This document provides an introduction to serum electrolytes, with a focus on sodium homeostasis and related disorders. It defines electrolytes as ions that dissociate in solution and conduct electricity. Sodium is the major cation in extracellular fluid and helps maintain fluid balance, blood pressure, and neuromuscular function. The kidney precisely regulates sodium levels through reabsorption and excretion in response to hormones like aldosterone and ANP. Abnormal sodium levels can cause hypernatremia or hyponatremia, depending on whether the body has too much or too little water relative to sodium.
It is the review research based topic of presentation on most important body's serum electrolytes "potassium". it is really a very useful effort to collecting the data material from such a many different websites and pages as i gave references in the end of this presentation.
This PPT is mainly useful for MBBS as well as other branch of Medicine to have an basic idea about Electrolytes. Also about What to see & What to do in cases of Electrolytes Imbalances.
Electrolytes are minerals which are present in the blood and body tissues and are essential for metabolism, for proper nerve and muscle functioning, for maintenance of proper water balance, and proper blood pH (acid-base balance). The serum electrolyte test includes a group of tests to measure the following electrolytes: Sodium (Na+), Potassium (K+) and Chloride (Cl-).
Reference: https://www.1mg.com/labs/test/serum-electrolyte-1761
This chapter is largely about the water and electrolytes ( salts )in your plasma and how the body manages to keep you from drying up and blowing away even if you are in the hot Texas sun and without liquid drink.
It is the review research based topic of presentation on most important body's serum electrolytes "potassium". it is really a very useful effort to collecting the data material from such a many different websites and pages as i gave references in the end of this presentation.
This PPT is mainly useful for MBBS as well as other branch of Medicine to have an basic idea about Electrolytes. Also about What to see & What to do in cases of Electrolytes Imbalances.
Electrolytes are minerals which are present in the blood and body tissues and are essential for metabolism, for proper nerve and muscle functioning, for maintenance of proper water balance, and proper blood pH (acid-base balance). The serum electrolyte test includes a group of tests to measure the following electrolytes: Sodium (Na+), Potassium (K+) and Chloride (Cl-).
Reference: https://www.1mg.com/labs/test/serum-electrolyte-1761
This chapter is largely about the water and electrolytes ( salts )in your plasma and how the body manages to keep you from drying up and blowing away even if you are in the hot Texas sun and without liquid drink.
Fluid balance is an aspect of the homeostasis of body in which the amount of water in the body needs to be controlled, via osmoregulation and behavior, such that the concentrations of electrolytes (salts in solution) in the various body fluids are kept within healthy ranges.
The core principle of fluid balance is that the amount of water lost from the body must equal the amount of water taken in; for example, in humans, the output (via respiration, perspiration, urination, defecation, and expectoration) must equal the input (via eating and drinking, or by parenteral intake).
Calcium,magnesium,phosphate and chloride imbalances Jyothi Swaroop
Calcium,magnesium,phosphate and chloride imbalances
Their treatment,my main reference is Eric strong's lectures in youtube,and some of the websites.Hope everyone finding Serum electrolytes find atleast some use of it .
Thank you
A blood glucose test measures the glucose levels in your blood. Glucose is a type of sugar. It is your body's main source of energy. A hormone called insulin helps move glucose from your bloodstream into your cells. Too much or too little glucose in the blood can be a sign of a serious medical condition.
Renal function tests are very useful for effective clinical evaluation of renal failure for effective management. So it is useful for medical and allied professional students and clinical practitioners.
Fluid balance is an aspect of the homeostasis of body in which the amount of water in the body needs to be controlled, via osmoregulation and behavior, such that the concentrations of electrolytes (salts in solution) in the various body fluids are kept within healthy ranges.
The core principle of fluid balance is that the amount of water lost from the body must equal the amount of water taken in; for example, in humans, the output (via respiration, perspiration, urination, defecation, and expectoration) must equal the input (via eating and drinking, or by parenteral intake).
Calcium,magnesium,phosphate and chloride imbalances Jyothi Swaroop
Calcium,magnesium,phosphate and chloride imbalances
Their treatment,my main reference is Eric strong's lectures in youtube,and some of the websites.Hope everyone finding Serum electrolytes find atleast some use of it .
Thank you
A blood glucose test measures the glucose levels in your blood. Glucose is a type of sugar. It is your body's main source of energy. A hormone called insulin helps move glucose from your bloodstream into your cells. Too much or too little glucose in the blood can be a sign of a serious medical condition.
Renal function tests are very useful for effective clinical evaluation of renal failure for effective management. So it is useful for medical and allied professional students and clinical practitioners.
Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.
Introduction to protein , Structure of Amino acid, Asymmetric carbon, Nomenclature of amino acid, Classification of amino acid, Properties & functions of amino acids, Definition of protein, Peptide bond
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Top 10 Best Ayurvedic Kidney Stone Syrups in India
Introduction to serum electrolyte, sodium homeostasis & its related disorders
1. Introduction to Serum
Electrolytes , Sodium
homeostasis & related
disorders
Dr. Ifat Ara Begum
Associate Professor
Dept of Biochemistry
Dhaka Medical College
2. What is electrolyte?
An electrolyte is a chemical compound
that dissociates in a solution in to ions
that conduct electricity
They may be cations (positive charged)
or anions (negative charged)
In living system, each body fluid
compartment is electrically neutral
containing same amount of cations &
anions
5. Function of electrolytes
General functions:
Maintain body fluid osmolarity
Maintain integrity of body fluid
compartments
Concern with RMP & AP
Concern with neuromuscular
irritability/excitability & tissue
functions
6. Contd
Specific functions:
May act as cofactor of some enzymes
May be related with buffering activity:
Bicarbonate , phosphate
Calcium: Blood coagulation, bone
mineralization etc
7. Serum electrolyte profile with their
reference range
Name of electrolyte Serum conc.
(mmol/L)
Na+
135-145
K+
3.5-5
HCO3
-
22-28
Cl-
98-107
9. Introduction to sodium
The major cation of ECF
Normal range in ECF: 135-145 mmol/L
Normal range in ICF: 10-12 mmol/L
Major partner of Na+
is Cl-
The primary source of dietary sodium is
sodium chloride or salt,
Sodium salts are one of the important
osmotically active solutes in ECF
10. Contd
Plasma sodium concentration is affected by
change of water balance & is a poor guide of
body Na content
Body Na+
content :
a) ECF volume is the direct function of
body Na content
b) Body Na+
content changes with the
change of Na+
balance (positive /
negative Na balance)
11. Contd
Urinary Na+
excretion depends on ECF
volume , not ECF Na+
concentration
Regulation of Na+
balance is equivalent
to the body fluid volume regulation
12. Function of sodium
Provides 92% of ECF osmolarity &
maintains internal environment
Is concerned with
RMP, AP & neuromuscular/ tissue
excitability
Maintenance of electrolyte & fluid
balance
Cardiac rhythmicity & contractility
Exocrine secretion
Maintenance of blood volume & BP
13. Renal handling of sodium
May be discussed under following
headlines:
I. Tubular load of sodium
II. Tubular reabsorption of sodium
III. Renal excretion of sodium
14. i) Tubular load of sodium
Tubular load equals to GFR X Plasma
concentration
= 180 L/day X 140 mmol/L
= 25250 mmol/day
15. ii) Tubular reabsorption of sodium
More than 90% of tubular load
i. From PCT: 60 - 70%
ii. From ALH (thick): 20 – 30%
iii. From DCT: 5% (stimulated by
aldosterone)
iv. From CD: 1- 8% (stimulated by
aldosterone & inhibited by ANP)
16. iii) Renal excretion of sodium
It is 100 200 ml/day
Factors regulating renal sodium
excretion:
1. GFR :Aldosterone escape
mechanism
2. ECV : Proportionately related with
renal Na excretion
3. SNS activity: Stimulation of SNS
reduces renal Na excretion
17. Contd
4. Hormones :
Hormones increasing tubular
reabsorption of NaCl , thereby
reducing the renal sodium excretion :
Aldosterone (DCT & CD) ,
Angiotensin II (PCT) , Catecholamine
(PCT)
Hormones decreasing reabsorption of
NaCl from CD , thereby increasing the
renal sodium excretion: ANP
18. Contd
5. Peritubular capillary
hemodynamic :
Increased HP decreases NaCl
reabsorption & increases renal Na
excretion
Increased COP increases NaCl
reabsorption & decreases renal Na
excretion
19. Contd
6. Renal vasodilators (like PG, EDRF,
Bradykinin, Dopamine etc) : Increase
GFR & increase Na excretion
20. Sodium homeostasis
(ECF volume homeostasis)
May be discussed under following
headings:
Body sodium content
Compartmental distribution of sodium
Sodium balance
AND
Regulation of sodium balance (volume
regulation)
23. Sodium balance
Intake: 100 – 200 mmol/day via
foods, drinks, added salt
Output: 100 – 200 mmol/day via
a) Urine: 150 mmol/day (major route of
Na excretion
b) Feces: 5 – 10 mmol/day
c) Sweat: 25 mmol/day
24. Regulation of sodium balance
(Volume regulation)
As most of the body Na lies in ECF, so
ECF volume directly depends on total
body Na content.
Body senses the body Na status
indirectly by sensing the ECF volume
status through baroreceptors
Recognition of Na status signals the
kidney to respond accordingly
a) To retain salt & water (in Na deficit)
b) To excrete salt & water (in Na excess)
25. Contd
i.e. for Na regulation, there are
a) Afferent limb (sensor/sensing
mechanism)
b) Efferent limb (effector organ)
26. Contd
Afferent limb/sensor/sensing
mechanism:
Baroreceptors present in atria ,
carotid sinus, aortic arch , great veins
& afferent arteriole of kidney act as
afferent limb
They are :
Stimulated by: volume expansion
(increased body Na content)
Inhibited by volume contraction
27. Contd
Efferent limb/effector organ:
Kidney acts as efferent limb/effector
organ
They respond to volume status (body
Na content) by NaCl retention
/excretion and its regulation
28. Events following excess NaCl intake
Excess NaCl intake
Hypervolemia
Stimulation of baroreceptors
Inhibition
of SNS
Inhibition
of RAAS
Increased
secretion
of ANP
30. Contd
All these events finally causes salt &
water excretion to normalize the ECF
volume by:
i. Decreased catecholamine, angiotensin
II & aldosterone
ii. Increased ANP
iii. Increased GFR & aldosterone escape
31. Events following decreased NaCl
intake
Reduced NaCl intake
Hypovolemia
Inhibition of baroreceptors
Stimulatio
n of SNS
Stimulation
of RAAS
Decreased
secretion
of ANP
32. Contd
Stimulatio
n of SNS
Inhibition
of RAAS
Catecholamine
release
↑NaCl
reabsorp.
Renal
vasoconstriction
↓GFR leading
to failure of
aldosterone
escape
↑production
of renin,
angiotensin II,
aldosterone
33. Contd
All these events finally causes salt &
water retention to normalize the ECF
volume by:
i. Increased catecholamine, angiotensin
II & aldosterone
ii. Decreased ANP
iii. Decreased GFR & failure of
aldosterone escape
34. Osmoregulation versus Volume
regulation
Features Osmoregulation Volume
regulation
Sensor Osmoreceptor Baroreceptor
Sensed stimulus ECF osmolarity ECF volume
Effector organ Kidney Kidney
Effector/mediator ADH & thirst Aldosterone, ANP,
Angiotensin II,
Catecholamine,
GFR
36. Aldosterone escape
It is the phenomenon characterized by
excessive urinary Na+
excretion despite
maximum aldosterone activity in CD
It happens following hypervolemia of
any cause, due to
Increased tubular load of Na+
Increased ANP secretion
37. Contd
Following
hypervolemia,
there is ↑ ANP
Following
hypervolemia, there is
↑ GFR & ↑ tubular load
of Na+
Decreased Na+
reabsorption in CD
↑ Na+
delivery to distal
nephron despite utmost Na+
reabsorption from PCT
In CD, Na+
load becomes
more than maximum
capacity of aldosterone to
reabsorb Na+
Na+
appears in urine by escaping aldosterone
38. Abnormalities of sodium homeostasis
2 types of abnormalities:
1. Hypernatremia
2. Hyponatremia
39. 1. Hypernatremia
The clinical state of elevated Na+
concentration (>145 mmol/L)
Occurs mostly due to water imbalance ,
not Na+
imbalance
Always associates with
hyperosmolarity
Its causes lead to development of
hyperosmolar state in ECF
42. Point Euvolemic Hypervolemic Hypovolemic
Osmolarity
of plasma
High (>295
mosm/L)
High (>295
mosm/L)
High (>295
mosm/L)
Body total
Na+
content
Normal High Low
Common
causes
DI, reduced
water intake
Excess infusion
of hypertonic
saline, Sea
water intake,
Conn’s
/Cushing
syndrome etc
S. diarrhoea/
burn,
persistent
vomiting,
profuse
sweating , salt
losing
43. Lab evaluation of hypernatremia
Euvolemia Hypernatremia Hypervolemi
a
Hypovolemia
Oligouria
(non-renal cause)
Polyuria
(renal cause)
DI
Conditions
leading to
Hypertonic
hypervolemia
44. Clinical consequences or S/S of
hypernatremia
It may be
Acute :Develops in ≤ 48 hours & more
serious
Chronic : Develops over 48 hours . Less and
well tolerated
S/S appears when serum concentration of
sodium is >155 mmol/L
S/S is due to cellular dehydration (esp.
cerebral dehydration)
45. Contd
If person is awake & alert: Thirst is the
prominent symptom
Other S/S include anorexia, nausea, vomiting,
altered mental status, neuromuscular
hyperactivity, agitation, irritability, lethargy,
stupor, convulsion, coma, even death
46. 2. Hyponatremia
The clinical state of decreased Na+
concentration (<135 mmol/L)
The commonest electrolyte disorder in
clinical practice
Occurs mostly due to water imbalance ,
not Na+
imbalance
Usually (not always) associates with
hypoosmolarity
52. Clinical consequences or S/S of
hyponatremia
Severity depends on
Severity of hyponatremia
The rate at which sodium concentration is
reduced
It may be
Acute :Develops in ≤ 48 hours & more severe
degrees of cerebral oedema may occur
Chronic : Develops over 48 hours . Less and
well tolerated cerebral oedema
53. Contd
S/S appears when
Serum concentration of sodium is <120
mmol/L
Or when sodium level is decreased rapidly
S/S is due to cellular overhydration (esp.
cerebral edema)
54. Contd
S/S includes:
• CNS: Lethargy, headache, disorientation,
drowsiness, confusion, convulsion, coma,
even death
• GIT: Anorexia, nausea, vomiting etc
• Musculoskeletal : Cramps, sluggish deep
tendon reflex etc
56. Pseudo hyponatremia
The artificial lowering of plasma sodium
concentration because of increased solid
phase (formed by plasma protein & lipids) of
plasma
[In normal individual, solid phase is ignored
& 1 L plasma is assumed to be equivalent to
1 L water where 140 mmol/L Na+
is found]
57.
58. Contd
Here Na+
concentration per liter of plasma
water is normal , so patient shows the status
of isotonicity
Common causes:
Hyperlipidaemia (hypertriglyceridemia,
hypercholesterolemia )
Hyperproteinemia (e.g. multiple
myeloma or i/v infusion of immunoglobulin)
etc
60. SIADH
A condition characterized by excessive
release of ADH from pituitary gland or
another source, causing the body to
retain fluid and lower the blood sodium
level by dilution.
It is mainly caused by cancer, esp. that
of the lungs
61. Acute dilutional hyponatremia
Hyponatremia develops within 48 hours due
to addition of water to ECF
Causes:
Excessive i/v fluid infusion
Fresh water drowning
Psychogenic polydypsia
Post operative period (due to ↑ADH release)
Acute hyperglycemia
ARF
63. Hypoosmolar state
Clinical condition leading to ECF
hypoosmolarity
Causes:
All causes of hypotonic hyponatremia
(consider volume status)
Excessive hypotonic fluid infusion
Fresh water drowning
Psychogenic polydypsia
Postoperative period
64. Diabetes Insipidus
Clinical condition characterized by polyuria
due to ADH deficiency/resistance
It may be :
a. Central DI: If the cause is ↓ADH release
from hypothalamus
b. Nephrogenic DI: If the cause is resistance of
CD to ADH
65. Contd
Causes of central DI Causes of nephrogenic DI
Genetic
CNS disorders : Tumour,
TB, encephalitis, head injury
etc
Idiopathic
Genetic
Heavy metal poisoning
Renal disease like
Interstitial nephritis etc
Hypokalemia
Hypercalcemia
66. Contd
Common lab findings:
Urine volume: >10 L/day (Polyuria)
Urinary osmolarity: <150 mosm/L
[After ADH analogue injection: if Uosm is
>750 mosm/L , it is central DI
If no improvement, its nephrogenic DI]
67. Contd
Mild hypernatremia: if volume depletion is
present
Basal serum ADH conc.
In central DI: Low
In nephrogenic DI: High
Plasma osmolarity: Maintained at near
normal by water intake due to increased
thirst
Urinary sodium: >20 mmol/L