polio biochemical changes in urine
TRANSCRIPT
![Page 1: Polio Biochemical changes in Urine](https://reader033.vdocument.in/reader033/viewer/2022060205/55a145841a28abac048b474f/html5/thumbnails/1.jpg)
Biochemical Alterations and
Mechanism for Changes in Urinary
pH,
Sodium,
Potassium,
Calcium
and
Phosphorous
in Patients of Acute PoliomyelitisBy: Samyek Napit
Roll No. 66
NAIHS-COM, KTM
![Page 2: Polio Biochemical changes in Urine](https://reader033.vdocument.in/reader033/viewer/2022060205/55a145841a28abac048b474f/html5/thumbnails/2.jpg)
Urinary pH
Normal pH of urine: 4.6 – 8
Average pH = 6 In poliomyelitis(spinal, bulbar,
bulbospinal), pH of the urine drops
below average values
Hence, acidic
![Page 3: Polio Biochemical changes in Urine](https://reader033.vdocument.in/reader033/viewer/2022060205/55a145841a28abac048b474f/html5/thumbnails/3.jpg)
Mechanism of alteration of
Urine pH:
Tightness of intercoastal muscles, failure
of diaphragm muscles, hypoventilation
due to depression of respiratory centers
Retention of CO2 in blood
Respiratory Acidosis
![Page 4: Polio Biochemical changes in Urine](https://reader033.vdocument.in/reader033/viewer/2022060205/55a145841a28abac048b474f/html5/thumbnails/4.jpg)
• Acidity of the blood
• more H+ ions are excreted in the urine
ALSO,
![Page 5: Polio Biochemical changes in Urine](https://reader033.vdocument.in/reader033/viewer/2022060205/55a145841a28abac048b474f/html5/thumbnails/5.jpg)
Other factors responsible for increasing
the pH:-
1. High phosphate level (excreted as
NaH2PO4 )
2. High NH4+ being secreted
![Page 6: Polio Biochemical changes in Urine](https://reader033.vdocument.in/reader033/viewer/2022060205/55a145841a28abac048b474f/html5/thumbnails/6.jpg)
K+ levels in urine
Normal level of K+
( on a regular diet ) 25 to 125 mEq/
liter per day
In acute poliomyelitis:
Rise in K+ until the serum K+ is low
![Page 7: Polio Biochemical changes in Urine](https://reader033.vdocument.in/reader033/viewer/2022060205/55a145841a28abac048b474f/html5/thumbnails/7.jpg)
Destruction of tissues
Discharge of intracellular deposit of K+
into the extracellular fluid
Blood is brought to the kidney
In Kidney, K+ is conserved via Potassium-Hydrogen exchanger
![Page 8: Polio Biochemical changes in Urine](https://reader033.vdocument.in/reader033/viewer/2022060205/55a145841a28abac048b474f/html5/thumbnails/8.jpg)
BUT, K+ levels are too high
Result: Potassium concentration in
urine is high
![Page 9: Polio Biochemical changes in Urine](https://reader033.vdocument.in/reader033/viewer/2022060205/55a145841a28abac048b474f/html5/thumbnails/9.jpg)
Poliomyelitis
• Bulbar
Blood Pressur
e
• Increase
K+ or Na+
• More conservation
![Page 10: Polio Biochemical changes in Urine](https://reader033.vdocument.in/reader033/viewer/2022060205/55a145841a28abac048b474f/html5/thumbnails/10.jpg)
Na+ Levels in Urine
Normal Values
40-220 mEq/liter/day
BUT,
Varies with diet and level of
aldosterone hormone
![Page 11: Polio Biochemical changes in Urine](https://reader033.vdocument.in/reader033/viewer/2022060205/55a145841a28abac048b474f/html5/thumbnails/11.jpg)
In Acute Poliomyelitis
Marked drop in excretion of Na+ via
urine (however, Na+ is lost via extra-
renal channels)
But depends on the hydration of the
patient
![Page 12: Polio Biochemical changes in Urine](https://reader033.vdocument.in/reader033/viewer/2022060205/55a145841a28abac048b474f/html5/thumbnails/12.jpg)
In case of poliomyelitis, the serum Na+ is
elevated only slightly
Blood reaching the kidney is only slightly
elevated in Na+ level
Furthermore, the Na+ is conserved by the
kidney by using Na+-H+ exchanger
RESULT: Na+ excretion is low
![Page 13: Polio Biochemical changes in Urine](https://reader033.vdocument.in/reader033/viewer/2022060205/55a145841a28abac048b474f/html5/thumbnails/13.jpg)
Ca++ Levels in Urine
Normal
On normal diet = 100-300 mg/day
On calcium low diet= 50-150 mg/day
In Poliomyelitis:
gradual increase in Ca++ level
![Page 14: Polio Biochemical changes in Urine](https://reader033.vdocument.in/reader033/viewer/2022060205/55a145841a28abac048b474f/html5/thumbnails/14.jpg)
Changes in Calcium level and
Phosphorous level Acute Poliomyelitis is at times
accompanied by paralysis(flaccid)
Disuse of the part (esp. limbs)
Loss of balance between the
osteoblastic and osteoclastic activity
![Page 15: Polio Biochemical changes in Urine](https://reader033.vdocument.in/reader033/viewer/2022060205/55a145841a28abac048b474f/html5/thumbnails/15.jpg)
Demineralization
![Page 16: Polio Biochemical changes in Urine](https://reader033.vdocument.in/reader033/viewer/2022060205/55a145841a28abac048b474f/html5/thumbnails/16.jpg)
Left:X-Ray of pelvis and femur on the first month of onset of
disease
Right:X-ray of pelvis and femur after the six months of illness
![Page 17: Polio Biochemical changes in Urine](https://reader033.vdocument.in/reader033/viewer/2022060205/55a145841a28abac048b474f/html5/thumbnails/17.jpg)
Left:X-Ray of tibiae on the first month of onset of disease
Right:X-ray of tibiae after the two months of illness
![Page 18: Polio Biochemical changes in Urine](https://reader033.vdocument.in/reader033/viewer/2022060205/55a145841a28abac048b474f/html5/thumbnails/18.jpg)
Increase in serum Ca++ and PO4-
Other causes for Ca++
-Hypoalbuminemia
Increased excretion of Ca++ and PO4- in
urine
![Page 19: Polio Biochemical changes in Urine](https://reader033.vdocument.in/reader033/viewer/2022060205/55a145841a28abac048b474f/html5/thumbnails/19.jpg)
High levels of Ca++ can lead to renal stones, Nephrocalcinosis
Loss of Ca++ and PO4-leads to loss of
flexibility of bone(loss of water via hydroxyapatite) and osteoporosis
Further complications of Poliomyelitis
![Page 20: Polio Biochemical changes in Urine](https://reader033.vdocument.in/reader033/viewer/2022060205/55a145841a28abac048b474f/html5/thumbnails/20.jpg)
Knowing about the levels of Na+, K+
,Ca++, PO4-can help in learning about
the stage of the disease
![Page 21: Polio Biochemical changes in Urine](https://reader033.vdocument.in/reader033/viewer/2022060205/55a145841a28abac048b474f/html5/thumbnails/21.jpg)
References:
Nelson’s Textbook of Pediatrics, 19th Edition
![Page 22: Polio Biochemical changes in Urine](https://reader033.vdocument.in/reader033/viewer/2022060205/55a145841a28abac048b474f/html5/thumbnails/22.jpg)
THANK
YOU!