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MindMap Gallery Pathophysiology—Water and electrolyte metabolism disorders

Pathophysiology—Water and electrolyte metabolism disorders

The focus of the pathophysiology examination is that in pathophysiology, water and electrolyte metabolism disorders are an important concept, which involves the stability of the human internal environment and the normal physiological functions of the body.

Edited at 2024-01-15 16:30:37

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Pathophysiology—Water and electrolyte metabolism disorders

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Outline

Water and sodium metabolism disorders

Normal water and sodium balance

Volume and distribution of body fluids

Total body fluid volume = 60% of body weight

Intracellular fluid = 40% of body weight

Extracellular fluid = 20% of body weight

Extracellular fluid plasma = 5% of body weight

Interstitial fluid = 15% of body weight

electrolyte composition of body fluids

Colloidal osmotic pressure maintains balance inside and outside blood vessels

Crystal osmotic pressure maintains balance inside and outside the cell

Osmotic pressure of body fluids

The osmotic pressure generated by plasma proteins is extremely small, but it is extremely important for maintaining intravascular and intravascular exchange and blood volume.

Plasma osmotic pressure 290~310mmol/L (300mmol/l)

water balance

Intake (2000-2500ml)

Drinking water 1000-1300ml

Food water 700-900ml

Metabolic water 300ml

Discharge (2000-2500ml)

Urine 1000-1500ml

Skin 500ml

Lung 350ml

Feces 150ml

sodium balance

Source - table salt

Absorption—small intestine

Excretion—Kidneys—Eat more and you will excrete more, eat less and you will excrete less, and you will not excrete if you don’t eat.

Serum Na—140mmol/l

Intracellular fluid Na—10mmol/l

adjust

thirst

Increase in extracellular fluid osmotic pressure → thirst center → drinking behavior → decrease extracellular fluid osmotic pressure

Decreased blood volume → thirst center

antidiuretic hormone

Increase in extracellular fluid osmotic pressure → hypothalamic supraoptic nucleus and paraventricular nucleus osmoreceptors → release of ADH (antidiuretic hormone) →

Enhance water reabsorption by renal distal convoluted tubules and collecting ducts

Inhibit aldosterone secretion → reduce Na reabsorption

Decreased blood volume/blood pressure → Left atrium and large thoracic vein volume receptors Carotid sinus and aortic arch baroreceptors → VP (vasopressin) release →

aldosterone

Inhibit aldosterone secretion → reduce Na reabsorption

Atrial natriuretic peptide ANP

Reduce renin secretion

Inhibit aldosterone secretion

Antagonizes the vasoconstrictor effect of angiotensin

Antagonizes the sodium-sparing effect of aldosterone

Aquaporin AQP

Water and sodium metabolism disorders

Classification based on volume and osmotic pressure of body fluids

Capacity is too small

hypertonic dehydration

hypotonic dehydration

isotonic dehydration

Too much capacity

Edema (isotonic)

Water intoxication (hypotonic)

Salt poisoning (hypertonic)

Classification based on blood sodium concentration and body fluid volume

Hyponatremia

hypovolemic hyponatremia

hypervolemic hyponatremia

isovolemic hyponatremia

hypernatremia

hypovolemic hypernatremia

hypervolemic hypernatremia

isovolemic hypernatremia

Normal serum sodium concentration

isotonic dehydration

Edema

dehydration

Hypotonic dehydration/hypovolemic hyponatremia

Features

Lose more sodium than water

Serum Na concentration <135mmol/l

Plasma osmotic pressure <290mmol/l

Decreased extracellular fluid volume

Causes and Mechanisms

Body fluid loss only replenishes water

lost through kidneys

Long-term continuous use of diuretics

Adrenocortical insufficiency

Parenchymal renal disease (the renal medulla cannot maintain a normal concentration gradient and the function of the ascending branch of the medullary loop is impaired)

renal tubular acidosis

Collecting duct H secretion dysfunction→H-Na exchange disorder→Na increases with urine excretion

Extrarenal loss

Fluid loss through the gastrointestinal tract (vomiting, diarrhea) only replenishes water

Fluid accumulation in the third space (pleural effusion, ascites)

Skin loss (profuse sweating) only replenishes water

Effects on the body

hypovolemic shock

Decreased plasma osmotic pressure without feeling thirsty

Early stage—lowering of plasma osmotic pressure→suppression of ADH→low specific gravity urine and no significant reduction in urine output

Late stage - sharp decrease in blood volume → stimulation of ADH → oliguria

Obvious signs of water loss (loss of skin elasticity, sunken eye sockets, and fontanelles in infants and young children)

Transrenal Na loss—urinary Na increases, extrarenal Na loss—activates RAAS and decreases urinary Na

The main pathogenesis link—extracellular fluid hypotonicity

Main site of dehydration—reduced extracellular fluid, prone to hypovolemic shock

Prevention and control

Prevent and treat primary disease

Correct incorrect rehydration methods

Rehydration

Mild to moderate—normal saline

Severe—a small amount of hypertonic saline

Prevent and treat shock

Hypertonic dehydration/hypovolemic hypernatremia

Features

Losing more water than sodium

Serum Na concentration＞150mmol/l

Plasma osmotic pressure＞310mmol/l

Both extracellular and intracellular fluid volumes decrease

Causes and Mechanisms

reduced water intake

Too much water loss

Transrenal water loss (central diabetes insipidus, dehydrating agents, high-protein diet)

Transcutaneous water loss (high fever, heavy sweating, hyperthyroidism)

Water loss through the respiratory tract (hyperventilation)

Gastrointestinal water loss (vomiting, diarrhea)

Effects on the body

Thirsty

Decreased extracellular fluid content (decreased urine output, increased urine specific gravity)

Transfer of intracellular fluid to extracellular fluid

central nervous system dysfunction

Drowsiness, convulsions, coma, death

cerebral hemorrhage

dehydration fever

The main pathogenesis link—extracellular fluid hypertonicity

The main site of dehydration—intracellular fluid

Prevention and control

Mainly supplement sugar, first sugar and then salt

Prevent and treat primary disease

Hydration (intravenous infusion of 5% glucose solution)

Appropriate supplementation

Appropriate supplement of K

isotonic dehydration

Features

Sodium and water are lost in equal proportions

Normal serum sodium concentration

Plasma osmolarity is normal

Isotonic dehydration - no treatment → no evaporation Respiration → hypertonic dehydration

Isotonic dehydration - supplying too much hypotonic solution → hypotonic dehydration

Edema

concept

Accumulation of excess fluid in tissue spaces or body cavities

Classification

According to the affected area

generalized edema

localized edema

According to the cause of disease

Kidney, heart, liver, malnutrition

Organized by diseased organ

Subcutaneous edema, cerebral edema, pulmonary edema

Press the skin to see if there are any depressions

Hidden edema

Overt edema

Pathogenesis

Imbalance of fluid exchange inside and outside blood vessels

Increased capillary hydrostatic pressure

Congestive heart failure - generalized edema

Tumor compression—local edema

arterial congestion-inflammatory edema

Decreased plasma colloid osmotic pressure

Cirrhosis, malnutrition-protein synthesis disorder

Nephrotic syndrome – excessive protein loss

Malignant tumors-increased protein breakdown

Increased microvascular wall permeability

inflammation

exudate

Leakage

Lymphatic drainage is blocked

Tumor blockage

breast cancer

Filariasis

Imbalance in fluid exchange between the body and the outside (sodium and water retention)

Decreased glomerular filtration rate

Extensive glomerular disease

Effective circulating blood volume is significantly reduced

Increased reabsorption of sodium and water by the proximal convoluted tubule

Decreased atrial natriuretic peptide secretion

Increased glomerular filtration fraction

Glomerular filtration fraction = glomerular filtration rate/renal blood flow

Normally approximately 20% of renal plasma flow is filtered by the glomerulus

Congestive heart failure/nephrotic syndrome → Decreased effective circulating blood volume

→The efferent arterioles contract more obviously than the afferent arterioles →The glomerular filtration rate is relatively increased →The protein-free filtrate is relatively increased →The protein content of the blood flowing into the capillaries around the renal tubules is relatively increased, and the plasma colloid osmotic pressure is increased →Na water reabsorption increase

Increased reabsorption of sodium and water by the distal convoluted tubule and collecting duct

Increased aldosterone levels

Increased secretion

Decreased inactivation

Increased secretion of antidiuretic hormone

Increased plasma osmolality

Effective circulating blood volume decreases

Features

skin

pitting edema/overt edema

Excessive fluid accumulation in the subcutaneous tissue may cause depression when pressed with fingers.

Hidden edema

Patients with generalized edema have an increase in tissue fluid before the depression appears, which can reach 10% of the original body weight.

generalized edema

Cardiac edema - sagging areas of the body

Renal edema—eyelids and face

Hepatic edema-ascites

Effect on the body

favorable

Dilute venom and transport antibodies during inflammatory edema

unfavorable

nutritional disorders

Effects on tissue and organ functions