Electrolyte Disorders - CatsTCMNotes：电解质紊乱catstcmnotes.pptVIP

Electrolyte Disorders WS04111: WTD3 Water Metabolism Water intake regulated by: Thirst is the response to water loss ADH release center is close to the thirst center Water loss regulated by: Proximal renal tubular absorption (reabsorbs 125 L/day of the 200 L/ day filtered by glomerulus) Loop of Henle- absorbs sodium and dilutes urine (only sodium is reabsorbed) Collecting duct- controlled by ADH- affects the total amount of urine excreted Sodium Imbalance: Hyponatremia (Low Sodium) (fig.21-1) Hypovolemia:- Dehydration/ Diarrhea/Vomiting Renal Salt loss:- Diuretics/ ACE inhibitors Hypervolemic:- CHF/ Liver disease/ Nephrotic syndrome/ ESRD (ESRD = end stage renal disease) Sodium Imbalance: Hyponatremia Signs and Symptoms Mild ones (130-135) usually asymptomatic (125-130) Nausea and malaise (115-120) Headache/ Lethargy/ Disorientation Red flag: seizure/ coma cardiac arrest/ death Sodium Imbalance: Hyponatremia- Treatment Replace fluid with iv-0.45% sodium chloride (half normal saline) Asymptomatic cases- Water restirction Fludrocortisone Hypernatremia Only when sodium levels are greater than 155- clinically significant effects are seen Decreased fluid intake Increased skin loss Increased GI loss (due to loss of water) Renal- ‘osmotic’ diuresis- (hyperglycemia)/ lack of ADH Renal- drugs- lithium Hypernatremia- symptoms and signs Depression, confusion, coma, convulsions Therapy: Free water by mouth IV 5% dextrose Vasopressin/ Thiazides (increase proximal tubular reabsorption of water- reduces water delivery to distal tubule and helps) Sodium Metabolism Primary osmotic agent (mostly ECF) Distal tubule and collecting duct are major regulators of urinary sodium output ?Hormones- Aldosterone (increases sodium reabsorption) controlled by Renin- Angiotensin Atrial natriuretic peptide/ Dopamine/ Prostaglandins- inhibits Na reabsorption CHF-Liver-Nephrotic syndrome-CRF- Steroid- all lead to Na retention Urine sodium excretion less than 20