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Disorder of Water and Sodium

KURNIA F. JAMIL

Department of Internal MedicineRSZA/FK UNSYIAH

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Age TBW as % of body weight

ECF as % of body weight

ICF as % body weight

Premature 75-80    

Newborn 70-75 50 35

1 Year Old 65 25 40-45

Adolescent Male 60 20 40-45

Adolescent Female 55 18 40

Adapted from Feld. (1988) 

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Body Weight

Total Body Water

ICF ECF

Intravascular  Volume

Interstitial  Volume

RULE OF THIRD

1/3

1/3

1/3

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THE INTEGRATED VOLUME RESPONSESYSTEMIC

HEMODYNAMIC CHANGES

EXTERNAL SALT AND WATER BALANCE

Response Tachycardia ThirstPeripheral resistance Renal Na+ , water retentionVenous capacitance

Onset Minutes HoursMajor activators

Catecholamines Catecholamines

ADH AldosteroneAngiotensin II ADHEndothelin-1  Prostaglandin H2

  Thromboxane A2

Major inactivators

Prostaglandin E2 Prostaglandin E2

Atriopeptin Atriopeptin

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MAJOR CAUSES OF VOLUME DEPLETION

RENAL LOSSES EXTRARENAL LOSSES

Hormonal Deficit Hemorrhage   Pituitary diabetes insipidus Cutaneous Losses   Aldosterone insufficiency   Sweating    Addison's disease   Burns    Hyporeninemic hypoaldosteronism Gastrointestinal LossesRenal Deficits   Vomiting  Specific tubular nephropathies:   Diarrheal disorders    Renal tubular acidosis   Gastrointestinal fistulas     Bartter's syndrome   Tube drainage     Nephrogenic diabetes insipidus   Diuretic abuse     Postobstructive diuresis  Excessive filtration of non-electrolytes:    Osmotic diuresis  Generalized renal disease:    Chronic renal failure

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Gejala Klinis Dehidrasi Postural Giddiness Postural Tachycardia Weakness Circulatory Collapse Tidak ada gejala bukan berarti

tidak ada defisit Turgor kulit turun dan mukosa

lidah kering

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Gejala Klinis Dehidrasi Tergantung :

Jumlah volume tubuh yang hilang Kecepatan (Rate of volume loss) Jenis cairan tubuh yang hilang :

Air Air ditambah Natrium Darah

Response dari sistim pembuluh darah

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Sign and Symptoms of Hyponatremia

Central Nervous System Gastrointestinal SystemMild Anorexia Apathy Nausea Headache Vomiting Lethargy Musculoskeletal SystemModerate Cramps Agitation Diminished deep tendon reflexes Ataxia Confusion Disorientation PsychosisSevere Stupor Coma Pseudobulbar palsy Tentorial herniation Cheyne‑Stokes respiration Death

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Treatment of Hyponatremia

The rate of correction of hyponatremia should be dictated by the rapidity of its onset.

Acute hyponatremia may be corrected at rates of up to 1 to 2 mEq/L/hr, and Chronic hyponatremia should be corrected at a rate not greater than 0.5 mEq/L/hr. As a general rule, the serum sodium should not be corrected to above 120 mEq/L or increased by more than 20 mEq/L in a 24-hour period.

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Causes of Hypernatremia

Reduced water intake

Disorders of thirst perception Inability to obtain water

Depressed mentation Intubated patient

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Causes of HypernatremiaIncreased water loss

Gastointestinal Vomiting, diarrhea Nasogastric suctioning Third spacing

Renal Tubular concentrating defects Osmotic diuresis (e.g., hyper- glycemia, mannitol) Diabetes insipidus Relief of urinary obstruction

Dermal Excessive sweating Severe burns

Hyperventilation

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Causes of Hypernatremia

Gain of sodium Exogenous sodium intake

Salt tablets Sodium bicarbonate Hypertonic saline

solutions Improper formula

preparation Salt water drowning Hypertonic renal

dialysate Increased sodium reabsorption

Hyperaldosteronism Cushing's disease Exogenous

corticosteroids Congenital adrenal

hyperplasia

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Hypokalemia without total body K depletion

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Hypokalemia with total body k depletion

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Treatment of hypokalemia

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Diagnostic approach to Hyperkalemia

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Treatment of Hyperkalemia