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Disorder of Water and Sodium

KURNIA F. JAMIL

Department of Internal Medicine
RSZA/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 RESPONSE

SYSTEMIC
HEMODYNAMIC
CHANGES
EXTERNAL SALT AND
WATER BALANCE
Response Tachycardia Thirst
Peripheral resistance Renal Na
+
, water retention
Venous capacitance
Onset Minutes Hours
Major
activators
Catecholamines Catecholamines
ADH Aldosterone
Angiotensin II ADH
Endothelin-1
Prostaglandin H
2

Thromboxane A
2

Major
inactivators
Prostaglandin E
2
Prostaglandin E
2

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 Losses
Renal 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 System
Mild Anorexia
Apathy Nausea
Headache Vomiting
Lethargy Musculoskeletal System
Moderate Cramps
Agitation Diminished deep tendon
reflexes
Ataxia
Confusion
Disorientation
Psychosis
Severe
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 Hypernatremia
Increased 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