Disorders of Fluid and eletrolyte Metabolism  2005-3-10 Huashan Hospital,Fudan University Water and Sodium Metabolism Control of water excretion Control of sodium excretion Hyponatremia and hypernatremia Control of Water Excretion Regulation of thirst Antidiuretic hormone Control of Sodium Excretion Nephron segmental reabsorption Regulation of sodium balance Nephron Segmental reabsorption Glomerulotubular balance Proximal tubule Henle’s loop Distal convoluted tubule Collecting tubule Regulation of Sodium Balance Extrarenal mechanisms intrarenal mechanisms Extrarenal mechanisms Renal nerves Renin-angiotensin System Atrial natriuretic peptide Vasopressin Endogenous Na-K-ATPase inhibitors intrarenal mechanisms Renal hemodynamics Physical factors Prostaglandins Kallikrein-kinin system Endothelium-derived factors Hyponatremia Etiology and classification Clinical features Treatment Etiology and Classification Isotonic hyponatremia Hypertonic hyponatremia hypotonic hyponatremia Isotonic hyponatremia Pseudo-hyponatremia Hyperlipidemia hyperproteinemia Hypertonic hyponatremia Hyperglycemia Hypertonic infusion hypotonic hyponatremia Hypovolemic hyponatremia Hypervolemic hyponatremia Isovolemic hyponatremia Hypovolemic hyponatremia GI loss Skin loss 3rd space Renal loss Adrenal insufficiency Hypervolemic hyponatremia CHF Liver damage nephrosis Isovolemic hyponatremia Water intox Renal failure SIADH Reset osmostat Clinical Features Neurologic manifestation Headache Nausea Vomiting Weakness Seizures coma Treatment Increase serum sodium by 1-2mM/h Diuretic--people unable to excrete dilute urine hypernatremia Etiology and classification Clinical features Treatment Etiology and Classification Hypovolemic hypernatremia Hypervolemic hypernatremia Isovolemic hypernatremia Renal Potassium Handling Potassium-aldosterone feedback system Plasma pH Volume expansion-increased urinary flow rate Antidiuretic hormone Extrarenal Control of Potassium Insulin Catecholamines Aldosterone Parathyroid hormone Acid-base balance Drugs hypokalemia Etiology Clinical features Treatment Etiology Hypokalemia secondary to transcellular redistribution Hypokalemia with potassium depletion Hypokalemia With Potassium depletion Renal loss Inadequate intake Sweat loss Gastrointestinal tract loss Clinical Features Fatigue, weakness, myalgia Arrhythmias Constipation Polyuria ECG changes Treatment Oral replacement Therapy for specific causes * Hypovolemic hypernatremia GI loss Skin loss Renal loss Adrenal insufficiency Hypervolemic hypernatremia Iatrogenic Mineralocort excess Isovolemic hypernatremia diabet Reset osmostat Iatrogenic Skin loss Clinical Features Neurologic manifesttation hypertonia hyperreflexia Intracranial bleeding high fever Seizures coma Treatment decrease serum sodium by 0.5mM/h Diuretic potassium Metabolism Control of potassium excretion Hypokalemia and hyperkalemia Control of potassium Excretion Renal potassium handling Extrarenal control of potassium * * *