山东大学基础医学院：《病理生理学 Pathophysiology》课程PPT教学课件（7年制）02 water and electrolyte disorders 水和电解质紊乱

Water and electrolyte di isorders

Water and electrolyte disorders

水、电解质代谢的生理基础 )体液 1.体液及其分布 Intracellular fluid Total (ICF)40% (60 interstitial fluid 15% extracellular fluid plasma 5% (ECF)20% transcellular fluid 2% (透细胞液)

一、水、电解质代谢的生理基础 (一) 体液 1. 体液及其分布 Intracellular fluid Total (ICF) 40% (60%) interstitial fluid 15% extracellular fluid plasma 5% (ECF) 20% transcellular fluid 2% (透细胞液)

2.体液中主要电解质及其分布 extracellular fluid. Na+、CI、HCO3 intracellular fluid K+、HPO4 在Na+-K+- ATPase作用下,细胞内外Na+、 K+保持不对等分布

2. 体液中主要电解质及其分布 extracellular fluid: Na+ 、Cl-、HCO3 - intracellular fluid： K+ 、HPO4 2- 在Na+- K+-ATPase作用下，细胞内外Na+ 、 K+保持不对等分布

3. Osmotic pressure of body fluid (plasma) Positive ion 151mmoVL Negative ion: 139 mmol/L /total 280-310mmol/L Nonelectrolyte: 10mmol/L (678.3kpa) Plasma colloidal osmotic pressure 3.72kpa(28mmHg

3. Osmotic pressure of body fluid (plasma) Positive ion: 151mmol/L Negative ion: 139mmol/L total 280-310mmol/L Nonelectrolyte: 10mmol/L (678.3kpa) Plasma colloidal osmotic pressure: 3.72kpa(28mmHg)

(= movement of water and electrolytes 1. plasma interstitial fluid capillary protein RBC 2. intra- and extra- cellular fluid proteins and positive ion: permeability t water and negative ion: permeability (water movement- balance of osmotic pressure)

（二） 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

3. Balance of body water and sodium drink 1200ml water intake food 1000ml (2000-2500ml) oxidation 300ml balance of water urine 1200-1500ml water loss skin 500ml (2000-2500ml respiration 350ml feces 150ml Balance Intake/d 100-200mmol (digestive tract) of sodium Loss/d 100-200mmol (urinary system) ECF: 50% Distribution ICF: 10% of sodium骨基质:40%(正常血清钠:130-150mmo)

3. Balance of body water and sodium drink 1200ml water intake food 1000ml (2000-2500ml) oxidation 300ml balance of water urine 1200-1500ml water loss skin 500ml (2000-2500ml) respiration 350ml feces 150ml Balance Intake/d 100-200mmol (digestive tract) of sodium Loss/d 100-200mmol (urinary system) ECF:50% Distribution ICF: 10% of sodium 骨基质:40% (正常血清钠:130-150mmol)

()Regulation of osmotic pressure and volume Hypertonic thirst 1. body water// of ECF ADHt; aldosterone↓ sodium个 thirst AngI'ADH↑ body volume↓ aldosterone↑ receptor of volume e ADH↑ 2. body water f sodiun↓」ADH reabsorption of sodium I 3. blood volume →→ ANPt t aldosterone(ADS)↓ tension 4. others ADH↑ pain

(三) Regulation of osmotic pressure and volume Hypertonic thirst of ECF 1.body water ADH ; aldosterone sodium thirst Ang Ⅱ 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

Figure: regulation ofaDH secretion oSmotic pressure R pressure r ADH volume r heart

Figure: regulation of ADH secretion osmotic pressure R pressure R ADH volume R heart

二、 water and sodium disorders hypertonic hypertonic dehydration isotonic water excess isotonic hypotonic hypotonic ()细胞外液容量不足( extracellular fluid deficit 1. Hypotonic dehydration sodium loss water loss serum sodium 130mmolL plasma osmotic pressure 280m0sm/L

二、water and sodium disorders hypertonic hypertonic dehydration isotonic water excess isotonic hypotonic hypotonic (一) 细胞外液容量不足(extracellular fluid deficit) 1. Hypotonic dehydration sodium loss ＞ water loss serum sodium ＜ 130mmol/L plasma osmotic pressure ＜ 280mOsm/L

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 O movement of body fluid ECF- ICF cellular swelling Blood volume↓ Extracellular fluid↓ Shock dehydrated signs edema of brain and lung

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