CHAPTER 046 SODIUM AND WATER PART 15

Chapter 046. Sodium and Water (Part 15) Algorithm depicting clinical approach to hypokalemia. TTKG, transtubular K+ concentration gradient; RTA, renal tubular acidosis. After eliminating decreased intake and intracellular shift as potential causes of hypokalemia, examination of the re[r]

Chapter 046. Sodium and Water (Part 1) Harrison's Internal Medicine > Chapter 46. Fluid and Electrolyte Disturbances > Sodium and Water Sodium and Water: Introduction Composition of Body Fluids Water is the most abundant constituent in the body, comprising approximately 50% of[r]

Chapter 046. Sodium and Water (Part 7) Diagnosis (Fig. 46-1) Hyponatremia is not a disease but a manifestation of a variety of disorders. The underlying cause can often be ascertained from an accurate history and physical examination, including an assessment of ECF volume status and effectiv[r]

Chapter 046. Sodium and Water (Part 18) Algorithm depicting clinical approach to hyperkalemia. NSAID, nonsteroidal anti-inflammatory drug; ACE, angiotensin-converting enzyme; RTA, renal tubular acidosis; TTKG, transtubular K+ concentration gradient. The appropriate renal response to hyperkal[r]

Chapter 046. Sodium and Water (Part 17) Decreased aldosterone synthesis may be due to primary adrenal insufficiency (Addison's disease) or congenital adrenal enzyme deficiency (Chap. 336). Heparin (including low-molecular-weight heparin) inhibits production of aldosterone by the cells of the[r]

Chapter 046. Sodium and Water (Part 14) Liddle's syndrome is a rare familial (autosomal dominant) disease characterized by hypertension, hypokalemic metabolic alkalosis, renal K+ wasting, and suppressed renin and aldosterone secretion. Increased distal delivery of Na+ with a nonreabsorbable[r]

Chapter 046. Sodium and Water (Part 13) Redistribution into Cells Movement of K+ into cells may transiently decrease the plasma K+ concentration without altering total body K+ content. For any given cause, the magnitude of the change is relatively small, often <1 mmol/L. However, a co[r]

Chapter 046. Sodium and Water (Part 12) Table 46-3 Causes of Hypokalemia I. Decreased intake A. Starvation B. Clay ingestion II. Redistribution into cells A. Acid-base 1. Metabolic alkalosis B. Hormonal 1. Insulin 2. β2-Adrenergic agonists (endogenous or exogenous) 3. α-Adrenergic an[r]

Chapter 046. Sodium and Water (Part 10) Figure 46-2 Many causes of hypernatremia are associated with polyuria and a submaximal urine osmolality. The product of the urine volume and osmolality, i.e., the solute excretion rate, is helpful in determining the basis of the polyuria (see above).[r]

Chapter 046. Sodium and Water (Part 9) The source of free water loss is either renal or extrarenal. Nonrenal loss of water may be due to evaporation from the skin and respiratory tract (insensible losses) or loss from the gastrointestinal tract. Insensible losses are increased with fever, ex[r]

Chapter 046. Sodium and Water (Part 8) The rate of correction of hyponatremia depends on the absence or presence of neurologic dysfunction. This, in turn, is related to the rapidity of onset and magnitude of the fall in plasma Na+ concentration. In asymptomatic patients, the plasma Na+ conce[r]

Chapter 046. Sodium and Water (Part 16) Metabolic acidoses, with the exception of those due to the accumulation of organic anions, can be associated with mild hyperkalemia resulting from intracellular buffering of H+ (see above). Insulin deficiency and hypertonicity (e.g., hyperglycemia) pro[r]

Chapter 046. Sodium and Water (Part 6) Hyponatremia in the setting of ECF volume expansion is usually associated with edematous states, such as congestive heart failure, hepatic cirrhosis, and the nephrotic syndrome. These disorders all have in common a decreased effective circulating arteri[r]

Chapter 046. Sodium and Water (Part 4) Extrarenal Nonrenal causes of hypovolemia include fluid loss from the gastrointestinal tract, skin, and respiratory system and third-space accumulations (burns, pancreatitis, peritonitis). Approximately 9 L of fluid enters the gastrointestinal tract dai[r]

Chapter 046. Sodium and Water (Part 3) Hypovolemia Etiology True volume depletion, or hypovolemia, generally refers to a state of combined salt and water loss exceeding intake, leading to ECF volume contraction. The loss of Na+ may be renal or extrarenal (Table 46-1). Table 46-1 Causes of H[r]

Chapter 046. Sodium and Water (Part 11) Potassium: Introduction Potassium Balance Potassium is the major intracellular cation. The normal plasma K+ concentration is 3.5–5.0 mmol/L, whereas that inside cells is about 150 mmol/L. Therefore, the amount of K+ in the ECF (30–70 mmol) constitutes[r]

Chapter 046. Sodium and Water (Part 2) Water Excretion In contrast to the ingestion of water, its excretion is tightly regulated by physiologic factors. The principal determinant of renal water excretion is arginine vasopressin (AVP; formerly antidiuretic hormone), a polypeptide synthesized[r]

Chapter 046. Sodium and Water (Part 5) Hypovolemia: Treatment The therapeutic goals are to restore normovolemia with fluid similar in composition to that lost and to replace ongoing losses. Symptoms and signs, including weight loss, can help estimate the degree of volume contraction and shou[r]

large amount of text books for the subjects we teach are not likely enough to help us to become an exciting teacher. In other words, a good teacher often reads many other books which are not related to the subjects he or she is supposed to teach. The large extent of knowledge on different fields mak[r]

proteolysis as fermentation duration increased. A clippedform of trappin-2 resulting from a cleavage C-terminal toLys32 appeared together with the full-length trappin-2 afterthree days of fermentation. Such a proteolytic susceptibilityafter lysyl residues was observed by Bourbonnais et al.[30]who ex[r]