WATER EXCESS and WATER DEPLETION

Presenter: Yona Gandye (MD)

Facilitater: Dr. Ntogwisangu
OUTLINE:

OVERVIEW

DEFINITION

CAUSES

FEATURES

COMPESATION

REFERENCES
 OVERVIEW

ECF volume is mainly determined by the

balance between input and out put of Water
and Salts, in this case therefore any
disturbances that may affect(input/output)
depending on the severity may lead to water
excess or depletion.
 WATER EXCESS

By definition: Water excess is the

retention of water in excess of salts
 WATER EXCESS

Causes of water excess

Primary
Secondary
 Primary causes
Over hydration(Water intoxication)
-Water intoxication results when an individual attempt to consume large amount of water. Water can be
considered poisoning when over consumed like any other substance. The recommendation from
the medical field is to drink at least 1-2 lts/day,! Depending upon body mass. Water intoxication
would only occur at levels far higher than that.
-At the on set this fluid outside the cell has excessive amount of solute(sodium and other electrolytes)
in comparison to the inside of the cells, the fluid shift through osmosis into the cells in order to
balance its conc. This causes the cell to swell. In the brain this swelling increases intracranial
pressure. It is this increase in pressure that leads to the first observable symptoms of water
intoxication: headache, nausea ,vomiting, confusion, irritability and drowsiness. This are sometimes
followed by difficult in breathing during exhaustion and reduce the ability to interpret sensory
information . The cells in the brain may swell to the point where blood flow is interrupted leading
to cerebral oedema and pressure to the brain stem causing CNS dysfunction both of which m ay
lead to seizures, brain damage, coma and death
E.g: 1.Infants under six months of age get water intoxication by drinking several bottles of diluted
formula.
2.Athlete sweat heavily losing both water and electrolytes. Water intoxication and hyponatremia
results when a dehydrated person drinks too much water without the accompanying electrolytes
SECONDARY CAUSES
Addisons disease(excess sodium loss)
Cortisol deficiency
Renal failure
Paraneoplastic syndrome
Trauma(Head injury)
 Physiological Disturbances
Water intoxication(Hyper-
hydration/poisoning)
Hyponatremia
Hypo-osmolarity
Increase in ICF Volume at the expense of ECF
Volume expansion.
Oedema
 Clinical Features
Skin tugor become doughy
Nause/vomiting
Headache, drowsiness and dizzness
Blurred vision, fits and coma
 COMPENSATORY MECHANISMS
RAAS
ADH
THIRST
 WATER DEPLETION
By Definition: Water depletion is the excess loss
of pure water/water in excess of salts from the
ECF.
When the body loses water, it is usually depleted
from both the extracellular and intracellular
compartments, but it may not necessarily be lost
equally from each of the fluid spaces. Loss of NaCl
(the major solute of the extracellular fluid)
together with water results in proportionately
more extracellular fluid being depleted than if
water alone is lost.
 Physiological disturbances
Increase in the osmolarity of ECF and ICF
Reduction in the ICF volume.
 causes
Sweating
ADH deficiency
Renal irresponsiveness to ADH
DM
Cholera
Cushings syndrome
 Clinical Manifestation
As a result of lowering of the ECF volume:
-BP reduction
-Signs of dehydration(reduced urine vol.)
-Thirst
-Headache, confusion and coma
 Compensatory Mechanisms
Aim is:
-Stimulation of the thirst centre
-Stimulation of the ADH
-RAAS activity
-Baroreceptor control of BP changes
-Synthesis of osmotically active cells in the brain
 References.
Guyton and Hall textbook of medical
physiology 11th edition.
Harrisons principle of internal medicine, 17E
2008
The Merck manual of diagnosis and therapy b
y Mark Beers.