-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 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.
Abnormal constituents of urine
1. ABNORMAL CONSTITUENTS OF URINE
2. Introduction o Urine is an excretory product of the body o It is formed in the body o Urine examination helps in the dignosis of various disease Volume :the average output of urine is about 1.5Lt/day. urine volume may be increased in excess water intake ,diabetes and renal disease. urine volume may be decreased in sweating , dehydration and kidney damage o Physical characteristics of urine appearance :
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.
The minerals form only a small portion of the total body weight. They form only 7% of the composition of human body.
Many of these minerals are widely distributed in foods so that a well-balanced diet will supply them in sufficient quantities.
The mineral elements present in the animal body may be classified into 2 groups:
1.Principal elements(macro nutrients)
2.Trace elements(micro nutrients)
Abnormal constituents of urine
1. ABNORMAL CONSTITUENTS OF URINE
2. Introduction o Urine is an excretory product of the body o It is formed in the body o Urine examination helps in the dignosis of various disease Volume :the average output of urine is about 1.5Lt/day. urine volume may be increased in excess water intake ,diabetes and renal disease. urine volume may be decreased in sweating , dehydration and kidney damage o Physical characteristics of urine appearance :
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.
The minerals form only a small portion of the total body weight. They form only 7% of the composition of human body.
Many of these minerals are widely distributed in foods so that a well-balanced diet will supply them in sufficient quantities.
The mineral elements present in the animal body may be classified into 2 groups:
1.Principal elements(macro nutrients)
2.Trace elements(micro nutrients)
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THIS SEMINAR GIVES THE BASIC OVERVIEW THAT HOW YOU CAN MANAGE THE PATIENT WHO COMES TO YOU A FLUID AND ELECTROLYTE IMBALANCE . AND BASIC MECHANISM OF HOMEOSTASTIS
fluid and electrolyte imbalance
normal physiology of fluid regulation
FLUID IMBALANCES- fluid volume excess, fluid volume deficit, third spacing,
ELECTROLYTE IMBALANCES- hypo and hypernatremia, hypo and hyperkalemia, hypo and hypercalcemia
water and electrolyte (2).pptx Body is composed of about 60-70% water Distr...Shivangi sharma
URINE
Major route of water loss
Normal urine 1-2L/day.
Water loss through kidneys well regulated to meet body demands.
Urine production cannot be completely shut down, despite there being no water intake
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detail description about the fluid and electrolyte balance. fluids and electrolytes needed during surgeries and during trauma are described. a note is added on acid base balance in the body
This explains the complex carbohydrates and chemistry of heterpolysaccharides. composition, distribution and its function is explained for each GAGs. brief notes on blood group ag is available. difference between proteoglycan and glycoprotein is explained in a essay way to understand. clinical importance is also added.
rft is described in detail . function of kidney, objectives of doing the test. the various test available for assessing the renal function with clinical interpretation is available.
it describes transcription with simple diagram and animation. its steps and inhibitors are described for both eukaryotes and prokaryotes. it will be easily understood by UG students . post transcriptional modification of all the RNA are also described with diagrams.
describes the structure of hb, its variants in detail. Oxygen dissociation curve is explained with graph. Hemoglobinopathy is explained with diagram. myoglobin is also explained.
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simple diagrammatic presentation of heme catabolism. highlighted the steps with explanation. Definition , causes, clinical features and biochemical investigation of various types of jaundice is explained in detail. congenital jaundice is included.
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describes the sources of lipids. enzymes and stages of digestion in detail. absorption form , transport form and disorders of digestion & absorption included.
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This topic covers the brief introduction of Ag and Ab in detail. Types and functions of Ig is explained in detail. Paraproteinemias is explained with simple pictures.
by Dr. N.Sivaranjani, MD
Describes the plasma membrane in detail, explains the each major component with its functions.
Transport mechanism across the cell is covered with detailed explanation with examples.
by Dr. N.Sivaranjani, MD
Enzyme inhibition is explained with its kinetics, animations showing mechanism of inhibitors action, examples of inhibitors are explained in detail with Enzyme inhibited.
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Describes the structural organisation of proteins with example and its determination, interrelationship b/w structure and function of proteins, also biologically important peptides is covered.
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The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
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This will be used as part of your Personal Professional Portfolio once graded.
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Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
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Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
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The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
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This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
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Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
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The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
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3. 60% of body consists of fluid
Intracellular space
Extracellular space
Distribution of water in different body water
compartments depends on the solute
content of each
compartment
Osmolality of the intra and
extra-cellular fluid is the same, but
there is marked difference in the
solute content.Dr. N. Sivaranjani 3
4. Distribution of Body Water
Intravascular
Interstitial
IntracellularICF
ECF Na+
K+
Cl-
Essential for normal cell function
Provides medium for metabolic processes
spaces between cells
plasma-arteries, veins, capillaries
Cerebrospinal fluid, Pleural spaces, Synovial spaces
Peritoneal fluid spaces
Transcellular
1 L
Dr. N. Sivaranjani 4
5. Fluid composition varies with body fat, age and gender
75% water
ECF=45%,ICF=30%
65% water,
ECF= 25%, ICF = 40%
Adult female
50% water,
ECF=10-15%,
ICF=40%
fat cells contain little
water and lean tissue is
rich in water, the more
obese the person, the
smaller the percentage
of total body water.Dr. N. Sivaranjani 5
6. Human life is suspended in a saline solution having a salt concentration of 0.9%
Body fluids must remain fairly constant with regard to amount of H2O & specific electrolytes
Primary component of body fluid: Water
Women lower % body water than men
Total body water decreases with age
Dr. N. Sivaranjani
6
7. How importance is water
Water provides a medium for transporting nutrients to cells and
wastes from cells and for transporting substances such as hormones,
enzymes, blood platelets, and red and white blood cells
Water facilitates cellular metabolism and proper cellular chemical
functioning
Water acts as a solvent for electrolytes and nonelectrolytes
Helps maintain normal body temperature
Facilitates digestion and promotes elimination
Acts as a tissue lubricant
Component in all body cavities [parietal, pleural… fluids]
Water is the
principal body
fluid which is
essential for
life.
Dr. N. Sivaranjani 7
8. Intake and output of water
Factors that Dictate Body Water Requirement
1) Amount needed to give the proper osmotic concentration
2) Amount needed to replace water lost excretion
Normal Routes of water gain and loss
INTAKE OUTPUTml/day ml/day
Exogenous :-
Fluid intake 1,500
Food 700
Endogenous :-
Metabolism 300
TOTAL 2,500
Insensible loss (skin + lung) 850
Feces 150
Urine (kidney) 1,500
TOTAL 2,500
10. Regulation of Body Fluid Compartments
Diffusion
Molecules → from an area of ↑ concentration to an area of ↓
concentration
Osmosis
is the movement of water through a semipermeable membrane to a
higher concentration of solutes.
Active Transport
is movement of substance across permeable membrane and gradient;
requires energy and pump.
Filtration
H2O & dissolved substances → from an area of high hydrostatic
pressure to an area of low hydrostatic pressure
Dr. N. Sivaranjani 10
15. Osmotic Pressure
The amount of hydrostatic pressure required to stop the flow of
water by osmosis
Osmolality
reflects the concentration of fluid that affects the movement of
water between fluid compartments by osmosis
Dr. N. Sivaranjani 15
16. Osmolality : Number of osmotically active particles present per
kilogram of water.
Osmolarity: Number of osmotically active particles present per litre of
water.
Electrolytes: Electrolytes are substances whose molecules dissociate into
ions when placed in solution
Ions : An ion is an atom or group of atoms with an electrical
charge.
Dr. N. Sivaranjani 16
17. Normal plasma Osmolality = 285-292 mOsm/kg
Plasma osmolality can be measured directly using the osmometer
or indirectly as the concentration of effective osmoles
Osmolality =2(Na+) + 2(K+) + Urea + Glucose, mmol/L.
Plasma osmolality (mmol/kg) = 2x Plasma Na+(mmol/l)
Estimated by doubling serum Na concentration
Clinical uses :- diagnosis of disorders of water and electrolyte
balance and NKHC
Osmolality increases – Hyperglycemia, DKA, NKHC, Hypernatremia with water
loss (DI)
Decreased – Hyponatremia – water and Na gain (CCF), SIADH.Dr. N. Sivaranjani 17
18. The difference in measured osmolality and calculated osmolality
called Osmolar Gap. (normal - numerically similar)
Increase in osmotically active substances – Ethanol,
Mannitol, neutral and cationic amino acids.
Fractional water content of plasma is reduced –
hyperlipidemia or hyperproteinemia .
Dr. N. Sivaranjani 18
19. In a healthy state, the osmotic pressure of ECF, mainly due to Na+ ions, is
equal to the osmotic pressure of ICF which is predominantly due to K+ ions
Dr. N. Sivaranjani
19
20. Tonicity - measure of transport of water across the biological system causing
change in cell volume.
0.9% Normal SalineDr. N. Sivaranjani
20
22. (0.45% NS)
< concentration of solutes as plasma
Causes H2O to move into cells & swell
(hemolysis)
Dr. N. Sivaranjani
22
23. (3% NS)
> concentration of solutes as plasma
Causes H2O to draw out of cell
(shrink)
Mannitol –treatment of cerebral
edema.
Dr. N. Sivaranjani
23
25. ELECTROLYTES
Substances whose molecules dissociate into ions
(charged particles) when placed into water
Cations: positively-charged
Anions: negatively-charged
Sodium – major cation of ECF
Chloride - major anion of ECF
Potassium – major cation of ICF
Phosphate – major anion of ICF
Dr. N. Sivaranjani 25
27. Functions of Electrolytes
Promote neuromuscular irritability
Regulate acid and base balance
Regulate distribution of body fluids among body
fluid compartments
Dr. N. Sivaranjani 27
28. are regulated together
kidneys play a predominant role
major regulatory factors are the hormones - Aldosterone,
ADH and
Renin angiotensin
Atrial natriuretic peptide
Hypothalamic regulation - Stimulates thirst and ADH release
Pituitary regulation - Releases ADH
Adrenal cortical regulation – Releases Aldosterone
Renal regulation - Primary organs for regulating fluid and electrolyte balance
Selective reabsorption of water and electrolytes
Renal tubules are sites of action of ADH and aldosterone
Electrolyte and water balance
Dr. N. Sivaranjani 28
29. Synthesis Action Action on sodium
and water
Aldosterone secreted by the zona
glomerulosa
of the adrenal cortex
regulates the
Na+ → K+ exchange and
Na+ → H+ exchange at
the renal tubules.
Sodium and water
retention
Anti-Diuretic
Hormone (ADH)
Under control of
hypothalamus, posterior
pituitary releases ADH
increase the water
reabsorption by the renal
tubules.
Retention of
water
Renin-
Angiotensin
System
release of renin by the
juxtaglomerular cells
Angiotensin-II BP by
vasoconstriction of the
arterioles.
It also stimulates
aldosterone production
Retention of
sodium and water
Atrial natriuretic
peptides
stimulation of atrial
stretch receptors
Inhibit renin and
aldosterone secretion –
cause elimination of sodium
Increases urinary
excretion of
sodium.Dr. N. Sivaranjani 29
30. DECREASED FLUID VOLUME
Stimulation of thirst
center in hypothalamus
Increase in thirst
↑ intake of water
INCREASES PLASMA OSMOLALITY
Dr. N. Sivaranjani 30
31. Posterior pituitary
gland
Osmoreceptors in
hypothalamus +↑Osmolarity
↑ADH
Kidney
↑H2O reabsorption
↑vascular volume and
↓osmolarity
Stress, hypoglycaemia,
Anesthetic agents, Heat,
Nicotine, Antineoplastic
agents, Narcotics,
Surgery
ANTIDIURETIC HORMONE REGULATION MECHANISMS
Fluid
volume
Increase permeability of renal
collecting ducts to water by
binding to V2 receptors –
cause insertion of water
channels to luminal
membrane
32. Juxtaglomerular cells↓Serum Sodium
↓Blood volume
↓Blood Pressure
↓renal blood flow Angiotensin I
Distal renal
tubules
Angiotensin II
Adrenal Cortex↑Sodium reabsorption (H2O
resorbed with sodium)
Angiotensinogen in
plasmaRENIN
Angiotensin-
converting enzyme
ALDOSTERONE
Via vasoconstriction of arterial smooth muscle
ALDOSTERONE-RENIN-ANGIOTENSIN SYSTEM
Increases Blood Pressure
33. INCREASED BLOOD VOLUME ,
INCRESED BLOOD PRESSURE
ATRIAL NATRIURETIC PEPTIDE RELEASE
Reduces in thirst
Decreased intake of water
STIMULATION OF ATRIAL STRETCH RECEPTORS
Inhibits release of ADH
Diuresis – increase urine output
Inhibits release of
Aldosterone
Decreases Na reabsorption
Natriuresis – Na excretion
35. Volume Disorders 2° Alteration in Sodium Balance
ECF Expansion
Isotonic Inc N N Water and Na retention – Edema- 2̊ Cardiac failure
2̊ Hyper- aldosteronism due to hypoalbunemia.
Hypertonic Inc Dec Inc Na retention due to excess mineralocorticoid –
cushing’s syndrome or conn’s syndrome
Hypotonic Inc Inc Dec water retention due to ADH excess or
Glomerular dysfuncion
Volume ECF ICF Conditions
Disorder Vol. Vol. Osmolality
36. ECF Contraction
Isotonic Dec N Normal loss of Na & water
common cause – loss of GIT fluid
SI obstruction, SI fistulae, paralytic ileus
Hypertonic Dec Dec Increased water depletion
Diarrhea – Commonest cause
Diabetes insipidus - rare
Hypotonic Dec Inc Decreased sodium depletion
infusion of IV fluids with low Na-dextrose
aldosterone deficiency- Addison’s disease
Volume ECF ICF Conditions
Disorder Vol. Vol. Osmolality
38. Dehydration / water depletion
Pure (tissue) water loss – less common
Depletion of Na and water – more common
and hypovolemia to sodium loss and thus loss of blood volume.
Dr. N. Sivaranjani 38
39. Causes of water depletion :
Decreased intake of water –
• Inadequate water supply
• Mechanical obstruction for drinking
• Impaired response of thirst center – Comatose patient
Increased loss of water –
• Increased renal loss of water – RTA, DI
• Increased loss of water from skin – Burns,
excessive sweating
• Increased loss through lungs – hyperventilation
• Increased loss of gut – vomiting ,diarrhea
Dr. N. Sivaranjani 39
40. Earliest Detectable Signs
low BP
Dry skin and mucous membranes
Sunken eye balls, fontanels
Circulatory Failure (coolness, mottling of
extremities)
Loss of skin elasticity
Delayed cap refill
lethargy , confusion and coma
Dr. N. Sivaranjani 40
41. Skin turgor assessment – this
assessment can be done on the forearm.
Skin that does not flatten immediately
after release is called “tenting”, an
example of fluid volume deficit.
Dry and cracked lips
Sunken eyes
Thirst and
discomfort
Dr. N. Sivaranjani 41
44. Manifestations of ECF Deficit (Dehydration)
Signs & Symptoms
Weight loss
Blood pressure drop
Delayed capillary refill
Oliguria
Sunken fontanel
Decreased skin turgor
Physiologic Basis
Decreased fluid vol.
Inadequate circ. Blood
Decreased vascular volume
Inadequate kidney circ.
Decreased fluid volume
Decreased interstitial fluid
Dr. N. Sivaranjani 44
45. Degrees of Dehydration
Mild Moderate Severe
Fluid Vol loss <50ml/kg 50-90ml/kg >100 ml/kg
Skin Color Pale Gray Mottled
Skin Elasticity Decreased Poor Very Poor
M.M. Dry Very Dry Parched
U.O. Decreased Oliguria Marked
Oliguria
BP Normal Normal or
lowered
Lowered
Pulse Normal or
Increased
Increased Rapid,
thready
Dr. N. Sivaranjani 45
46. Biochemical finding :
plasma sodium – increased
urine volume – decreased
urine concentrated
Treatment :
Aim - Expand ECF volume and improve circulatory
and renal function
plenty of water
Treatment of underlying causes
Replacement of fluid deficit –
5% dextrose
47. Water intoxication / water excess /over hydration
predominant water excess
Decrease in serum Na+
Causes :
Excessive intake of water
Compulsive drinking of water – psychogenic polydypsia
Excessive administration of fluid through parental route
Impaired renal excretion of water
Severe renal failure
SIADH syndrome of inappropriate ADH
Drugs acting as vasopressin agonist
Dr. N. Sivaranjani 47
48. SIADH –
Plasma hypo-osmolality
Normal renal , thyroid, adrenal function
Increased urine Na excretion
Dilutional hyponatremia
Elevated serum ADH
Clinical features
Behavioral disturbances
Confusion
Headache
Muscle twitching
Convulsion
Coma