs&skin)
800
H2O in food 1,000 Sweat 100
Metabolically
produced
300 Feces 100
Kidney 1,500
TOTAL INPUT 2,500 TOTAL LOSS 2,500
24-May-23 Body Fluids 13
14. BODY FLUID COMPARTMENTS
Total body fluid distributed among three major
compartments
Intracellular fluid compartment (ICF)
Extra cellular fluid compartment (ECF)
which include plasma & interstitial fluid.
24-May-23 Body Fluids 14
15. BODY FLUID COMPARTMENTS
Trans-cellular fluid compartment(TCF)
Fluid in lumen of epithelial cells: gall
bladder, intestine, CSF, intra ocular,
synovial fluid , pleural and pericardium
cavity
24-May-23 Body Fluids 15
16. TOTAL BODY WATER
Total fluid volume constitute 60% of the total
body weight)
40% intracellular Volume (ICV) - 2 liters is red
cell volume
20% is extracellular volume
- 4% is plasma volume
- 16 is interstitial fluid volume
The main cat ion in the extracellular fluid is
Na+ which is 140 meq/litre
Intracellular potassium concentration is 150
meq/litre
17. Total Body Water
Women have more fat
Contain less water than men (total
body water is 45 – 50% of body wt)
Children
neonate contain more water than
adults (75 - 80% TBWt)
By about 1 yr body water = 60% of
body wt
24-May-23 Body Fluids 17
18. Fluid Compartments
Intracellular Fluid
Volume = 28 L,
2/3 TBW
Interstitial
Fluid
Volume =
10.5 L,
75% of ECF
Plasma
Vol = 3.5
L, 25% of
ECF
24-May-23 Body Fluids 18
ICF (2/3 TBW) ECF (1/3 TBW)
Total Body Water (TBW) 42 L, 60% of Body Wt
19. BLOOD VOLUME
Blood contains both ECF and ICF
–ICF is the fluid within the RBC
Average Blood volume = 8% of body wt= 5.6
–On the average
• 60% of blood vol = plasma ( 3 liters)
• 40% of blood vol = RBC (2 liters)
–Values vary considerably in different people
depending on
• Sex, weight, and other factors
19
20. Compositions of ECF
• Plasma and interstitial fluid
– Separated by highly permeable
capillary membrane
– Ionic composition similar
• Permeability of protein is small
– Small amount of protein leak into
interstitial space
• For practical purposes
– Concentration of ions in plasma
and ICF are equal
24-May-23 Body Fluids 20
plasma
ICF
Interstitial
fluid
Capillary
21. Compositions of ECF
• ECF contain
• Large amounts of
– Na+ = 145 mEq/L
– Cl- = 140 mEq/L
– HCO3
- = 24 mEq/L
• Small quantities of
– K+ = 4 mEq/L
– Ca++ = 1 mEq/L
– mg++ = 1.5 mEq/L
– Organic acids, Sulfates,
Phosphates
24-May-23 Body Fluids 21
plasma
ICF
Interstitial
fluid
Capillary
22. Compositions of ICF
• ICF separated from ECF by
a selectively permeable
membrane
– It is highly permeable to water
– Not highly permeable to most
electrolytes
• ICF contains
– Small amount of
• Na+ = 14 mEq/L
• Cl- = 10 mEq/L
24-May-23 Body Fluids 22
plasma
ICF
Interstitial
fluid
Capillary
25. 24-May-23 Body Fluids 25
1. Crystalloids
Normal saline
Dextrose saline
Hartmann’s solution
2. Colloids
Natural, e.g. blood, albumin
Synthetic, e.g. gelatin-based infusions
TYPES OF FLUIDS
26. 24-May-23 Body Fluids 26
On the wards you will mainly use
crystalloids to provide the normal daily
requirement and replace additional losses.
Three major types of fluid are used: 0.9%
sodium chloride, dextrose saline and 5%
dextrose.
The composition of these fluids is shown
27. 24-May-23 Body Fluids 27
1 L 0.9% sodium chloride contains 153
mmol NaCl.
1 L dextrose saline contains 31 mmol
NaCl + 40 g dextrose.
1 L 5% dextrose contains 50 g dextrose.
Potassium can be added to these solutions in
the form of potassium chloride (KCl).
28. ELECTROLYTES
SODIUM
• It Is the principal extracellular cation and
solute
• Essential for generation of action potential
in neurologic and cardiac tissue
• Increases or decreases of total body sodium
correspond with increase or decreases of
ECV and PV
29. HYPONATREMIA
Defined as (Na+) < 130 meq/L
It may occur as a result of water retention,
sodium loss or both
30. HYPONATREMIA
Most common clinical association with
hyponatraemia is:
Post operative state
Acute intracranial disease
Malignant disease
Kidney diseases
Gastrointestinal losses
Use of diuretics (especially with along with low
sodium diet)
31. SIGN & SYMPTOMS
Depends on both the rate and severity of the
decrease in plasma sodium concentration
Symptoms that can accompany severe
hyponatramea ( Na+ < 120meq/L ) include:
Loss of appetite
Nausea, Vomiting
Cramps, Weakness
Altered level of consciousness, seizures and
Coma
32. TREATMENT
Identify the cause and treat
Administration of sodium
orally
by NG tube or
parenterally- Ringer’s lactate solution or
isotonic saline [0.9%Nacl]is given
33. HYPERNATRAEMIA
It is defined as a plasma sodium concentration
more than 150meq/L
Result from pure water loss, hypotonic fluid
loss or salt gain
34. Causes of hypernatraemia
1. Pure water depletion
A. Extrarenal loss
• Failure of water intake
(coma, elderly, postoperative patients)
• Mucocutaneous loss –Fever
B. Renal loss
• Diabetes insipidus
• Chronic renal failure
35. Causes of hypernatraemia
2. Hypotonic fluid loss
A. Extrarenal loss
• Gastrointestinal (vomiting,diarrhoea)
• Excessive sweating
B. Renal loss
• Osmotic diuresis (glucose, urea, mannitol)
36. Causes of hypernatraemia
2. Hypotonic fluid loss
C. Salt gain
• Iatrogenic (sodium bicarbonate, hypertonic
saline)
• Salt ingestion
• Steroid excess
37. Treatment
Treat underlying cause
Administration of water orally/nasogastric tube
Administration of hypotonic sodium solution
0.3 or 0.45%
Change in serum sodium not more than 2
mmol/L h
Rapid rehydration can cause cerebral edema
38. POTASSIUM
Plays an important role in cell membrane
physiology especially in maintaining resting
membrane potential and in generating action
potentials in the central nervous system and
the heart
39. POTASSIUM
Intracellular potassium - 150meq/litre
Extracellular concentration 3.5 to 5.0mml/l
(plasma level)
Total body potassium in a 70kg adult -.4.256
meq)
Insulin and beta adrenergic agonists promote
potassium entry into the cell
43. Treatment of hypokalaemia
Diagnosis and treatment of the cause
Potassium supplements, in the form of milk,
fruit juice, tender coconut water
Syrup potassium chloride orally -15ml
contains 20 mmol of potassium
44. Treatment of hypokalaemia count..
Intravenous potassium chloride can be given at
a rate not exceeding o.5mmol/kg/h under
electrocardiographic monitoring
A maximum of 200mmol/day should not be
exceeded in a 70kg individual
50. Signs and symptoms
Symptoms are nonspecific and include
weakness and fatigue
palpitations or chest pain
occasional bradycardia due to heart block or
tachypnoea from respiratory muscle weakness
Muscle weakness and flaccid paralysis
Depressed or absent tendon reflexes
51. Treatment of hyperkalaemia
Calcium gluconate (10%) 10 – 30ml
Sodium bicarbonate 1-2 mmol/kg over 10-15
minutes
100ml of 50% dextrose with 10-12 units of
insulin over 15 -20 minutes
Hyperventilation
Salbutamol nebulisation
Peritoneal or haemodialysis
52. CALCIUM
Calcium is the most abundant mineral in the
body
99 percent is deposited in the skeleton
Calcium ions are important for the control of
muscular and neural activities, in blood
clotting, as cofactors for enzymatic reactions
53. HYPOCALCEMIA
Hypocalcaemia exists when calcium level is
less than 9mEq/L
Causes
i. Hypoparathyroidism
ii. Vitamin D deficiency
iii. Chronic renal failure
iv. hypoalbuminaemia
54. Symptoms and Signs
Numbness and tingling sensation of fingers
hyperactive reflexes, muscle cramps
pathological fractures,
prolonged bleeding time
Chvostek’s sign
55. Treatment:
Treat underlying cause
Asymptomatic hypocalcaemia is treated with
oral CaCl, Ca gluconate or Ca lactate
Tetany from acute hypocalcaemia needs IV
CaCl or Ca gluconate to avoid hypotension
bradycardia and other dysrrhythmias
Chronic or mild hypocalcaemia can be treated
by consumption of food high in calcium
56. HYPERCALCEMIA
Hypercalcaemia exists when the Ca2+
concentration of the ECF is above 11 mEq/L
Features
Intractable nausea,
vomiting and dehydration
Coma and Death
58. Treatment
IV normal saline, given rapidly with Lasix
promotes urinary excretion of calcium
Drug therapy - Slower onset of action
i. Mithramycin - 24-48hrs - directly acts on
bones
ii. Calcitonin - 24-48hrs - inhibits calcium
reabsorption
iii. Etidronate - >3days - inhibits bone resorption