Regulation of plasma osmolality &siadh
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This document discusses the regulation of plasma osmolality and the syndrome of inappropriate antidiuretic hormone secretion (SIADH). It explains that plasma osmolality is tightly regulated between 285-295 mOsm/kg through modification of water intake and excretion. The hypothalamus senses plasma osmolality and signals the pituitary gland to secrete antidiuretic hormone (ADH) when levels rise, causing the kidneys to conserve water. SIADH occurs when ADH is inappropriately secreted despite low plasma osmolality, causing excessive water retention and hyponatremia. The document outlines criteria for diagnosing SIADH and factors that can limit the kidney's ability to excrete water
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This document discusses fluids in the human body. It covers topics such as total body water, intracellular and extracellular fluid compartments, fluid intake and output, and perioperative fluid management. Specifically, it addresses maintenance fluid therapy, calculating fluid requirements based on weight, and replacing preoperative deficits and ongoing losses through replacement therapy. Replacement solutions are discussed for various fluid losses through the gastrointestinal tract, urine, drains, and third spacing.
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This document discusses fluid and electrolyte balance in the human body. It covers the following key points:
- Water accounts for approximately 60% of body weight in men and 55% in women, with the majority located intracellularly.
- Sodium is the main extracellular cation and helps determine extracellular fluid osmolality and volume. The body tightly regulates sodium levels to maintain fluid balance.
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- The body uses various mechanisms and hormones like vasopressin, the renin-angiotensin-aldosterone system, and natriuretic peptides to maintain fluid homeostasis and respond to
Fluids and electrolytes balance
This document provides an overview of body fluids and electrolyte balance. It discusses the sources and composition of body fluids, how fluids move between compartments, and the regulation of fluid balance and electrolytes like sodium, potassium, calcium, and phosphate. Key points include that total body water is 50-70% of weight, fluids move via diffusion, osmosis, active transport and filtration, and homeostasis of fluids and electrolytes is maintained through mechanisms that regulate volumes and solute concentrations.
Fluid and electrolyt balance
This document provides an overview of body fluids, their regulation and homeostasis. It discusses the sources and composition of body fluids, how they move between compartments, and the regulation of fluid balance and electrolytes. Key points covered include the roles and normal levels of electrolytes like sodium, potassium and chloride. Mechanisms that maintain fluid and electrolyte balance like thirst, ADH release and kidney function are described. Causes and treatments of fluid and electrolyte imbalances are also summarized.
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The document discusses fluid and electrolyte balance in the human body. It covers topics such as fluid compartments, electrolyte distribution, mechanisms of fluid movement, assessment of fluid status, causes of fluid and electrolyte imbalances, and management of volume deficits and excesses. Specifically, it provides details on:
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- Common intravenous fluid types used in treatment, including crystalloids and colloids.
- Clinical signs of moderate and severe volume deficits and how to evaluate chronic vs acute deficits.
- Causes of fluid losses or gains in surgical
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This document discusses various biochemical indices related to water and mineral metabolism in the body. It covers electrolyte abnormalities including hyponatremia, hypernatremia, hypokalemia, and hyperkalemia. For each condition, it describes symptoms, laboratory findings, and approaches to treatment and fluid replacement.
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This document discusses water, electrolyte, and acid-base balance in the human body. It covers several key points:
- Water makes up about 60% of the human body and is essential for biochemical reactions and transport. The body carefully regulates water intake, output, and distribution between intracellular and extracellular fluid.
- Electrolytes like sodium, potassium, and chloride are important for maintaining fluid balance and osmotic pressure. The kidneys play a key role in regulating electrolyte concentrations through hormones.
- Acid-base balance is critical and maintained through buffers, respiratory and renal systems that regulate bicarbonate and carbon dioxide levels to keep blood pH between 7.35-7.45. Dis
Postoperative fluid and electrolyte management.pptx
The document discusses postoperative fluid and electrolyte management. It covers enhanced recovery after surgery (ERAS) protocols, preoperative and postoperative diets, fluid compartments and electrolytes in the body, perioperative fluid management, monitoring of fluid balance and electrolytes, and management of common abnormalities like hyponatremia. It also provides guidance on fluid management for patients with medical conditions like diabetes and thyroid disorders in the postoperative period.
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Maintenance ,Replacement and Deficit Therapy in children
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Regulation of plasma osmolality &siadh
- 1. Regulation of Plasma Osmolality & SIADH Dr.Himanshu S Dave Department of Pediatrics NRCH, New Delhi
- 2. • The plasma osmolality is tightly regulated and maintained at 285-295 mOsm/kg. • Modification of water intake and excretion maintains normal plasma osmolality. • In the steady state the combination of water intake and water produced by the body from oxidation balances water losses from the skin, lungs, urine, and gastrointestinal (GI) tract. • Only water intake and urinary losses can be regulated.
- 3. • Osmoreceptors in the hypothalamus sense plasma osmolality. • An elevated effective osmolality leads to secretion of antidiuretic hormone (ADH) by neurons in the supraoptic and paraventricular nuclei in the hypothalamus.
- 4. • The axons of these neurons terminate in the posterior pituitary. • Circulating ADH binds to its V2 receptors in the collecting duct cells of the kidney, and causes insertion of water channels (aquaporin-2) into the renal collecting duct cells.
- 5. • This produces increased permeability to water, permitting resorption of water into the hypertonic renal medulla. • Urine concentration increases and water excretion decreases. • Urinary water losses cannot be eliminated because there is obligatory excretion of urinary solutes, such as urea and sodium.
- 6. • The regulation of ADH secretion is tightly linked to plasma osmolality, responses being detectable with a 1% change in osmolality. • ADH secretion virtually disappears when plasma osmolality is low, allowing excretion of maximally dilute urine. • The resulting loss of free water (i.e., water without Na+ ) corrects plasma osmolality.
- 7. • ADH secretion : a graded adjustment as the osmolality changes. • Water intake is regulated by hypothalamic osmoreceptors, which stimulate thirst when the serum osmolality increases. • Thirst occurs with a small increase in the serum osmolality. • Control of osmolality is subordinate to maintenance of an adequate intravascular volume.
- 8. • When volume depletion: Both ADH secretion and thirst are stimulated, regardless of the plasma osmolality. • The sensation of thirst requires moderate volume depletion but only a 1–2% change in the plasma osmolality.
- 9. • A number of conditions can limit the kidney's ability to excrete adequate water to correct low plasma osmolality. • In SIADH , ADH continues to be produced despite a low plasma osmolality.
- 10. • The GFR affects the kidney's ability to eliminate water. • With a decrease in the GFR, less water is delivered to the collecting duct,limiting the amount of water that can be excreted. • The impairment in the GFR must be quite significant to limit the kidney's ability to respond to an excess of water.
- 11. • The minimum urine osmolality is approx 30- 50 mOsm/kg. • This places an upper limit on the kidney's ability to excrete water; sufficient solute must be present to permit water loss. • Massive water intoxication may exceed this limit, whereas a lesser amount of water is necessary in the child with a diet that has very little solute.
- 12. • This produce severe hyponatremia in children who receive little salt and have minimal urea production as a result of inadequate protein intake. • Volume depletion is an extremely important cause of decreased water loss by the kidney despite a low plasma osmolality. • This “appropriate” secretion of ADH occurs because volume depletion takes precedence over the osmolality in the regulation of ADH.
- 13. • The maximum urine osmolality is approx 1,200 mOsm/kg. • The obligatory solute losses dictate the minimum volume of urine that must be produced, even when maximally concentrated.
- 14. • Obligatory water losses increase in patients with high salt intake or high urea losses, as may occur after relief of a urinary obstruction or during recovery from acute kidney injury. • An increase in urinary solute and thus water losses occurs with an osmotic diuresis , which occurs classically from glycosuria in diabetes mellitus as well as iatrogenically after mannitol administration.
- 15. • The maximum urine osmolality in a newborn, especially premature , is less than that in an older infant or child. • This limits the ability to conserve water and makes such a patient more vulnerable to hypernatremic dehydration.
- 16. • Very high fluid intake, in psychogenic polydipsia , can dilute the high osmolality in the renal medulla, which is necessary for maximal urinary concentration. • If fluid intake is restricted in patients with this condition, the kidney's ability to concentrate the urine may be somewhat impaired, although this defect corrects after a few days without polydipsia.
- 17. • This may also occur during the initial treatment of central diabetes insipidus with desmopressin acetate; the renal medulla takes time to achieve its normal maximum osmolality.
- 18. Diagnostic Criteria for Syndrome of Inappropriate Antidiuretic Hormone Secretion • Absence of: -Renal, adrenal, or thyroid insufficiency -Heart failure, nephrotic syndrome, or cirrhosis -Diuretic ingestion -Dehydration
- 19. • Urine osmolality >100 mOsm/kg (usually > plasma) • Serum osmolality <280 mOsm/kg and serum sodium <135 mEq/L • Urine sodium >30 mEq/L • Reversal of “sodium wasting” and correction of hyponatremia with water restriction
- 20. THANK YOU