1. chapter 3 Disturbance of water and electrolyte metabolism
Medical College of Henan University
Zheng Hong

2. Normal metabolism of water and electrolyte

3. Water and electrolytes balance
volume
composition
osmotic pressure
distribution
maintain relatively 
constant

4. Fluid of different groups of people
Body fluid
TBW (%)
Adult male
TBW(%)
Adult female
TBW(%) Infant
Normal 60 50 70
Lean 80
Obese 42

5. Total body water (TBW) 60%
Intracellular fluid (ICF)
40％
Extracellular fluid (ECF)
15％
Interstitial fluid(ISF) 5%
Plasma
Transcellular fluid(third space) 1％

6. The main distribution of body fluid and electrolyte
extracellular fluid:
Na+、Cl-、HCO3-
intracellular fluid：
K+、HPO42-

7. Positive ion: 151mmol/L Osmotic pressure of body fluid (plasma)
Negative ion: mmol/L total mmol/L
Nonelectrolyte: 10mmol/L (678.3kpa)
Plasma colloidal osmotic pressure:
3.72kpa(28mmHg)

8. Movement of water and electrolytes 1. plasma interstitial fluid
capillary protein
2. intra- and extra- cellular fluid
proteins and positive ion: permeability
water and negative ion: permeability
(water movement balance of osmotic pressure) R B C

9. Balance of body water Daily intake (ml/day) Daily output
Drinking
Urine
Water in food
Lungs
Water of oxidation
Skin
Stool
Total
Total

10. Regulation of water and sodium balance
Thirst
Antidiuretic hormone(ADH)
Aldosterone

11. Regulation of osmotic pressure and volume
Hypertonic thirst
of ECF
1.body water ADH ; aldosterone
sodium thirst
AngⅡ ADH
body volume aldosterone
receptor of volume
ADH
  2.body water
sodium ADH
reabsorption of sodium
3.blood volume ANP aldosterone(ADS)
tension
4.others ADH
pain

12. dehydration isotonic water excess isotonic hypotonic hypotonic
water and sodium disorders
hypertonic hypertonic
dehydration isotonic water excess isotonic
hypotonic hypotonic

13. Hypotonic dehydration
sodium loss ＞ water loss
serum sodium ＜ 130mmol/L
plasma osmotic pressure ＜ 280mOsm/L

14. 1) cause and Pathogenesis
excessive loss of water and sodium replaced with water only.
vomiting, diarrhea; burn; diuretics;
Addison’s disease (ADS ) ;
chronic renal failure; renal tubular acidosis
2) adaptive response and effect on body
①  movement of body fluid
ECF ICF cellular swelling
Blood volume
Extracellular fluid
Shock dehydrated signs edema of brain and lung

15.  ②  urinary alteration
urine specific urine
volume gravity [Na+]
early ADH ± or
stage ADS
  late ADH
stage ADS
(注：经肾失钠的低渗性脱水，尿钠不减少)

16. ① treating primary disease ② 0.9%NaCl
3) principles of treatment
①  treating primary disease
②  0.9%NaCl

17. Hypertonic dehydration
water loss ＞ sodium loss
serum sodium ＞ 150mmol/L
plasma osmotic pressure＞310mOsm/L

18. 1) cause and pathogenesis
lack of water(desert;sea)
①  intake
to drink inability(coma;baby)
lung: hyperpnea(hypoxia;acidosis) 
skin: fever; hyperthyroidism; sweat;
exposure to hot environment 
②  loss digestive tract: vomiting; diarrhea;
baby diarrhea([Na+]: 60mmol/L)
kidney: diabetes(ketosis);
diabetes insipidus
diuretic(mannitol;hypertonic glucose)

19. 2) effect on body
①   hypertonic of ECF thirst
②   movement of the body fluid
ICF ECF cell dehydration
Brain dehydration
Sleepiness subarachnoid space bleeding
Dehydration of sweat glands
dehydrated fever
dehydration of heat
regulating center

20. ③urinary alteration
urine specific urine
volume gravity [Na+]
early ADH
stage ADS ±
  late ADH
stage ADS  
3) principles of treatment
Water first, later sodium, and water is greater than sodium.

21. isotonic dehydration ① water loss ≈ sodium loss
② serum sodium = mmol/L
③ plasma osmotic pressure: mOsm/L
1) cause and pathogenesis
   ① vomiting; diarrhea; gastrointestinal suction;
biliary fistula; intestinal fistula
     ② ascitic fluid; pleural effusion

22. Supplement slightly lower hypotonic liquid.
2) effects on body
① slight thirst
② blood volume dehydrated signs; BP  
③ urinary alteration
urine specific urine
volume gravity [Na+]
early ADH
stage ADS
 late ADH  
3) principles of treatment
Supplement slightly lower hypotonic liquid.

23. brain cells swelling extracellular fluid excess 1. water intoxication
water intake , total sodium ±; ECF , ICF ;
hyponatremia; Serum sodium < 130mmol/L
1) cause
     excessive water intake
     renal loss (acute renal failure;
acute congestive heart failure)
2) effects on body
brain cells swelling
water moves into cells
pulmonary edema
3) principles of treatment diuresis

24. 2. Edema interstitial fluid fluid in the body cavities hydrops
fluid in the cells cellular edema
(1) pathogenesis
1)imbalance of exchange between intra- and extra-
body fluid (retention of water and sodium)
basic mechanism: glomerular-tubular imbalance
① GFR acute glomerulonephritis
heart failure
② reabsorption of proximal tubule
sympathetic nerve filtration fraction
ANP reabsorption of water and sodium

25. frank edema

26. Obstruction of lymphatic vessels

28. ③ reabsorption of distal tubule ADH , aldosterone
④ redistribution of renal blood flow
sympathetic nerves and renin
2) imbalance of exchange between intra- and
extra-vascular fluid
① capillary blood pressure
② plasma colloid osmotic pressure
③ permeability of capillary
④ obstruction of lymph
3) kinds of edema

29. Potassium Disorders

30. Preface: normal metabolism of potassium
1. normal serum potassium: mmol/L
2. distribution of potassium
ICF:98% (muscle:75%)
ECF: 2%
3. balance between intra- and extracellular K+
normal: 15 h
4. intake and loss of potassium
intake: food; loss: urine; feces; sweat

31. 5. influencing facter of potassium homeostasis
acidosis alkalosis
hypoxia serum insulin serum
damage of cells [K+] ADS [K+]
catabolism anabolism
distal flow rate distal flow rate

32. concept: serum potassium＜3.5mmol/L
Hypokalemia
concept: serum potassium＜3.5mmol/L
1.  cause and pathogenesis
①  intake fast
alkalosis
injection of insulin
② move into Barium poisoning
cells hypokalemic periodic
paralysis

33. GI: vomiting; diarrhea;
Gastrointestinal suction
Skin: excessive sweats
furosemide
diuretic
③ losses diamox
diuretic phase of ARF
ren: pyelonephritis
primary hyperaldosteronism
lack of magnesium
renal tubular acidosis

34. 3. effect on body 1) nerves and muscles excitability serum[K+]
hyperpolarization Et Em

35. 2) heart arrhythmia
0 mv
serum[K+] mv
-60mv
-90mv
depolarization

36. [K+]ECF K+ permeability depolarization
Excitability:
[K+]ECF K+ permeability depolarization
repolarization excitability
ECG T wave
Conductivity:
RP phase of AP  
conductivity conductive block
unidirectional block ECG P-R

37. Autorhythmicity:
Contractility: acute ; chronic
③ Ren polyuria (sensitivity of ADH )
④ GI smooth muscles (hyperpolarization)
⑤ acid-base balance (metabolic alkalosis) 
4. principles of treatment
supply potassium, po best.
Principle: The urine volume is normal to supplement potassium.

38. Concept: serum [K+]＞5.5mmol/L
Hyperkalemia
Concept: serum [K+]＞5.5mmol/L
1. cause and pathogenesis
acute renal failure
chronic renal failure GFR
① loss of shock
potassium
Addison’s disease
Anti aldosterone diuretics

39.  ②  K+ move out of cells
Acidosis; hypoxia; hemolysis; crush syndrome;
Hyperkalemia with periodic paralysis
      ③ intake of % KCl
potassium penicillin potassium
transfusion of bank blood
2.   effects on body
①   skeletal muscle
＜8mmol/L RP (depolarization) excitability
stabbing; tremor
＞8mmol/L RP inactivation of Na+ channel
depolarization paralysis

40. ② heart (hyperkalemia K+ permeability ) 5.5-7mmol/L→ RP → E
excitability
7-9mmol/L→ RP → E
T wave ; QT short
cardiac arrest
PR QT

41. Autorhythmicity: K+ out ward of phase 4
Spontaneous depolarization heart rate
Conductivity: RP Na+ inward of phase 0
conductivity conductive block
unidirectional block
Contractility : inhibition of Ca2+ inward flow
contractility
③ acid-base balance

42. 3.   principles of treatment
①  transfusion of insulin and glucose
②  transfusion of sodium bicarbonate
③  transfusion of calcium