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DISORDERS OF WATER
&
ELECTROLYTE BALANCE
By
Santhosh Kumar .N
Asst.Professor
SIMS & RH, Tumkur
Dehydration
a) Simple dehydration
b) Dehydration due to combined water and Na+ deficiency
• Combined water and Na+ deficiency is more common then
simple dehydration
• Results from a net –Ve balance of water and Na+
• In this case water balance may be more –Ve than equal to,
or less –Ve than Na+ balance
Santhosh Kumar .N/ Dept.of Biochem/ SIMS&RH
Hypernatremic or
hyperosmolar dehydration
Normonatremic or
isomolar
Hyponatremic or
hyposmolar
Water balance is more
negative than Na+ balance
Equally negative If it is less negative
than Na+ balance
Causes of H2O & Na+
deficits
Increase in ECW osmolarity
causes water to move out of
the cell & contraction of
ICW volume occurs
Total water deficit is shared
by EC & IC compartment.
The EC volume
contraction is
intermediate.
No changes occurs
in ECW & ICW
osmolarity so that
water does not move
out of or into cells
ECW volume depletion
is largest with
increased ICW volume
Decrease in ECW
osmolarity causes water
to move into cells
Causes:
Excessive sweating
Water & food deprivation
Diuretic therapy
Osmotic diuresis with
glycosuria
Causes :
Vomiting
Diarrhea
Causes: More sweating
renal disease
Adrenocortical
insufficiency
Addison’s disease
Diuretic therapy
(Water Depletion)
 Diabetes insipidus
Wrinkled skin, dry mucous membranes, muscle
cramps , increase blood urea nitrogen &
hematocrit, with hypotension
and shock may occurs
Santhosh Kumar .N/ Dept.of Biochem/ SIMS&RH
Causes:
Treatment:
• Simple dehydration: patient is asked to drink plenty of
water, if not possible an isotonic solution of 5% dextrose
is given IV.
• Due to combined deficiency of water & electrolyte: An
isotonic solution of sodium chloride (Normal saline) is
given IV
EDEMA
• Due to excess water & Sodium content of the body, leads to
edema
• Occurs in water intoxication, excessive administration of
intravenous fluids, protein deficiency, increased secretion of
ADH, cancer & drugs
• Various liver diseases that result in decreased protein
synthesis also leads to edema.
Santhosh Kumar .N/ Dept.of Biochem/ SIMS&RH
Factors contributing to edema
• Inhalation of gases, inflammation (pneumonia) or respiration
burns may increase the permeability of pulmonary capillaries
with loss of proteins & fluids
Causes of edema:
Malnutrition,
Obstructed lymph flow,
Fluid accumulation in lungs
Left ventricular heart failure,
Early phases of congestive heart failure,
Glomerular nephritis,
Nephrotic syndrome,
Water intoxication / Overhydration
• Water intoxication results due to the retention of excess
water in the body which occurs
– Due to renal failure
– Excessive administration of fluids parenteral
– Hyper secretion of ADH (SIADH: syndrome of
inappropriate ADH secretion )
– Results in hyponatremia & hyposmolarity of ECW
with expansion of the ECW & ICW compartment
Santhosh Kumar .N/ Dept.of Biochem/ SIMS&RH
Symptoms
• Acute fall in serum sodium results in
Nausea, vomiting, headache,
Muscular weakness, confusion,
In severe case convulsions, coma and
even death can occurs
Investigations Reference
values
Clinical Interpretations
Increased Decreased
Sodium
(Na+ )
135 - 145
mEq/L
Hypernatremia: Cushing’s
syndrome, Prolonged cortisone
therapy.
Hyponatremia: Vomiting,
Diarrhea, Burns, Addison’s
disease & Severe sweating
Potassium
( K+)
3.5 - 5.1
mEq/L
Hyperkalemia; Renal failure,
Addison’s disease & Diabetic
coma , cardiac arrest & paralysis
Hypokalemia: Prolonged
vomiting, Severe diarrhea,
Cushing’s syndrome,&
muscular weakness
Chlorides
(Cl-)
96 – 110
mEq/L
Hyperchloremia: Dehydration,
Severe diarrhea, Renal tubular
acidosis, Cushing‘s syndrome &
Respiratory acidosis.
Hypochloremia:Vomiting,
Diarrhea, Respiratory
alkalosis & Excessive
sweating
Calcium 8.5 -
10.5mg/dl
Bone disorders , Acute &
Chronic renal failure
Hypo parathyroidism &
Acute pancreatitis
Thank Q
The End
Santhosh Kumar .N/ Dept.of Biochem/ SIMS&RH

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W&EB: 02 Disorders of Water & Electrolyte Balance

  • 1. DISORDERS OF WATER & ELECTROLYTE BALANCE By Santhosh Kumar .N Asst.Professor SIMS & RH, Tumkur
  • 2. Dehydration a) Simple dehydration b) Dehydration due to combined water and Na+ deficiency • Combined water and Na+ deficiency is more common then simple dehydration • Results from a net –Ve balance of water and Na+ • In this case water balance may be more –Ve than equal to, or less –Ve than Na+ balance Santhosh Kumar .N/ Dept.of Biochem/ SIMS&RH
  • 3. Hypernatremic or hyperosmolar dehydration Normonatremic or isomolar Hyponatremic or hyposmolar Water balance is more negative than Na+ balance Equally negative If it is less negative than Na+ balance Causes of H2O & Na+ deficits Increase in ECW osmolarity causes water to move out of the cell & contraction of ICW volume occurs Total water deficit is shared by EC & IC compartment. The EC volume contraction is intermediate. No changes occurs in ECW & ICW osmolarity so that water does not move out of or into cells ECW volume depletion is largest with increased ICW volume Decrease in ECW osmolarity causes water to move into cells Causes: Excessive sweating Water & food deprivation Diuretic therapy Osmotic diuresis with glycosuria Causes : Vomiting Diarrhea Causes: More sweating renal disease Adrenocortical insufficiency Addison’s disease Diuretic therapy
  • 4. (Water Depletion)  Diabetes insipidus Wrinkled skin, dry mucous membranes, muscle cramps , increase blood urea nitrogen & hematocrit, with hypotension and shock may occurs Santhosh Kumar .N/ Dept.of Biochem/ SIMS&RH Causes:
  • 5. Treatment: • Simple dehydration: patient is asked to drink plenty of water, if not possible an isotonic solution of 5% dextrose is given IV. • Due to combined deficiency of water & electrolyte: An isotonic solution of sodium chloride (Normal saline) is given IV
  • 6. EDEMA • Due to excess water & Sodium content of the body, leads to edema • Occurs in water intoxication, excessive administration of intravenous fluids, protein deficiency, increased secretion of ADH, cancer & drugs • Various liver diseases that result in decreased protein synthesis also leads to edema. Santhosh Kumar .N/ Dept.of Biochem/ SIMS&RH
  • 7. Factors contributing to edema • Inhalation of gases, inflammation (pneumonia) or respiration burns may increase the permeability of pulmonary capillaries with loss of proteins & fluids Causes of edema: Malnutrition, Obstructed lymph flow, Fluid accumulation in lungs Left ventricular heart failure, Early phases of congestive heart failure, Glomerular nephritis, Nephrotic syndrome,
  • 8. Water intoxication / Overhydration • Water intoxication results due to the retention of excess water in the body which occurs – Due to renal failure – Excessive administration of fluids parenteral – Hyper secretion of ADH (SIADH: syndrome of inappropriate ADH secretion ) – Results in hyponatremia & hyposmolarity of ECW with expansion of the ECW & ICW compartment Santhosh Kumar .N/ Dept.of Biochem/ SIMS&RH
  • 9. Symptoms • Acute fall in serum sodium results in Nausea, vomiting, headache, Muscular weakness, confusion, In severe case convulsions, coma and even death can occurs
  • 10. Investigations Reference values Clinical Interpretations Increased Decreased Sodium (Na+ ) 135 - 145 mEq/L Hypernatremia: Cushing’s syndrome, Prolonged cortisone therapy. Hyponatremia: Vomiting, Diarrhea, Burns, Addison’s disease & Severe sweating Potassium ( K+) 3.5 - 5.1 mEq/L Hyperkalemia; Renal failure, Addison’s disease & Diabetic coma , cardiac arrest & paralysis Hypokalemia: Prolonged vomiting, Severe diarrhea, Cushing’s syndrome,& muscular weakness Chlorides (Cl-) 96 – 110 mEq/L Hyperchloremia: Dehydration, Severe diarrhea, Renal tubular acidosis, Cushing‘s syndrome & Respiratory acidosis. Hypochloremia:Vomiting, Diarrhea, Respiratory alkalosis & Excessive sweating Calcium 8.5 - 10.5mg/dl Bone disorders , Acute & Chronic renal failure Hypo parathyroidism & Acute pancreatitis
  • 11. Thank Q The End Santhosh Kumar .N/ Dept.of Biochem/ SIMS&RH