balance{ water}

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  • 1. BALANCE WATER ACID-BASE ELECTROLYTE

2. WATER BALANCE

  • NORMAL WATER CONTENT OF BODY
  • 75% AT BIRTH
  • 55-60% YOUNG ADULTS
    • MEN SLIGHTLY HIGHER THAN WOMEN
    • (MORE FAT, LESS WATER)
  • 45% IN ELDERLY, OBESE

3. WATER BALANCE

  • TOTAL BODY WATER
  • ~40 LITERS
  • SEVERAL FLUID COMPARTMENTS
    • 65% INTRACELLULAR FLUID (ICF)
    • 35% EXTRACELLULAR FLUID (ECF)
      • 25% INTERSTITIAL FLUID (TISSUE FLUID)
      • 8% BLOOD PLASMA AND LYMPH
      • 2% TRANSCELLULAR FLUID
        • SYNOVIAL, PLEURAL, PERICARDIAL, ETC.

4. WATER BALANCE

  • TOTAL BODY WATER
  • ENTERS BODY
    • OSMOSIS FROM DIGESTIVE TRACT
      • ALSO PRODUCED BY AEROBIC RESPIRATION
      • ALSO PRODUCED BY CONDENSATION REACTIONS
  • EXITS BODY
    • URINARY, DIGESTIVE, RESPIRATORY, & INTEGUMENTARY SYSTEMS

5. WATER BALANCE

  • TOTAL BODY WATER
  • FLUID EXCHANGED BETWEEN COMPARTMENTS
    • CAPILLARY WALLS, PLASMA MEMBRANES
    • DRIVEN BY TRANSIENT OSMOTIC GRADIENTS
    • OSMOTIC GRADIENTS DEPENDENT ON SOLUTE MOLECULES
    • MOST ABUNDANT SOLUTES ARE ELECTROLYTES
    • WATER BALANCE AND ELECTROLYTE BALANCE ARE CLOSELY RELATED

6. 7. WATER BALANCE

  • WATER BALANCE
  • FLUID GAIN = FLUID LOSS
  • BOTH TYPICALLY ~2500 ML / DAY

8. WATER BALANCE

  • WATER GAIN
  • TYPICALLY ~2500 ML / DAY
  • 1600 ML FROM DRINK
  • 700 ML FROM FOOD
  • 200 ML FROM METABOLISM
    • AEROBIC RESPIRATION
    • CONDENSATION REACTIONS
      • A.K.A. DEHYDRATION REACTIONS

9. WATER BALANCE

  • WATER LOSS
  • TYPICALLY ~2500 ML / DAY
  • 1500 ML EXCRETED AS URINE
  • 200 ML ELIMINATED IN FECES
  • 300 ML EXPIRED IN BREATH
  • 100 ML SECRETED AS SWEAT
  • 400 ML LOST AS CUTANEOUS TRANSPIRATION
    • DIFFUSES THROUGH EPIDERMIS, EVAPORATES

10. 11. 12. WATER BALANCE

  • WATER LOSS
  • CAN VARY GREATLY
    • INCREASED RESPIRATORY LOSS IN COLD WEATHER
    • INCREASED SWEAT LOSS IN WARM WEATHER
    • INCREASED RESPIRATORY AND SWEAT LOSS, DECREASED URINE OUTPUT DURING PHYSICAL EXERTION

13. WATER BALANCE

  • WATER LOSS
  • OBLIGATORY WATER LOSS
    • RELATIVELY UNAVOIDABLE
    • EXPIRED AIR, CUTANEOUS TRANSPIRATION, SWEAT, FECAL MOISTURE, MINIMUM URINE OUTPUT (~400 ML/DAY)

14. WATER BALANCE

  • REGULATION OF WATER INTAKE
  • GOVERNED BY THIRST
    • PROVOKED BY INCREASED PLASMA OSMOLARITY
    • PROVOKED BY BLOOD LOSS
  • THIRST CENTER IN HYPOTHALAMUS
    • RESPONDS TO SIGNS OF DEHYDRATION
      • ANGIOTENSIN II
      • ANTIDIURETIC HORMONE (ADH)
      • SIGNALS FROM OSMOCENTERS
    • INHIBITS SALIVATION

15. WATER BALANCE

  • REGULATION OF WATER INTAKE
  • INHIBITED SALIVATION
    • DRY MOUTH
    • SENSE OF THIRST
    • INGESTION OF WATER
      • COOLS AND MOISTENS MOUTH
      • DISTENDS STOMACH AND INTESTINES
      • REHYDRATES BLOOD
    • THIRST INHIBITED

16. 17. WATER BALANCE

  • REGULATION OF WATER OUTPUT
  • CONTROLLED VIA ALTERATIONS IN URINE VOLUME
  • URINE VOLUME AFFECTED BY
    • SODIUM REABSORPTION
      • WATER FOLLOWS SODIUM REABSORPTION
      • MORE LATER
    • ANTIDIURETIC HORMONE (ADH)
      • BLOOD VOLUME , [Na+] , OSMORECEPTORS STIMULATED, PITUITARY RELEASES ADH
      • AQUAPORINS PRODUCED IN KIDNEYS COLLECTING DUCTS
      • FACILITATE REABSORPTION
      • ALSO WORKS IN REVERSE

18. 19. WATER BALANCE

  • WATER BALANCE DISORDERS
  • FLUID DEFICIENCY
    • VOLUME DEPLETION (HYOVOLEMIA)
    • DEHYDRATION
  • FLUID EXCESS
    • VOLUME EXCESS
    • HYPOTONIC HYDRATION
  • FLUID SEQUESTRATION

20. WATER BALANCE

  • WATER BALANCE DISORDERS
  • FLUID DEFICIENCY: HYPOVOLEMIA
  • CAUSED BY PROPORTIONATE LOSS OF WATER AND SODIUM WITHOUT REPLACEMENT
  • TOTAL BODY WATER DECREASED
  • OSMOLARITY UNCHANGED
  • CAUSES
    • HEMORRHAGE
    • SEVERE BURNS
    • CHRONIC VOMITING OR DIARRHEA
      • MAJOR CAUSE OF INFANT MORTALITY

21. WATER BALANCE

  • WATER BALANCE DISORDERS
  • FLUID DEFICIENCY: DEHYDRATION
  • CAUSED BY LOSS OF MORE WATER THAN Na +
  • TOTAL BODY WATER DECREASED
  • ECF OSMOLARITY INCREASES
  • CAUSES
    • LACK OF DRINKING WATER
    • DIABETES MELLITUS
    • ADH HYPOSECRETION
    • PROFUSE SWEATING
    • OVERUSE OF DIURETICS

22. WATER BALANCE

  • WATER BALANCE DISORDERS
  • FLUID DEFICIENCY: DEHYDRATION
  • AFFECTS ALL FLUID COMPARTMENTS
  • INFANTS MORE VULNERABLE THAN ADULTS
    • HIGHER METABOLISMMORE WASTES
      • MORE WASTESMORE URINE VOLUME
    • IMMATURE KIDNEYS
      • URINE LESS CONCENTRATED
    • GREATER SURFACE AREA-TO-VOLUME RATIO
      • GREATER WATER LOSS BY EVAPORATION

23. WATER BALANCE

  • WATER BALANCE DISORDERS
  • EFFECTS OF FLUID DEFICIENCY
  • CIRCULATORY SHOCK
    • DUE TO LOSS OF BLOOD VOLUME
  • NEUROLOGICAL DYSFUNCTION
    • DUE TO DEHYDRATION OF BRAIN CELLS

24. WATER BALANCE

  • WATER BALANCE DISORDERS
  • FLUID EXCESS
  • LESS COMMON THAN FLUID DEFICIENCY
    • KIDNEYS ARE TYPICALLY ABLE TO EXCRETE MORE URINE

25. WATER BALANCE

  • WATER BALANCE DISORDERS
  • FLUID EXCESS: VOLUME EXCESS
  • CAUSED BY PROPORTIONATE RETENTION OF EXCESS WATER AND SODIUM
  • TOTAL BODY WATER INCREASED
  • OSMOLARITY UNCHANGED
  • CAUSES
    • ALDOSTERONE HYPERSECRETION
    • RENAL FAILURE

26. WATER BALANCE

  • WATER BALANCE DISORDERS
  • FLUID EXCESS: HYPOTONIC HYDRATION
  • WATER INTOXICATION, POS H 2 0 BALANCE
  • CAUSED BY RETENTION OF MORE WATER THAN SODIUM
  • TOTAL BODY WATER INCREASED
  • ECF OSMOLARITY DECREASES
  • CAUSES
    • REPLACEMENT OF WATER AND SALT WITH WATER
      • LACK OF PROPORTIONATE INTAKE OF ELECTROLYTES
    • ADH HYERSECRETION

27. WATER BALANCE

  • WATER BALANCE DISORDERS
  • EFFECTS OF FLUID EXCESS
  • PULMONARY EDEMA
  • CEREBRAL EDEMA

28. WATER BALANCE

  • WATER BALANCE DISORDERS
  • FLUI