metabolism of water and its clinical significance
TRANSCRIPT
![Page 1: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/1.jpg)
Metabolism of water andits clinical significance
Dr. Rohini C Sane
![Page 2: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/2.jpg)
Water and electrolyte Balance• The organism possesses tremendous capacity to survive against odds
and maintain homeostasis .
• This is particularly true with regard to water ,electrolyte and acid- base status of the human body.
• Kidney actively participates in regulation of water ,electrolyte and acid-base Balance in human body.
![Page 3: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/3.jpg)
Water and electrolyte Balance
Water
Electrolyte Balance
Acid base
Functions of kidney
![Page 4: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/4.jpg)
Importance of Water
![Page 5: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/5.jpg)
Functions of water
1. Powerful solvent for ionic compounds & neutral molecules in organisms( aqueous medium for biochemical reactions )
2. Strong influence on state of dissociation of macro molecules
3. Influence on structural & functional components of cells ( the major body constituent)
4. Regulation of body temperature (high heat of vaporization helps in body cooling)
5. Vehicle for transport of solutes
![Page 6: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/6.jpg)
Weight contribution by water in a human body (age wise)
![Page 7: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/7.jpg)
Weight contribution by water in the human tissue
![Page 8: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/8.jpg)
![Page 9: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/9.jpg)
Daily Water transfer in human body
![Page 10: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/10.jpg)
Splanchnic and central compartments related with water
![Page 11: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/11.jpg)
Distribution of water in a human body (70kg)
CATEGORY WATER CONTENT -WEIGHT CONTRIBUTION (% )
HUMAN 60
MEN 55-70
WOMEN 45-60
COMPARTENT BODY WEIGHT (% ) VOLUME OF H₂O ( LITRES )
Total 60 42
Intracellular fluid ( ICF ) 40 28
Extracellular fluid ( ECF )* 20* 14*
Interstitial fluid * 15* 10.5*
Plasma* 5* 3.5*
Women & obese have less water .( Higher content of stored fat in an anhydrous form)
![Page 12: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/12.jpg)
Distribution of water in a human body
![Page 13: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/13.jpg)
Distribution of water in a human body (70kg)The body water compartments
Total body water (42L )-60% of body weight
Extracellular fluid ( ECF )-(14L )20% of body weight
Intravascular volume of plasma
2.8L)-4% of body weight
Extravascular or interstitial fluid
11.2L)-16% of body weight
Intracellular fluid ( ICF -28L)-40% of body weight
One third of ECF
two third of ECF
![Page 14: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/14.jpg)
Distribution of Water in the Body
Extra cellular fluid (ECF )
• Plasma ( one third of ECF)
• Lymph (1.5 L )
• Bone
• Cartilage
• Trans- vascular fluid
• Interstial fluid & lymph
Intra cellular fluid (ICF )
• Single compartment –constant composition-two third of total body water
Mixing & exchange of nutrients & metabolites waste between plasma & lymph or Interstial fluid
No exchange between plasma & different structures- bone ,cartilage , connective tissue ( a vascularity )
![Page 15: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/15.jpg)
Distribution of water in the Body
❖Distribution of water between different compartments depends on the concentration gradient of solutes on the either side of the membrane ( osmotic gradient ).
![Page 16: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/16.jpg)
Distribution of Body fluid
![Page 17: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/17.jpg)
![Page 18: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/18.jpg)
Distribution of water in the Body
![Page 19: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/19.jpg)
![Page 20: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/20.jpg)
Comparison of ECF and ICF
![Page 21: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/21.jpg)
Trans vascular fluids (1.5L )
1. CSF
2.Synovial fluid
3.Peritoneal fluids
4. Alimentary secretions(Lumen of Gastro intestinal tract)
5.Pleural fluid
6. Aqueous humor
![Page 22: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/22.jpg)
1. CSF
![Page 23: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/23.jpg)
2.Synovial fluid
![Page 24: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/24.jpg)
Peritoneal fluids -3
![Page 25: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/25.jpg)
Alimentary secretions(Lumen of Gastro intestinal tract) :4
![Page 26: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/26.jpg)
Pleural fluid-5
![Page 27: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/27.jpg)
Aqueous humor -6
![Page 28: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/28.jpg)
Daily intake of Water by the human body in balanced status Sources of water to the human body in balanced status:
1. Exogenous water sources
2. Endogenous water sources
![Page 29: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/29.jpg)
Daily intake of Water by the human body in balanced status
Exogenous Sources of water to the human body in balanced status:
1. Ingested water
2. Water content of solid food
3. Beverages
❖Daily intake of Water by the human body 0.5 – 5 L ( depends on social habits and climates)
Ingestion of water is controlled by a thirst center located in hypothalamus.
![Page 30: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/30.jpg)
Endogenous water sourcesEndogenous water sources = metabolic water produced within
human body by oxidation of food stuff ( 300- 350 ml / day )
Foodstuff (1 gm ) yield of Endogenous water
on oxidation
Carbohydrate 0.6 ml
Protein 0.4 ml
Lipid 1.1 ml
125 ml of Endogenous water is generated for 1000 Cal consumed by the human body.
![Page 31: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/31.jpg)
Metabolic water( endogenous water)
❖Metabolic water due to oxidation of food stuff (1gm )
Carbohydrate
0.6 ml
Protein
0.4ml
Lipid
1.0 ml
![Page 32: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/32.jpg)
Regulation of water content in the human body
Regulation of water content in the human body is achieved by balancing the daily water intake and water output.
• The thirst center located in the third ventricle in hypothalamus , which is stimulated by ECF hyperosmaolality and hypovolemia and inhibited by hypoosmolality and hypervolemia.
• Vasopressin or Antidiuretic hormone (ADH),the anterior pituitary hormone that enhances water reabsorption in response to an increase in ECF osmality or hypovolemia.
• Vasopressin secretion is regulated by hypothalamus which responds to impulses from stretch receptors in left atrium baroreceptors in the aortic arch and carotid sinus .
![Page 33: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/33.jpg)
Thirst center located in the third ventricle in hypothalamus
![Page 34: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/34.jpg)
Control of intake of Water by the human body in balanced status
Increased in osmality of plasma
Stimulation of thirst center of hypothalamus
Increased water intake
![Page 35: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/35.jpg)
Water output from the human body
❖Routes of elimination of water from the human body
1. urine ( major route)
2. Skin
3. Lungs
4. Feces
![Page 36: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/36.jpg)
Water output from the human body
![Page 37: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/37.jpg)
Water output through : 1.Urine❖Urine is a major route of elimination of water from the human
body.
❖Daily output of urine by the human body in balanced status = 1 - 2 L/day
❖Kidney regulates retention and elimination of water from the human body.
❖Water loss by Kidney is highly variable(to get rid of / to retain water).
❖Volume of water as a medium essential to eliminate waste products from the human body = 500 ml / day
❖The human body cannot stop the production of Urine even if water intake is nil.
![Page 38: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/38.jpg)
Hormonal regulation of excretion of Urine
![Page 39: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/39.jpg)
Hormonal regulation of urine production and excretion
Everyday
• 180 L of water filtered by glomeruli into renal tubules
• 178 L of water absorbed by renal tubular cells
• 1-2 L of water excreted as urine (tightly controlled by ADH )
![Page 40: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/40.jpg)
Hormonal regulation of excretion of Urine
❖Volume of water filtered by glomeruli into renal tubules of Kidney= 180 L/day ( most of this is reabsorbed and 1-2 L /day is excreted as urine )
❖Vasopressin = Antidiuretic Hormone (ADH ) from posterior pituitarygland regulates excretion of water by Kidney.
![Page 41: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/41.jpg)
Hormonal regulation of excretion of Urine
❖Vasopressin = Antidiuretic Hormone (ADH ) from posterior pituitarygland regulates excretion of water by Kidney.
Increased in osmality of plasma
Increased in secretion of Antidiuretic Hormone (ADH ) from posterior pituitary gland
Increased water reabsorption by the renal tubules
Less urine output till homeostasis is achieved
![Page 42: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/42.jpg)
Hormonal regulation of excretion of Urine
❖Vasopressin = Antidiuretic Hormone (ADH ) from posterior pituitarygland regulates excretion of water by Kidney.
Decreased in osmality of plasma
Suppression in secretion of Antidiuretic Hormone(ADH ) from posterior pituitary gland
Reduced water reabsorption by the renal tubules
more urine output till homeostasis is achieved
![Page 43: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/43.jpg)
Hormonal regulation of excretion of Urine ❖Diabetes insipidus : deficiency of ADH increased loss of
water from body.
❖Plasma osmality is dependent on the sodium concentration hence sodium indirectly controls the amount of water in the human body.
![Page 44: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/44.jpg)
![Page 45: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/45.jpg)
Water output through :2. skin❖Skin : loss of water (450 ml /day )through perspiration an
unregulated process by the body depends upon atmospheric temperature & humidity
➢↑ atmospheric Temperature ↑ water loss through skin (loss is more in hot climate)
➢For every ↑ body Temperature by 1⁰ C(fever) 15% ↑ water loss through skin
![Page 46: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/46.jpg)
Water output through :3. Lungs❖Water output from Lungs :
Loss of water during Respiration by Lungs about 400 ml /day in expired air
✓ Hot climate
✓ Fever water loss through lungs ↑
➢loss of water via skin through perspiration
➢Loss of water via lung through respiration insensible water loss
![Page 47: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/47.jpg)
Water output through :4 feces ❖Water output through feces : Water entering in GIT most of it
reabsorbed in intestine 150/ml /day loss through feces in healthy individual
Diarrhea increased fecal loss of water
![Page 48: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/48.jpg)
Water balance in the body ( daily intake & output):1
Body H₂O
(4200 ml )
1.Drinking H₂O &
Beverage (1500ml )
2. Food stuff (700ml )
3. Metabolic water (300ml )
Water intake 2500ml
Water output 2500 ml
Intake of water is controlled by thirst Centre (part of Hypothalamus )
Water balance of human body is regulatedpredominantly by controlling water output
(initially by Obligatory loss via skin , lungs and feces followed by urinary output).
![Page 49: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/49.jpg)
Water balance in the body (daily intake & output):2
Body H₂O
(4200 ml )
Kidney Urine
( 1500ml)
/day
Skin
(450 ml )
Insensible & sensible
perspiration
Lungs
( 400ml )
Water vapor in expired
air
Intestine
Feces
( 150ml )
Starvation : obligatory water loss 500 ml/day
![Page 50: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/50.jpg)
Body H₂O
(4200 ml )
2. Food stuff
(700ml )3.
Metabolic water
(300ml )
1.Drinking H₂O &
Beverage (1500ml )
Urine ( 1500ml)
Skin(450 ml )
Feces ( 150ml )
Lungs ( 400ml )
Water balance in the body : daily intake & output :3
Water intake 2500ml
Water output 2500 ml
![Page 51: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/51.jpg)
Abnormalities associated with Water balance
Abnormalities associated with Water balance :
1. Dehydration
2. Overhydration
![Page 52: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/52.jpg)
Disorders of water &Electrolyte balance
❖Water & Electrolyte imbalance lead to
➢Dehydration
➢Over hydration
Causes of Water & Electrolyte imbalance:
1. Imbalance of Water intake & output
2. Imbalance of Sodium intake & output
![Page 53: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/53.jpg)
• Dehydration is the disturbance of water balance in which the output exceeds the intake causing a reduction of body water below the normal level or excessive water loss or both. ( water depletion in the body )
• Dehydration may be as a result of
1.Pure water depletion
( without corresponding loss of electrolytes )
2. Mixed type in which both Water and salt depletion occur
![Page 54: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/54.jpg)
Causes of dehydration
Dehydration may occur as a result of
1. Diarrhea
2. Vomiting
3. Excessive sweating
4. Fluid loss in burns
5. Adreno-corticoid dysfunction
6. Kidney diseases ( e.g. renal insufficiency )
7. Deficiency of ADH ( Diabetes Insipidus )
![Page 55: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/55.jpg)
Pure water depletion( without corresponding loss of electrolytes )
A –Decreased water intake of as in
• Elderly debilitated persons
• Unconscious patients
• Severe dysphagia
• Postoperative patients ,when oral intake has been stopped
B- increased water loss due to
• Sweating ,during fever
• Hyperventilation
• Infantile gastroenteritis
• Diabetes insipidus due to ADH deficiency
• Diabetes Mellitus due to osmotic diuresis
• Nephritis
• Acute renal failure
1.Pure water depletion ( without corresponding loss of electrolytes )occurs under following conditions
![Page 56: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/56.jpg)
Biochemical findings in dehydration❖Biochemical findings in dehydration include
1. Volume of the ECF ( e.g. plasma )decreases with concomitant rise in electrolyte concentration ( increased ECF osmolality) and osmotic pressure
2. Water is drawn from intracellular fluid shrunken cells and disturbed metabolism( e.g. increased protein breakdown )
3. Increased ADH secretion increased water retention decreased urinary output (decreased urine volume )
4. Decreased urine sodium
5. Increased concentration of plasma sodium ,protein ( Normal or slight increased ) and blood urea ( mild)
6. Water depletion often accompanied by loss of electrolytes from body (Na⁺ ,K⁺ etc.)
![Page 57: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/57.jpg)
![Page 58: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/58.jpg)
![Page 59: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/59.jpg)
Dehydration of muscles and nerveCells leading to weakness and confusion .
- Oliguria
( and tongue )thirst
Hemoconcentration
![Page 60: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/60.jpg)
Consequences of dehydration
❖Consequences of dehydration include :
• increased in plasma sodium and osmality
• Deceased renal flow which stimulates Aldosterone secretion with increased reabsorption of sodium that aggravates hypernatremia
• Increased in ECF osmolality ,resulting in diffusion of water from the cells to the ECF
![Page 61: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/61.jpg)
Dehydration( vicious cycle )
Sodium depletion
Anorexia
VomitingLoss of NaCl in vomitus
Salt depletion
![Page 62: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/62.jpg)
![Page 63: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/63.jpg)
Homeostatic mechanisms in dehydration ❖Homeostatic mechanisms in dehydration that compensate
dehydration include:
• Stimulation of thirst center with increased intake of water
• ADH secretion with increased water reabsorption ( except Diabetes insipidus )
![Page 64: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/64.jpg)
Management of Dehydration
• Treatment of choice of dehydration : Intake of plenty of water
• Intravenous administration of isotonic solution (usually 5% glucose ) to patient who cannot take orally (and should be monitored carefully )
• if dehydration is accompanied by loss of electrolytes : oral/intravenous administration of isotonic solution (usually 5% glucose ) until urine volume exceeds 1500ml
![Page 65: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/65.jpg)
Management of Dehydration
![Page 66: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/66.jpg)
Management of Dehydration in children
![Page 67: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/67.jpg)
Management of Dehydration in children
![Page 68: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/68.jpg)
Osmotic imbalance and dehydration in Cholera
• Cholera is transmitted through water and food contaminated by the bacterium Vibrio Cholerae.
• Vibrio Cholerae produces a toxin which stimulate intestinal cells to secrete various ions ( Cl - , Na+ ,K +,HCO3 - ) into intestinal lumen.
![Page 69: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/69.jpg)
Vibrio Cholera
![Page 70: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/70.jpg)
Osmotic imbalance and dehydration in Cholera Vibrio Cholerae produces a toxin which stimulate intestinal cells to secrete various ions
( Cl-
, Na+,K+,HCO3-) into intestinal lumen
These ions collectively raise the osmotic pressure and suck water into lumen
Diarrhea (heavy loss of water 5-10 L /day )
Loss of dissolved salts and severe dehydration
Death if not treated with oral rehydration therapy (ORT)
![Page 71: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/71.jpg)
Overhydration ( water intoxication )
Definition of Overhydration : state of pure water excess or water intoxication• Retention of large quantity of water deleterious effects • excretion large volume of dilute urine ( when water without electrolyte
given )❖Causes of Overhydration : a) Excessive intake of large volumes of salt free fluids b) Renal failure c) Excessive administration of fluids parenterally d) Hyper secretion of ADH ( syndrome of inappropriate ADH secretion –
SIADH )This lead to decrease plasma electrolytes(dilution of ECF &ICF)
↓Decreased osmolarity
![Page 72: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/72.jpg)
Syndrome of inappropriate ADH secretion –SIADH
![Page 73: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/73.jpg)
Biochemical tests for Diagnosis of SIADH
![Page 74: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/74.jpg)
Overhydration ( water intoxication )
![Page 75: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/75.jpg)
Clinical Symptoms of Overhydration ( water intoxication )
1 . Nausea
2. Vomiting
3. Head ache
4.Muscular weakness /lethargy
5. Confusion
7 convulsion
8. Coma
9. Death
![Page 76: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/76.jpg)
Biochemical findings in water excess
❖Biochemical findings in water excess include:
• Decrease in plasma sodium
• Increase in ECF volume
• Decrease in plasma proteins
• Decrease in ECF osmolality
• Increase in urine volume
• Decrease in urine sodium: in Addison’s disease
• Increase in urine sodium: other conditions
![Page 77: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/77.jpg)
Management in water excess
Management in water excess include :
➢Restriction of water intake
➢Infusion of hypertonic saline if water intoxication occurs
![Page 78: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/78.jpg)
![Page 79: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/79.jpg)
Rabies
![Page 80: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/80.jpg)
![Page 81: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/81.jpg)
Clinical symptom of Rabies
Hydrophobia is One of the diagnostic symptom of
Rabies
![Page 82: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/82.jpg)
Consequences of viral infection in Rabies
![Page 83: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/83.jpg)
Management of Rabies
![Page 84: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/84.jpg)
Comparison of Overhydration ( water intoxication ) and Dehydration
![Page 85: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/85.jpg)
Management of Dehydration and Overhydration ( water intoxication )
![Page 86: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/86.jpg)
Cushing's syndrome is associated with Water and sodium retention
![Page 87: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/87.jpg)
Overhydration ( water intoxication )
![Page 88: Metabolism of water and its clinical significance](https://reader034.vdocument.in/reader034/viewer/2022051301/5a66961b7f8b9a0c768b49ab/html5/thumbnails/88.jpg)