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FLUID AND ELECTROLYTE REGULATION AND ACID BASE BALANCE

FLUID AND ELECTROLYTE REGULATION AND ACID BASE BALANCE. EXTRACELLULAR VS INTRACELLULAR FLUIDS. EXTRACELLULAR FLUIDS. INTERSTITIAL OR TISSUE FLUID PLASMA LYMPH CEREBROSPINAL FLUID INTRAOCULAR FLUID SYNOVIAL FLUID PERICARDIAL FLUID PLEURAL FLUID PERITONEAL FLUID.

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FLUID AND ELECTROLYTE REGULATION AND ACID BASE BALANCE

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  1. FLUID AND ELECTROLYTE REGULATION AND ACID BASE BALANCE

  2. EXTRACELLULAR VS INTRACELLULAR FLUIDS

  3. EXTRACELLULAR FLUIDS • INTERSTITIAL OR TISSUE FLUID • PLASMA • LYMPH • CEREBROSPINAL FLUID • INTRAOCULAR FLUID • SYNOVIAL FLUID • PERICARDIAL FLUID • PLEURAL FLUID • PERITONEAL FLUID

  4. EXTRACELLULAR FLUID COMPOSITION • PLASMA AND TISSUE FLUIDS VERY SIMILAR • SEPARATED BY CAPILLARY WALLS THAT ALLOW FAIRLY FREE EXCHANGE OF LOW MOLECULAR WEIGHT SUBSTANCES

  5. DIFFERENCES • DUE TO FACT PROTEINS CANNOT PASS THROUGH MEMBRANES\ • PROTEINS NORMALLY ANIONS • LEADS TO MORE SODIUM AND LESS CHLORIDE IN PLASMA THAN INTERSTITIAL FLUID

  6. COMPOSITION OF INTRACELLULAR FLUID • SEPARATED FROM EXTRACELLULAR BY CELL MEMBRANE THAT IS RELATIVELY IMPERMEABLE TO PROTEINS • SODIUM POTASSIUM PUMP ACCUMULATES SODIUM TO OUTSIDE AND POTASSIUM TO INSIDE

  7. REGULATION OF THE INTERNAL ENVIRONMENT • WATER • ELECTROLYTES • KIDNEYS PLAY A MAJOR ROLE

  8. SODIUM REGULATION • MAJOR EXTRACELLULAR CATION • MAJOR OSMOTIC EFFECTS • WHERE SODIUM GOES WATER FOLLOWS • GREATLY AFFECTS PLASMA VOLUME AND BLOOD PRESSURE

  9. INGESTION OF SODIUM • REGULATORY COMPONENT • HEDONISTIC COMPONENT • AVERAGE CONSUMPTION IN US IS 10-15 GRAMS PER DAY • 0.5 GRAMS ARE NEEDED

  10. RENAL EXCRETION & REABSORPTION OF SODIUM • KIDNEYS CONTROL BODY’S SODIUM LEVELS • RELATIONSHIP BETWEEN GLOMERULAR FILTRATION RATE OF SODIUM AND THE TUBULAR REABSORPTION RATE DETERMINES SODIUM EXCRETION • SODIUM IS FREELY FILTERED

  11. FACTORS THAT AFFECT GLOMERULAR FILTRATION RATE • ARTERIAL BLOOD PRESSURE • ACTIVITY OF SYMPATHETIC NERVES

  12. CONTROL OF SODIUM REABSORPTION • IMPORTANT IN LONG TERM CONTROL OF SODIUM EXCRETION • ALDOSTERONE • RENIN-ANGIOTENSIN

  13. ALDOSTERONE • STIMULATES SODIUM REABSORPTION • DISTAL CONVOLUTED TUBULES • COLLECTING TUBULES

  14. HIGH ALDOSTERONE LEVELS • ALMOST ALL SODIUM IS REABSORBED • 0.1 GRAM OF SODIUM EXCRETED

  15. LOW ALDOSTERONE LEVELS • AS MUCH AS 30-40 G OF SODIUM CAN BE EXCRETED

  16. REGULATION OF ALDOSTERONE SECRETION • RENIN • PRODUCED BY JUXTAGLOMERULAR COMPLEX

  17. FACTORS THAT LEAD TO RENIN SECRETION • DECREASE IN RENAL ARTERIAL PRESSURE • INCREASE IN ACTIVITY OF SYMPATHETIC NERVES

  18. EFFECTS OF RENIN • CONVERTS ANGIOTENSINOGEN INTO ANGIOTENSIN I

  19. FATE OF ANGIOTENSIN I • PASSES THROUGH LUNGS AND IS CONVERTED INTO ANGIOTENSIN II

  20. EFFECT OF ANGIOTENSIN II • STIMULATES ALDOSTERONE RELEASE FROM ADRENAL GLAND

  21. EFFECT OF ALDOSTERONE • STIMULATES REABSORPTION OF SODIUM FORM DISTAL CONVOUTED TUBULES AND COLLECTNG TUBULES

  22. FACTORS THAT LEAD TO SODIUM EXCRETION • INCREASE IN SYSTEMIC BLOOD PRESSURE • INCREASED NERVE IMPULSES FROM CIRCULATORY PRESSURE RECEPTORS--THIS CAUSES DECREASED ACTIVITY OF SYMPATHETIC NERVES WHICH CAUSES DILATION OF AFFERENT ARTERIOLES • DECREASED RELEASE OF RENIN--DECREASED RELEASE OF ALDOSTERONE • RELEASE OF ATRIAL NATRIURETIC FACTOR

  23. NET EFFECT • INCREASE AMOUNT OF SODIUM IN GLOMERULAR FILTRATE • DECREASE AMOUNT OF SODIUM REABSORBED FROM TUBULES • INCREASED EXCRETION OF SODIUM • BODY LEVELS OF SODIUM DECLINE • WATER FOLLOWS

  24. SODIUM CONCENTRATION VS TOTAL SODIUM CONTENT

  25. REGULATION OF WATER CONTENT • INGESTION • THIRST • RENAL EXCRETION

  26. INGESTION • HABIT AND SOCIAL FACTORS USUALLY MORE INFLUENTIAL

  27. THIRST • RESULTS FROM INCREASED OSMOTIC CONCENTATION • REDUCED PLASMA VOLUME • OSMORECEPTORS IN HYPOTHALAMUS MONITOR • MAYBE CIRCULATORY RECEPTORS • ANGIOTENSIN II

  28. EXCRETION OF WATER • RELATIONSHIP BETWEEN GLOMERULAR FILTRATION RATE AND TUBULAR REABSORPTION RATE • WATER IS FREELY FILTERED FROM PLASMA • FACTORS THAT AFFECT GLOMERULAR FILTRATION RATE AFFECTS WATER EXCRETION • SODIUM REGULATION ALSO VERY IMPORTANT • DEPENDENT ON ANTIDIURETIC HORMONE

  29. ANTIDIURETIC HORMONE AND WATER EXCRETION • AFFECTS PERMEABILITY OF COLLECTING TUBULES TO WATER • OSMORECEPTORS IN HYPOTHALAMUS • CIRCULATORY PRESSURE RECPTORS LEFT ATRIUM OF HEART

  30. FACTORS THAT INFLUENCE WATER EXCETION • OSMOTIC PRESSURE OF EXTRACELLULAR FLUID • RARELY SEPARATE FROM FACTORS THAT INFLUENCE SODIUM EXCRETION

  31. POTASSIUM REGULATION • EXTRACELLULAR LEVELS CLOSELY REGULATED • EXCRETION USUALLY EQUALS THE AMOUNT OF INGESTION • FREELY FILTERED INTO FILTRATE • CAN BE SECRETED OR REABSORBED BY TUBULES • USUALLY ALL IS REABSORBED • AMOUNT EXCRETED DEPENDS ON HOW MUCH IS SECRETED

  32. ROLE OF TUBULAR CELLS IN POTASSIUM EXCRETION • HIGH CONCENTRATION IN CELLS -- MORE POTASSIUM SECRETED • LOWER CONCENTRATION IN CELLS -- LESS POTASSIUM SECRETED

  33. ROLE OF ALDOSTERONE IN POTASSIUM EXCRETION • PROMOTES REABSORPTION OF SODIUM BY TUBULES • INCREASED POTASSIUM CONCENTRATION IN EXTRACELLULAR CELLS BATHING ADRENAL CELLS INCREASES ALDOSTERONE SECRETION

  34. REGULATION OF CALCIUM • BONE (CONTAINS 99% OF CALCIUM) • KIDNEYS • GI TRACT

  35. EFFECTS OF PARATHYROID HORMONE • INCREASES PLASMA CALCIUM LEVELS • DECREASES PLASMA PHOSPHATE CONCENTRATIONS • INCREASES MOVEMENT OF CALCIUM AND PHOSPHATE FROM BONE TO EXTRACELLULAR FLUID

  36. OSTEOCLASTS • BREAK DOWN BONE

  37. EFFECTS OF PARATHYROID HORMONE ON KIDNEY • DECREASES THE URINARY EXCRETION OF CALCIUM • INCREASES EXCRETION OF PHOSPHATE • ENHANCES TRANSFORMATION OF VITAMIN D3 TO 1,25 DIHYDROXYCHOLECALCIFEROL

  38. 1,25 DIHYDROXYCHOLECALCIFEROL • STIMULATES CALCIUM ABSORPTION BY INTESTINES

  39. CONTOL OF PARATHYROID HORMONE SECRETION • CALCIUM LEVELS THAT BATH CELLS OF PARATHYROID

  40. CALCITONIN AND CALCIUM LEVELS • FROM THYROID GLAND • LOWERS PLASMA LEVELS OF CALCIUM • INHIBITS REMOVAL OF CALCIUM FROM BONE INHIBITS OSTEOCLASTS • LESS IMPORTANT THAN PARATHYROID

  41. CONTROL OF CALCITONIN SECRETION • CALCIUM LEVELS THAT BATH CELLS OF THYROID

  42. REGULATION OF MAGNESIUM

  43. RARE DISORDER CAUSES MALNUTRITION ALCOHOLISM REDUCED ABSORPTION RENAL TUBULE PROBLEMS SOME TYPES OF DIURETICS INCREASED NEUROMUSCULAR ACTIVITY IRRITIBILITY INCREASED REFLEXES MUSCLE WEAKNESS TETANY CONVULSIONS HYPOMAGNESMIA

  44. RARE DISORDER CAUSES RENAL FAILURE ANTACIDS CONTAINING MAGNESIUM DEPRESSED SKELETAL MUSCLE CONTRACTIONS DEPRESSED OF NERVE FUNCTION NAUSEA VOMITING MUSCLE WEAKNESS HYPOTENSION BRADYCARDIA REDUCTION IN RESPIRATION HYPERMAGNESMIA

  45. REGULATION OF PHOSPHATE

  46. CAUSES RENAL FAILURE SIDE EFFECTS OF CHEMOTHERAPY HYPERPARATHYOIDISM REDUCED PLASMA CALCIUM CONCENTRATION DUE TO CALCIUM PHOSPHATE DEPOSITED IN TISSUES LUNGS KIDNEYS JOINTS HYPERPHOSPHATEMIA

  47. CAUSES REDUCED ABSORPTION OF MAGNESIUM HYPERPARATHYROIDISM INCREASED RENAL EXCRETION OF PHOSPHATE SYMPTOMS REDUCED METABOLIC RATE REDUCED OXYGEN TRANSPORT WHITE BLOOD CELL FUNCTION REDUCED REDUCED BLOOD CLOTTING HYPOPHOSPHATEMIA

  48. ACID BASE REGULATION • ACIDS • BASES • p H OF BLOOD • p H OF INTERSTITIAL FLUIDS • BUFFER SYSTEMS • ROLE OF RESPIRATORY SYSTEM • ROLE OF KIDNEYS

  49. ACIDS • INCREASE HYDROGEN ION CONCENTRATION • PROTON DONORS

  50. BASES • HYROGEN ACCEPTOR • PROTON ACCEPTOR

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