This document discusses water and electrolyte balance in the human body. It covers several key points:
1) Water is the most abundant component of the body, accounting for 60-70% of total body weight in adults. Humans can survive one month without food but only about a week without water.
2) Water content varies between tissues and changes with age. It is regulated to maintain homeostasis through thirst, antidiuretic hormone secretion, and kidney function.
3) Sodium, potassium, and chloride are the major electrolytes and their plasma levels are tightly controlled. Imbalances can cause dehydration or water retention.
4) Diuretics are sometimes used to treat water
-water balance --> body composed of about 60-70% water
-total body water-->42L, ICF --> 28L, ECF --> 14L
- water output by urine,skin,lungs,feces.
-electrolyte bALANCE , expressed as mEq/L.
Water and electrolyte balance is clinically very important topic . It will be very useful for both UG and PG medical students. Efforts are made to explain basic concepts clearly.
Metabolism of water and its clinical significancerohini sane
A comprehensive presentation on Metabolism of water and its clinical significance for MBBS, BDS, B Pharm & Biotechnology students to facilitate self- study.
-water balance --> body composed of about 60-70% water
-total body water-->42L, ICF --> 28L, ECF --> 14L
- water output by urine,skin,lungs,feces.
-electrolyte bALANCE , expressed as mEq/L.
Water and electrolyte balance is clinically very important topic . It will be very useful for both UG and PG medical students. Efforts are made to explain basic concepts clearly.
Metabolism of water and its clinical significancerohini sane
A comprehensive presentation on Metabolism of water and its clinical significance for MBBS, BDS, B Pharm & Biotechnology students to facilitate self- study.
Are most abundantly distributed organic compounds.
70 kg man= protein weight constitute 12 kg
Skeleton and connective tissue contains half
Body protein and other half is intracellular.
Are most abundantly distributed organic compounds.
70 kg man= protein weight constitute 12 kg
Skeleton and connective tissue contains half
Body protein and other half is intracellular.
Basic Intravenous Therapy 3: Fluids And Electrolytes, Balance and Imbalance, ...Ronald Magbitang
Lecture Presentation in Basic Intravenous Therapy Seminar, discussion on Body Fluids and Electrolytes, Normal Values and the Imbalances, the symptomatology and treatment and precautions, and, finally the different types of commonly available, utilized IVF in clinics
Iv fluid therapy (types, indications, doses calculation)kholeif
All what you need to know intravenous fluids, types, indications, contraindications, how to calculate fluid rate and drug dosages.
Embed code (http://www.slideshare.net/slideshow/embed_code/16138690)
Multiple Choice Questions with Explanatory Answers on Chemistry of Carbohydrates for Medical, Biochemistry and Biology students - Chapter 1 of Multiple Choice Questions in Biochemistry by RC Gupta
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
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
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
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
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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
Title: Sense of Taste
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 structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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
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2 Case Reports of Gastric Ultrasound
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
2. Water is the most abundant component of
our body
Need for water is more urgent than that for
any other nutrient
Humans beings can live one month without
food but only six days without water
EMB-RCG
3. EMB-RCG
In adults, water accounts for:
70% of the total body weight in males
60% of the total body weight in females
5. EMB-RCG
Water content differs in different tissues:
Muscles: 70%
Adipose tissue: 30%
Bones: 10%
Water content is more in muscular
persons than in obese persons
6. Water:
Bathes all cells
Gives shape and form to cells
Serves as a lubricant
Is the solvent for all ions and molecules
Transports materials to and from cells
Is the medium for all biochemical reactions
7. Latent heat of evaporation
Specific heat
Dielectric constant
Solvent power
Some properties of water which make it
an ideal medium for body fluids are its:
Water has been chosen as the universal
solvent for all living organisms
8. Solvent power
Water is an efficient and suitable solvent
for most of the solutes present in our
body
Some compounds which do not dissolve
readily in water can form colloidal
solutions
9. Water has a high dielectric constant
A large number of oppositely charged
particles can co-exist in water due to this
Dielectric constant
10. Specific heat
Water has a very high specific heat which
means that a large amount of heat is
required to raise the temperature of water
Due to this, body temperature doesn’t rise
appreciably when thermal energy is
released during oxidation of nutrients
11. Latent heat of evaporation
Water has a high latent heat of evaporation
relative to other liquids
A large amount of thermal energy is
required for evaporation of water
When water evaporates from skin and
lungs, a large amount of heat is lost
This prevents a rise in body temperature
12. Distribution of water
Compartment Water
Total water in an
average man 50 litres
Water in intra-cellular
compartment 35 litres
Water in extra-cellular
compartment 15 litres
13. Un-exchangeable fluid
The water present outside the cells is
known as extra-cellular fluid (ECF)
The ECF is further distributed into some
sub-compartments:
Trans-cellular fluid
Interstitial fluid
Plasma
14. Sub-compartment Volume
3 litresPlasma (vascular compartment)
Interstitial fluid (in between cells) 7 litres
Trans-cellular fluid (in cavities) 1 litre
4 litres
Un-exchangeable fluid (in bones,
cartilages, dense connective
tissue etc)
15. Osmolality
Concentration of solutes/particles in fluid,
expressed in milliosmol (mosm) per kg
Determines distribution of water in
different compartments
Water moves from lower to higher
osmolality
16. The major osmotically active solutes in
body fluids are:
Electrolytes have more osmotic power as
they dissociate into at least two particles
Non-electrolytes e.g. glucose, lipids etc
Electrolytes e.g. inorganic salts and proteins
18. Effective osmolality of a compartment is
determined by the solutes restricted to
that compartment
Effective osmolality of the compartment is
also known as its tonicity
19. Selective distribution of ions in different
compartments is maintained by specific
ion channels and ion pumps
A lot of energy is spent for maintaining the
differential distribution of ions in different
compartments
20. Cations
Sodium is the major cation in extracellular
fluid
Potassium is the major cation in intracellular
fluid
This differential is maintained by Na+, K+-
exchanging ATPase
EMB-RCG
21. Anions
The major anions in extracellular fluid are
chloride and bicarbonate
The major anions in intracellular fluid are
phosphates and proteins
22. Proteins
Proteins are present in a:
Fairly high concentration in
intracellular fluid
Smaller but significant
concentration in plasma
Negligible concentration in
interstitial fluid
23. Effective osmolality is determined by:
Sodium and its associated
anions in the extracellular fluid
Potassium and its associated
anions in the intracellular fluid
24. The ions and molecules have specific
distribution in the intracellular fluid
These are vital for the functioning of the
cells, and are zealously maintained
25. Changes in osmolality are usually due to
shift of salts (mainly sodium)
When salts shift, water follows salts
26. Shrinkage of cells due to shifting of water
out of the cells can seriously affect the
functioning of cells
Swelling of cells due to shifting of water
into the cells can also seriously affect the
functioning of cells
27. Hyper-osmolality of extracellular fluid
draws water out of cells into the extra-
cellular compartment
Hypo-osmolality of extracellular fluid
drives water from extracellular compart-
ment into the cells
28. Osmolality of plasma is 275-290 mosmol/kg
A 0.9% solution of NaCl in water has
the same osmolality (or tonicity) as plasma
A 5% solution of glucose in water also has
the same osmolality (or tonicity) as plasma
These two are said to be isosmotic or
isotonic with plasma
29. Oncotic pressure
Osmotic pressure exerted by proteins is
called oncotic pressure
It is also known as colloid osmotic pressure
The normal oncotic pressure of plasma is
about 25 mm of Hg
30. A decrease in the concentration of proteins in
plasma decreases oncotic pressure of plasma
Water is forced out of capillaries at the arterial
end due to greater hydrostatic pressure
It cannot re-enter at the venous end if the oncotic
pressure is less than the hydrostatic pressure
This will result in oedema
31. Water intake and output
Water balance of the body depends upon
the relative intake and output of water
Water is taken in as drinking water and in
the form of food and beverages
Some water is formed in the body during
oxidative reactions (metabolic water)
32. Metabolic water
Oxidation of 1 gm of carbohydrate
produces 0.60 gm of water
Oxidation of 1 gm of fat produces
1.07 gm of water
Oxidation of 1 gm of protein
produces 0.41 gm of water
33. In a temperate climate, intake of water is:
Source Volume
Drinking water about 1.5 L /day
Water in food and beverages about 1.0 L /day
Metabolic water about 0.3 L /day
Total intake about 2.8 L /day
34. Route Volume
Urine about 1.5 L /day
Faeces about 0.1 L /day
Water vapour in expired air about 0.4 L /day
Water loss in the form of sweat about 0.8 L /day
Total output about 2.8 L /day
Water is lost from the body in the form of:
35. In hot climates, sweat loss is much more
This is compensated by increased intake of
drinking water
If it is not compensated, urine output will
decrease
However, urine output cannot decrease
below a certain level
36. Normal excretion of solutes by the kidneys
is about 600 milliosmol/day
Minimum water required to dissolve 600
milliosmol solutes is 500 ml
If urine output is below 500 ml/day,
excretion of metabolic waste decreases
A urine output below 500 ml/day is called
oliguria
37. Regulation of water balance
Water balance is maintained by:
The thirst centre in
hypothalamus
Antiduretic hormone
of posterior pituitary
These two receive signals about osmolality
of plasma from osmoreceptors located in
the hypothalamus
38. Osmo-receptors can perceive a change of
even 1-2% in the osmolality of plasma
If there is an increase in the osmolality of
plasma:
Thirst centre is
stimulated which
increases water
intake
Posterior pituitary
secretes anti-
diuretic hormone
which decreases
urine output
39.
40. ADH secretion begins when the osmolality
of plasma reaches about 285 mosmol/kg
The thirst centre is stimulated when the
osmolality of plasma reaches about 295
mosmol/kg
41. When blood circulates through the kidneys,
125 ml of glomerular filtrate is formed per
minute
About 180 litres of glomerular filtrate is
formed in 24 hours
Glomerular filtration rate
42. When the filtrate passes through the
tubules, a large amount of solutes and
water are absorbed
The re-absorption can be divided into:
Obligatory re-
absorption
Facultative re-
absorption
Tubular re-absorption
43. A large amount of solutes is absorbed
when the filtrate passes through proximal
convoluted tubules and loop of Henle
A corresponding amount of water is re-
absorbed due to osmotic effect of solutes
This is known as obligatory re-absorption
Obligatory re-absorption
45. Cells of distal convoluted tubules and
collecting ducts are not permeable to water
in the absence of ADH
Binding of ADH to its receptors (V2
receptors) on the surface of these cells
activates adenylate cyclase
Facultative re-absorption
46. Active adenylate cyclase increases the
intracellular concentration of cAMP
cAMP activates protein kinase A
Active protein kinase A phosphorylates
some cytosolic proteins
47. The phosphorylated proteins translocate
aquaporins from cytosol into cell membrane
Aquaporins are water channels
Water moves into the cell through these
water channels
48.
49. Movement of water into distal convoluted
tubules and collecting ducts is proportional
to plasma ADH concentration
The ADH-regulated re-absorption is known
as facultative re-absorption of water
Normally, this is about 25.5 litres/day
50. About 1.5 litres of water is not absorbed by
tubules
This is excreted in the form of urine every
day
Facultative re-absorption can be adjusted
to maintain the water balance of the body
51. Electrolyte balance
Sodium, potassium and chloride are the
major electrolytes
Their plasma levels are:
Sodium:
135 -145
mEq/L
Potassium:
3.5 - 5.0
mEq/L
Chloride:
96 -106
mEq/L
52. Sodium
The most important cation in regulation
of fluid and electrolyte balance
The most abundant cation in the ECF
Contibutes significant osmotic pressure
55. Regulation of sodium
Aldosterone promotes tubular re-
absorption of sodium
Oesrogens have a similar but weaker
effect
Atrial natriuretic peptide inhibits release of
aldosterone
56. Plasma K+ level regulates potassium balance
High plasma K+ level promotes tubular
secretion of potassium
Low plasma K+ level inhibits tubular secretion
of potassium
Aldosterone increases potassium secretion
Regulation of potassium
57. Regulation of chloride
Chloride is the major anion associated
with sodium
It moves with sodium
Aldosterone increases the tubular
reabsorption of chloride
58. Dehydration can result from diminished
intake of water or excessive loss of
water
Excessive water loss is a far more
common cause of dehydration
Dehydration
59. Excessive water loss can be due to:
• Excessive sweating
• Vomiting
• Diarrhoea
• Haemorrhage
• Burns
60. Excessive water loss can also occur in
uncontrolled diabetes mellitus
To dissolve the glucose being excreted
in urine, urinary water output increases
61. Excess water loss in urine may also occur
in renal diseases
This happens when the kidneys fail to
reabsorb water e.g. in chronic glomerulo-
nephritis
62. Extremely severe water loss
can occur in diabetes insipidus
Diabetes insipidus can be:
Central diabetes insipidus
Nephrogenic diabetes insipidus
63. Central diabetes insipidus is due to
decreased secretion of ADH
Nephrogenic diabetes insipidus is due
to decreased responsiveness of target
cells to ADH
64. Dehydration is corrected by administra-
tion of fluids
The fluids may be given orally or intra-
venously
The composition of the fluid given
should be similar to that of the fluid lost
Correction of dehydration
65. Excessive retention of water can occur
in acute renal failure
Kidneys fail to excrete water in acute
renal failure
Sometimes, it can result from over-
administration of intravenous fluids
Water intoxication
66. Hypersecretion of ADH is a rare cause
of water retention
Apart from treatment of the primary
cause, diuretics may be used to
increase the output of urine
67. Most diuretics act by inhibiting the
tubular reabsorption of some solutes
Water is lost in urine to dissolve the
extra solutes
Diuretics
68. Some commonly used diuretics are:
• Acetazolamide
• Spironolactone
• Thiazides
• Furosemide
• Ethacrynic acid
• Mannitol
69. Acetazolamide is a competitive inhibitor
of carbonic anhydrase
It decreases the formation of carbonic
acid in proximal convoluted tubules
Normally, carbonic acid dissociates into
H+ and HCO3
–
Acetazolamide
70. H+ is secreted into tubular fluid in
exchange for Na+
By disrupting this exchange, acetazola-
mide increases urinary Na+ excretion
Extra water is excreted to dissolve Na+
Excessive use of acetazolamide can
cause acidosis due to H+ retention
71. Spironolactone is a structural analogue
of aldosterone
Due to structural resemblance, it binds
to aldosterone receptors
This prevents the action of aldosterone
on distal convoluted tubules
Spironolactone
72. When the action of spironolactone is
blocked, excretion of sodium and
chloride increases
Water excretion is increased due to the
osmotic effect of sodium and chloride
73. Thiazides inhibit sodium re-absorption
in the distal convoluted tubules
They also increase potassium loss
Thiazides
74. Furosemide decreases reabsorption of
sodium and chloride in the loop of Henle
Hence, it is known as a loop diuretic
It is a potassium-sparing diuretic as it
does not cause potassium loss
Furosemide
75. Action of ethacrynic acid is very similar
to that of furosemide
This is also a potassium-sparing loop
diuretic
Ethacrynic acid
76. Mannitol is an osmotic diuretic
It is filtered by the glomeruli but is
not re-absorbed by the tubules
Extra water is lost in urine due to
the osmotic effect of mannitol
Mannitol
77. Dehydration described earlier is never
due to a pure water loss
The fluids lost from the body contain
electrolytes also
The loss usually occurs from the extra-
cellular compartment as the intracellular
fluid is tightly protected
ECF contraction and expansion
78. Dehydration results in a decrease in
ECF volume (ECF contraction)
Depending upon the osmolality of the
fluid lost, ECF contraction can be:
Isotonic Hypotonic Hypertonic
79. Retention of water causes an increase
in the volume of ECF (ECF expansion)
ECF expansion can be:
Isotonic Hypotonic Hypertonic
80. Isotonic contraction or expansion of ECF
does not affect the ICF
If ECF becomes hypotonic or hypertonic,
secondary changes occur in the ICF
81. Isotonic fluid is lost from the body
Can occur in diarrhoea due to loss of
isotonic secretions
Can occur in intestinal obstruction due
to collection of secretions in the gut
Isotonic ECF contraction
82. Hypertonic fluid is lost from the body
Can occur in Addison’s disease due to
excessive loss of sodium and chloride
in urine
Hypotonic ECF contraction
83. Hypotonic fluid is lost from the body
Can occur in fevers and heat exposure
due to excessive sweating or insensible
perspiration
Hypertonic ECF contraction
84. Isotonic fluid accumulates in interstitial
tissue
Can occur due to oedema caused by
hypertension, congestive heart failure,
nephrotic syndrome, cirrhosis of liver etc
Isotonic ECF expansion
85. More water is retained than solutes
Can occur in acute glomerulonephritis
due to decreased glomerular filtration
Hypotonic ECF expansion
86. Retention of solutes is more than that of
water
Can occur in primary aldosteronism and
Cushing’s disease due to retention of
sodium and chloride
Hypertonic ECF expansion
87. ECF contraction clinically manifests as a
decrease in blood volume (hypovolaemia)
Sudden and excessive loss of fluids from
the body can cause life-threatening hypo-
volaemia
Hypovolaemia
88. But hypovolaemia is not always due to
loss of fluids
It can occur when the total body water is
normal, or even increased
It may be due to shifting of water from
the vascular compartment into interstitial
tissue
89. A decrease in blood volume decreases
the blood pressure
Restoration of blood volume and blood
pressure requires the actions of:
Renin-angiotensin system
Aldosterone
ADH
90.
91. Compensatory mechanisms may
be unable to correct hypovolaemia:
If it is too severe
If the pathological condition
causing hypovolaemia persists
93. Renal Na and
H2O loss can
occur in:
• Chronic renal
diseases
• Diabetes
mellitus
• Addison’s
disease
• Diabetes
insipidus etc
Extra-renal Na
and H2O loss
can occur in:
• Fevers
• Vomiting
• Diarrhoea
• Intestinal
obstruction
• Haemorrhage
• Burns etc
94. A shift of water from the vascular
compartment into interstitial tissue
(oedema) can cause hypovolaemia
Redistribution of water
Oedema can occur due to a decrease
in oncotic pressure of plasma or due
to an increase in capillary permeability
98. Hypotonic hypovolaemia
can occur due to:
Chronic renal disease
Excessive use of diuretics
Addison’s disease
Congestive heart failure
Nephrotic syndrome
Cirrhosis of liver
100. Treatment of hypovolaemia should
comprise:
Treatment of the
primary cause
Correction of
fluid balance
101. In hypovolaemia due to shifting of water
from vascular compartment, correction
requires salt restriction and diuretics
In hypovolaemia due to sodium and
water loss, correction requires oral or
intravenous administration of fluids
102. Oral rehydration is preferable if hypo-
volaemia is mild
Severe cases require intravenous fluids
103. In isotonic hypovolaemia, isotonic (0.9%)
saline should be given
In hypotonic hypovolaemia, hypertonic
(3%) saline is preferable
In hypertonic hypovolaemia, hypotonic
(0.45%) saline or 5% GDW (glucose in
distilled water) is preferable
Intravenous fluids
104. While giving intravenous fluids, a watch
should be kept on serum potassium
Care should be taken not to over-
hydrate the patient
Fluid imbalance may be accompanied
by disturbances in acid-base balance
Acid-base imbalance should also be
corrected along with the fluid imbalance