Disturbances of water and mineral balance. Edema
description
Transcript of Disturbances of water and mineral balance. Edema
Disturbances of water and mineral balance. Edema
Water Balance
Young men: 60-65% of body weight
Young women: 50-55% of body weight
Children under 1 year: 65-75% of body weight
A man over 60 years: 50% of body weight
Women over 60 years: 45% of body weightIn obese individuals, the water forms a smaller percentage than in thin
H2O
Water content in the body
TBW60-65%
(45 liters)
40-45%(30 liters)
20-23%(15 liters) 16% (12 liters)
4% (3 liters)
ECF/ICF=1/2
Plasma/IST=1/4
ECF
ICF
ISF
Plasma
Daily water balance
Liquids1 l
Food1 lMetabolism
0,5 l
Urine1-2 l
Stool0,1 l
Perspiration0,6-0,8 l
Respiration0,5 l
The excretion of urine
Feeling thirstysurplus
deficit
Major ions
ECF (extracellular fluid)
140 mmol/l Na+
104 mmol/l Cl-
24-27 mmol/l HCO3-
140 mmol/l K+4,3 mmol/l K+
12 mmol/l Na+
3 mmol/l Cl-
10 mmol/lHCO3-
ICF (intracelluar fluid)
The balance of sodium and chloride
Daily sodium balance
Food50-350 mmol
Urine50-350 mmol
Stool10 mmol
Sweat10 mmol
Daily balance of chloride
Food50-350 mmol
Urine50-350 mmol
Stool10 mmol
Sweat10 mmol
Osmotic balance in body fluids
<
Osmotic pressure
C1 C2 > = P2P1 > =
is related to the concentration of all dissolved particles
H2O
H2O
H2O
H2O
[H2O]1 [H2O] 2 =
Osmotic pressureis related to the concentration of dissolved particles
H2O
relative tothe weight of the solvent: osmolality (mmol/kg solvent)
H2O
H2O
H2O
H2O
H2O
H2O
HyperosmolalityHyperosmolarity
HyposmolalityHyposmolarity
the volume of solution : osmolarity (mmol/l solution).
Cell
Isotonic environment
Blood-vessel
Interstitial fluid
290 ± 10 mmol/l
Cell
Hypertonic environment
> 300 mmol/l
Blood-vessel
Interstitial fluid
H2OH2O
Hypertonic environment
> 300 mmol/l
Céva
Intersticium
Cell
Hypertonic environment
Cell
Isotonic environment
Blood-vessel
Interstitial fluid
290 ± 10 mmol/l
Cell< 280 mmol/l
Blood-vessel
Interstitial fluid
H2OH2O
Hypotonic environment
Cell
Hypotonic environment
< 280 mmol/l
Blood-vessel
Interstitial fluid
Blood-vessel
Cell
Interstitial fluid
Isotonic environmentHyperosmolarity due to the
rise of blood urea
290 ± 10 mmol/lTotal osmolarity > 300
Effective osmolarity = Total osmolarity – urea concentration
The balance of the capillary and its disorders
(water and soluti movement between plasma and interstitium)
Cell
Isotonic environment
290 ± 10 mmol/l
Blood-vessel
Interstitial fluid
H 20
Hydraulic
pressure gradient
Oncotic
pressure gradient
H 20
arteriolevenule Capillary
Oncotic pressure gradient
Hyd
raul
ic p
ress
ure g
radi
ent
Movement of the filtrate
Precapillarysphincter
Lymphatic drainage
Lymphatic drainage
proteins
proteins Interstitial fluid
arteriolevenule Capillary
proteins
proteins
Accumulation filtrate
in the interstitium
Increase hydraulic pressure gradient
Congestionin right cardiac
insufficiency
Oncotic pressure gradient
Hyd
raul
ic p
ress
ure g
radi
entLymphatic drainage
Lymphatic drainage
Precapillarysphincter
Interstitial fluid
Increased interstitial
counterpressure
Swelling
arteriolevenule Capillary
Precapillarysphincter
proteins
proteins
Oncotic pressure gradient
Hyd
raul
ic p
ress
ure g
radi
entLymphatic drainage
Lymphatic drainage
Interstitial fluid
Congestionin right cardiac
insufficiency
Increase hydraulic pressure gradient
arteriolevenule Capillary
Precapillarysphincter
proteins
proteins
Oncotic pressure gradient
Hyd
raul
ic p
ress
ure g
radi
entLymphatic drainage
Lymphatic drainage
Interstitial fluid
Decrease of oncotic pressure gradient
Movement of the filtrate
Decrease of oncotic pressure gradient
Accumulation filtrate
in the interstitium
Decrease of plasma proteins concentration
The accumulation of proteins
in the interstitium
Reduced lymphatic drainage
arteriolevenule Capillary
Precapillarysphincter
proteins
proteins
Hyd
raul
ic p
ress
ure g
radi
ent
Lymphatic drainage
Interstitial fluid
Prekapilárnísfinkter
arteriolevenule Capillary
Precapillarysphincter
Decrease of oncotic pressure gradient
Decrease of plasma proteins concentration
The accumulation of proteins
in the interstitium
Reduced lymphatic drainage
Increased interstitial
counterpressure
Swelling
proteins
proteins
Lymphatic drainage
Hyd
raul
ic p
ress
ure
grad
ient
Interstitial fluid
arteriolevenule Capillary
Precapillarysphincter
Movement of the filtrate
Oncotic pressure gradient
Hyd
raul
ic p
ress
ure g
radi
entLymphatic drainage
Lymphatic drainage
proteins
proteins Interstitial fluid
Inflammation
Dilation of capillaries
Inflammation
Dilation of capillaries
Incr
ease
of hy
drau
lic
capl
illar
y pr
essu
re
Increase of hydrauliccapillary pressure
arteriolevenule Capillary
Precapillarysphincter
Oncotic pressure gradient
Lymphatic drainage
proteins
proteins Interstitial fluid
Lymphatic drainage
Accumulation filtrate
in the interstitium
proteins
Reduction of oncotic pressure gradient
Accumulation of macromolecularproducts of inflammatory reactions
Increased capillary permeability
arteriolevenule Capillary
Precapillarysphincter
Inflammation
Dilation of capillaries
Incr
ease
of hy
drau
lic
capl
illar
y pr
essu
re
Increase of hydrauliccapillary pressure
Interstitial fluid
Accumulation filtrate
in the interstitium
Lymphatic drainage
proteins
arteriolevenule Capillary
Precapillarysphincter
proteins
Reduction of oncotic pressure gradient
Accumulation of macromolecularproducts of inflammatory reactions
Increased capillary permeability
Inflammation
Dilation of capillaries
Incr
ease
of h
ydra
ulic
capl
illar
y pre
ssur
e
Increase of hydrauliccapillary pressure
Interstitial fluid
Accumulation filtrate
in the interstitium
Lymphatic drainage
proteins
arteriolevenule Capillary
Precapillarysphincter
proteins
Reduction of oncotic pressure gradient
Accumulation of macromolecularproducts of inflammatory reactions
Increased capillary permeability
Inflammation
Dilation of capillaries
Incr
ease
of hy
drau
lic
capl
illar
y pr
essu
re
Increase of hydrauliccapillary pressure
Interstitial fluid
Lymphatic drainage
proteins
Increased interstitial
counterpressure
Swelling
Control volume and osmolarity
Volume - is detected by atrial tension in the wall (low-pressure baroreceptors),by tension in the artery wall and in the glomus caroticus the aortic arch (high-receptors)
Osmolarity – is detected by osmoreceptors in the hypothalamus and possibly also liver
Control volume related to regulation of circulating blood volume and thus with hemodynamics (particularly with the regulation of arterial pressure)
Control volume and osmolarity closely related to regulation of sodium excretion (sympaticus, aldosterone, ANF) and control urine osmolarity (ADH)
Therefore, we are talking about so-called "effective circulating volume"
atriaLow pressure
baroreceptorsaortic arch
juxtaglomerul.appatus
High pressurebaroreceptors
glomuscaroticum
Osmoreceptorsanterolateral hypothalamus
ADHEffective circulating volume
Sympatheticand parasympathetic
Atrialnatriuretic
faktorRenin
atria
Angiotensinogen Angiotensin I
Angiotensin IIAngiotensin III
Adrenal
corte
x
Converting enzyme(endothelial cells in lung)
Aldosterone
High pressurebaroreceptorsin vas afferens
NaCl deliveryto macula densa
Sympathetic
activity
The tension in atrial wall
atrial rate
Feeling thirstyAn
giot
ensi n
I I in
crea
ses t
he se
nsi ti
vit y
osm
orec
epto
rs liver osmoreceptors?
Low pressure baroreceptors
High pressurebaroreceptors
Liverosmoreceptors
?
Angiotensin II
nucleusparaventricularis
osmoreceptors
+
Plasma osmolarity
-pressure risepressure drop
+
++
nucleussupraopticus
capillary
neurohypophysisADH
vagusNausea,vomiting
+
-
Alcohol
Enkephalin
glucocorticoids
Dopamin+
Hypoxiahypoglycemia
+
---
ADH
[pg/
ml]
270 275 280 285 290 295 300Plasma osmolarity
[mOsm/l]265
5
10
Hypovolemia
Normal
effec
tive ci
rculati
ng vo
lume
Hypervolemia
The feeling of thirst in hypovolemia
Feeling thirsty at normal volume
ADH
[pg/
ml]
-10% -20% -30%
5
10
15
b
ADH is mainly regulated by osmolarity, less by volume
Decrease of the effectivecirculating volumeat normal osmolarity
Na+ excretion in the kidney
Na+Decreased effective circulating volume
Brain
ADH
Renin
Angiotensin I
Lungs
Angiotensin II
Adrenal cortex
AldosteroneH2O a Na+
excretion
GFR
Na+ resorption
Na+ resorption
H2O resorption
Sympathetic activity
Atrial Natriuretic Faktor
Heart
Na+ resorption
Na+Euvolemia Delivery
Na+Euvolemia
ECF VolumeDelivery DeliveryEffective circulating volume
Na+Increased effective circulating volume
Sympathetic activity
Atrial Natriuretic Faktor
Heart
Brain
ADH
Renin
Angiotensin I
Lungs
Angiotensin II
Adrenal cortex
AldosteroneH2O a Na+
excretion
GFR
Na+ resorption
H2O resorption
H2O resorption
Na+ resorption
Na+Euvolemia Delivery
Na+Euvolemia Delivery Delivery
ECF Volume
Effective circulating volume
H+ -ATPase
H+
karboanhydrase
CO2
H2O
H+
OH-
HCO3-
HCO3-
-intercalar cells
Cl-
Cl-
Na+ K+
Na+-K+
ATPase
K+Na+
Cl-
Cl-Na+ K+
Aldosterone
NH3 NH4+
HCO3- CO2
HPO42- H2PO4
- (titratable acids)
HCO3- Cl-
H+ -ATPase
H2OH+
OH-
CO2
HCO3-karboanhydrase
Cl-
Cl-H+b-intercalar cellsPrincipal cells
lumen
++ +
+
Cl-
+
-+
-
Question
Why in healthy people with reducing the volume of extracellular fluid and subsequent activation of renin-angiotensin-aldosterone system are not lost potassium?
K+ secretion
Stimulus:
Effective circulating volume
Na+ reabsorption(proximal tubule)
Flow rate of urine in the tubule
Reabsorption of Na+
(collecting ducts)
Aldosterone
+ +
-
+
K+secretion (collecting ducts)Does not change
Effective circulating volume
Na+ reabsorption(proximal tubule)
Flow rate of urine in the tubule
Reabsorption of Na+
(collecting ducts)
Aldosterone
K+secretion (collecting ducts)
+
+
+
Stimulus: 1. diuretics
2. osmotic diuresis +
Question
What is the regulatory importance of atrial natriuretic factor?
ANF acts as a safety valve when the compensatory increase in circulating blood
volume
Moving water from intravazálníhointo the interstitial space
Congestion - increase in secondarycapillary pressure
Activation of renin-angiotensin-aldosterone
system
Water retention in the kidneys
Heart filling in diastole
Cardiac output
Effective circulating volume
Venous filling
Heart failure
ANF
Reply to approximately 4 minutesThe safety valve!
The regulatory response to approximately 100 minutes
Transfers of water between the ICF and ECF
Osmolarity disorders
H2O
a) Cells in the hypertonic environment
Osmotic shift of water from cells
Reducing the volume of cells
H2O
H2O
a) Cells in the hypertonic environment
Osmotic shift of water from cells
Reducing the volume of cells
Active increase in osmotic pressurein the cell and subsequent transfer of water
Cell volume increases slightly
H2CO3
CO2
HCO3-H+
Na+ H+Cl-
Na+
Cl-
2Cl-
Na+
K+H2OResponding cells- income soluti
Rise of intracellular osmolarity
Suck in water
Hype
rton
ic c
ell e
nviro
nmen
t
H2O
HCO3-
H2O
Organic osmoles
Slow fall in the PNa
Organic osmoles K+ + A-
Organic osmoles K+ + A-
Organic osmoles K+ + A-
Skull
Normal brain cell volume
Blood vessels
Raise the PNa
H2O
Adaptive changes
Organic osmoles K+ + A-
Rapid fall in the PNa
H2O
H2O
Shrunken brain cells;
stretched blood vessel may rupture
H2O
K+ + A-
Organic osmoles K+ + A-
Organic osmoles
Brain cell volume ist almost normal
Increased brain volume
H2O
Herniate
H2O
b) Cell in hypotonic environment
Osmotic movement of water into the cell
Increasing the volume of cells
H2O
H2O
b) Cell in hypotonic environment
Osmotic movement of water into the cell
Increasing the volume of cells
Active reduction of osmotic pressurein the cell and subsequent transfer of water
Cell volume is somewhat reduced
Cl-
Cl-
Cl-
K+
K+
Cl-
K+
K+
Loss of solutiDecrease in osmolarity
Water loss
Hypo
toni
c ce
ll en
viro
nmen
t
H2O
Responding cells- Loss of soluti
H2O
Organic osmoles
Skull
Normal brain cell volume
Acute fall in PNa
H2O
Swollen brain cells and
higher intracranial
pressure
H2O
H2O
Rapid rise in the PNa
H2O
Slow rise in the PNa
Organic osmoles K+ + A-
Organic osmoles K+ + A-
Adaptive changes
Organic osmoles K+ + A- K+ + A-
Organic osmoles K+ + A-
Organic osmoles
Brain cell volume ist almost normal
Osmotic demyelinisation due
to cell volume shrinkage
H2O
Extravascular fluid Dehydratation
hypertonic isotonic hypotonic
Hyperhydratation hypotonic isotonic (hypertonic)
Disorders of the volume and osmolarity
Itravascular fluid• hypovolemia
shock• hypervolemia
Renal failure and water intake
Clinical signsHct, Hb,Tot.pl.prot.
Plasma Na+
PlasmOsm.
MCV
Dehydratationhyperosmoticisoosmoticnormoosmotic ↑ ↑
normal↓
↓normal
↑
Hyperhydratation
hypoosmoticisoosmotichyperosmotic
↓ ↓normäl
↑
↑normal
↓
Dehydratation
Dehydratation• Hypotonic (hypoosmolar)• Isotonic (isoosmolar)• Hypertonic (hyperosmolar)
• Hypotonic (hypoosmolar)• Isotonic (isoosmolar)• Hypertonic (hyperosmolar)
Hyperhydratation
Water loss
Soluti loss
Water retention Soluti
retention
volume
Water retention Water
loss
osmolarity
Euvolemia• Hypotonic (hypoosmolar)• Isotonic – normal fysiology state• Hypertonic (hyperoosmolar)
Isotonic dehydratationECT ICT
Initial stateCause: loss of isotonic fluid
(the same loss of water soluti)
Loss of isotonic fluid from the ECF does not displace the water between the ICF and ECF
Isotonic hyperhydratationECT ICT
Initial stateCause: isotonic fluid retention (the same water retention and soluti)
Retention of isotonic fluid from the ECF does not displace the water between the ICF and ECF
H2O
Solutes
H2O
Soluti
Hypotonic dehydratation
H2O
H2O
Cause: The greater solute loss than water
loss
ECT ICT
Initial state
Start failure
Osmotic equilibrium-increasing volume of ICF
Compensatory reduction in osmolarity in ICF ...
leads to a shift of water from ICF ...
…and to correction of increased volume of ICT
H2OSolutes
The active changes in
cellular osmolarity occurs
mainly in brain tissue
Hypertonic dehydratation
H2O
H2O
Cause: more water loss than the solute
loss
ECT ICT
H2O
Initial state
Start failure
Osmotic equilibrium, reducing the volume of ICF
Compensatory increase in osmolarity in ICF ...
…leads to water movement in ICF ...
…and to correction of reduced volume of ICT
Solutes
The active changes in
cellular osmolarity occurs
mainly in brain tissue
Hypertonic hyperhydratation
H2O
Cause: more soute retention than water
retention
ECT ICT
Solutes
Initial state
Start failure
Osmotic equilibrium, reducing volume of ICF
Compensatory increase in osmolarity in ICF...
…leads to water movement in ICF ...
... and to correction of reduced volume of ICF
H2O
H2O
H2O
The active changes in
cellular osmolarity occurs
mainly in brain tissue
Hypotonic hyperhydratation
Cause: The greater water retention than
soluti retention
ECT ICT
Initial state
Start failure
Osmotic equilibrium-increasing volume of ICF
Compensatory reduction in osmolarity of the ICF ...
leads to a shift of water from ICF ...
and to correction of increased volume of ICF
H2O
H2O
Solutes
H2O
The active changes in
cellular osmolarity occurs
mainly in brain tissue
Isotonic hyperhydratationECT ICT
Initial state
H2OSolutes
H2OEdema
Congestive heart failure Cirrhosis of the liver Nephrotic syndrome
Cardiac output
Capillary pressure
Effective circulating volume
Transfer of fluid from intravascular space ino ISF
Ascites
AlbuminAlbumin
SympatheticRenin - angiotensin - aldosterone
Na+ reabsorption in the kidney
Edema (hyperhydration)
Glomerular filtrationPrimary Na+ reabsorpce
Primary renal disease Primary reninPrimary aldosterone
Angiotensin 2
Aldosteron
Na+ reabsorption
Na+ and water retention in the kidneys
Edema, hypertension(hyperhydratation)
H2OWater deficitSolutes retention
(relative or absolute)
solutes
Causes of hyperosmolarity
H2O
Water retention
(relative or absolute)
Solutes deficit
solutes
Causes hyposmolarity
Na+ H2ONa+ H2O
Na+
H2O
Na+H2O
Na+ H2O
Na+H2O
Na+
H2O
Na+H2O
Na+ H2O
isovolemia hypervolemiahypovolemia(dehydratation)
hypernatremia
hyponatremia
normonatremia(140 mmol/l)
Na+ H2ONa+ H2O
Na+
H2O
Na+H2O
Na+ H2O
Na+H2O
Na+
H2O
Na+H2O
Na+ H2O
Plas
ma
Na+ c
once
ntra
tion
Extracellular dehydratation Extracellular edema
hypernatremia
hyponatremia
normonatremia(140 mmol/l)
K+ - main itracellular cationt
Potassium and Acid-Base
H+
Na+
K+
K+
H+
metabolismus
Na+2
+
4
5
[Na+]e-[Na+]i
+1 + +-
3
K+
H+
K+
Exchange H+/K+ a H+/Na+ in acidemia with acumulation of
organic acids
Na+ Na+
b) A acidemia, with accumulation of organic acids
Na+
K+
K+
H+
metabolism
H+
H+
Na+
K+
K+
H+
metabolism
H+
H+H+
K+K+
Anion-
Anion -
H-Anion
Exchange H+/K+ a H+/Na+ in acidemia
1
4
2
1
2
Na+Na+
a)acidemia, without accumulation of organic acids
5
Na+3
3
Na+
K+
K+
H+
metabolism
H+
K+
H+
K+
H+
H+/K+ a H+/Na+ exchange in alkalemia
a) Alkalemia without kalium depletion
1
2
3 4
5 6
Na+
Na+Na+
K+
H+
K+H+
H+/K+ a H+/Na+ exchange as a result of kalium depletion
H+
Na+
K+
K+
H+
metabolism
12
67
3Na+
Na+Na+
5
[Na+]e-[Na+]i
4
Na+
K+
K+
H+
metabolism
H+
K+
H+
K+
H+
H+/K+ a H+/Na+ exchange in alkalemia
1
2
3 4
5 6
Na+
Na+Na+
a) Alkalemia as a result of kalium depletiona) Alkalemia without kalium depletion
1
K+mmol/l
6,9
2
3
4
5
6
7
8
7,0 7,1 7,2 7,3 7,4 7,5 7,6 7,7 7,8 pH
Normal kalemia rangeA
K+
H+ H+
K+
A: Norm
B
K+
H+ H+
K+
B: Acidemia - exchange K+ / H+
K+
C
K+
H+ H+
K+
C: long lasting acidemia - K+ depletion
K+
D
K+
H+ H+
K+
D: Rapid alkalinization - H+/K+ - dangerous hypokalemia
K+
From -3% to 37%
Normal or increased intake of potassium
from 5% to 30%
33%
Normal intake of potassium
K+
13%
10%
3%
15%
33%
13%
From 10% to 50%
15%15% - 80%
Potassium depletion
K+
33%
Normal intake of potassium
13%
10%
3%
15%
33%
13%
10%
15% 1%
H+ -ATPase
H+
karboanhydrase
CO2
H2O
H+
OH-
HCO3-
HCO3-
-intercalar cells
Cl-
Cl-
Na+ K+
Na+-K+
ATPase
K+Na+
Cl-
Cl-Na+ K+
Aldosterone
NH3 NH4+
HCO3- CO2
HPO42- H2PO4
- (titratable acids)
HCO3- Cl-
H+ -ATPase
H2OH+
OH-
CO2
HCO3-karboanhydrase
Cl-
Cl-H+b-intercalar cellsPrincipal cells
lumen
++ +
+
Cl-
+
-+
-
K+K+
Diuretics (Furosemid)
Large delivery of sodium in CCD (e.g. in osmotic diuresis) Low chloride in CCS
Hyperaldosteronism
Potassium depletion
Catabolism
Long lasting acidemia
Intracellular acidosis in proximal tubuleK+
H+
H+
Enhanced resorption Cl-
Enhanced resabsorption
Cl-
Effect of hypokalemia on
ECF volumeECF
Enhanced resorption HCO3
-
K+K+
Oliguric phase of acute renal failure
Hypoaldosteronism(m. Addisoni)
Potassium retention
Tubular damage(e.g. interstitial nephritis, diabetic nephropathy)
Vomiting
No acid-base changes
Stomach
CO2 H2O
HCO3-
H+
Cl-
Cl-
CO2 H2O
HCO3- H+
Cl-
CO2
H2O
Balanced
Duodenum and pancreas
Normal state
H+
HCO3-
retention
H+ loss
Chloride loss
Hypochloremic alkalosis
Stomach
CO2 H2O
HCO3-
H+
Cl-
Cl-
CO2 H2O
HCO3- H+
Cl-
CO2
H2O
Unbalanced
Duodenum and pancreas
Vomitoing
H+
Cl- H+
HCO3-
Hypotonic fluid loss
Hypertonic dehydratation
H+Cl-
H+K+
K+H+
K+H+
Paradoxal urine acidification
Potassium depletion
Increases lossse ofn
Intracellular fluid
Primary cause: Losses of Cl- a H+
by vomiting
Metabolic alkalosis
H+
Cl-
K+
K+
H+
Na+Glomerulal filtration
(hypochloremic alkalosis)
Increased exchange Na+ with K+ and Na+ with H+
Excretion of potassium increases,acidification of urine regardless of alkalosis
Na+Glomerular filtraton
(norm)
Readsorbtion of sodium and chlorides
Depletion of chlorides
Cl-
Cl-
Na+
Na+
Remnant of sodium is exchanged with and H+
K+
K+
H+
H+
NH4+
Na+/Cl- reabsorbtion is diminished
Cl-
Na+
Na+
Diarrhoea
Na+ Cl- H2O
HCO3-
NHE AE
CO2 + H2O
H+
HCO3-H+
H+HCO3
-
CO2 + H2O
Na+ Cl-
Na+
Cl-
H2O
Normal state: reabsorbiton NaCl + water in colon
Na+ Cl- H2O
HCO3-
NHE AE
CO2 + H2O
H+
HCO3-H+
H+HCO3
-
CO2 + H2O
Na+ Cl-
Na+
Cl-
H2O
Increased delivery (H2O, Na+, Cl-) to colon
Increased NHE and AE transport
Na+ Cl-
H2O
HCO3-
AE
CO2 + H2O
H+
HCO3-H+
H+HCO3
-
CO2 + H2O
Na+ Cl-
Na+
Cl-
H2O Na+
HCO3-
NHE
Cl- HCO3-
H2O
K+
AE has a lager capacity then NHE
Delivery (H2O, Na+, Cl-) to colon is higher then capacity of colon reabsorbtion -> diarhoea
Alkalic diarrhoea
Hypotonic fluid loss
Hypertonic dehydratationHyperchloremic acidosis
HCO3-
Severe alkalic diarrhoea
Hyperchloremic acidosis
HCO3-
Potassium loss
Hypotonic fluid loss
Hypertonic dehydratation
Acute volume changes and acid-base disturbances
CO2
H2O
H2CO3
HCO3
H+
Buf -
HBuf
-
TA + NH4+
CO2 balance
H+ balance
Normal state
CO2
H2O
H2CO3
HCO3
H+
Buf -
HBuf
-
TA + NH4+
Buffers system acid-base disturbances:Dilutional acidemia
Dilution
CO2 balance
H+ balance
CO2
H2O
H2CO3
HCO3
H+
Buf -
HBuf
-
TA + NH4+
equilibrium shift
CO2 balance
H+ balance
Buffers system acid-base disturbances:Dilutional acidemia
Dilution
CO2
H2O
H2CO3
HCO3
H+
Buf -
HBuf
-
TA + NH4+
CO2 balance
H+ balance
Normal state
CO2
H2O
H2CO3
HCO3
H+
Buf -
HBuf
-
TA + NH4+
CO2 balance
H+ balance
Hemoconcentration
Buffers system acid-base disturbances:Contractional alkalemia
CO2
H2O
H2CO3
HCO3
H+
Buf -
HBuf
-
TA + NH4+
CO2 balance
H+ balance
Hemoconcentration
Buffers system acid-base disturbances:Contractional alkalemia
equilibrium shift
equilibrium shift