Disorder of water balance 12:13 PM Osmotic activity of ECF is governed mainly by Nat - Other contributors © Anions (HCO3-, Cl-) © Glucose © Urea In ICF, potassium is major determinant Osmolality - measure of number of dissolved particles in a solution - Calculated osmolality: 2[Na + K] + [glucose] + [urea] = Unit: mmol/kg = Normal: 7-17 Osmolal gap - Difference between measured and calculated osmolality = Normal <10 = High osmolal gap (large number of unmeasured substances © Gross hyperlipidemia © Gross hyperproteinemia © Alcohol ingestion (ethanol, methanol) © Mannitol treatment PHYSIOLOGICAL RESPONSES TO WATER LOSS Water loss Increased ECF osmolality Stimulation of Stimulation of hypothalamic AVP/ADH release thirst centre Renal water Increased water intake retention > Restoratioi\ of ECF osmolality Hypovolemia - Deficiency amount of water and electrolyte in ECF with near normal water / electrolyte proportions - Signs © Increase pulse Decrease blood pressure Decreased urine output Decreased conciousness Deceased skin tugor Sunken / soft eyeballs © Dry mucosa membrane = Clinical diagnosis © BUN:creatinine > 20:1 © Increased specific gravity © Increased hematocrit level ° ° oo0000 Electrolyte imbalance Acid-base disorder Pure water —Inadequate_-—_Loss of fluid -Too old, too young or depletion fluid intake containing very small_ too sick to drink despite normal amount of Na+ - Inappropriate IV / increased -H2O0 loss> Na+ therapy renal loss loss - Disturbance of thirst center Isotonic fluid Loss of fluid Same amount of H20 loss with similar and Nat loss from Nat content as body ECF -Nat concentration and ECF will not change Hypotonic fluid Dehydration —_Nat loss > H20 loss due to loss of -Na fluid containing concentration significant is ECF is low amount of Na (hypotonic Coupled with compated to inadequate IC) fluid intake - Water moves from ECF to ICF 0 Cell swelling Hypervolemia - Excessive intake ° ° iatrogenic Psychogenic polydipsia = Impaired secretion ° oo° Inappropriate secretion of ADH (SIADH) Renal failure Hypoadrenalism hypothyroidism ~ Loss of blood - Loss of serum - Third space accumulations *tleus + Pancreatitis, * Peritonitis * Crush injury Etc ~ Skin loss - excessive sweating ~ Gut losses = Renal loss * Diuretics * Addisons's disease + Salt losing nephritis | Redistribution of water from ICF Increased ICF water —__