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Slide 1-

Water And Electrolytes Balance And Imbalance In Human Body Dr Anissa Atif Mirza
Slide 2-

Body Water
Slide 3-

Water is the chief constituent of human body. Water is the chief solvent of body.
Slide 4-

Water comprises 60-70% of total body weight Human body cannot exist without Water the.
Slide 5-

Sources Of Body Water
Slide 6-

Exogenous Sources Of Water Drinking Water ,Beverages -1000-1500 ml Water from Cooked Foods
Slide 7-

Water intake through mouth is highly variable 1-5 Litres this depend on : Social habits Climatic condition
Slide 8-

Endogenous Sources Of Water Metabolic Water - 400 ml Produced during metabolism oxidation of food substances. (At end of ETC Process)
Slide 9-

Distribution Of Body Water
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In an adult of 70 kg body Total Body Water -60- 70% /36-49 Lt Intracellular Fluid -65 % - 35 L Extracellular Fluid -35% -14 L Interstitial Tissue Fluid -25% -11L Plasma /Intra Vascular Fluid -8% -3L Transcellular Fluid- 2%
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19/10/2009 12 12
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15
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Body water content in percentage of a body weight is lowest in. (A)Well built man (B) Fat woman (C)Well nourished child (D) Fat Man
Slide 17-

Functions Of Body Water
Slide 18-

Involved in Biochemical reactions Water act as reactant in many hydration Hydrolytic reactions of metabolic pathways. Transporting media of body: Transportation of nutrients and waste metabolites through aqueous media of blood and tissue floods. Regulates body temperature
Slide 19-

Water transports Hormones, Enzymes, blood platelets, and red and white blood cells Water act as a solvent for Electrolytes and Non electrolytes Water Facilitates Digestion and promoting Elimination of ingested food Water serve as a tissue Lubricant
Slide 20-

Body Water Input and Output
Slide 21-

Body Water Input Body can gain water by Ingestion of liquids and moist foods (2300mL/day) Metabolic synthesis of water during cellular respiration (200mL/day)
Slide 22-

Body Water Output Body losses water through: Kidneys (1500mL/day) Evaporation from Skin (600mL/day) Exhalation from Lungs (300mL/day) Feces (100mL/day)
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23
Slide 24-

BODY ELECTROLYTES
Slide 25-

What Are Electrolytes? Substance when dissolved in solution dissociates into ions These ions are able to carry an electrical current
Slide 26-

An Electrolyte is a substance Which develops an electrical charge when dissolved in water
Slide 27-

Body Electrolytes Salts like NaCl and KCl in aqueous solutions gets dissociated to Charged ions Na+ and Cl- called as Electrolytes. The concentration of these Electrolytes is expressed as mEq/L.
Slide 28-

Types Of Electrolytes CATION - Positively charged Electrolyte ANION - Negatively charged Electrolyte
Slide 29-

Water molecules completely surround these dissociated ions These prevents union of Cations and Anions.
Slide 30-

Distribution Of Body Electrolytes In ECF and ICF
Slide 31-

31 ELECTROLYTES IN BODY FLUID COMPARTMENTS
Slide 32-

To Maintain Electrical Neutrality In Each Fluid Compartments Number Cations =Number Anions
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Predominant Cations and Anions of ECF: Na+ and Cl- respectively.
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Thus the predominant Cations and Anions of ICF K+ and HPO4-- respectively.
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Copyright 2009, John Wiley & Sons, Inc. Electrolyte and protein anion concentrations
Slide 39-

Functions Of Body Electrolytes
Slide 40-

Electrolytes are well distributed in the body compartments. Electrolytes in the medium/compartments produce osmotic pressure. This osmotic pressure helps in maintaining water balance.
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ELECTROLYTES Na+: Most abundant electrolyte in the ECF. K+: Essential for normal membrane excitability for nerve impulse Cl-: Regulates osmotic pressure and assists in regulating acid-base balance
Slide 42-

Ca2+: Promotes nerve impulse and muscle contraction/relaxation Mg2+: Plays role in carbohydrate and protein metabolism, storage and use of intracellular energy and neural transmission. Important in the functioning of the heart, nerves, and muscles
Slide 43-

For more detail functions of Electrolytes Refer Minerals Chapter.
Slide 44-

Movement of Water and Electrolytes
Slide 45-

Diffusion – movement of particles down a concentration gradient. Diffusion: the random movement of particles in all directions through a solution
Slide 46-

Osmosis: movement of water across a membrane from a less concentrated solution to a more concentrated solution Osmosis – diffusion of water across a selectively permeable membrane
Slide 47-

Osmolarity: The number of moles per liter of solution Osmolality: The number of moles per Kg of Solvent.
Slide 48-

Sodium and its associated ions in plasma make the largest contribution (90%) for plasma Osmolality. Osmolality is measured by Osmometer
Slide 49-

Plasma Osmolality = 2 x Plasma Na + mmol/L
Slide 50-

Osmolality: concentration of a solution determined by the number of dissolved particles per kilogram of water. Osmolality controls water movement and distribution in body fluid compartments
Slide 51-

Active transport: Movement of solutes across membranes; Requires transporters and expenditure of energy Movement of particles is up a concentration gradient
Slide 52-

Filtration: transfer of water and solutes through a membrane From a region of high pressure to a region of low pressure
Slide 53-

Normal Fluid and Electrolytes Exchanges In Body Water And Electrolytes Movement INN and OUT of Cells.
Slide 54-

Remember Normally in a healthy body there is osmotic equilibrium maintained in each compartment.
Slide 55-

In a healthy body the semipermeable cell membrane Allows only passage of Water but not Electrolytes through it.
Slide 56-

Disturbance in osmotic equilibrium of compartments Draws water from the compartment with lower osmotic pressure (Hypotonic) Into the compartment with higher osmotic pressure (Hypertonic) Until equilibrium is restored.
Slide 57-

In the concentration gradient of K+ and Cl- K+ tends to diffuse out of the cells and Cl -enters into cells.
Slide 58-

During difference in electrical potential For example in relative negativity inside the cells There tend to keep Cl - out and K + inn.
Slide 59-

Remember Cells do not allow accumulation of Na + Na rapidly enters in the cells By the Sodium pump, Na is effectively extrudes out from ICF By active transport of Na out of cells.
Slide 60-

However in case of Na + diffusion into cells It is favored by both the concentration gradient and electrical potential.
Slide 61-

Remember Where Sodium goes, Water follows.
Slide 62-

Homeostasis Of Body Water OR Regulation Of Body Water
Slide 63-

Water Balance An healthy adult individual always try To maintain water balance by the homeostatic mechanisms. Since Water balance is vital for human body
Slide 64-

A body is said to be in water balance In a day When the amount of water intake in the body is equal To the amount of water output by that body.
Slide 65-

A healthy body tries to regulate the body water Proportionately distribute the water in ICF and ECF
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Water Input = Water Out put 2100ml 2100 ml Sensible loss Drinking Water 1000 ml Urine 1000 ml Cooked Foods 700 ml Feces 100 ml Metabolic Water 400 ml Insensible loss Skin 600 ml Lungs 400 ml
Slide 68-

Electrolyte Balance Healthy body obeys the law of electrical neutrality. Fluid in any body compartment contain, equal number of Cations and Anions.
Slide 69-

Specific concentrations of Electrolytes in the body compartments are of most important In distribution and retention of body water.
Slide 70-

In healthy state the Osmotic pressure due to Cations is equal to the osmotic pressure due to Anions. Which is predominantly due to equal concentrations of Cations and Anions in each compartment.
Slide 71-

Factors Regulating Water And Electrolyte Balance
Slide 72-

In human body Water and Electrolytes go togetherly. That means the osmotic equilibrium created by Electrolytes help in maintaining water balance. If there is imbalance in Electrolytes it directly affects Water balance.
Slide 73-

Since the Electrolytes and Water balance go hand in hand in human body. Hence factors regulating the water and electrolytes are same.
Slide 74-

74 Homeostasis of Water And Electrolytes Is Maintained By
Slide 75-

Ion transport Water movement Kidney function These functions act to keep body fluids: Electrically neutral Osmotically stable Solute Homeostasis Maintained by:
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76
Slide 77-

Fluid Exchanges
Slide 78-

A body consume fluids and food items variably depending upon habits and climatic condition. Intake of water and electrolytes is rarely proportional.
Slide 79-

Kidneys play a predominant role In regulating water and electrolyte balance in the body normally.
Slide 80-

Kidneys play role to excrete Excess water through urine (Dilute form of Urine) OR Excess Electrolytes through urine (Concentrated form of Urine)
Slide 81-

Biochemical Factors Regulating Water And Electrolyte Balance
Slide 82-

Neural Mechanism- Thirst Mechanism Antidiuretic Hormone/Vasopressin Renin Angiotensin System Aldosterone Atrial Natriuretic Peptide(ANP) Kinins ( Increases Salt and Water excretion)
Slide 83-

1.Neural Mechanism/Thirst Mechanism Regulate Low Body Water
Slide 84-

When the body water is lowered due to: No intake of fluids Body fluids lost through obligatory losses (Urine and Feces). This leads to decrease in volume of body fluids with respect to solutes and rise in osmotic pressure.
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85
Slide 86-

The ECF volume decreases and becomes hypertonic. This tends to draw water from ICF causing cellular dehydration.
Slide 87-

The cellular dehydration stimulates The thirst centre located in hypothalamus.
Slide 88-

In response to the stimulus to thirst center There occurs dryness of mouth and Pharynx . Feeling of thirst makes drink water Water ingested orally quench the thirst to regulate the body water.
Slide 89-

2. Antidiuretic Hormone/Vasopressin
Slide 90-

Antidiuretic Hormone/Vasopressin Anti Diuretic Hormone(ADH) is produced in Hypothalamus Stored in posterior pituitary gland
Slide 91-

The action of Peptide Hormone ,ADH is via cyclic AMP.
Slide 92-

An increase in Osmolality (Na+ conc) of plasma Promotes ADH secretion and vice versa.
Slide 93-

ADH is water conservation hormone It acts on renal collecting tubule For reabsorption of water by renal tubules.
Slide 94-

Role Of Anti Diuretic Hormone (ADH) When the body water is depleted ADH exerts Antidiuretic effect.
Slide 95-

ADH affects renal tubules Provides for the facultative reabsorption of water from distal tubules. Urine output will be lower Urine concentration will be increased Body water will be maintained
Slide 96-

3. RENIN ANGIOTENSIN MECHANISM
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Renin-Angiotensin System works when the: Blood volume is low Blood pressure is low
Slide 98-

Kidney, Liver and Lungs are involved in Renin Angiotensin System.
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Renin is released by kidneys in response to decreased blood volume
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Renin causes Angiotensinogen (plasma protein formed in Liver) to split & produce Angiotensin I
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Lungs convert Angiotensin I to Angiotensin II By Angiotensin Converting Enzyme.
Slide 103-

Angiotensin II then stimulates adrenal gland to release Aldosterone Aldosterone then increase the peripheral vasoconstriction
Slide 104-

Renin Angiotensin System regulates Aldosterone hormone from Adrenal gland During homeostatic mechanism of Water and Electrolyte Balance.
Slide 105-

Fall in E.C.F volume Decreases blood pressure Sensed by Juxtaglomerular apparatus of Nephrons of Kidneys to secrete Renin Renin then stimulate Liver Angiotensinogen to produce Angiotensin –I
Slide 106-

Angiotensin I is converted to Angiotensin By Lung produced enzyme Angiotensin Converting Enzyme(ACE).
Slide 107-

Angiotensin II stimulates the release of Aldosterone from Adrenal gland.
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4. Role Of Aldosterone
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Aldosterone Aldosterone is a Steroid Hormone. It is a Mineralocorticoid produced by Zona Glomerulus of Adrenal Cortex. It has most important effect on Mineral Metabolism.
Slide 111-

ALDOSTERONE Aldosterone is released as part of Renin Angiotensin mechanism Acts on renal distal convoluted tubule
Slide 112-

The hormone Aldosterone by its action: Increases the rate of reabsorption of Na+ (95 %) and Cl- Increases K+ loss through Urine
Slide 113-

Role Of Aldosterone Aldosterone increases Sodium uptake from the tubular fluid Regulates water reabsorption by renal tubules and add into the blood Makes excretion of Potassium
Slide 114-

Thus Aldosterone maintain Water and Electrolyte Balance by its action on renal tubules: Reabsorbs Sodium Retains Water Looses Potassium
Slide 115-

Factors Affecting Aldosterone Secretion
Slide 116-

5. Atrial Natriuretic Peptide or Factor (ANP)/ (ANF)
Slide 117-

Atrial Natriuretic Peptide or Factor (ANP)/ (ANF) ANP is a Cardiac hormone Secreted by right Atrium of Heart. Chemically ANP is a Polypeptide hormone
Slide 118-

ANP ANP is released in response to increased blood pressure in the atria ( due to increased blood volume) ANP opposes the Renin-Angiotensin-Aldosterone system
Slide 119-

ANP suppresses Renin level Decreases the release of Aldosterone Decreases ADH release ANP stimulates excretion of Na and H2O Reduces vascular resistance by causing vasodilation.
Slide 120-

Role Of Atrial Natriuretic Peptide (ANP) ANP increases the urinary excretion of Na+ and regulates the electrolytes balance.
Slide 121-

6. Role of Kinins
Slide 122-

Kinins are proteins in the blood Kinins cause inflammation and affect blood pressure (especially lowers the blood pressure). Kinins increases Salt and Water excretion.
Slide 123-

Osmolarity of a Solutions
Slide 124-

Osmolarity of Solutions Isotonic Solution— Same concentration of solutes as plasma Hypertonic Solution— Greater concentration of solutes than plasma Hypotonic Solution— Lesser concentration of solutes than plasma
Slide 125-

Example Of ISOTONIC SOLUTIONS 0.9% Sodium Chloride Solution / Normal Saline Ringer’s Solution typically contains Sodium Chloride Potassium Chloride Calcium Chloride Sodium Bicarbonate Lactate Ringer’s Solution Contains additionally Lactate
Slide 126-

1 mol NaCl weighs 58.44g NaCl 1 mmol NaCl weighs 0.058 g NaCl One mmol of NaCl contains 58.3 mg NaCl
Slide 127-

127
Slide 128-

HYPOTONIC SOLUTIONS 5% DEXTROSE & WATER 0.45% SODIUM CHLORIDE 0.33% SODIUM CHLORIDE
Slide 129-

129 Cell in a hypotonic solution
Slide 130-

HYPERTONIC SOLUTIONS 3% SODIUM CHLORIDE 5% SODIUM CHLORIDE WHOLE BLOOD ALBUMIN TOTAL PARENTERAL NUTRITION TUBE FEEDINGS CONCENTRATED DEXTROSE (>10%)
Slide 131-

131 Cell in a hypertonic solution
Slide 132-

Water And Electrolyte Imbalances
Slide 133-

In a human body water distribution in compartments Is due to osmotic pressure produced by Electrolytes
Slide 134-

Since Water and Electrolytes balance in the body go together Hence imbalance in any one of it ,affects both. In simple words if there is Electrolyte imbalance, it directly affects and causes Water Imbalance.
Slide 135-

What Conditions Leads To Water And Electrolyte Imbalance?
Slide 136-

Factors Involved In Water and Electrolyte Balance Water intake Electrolyte intake Organs and Mechanisms Hypothalamus Pituitary Gland Kidneys Liver Lung Adrenal glands Cardiac tissue Related Genes Cholesterol Amino acids
Slide 137-

REGULATION OF FLUID VOLUME
Slide 138-

Any defect in the organs associated to factor regulating Water and Electrolyte balance May lead to Water and Electrolyte imbalance.
Slide 139-

Anything that alters the concentrations of Electrolytes Will alter the concentration of water, and vice versa.
Slide 140-

Remember In condition of Water and Electrolyte imbalances Care should be taken to manage both the entities simultaneously.
Slide 141-

Conditions Of Water and Electrolyte Imbalances
Slide 142-

Water Electrolyte Imbalance Conditions Dehydration Over hydration
Slide 143-

Dehydration Dehydration is a condition of Water imbalance. Dehydration is characterized by disturbance of Water and electrolyte balance.
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In a dehydrated body the output of water exceeds the water intake. This causes reduction of body water below the normal level.
Slide 145-

Basic Cause Of Dehydration No Ingestion of water Excessive Loss of body fluids
Slide 146-

Features Of Dehydration Water Deficiency Condition Low body water Low blood volume Disturbance in body Electrolytes.
Slide 147-

Types Of Dehydration
Slide 148-

Types Of Dehydration Primary Dehydration /Due to pure water depletion Mixed Type Dehydration /Due to both Water and Salt depletion Secondary dehydration/Due to pure salt depletion
Slide 149-

Primary Dehydration OR Pure Water Depletion
Slide 150-

Causes Of Primary Dehydration Very weak or very ill patients unable to ingest Water. Mental Patients who refuses to drink water In Coma Condition Person lost in desert or Shipwrecked
Slide 151-

Defect to hypothalamus Patients with renal tubular disorder Diabetes insipidus-ADH insufficiency.
Slide 152-

Biochemical Alterations Pure Water depletion occurs almost always: Because of lack of Water intake Rather than because of excess looses from the body.
Slide 153-

Body water stores get depleted because of: Continuing obligatory losses of water through Urine and Feces to excrete metabolic waste.
Slide 154-

The only source of water supply in this condition is Metabolic water obtained from oxidation of food stuffs.
Slide 155-

The volume of ECF is maintained almost to normal in this condition. At the expense of I.C.F which is grossly reduced in volume Causing intracellular dehydration.
Slide 156-

Neural mechanism is activated But if this is not responded By oral Water ingestion Causes water depletion in body.
Slide 157-

Clinical Manifestations Dry tongue and pinched facies (Due to intense thirst) Oligouria- ADH secreted causes reabsorption of water from kidney tubules Causing a gradual diminution of Urine volume.
Slide 158-

Management Give water to drink by mouth 5% Glucose by I.V (Hypotonic Soln) To correct intracellular dehydration. Note: Never give Isotonic Saline. (0.9 % w/v NaCl solution).
Slide 159-

Mixed Type Of Dehydration Water and Salt Depletion
Slide 160-

This is the most common type of dehydration condition.
Slide 161-

Causes of Mixed Type Dehydration Severe Vomiting Severe Diarrhea
Slide 162-

Biochemical Alterations Mixed dehydration has both low volume of both water and electrolytes. Here the volume of fluids in both E.C.F and I.C.F is reduced. The patient appears dehydrated and complains of thirst.
Slide 163-

Manifestations Feeling of thirst Low BP Increased blood Urea Urinary out put is diminished
Slide 164-

Management Administering Mixture of Saline and 5 % Glucose in 1:1 proportion.
Slide 165-

Secondary Dehydration Pure Salt Depletion
Slide 166-

Pure Salt Depletion Secondary Dehydration This occurs when fluids of high Na/Cl content are lost from the body And body is replaced by Salt deficient fluids.
Slide 167-

Causes Excessive Sweating GIT loss of fluids during vomiting and diarrhea Continuous aspirations of G.I fluids In Addisons disease (Insufficiency of Adrenal Cortex) Vigorous use of diuretics
Slide 168-

Biochemical Alterations The loss of body water and electrolytes Replaced with water without salts leads to pure salt depletion
Slide 169-

In pure salt depletion E.C.F becomes hypotonic. The lowered osmotic pressure inhibits the release of ADH In this response Kidneys excrete water in an attempt to maintain normal extracellular Na concentration
Slide 170-

This decreases plasma and interstitial fluids . The water from ECF (hypotonic) flows into the I.C.F of cells (hypertonic soln). This further reduces the volume of ECF.
Slide 171-

In this condition there is no cellular dehydration. No response to thirst centre.
Slide 172-

Copyright 2009, John Wiley & Sons, Inc. Series of Events in Secondary Dehydration
Slide 173-

Manifestations Of Secondary Dehydration Absence of Thirst (No intracellular dehydration) Patient is apathetic, listless Hallucinations and Confusions are common Anorexia and Nausea Cramps in thigh, abdominal and respiratory muscles. Sunken eyes, inelastic skin Low BP, decreased GFR and excretion
Slide 174-

Management of Secondary Dehydration By administering Isotonic solution 0.9% NaCl.
Slide 175-

Differences In Primary And Secondary Dehydration
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Over Hydration /Water Excess
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Over hydration /Water Excess Here there is excess of body water.
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Over Hydration / Water Intoxication Due to excess water intake Due to water retention
Slide 183-

Causes Of Water Excess Excessive administration of parenteral fluids. Renal Failure (No/Less excretion of Urine) Hypersecretion of ADH Administration of Narcotics ,Anaesthesia causes secretion of ADH Excess of Aldosterone (Conn’s Syndrome)
Slide 184-

Manifestations Headache Nausea Incoordination of Movements Delirium
Slide 185-

Management Withholding drinking of fluids. Administration of 3-5% Hypertonic Saline intravenously.
Slide 186-

ELECTROLYTE IMBALANCES
Slide 187-

ELECTROLYTE IMBALANCES Hyponatremia (sodium deficit < 130mEq/L) Hypernatremia (sodium excess >145mEq/L) Hypokalemia (Potassium deficit <3.5mEq/L) Hyperkalemia (Potassium excess >5.1mEq/L) Chloride imbalance (<98mEq/L or >107mEq/L) Magnesium imbalance (<1.5mEq/L or >2.5mEq/L)
Slide 188-

Common Conditions And Disorders Associated With Water And Electrolyte Imbalances
Slide 189-

Edema
Slide 190-

Edema/Swelling Condition in which excess fluid accumulates in the interstitial compartment. It is a response to inflammation and injury
Slide 191-

Common Conditions Of Edema Inflammation Infections Pregnancy Medications
Slide 192-

Causes Of Edema Increased Hydrostatic Pressure Small blood vessels become leaky and releases fluid into nearby tissues. Venous obstruction, Lymphedema, CHF, Renal failure Lowered Plasma Osmotic pressure (Protein loss) Liver failure, Malnutrition, Burns Increased capillary membrane permeability Inflammation, Sepsis
Slide 193-

Types Of Edema Generalized Edema Organ specific Edema [cerebral, ascites , pleural) Cutaneous Pitting Edema Non Pitting Edema
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Consequences Of Edema Imbalance in Water and Electrolyte distribution. Impaired blood flow Slow healing Increased risk of infections Pressure sores over bony prominences Impaired organ function (Brain, Liver, Gut, Kidney)
Slide 196-

Treatment Of Edema Treat the underlying cause of Edema. Defect in heart/Lungs/Liver /Kidney should be treated Reducing amount of salt
Slide 197-

Diabetes insipidus
Slide 198-

Diabetes insipidus Endocrine Disorder ADH insufficiency Affecting Water and Electrolyte imbalance of the body.
Slide 199-

Diabetes insipidus Diabetes insipidus (DI) is a condition characterized by: Excretion of large amounts of severely dilute urine With excessive thirst
Slide 200-

Incidence Of DI 3 in 100,000 individuals of general population.
Slide 201-

Causes And Types of DI
Slide 202-

Central Diabetes Insipidus Central Diabetes insipidus (CDI) Involves a deficiency of Vasopressin / Antidiuretic hormone
Slide 203-

Nephrogenic Diabetes insipidus The second common type of DI is Nephrogenic Diabetes insipidus (NDI), Is due to kidney or nephron dysfunction Caused by an insensitivity of the Kidneys or nephrons to ADH.
Slide 204-

Manifestations Of DI Polyuria with dilute urine. Due to osmotic diuresis Excessive thirst(Polydypsia) Dehydration Electrolyte imbalance
Slide 205-

Diagnosis Urine Osmolarity Urine Specific gravity Electrolyte concentrations in serum and urine Fluid Deprivation test
Slide 206-

Treatment Central DI respond to Desmopressin which is given as intranasal or oral tablets
Slide 207-

Addisons Disease Hypoadrenocorticism
Slide 208-

Addisons Disease Thomas Addison first discoverer (1849) Autoimmune disease Endocrine disorder
Slide 209-

Cause Defect in Adrenal glands Adrenal gland insufficiency Deficient Aldosterone and Cortisol
Slide 210-

Incidence Of DI 1 in 100,000
Slide 211-

Biochemical Alterations Hypoglycemia (reduced level of blood glucose) Hyponatremia (low sodium level in the blood) Hyperkalemia (elevated potassium level in the blood) Hypercalcemia (elevated calcium level in the blood)
Slide 212-

Manifestations Low blood pressure Syncope (loss of consciousness and inability to stand) Confusion, Psychosis, slurred speech Severe Lethargy Convulsions
Slide 213-

Diagnosis Blood Electrolytes (Na and K) Blood Glucose Blood Calcium
Slide 214-

Blood Cortisol levels ACTH Stimulation Test Uses synthetic pituitary ACTH hormone Tetracosactide used for diagnosis
Slide 215-

Management Standard therapy involves intravenous injections of Glucocorticoids of Hydrocortisone tablets, Prednisone tablets Large volumes of intravenous saline solution with Dextrose/Glucose. Oral doses of Fludrocortisone Acetate
Slide 216-

Cushings Syndrome Hyperadrenocorticism
Slide 217-

Cause Over activity of Adrenal glands Excess of Aldosterone and Cortisol
Slide 218-

Incidence 1 in 100,000
Slide 219-

Biochemical Alterations Hyperglycemia (Increased level of blood glucose) Hypernatremia (High Sodium level in the blood) Hypokalemia (Low potassium level in the blood) Hypocalcemia (Low Calcium level in the blood)
Slide 220-

Manifestations High blood pressure Weight gain ,Central obesity. Buffalo Hump and Moon Face Insomnia Excessive Sweating Depression Anxiety
Slide 221-

Diagnosis Blood Electrolytes (Na+ and K+) Blood Glucose Blood Calcium Blood Cortisol levels
Slide 222-

Management In adrenal Adenomas surgical removal. Ketoconazole, Metyrapone inhibit Cortisol biosynthesis. Mifepristone is a powerful Glucocorticoid type II receptor antagonist
Slide 223-

Effects of Stress on Water And Electrolyte Balance
Slide 224-

The Hypothalamus and Pituitary gland Integrate communication between nervous and endocrine systems Stress severely affect this coordination and affect Water and Electrolyte balance
Slide 225-

Diagnostic Tests To Check for Fluid and Electrolytes Balance And Imbalance
Slide 226-

Blood Investigations Serum Electrolytes Serum Creatinine = 0.6 – 1.5 mg/dl Blood Urea and BUN = 8-20 mg/dL Serum Osmolality Serum Albumin – 3.5-5.5 g/dL Serum Hematocrit = 40-54%/men, 38-47% for women (Decreased in Dehydration)
Slide 227-

Urine Investigations Urine pH Urine specific gravity Urine Osmolarity Urine Creatinine Clearance Urine Sodium Urine Potassium
Slide 228-

Questions
Slide 229-

Distribution & functions of Water in human body. What are Electrolytes? Give its distribution & functions related to human body.
Slide 230-

What is water electrolyte balance? Explain the factors involved in water electrolyte balance. What are disorders of Water and Electrolyte imbalances?
Slide 231-

Dehydration- types, causes & management. Differentiate between Primary and Secondary Dehydration Over hydration/Water Toxicity/Water Intoxication. Edema Diabetes Insipidus. Addison's & Cushing Syndrome.
Slide 232-

Thank You