WATER & SODIUM

Water :

 Is the solvent for all process in the human body.

 Its transports nutrients for cells, determines cell

volume and it removes the waste product by way of
urine, and acts as the body’s coolant by way of
sweating.

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Water distribution:
 TBW in infants is
73% of total body
weight due to low
body fat, low bone
mass, which decline
through out life to
55-60%.

Nidal Yahya PhD student/IEDs Chemical Pathology

Department
 Water is freely permeable through the ICF and
ECF except in the kidney and its distribution is
determines by the osmotic gradient.

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Department
Osmolality:

 Is a physical property of a solution that is based on

the concentration of solutes expressed as
millimoles per kilogram of solvent (w/w).
 Osmolarity: Means osmotic pressure exerted by
the number of moles per liter of solution. (W/V)

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 The fluid movement is regulated by the oncotic
pressure (contribution of plasma proteins) and the
hydrostatic pressure.
 The leakage of fluid from the blood is picked up by
lymphatic vessels and return to the blood stream.

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Nidal Yahya PhD student/IEDs Chemical Pathology Department
Regulation of water:

 The major regulatory factors are the hormonal

factor (ADH, aldosterone) and the other factor is
the thirst center in the hypothalamus.
 At equilibrium, the osmolality of ECF and ICF are
identical 282-295 mmol/l.
 Any changes in total body water will result in
imbalance between the two compartment.

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 Any loss of water from the ECF will increase the
osmolality and result in movement of water from
the ICF to ECF.
 Increase EC osmolality will stimulate the
hypothalamic thirst center to increase the drinking
desire and to stimulate the ADH secretion.
 Then the ADH act on the renal tubules to increase
water reabsorption and concentrated urine output.

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 In decreased EC osmolality the hypothalamic thirst
center is inactive and to stimulate the ADH
secretion is off lead to diluted urine output.

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Water imbalance:

 1. water load: As excess intake of water.

 begins to lower plasma osmolality, both ADH and
thirst are suppressed.
 In the absence of AVP, water is not reabsorbed,
causing a large volume of dilute urine to be
excreted, as much as 10 to 20 L daily.

Nidal Yahya PhD student/IEDs Chemical Pathology Department

 2. Water Deficit: low water intake or loss of water.
 Increase plasma osmolality act as stimulator for
both thirst center and increased ADH secretion
which act on the renal tubules to prevent water loss
and the thirst center promote the desire to drink.

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Sodium:

 Na is the most abundant cation in the ECF,

representing 90% of all EC cations, and largely
determines the osmolality of the plasma.

 Because water follows Na across cell membranes,

thus continual removal of it from the cell prevents
osmotic rupture of the cell by also drawing water
from the cell.

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 Dietary intake as 8-15 g/day as NaCl; 70 % is free
and exchangeable, the reminder is bound in the
bone.
 Na output through the kidney, skin and the gut as
10 mmol/l.
 The kidneys have the ability to conserve or excrete
large amounts of Na, depending on the Na content
of the ECF and the blood volume.

Nidal Yahya PhD student/IEDs Chemical Pathology Department

Functions of sodium:
 1. Maintain osmotic pressure.
 2. Maintain acid-base balance.
 3. Act on transmission of nerve pulse.

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Regulation of Na:

 The plasma Na concentration depends:

1. The intake of water in response to thirst
2. The excretion of water, largely affected by AVP
release.
3. The blood volume status, which affects Na
excretion through aldosterone, angiotensin II, and
atrial natriuretic peptide.

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Sodium regulation:

 Factors stimulate the RAA system:

 1. sympathetic nervous system
 2. decreased filtration
 3. decreased stretch due to decreased BP.

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Renin-Anagiotensinogen- Aldosterone system:

 Renin is protolytic enzyme secreted from renal cell

in response to decrease blood volume which
convert the AG to AGI and then to AGII by action
of AC enzyme.
 AGII cause vasoconstriction to increase blood
pressure and stimulate secretion of ADH.

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 ADH increase Na reabsorption at the DCT in
exchange with H+ and K + .

 Aldosterone also stimulated Na reabsorption and

diminished urine output and increase blood volume
in response to high K + concentration.

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 Arterial natriuretic peptides: are polypeptide
hormone secreted by the cardiac cell in response to
atrial stretch receptors, it increase urinary excretion
and increase GFR.

 Dopamine and estrogen enhance Na reabsorption

by renal tubule.

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Nidal Yahya PhD student/IEDs Chemical Pathology Department
Sodium disorders:

 1. Hypernatremia :
 Is defined as an increased sodium concentration in
plasma water, and is generally diagnosed at serum
sodium levels >145 mmol/L.

 Hypernatremia is always associated with an

increased effective plasma osmolality, and hence
with a reduced cell volume.

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 Symptoms most commonly involve the CNS as a
result of the hyperosmolar state such as altered
mental status, lethargy, irritability, restlessness,
seizures, muscle twitching, hyper reflexes, fever,
nausea or vomiting, difficult respiration, and
increased thirst.

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Nidal Yahya PhD student/IEDs Chemical Pathology Department
Nidal Yahya PhD student/IEDs Chemical Pathology Department
2. Hyponatremia:
 Is defined as reduced plasma sodium concentration
to a value less than 135 mmol/L.

 The five most common causes of Hyponatremia are

overhydration, diuretics, SIADH, diabetic
hyperosmolarity and Addison’s disease.

Nidal Yahya PhD student/IEDs Chemical Pathology Department

Nidal Yahya PhD student/IEDs Chemical Pathology Department
Nidal Yahya PhD student/IEDs Chemical Pathology Department
Nidal Yahya PhD student/IEDs Chemical Pathology Department
Potassium:
 Is the major intracellular cation in the body, with a
concentration 20 times greater inside the cells than
outside.
 90% of K is free and exchangeable, the reminder is
bound in RBCs, bone and brain.
 Its also controlled by the Na-K-ATPase pump.

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 Dietary intake is 50-150 mmol/day.
 Its absorbed from the GIT with rapidly distribution
and small amount are taken by cell and the most is
excreted by the kidney.

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Functions of K:

 1. play an important role in nerve conduction.

 2. play an important role in muscle function.
 3. acid-base balance and osmotic pressure.
 4. . play an important role in heart contraction and
cardiac output.

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 Regulation of potassium in DCT affected by Na
intake, aldosterone stimulation and acid-base
balance.

Nidal Yahya PhD student/IEDs Chemical Pathology Department

Potassium disorders:

 1. Hypokalemia:
 Is a plasma K concentration below the lower limit
of the reference range.
 Hypokalemia can occur with GI or urinary loss of
K or with increased cellular uptake of K.

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 Symptoms of hypokalemia such as weakness,
 fatigue, and constipation.
 Hypokalemia can lead to muscle weakness or
paralysis, which can interfere with breathing.
 The dangers of hypokalemia associated with
cardiovascular disorders can increased the risk of
arrhythmia, which may cause sudden death in
certain patients.

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Nidal Yahya PhD student/IEDs Chemical Pathology Department
Hyperkalemia:

 Hyperkalemia may be caused by one of three

mechanisms:
 (1) shift of potassium from the cells to the ECF
 (2) increased potassium intake
 (3) reduced renal potassium excretion.

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 The most common cause of hyperkalemia in
hospitalized patients is due to therapeutic K
administration.
 In metabolic acidosis, as excess H moves
intracellularly to be buffered, K leaves the cell to
maintain electro neutrality.

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 Symptoms of hyperkalemia can cause muscle
weakness, tingling, numbness, or mental confusion
by altering neuromuscular conduction.
 Hyperkalemia disturbs cardiac conduction, which
can lead to cardiac arrhythmias and possible
cardiac arrest.

Nidal Yahya PhD student/IEDs Chemical Pathology Department

Nidal Yahya PhD student/IEDs Chemical Pathology Department
Nidal Yahya PhD student/IEDs Chemical Pathology Department
Nidal Yahya PhD student/IEDs Chemical Pathology
Department