Water and salt metabolism Water and salt metabolism-Kazda A.pdf
- 1. WATER AND SALT WATER AND SALT METABOLISM METABOLISM METABOLISM METABOLISM A. Kazda A. Kazda
- 2. Water and electrolytes Water and electrolytes
- 5. Concentration of ions in body fluids Ions plasma mmol/l Interstitial fluid mmol/l Intracellular fluid mmol/l Na+ 141 143 10 K+ 4 4 155 Ca 2,5 1,3 <0,001 Mg 1 0,7 15 Cl- 103 115 8 HCO3 - 25 28 10 H2PO4 1 1 65 SO4 2- 0,5 0,5 10 org. acids 4 5 2 proteinates 17 1 47 pH 7,4 7,4 7,4
- 8. WATER IVT IST ICT Three compartments of body fluids Three compartments of body fluids IVF IVF ISF ISF ICF ICF UREA GLUCOSE SODIUM CATION PROTEINS capillary capillary wall wall cell cell membrane membrane
- 10. WATER IVT IST ICT Three compartments of body fluids Three compartments of body fluids IVF IVF ISF ISF ICF ICF UREA GLUCOSE SODIUM CATION PROTEINS capillary capillary wall wall cell cell membrane membrane
- 13. Therapy of hyponatremia Therapy of hyponatremia In case of acute disturbance lasting only 1 In case of acute disturbance lasting only 1 ¨C ¨C 2 days, to elevate S_Na 2 days, to elevate S_Na+ + maximally about 1 maximally about 1- -2 mmol/l/h 2 mmol/l/h By longer lastings states to increase By longer lastings states to increase S_Na S_Na+ + only about only about 0,5 mmol/l/h 0,5 mmol/l/h Limits of correction Limits of correction S_Na S_Na+ + mmol/time: mmol/time: Limits of correction Limits of correction S_Na S_Na mmol/time: mmol/time: a) a) 6 6 ¨C ¨C 8 mmol/24 h (NON 10 and more) 8 mmol/24 h (NON 10 and more) b) b) 12 12 ¨C ¨C 14 mmol/48 h (NON 18 and more) 14 mmol/48 h (NON 18 and more) c) c) 14 14 ¨C ¨C 16 mmol/72 h (NON 20 and more) 16 mmol/72 h (NON 20 and more) Sterns 2009 The need of Na must be covered by correction dose plus by substitution dose. The need of Na must be covered by correction dose plus by substitution dose.
- 15. WATER IVT IST ICT IVF IVF ISF ISF ICF ICF Three compartments of body fluids Three compartments of body fluids WATER UREA GLUCOSE SODIUM CATION PROTEINS capillary capillary wall wall cell cell membrane membrane
- 17. Therapy of hypernatremia Therapy of hypernatremia It is necessary to diagnose if hypernatremia is accompanied by hypo It is necessary to diagnose if hypernatremia is accompanied by hypo- - normo normo- - or or hyper hyper- -volemia, how long does it last and to judge the clinical signs. volemia, how long does it last and to judge the clinical signs. 1. 1. In presence of hypovolemia or hypotension suplementation In presence of hypovolemia or hypotension suplementation of IVF by isotonic of IVF by isotonic solutions (0,9% NaCl, Ringer solutions (0,9% NaCl, Ringer- -lactate) or by moderately hypotonic solutions lactate) or by moderately hypotonic solutions (0,225% nebo 0,45% NaCl). (0,225% nebo 0,45% NaCl). 2. 2. In presence of normovolemia or hypervolemia: In presence of normovolemia or hypervolemia: thiazide diuretics and 5% thiazide diuretics and 5% 2. 2. In presence of normovolemia or hypervolemia: In presence of normovolemia or hypervolemia: thiazide diuretics and 5% thiazide diuretics and 5% glucose to keep the volume of circulating fluids. glucose to keep the volume of circulating fluids. 3. 3. The acute development The acute development is treated more intensively. There is not yet developed is treated more intensively. There is not yet developed the compensation of the brain in contrast to longer lasting hypernatremia. The the compensation of the brain in contrast to longer lasting hypernatremia. The decrease of decrease of S_Na+ S_Na+ in acute states 1 1- -2 mmol/l/h, and in longer lasting states 2 mmol/l/h, and in longer lasting states 0,5 mmol/l/h is recommended. 0,5 mmol/l/h is recommended. 4. 4. Monitoring of S_Na Monitoring of S_Na+ + in symptomatic states every 2 in symptomatic states every 2- -4 h, later till to normalization 4 h, later till to normalization every 4 every 4- -8 h. 8 h. 5. 5. The daily decrease of S_Na+ not more as 8 (max 10) mmol/l/d. The daily decrease of S_Na+ not more as 8 (max 10) mmol/l/d. Jabor 2008 Jabor 2008 Another authors accept maximally 10 Another authors accept maximally 10- -12 mmol/d. 12 mmol/d. Bagshaw 2009 Bagshaw 2009 Kraft 2005 Kraft 2005
- 21. Thank you Thank you for your attention for your attention