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Disturbances of water and mineral balance. Edema

Disturbances of water and mineral balance. Edema. Water Balance. H 2 O. Children under 1 year: 65-75% of body weight. Young men: 60-65% of body weight. Young women: 50-55% of body weight. A man over 60 years: 50% of body weight. Women over 60 years: 45% of body weight.

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Disturbances of water and mineral balance. Edema

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  1. Disturbancesofwaterandmineral balance. Edema

  2. Water Balance

  3. H2O Children under 1 year: 65-75% of body weight Young men: 60-65% of body weight Young women: 50-55% of body weight A man over 60 years: 50% of body weight Women over 60 years: 45% of body weight In obese individuals, the water forms a smaller percentage than in thin

  4. Water content in the body 20-23% (15 liters) ECF Plasma 4% (3 liters) 16% (12 liters) ISF TBW 60-65% (45 liters) Plasma/IST=1/4 ICF ECF/ICF=1/2 40-45% (30 liters)

  5. Food 1 l Liquids 1 l Metabolism 0,5 l deficit surplus Feeling thirsty Theexcretionof urine Dailywater balance Respiration 0,5 l Urine 1-2 l Perspiration 0,6-0,8 l Stool 0,1 l

  6. Major ions ICF (intracelluar fluid) ECF (extracellular fluid) 4,3 mmol/l K+ 140 mmol/l K+ 12 mmol/l Na+ 140 mmol/l Na+ 3 mmol/l Cl- 104 mmol/l Cl- 10 mmol/lHCO3- 24-27 mmol/l HCO3-

  7. The balance of sodium and chloride

  8. Food 50-350 mmol Dailysodium balance Sweat 10 mmol Urine 50-350 mmol Stool 10 mmol

  9. Food 50-350 mmol Daily balance of chloride Sweat 10 mmol Urine 50-350 mmol Stool 10 mmol

  10. Osmotic balance in body fluids

  11. H2O H2O H2O H2O Osmoticpressure is related to the concentration of alldissolved particles P2 P1 = > = > C2 C1 < [H2O] 2 [H2O]1 =

  12. Osmoticpressure isrelated to the concentration of dissolved particles relative tothe weight of the solvent:osmolality(mmol/kg solvent) • the volume ofsolution : osmolarity (mmol/l solution). Hyperosmolality Hyposmolality Hyperosmolarity Hyposmolarity H2O H2O H2O H2O H2O H2O H2O

  13. Isotonicenvironment Cell 290 ± 10 mmol/l Blood-vessel Interstitial fluid

  14. H2O H2O Hypertonicenvironment Cell > 300 mmol/l Blood-vessel Interstitial fluid

  15. Hypertonicenvironment > 300 mmol/l Cell Hypertonicenvironment Céva Intersticium

  16. Isotonicenvironment Cell 290 ± 10 mmol/l Blood-vessel Interstitial fluid

  17. H2O H2O Hypotonicenvironment Cell < 280 mmol/l Blood-vessel Interstitial fluid

  18. Hypotonicenvironment Cell < 280 mmol/l Blood-vessel Interstitial fluid

  19. Hyperosmolarity due to the rise of blood urea Isotonicenvironment Cell Total osmolarity > 300 290 ± 10 mmol/l Blood-vessel Effective osmolarity = Total osmolarity – ureaconcentration Interstitial fluid

  20. The balance of the capillary and its disorders(waterandsolutimovementbetween plasma andinterstitium)

  21. H20 Oncotic pressure gradient Isotonicenvironment Cell 290 ± 10 mmol/l Hydraulic pressure gradient H20 Blood-vessel Interstitial fluid

  22. Lymphaticdrainage Movementofthefiltrate Interstitial fluid Hydraulicpressure gradient proteins Oncoticpressure gradient Precapillary sphincter arteriole Capillary venule proteins Lymphaticdrainage

  23. Lymphaticdrainage Accumulation filtratein theinterstitium Interstitial fluid Hydraulicpressure gradient proteins Oncoticpressure gradient Increasehydraulic pressure gradient Congestionin rightcardiacinsufficiency Precapillary sphincter arteriole Capillary venule proteins Lymphaticdrainage

  24. Lymphaticdrainage Swelling Increasedinterstitialcounterpressure Interstitial fluid Hydraulicpressure gradient proteins Oncoticpressure gradient Increasehydraulic pressure gradient Congestionin rightcardiacinsufficiency Precapillary sphincter arteriole Capillary venule proteins Lymphaticdrainage

  25. Lymphaticdrainage Movementofthefiltrate Interstitial fluid Hydraulicpressure gradient proteins Oncoticpressure gradient Decreaseofoncoticpressure gradient Precapillary sphincter arteriole Capillary venule proteins Lymphaticdrainage

  26. Reducedlymphaticdrainage Accumulation filtratein theinterstitium The accumulation of proteinsin the interstitium Interstitial fluid Hydraulicpressure gradient proteins Decreaseofoncoticpressure gradient Precapillary sphincter Decreaseof plasma proteinsconcentration arteriole Capillary venule proteins Lymphaticdrainage

  27. Swelling Increasedinterstitialcounterpressure Reducedlymphaticdrainage The accumulation of proteinsin the interstitium Interstitial fluid Hydraulicpressure gradient proteins Decreaseofoncoticpressure gradient Precapillary sphincter Prekapilární sfinkter Decreaseof plasma proteinsconcentration arteriole Capillary venule proteins Lymphaticdrainage

  28. Lymphaticdrainage Inflammation Movementofthefiltrate Interstitial fluid Hydraulicpressure gradient proteins Oncoticpressure gradient Dilationofcapillaries Precapillary sphincter arteriole Capillary venule proteins Lymphaticdrainage

  29. Lymphaticdrainage Inflammation Accumulation filtratein theinterstitium Increaseofhydrauliccaplillarypressure Interstitial fluid proteins Increaseof hydrauliccapillary pressure Oncoticpressure gradient Dilationofcapillaries Precapillary sphincter arteriole Capillary venule proteins Lymphaticdrainage

  30. Accumulation of macromolecularproducts of inflammatory reactions Inflammation Accumulation filtratein theinterstitium Increaseofhydrauliccaplillarypressure Interstitial fluid proteins Increaseof hydrauliccapillary pressure Reductionofoncoticpressure gradient Dilationofcapillaries Increasedcapillary permeability Precapillary sphincter arteriole Capillary venule proteins Lymphaticdrainage

  31. Accumulation of macromolecularproducts of inflammatory reactions Inflammation Accumulation filtratein theinterstitium Increaseofhydrauliccaplillarypressure Interstitial fluid proteins Increaseof hydrauliccapillary pressure Reductionofoncoticpressure gradient Dilationofcapillaries Increasedcapillary permeability Precapillary sphincter arteriole Capillary venule proteins Lymphaticdrainage

  32. Swelling Increasedinterstitialcounterpressure Accumulation of macromolecularproducts of inflammatory reactions Inflammation Increaseofhydrauliccaplillarypressure Interstitial fluid proteins Increaseof hydrauliccapillary pressure Reductionofoncoticpressure gradient Dilationofcapillaries Increasedcapillary permeability Precapillary sphincter arteriole Capillary venule proteins Lymphaticdrainage

  33. Control volume related to regulation of circulating blood volume and thus with hemodynamics (particularly with the regulation of arterial pressure) Control volume and osmolarity Therefore, we are talking about so-called "effective circulating volume" Volume -is detected by atrial tension in the wall (low-pressure baroreceptors),by tension in the artery wall and in the glomuscaroticusthe aortic arch (high-receptors) Osmolarity – isdetected by osmoreceptors in the hypothalamus and possibly also liver Control volume and osmolarity closely related to regulation of sodium excretion (sympaticus, aldosterone, ANF) and control urine osmolarity(ADH)

  34. Feeling thirsty Osmoreceptors ADH Effectivecirculating volume anterolateralhypothalamus liver osmoreceptors? Sympathetic andparasympathetic glomus caroticum Lowpressurebaroreceptors atria aortic arch Highpressure baroreceptors Angiotensin II increases the sensitivity osmoreceptors atria The tension inatrial wall atrialrate juxtaglomerul. appatus NaCldelivery to maculadensa Atrial natriuretic faktor Sympatheticactivity Renin Highpressure baroreceptors in vasafferens Adrenalcortex Angiotensin I Angiotensinogen Converting enzyme(endothelial cells in lung) Angiotensin III Angiotensin II Aldosterone

  35. nucleus paraventricularis - vagus + pressurerise Nausea, vomiting + pressure drop Plasma osmolarity osmoreceptors + Lowpressure baroreceptors Highpressure baroreceptors + + Angiotensin II Hypoxia hypoglycemia + nucleus supraopticus Dopamin + - - Enkephalin - - glucocorticoids ? Alcohol Liver osmoreceptors neurohypophysis ADH capillary

  36. Normal effectivecirculating volume 10 ADH [pg/ml] Hypovolemia Hypervolemia 5 Plasma osmolarity [mOsm/l] 270 265 275 280 285 295 300 290 Feeling thirsty at normal volume The feeling of thirst in hypovolemia

  37. 15 10 ADH [pg/ml] 5 -10% -20% -30% ADH is mainly regulated by osmolarity, less by volume Decreaseof the effectivecirculating volumeat normal osmolarity b

  38. Na+excretion in thekidney

  39. Na+ Decreasedeffectivecirculating volume Sympatheticactivity Renin GFR Angiotensin I Na+resorption Lungs Heart Na+resorption Na+resorption AtrialNatriuretic Faktor H2O resorption Angiotensin II Brain Adrenalcortex H2O a Na+ excretion ADH Aldosterone

  40. Na+ Euvolemia Delivery

  41. Na+ ECF Volume Euvolemia Delivery Delivery Effectivecirculating volume

  42. Na+ Increasedeffectivecirculating volume Sympatheticactivity Renin GFR Angiotensin I Na+resorption Lungs Heart H2O resorption Na+resorption AtrialNatriuretic Faktor H2O resorption Angiotensin II Brain Adrenalcortex ADH H2O a Na+ excretion Aldosterone

  43. Na+ Euvolemia Delivery

  44. Na+ ECF Volume Euvolemia Delivery Delivery Effectivecirculating volume

  45. b-intercalarcells Principalcells -intercalarcells Cl- H+ K+ Na+ Cl- HCO3- Cl- Aldosterone + Cl- + CO2 karboanhydrase HCO3- H+ -ATPase Na+-K+ ATPase OH- H+ H2O H2O Na+ K+ OH- H+ HCO3- karboanhydrase H+ -ATPase CO2 Cl- + + + + - Na+ H+ K+ Cl- HCO3- - CO2 HCO3- lumen H2PO4- HPO42- (titratableacids) NH3 NH4+ Cl- Cl-

  46. Question Why in healthy peoplewith reducing the volume of extracellular fluid and subsequent activationof renin-angiotensin-aldosterone system are not lost potassium?

  47. Stimulus: K+secretion (collectingducts) Does not change K+secretion + + Effectivecirculating volume Na+ reabsorption (proximal tubule) Aldosterone + - Flow rate of urine in the tubule Reabsorption of Na+(collecting ducts)

  48. K+secretion (collectingducts) + Effectivecirculating volume Stimulus: 1. diuretics 2. osmoticdiuresis + Na+ reabsorption (proximal tubule) Aldosterone + + Flow rate of urine in the tubule Reabsorption of Na+(collecting ducts)

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