WATER-ELECTROLYTE BALANCE Causes, Mechanisms and Symptoms in Different Types of Dehydration Disorder Causes Isotonic Loss of plasma (burns

s of total body, traumatic shock) dehydration Blood loss Loss of fluid to the potential spaces of the body (intestine, pleural and peritoneal cavities) Polyuria (renal failure, diuretics) Hypertonic Profuse perspiration (loss of hypotonic solution) dehydration Polyuria: Deficiency of ADH diabetes insipidus Diabetes Mellitus Diuretics Decreased ingestion of water: Disability (coma, young babies) Disasters Disturbed absorption in the GI system (diarrhea) Hypotonic Decreased absorption of Na: dehydration Low sodium diet Disorders of GI system Loss of Na: Diarrhea, perspiration (if compensated with water only) Polyuria in renal diseases Hypoaldosteronism, diuretics, that cause loss of Na ADH antidiuretic hormone; NS nervous system; GI gastrointestinal.

Mechanisms and appearances Hypovolemia in all types of dehydration results in: Tachycardia Decreased central venous pressure, arterial hypotension Decreased brain blood supply (syncope, dizziness) Decreased heart blood supply (fatigue) Hyperosmolarity causes water to flow out of the cells. Cellular dehydration results in: Thirst and ingestion of water Increased release of ADH and water retention (oliguria) Dry and inflamed mucosa Decreased loss of heat (because of dry skin) Disorders of the NS (apathy, sleepiness, excitement, convulsions, up to coma and death) Hypoosmolarity causes water to flow into the cells. Cellular edema results in: Severe hypovolemia and results of it Lack of cellular dehydration does not activate center of thirst, no water is ingested Increased pressure of the cerebrospinal fluid Brain disorders (headache, vomiting, disorders of consciousness)

WATER-ELECTROLYTE BALANCE Causes, Mechanisms and Symptoms in Different Types of Hyperhydration Disorder Causes Isotonic Uncontrolled infusion of isotonic NaCl solution hyperhydration Edema Impaired renal function (decreased glomerular filtration) Hypertonic Ingestion of excess NaCl (high salt diet, drinking sea hyperhydration water in ship-wreck) Uncontrolled infusion of hypertonic solutions Decreased excretion of Na+ in urine: Decreased glomerular filtration Renal failure Hyperaldosteronism Hypotonic Excess formation of water after metabolizing of glucose hyperhydration (infusion of glucose solutions) Decreased excretion of water: Inappropriate secretion of ADH by tumor cells Renal failure ADH antidiuretic hormone; NS nervous system; GI gastrointestinal.

Mechanisms and appearances Hypervolemia in all types of hyperhydration results in: Hypertension Edema (brain or lung edema could be life threatening) Hyperosmolarity causes water to flow out of the cells. Cellular dehydration and hyperosmolarity result in: Thirst and ingestion of water Release of ADH followed by water retention (oliguria) Additional increase of extracellular volume Hyperosmolarity of interstitial fluid results in edema Disorders of the NS Hypoosmolarity causes water to flow into the cells. Severe cellular edema results in: Increased pressure of the cerebrospinal fluid Brain disorders (headache, vomiting, disorders of consciousness)

WATER-ELECTROLYTE BALANCE Laboratory Tests to Asses Water Electrolyte Balance. Disorder Protein (S) Hct Na (S) Isotonic hyperhydration Isotonic dehydration Hypotonic hyperhydration Hypotonic dehydration Hypertonic hyperhydration Hypertonic dehydration

Omolarity (S)

MCV

S Serum; Hct Hematocrite (% of volume of red blood cells from the whole blood volume); MCV Mean Corpuscular Volume (mean size of red blood cells). In isotonic disorders MCV is normal. In hypertonic disorders water leaves the cells to equalize osmotic pressure in the extracellular and intracellular fluid, thus the cells shrink (decreased MCV). In hypotonic disorders water flows from the extracellular compartment into the cells, thus causing the cells to swell (increased MCV).