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Pathophysiology of Water Electrolyte Metabolism

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Pathophysiology of Water Electrolyte Metabolism PATHOPHYSIOLOGY OF WATER ELECTROLYTE METABOLISM. PATHOPHYSIOLOGY OF MINERAL METABOLISM. I. PLAN OF STUDY OF THE TOPIC. 1. Changes in water distribution and water volume. 2. Types of dehydration, causes and mechanisms of development. 3. Effect of dehydration on the body. 4. Edema and dropsy: definition, classification. 5. Mechanisms of edema development: pathogenic factors and pathogenesis of different types of edema. 6. Significance of edema for organism. 7. Etiological and pathogenetic principles of edema and dehydration treatment. 8. Disturbance of trace elements metabolism. 9. Disturbance of macronutrients metabolism. II. QUATIONS FOR SELFCONTROL. 1. Types of water balance disturbances. 2. Extracellular water sector. 3. Basic mechanisms of volume water sectors changes. 4. Types of dehydration according to mechanisms of development. 5. Mechanisms of dehydration caused by primary absolute lack of water. 6. Types of dehydration according to speed of water losing. 7. Types of dehydration according to degree of water or electrolyte lack. 8. Pathological conditions when develops " water deficiency due to of limited water supply." 9. Manifestations of intracellular dehydration. 10. Main mechanisms of dehydration from due to a lack of electrolytes. 11. Main causes of hyperosmolar dehydration in the loss of electrolytes through the gastrointestinal tract. 12. Phenomena arising from the violation of the blood supply to the nervous tissue during dehydration. 13. Definition of edema. 14. Classification of edema according to prevalence. 15. Classification of edema according to speed of development. 16. Classification of edema according to pathogenesis. 17. Classification of edema according to etiology. 18. Definition of dropsy. 19. Types of dropsy. 20. Types of lymphatic insufficiency. 21. Pathogenic factors in the development of cardiac edema. 22. Pathogenic factors in the development of nephrotic edema. 23. Pathogenic factors in the development of nephritic edema. 24. Basic principles of therapy in cases of water-electrolyte disorders. 25. Biological role of sodium. Types of hyponatremia depending on the osmolality of the extracellular fluid. 26. Types and causes of hypotonic hyponatremia. 27. Causes and main clinical manifestations of hypernatremia. 28. Biological role of potassium. Causes and main clinical manifestations of hypo - and hyperkalemia. 29. Biological role of calcium and phosphorus in the human body. 30. Causes, mechanisms and main clinical manifestations of hypocalcemia. 31. Causes and main symptoms of hypercalcemia. 32. Causes and main clinical manifestations of hypo-and hyperphosphatemia. 33. Biological role of magnesium, causes and main symptoms of hypo - and hypermagnesemia. 34. Biological role of iron, causes and main symptoms of decrease and increase of iron. 35. Biological role of copper, causes and main symptoms of hypo - and hypercupremia. 36. Biological role of zinc, causes and main symptoms of zinc deficiency and excess in the body. 37. Biological role of manganese, causes and main symptoms of manganese deficiency and excess in the body. 38. Biological role of chromium, causes and main symptoms of chromium deficiency and excess in the body. 39. Biological role of selenium, causes and main symptoms of selenium deficiency and excess in the body. 40. Biological role of molybdenum, causes and main symptoms of molybdenum deficiency and excess in the body. 41. Biological role of iodine, causes and main symptoms of iodine deficiency in the body. 42. Biological role of cobalt, causes and main symptoms of cobalt deficiency and excess in the body. 43. Biological role of fluorine, causes and main symptoms of fluorine deficiency and excess in the body. 12.8. DISORDERS OF WATER-ELECTROLYTE EXCHANGE (DISHYDRIA). DEHYDRATION. EDEMA Water is a universal environment and an indispensable structural component of any living system. It is a unique solvent of biopolymers and the necessary environment for the passage of all biochemical reactions of the body. In liquid water, at the temperature of a human body, its free molecules and structured “crystalline” aggregates, which are in a state of mobile equilibrium, are chaotically distributed. The degree of structuring of water in cells reflects their functional activity under the action of a wide variety of external and internal environment factors, even in ultra-low-intensive doses. The structure of the water in cells determines the ability of tissues to saturate and give away water (hydration ability of tissues). The high frequency of disorders of water and electrolyte metabolism and the severity of the processes caused by this disorder, especially in childhood, make the problem important and actual. 12.8.1. Changes in the distribution and volume of water in the human body The following violations of the water balance disorders are known: negative, accompanied by the development of dehydration of the body with all the consequences , and positive, leading to the development of edema and hydropsy. The total water content in the body (total body water) depends on age, body weight and gender (tab. 12-12). As you can seen from the table, the total water content of the body decreases with age, and this process continues permanently to extreme old age. At the same time the amount of water in the cells decreases, while the volume of extracellular fluid increases slightly. Table 12-12. Body water content,% to body weight Age Total bodyExtracellular Intracellular period water fluid fluid Embryo 2m 95 - - Fetus 5m 87 - - Children Newborn months year years Grown-ups Men + Women + The total body water in an adult man body aged 25–30 years is on average about 60% of his body weight (about 42 liters with a body weight of 70 kg), in an adult woman - 50%. Normal variations of average values should not be more than 15%. Intracellular water sector of the body (intracellular water of the body). A significant part of water (30-35% of body weight) is concentrated inside the cells - the intracellular water sector of the body. It is the water of the cell mass of the body. A 25-year-old man with a weight 70 kg has about 25 liters of water inside the cells, a woman of the same age weighing 60 kg has about 17 liters (with a total body water volume = 32 liters). Intracellular fluid is presented in the form of three states: 1) protoplasmic water associated with hydrophilic structures; 2) water of attraction on the surface of colloidal structures; 3) capillarity water - in the gaps of protoplasm - the most mobile, relatively free water of cells. In various pathological conditions, the volume of the intracellular water sector can vary in the direction of its increase (for example, during water intoxication), and in the direction of decrease (water depletion). These changes occur more often due to the variation of the volume of mobile water in cells. As usually, the change in the volume of the intracellular sector of the organism develops more slowly and later in comparison to the change of the volume of the extracellular water sector (especially the volume of blood plasma). Extracellular water sector of the body (extracellular body water). Its volume is 20-24% of human body weight (about 17 liters for men weighing 70 kg). This sector includes plasma water, interstitial and transcellular fluids. Blood plasma water is part of the extracellular water sector (intravascular water sub-sector of the body). One of the most important functions of blood plasma is the formation of the environment for the normal functioning of blood corpuscles. The volume of blood plasma is 3.5-5% of body weight. The content of proteins in the blood plasma for an adult is 70-80 g / l (it creates a colloid osmotic pressure of 3.25-3.64 kPa, or 25-28 mm Hg), which significantly exceeds their content in the interstitial liquids (10-30 g / l). Pure water in blood plasma constitutes 93% of its volume. Interstitial fluid is an extracellular and extravascular fluid. It washes the cells directly, is close in ionic and molar composition to the blood plasma (with the exception of protein content) and, together with lymph, makes up 15-18% of body weight. This fluid is in constant exchange with blood plasma, so about 20 liters of fluid with substances dissolved in it pass from the vessels into the tissues in a day, and the same amount returns from the tissues to the general circulation, with 3 liters through the lymphatic vessels. Transcellular fluid is a special group of body fluids. It does not balance with the blood plasma, but is formed as a result of the cell activity, which is why it occupies a special position in the body. This group of fluids includes digestive juices, the contents of the renal tubules, synovial, articular and cerebrospinal fluids, chamber moisture of the eyes, etc. The proportion of an adult person accounts for 1-1.5% of his body weight. Changes in the volume of water sectors of the body. The volume of all these body fluids that make up the extracellular water sector, as well as the fluids of the intracellular water sector, can significantly decrease and increase. These changes can occur as a result of: 1) the primary change in the electrolyte composition of the body fluids (decrease or increase of electrolytes); 2) primary dehydration; 3) pathological water retention in the body. Wherein, mobile body fluids - intravascular and interstitial - change their volumes first of all. The body fluids have a fairly constant electrolyte composition (Table 12-13), are electrically neutral and are in a state of osmotic equilibrium. However, the electrolyte composition of extracellular fluids is significantly different from the electrolyte composition of intracellular fluids. Cellular fluids contain significantly more ions of potassium, magnesium, phosphates, extracellular fluids - ions of sodium, chlorine, calcium, bicarbonates. The content of proteins in the cells is much higher than their content in the interstitial fluid. Table 12-13. Molar and ionic composition of human body fluids * *The concentration of non-dissociating compounds (glucose, urea, etc.) is not taken into account; it is approximately 7-9 mmol / l.
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