Water-electrolyte (im) Kiril Terziski, MD, PhD Pathophysiology Dept. Medical University of Plovdiv
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1 Water-electrolyte (im) Kiril Terziski, MD, PhD Pathophysiology Dept. Medical University of Plovdiv
2 Crawling out of... water Evolution Belief is optional. Participation is not!
3 Water is life Medium for metabolism Solvent for secretions Absorption Transport Thermoregulation...
4 Getting solid with age
5 Water distribution
6 Water flows Osmotic pressure Oncotic pressure Donnan s Law...the behavior of charged particles near asemi-permeable membrane that sometimes fail to distribute evenly across the twosides ofthe membrane
7 Na mmol.l -1 K mmol.l -1 Cl mmol.l -1 Ca mmol.l -1 Ion drive
8 Give what you get Thirst (water intake) Urine production (water loss)
9 The role of the kidneys Filtration ADH action site Juxtamedullary and cortical nephrones Countercurrent multiplier
10 RAAS, ADH and thirst Atrial Natriuretic Peptide Brain Natriuretic Peptide Prostaglandines (renal)
11 The regulation in action
12 Disturbances in water-electrolyte balance - classification Dehydration Isotonic (Isoosmolal) Hypotonic (Hypoosmolal) Hypertonic (Hyperosmolal) Hyperhydration Isotonic (Isoosmolal) Hypotonic (Hypoosmolal) Hypertonic (Hyperosmolal)
13 Dehydration Diabetes insipidus Diabetes mellitus Extreme sweating Addison s disease Brain tumors No thirst!
14 Hyperhydration Salt-water drinking Extreme thirst! Water intoxication
15 Signs of dehydration Tachycardia Arterial hypotension No micturition Hypovolemic shock
16 Vulnerable populations Body surface area/ Body mass Net ammount of water (Im)maturity of homeostasis Concentration ability of kidneys Dependence on caregivers Inability to speak Frequent pathology Net ammount of water Imperfect homeostasis Concentration ability of kidneys Dependence on caregivers Dementia Frequent pathology
17 Vulnerable populations...turning again towards childish treble, pipes And whistles in his sound. Last scene of all, That ends this strange eventful history, Is second childishness and mere oblivion, Sans teeth, sans eyes, sans taste, sans everything. The Seven Ages of Man by W. Shakespeare Net ammount of water Imperfect homeostasis Concentration ability of kidneys Dependence on caregivers Dementia Frequent pathology
18 Oedemas
19 Common mechanisms Factors, influencing water exchange in the tissues: Hydrodynamic pressure (HP) Oncoticpressure (OP) Capillary permeability Lymph drainage HP-OP=Filtration pressure (force) OP-HP=Absorption (force)
20 Simplified example #HP Filtration pressure alongside the capillary +10 AUC1 AUC2-8 AUC2<AUC1 Positive water balance in the interstitium Lymph drainage
21 Simplified example $OP Filtration pressure alongside the capillary +10 AUC1 AUC2-8 AUC2<AUC1 Positive water balance in the interstitium Lymph drainage
22 Simplified example #Permeability Filtration pressure alongside the capillary +10 AUC1 AUC2-8 AUC2<AUC1 Positive water balance in the interstitium Lymph drainage
23 Simplified example $Lymph drainage Filtration pressure alongside the capillary +10 AUC1 AUC2-8 AUC2<AUC1 Positive water balance in the interstitium Lymph drainage
24 Different diseases, different mechanisms #HP Chronic heart failure Varices Inflammation* $OP Nephroticsyndrome Hypoproteinemia Inflammation* #Permeability Allergy Inflammation* $Lymph drainage Parasites Surgery
25 A little bit of Greek Anasarca-extreme generalized oedema Ascites-accumulation of fluid in the peritoneal cavity Hydrothorax -effusion in the pleural cavity Hydropericardium-effusion in the pericardial cavity Hydrocephalus -abnormal accumulation of fluid in the cerebral ventricles Hydrocele-effusion in the scrotal pouch Synovial hydrops-abnormal accumulation of fluid in the joints
26 Pulmonary oedema Exogenous (toxins, hyperoxia) Endogenous Cardiogenic(LV-CHF) Non-cardiogenic(Shock)
27 Pulmonary oedema Pleural space (negative P) μ-comunications Alveoli Interstitial space Capillaries Wash-out of surfactant Prooedematous factors (#HP) # Retraction force # H2O suction 3 Alveolar membrane 2 Capillary membrane 1 Alveolar oedema Interstitial oedema Pulmonary congestion
28 Pulmonary oedema from Pathophysiology to symptoms 3 Alveolar oedema 2 Interstitial oedema 1 Pulmonary congestion Severe dyspnea Boiling pot Frothy sputum Emergency condition Dyspnea Dry sonoric ronhi Wheezing J-reflex Tachypnea Hyperventilation Mild dyspnea Anti-oedematous mechanisms: Arteriolospasm μ-communications Hypocapnia Low pressure system CO2 washout
29 Brain oedema Peculiarities Intracellularoedema Confined in the skull Etiology Head trauma Hyponatremia High altitude Brain tumors Hydrocephalus Symptoms Headaches Confusion Unconsciousness/Coma
30 Size does matter! Brain herniation in foramen magnum causes compression of the vital centers intheforelyingbrainstem
31
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