MindMap Gallery PathophysiologyWater and electrolyte metabolism disorders
This is a mind map about the pathophysiology of water and electrolyte metabolism disorders. Water and electrolyte metabolism disorders, also known as water and electrolyte balance disorders, refer to abnormalities in the amount, composition or distribution of water and electrolytes in human body fluids caused by any reason, and then resulting in physiological dysfunction.
Edited at 2024-10-20 23:10:02Rumi: 10 dimensões do despertar espiritual. Quando você para de se procurar, encontrará o universo inteiro porque o que está procurando também está procurando por você. Qualquer coisa que você persevera todos os dias pode abrir uma porta para as profundezas do seu espírito. Em silêncio, deslizei para o reino secreto e gostei de tudo para observar a magia ao meu redor e não fiz barulho. Por que você gosta de rastejar quando nasce com asas? A alma tem seus próprios ouvidos e pode ouvir coisas que a mente não pode entender. Procure para dentro para a resposta a tudo, tudo no universo está em você. Os amantes não acabam se encontrando em algum lugar, e não há despedida neste mundo. Uma ferida é onde a luz entra em seu coração.
A insuficiência cardíaca crônica não é apenas um problema da velocidade da freqüência cardíaca! É causada pela diminuição da contração miocárdica e da função diastólica, o que leva a um débito cardíaco insuficiente, o que, por sua vez, causa congestão na circulação e congestão pulmonar na circulação sistêmica. Das causas, o indução aos mecanismos de compensação, os processos fisiopatológicos de insuficiência cardíaca são complexos e diversos. Ao controlar o edema, reduzir a frente e pós -carga do coração, melhorando a função de conforto cardíaco e prevenindo e tratando as causas básicas, podemos efetivamente responder a esse desafio. Somente entendendo os mecanismos e as manifestações clínicas da insuficiência cardíaca e as estratégias de prevenção e tratamento, podemos proteger melhor a saúde do coração.
A lesão de isquemia-reperfusão é um fenômeno que a função celular e os distúrbios metabólicos e os danos estruturais piorarão depois que órgãos ou tecidos restauram o suprimento sanguíneo. Seus principais mecanismos incluem aumento da geração de radicais livres, sobrecarga de cálcio e o papel dos microvasculares e leucócitos. O coração e o cérebro são órgãos danificados comuns, manifestados como mudanças no metabolismo do miocárdio e mudanças ultraestruturais, diminuição da função cardíaca etc. As medidas de prevenção e controle incluem remover os radicais livres, reduzir a sobrecarga de cálcio, melhorar o metabolismo e controlar as condições de reperfusão, como baixo sódio, baixa temperatura, baixa pressão, etc. A compreensão desses mecanismos pode ajudar a desenvolver opções eficazes de tratamento e aliviar lesões isquêmicas.
Rumi: 10 dimensões do despertar espiritual. Quando você para de se procurar, encontrará o universo inteiro porque o que está procurando também está procurando por você. Qualquer coisa que você persevera todos os dias pode abrir uma porta para as profundezas do seu espírito. Em silêncio, deslizei para o reino secreto e gostei de tudo para observar a magia ao meu redor e não fiz barulho. Por que você gosta de rastejar quando nasce com asas? A alma tem seus próprios ouvidos e pode ouvir coisas que a mente não pode entender. Procure para dentro para a resposta a tudo, tudo no universo está em você. Os amantes não acabam se encontrando em algum lugar, e não há despedida neste mundo. Uma ferida é onde a luz entra em seu coração.
A insuficiência cardíaca crônica não é apenas um problema da velocidade da freqüência cardíaca! É causada pela diminuição da contração miocárdica e da função diastólica, o que leva a um débito cardíaco insuficiente, o que, por sua vez, causa congestão na circulação e congestão pulmonar na circulação sistêmica. Das causas, o indução aos mecanismos de compensação, os processos fisiopatológicos de insuficiência cardíaca são complexos e diversos. Ao controlar o edema, reduzir a frente e pós -carga do coração, melhorando a função de conforto cardíaco e prevenindo e tratando as causas básicas, podemos efetivamente responder a esse desafio. Somente entendendo os mecanismos e as manifestações clínicas da insuficiência cardíaca e as estratégias de prevenção e tratamento, podemos proteger melhor a saúde do coração.
A lesão de isquemia-reperfusão é um fenômeno que a função celular e os distúrbios metabólicos e os danos estruturais piorarão depois que órgãos ou tecidos restauram o suprimento sanguíneo. Seus principais mecanismos incluem aumento da geração de radicais livres, sobrecarga de cálcio e o papel dos microvasculares e leucócitos. O coração e o cérebro são órgãos danificados comuns, manifestados como mudanças no metabolismo do miocárdio e mudanças ultraestruturais, diminuição da função cardíaca etc. As medidas de prevenção e controle incluem remover os radicais livres, reduzir a sobrecarga de cálcio, melhorar o metabolismo e controlar as condições de reperfusão, como baixo sódio, baixa temperatura, baixa pressão, etc. A compreensão desses mecanismos pode ajudar a desenvolver opções eficazes de tratamento e aliviar lesões isquêmicas.
Water and electrolyte metabolism disorders
normal water and sodium balance
Volume and distribution of body fluids
intracellular fluid
extracellular fluid
tissue fluid
plasma
electrolyte composition of body fluids
Na⁺, K⁺, Ca²⁺, Mg²⁺, Cl⁻, HCO₃⁻, HOP₄²⁻, SO₄²⁻, organic acids, proteins
normal value
Blood Na⁺: 135~150mmol/l
Blood K⁺: 3.5~5.3mmol/l
Blood Cl⁻: 98~106mmol/l
Blood HCO₃⁻: 22~27mmo;/l
Osmotic pressure of body fluids and water exchange
Plasma osmotic pressure: 280~310mmol/l
water exchange
Movement of water inside and outside cells
Movement of water inside and outside blood vessels
Movement of water inside and outside the body
Physiological water requirement: 1500ml
Physiological functions of water
Promote substance metabolism
regulate body temperature
lubrication
Exists in the form of bound water and exerts its complex physiological functions
Physiological functions of electrolytes and sodium balance
Physiological functions of electrolytes
Maintain osmotic pressure and acid-base balance of body fluids
Involved in the formation of action potentials from the cell's resting potential
Participate in metabolic and physiological functional activities
sodium balance
60% exchangeable sodium (50% in extracellular fluid, 10% in intracellular fluid)
40% non-exchangeable sodium
Regulation of water and sodium balance
Osmotic stimulation
Osmoreceptors
non-osmotic stimulus
blood volume→volume receptor
blood pressure → baroreceptor
thirst
Extracellular fluid osmotic pressure
blood volume
antidiuretic hormone (ADH)
aldosterone
Retain sodium, retain water and expel potassium
Atrial natriuretic peptide (ANP)
Powerful natriuretic effect
Antagonizes the action of the renin-aldosterone system
ANP significantly reduces the increase in plasma ADH levels during water or blood loss
Water and sodium metabolism disorders
Hyponatremia: Serum Na⁺ concentration <135mmo/l
Hypernatremia: Serum Na⁺ concentration >150mmol/l
Normonatremic water disorders (isotonic dehydration, edema)
dehydration
Refers to a pathological process in which extracellular fluid is reduced due to excessive body fluid loss or insufficient water intake, accompanied by functional and metabolic changes.
hypertonic dehydration
Hypertonic dehydration = hypovolemic hypernatremia (hyperosmolar, high sodium)
Features
Water loss > Sodium loss
Serum Na⁺ concentration>150mmol/l
Plasma osmotic pressure>310mmol/l
reason
Insufficient input
water source cut off
Loss of thirst
difficulty eating
Lost too much
sweating profusely
Respiratory evaporation
Diabetes insipidus and osmotic diuresis
Intestinal fluid loss (diarrhea in some infants and young children)
Influence
The extracellular fluid is hypertonic and the intracellular fluid is reduced in the main dehydrated parts.
Pulse speed, blood pressure↓
Aldosterone secretion does not increase in the early stage but increases in the late stage
Little urine, high specific gravity
hallucinations, restlessness
Thirsty
dehydration fever
Pathophysiological basis of prevention and treatment
Replenish water in time
Proper sodium supplementation
isotonic dehydration
Equipment dehydration = low -capacity such as other sodium disease
Features
Sodium loss = water loss
Serum Na⁺ concentration 135~150mmol/l
Plasma osmotic pressure 280~310mmol/l
reason
Loss of isotonic fluid
Skin loss: extensive burns
Gastrointestinal loss: paralytic obstruction; massive vomiting, diarrhea or gastrointestinal aspiration; loss of digestive juices caused by congenital digestive abnormalities in newborns
Influence
Extracellular fluid osmotic pressure is normal and serum sodium is normal
Reduction of extracellular fluid → blood volume ↓, tissue fluid volume ↓
Intracellular fluid changes are not obvious
Blood volume↓→Aldosterone, ADH secretion↑→Urine volume↓
Pathophysiological basis of prevention and treatment
The amount of water replenishment and the amount of Na⁺ replenishment
Easy to change to the other two types of dehydration
No treatment → hypertonic dehydration
Treatment→Hypotonic dehydration
hypotonic dehydration
Hypotonic dehydration = hypovolemic hyponatremia (hypotonic, low sodium)
Features
Sodium loss>water loss
Serum Na⁺ concentration <135mmol/l
Plasma osmotic pressure <280mmol/l
reason
lost through kidneys
Extrarenal loss
Iatrogenic causes (the above two): improper treatment of hypertonic dehydration or isotonic dehydration
Influence
Decreased extracellular fluid → significant decrease in blood volume → hypovolemic shock, circulatory failure
No thirst
Normal urine output (early stage)
Apathy and lethargy
Pulse speed, blood pressure ↓. arterial atrophy
Oligouria, azotemia, urinary Na⁺↓
dehydration
Pathophysiological basis of prevention and treatment
Light or moderate normal saline supplementation (body drainage volume > Na⁺ discharge volume)
Severely add a small amount of hypertonic saline (reduce cell edema)
Too much water
water intoxication
Water intoxication = hypervolemic hyponatremia
The pathological process of hypotonic fluid retention in the body
Features
Water retention in the body significantly increases the amount of body fluids
Serum Na⁺ concentration <135mmol/l
Plasma osmotic pressure <280mmol/l
reason
Decreased water excretion: acute and chronic renal dysfunction
Too much water
Effect on the body
The amount of fluid inside and outside the body increases, and the osmotic pressure decreases
The main site of water retention is within cells
The most harmful thing to the body is cerebral edema
Blood Na⁺↓, blood dilution
Drowsiness, restlessness, brain herniation
Pathophysiological basis of prevention and treatment
prevention
Water restrictions
Excretion: Diuretic
Transfer: small dose of hypertonic saline (reduces cell edema)
Edema
Accumulation of excess fluid in tissue spaces or body cavities When excess fluid accumulates in a body cavity, it is called hydrops or effusion
Classification
scope
local edema
generalized edema
Organs and tissues
subcutaneous edema
Laryngeal edema
papilledema
Pulmonary edema
cerebral edema
Cause of disease
character
renal
Hepatic
inflammatory
allergic
dystrophic
The presence of edema fluid
Overt edema (also called pitting edema)
Hidden edema
mechanism
Two balance → imbalance
Imbalance of fluid exchange inside and outside blood vessels (interstitial fluid production is greater than reflux)
Basic factors affecting tissue fluid production and reflux
Effective hydrostatic pressure = intracapillary pressure – tissue hydrostatic pressure
Effective colloid osmotic pressure = plasma colloid osmotic pressure – tissue colloid osmotic pressure
Average effective filtration pressure = effective hydrostatic pressure - effective colloid osmotic pressure
lymphatic drainage
Interstitial fluid generation>reflux
Capillary hydrostatic pressure↑
Congestive heart failure, venous compression, venous thrombosis → intracapillary pressure ↑ → effective filtration pressure ↑ → interstitial fluid production ↑
Plasma colloid osmotic pressure↓
Protein synthesis disorder, excessive protein loss, enhanced protein catabolism →Plasma colloid osmotic pressure↓→Effective colloid osmotic pressure↓→Average effective filtration pressure↓→Tissue fluid production↑
Microvascular wall permeability↑
Various inflammations → release inflammatory mediators, damage microvessel walls → increase permeability of microvessel walls → protein filtration → plasma colloid osmotic pressure ↓ tissue colloid osmotic pressure ↑ → effective colloid osmotic pressure ↓ → average effective filtration pressure ↑ → tissue fluid production ↑
Exudate: low protein content, low specific gravity, low cell number
Leakage: high protein content and high specific gravity. Too many white blood cells
lymphatic drainage disorder
Malignant tumor invasion, filariasis → protein-containing edema fluid accumulates in tissue spaces
Imbalance in fluid exchange between the body and the outside (sodium and water retention)
Tube imbalance
mechanism
ANP secretion↓: effective circulating blood volume is obvious↓→atrial stretch receptors are excited→ANP secretion↓→proximal tubule reabsorption↑
glomerular filtration fraction↑
Decreased glomerular filtration rate
Filtration area↓
Effective circulating blood volume↓
Increased tubular collecting duct reabsorption
Proximal tubule reabsorption↑
Distal tubule and collecting duct reabsorption↑ (aldosterone, ADH↑)
Features
The size of the organ increases, the weight increases, and the capsule is pulled and shiny
Interstitial fibers in the edema are separated and sparse
weight changes
skin characteristics
Overt edema
Hidden edema
Distribution characteristics of systemic edema
cardiac edema
Left heart failure → cardiogenic pulmonary edema
Right heart failure→cardiac edema
Characteristics: It occurs first in the sagging area due to the effect of gravity.
hepatic edema
Characteristics: Mainly ascites
renal edema
Features: It first appears on the eyelids and face with loose tissue structure and large stretch.
Effect on the body
cell dystrophy
organ tissue dysfunction
Potassium metabolism disorders
normal potassium metabolism
Characteristics of kidney excretion of potassium: Eat more and excrete more, eat less and excrete less, even if you don’t eat, you will excrete it.
Regulation of potassium balance
transcellular transfer
renal regulation
Colon excretion of potassium
Regulation of potassium by the distal tubule and collecting duct
Factors affecting potassium secretion from chief cells
Na⁺-K⁺ pump activity of basement membrane
Permeability of luminal membrane to K⁺
Electrochemical gradient of potassium from blood to canalicular lumen
Factors affecting potassium excretion by the distal convoluted tubule and collecting duct
aldosterone
Extracellular fluid potassium concentration
Yuanye urinary flow rate
acid-base balance state
Potassium physiological function
Participate in cell metabolism
Maintain cell membrane resting potential
Regulate osmotic pressure and acid-base balance
potassium metabolism disorder
Normal value: Blood K⁺: 3.5~5.3mmol/l
hypokalemia
Blood K⁺<3.5mmol/l
Lack of intracellular potassium, Lack of potassium in the body
Causes and Mechanisms
Insufficient intake: Reduced sources of potassium and excretion without eating → hypokalemia
Excessive potassium loss: kidney potassium loss, digestive juice loss, large amount of sweat loss
Transfer of potassium into cells
Effects on the body
Disorders associated with abnormal membrane potential
Effects on neuromuscular excitability
Neuromuscular excitability↓
Blood K⁺↓→Difference between intracellular and intracellular [K⁺]↑→Resting potential↑ (negative value↑)→Difference between resting potential and threshold potential↑→Excitability↓
Hyperpolarization block: a phenomenon in which neuromuscular excitability is reduced due to an increase in the distance between the resting potential and the threshold potential.
clinical manifestations
CNS: malaise, fatigue, lethargy
Skeletal muscles: limb weakness, paralysis, respiratory muscle paralysis
Gastrointestinal smooth muscle: loss of appetite, bloating, paralytic ileus
effects on heart
Excitability ↑, self-discipline ↑, contractility ↑, conductivity ↓ (contractility first ↑ and then ↓, in severe cases ↓)
changes in electrocardiogram
U wave: significantly increased
ST segment: depressed, shortened
T wave: significantly increased
QRS wave: widened, small amplitude
Harmful to the heart
Arrhythmia
Increased sensitivity to digitalis
Damage associated with cellular metabolic disorders
Skeletal muscle damage
Potassium deficiency → ischemic-hypoxic muscle spasm, necrosis, rhabdomyolysis
Effects on kidney function
Reduced responsiveness of collecting ducts to ADH → polyuria
Effect on acid-base balance
Hypokalemia ↔ Alkalosis Paradoxical aciduria
Pathophysiological basis of prevention and treatment
Treat primary disease
Principles of potassium supplementation
See urine for potassium supplementation. Quiet tweeting is prohibited
Best taken orally
Not too early (intravenous infusion only when urine output is above 500ml/d)
It should not be too concentrated (<40mmol/l)
It should not be too fast (10~20mmol/l)
Not too much (<120mmol/D)
hyperkalemia
Blood K⁺>5.3mmol/l
Causes and Mechanisms
Decreased potassium excretion: renal failure, aldosterone↓, potassium diuretics
Escape of K⁺ from cells: cell damage, acidosis, hyperglycemia and insulin deficiency
Too much potassium
Effects on the body
Disorders associated with abnormal membrane potential
Effects on neuromuscular excitability
Neuromuscular excitability sequence: paresthesias, tingling, muscle tremors
[K⁺] difference between inside and outside the cell↓→resting potential↓→
Distance from threshold potential↓→Excitability↑ (mild) Serum potassium concentration 5.4~6.0mmol/l
Resting potential ≥ threshold potential → excitability ↓ (severe) serum potassium concentration > 6.0mmol/l
Depolarization (depolarization) block: a phenomenon in which excitability is reduced when the resting potential is equal to or lower than the threshold potential
effects on heart
Excitability ↑, conductivity ↓, self-discipline ↓, contractility ↓ (excitability first ↑ and then ↓, in severe cases ↓)
changes in electrocardiogram
T wave high and sharp
P wave decreases and widens
Prolonged P-R interval
QRS widening
R wave decrease
Harmful to the heart
conduction block
Self-discipline↓
Excited reentry → arrhythmia, severe death
Damage related to cellular metabolism
Effect on acid-base balance
Hyperkalemia ↔ Acidosis Paradoxical alkaline urine
Pathophysiological basis of prevention and treatment
Reduce total potassium levels in the body
Promotes potassium movement into cells
Counters potassium toxicity
Correct other electrolyte imbalances