SectionIIDisordersofWaterandSodiumMetabolism.ppt

Section II: Disorders of Water and Sodium Metabolism 一、 Classification According to the changes of volume: 1. Dehydration 2. Overhydration According to the changes of [Na+]e: 1. Hypernatremia 2. Hyponatremia 3.Normonatremia with changes of volume According to the clinic importance: (1) Dehydration 1) Hypertonic dehydration 2) Hypotonic dehydration 3) Isotonic dehydration (2) Overhydration 1) Hypertonic overhydration 2) Hypotonic overhydration (Water intoxication) 3) Isotonic overhydration (Edema) 二、Dehydration Dehydration脱水 (Hypovolemia) Concept: The volume of body fluid decreases below the normal range after the loss of body fluid. In dehydration the [Na+]e may be in three manifestations: --------------------------------------------------------------- Dehydration [Na+] Osmotic pressure (mmol/L) (mOsm/L) --------------------------------------------------------------- Hypertonic 150 310 Hypotonic 130 280 Isotonic 130~150 280~ 310 -------------------------------------------------------------- 1 Hypertonic Dehydration (1) Concept (2) Causes (3) Adaptive (compensatory) responses of the body (4) Characteristic effects (5) Principle of treatment 1 Hypertonic Dehydration (1) Concept Both water and sodium are lost (hypovolemia), but the water loss is in excess of salt loss. Then the volume of ECF is reduced, the [Na+] is over 150 mmol/L, the plasma osmotic pressure is over 310 mOsm/L. (2) Causes 1) Decreased water intake can be seen in: ① No water during navigation or in desert. ② No sense of thirst due to brain injury or coma, ③ Severe vomiting ④ Difficulty in swallowing because of esophageal diseases. ⑤ Underdose of infusion in treatment of patients 2) Increased loss of water ①via skin ②via