CHPT 9 WATER

Nutrition

Water

bull Humans canrsquot live but for a few days without waterhellip10-14 days

Why is water important

bull It is the main component of all body cells

bull It makes up 50-60 of the body wt in normal adults

bull Men have more water wt due to the size of their muscles and muscle tissue

bull Newborns have the highest of H2O =75 of their body is water

Other functions of water

bull Solvent for nutrients and body wastesbull Aids in chemical reactionsbull Transports nutrients and wastes in bloodbull Needed for hydrolysis and digestionbull Lubricates jointsbull Regulated body temp by evaporation of

perspirationbull Serves as a shock absorber

bull Water content in muscle is greater than water content in fat

Body Water Content

Obese Normal Muscular 40 60 70

2 compartment of body water

bull 1 Intracellular ndash is the water within the cells itrsquos approx 65 of total body fluid

bull 2 Extracellular ndash is the water outside of the cells approx 35 of total body fluid

bull (includes intravascular amp interstitial fluid)

What do these compartments mean

bull Intracellular ndash is inside the cell where K+ is found

bull Intravascular ndash inside the blood vessel

bull Interstitial ndash around the tissues

bull Extracellular ndash is both intravascular (inside of the blood vessel) AND interstitialhellipthis is where Na+ is found

bull How does the ldquopierdquo from the previous slide fit into the body exactly

bull TIP bull Water should always be in the 1st space firstbull Water should always be in the 2nd space second in

order for the normal body to function

bull And we try not to allow water to move to the 3rd space

Cell = 1st spaceExtracellular (interstitial amp intravascular) = 2nd spaceAbdomen and feet = 3rd space (ascites)

1 cell

1 cell

2 extracellularinterstitial

2 bloodvessel(Intravascular)

Best source of water

bull Is in drinking water

bull Beverages of all other types are 2nd best

bull Food contains water like fruits soups jello milk vegetables

bull Energy metabolism produces H20

Estimated daily fluid intake for adults

bull Ingested liquids 1500ml

bull Water in foods 700ml

bull Water from oxidation 200mlraquo __________

bull TOTAL 2400ml

HOMEOSTASIS

bull Keeping the body = or at a balance

bull Our body has this mechanism related to fluids called

bull Fluid amp electrolyte balancebull This balance is for too little water (dehydration) or fluid

overload (too much water) in the bodyhellipboth can occur

Fluid amp electrolyte balance

bull Water lost by healthy individuals through feces perspiration and the respiratory tract must be replaced in both volume and in electrolyte content

Specific Gravity (SG)

bull This is a measurement of the weight of the particles in urine compared to the water in urine

bull If you have lots of particles = heavy urine=big number like 1020-1030

bull If you have diluted urine due to excess urination = light weight urine = low number like 1005-1010

Urine Specific Gravity

bull Normal SG complete range-1005-1030bull Normal urine is 1010-1020bull This means that urine is straw yellow in

color and that the patient is urinating a minimum of 30mLhr

bull Small machine or test strip can tell you the SG of urine

Equipment to test SG

Vomiting amp Diarrhea

bull This type of illness where there is great water loss must be replaced quickly

bull IVFs in this case would be needed

Symptoms of dehydration

bull Hypotension - (not enough fluid in the blood vessels to be pumped everywhere throughout your body)

bull Thirst

bull Eyes are sunken in

bull Mucus membranes are dry

bull Dry skindecreased skin turgor

bull Fever

bull Tachycardia

bull Mental disorientation

bull Specific gravity of lt1010 = clear

clear urine

Treatment of this water loss

bull Replacement of the electrolytes and fluids

bull IVFs are a replacement if the amount lost is great

bull Drinking by mouth is preferred

Sensible vs insensible loss

bull SENSIBLE LOSS ndash is noticeable loss of water as in urine losshellipnormal loss

bull INSENSIBLE LOSS ndash unnoticed water loss is in feces perspiration and respiration

Normal daily water loss

bull The body must excrete 500ml of water as urine each day in order to get rid of the waste products of metabolism

bull This is 500 divided by 24 hrs= 208cchrbull + what we sweat and breathe off therefore

bull We should be excreting at least 30cchr minimum

DEHYDRATION amp OSMOSIS

bull Water moves through the cell walls by this mechanism

bull Remember water likes to dilute ldquostuffrdquo

bull Therefore water moves from an area with less stuff to an area with lots of stuff to dilute it

bull Where salt or protein ishellipwater follows

ELECTROLYTES

bull Na+

bull Cl-

bull K+

bull These electrolytes maintain the balance between intracellular and extracellular fluid

bull

bull Intravascular amp Interstitial

Potassium K+

bull Is the principal electrolyte in INTRAcellular fluid

Sodium Na+

bull Is the principal electrolyte in extracellular fluid

Why we get thirsty

bull If the cell (1st space) becomes dehydrated as in the body lost water we become thirsty

Why else can you become thirsty

bull When the electrolytes in the extracellular fluid are increased (hypertonic solution as in the

consumption of high sugar or salt) the intracellular fluid moves out of the cell to the extracellular fluid to try and dilute it or push the particles away from each other

bull This causeshellip

Osmosis

bull The water from the inside of the cell (intracellular) to move out of the cell (osmosis) shrinking the cell = dehydration of the cell occurs

= thirst

Is there any safety mechanism in the body to prevent this from

happening

bull YEShelliphellip 2 mechanisms try and prevent the body from getting dehydrated

bull 1) ADH

bull 2) Aldosterone

The hypothalamus saves the day

bull It is responsible for regulating appetite

and thirst

bull The hypothalamus

is located at the

base of the brain

During this timehellip

bull When the cell (1st space) releases all of its water to the extracellular fluid to try and separate those particles to dilute them the cell shrinks and the body says ldquought ohhhhrdquo

bull The hypothalamus sends a message to the pituitary gland to secrete ADH (antidiuretic hormone) when the electrolytes become too concentrated in the blood

PITUITARY GLAND

bull Known as the ldquoMaster Glandrdquobull It helps keep water in the blood via the kidneysbull It controls growth by sending growth hormonesbull It aids in releasing pitocin and sending breastmilk

out of the breastsbull It aids in reproduction by sending sex hormones

out to make a baby

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Water

bull Humans canrsquot live but for a few days without waterhellip10-14 days

Why is water important

bull It is the main component of all body cells

bull It makes up 50-60 of the body wt in normal adults

bull Men have more water wt due to the size of their muscles and muscle tissue

bull Newborns have the highest of H2O =75 of their body is water

Other functions of water

bull Solvent for nutrients and body wastesbull Aids in chemical reactionsbull Transports nutrients and wastes in bloodbull Needed for hydrolysis and digestionbull Lubricates jointsbull Regulated body temp by evaporation of

perspirationbull Serves as a shock absorber

bull Water content in muscle is greater than water content in fat

Body Water Content

Obese Normal Muscular 40 60 70

2 compartment of body water

bull 1 Intracellular ndash is the water within the cells itrsquos approx 65 of total body fluid

bull 2 Extracellular ndash is the water outside of the cells approx 35 of total body fluid

bull (includes intravascular amp interstitial fluid)

What do these compartments mean

bull Intracellular ndash is inside the cell where K+ is found

bull Intravascular ndash inside the blood vessel

bull Interstitial ndash around the tissues

bull Extracellular ndash is both intravascular (inside of the blood vessel) AND interstitialhellipthis is where Na+ is found

bull How does the ldquopierdquo from the previous slide fit into the body exactly

bull TIP bull Water should always be in the 1st space firstbull Water should always be in the 2nd space second in

order for the normal body to function

bull And we try not to allow water to move to the 3rd space

Cell = 1st spaceExtracellular (interstitial amp intravascular) = 2nd spaceAbdomen and feet = 3rd space (ascites)

1 cell

1 cell

2 extracellularinterstitial

2 bloodvessel(Intravascular)

Best source of water

bull Is in drinking water

bull Beverages of all other types are 2nd best

bull Food contains water like fruits soups jello milk vegetables

bull Energy metabolism produces H20

Estimated daily fluid intake for adults

bull Ingested liquids 1500ml

bull Water in foods 700ml

bull Water from oxidation 200mlraquo __________

bull TOTAL 2400ml

HOMEOSTASIS

bull Keeping the body = or at a balance

bull Our body has this mechanism related to fluids called

bull Fluid amp electrolyte balancebull This balance is for too little water (dehydration) or fluid

overload (too much water) in the bodyhellipboth can occur

Fluid amp electrolyte balance

bull Water lost by healthy individuals through feces perspiration and the respiratory tract must be replaced in both volume and in electrolyte content

Specific Gravity (SG)

bull This is a measurement of the weight of the particles in urine compared to the water in urine

bull If you have lots of particles = heavy urine=big number like 1020-1030

bull If you have diluted urine due to excess urination = light weight urine = low number like 1005-1010

Urine Specific Gravity

bull Normal SG complete range-1005-1030bull Normal urine is 1010-1020bull This means that urine is straw yellow in

color and that the patient is urinating a minimum of 30mLhr

bull Small machine or test strip can tell you the SG of urine

Equipment to test SG

Vomiting amp Diarrhea

bull This type of illness where there is great water loss must be replaced quickly

bull IVFs in this case would be needed

Symptoms of dehydration

bull Hypotension - (not enough fluid in the blood vessels to be pumped everywhere throughout your body)

bull Thirst

bull Eyes are sunken in

bull Mucus membranes are dry

bull Dry skindecreased skin turgor

bull Fever

bull Tachycardia

bull Mental disorientation

bull Specific gravity of lt1010 = clear

clear urine

Treatment of this water loss

bull Replacement of the electrolytes and fluids

bull IVFs are a replacement if the amount lost is great

bull Drinking by mouth is preferred

Sensible vs insensible loss

bull SENSIBLE LOSS ndash is noticeable loss of water as in urine losshellipnormal loss

bull INSENSIBLE LOSS ndash unnoticed water loss is in feces perspiration and respiration

Normal daily water loss

bull The body must excrete 500ml of water as urine each day in order to get rid of the waste products of metabolism

bull This is 500 divided by 24 hrs= 208cchrbull + what we sweat and breathe off therefore

bull We should be excreting at least 30cchr minimum

DEHYDRATION amp OSMOSIS

bull Water moves through the cell walls by this mechanism

bull Remember water likes to dilute ldquostuffrdquo

bull Therefore water moves from an area with less stuff to an area with lots of stuff to dilute it

bull Where salt or protein ishellipwater follows

ELECTROLYTES

bull Na+

bull Cl-

bull K+

bull These electrolytes maintain the balance between intracellular and extracellular fluid

bull

bull Intravascular amp Interstitial

Potassium K+

bull Is the principal electrolyte in INTRAcellular fluid

Sodium Na+

bull Is the principal electrolyte in extracellular fluid

Why we get thirsty

bull If the cell (1st space) becomes dehydrated as in the body lost water we become thirsty

Why else can you become thirsty

bull When the electrolytes in the extracellular fluid are increased (hypertonic solution as in the

consumption of high sugar or salt) the intracellular fluid moves out of the cell to the extracellular fluid to try and dilute it or push the particles away from each other

bull This causeshellip

Osmosis

bull The water from the inside of the cell (intracellular) to move out of the cell (osmosis) shrinking the cell = dehydration of the cell occurs

= thirst

Is there any safety mechanism in the body to prevent this from

happening

bull YEShelliphellip 2 mechanisms try and prevent the body from getting dehydrated

bull 1) ADH

bull 2) Aldosterone

The hypothalamus saves the day

bull It is responsible for regulating appetite

and thirst

bull The hypothalamus

is located at the

base of the brain

During this timehellip

bull When the cell (1st space) releases all of its water to the extracellular fluid to try and separate those particles to dilute them the cell shrinks and the body says ldquought ohhhhrdquo

bull The hypothalamus sends a message to the pituitary gland to secrete ADH (antidiuretic hormone) when the electrolytes become too concentrated in the blood

PITUITARY GLAND

bull Known as the ldquoMaster Glandrdquobull It helps keep water in the blood via the kidneysbull It controls growth by sending growth hormonesbull It aids in releasing pitocin and sending breastmilk

out of the breastsbull It aids in reproduction by sending sex hormones

out to make a baby

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Why is water important

bull It is the main component of all body cells

bull It makes up 50-60 of the body wt in normal adults

bull Men have more water wt due to the size of their muscles and muscle tissue

bull Newborns have the highest of H2O =75 of their body is water

Other functions of water

bull Solvent for nutrients and body wastesbull Aids in chemical reactionsbull Transports nutrients and wastes in bloodbull Needed for hydrolysis and digestionbull Lubricates jointsbull Regulated body temp by evaporation of

perspirationbull Serves as a shock absorber

bull Water content in muscle is greater than water content in fat

Body Water Content

Obese Normal Muscular 40 60 70

2 compartment of body water

bull 1 Intracellular ndash is the water within the cells itrsquos approx 65 of total body fluid

bull 2 Extracellular ndash is the water outside of the cells approx 35 of total body fluid

bull (includes intravascular amp interstitial fluid)

What do these compartments mean

bull Intracellular ndash is inside the cell where K+ is found

bull Intravascular ndash inside the blood vessel

bull Interstitial ndash around the tissues

bull Extracellular ndash is both intravascular (inside of the blood vessel) AND interstitialhellipthis is where Na+ is found

bull How does the ldquopierdquo from the previous slide fit into the body exactly

bull TIP bull Water should always be in the 1st space firstbull Water should always be in the 2nd space second in

order for the normal body to function

bull And we try not to allow water to move to the 3rd space

Cell = 1st spaceExtracellular (interstitial amp intravascular) = 2nd spaceAbdomen and feet = 3rd space (ascites)

1 cell

1 cell

2 extracellularinterstitial

2 bloodvessel(Intravascular)

Best source of water

bull Is in drinking water

bull Beverages of all other types are 2nd best

bull Food contains water like fruits soups jello milk vegetables

bull Energy metabolism produces H20

Estimated daily fluid intake for adults

bull Ingested liquids 1500ml

bull Water in foods 700ml

bull Water from oxidation 200mlraquo __________

bull TOTAL 2400ml

HOMEOSTASIS

bull Keeping the body = or at a balance

bull Our body has this mechanism related to fluids called

bull Fluid amp electrolyte balancebull This balance is for too little water (dehydration) or fluid

overload (too much water) in the bodyhellipboth can occur

Fluid amp electrolyte balance

bull Water lost by healthy individuals through feces perspiration and the respiratory tract must be replaced in both volume and in electrolyte content

Specific Gravity (SG)

bull This is a measurement of the weight of the particles in urine compared to the water in urine

bull If you have lots of particles = heavy urine=big number like 1020-1030

bull If you have diluted urine due to excess urination = light weight urine = low number like 1005-1010

Urine Specific Gravity

bull Normal SG complete range-1005-1030bull Normal urine is 1010-1020bull This means that urine is straw yellow in

color and that the patient is urinating a minimum of 30mLhr

bull Small machine or test strip can tell you the SG of urine

Equipment to test SG

Vomiting amp Diarrhea

bull This type of illness where there is great water loss must be replaced quickly

bull IVFs in this case would be needed

Symptoms of dehydration

bull Hypotension - (not enough fluid in the blood vessels to be pumped everywhere throughout your body)

bull Thirst

bull Eyes are sunken in

bull Mucus membranes are dry

bull Dry skindecreased skin turgor

bull Fever

bull Tachycardia

bull Mental disorientation

bull Specific gravity of lt1010 = clear

clear urine

Treatment of this water loss

bull Replacement of the electrolytes and fluids

bull IVFs are a replacement if the amount lost is great

bull Drinking by mouth is preferred

Sensible vs insensible loss

bull SENSIBLE LOSS ndash is noticeable loss of water as in urine losshellipnormal loss

bull INSENSIBLE LOSS ndash unnoticed water loss is in feces perspiration and respiration

Normal daily water loss

bull The body must excrete 500ml of water as urine each day in order to get rid of the waste products of metabolism

bull This is 500 divided by 24 hrs= 208cchrbull + what we sweat and breathe off therefore

bull We should be excreting at least 30cchr minimum

DEHYDRATION amp OSMOSIS

bull Water moves through the cell walls by this mechanism

bull Remember water likes to dilute ldquostuffrdquo

bull Therefore water moves from an area with less stuff to an area with lots of stuff to dilute it

bull Where salt or protein ishellipwater follows

ELECTROLYTES

bull Na+

bull Cl-

bull K+

bull These electrolytes maintain the balance between intracellular and extracellular fluid

bull

bull Intravascular amp Interstitial

Potassium K+

bull Is the principal electrolyte in INTRAcellular fluid

Sodium Na+

bull Is the principal electrolyte in extracellular fluid

Why we get thirsty

bull If the cell (1st space) becomes dehydrated as in the body lost water we become thirsty

Why else can you become thirsty

bull When the electrolytes in the extracellular fluid are increased (hypertonic solution as in the

consumption of high sugar or salt) the intracellular fluid moves out of the cell to the extracellular fluid to try and dilute it or push the particles away from each other

bull This causeshellip

Osmosis

bull The water from the inside of the cell (intracellular) to move out of the cell (osmosis) shrinking the cell = dehydration of the cell occurs

= thirst

Is there any safety mechanism in the body to prevent this from

happening

bull YEShelliphellip 2 mechanisms try and prevent the body from getting dehydrated

bull 1) ADH

bull 2) Aldosterone

The hypothalamus saves the day

bull It is responsible for regulating appetite

and thirst

bull The hypothalamus

is located at the

base of the brain

During this timehellip

bull When the cell (1st space) releases all of its water to the extracellular fluid to try and separate those particles to dilute them the cell shrinks and the body says ldquought ohhhhrdquo

bull The hypothalamus sends a message to the pituitary gland to secrete ADH (antidiuretic hormone) when the electrolytes become too concentrated in the blood

PITUITARY GLAND

bull Known as the ldquoMaster Glandrdquobull It helps keep water in the blood via the kidneysbull It controls growth by sending growth hormonesbull It aids in releasing pitocin and sending breastmilk

out of the breastsbull It aids in reproduction by sending sex hormones

out to make a baby

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Other functions of water

bull Solvent for nutrients and body wastesbull Aids in chemical reactionsbull Transports nutrients and wastes in bloodbull Needed for hydrolysis and digestionbull Lubricates jointsbull Regulated body temp by evaporation of

perspirationbull Serves as a shock absorber

bull Water content in muscle is greater than water content in fat

Body Water Content

Obese Normal Muscular 40 60 70

2 compartment of body water

bull 1 Intracellular ndash is the water within the cells itrsquos approx 65 of total body fluid

bull 2 Extracellular ndash is the water outside of the cells approx 35 of total body fluid

bull (includes intravascular amp interstitial fluid)

What do these compartments mean

bull Intracellular ndash is inside the cell where K+ is found

bull Intravascular ndash inside the blood vessel

bull Interstitial ndash around the tissues

bull Extracellular ndash is both intravascular (inside of the blood vessel) AND interstitialhellipthis is where Na+ is found

bull How does the ldquopierdquo from the previous slide fit into the body exactly

bull TIP bull Water should always be in the 1st space firstbull Water should always be in the 2nd space second in

order for the normal body to function

bull And we try not to allow water to move to the 3rd space

Cell = 1st spaceExtracellular (interstitial amp intravascular) = 2nd spaceAbdomen and feet = 3rd space (ascites)

1 cell

1 cell

2 extracellularinterstitial

2 bloodvessel(Intravascular)

Best source of water

bull Is in drinking water

bull Beverages of all other types are 2nd best

bull Food contains water like fruits soups jello milk vegetables

bull Energy metabolism produces H20

Estimated daily fluid intake for adults

bull Ingested liquids 1500ml

bull Water in foods 700ml

bull Water from oxidation 200mlraquo __________

bull TOTAL 2400ml

HOMEOSTASIS

bull Keeping the body = or at a balance

bull Our body has this mechanism related to fluids called

bull Fluid amp electrolyte balancebull This balance is for too little water (dehydration) or fluid

overload (too much water) in the bodyhellipboth can occur

Fluid amp electrolyte balance

bull Water lost by healthy individuals through feces perspiration and the respiratory tract must be replaced in both volume and in electrolyte content

Specific Gravity (SG)

bull This is a measurement of the weight of the particles in urine compared to the water in urine

bull If you have lots of particles = heavy urine=big number like 1020-1030

bull If you have diluted urine due to excess urination = light weight urine = low number like 1005-1010

Urine Specific Gravity

bull Normal SG complete range-1005-1030bull Normal urine is 1010-1020bull This means that urine is straw yellow in

color and that the patient is urinating a minimum of 30mLhr

bull Small machine or test strip can tell you the SG of urine

Equipment to test SG

Vomiting amp Diarrhea

bull This type of illness where there is great water loss must be replaced quickly

bull IVFs in this case would be needed

Symptoms of dehydration

bull Hypotension - (not enough fluid in the blood vessels to be pumped everywhere throughout your body)

bull Thirst

bull Eyes are sunken in

bull Mucus membranes are dry

bull Dry skindecreased skin turgor

bull Fever

bull Tachycardia

bull Mental disorientation

bull Specific gravity of lt1010 = clear

clear urine

Treatment of this water loss

bull Replacement of the electrolytes and fluids

bull IVFs are a replacement if the amount lost is great

bull Drinking by mouth is preferred

Sensible vs insensible loss

bull SENSIBLE LOSS ndash is noticeable loss of water as in urine losshellipnormal loss

bull INSENSIBLE LOSS ndash unnoticed water loss is in feces perspiration and respiration

Normal daily water loss

bull The body must excrete 500ml of water as urine each day in order to get rid of the waste products of metabolism

bull This is 500 divided by 24 hrs= 208cchrbull + what we sweat and breathe off therefore

bull We should be excreting at least 30cchr minimum

DEHYDRATION amp OSMOSIS

bull Water moves through the cell walls by this mechanism

bull Remember water likes to dilute ldquostuffrdquo

bull Therefore water moves from an area with less stuff to an area with lots of stuff to dilute it

bull Where salt or protein ishellipwater follows

ELECTROLYTES

bull Na+

bull Cl-

bull K+

bull These electrolytes maintain the balance between intracellular and extracellular fluid

bull

bull Intravascular amp Interstitial

Potassium K+

bull Is the principal electrolyte in INTRAcellular fluid

Sodium Na+

bull Is the principal electrolyte in extracellular fluid

Why we get thirsty

bull If the cell (1st space) becomes dehydrated as in the body lost water we become thirsty

Why else can you become thirsty

bull When the electrolytes in the extracellular fluid are increased (hypertonic solution as in the

consumption of high sugar or salt) the intracellular fluid moves out of the cell to the extracellular fluid to try and dilute it or push the particles away from each other

bull This causeshellip

Osmosis

bull The water from the inside of the cell (intracellular) to move out of the cell (osmosis) shrinking the cell = dehydration of the cell occurs

= thirst

Is there any safety mechanism in the body to prevent this from

happening

bull YEShelliphellip 2 mechanisms try and prevent the body from getting dehydrated

bull 1) ADH

bull 2) Aldosterone

The hypothalamus saves the day

bull It is responsible for regulating appetite

and thirst

bull The hypothalamus

is located at the

base of the brain

During this timehellip

bull When the cell (1st space) releases all of its water to the extracellular fluid to try and separate those particles to dilute them the cell shrinks and the body says ldquought ohhhhrdquo

bull The hypothalamus sends a message to the pituitary gland to secrete ADH (antidiuretic hormone) when the electrolytes become too concentrated in the blood

PITUITARY GLAND

bull Known as the ldquoMaster Glandrdquobull It helps keep water in the blood via the kidneysbull It controls growth by sending growth hormonesbull It aids in releasing pitocin and sending breastmilk

out of the breastsbull It aids in reproduction by sending sex hormones

out to make a baby

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

bull Water content in muscle is greater than water content in fat

Body Water Content

Obese Normal Muscular 40 60 70

2 compartment of body water

bull 1 Intracellular ndash is the water within the cells itrsquos approx 65 of total body fluid

bull 2 Extracellular ndash is the water outside of the cells approx 35 of total body fluid

bull (includes intravascular amp interstitial fluid)

What do these compartments mean

bull Intracellular ndash is inside the cell where K+ is found

bull Intravascular ndash inside the blood vessel

bull Interstitial ndash around the tissues

bull Extracellular ndash is both intravascular (inside of the blood vessel) AND interstitialhellipthis is where Na+ is found

bull How does the ldquopierdquo from the previous slide fit into the body exactly

bull TIP bull Water should always be in the 1st space firstbull Water should always be in the 2nd space second in

order for the normal body to function

bull And we try not to allow water to move to the 3rd space

Cell = 1st spaceExtracellular (interstitial amp intravascular) = 2nd spaceAbdomen and feet = 3rd space (ascites)

1 cell

1 cell

2 extracellularinterstitial

2 bloodvessel(Intravascular)

Best source of water

bull Is in drinking water

bull Beverages of all other types are 2nd best

bull Food contains water like fruits soups jello milk vegetables

bull Energy metabolism produces H20

Estimated daily fluid intake for adults

bull Ingested liquids 1500ml

bull Water in foods 700ml

bull Water from oxidation 200mlraquo __________

bull TOTAL 2400ml

HOMEOSTASIS

bull Keeping the body = or at a balance

bull Our body has this mechanism related to fluids called

bull Fluid amp electrolyte balancebull This balance is for too little water (dehydration) or fluid

overload (too much water) in the bodyhellipboth can occur

Fluid amp electrolyte balance

bull Water lost by healthy individuals through feces perspiration and the respiratory tract must be replaced in both volume and in electrolyte content

Specific Gravity (SG)

bull This is a measurement of the weight of the particles in urine compared to the water in urine

bull If you have lots of particles = heavy urine=big number like 1020-1030

bull If you have diluted urine due to excess urination = light weight urine = low number like 1005-1010

Urine Specific Gravity

bull Normal SG complete range-1005-1030bull Normal urine is 1010-1020bull This means that urine is straw yellow in

color and that the patient is urinating a minimum of 30mLhr

bull Small machine or test strip can tell you the SG of urine

Equipment to test SG

Vomiting amp Diarrhea

bull This type of illness where there is great water loss must be replaced quickly

bull IVFs in this case would be needed

Symptoms of dehydration

bull Hypotension - (not enough fluid in the blood vessels to be pumped everywhere throughout your body)

bull Thirst

bull Eyes are sunken in

bull Mucus membranes are dry

bull Dry skindecreased skin turgor

bull Fever

bull Tachycardia

bull Mental disorientation

bull Specific gravity of lt1010 = clear

clear urine

Treatment of this water loss

bull Replacement of the electrolytes and fluids

bull IVFs are a replacement if the amount lost is great

bull Drinking by mouth is preferred

Sensible vs insensible loss

bull SENSIBLE LOSS ndash is noticeable loss of water as in urine losshellipnormal loss

bull INSENSIBLE LOSS ndash unnoticed water loss is in feces perspiration and respiration

Normal daily water loss

bull The body must excrete 500ml of water as urine each day in order to get rid of the waste products of metabolism

bull This is 500 divided by 24 hrs= 208cchrbull + what we sweat and breathe off therefore

bull We should be excreting at least 30cchr minimum

DEHYDRATION amp OSMOSIS

bull Water moves through the cell walls by this mechanism

bull Remember water likes to dilute ldquostuffrdquo

bull Therefore water moves from an area with less stuff to an area with lots of stuff to dilute it

bull Where salt or protein ishellipwater follows

ELECTROLYTES

bull Na+

bull Cl-

bull K+

bull These electrolytes maintain the balance between intracellular and extracellular fluid

bull

bull Intravascular amp Interstitial

Potassium K+

bull Is the principal electrolyte in INTRAcellular fluid

Sodium Na+

bull Is the principal electrolyte in extracellular fluid

Why we get thirsty

bull If the cell (1st space) becomes dehydrated as in the body lost water we become thirsty

Why else can you become thirsty

bull When the electrolytes in the extracellular fluid are increased (hypertonic solution as in the

consumption of high sugar or salt) the intracellular fluid moves out of the cell to the extracellular fluid to try and dilute it or push the particles away from each other

bull This causeshellip

Osmosis

bull The water from the inside of the cell (intracellular) to move out of the cell (osmosis) shrinking the cell = dehydration of the cell occurs

= thirst

Is there any safety mechanism in the body to prevent this from

happening

bull YEShelliphellip 2 mechanisms try and prevent the body from getting dehydrated

bull 1) ADH

bull 2) Aldosterone

The hypothalamus saves the day

bull It is responsible for regulating appetite

and thirst

bull The hypothalamus

is located at the

base of the brain

During this timehellip

bull When the cell (1st space) releases all of its water to the extracellular fluid to try and separate those particles to dilute them the cell shrinks and the body says ldquought ohhhhrdquo

bull The hypothalamus sends a message to the pituitary gland to secrete ADH (antidiuretic hormone) when the electrolytes become too concentrated in the blood

PITUITARY GLAND

bull Known as the ldquoMaster Glandrdquobull It helps keep water in the blood via the kidneysbull It controls growth by sending growth hormonesbull It aids in releasing pitocin and sending breastmilk

out of the breastsbull It aids in reproduction by sending sex hormones

out to make a baby

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Body Water Content

Obese Normal Muscular 40 60 70

2 compartment of body water

bull 1 Intracellular ndash is the water within the cells itrsquos approx 65 of total body fluid

bull 2 Extracellular ndash is the water outside of the cells approx 35 of total body fluid

bull (includes intravascular amp interstitial fluid)

What do these compartments mean

bull Intracellular ndash is inside the cell where K+ is found

bull Intravascular ndash inside the blood vessel

bull Interstitial ndash around the tissues

bull Extracellular ndash is both intravascular (inside of the blood vessel) AND interstitialhellipthis is where Na+ is found

bull How does the ldquopierdquo from the previous slide fit into the body exactly

bull TIP bull Water should always be in the 1st space firstbull Water should always be in the 2nd space second in

order for the normal body to function

bull And we try not to allow water to move to the 3rd space

Cell = 1st spaceExtracellular (interstitial amp intravascular) = 2nd spaceAbdomen and feet = 3rd space (ascites)

1 cell

1 cell

2 extracellularinterstitial

2 bloodvessel(Intravascular)

Best source of water

bull Is in drinking water

bull Beverages of all other types are 2nd best

bull Food contains water like fruits soups jello milk vegetables

bull Energy metabolism produces H20

Estimated daily fluid intake for adults

bull Ingested liquids 1500ml

bull Water in foods 700ml

bull Water from oxidation 200mlraquo __________

bull TOTAL 2400ml

HOMEOSTASIS

bull Keeping the body = or at a balance

bull Our body has this mechanism related to fluids called

bull Fluid amp electrolyte balancebull This balance is for too little water (dehydration) or fluid

overload (too much water) in the bodyhellipboth can occur

Fluid amp electrolyte balance

bull Water lost by healthy individuals through feces perspiration and the respiratory tract must be replaced in both volume and in electrolyte content

Specific Gravity (SG)

bull This is a measurement of the weight of the particles in urine compared to the water in urine

bull If you have lots of particles = heavy urine=big number like 1020-1030

bull If you have diluted urine due to excess urination = light weight urine = low number like 1005-1010

Urine Specific Gravity

bull Normal SG complete range-1005-1030bull Normal urine is 1010-1020bull This means that urine is straw yellow in

color and that the patient is urinating a minimum of 30mLhr

bull Small machine or test strip can tell you the SG of urine

Equipment to test SG

Vomiting amp Diarrhea

bull This type of illness where there is great water loss must be replaced quickly

bull IVFs in this case would be needed

Symptoms of dehydration

bull Hypotension - (not enough fluid in the blood vessels to be pumped everywhere throughout your body)

bull Thirst

bull Eyes are sunken in

bull Mucus membranes are dry

bull Dry skindecreased skin turgor

bull Fever

bull Tachycardia

bull Mental disorientation

bull Specific gravity of lt1010 = clear

clear urine

Treatment of this water loss

bull Replacement of the electrolytes and fluids

bull IVFs are a replacement if the amount lost is great

bull Drinking by mouth is preferred

Sensible vs insensible loss

bull SENSIBLE LOSS ndash is noticeable loss of water as in urine losshellipnormal loss

bull INSENSIBLE LOSS ndash unnoticed water loss is in feces perspiration and respiration

Normal daily water loss

bull The body must excrete 500ml of water as urine each day in order to get rid of the waste products of metabolism

bull This is 500 divided by 24 hrs= 208cchrbull + what we sweat and breathe off therefore

bull We should be excreting at least 30cchr minimum

DEHYDRATION amp OSMOSIS

bull Water moves through the cell walls by this mechanism

bull Remember water likes to dilute ldquostuffrdquo

bull Therefore water moves from an area with less stuff to an area with lots of stuff to dilute it

bull Where salt or protein ishellipwater follows

ELECTROLYTES

bull Na+

bull Cl-

bull K+

bull These electrolytes maintain the balance between intracellular and extracellular fluid

bull

bull Intravascular amp Interstitial

Potassium K+

bull Is the principal electrolyte in INTRAcellular fluid

Sodium Na+

bull Is the principal electrolyte in extracellular fluid

Why we get thirsty

bull If the cell (1st space) becomes dehydrated as in the body lost water we become thirsty

Why else can you become thirsty

bull When the electrolytes in the extracellular fluid are increased (hypertonic solution as in the

consumption of high sugar or salt) the intracellular fluid moves out of the cell to the extracellular fluid to try and dilute it or push the particles away from each other

bull This causeshellip

Osmosis

bull The water from the inside of the cell (intracellular) to move out of the cell (osmosis) shrinking the cell = dehydration of the cell occurs

= thirst

Is there any safety mechanism in the body to prevent this from

happening

bull YEShelliphellip 2 mechanisms try and prevent the body from getting dehydrated

bull 1) ADH

bull 2) Aldosterone

The hypothalamus saves the day

bull It is responsible for regulating appetite

and thirst

bull The hypothalamus

is located at the

base of the brain

During this timehellip

bull When the cell (1st space) releases all of its water to the extracellular fluid to try and separate those particles to dilute them the cell shrinks and the body says ldquought ohhhhrdquo

bull The hypothalamus sends a message to the pituitary gland to secrete ADH (antidiuretic hormone) when the electrolytes become too concentrated in the blood

PITUITARY GLAND

bull Known as the ldquoMaster Glandrdquobull It helps keep water in the blood via the kidneysbull It controls growth by sending growth hormonesbull It aids in releasing pitocin and sending breastmilk

out of the breastsbull It aids in reproduction by sending sex hormones

out to make a baby

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

2 compartment of body water

bull 1 Intracellular ndash is the water within the cells itrsquos approx 65 of total body fluid

bull 2 Extracellular ndash is the water outside of the cells approx 35 of total body fluid

bull (includes intravascular amp interstitial fluid)

What do these compartments mean

bull Intracellular ndash is inside the cell where K+ is found

bull Intravascular ndash inside the blood vessel

bull Interstitial ndash around the tissues

bull Extracellular ndash is both intravascular (inside of the blood vessel) AND interstitialhellipthis is where Na+ is found

bull How does the ldquopierdquo from the previous slide fit into the body exactly

bull TIP bull Water should always be in the 1st space firstbull Water should always be in the 2nd space second in

order for the normal body to function

bull And we try not to allow water to move to the 3rd space

Cell = 1st spaceExtracellular (interstitial amp intravascular) = 2nd spaceAbdomen and feet = 3rd space (ascites)

1 cell

1 cell

2 extracellularinterstitial

2 bloodvessel(Intravascular)

Best source of water

bull Is in drinking water

bull Beverages of all other types are 2nd best

bull Food contains water like fruits soups jello milk vegetables

bull Energy metabolism produces H20

Estimated daily fluid intake for adults

bull Ingested liquids 1500ml

bull Water in foods 700ml

bull Water from oxidation 200mlraquo __________

bull TOTAL 2400ml

HOMEOSTASIS

bull Keeping the body = or at a balance

bull Our body has this mechanism related to fluids called

bull Fluid amp electrolyte balancebull This balance is for too little water (dehydration) or fluid

overload (too much water) in the bodyhellipboth can occur

Fluid amp electrolyte balance

bull Water lost by healthy individuals through feces perspiration and the respiratory tract must be replaced in both volume and in electrolyte content

Specific Gravity (SG)

bull This is a measurement of the weight of the particles in urine compared to the water in urine

bull If you have lots of particles = heavy urine=big number like 1020-1030

bull If you have diluted urine due to excess urination = light weight urine = low number like 1005-1010

Urine Specific Gravity

bull Normal SG complete range-1005-1030bull Normal urine is 1010-1020bull This means that urine is straw yellow in

color and that the patient is urinating a minimum of 30mLhr

bull Small machine or test strip can tell you the SG of urine

Equipment to test SG

Vomiting amp Diarrhea

bull This type of illness where there is great water loss must be replaced quickly

bull IVFs in this case would be needed

Symptoms of dehydration

bull Hypotension - (not enough fluid in the blood vessels to be pumped everywhere throughout your body)

bull Thirst

bull Eyes are sunken in

bull Mucus membranes are dry

bull Dry skindecreased skin turgor

bull Fever

bull Tachycardia

bull Mental disorientation

bull Specific gravity of lt1010 = clear

clear urine

Treatment of this water loss

bull Replacement of the electrolytes and fluids

bull IVFs are a replacement if the amount lost is great

bull Drinking by mouth is preferred

Sensible vs insensible loss

bull SENSIBLE LOSS ndash is noticeable loss of water as in urine losshellipnormal loss

bull INSENSIBLE LOSS ndash unnoticed water loss is in feces perspiration and respiration

Normal daily water loss

bull The body must excrete 500ml of water as urine each day in order to get rid of the waste products of metabolism

bull This is 500 divided by 24 hrs= 208cchrbull + what we sweat and breathe off therefore

bull We should be excreting at least 30cchr minimum

DEHYDRATION amp OSMOSIS

bull Water moves through the cell walls by this mechanism

bull Remember water likes to dilute ldquostuffrdquo

bull Therefore water moves from an area with less stuff to an area with lots of stuff to dilute it

bull Where salt or protein ishellipwater follows

ELECTROLYTES

bull Na+

bull Cl-

bull K+

bull These electrolytes maintain the balance between intracellular and extracellular fluid

bull

bull Intravascular amp Interstitial

Potassium K+

bull Is the principal electrolyte in INTRAcellular fluid

Sodium Na+

bull Is the principal electrolyte in extracellular fluid

Why we get thirsty

bull If the cell (1st space) becomes dehydrated as in the body lost water we become thirsty

Why else can you become thirsty

bull When the electrolytes in the extracellular fluid are increased (hypertonic solution as in the

consumption of high sugar or salt) the intracellular fluid moves out of the cell to the extracellular fluid to try and dilute it or push the particles away from each other

bull This causeshellip

Osmosis

bull The water from the inside of the cell (intracellular) to move out of the cell (osmosis) shrinking the cell = dehydration of the cell occurs

= thirst

Is there any safety mechanism in the body to prevent this from

happening

bull YEShelliphellip 2 mechanisms try and prevent the body from getting dehydrated

bull 1) ADH

bull 2) Aldosterone

The hypothalamus saves the day

bull It is responsible for regulating appetite

and thirst

bull The hypothalamus

is located at the

base of the brain

During this timehellip

bull When the cell (1st space) releases all of its water to the extracellular fluid to try and separate those particles to dilute them the cell shrinks and the body says ldquought ohhhhrdquo

bull The hypothalamus sends a message to the pituitary gland to secrete ADH (antidiuretic hormone) when the electrolytes become too concentrated in the blood

PITUITARY GLAND

bull Known as the ldquoMaster Glandrdquobull It helps keep water in the blood via the kidneysbull It controls growth by sending growth hormonesbull It aids in releasing pitocin and sending breastmilk

out of the breastsbull It aids in reproduction by sending sex hormones

out to make a baby

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

What do these compartments mean

bull Intracellular ndash is inside the cell where K+ is found

bull Intravascular ndash inside the blood vessel

bull Interstitial ndash around the tissues

bull Extracellular ndash is both intravascular (inside of the blood vessel) AND interstitialhellipthis is where Na+ is found

bull How does the ldquopierdquo from the previous slide fit into the body exactly

bull TIP bull Water should always be in the 1st space firstbull Water should always be in the 2nd space second in

order for the normal body to function

bull And we try not to allow water to move to the 3rd space

Cell = 1st spaceExtracellular (interstitial amp intravascular) = 2nd spaceAbdomen and feet = 3rd space (ascites)

1 cell

1 cell

2 extracellularinterstitial

2 bloodvessel(Intravascular)

Best source of water

bull Is in drinking water

bull Beverages of all other types are 2nd best

bull Food contains water like fruits soups jello milk vegetables

bull Energy metabolism produces H20

Estimated daily fluid intake for adults

bull Ingested liquids 1500ml

bull Water in foods 700ml

bull Water from oxidation 200mlraquo __________

bull TOTAL 2400ml

HOMEOSTASIS

bull Keeping the body = or at a balance

bull Our body has this mechanism related to fluids called

bull Fluid amp electrolyte balancebull This balance is for too little water (dehydration) or fluid

overload (too much water) in the bodyhellipboth can occur

Fluid amp electrolyte balance

bull Water lost by healthy individuals through feces perspiration and the respiratory tract must be replaced in both volume and in electrolyte content

Specific Gravity (SG)

bull This is a measurement of the weight of the particles in urine compared to the water in urine

bull If you have lots of particles = heavy urine=big number like 1020-1030

bull If you have diluted urine due to excess urination = light weight urine = low number like 1005-1010

Urine Specific Gravity

bull Normal SG complete range-1005-1030bull Normal urine is 1010-1020bull This means that urine is straw yellow in

color and that the patient is urinating a minimum of 30mLhr

bull Small machine or test strip can tell you the SG of urine

Equipment to test SG

Vomiting amp Diarrhea

bull This type of illness where there is great water loss must be replaced quickly

bull IVFs in this case would be needed

Symptoms of dehydration

bull Hypotension - (not enough fluid in the blood vessels to be pumped everywhere throughout your body)

bull Thirst

bull Eyes are sunken in

bull Mucus membranes are dry

bull Dry skindecreased skin turgor

bull Fever

bull Tachycardia

bull Mental disorientation

bull Specific gravity of lt1010 = clear

clear urine

Treatment of this water loss

bull Replacement of the electrolytes and fluids

bull IVFs are a replacement if the amount lost is great

bull Drinking by mouth is preferred

Sensible vs insensible loss

bull SENSIBLE LOSS ndash is noticeable loss of water as in urine losshellipnormal loss

bull INSENSIBLE LOSS ndash unnoticed water loss is in feces perspiration and respiration

Normal daily water loss

bull The body must excrete 500ml of water as urine each day in order to get rid of the waste products of metabolism

bull This is 500 divided by 24 hrs= 208cchrbull + what we sweat and breathe off therefore

bull We should be excreting at least 30cchr minimum

DEHYDRATION amp OSMOSIS

bull Water moves through the cell walls by this mechanism

bull Remember water likes to dilute ldquostuffrdquo

bull Therefore water moves from an area with less stuff to an area with lots of stuff to dilute it

bull Where salt or protein ishellipwater follows

ELECTROLYTES

bull Na+

bull Cl-

bull K+

bull These electrolytes maintain the balance between intracellular and extracellular fluid

bull

bull Intravascular amp Interstitial

Potassium K+

bull Is the principal electrolyte in INTRAcellular fluid

Sodium Na+

bull Is the principal electrolyte in extracellular fluid

Why we get thirsty

bull If the cell (1st space) becomes dehydrated as in the body lost water we become thirsty

Why else can you become thirsty

bull When the electrolytes in the extracellular fluid are increased (hypertonic solution as in the

consumption of high sugar or salt) the intracellular fluid moves out of the cell to the extracellular fluid to try and dilute it or push the particles away from each other

bull This causeshellip

Osmosis

bull The water from the inside of the cell (intracellular) to move out of the cell (osmosis) shrinking the cell = dehydration of the cell occurs

= thirst

Is there any safety mechanism in the body to prevent this from

happening

bull YEShelliphellip 2 mechanisms try and prevent the body from getting dehydrated

bull 1) ADH

bull 2) Aldosterone

The hypothalamus saves the day

bull It is responsible for regulating appetite

and thirst

bull The hypothalamus

is located at the

base of the brain

During this timehellip

bull When the cell (1st space) releases all of its water to the extracellular fluid to try and separate those particles to dilute them the cell shrinks and the body says ldquought ohhhhrdquo

bull The hypothalamus sends a message to the pituitary gland to secrete ADH (antidiuretic hormone) when the electrolytes become too concentrated in the blood

PITUITARY GLAND

bull Known as the ldquoMaster Glandrdquobull It helps keep water in the blood via the kidneysbull It controls growth by sending growth hormonesbull It aids in releasing pitocin and sending breastmilk

out of the breastsbull It aids in reproduction by sending sex hormones

out to make a baby

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

bull How does the ldquopierdquo from the previous slide fit into the body exactly

bull TIP bull Water should always be in the 1st space firstbull Water should always be in the 2nd space second in

order for the normal body to function

bull And we try not to allow water to move to the 3rd space

Cell = 1st spaceExtracellular (interstitial amp intravascular) = 2nd spaceAbdomen and feet = 3rd space (ascites)

1 cell

1 cell

2 extracellularinterstitial

2 bloodvessel(Intravascular)

Best source of water

bull Is in drinking water

bull Beverages of all other types are 2nd best

bull Food contains water like fruits soups jello milk vegetables

bull Energy metabolism produces H20

Estimated daily fluid intake for adults

bull Ingested liquids 1500ml

bull Water in foods 700ml

bull Water from oxidation 200mlraquo __________

bull TOTAL 2400ml

HOMEOSTASIS

bull Keeping the body = or at a balance

bull Our body has this mechanism related to fluids called

bull Fluid amp electrolyte balancebull This balance is for too little water (dehydration) or fluid

overload (too much water) in the bodyhellipboth can occur

Fluid amp electrolyte balance

bull Water lost by healthy individuals through feces perspiration and the respiratory tract must be replaced in both volume and in electrolyte content

Specific Gravity (SG)

bull This is a measurement of the weight of the particles in urine compared to the water in urine

bull If you have lots of particles = heavy urine=big number like 1020-1030

bull If you have diluted urine due to excess urination = light weight urine = low number like 1005-1010

Urine Specific Gravity

bull Normal SG complete range-1005-1030bull Normal urine is 1010-1020bull This means that urine is straw yellow in

color and that the patient is urinating a minimum of 30mLhr

bull Small machine or test strip can tell you the SG of urine

Equipment to test SG

Vomiting amp Diarrhea

bull This type of illness where there is great water loss must be replaced quickly

bull IVFs in this case would be needed

Symptoms of dehydration

bull Hypotension - (not enough fluid in the blood vessels to be pumped everywhere throughout your body)

bull Thirst

bull Eyes are sunken in

bull Mucus membranes are dry

bull Dry skindecreased skin turgor

bull Fever

bull Tachycardia

bull Mental disorientation

bull Specific gravity of lt1010 = clear

clear urine

Treatment of this water loss

bull Replacement of the electrolytes and fluids

bull IVFs are a replacement if the amount lost is great

bull Drinking by mouth is preferred

Sensible vs insensible loss

bull SENSIBLE LOSS ndash is noticeable loss of water as in urine losshellipnormal loss

bull INSENSIBLE LOSS ndash unnoticed water loss is in feces perspiration and respiration

Normal daily water loss

bull The body must excrete 500ml of water as urine each day in order to get rid of the waste products of metabolism

bull This is 500 divided by 24 hrs= 208cchrbull + what we sweat and breathe off therefore

bull We should be excreting at least 30cchr minimum

DEHYDRATION amp OSMOSIS

bull Water moves through the cell walls by this mechanism

bull Remember water likes to dilute ldquostuffrdquo

bull Therefore water moves from an area with less stuff to an area with lots of stuff to dilute it

bull Where salt or protein ishellipwater follows

ELECTROLYTES

bull Na+

bull Cl-

bull K+

bull These electrolytes maintain the balance between intracellular and extracellular fluid

bull

bull Intravascular amp Interstitial

Potassium K+

bull Is the principal electrolyte in INTRAcellular fluid

Sodium Na+

bull Is the principal electrolyte in extracellular fluid

Why we get thirsty

bull If the cell (1st space) becomes dehydrated as in the body lost water we become thirsty

Why else can you become thirsty

bull When the electrolytes in the extracellular fluid are increased (hypertonic solution as in the

consumption of high sugar or salt) the intracellular fluid moves out of the cell to the extracellular fluid to try and dilute it or push the particles away from each other

bull This causeshellip

Osmosis

bull The water from the inside of the cell (intracellular) to move out of the cell (osmosis) shrinking the cell = dehydration of the cell occurs

= thirst

Is there any safety mechanism in the body to prevent this from

happening

bull YEShelliphellip 2 mechanisms try and prevent the body from getting dehydrated

bull 1) ADH

bull 2) Aldosterone

The hypothalamus saves the day

bull It is responsible for regulating appetite

and thirst

bull The hypothalamus

is located at the

base of the brain

During this timehellip

bull When the cell (1st space) releases all of its water to the extracellular fluid to try and separate those particles to dilute them the cell shrinks and the body says ldquought ohhhhrdquo

bull The hypothalamus sends a message to the pituitary gland to secrete ADH (antidiuretic hormone) when the electrolytes become too concentrated in the blood

PITUITARY GLAND

bull Known as the ldquoMaster Glandrdquobull It helps keep water in the blood via the kidneysbull It controls growth by sending growth hormonesbull It aids in releasing pitocin and sending breastmilk

out of the breastsbull It aids in reproduction by sending sex hormones

out to make a baby

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Cell = 1st spaceExtracellular (interstitial amp intravascular) = 2nd spaceAbdomen and feet = 3rd space (ascites)

1 cell

1 cell

2 extracellularinterstitial

2 bloodvessel(Intravascular)

Best source of water

bull Is in drinking water

bull Beverages of all other types are 2nd best

bull Food contains water like fruits soups jello milk vegetables

bull Energy metabolism produces H20

Estimated daily fluid intake for adults

bull Ingested liquids 1500ml

bull Water in foods 700ml

bull Water from oxidation 200mlraquo __________

bull TOTAL 2400ml

HOMEOSTASIS

bull Keeping the body = or at a balance

bull Our body has this mechanism related to fluids called

bull Fluid amp electrolyte balancebull This balance is for too little water (dehydration) or fluid

overload (too much water) in the bodyhellipboth can occur

Fluid amp electrolyte balance

bull Water lost by healthy individuals through feces perspiration and the respiratory tract must be replaced in both volume and in electrolyte content

Specific Gravity (SG)

bull This is a measurement of the weight of the particles in urine compared to the water in urine

bull If you have lots of particles = heavy urine=big number like 1020-1030

bull If you have diluted urine due to excess urination = light weight urine = low number like 1005-1010

Urine Specific Gravity

bull Normal SG complete range-1005-1030bull Normal urine is 1010-1020bull This means that urine is straw yellow in

color and that the patient is urinating a minimum of 30mLhr

bull Small machine or test strip can tell you the SG of urine

Equipment to test SG

Vomiting amp Diarrhea

bull This type of illness where there is great water loss must be replaced quickly

bull IVFs in this case would be needed

Symptoms of dehydration

bull Hypotension - (not enough fluid in the blood vessels to be pumped everywhere throughout your body)

bull Thirst

bull Eyes are sunken in

bull Mucus membranes are dry

bull Dry skindecreased skin turgor

bull Fever

bull Tachycardia

bull Mental disorientation

bull Specific gravity of lt1010 = clear

clear urine

Treatment of this water loss

bull Replacement of the electrolytes and fluids

bull IVFs are a replacement if the amount lost is great

bull Drinking by mouth is preferred

Sensible vs insensible loss

bull SENSIBLE LOSS ndash is noticeable loss of water as in urine losshellipnormal loss

bull INSENSIBLE LOSS ndash unnoticed water loss is in feces perspiration and respiration

Normal daily water loss

bull The body must excrete 500ml of water as urine each day in order to get rid of the waste products of metabolism

bull This is 500 divided by 24 hrs= 208cchrbull + what we sweat and breathe off therefore

bull We should be excreting at least 30cchr minimum

DEHYDRATION amp OSMOSIS

bull Water moves through the cell walls by this mechanism

bull Remember water likes to dilute ldquostuffrdquo

bull Therefore water moves from an area with less stuff to an area with lots of stuff to dilute it

bull Where salt or protein ishellipwater follows

ELECTROLYTES

bull Na+

bull Cl-

bull K+

bull These electrolytes maintain the balance between intracellular and extracellular fluid

bull

bull Intravascular amp Interstitial

Potassium K+

bull Is the principal electrolyte in INTRAcellular fluid

Sodium Na+

bull Is the principal electrolyte in extracellular fluid

Why we get thirsty

bull If the cell (1st space) becomes dehydrated as in the body lost water we become thirsty

Why else can you become thirsty

bull When the electrolytes in the extracellular fluid are increased (hypertonic solution as in the

consumption of high sugar or salt) the intracellular fluid moves out of the cell to the extracellular fluid to try and dilute it or push the particles away from each other

bull This causeshellip

Osmosis

bull The water from the inside of the cell (intracellular) to move out of the cell (osmosis) shrinking the cell = dehydration of the cell occurs

= thirst

Is there any safety mechanism in the body to prevent this from

happening

bull YEShelliphellip 2 mechanisms try and prevent the body from getting dehydrated

bull 1) ADH

bull 2) Aldosterone

The hypothalamus saves the day

bull It is responsible for regulating appetite

and thirst

bull The hypothalamus

is located at the

base of the brain

During this timehellip

bull When the cell (1st space) releases all of its water to the extracellular fluid to try and separate those particles to dilute them the cell shrinks and the body says ldquought ohhhhrdquo

bull The hypothalamus sends a message to the pituitary gland to secrete ADH (antidiuretic hormone) when the electrolytes become too concentrated in the blood

PITUITARY GLAND

bull Known as the ldquoMaster Glandrdquobull It helps keep water in the blood via the kidneysbull It controls growth by sending growth hormonesbull It aids in releasing pitocin and sending breastmilk

out of the breastsbull It aids in reproduction by sending sex hormones

out to make a baby

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Best source of water

bull Is in drinking water

bull Beverages of all other types are 2nd best

bull Food contains water like fruits soups jello milk vegetables

bull Energy metabolism produces H20

Estimated daily fluid intake for adults

bull Ingested liquids 1500ml

bull Water in foods 700ml

bull Water from oxidation 200mlraquo __________

bull TOTAL 2400ml

HOMEOSTASIS

bull Keeping the body = or at a balance

bull Our body has this mechanism related to fluids called

bull Fluid amp electrolyte balancebull This balance is for too little water (dehydration) or fluid

overload (too much water) in the bodyhellipboth can occur

Fluid amp electrolyte balance

bull Water lost by healthy individuals through feces perspiration and the respiratory tract must be replaced in both volume and in electrolyte content

Specific Gravity (SG)

bull This is a measurement of the weight of the particles in urine compared to the water in urine

bull If you have lots of particles = heavy urine=big number like 1020-1030

bull If you have diluted urine due to excess urination = light weight urine = low number like 1005-1010

Urine Specific Gravity

bull Normal SG complete range-1005-1030bull Normal urine is 1010-1020bull This means that urine is straw yellow in

color and that the patient is urinating a minimum of 30mLhr

bull Small machine or test strip can tell you the SG of urine

Equipment to test SG

Vomiting amp Diarrhea

bull This type of illness where there is great water loss must be replaced quickly

bull IVFs in this case would be needed

Symptoms of dehydration

bull Hypotension - (not enough fluid in the blood vessels to be pumped everywhere throughout your body)

bull Thirst

bull Eyes are sunken in

bull Mucus membranes are dry

bull Dry skindecreased skin turgor

bull Fever

bull Tachycardia

bull Mental disorientation

bull Specific gravity of lt1010 = clear

clear urine

Treatment of this water loss

bull Replacement of the electrolytes and fluids

bull IVFs are a replacement if the amount lost is great

bull Drinking by mouth is preferred

Sensible vs insensible loss

bull SENSIBLE LOSS ndash is noticeable loss of water as in urine losshellipnormal loss

bull INSENSIBLE LOSS ndash unnoticed water loss is in feces perspiration and respiration

Normal daily water loss

bull The body must excrete 500ml of water as urine each day in order to get rid of the waste products of metabolism

bull This is 500 divided by 24 hrs= 208cchrbull + what we sweat and breathe off therefore

bull We should be excreting at least 30cchr minimum

DEHYDRATION amp OSMOSIS

bull Water moves through the cell walls by this mechanism

bull Remember water likes to dilute ldquostuffrdquo

bull Therefore water moves from an area with less stuff to an area with lots of stuff to dilute it

bull Where salt or protein ishellipwater follows

ELECTROLYTES

bull Na+

bull Cl-

bull K+

bull These electrolytes maintain the balance between intracellular and extracellular fluid

bull

bull Intravascular amp Interstitial

Potassium K+

bull Is the principal electrolyte in INTRAcellular fluid

Sodium Na+

bull Is the principal electrolyte in extracellular fluid

Why we get thirsty

bull If the cell (1st space) becomes dehydrated as in the body lost water we become thirsty

Why else can you become thirsty

bull When the electrolytes in the extracellular fluid are increased (hypertonic solution as in the

consumption of high sugar or salt) the intracellular fluid moves out of the cell to the extracellular fluid to try and dilute it or push the particles away from each other

bull This causeshellip

Osmosis

bull The water from the inside of the cell (intracellular) to move out of the cell (osmosis) shrinking the cell = dehydration of the cell occurs

= thirst

Is there any safety mechanism in the body to prevent this from

happening

bull YEShelliphellip 2 mechanisms try and prevent the body from getting dehydrated

bull 1) ADH

bull 2) Aldosterone

The hypothalamus saves the day

bull It is responsible for regulating appetite

and thirst

bull The hypothalamus

is located at the

base of the brain

During this timehellip

bull When the cell (1st space) releases all of its water to the extracellular fluid to try and separate those particles to dilute them the cell shrinks and the body says ldquought ohhhhrdquo

bull The hypothalamus sends a message to the pituitary gland to secrete ADH (antidiuretic hormone) when the electrolytes become too concentrated in the blood

PITUITARY GLAND

bull Known as the ldquoMaster Glandrdquobull It helps keep water in the blood via the kidneysbull It controls growth by sending growth hormonesbull It aids in releasing pitocin and sending breastmilk

out of the breastsbull It aids in reproduction by sending sex hormones

out to make a baby

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Estimated daily fluid intake for adults

bull Ingested liquids 1500ml

bull Water in foods 700ml

bull Water from oxidation 200mlraquo __________

bull TOTAL 2400ml

HOMEOSTASIS

bull Keeping the body = or at a balance

bull Our body has this mechanism related to fluids called

bull Fluid amp electrolyte balancebull This balance is for too little water (dehydration) or fluid

overload (too much water) in the bodyhellipboth can occur

Fluid amp electrolyte balance

bull Water lost by healthy individuals through feces perspiration and the respiratory tract must be replaced in both volume and in electrolyte content

Specific Gravity (SG)

bull This is a measurement of the weight of the particles in urine compared to the water in urine

bull If you have lots of particles = heavy urine=big number like 1020-1030

bull If you have diluted urine due to excess urination = light weight urine = low number like 1005-1010

Urine Specific Gravity

bull Normal SG complete range-1005-1030bull Normal urine is 1010-1020bull This means that urine is straw yellow in

color and that the patient is urinating a minimum of 30mLhr

bull Small machine or test strip can tell you the SG of urine

Equipment to test SG

Vomiting amp Diarrhea

bull This type of illness where there is great water loss must be replaced quickly

bull IVFs in this case would be needed

Symptoms of dehydration

bull Hypotension - (not enough fluid in the blood vessels to be pumped everywhere throughout your body)

bull Thirst

bull Eyes are sunken in

bull Mucus membranes are dry

bull Dry skindecreased skin turgor

bull Fever

bull Tachycardia

bull Mental disorientation

bull Specific gravity of lt1010 = clear

clear urine

Treatment of this water loss

bull Replacement of the electrolytes and fluids

bull IVFs are a replacement if the amount lost is great

bull Drinking by mouth is preferred

Sensible vs insensible loss

bull SENSIBLE LOSS ndash is noticeable loss of water as in urine losshellipnormal loss

bull INSENSIBLE LOSS ndash unnoticed water loss is in feces perspiration and respiration

Normal daily water loss

bull The body must excrete 500ml of water as urine each day in order to get rid of the waste products of metabolism

bull This is 500 divided by 24 hrs= 208cchrbull + what we sweat and breathe off therefore

bull We should be excreting at least 30cchr minimum

DEHYDRATION amp OSMOSIS

bull Water moves through the cell walls by this mechanism

bull Remember water likes to dilute ldquostuffrdquo

bull Therefore water moves from an area with less stuff to an area with lots of stuff to dilute it

bull Where salt or protein ishellipwater follows

ELECTROLYTES

bull Na+

bull Cl-

bull K+

bull These electrolytes maintain the balance between intracellular and extracellular fluid

bull

bull Intravascular amp Interstitial

Potassium K+

bull Is the principal electrolyte in INTRAcellular fluid

Sodium Na+

bull Is the principal electrolyte in extracellular fluid

Why we get thirsty

bull If the cell (1st space) becomes dehydrated as in the body lost water we become thirsty

Why else can you become thirsty

bull When the electrolytes in the extracellular fluid are increased (hypertonic solution as in the

consumption of high sugar or salt) the intracellular fluid moves out of the cell to the extracellular fluid to try and dilute it or push the particles away from each other

bull This causeshellip

Osmosis

bull The water from the inside of the cell (intracellular) to move out of the cell (osmosis) shrinking the cell = dehydration of the cell occurs

= thirst

Is there any safety mechanism in the body to prevent this from

happening

bull YEShelliphellip 2 mechanisms try and prevent the body from getting dehydrated

bull 1) ADH

bull 2) Aldosterone

The hypothalamus saves the day

bull It is responsible for regulating appetite

and thirst

bull The hypothalamus

is located at the

base of the brain

During this timehellip

bull When the cell (1st space) releases all of its water to the extracellular fluid to try and separate those particles to dilute them the cell shrinks and the body says ldquought ohhhhrdquo

bull The hypothalamus sends a message to the pituitary gland to secrete ADH (antidiuretic hormone) when the electrolytes become too concentrated in the blood

PITUITARY GLAND

bull Known as the ldquoMaster Glandrdquobull It helps keep water in the blood via the kidneysbull It controls growth by sending growth hormonesbull It aids in releasing pitocin and sending breastmilk

out of the breastsbull It aids in reproduction by sending sex hormones

out to make a baby

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

HOMEOSTASIS

bull Keeping the body = or at a balance

bull Our body has this mechanism related to fluids called

bull Fluid amp electrolyte balancebull This balance is for too little water (dehydration) or fluid

overload (too much water) in the bodyhellipboth can occur

Fluid amp electrolyte balance

bull Water lost by healthy individuals through feces perspiration and the respiratory tract must be replaced in both volume and in electrolyte content

Specific Gravity (SG)

bull This is a measurement of the weight of the particles in urine compared to the water in urine

bull If you have lots of particles = heavy urine=big number like 1020-1030

bull If you have diluted urine due to excess urination = light weight urine = low number like 1005-1010

Urine Specific Gravity

bull Normal SG complete range-1005-1030bull Normal urine is 1010-1020bull This means that urine is straw yellow in

color and that the patient is urinating a minimum of 30mLhr

bull Small machine or test strip can tell you the SG of urine

Equipment to test SG

Vomiting amp Diarrhea

bull This type of illness where there is great water loss must be replaced quickly

bull IVFs in this case would be needed

Symptoms of dehydration

bull Hypotension - (not enough fluid in the blood vessels to be pumped everywhere throughout your body)

bull Thirst

bull Eyes are sunken in

bull Mucus membranes are dry

bull Dry skindecreased skin turgor

bull Fever

bull Tachycardia

bull Mental disorientation

bull Specific gravity of lt1010 = clear

clear urine

Treatment of this water loss

bull Replacement of the electrolytes and fluids

bull IVFs are a replacement if the amount lost is great

bull Drinking by mouth is preferred

Sensible vs insensible loss

bull SENSIBLE LOSS ndash is noticeable loss of water as in urine losshellipnormal loss

bull INSENSIBLE LOSS ndash unnoticed water loss is in feces perspiration and respiration

Normal daily water loss

bull The body must excrete 500ml of water as urine each day in order to get rid of the waste products of metabolism

bull This is 500 divided by 24 hrs= 208cchrbull + what we sweat and breathe off therefore

bull We should be excreting at least 30cchr minimum

DEHYDRATION amp OSMOSIS

bull Water moves through the cell walls by this mechanism

bull Remember water likes to dilute ldquostuffrdquo

bull Therefore water moves from an area with less stuff to an area with lots of stuff to dilute it

bull Where salt or protein ishellipwater follows

ELECTROLYTES

bull Na+

bull Cl-

bull K+

bull These electrolytes maintain the balance between intracellular and extracellular fluid

bull

bull Intravascular amp Interstitial

Potassium K+

bull Is the principal electrolyte in INTRAcellular fluid

Sodium Na+

bull Is the principal electrolyte in extracellular fluid

Why we get thirsty

bull If the cell (1st space) becomes dehydrated as in the body lost water we become thirsty

Why else can you become thirsty

bull When the electrolytes in the extracellular fluid are increased (hypertonic solution as in the

consumption of high sugar or salt) the intracellular fluid moves out of the cell to the extracellular fluid to try and dilute it or push the particles away from each other

bull This causeshellip

Osmosis

bull The water from the inside of the cell (intracellular) to move out of the cell (osmosis) shrinking the cell = dehydration of the cell occurs

= thirst

Is there any safety mechanism in the body to prevent this from

happening

bull YEShelliphellip 2 mechanisms try and prevent the body from getting dehydrated

bull 1) ADH

bull 2) Aldosterone

The hypothalamus saves the day

bull It is responsible for regulating appetite

and thirst

bull The hypothalamus

is located at the

base of the brain

During this timehellip

bull When the cell (1st space) releases all of its water to the extracellular fluid to try and separate those particles to dilute them the cell shrinks and the body says ldquought ohhhhrdquo

bull The hypothalamus sends a message to the pituitary gland to secrete ADH (antidiuretic hormone) when the electrolytes become too concentrated in the blood

PITUITARY GLAND

bull Known as the ldquoMaster Glandrdquobull It helps keep water in the blood via the kidneysbull It controls growth by sending growth hormonesbull It aids in releasing pitocin and sending breastmilk

out of the breastsbull It aids in reproduction by sending sex hormones

out to make a baby

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Fluid amp electrolyte balance

bull Water lost by healthy individuals through feces perspiration and the respiratory tract must be replaced in both volume and in electrolyte content

Specific Gravity (SG)

bull This is a measurement of the weight of the particles in urine compared to the water in urine

bull If you have lots of particles = heavy urine=big number like 1020-1030

bull If you have diluted urine due to excess urination = light weight urine = low number like 1005-1010

Urine Specific Gravity

bull Normal SG complete range-1005-1030bull Normal urine is 1010-1020bull This means that urine is straw yellow in

color and that the patient is urinating a minimum of 30mLhr

bull Small machine or test strip can tell you the SG of urine

Equipment to test SG

Vomiting amp Diarrhea

bull This type of illness where there is great water loss must be replaced quickly

bull IVFs in this case would be needed

Symptoms of dehydration

bull Hypotension - (not enough fluid in the blood vessels to be pumped everywhere throughout your body)

bull Thirst

bull Eyes are sunken in

bull Mucus membranes are dry

bull Dry skindecreased skin turgor

bull Fever

bull Tachycardia

bull Mental disorientation

bull Specific gravity of lt1010 = clear

clear urine

Treatment of this water loss

bull Replacement of the electrolytes and fluids

bull IVFs are a replacement if the amount lost is great

bull Drinking by mouth is preferred

Sensible vs insensible loss

bull SENSIBLE LOSS ndash is noticeable loss of water as in urine losshellipnormal loss

bull INSENSIBLE LOSS ndash unnoticed water loss is in feces perspiration and respiration

Normal daily water loss

bull The body must excrete 500ml of water as urine each day in order to get rid of the waste products of metabolism

bull This is 500 divided by 24 hrs= 208cchrbull + what we sweat and breathe off therefore

bull We should be excreting at least 30cchr minimum

DEHYDRATION amp OSMOSIS

bull Water moves through the cell walls by this mechanism

bull Remember water likes to dilute ldquostuffrdquo

bull Therefore water moves from an area with less stuff to an area with lots of stuff to dilute it

bull Where salt or protein ishellipwater follows

ELECTROLYTES

bull Na+

bull Cl-

bull K+

bull These electrolytes maintain the balance between intracellular and extracellular fluid

bull

bull Intravascular amp Interstitial

Potassium K+

bull Is the principal electrolyte in INTRAcellular fluid

Sodium Na+

bull Is the principal electrolyte in extracellular fluid

Why we get thirsty

bull If the cell (1st space) becomes dehydrated as in the body lost water we become thirsty

Why else can you become thirsty

bull When the electrolytes in the extracellular fluid are increased (hypertonic solution as in the

consumption of high sugar or salt) the intracellular fluid moves out of the cell to the extracellular fluid to try and dilute it or push the particles away from each other

bull This causeshellip

Osmosis

bull The water from the inside of the cell (intracellular) to move out of the cell (osmosis) shrinking the cell = dehydration of the cell occurs

= thirst

Is there any safety mechanism in the body to prevent this from

happening

bull YEShelliphellip 2 mechanisms try and prevent the body from getting dehydrated

bull 1) ADH

bull 2) Aldosterone

The hypothalamus saves the day

bull It is responsible for regulating appetite

and thirst

bull The hypothalamus

is located at the

base of the brain

During this timehellip

bull When the cell (1st space) releases all of its water to the extracellular fluid to try and separate those particles to dilute them the cell shrinks and the body says ldquought ohhhhrdquo

bull The hypothalamus sends a message to the pituitary gland to secrete ADH (antidiuretic hormone) when the electrolytes become too concentrated in the blood

PITUITARY GLAND

bull Known as the ldquoMaster Glandrdquobull It helps keep water in the blood via the kidneysbull It controls growth by sending growth hormonesbull It aids in releasing pitocin and sending breastmilk

out of the breastsbull It aids in reproduction by sending sex hormones

out to make a baby

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Specific Gravity (SG)

bull This is a measurement of the weight of the particles in urine compared to the water in urine

bull If you have lots of particles = heavy urine=big number like 1020-1030

bull If you have diluted urine due to excess urination = light weight urine = low number like 1005-1010

Urine Specific Gravity

bull Normal SG complete range-1005-1030bull Normal urine is 1010-1020bull This means that urine is straw yellow in

color and that the patient is urinating a minimum of 30mLhr

bull Small machine or test strip can tell you the SG of urine

Equipment to test SG

Vomiting amp Diarrhea

bull This type of illness where there is great water loss must be replaced quickly

bull IVFs in this case would be needed

Symptoms of dehydration

bull Hypotension - (not enough fluid in the blood vessels to be pumped everywhere throughout your body)

bull Thirst

bull Eyes are sunken in

bull Mucus membranes are dry

bull Dry skindecreased skin turgor

bull Fever

bull Tachycardia

bull Mental disorientation

bull Specific gravity of lt1010 = clear

clear urine

Treatment of this water loss

bull Replacement of the electrolytes and fluids

bull IVFs are a replacement if the amount lost is great

bull Drinking by mouth is preferred

Sensible vs insensible loss

bull SENSIBLE LOSS ndash is noticeable loss of water as in urine losshellipnormal loss

bull INSENSIBLE LOSS ndash unnoticed water loss is in feces perspiration and respiration

Normal daily water loss

bull The body must excrete 500ml of water as urine each day in order to get rid of the waste products of metabolism

bull This is 500 divided by 24 hrs= 208cchrbull + what we sweat and breathe off therefore

bull We should be excreting at least 30cchr minimum

DEHYDRATION amp OSMOSIS

bull Water moves through the cell walls by this mechanism

bull Remember water likes to dilute ldquostuffrdquo

bull Therefore water moves from an area with less stuff to an area with lots of stuff to dilute it

bull Where salt or protein ishellipwater follows

ELECTROLYTES

bull Na+

bull Cl-

bull K+

bull These electrolytes maintain the balance between intracellular and extracellular fluid

bull

bull Intravascular amp Interstitial

Potassium K+

bull Is the principal electrolyte in INTRAcellular fluid

Sodium Na+

bull Is the principal electrolyte in extracellular fluid

Why we get thirsty

bull If the cell (1st space) becomes dehydrated as in the body lost water we become thirsty

Why else can you become thirsty

bull When the electrolytes in the extracellular fluid are increased (hypertonic solution as in the

consumption of high sugar or salt) the intracellular fluid moves out of the cell to the extracellular fluid to try and dilute it or push the particles away from each other

bull This causeshellip

Osmosis

bull The water from the inside of the cell (intracellular) to move out of the cell (osmosis) shrinking the cell = dehydration of the cell occurs

= thirst

Is there any safety mechanism in the body to prevent this from

happening

bull YEShelliphellip 2 mechanisms try and prevent the body from getting dehydrated

bull 1) ADH

bull 2) Aldosterone

The hypothalamus saves the day

bull It is responsible for regulating appetite

and thirst

bull The hypothalamus

is located at the

base of the brain

During this timehellip

bull When the cell (1st space) releases all of its water to the extracellular fluid to try and separate those particles to dilute them the cell shrinks and the body says ldquought ohhhhrdquo

bull The hypothalamus sends a message to the pituitary gland to secrete ADH (antidiuretic hormone) when the electrolytes become too concentrated in the blood

PITUITARY GLAND

bull Known as the ldquoMaster Glandrdquobull It helps keep water in the blood via the kidneysbull It controls growth by sending growth hormonesbull It aids in releasing pitocin and sending breastmilk

out of the breastsbull It aids in reproduction by sending sex hormones

out to make a baby

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Urine Specific Gravity

bull Normal SG complete range-1005-1030bull Normal urine is 1010-1020bull This means that urine is straw yellow in

color and that the patient is urinating a minimum of 30mLhr

bull Small machine or test strip can tell you the SG of urine

Equipment to test SG

Vomiting amp Diarrhea

bull This type of illness where there is great water loss must be replaced quickly

bull IVFs in this case would be needed

Symptoms of dehydration

bull Hypotension - (not enough fluid in the blood vessels to be pumped everywhere throughout your body)

bull Thirst

bull Eyes are sunken in

bull Mucus membranes are dry

bull Dry skindecreased skin turgor

bull Fever

bull Tachycardia

bull Mental disorientation

bull Specific gravity of lt1010 = clear

clear urine

Treatment of this water loss

bull Replacement of the electrolytes and fluids

bull IVFs are a replacement if the amount lost is great

bull Drinking by mouth is preferred

Sensible vs insensible loss

bull SENSIBLE LOSS ndash is noticeable loss of water as in urine losshellipnormal loss

bull INSENSIBLE LOSS ndash unnoticed water loss is in feces perspiration and respiration

Normal daily water loss

bull The body must excrete 500ml of water as urine each day in order to get rid of the waste products of metabolism

bull This is 500 divided by 24 hrs= 208cchrbull + what we sweat and breathe off therefore

bull We should be excreting at least 30cchr minimum

DEHYDRATION amp OSMOSIS

bull Water moves through the cell walls by this mechanism

bull Remember water likes to dilute ldquostuffrdquo

bull Therefore water moves from an area with less stuff to an area with lots of stuff to dilute it

bull Where salt or protein ishellipwater follows

ELECTROLYTES

bull Na+

bull Cl-

bull K+

bull These electrolytes maintain the balance between intracellular and extracellular fluid

bull

bull Intravascular amp Interstitial

Potassium K+

bull Is the principal electrolyte in INTRAcellular fluid

Sodium Na+

bull Is the principal electrolyte in extracellular fluid

Why we get thirsty

bull If the cell (1st space) becomes dehydrated as in the body lost water we become thirsty

Why else can you become thirsty

bull When the electrolytes in the extracellular fluid are increased (hypertonic solution as in the

consumption of high sugar or salt) the intracellular fluid moves out of the cell to the extracellular fluid to try and dilute it or push the particles away from each other

bull This causeshellip

Osmosis

bull The water from the inside of the cell (intracellular) to move out of the cell (osmosis) shrinking the cell = dehydration of the cell occurs

= thirst

Is there any safety mechanism in the body to prevent this from

happening

bull YEShelliphellip 2 mechanisms try and prevent the body from getting dehydrated

bull 1) ADH

bull 2) Aldosterone

The hypothalamus saves the day

bull It is responsible for regulating appetite

and thirst

bull The hypothalamus

is located at the

base of the brain

During this timehellip

bull When the cell (1st space) releases all of its water to the extracellular fluid to try and separate those particles to dilute them the cell shrinks and the body says ldquought ohhhhrdquo

bull The hypothalamus sends a message to the pituitary gland to secrete ADH (antidiuretic hormone) when the electrolytes become too concentrated in the blood

PITUITARY GLAND

bull Known as the ldquoMaster Glandrdquobull It helps keep water in the blood via the kidneysbull It controls growth by sending growth hormonesbull It aids in releasing pitocin and sending breastmilk

out of the breastsbull It aids in reproduction by sending sex hormones

out to make a baby

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Equipment to test SG

Vomiting amp Diarrhea

bull This type of illness where there is great water loss must be replaced quickly

bull IVFs in this case would be needed

Symptoms of dehydration

bull Hypotension - (not enough fluid in the blood vessels to be pumped everywhere throughout your body)

bull Thirst

bull Eyes are sunken in

bull Mucus membranes are dry

bull Dry skindecreased skin turgor

bull Fever

bull Tachycardia

bull Mental disorientation

bull Specific gravity of lt1010 = clear

clear urine

Treatment of this water loss

bull Replacement of the electrolytes and fluids

bull IVFs are a replacement if the amount lost is great

bull Drinking by mouth is preferred

Sensible vs insensible loss

bull SENSIBLE LOSS ndash is noticeable loss of water as in urine losshellipnormal loss

bull INSENSIBLE LOSS ndash unnoticed water loss is in feces perspiration and respiration

Normal daily water loss

bull The body must excrete 500ml of water as urine each day in order to get rid of the waste products of metabolism

bull This is 500 divided by 24 hrs= 208cchrbull + what we sweat and breathe off therefore

bull We should be excreting at least 30cchr minimum

DEHYDRATION amp OSMOSIS

bull Water moves through the cell walls by this mechanism

bull Remember water likes to dilute ldquostuffrdquo

bull Therefore water moves from an area with less stuff to an area with lots of stuff to dilute it

bull Where salt or protein ishellipwater follows

ELECTROLYTES

bull Na+

bull Cl-

bull K+

bull These electrolytes maintain the balance between intracellular and extracellular fluid

bull

bull Intravascular amp Interstitial

Potassium K+

bull Is the principal electrolyte in INTRAcellular fluid

Sodium Na+

bull Is the principal electrolyte in extracellular fluid

Why we get thirsty

bull If the cell (1st space) becomes dehydrated as in the body lost water we become thirsty

Why else can you become thirsty

bull When the electrolytes in the extracellular fluid are increased (hypertonic solution as in the

consumption of high sugar or salt) the intracellular fluid moves out of the cell to the extracellular fluid to try and dilute it or push the particles away from each other

bull This causeshellip

Osmosis

bull The water from the inside of the cell (intracellular) to move out of the cell (osmosis) shrinking the cell = dehydration of the cell occurs

= thirst

Is there any safety mechanism in the body to prevent this from

happening

bull YEShelliphellip 2 mechanisms try and prevent the body from getting dehydrated

bull 1) ADH

bull 2) Aldosterone

The hypothalamus saves the day

bull It is responsible for regulating appetite

and thirst

bull The hypothalamus

is located at the

base of the brain

During this timehellip

bull When the cell (1st space) releases all of its water to the extracellular fluid to try and separate those particles to dilute them the cell shrinks and the body says ldquought ohhhhrdquo

bull The hypothalamus sends a message to the pituitary gland to secrete ADH (antidiuretic hormone) when the electrolytes become too concentrated in the blood

PITUITARY GLAND

bull Known as the ldquoMaster Glandrdquobull It helps keep water in the blood via the kidneysbull It controls growth by sending growth hormonesbull It aids in releasing pitocin and sending breastmilk

out of the breastsbull It aids in reproduction by sending sex hormones

out to make a baby

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Vomiting amp Diarrhea

bull This type of illness where there is great water loss must be replaced quickly

bull IVFs in this case would be needed

Symptoms of dehydration

bull Hypotension - (not enough fluid in the blood vessels to be pumped everywhere throughout your body)

bull Thirst

bull Eyes are sunken in

bull Mucus membranes are dry

bull Dry skindecreased skin turgor

bull Fever

bull Tachycardia

bull Mental disorientation

bull Specific gravity of lt1010 = clear

clear urine

Treatment of this water loss

bull Replacement of the electrolytes and fluids

bull IVFs are a replacement if the amount lost is great

bull Drinking by mouth is preferred

Sensible vs insensible loss

bull SENSIBLE LOSS ndash is noticeable loss of water as in urine losshellipnormal loss

bull INSENSIBLE LOSS ndash unnoticed water loss is in feces perspiration and respiration

Normal daily water loss

bull The body must excrete 500ml of water as urine each day in order to get rid of the waste products of metabolism

bull This is 500 divided by 24 hrs= 208cchrbull + what we sweat and breathe off therefore

bull We should be excreting at least 30cchr minimum

DEHYDRATION amp OSMOSIS

bull Water moves through the cell walls by this mechanism

bull Remember water likes to dilute ldquostuffrdquo

bull Therefore water moves from an area with less stuff to an area with lots of stuff to dilute it

bull Where salt or protein ishellipwater follows

ELECTROLYTES

bull Na+

bull Cl-

bull K+

bull These electrolytes maintain the balance between intracellular and extracellular fluid

bull

bull Intravascular amp Interstitial

Potassium K+

bull Is the principal electrolyte in INTRAcellular fluid

Sodium Na+

bull Is the principal electrolyte in extracellular fluid

Why we get thirsty

bull If the cell (1st space) becomes dehydrated as in the body lost water we become thirsty

Why else can you become thirsty

bull When the electrolytes in the extracellular fluid are increased (hypertonic solution as in the

consumption of high sugar or salt) the intracellular fluid moves out of the cell to the extracellular fluid to try and dilute it or push the particles away from each other

bull This causeshellip

Osmosis

bull The water from the inside of the cell (intracellular) to move out of the cell (osmosis) shrinking the cell = dehydration of the cell occurs

= thirst

Is there any safety mechanism in the body to prevent this from

happening

bull YEShelliphellip 2 mechanisms try and prevent the body from getting dehydrated

bull 1) ADH

bull 2) Aldosterone

The hypothalamus saves the day

bull It is responsible for regulating appetite

and thirst

bull The hypothalamus

is located at the

base of the brain

During this timehellip

bull When the cell (1st space) releases all of its water to the extracellular fluid to try and separate those particles to dilute them the cell shrinks and the body says ldquought ohhhhrdquo

bull The hypothalamus sends a message to the pituitary gland to secrete ADH (antidiuretic hormone) when the electrolytes become too concentrated in the blood

PITUITARY GLAND

bull Known as the ldquoMaster Glandrdquobull It helps keep water in the blood via the kidneysbull It controls growth by sending growth hormonesbull It aids in releasing pitocin and sending breastmilk

out of the breastsbull It aids in reproduction by sending sex hormones

out to make a baby

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Symptoms of dehydration

bull Hypotension - (not enough fluid in the blood vessels to be pumped everywhere throughout your body)

bull Thirst

bull Eyes are sunken in

bull Mucus membranes are dry

bull Dry skindecreased skin turgor

bull Fever

bull Tachycardia

bull Mental disorientation

bull Specific gravity of lt1010 = clear

clear urine

Treatment of this water loss

bull Replacement of the electrolytes and fluids

bull IVFs are a replacement if the amount lost is great

bull Drinking by mouth is preferred

Sensible vs insensible loss

bull SENSIBLE LOSS ndash is noticeable loss of water as in urine losshellipnormal loss

bull INSENSIBLE LOSS ndash unnoticed water loss is in feces perspiration and respiration

Normal daily water loss

bull The body must excrete 500ml of water as urine each day in order to get rid of the waste products of metabolism

bull This is 500 divided by 24 hrs= 208cchrbull + what we sweat and breathe off therefore

bull We should be excreting at least 30cchr minimum

DEHYDRATION amp OSMOSIS

bull Water moves through the cell walls by this mechanism

bull Remember water likes to dilute ldquostuffrdquo

bull Therefore water moves from an area with less stuff to an area with lots of stuff to dilute it

bull Where salt or protein ishellipwater follows

ELECTROLYTES

bull Na+

bull Cl-

bull K+

bull These electrolytes maintain the balance between intracellular and extracellular fluid

bull

bull Intravascular amp Interstitial

Potassium K+

bull Is the principal electrolyte in INTRAcellular fluid

Sodium Na+

bull Is the principal electrolyte in extracellular fluid

Why we get thirsty

bull If the cell (1st space) becomes dehydrated as in the body lost water we become thirsty

Why else can you become thirsty

bull When the electrolytes in the extracellular fluid are increased (hypertonic solution as in the

consumption of high sugar or salt) the intracellular fluid moves out of the cell to the extracellular fluid to try and dilute it or push the particles away from each other

bull This causeshellip

Osmosis

bull The water from the inside of the cell (intracellular) to move out of the cell (osmosis) shrinking the cell = dehydration of the cell occurs

= thirst

Is there any safety mechanism in the body to prevent this from

happening

bull YEShelliphellip 2 mechanisms try and prevent the body from getting dehydrated

bull 1) ADH

bull 2) Aldosterone

The hypothalamus saves the day

bull It is responsible for regulating appetite

and thirst

bull The hypothalamus

is located at the

base of the brain

During this timehellip

bull When the cell (1st space) releases all of its water to the extracellular fluid to try and separate those particles to dilute them the cell shrinks and the body says ldquought ohhhhrdquo

bull The hypothalamus sends a message to the pituitary gland to secrete ADH (antidiuretic hormone) when the electrolytes become too concentrated in the blood

PITUITARY GLAND

bull Known as the ldquoMaster Glandrdquobull It helps keep water in the blood via the kidneysbull It controls growth by sending growth hormonesbull It aids in releasing pitocin and sending breastmilk

out of the breastsbull It aids in reproduction by sending sex hormones

out to make a baby

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Treatment of this water loss

bull Replacement of the electrolytes and fluids

bull IVFs are a replacement if the amount lost is great

bull Drinking by mouth is preferred

Sensible vs insensible loss

bull SENSIBLE LOSS ndash is noticeable loss of water as in urine losshellipnormal loss

bull INSENSIBLE LOSS ndash unnoticed water loss is in feces perspiration and respiration

Normal daily water loss

bull The body must excrete 500ml of water as urine each day in order to get rid of the waste products of metabolism

bull This is 500 divided by 24 hrs= 208cchrbull + what we sweat and breathe off therefore

bull We should be excreting at least 30cchr minimum

DEHYDRATION amp OSMOSIS

bull Water moves through the cell walls by this mechanism

bull Remember water likes to dilute ldquostuffrdquo

bull Therefore water moves from an area with less stuff to an area with lots of stuff to dilute it

bull Where salt or protein ishellipwater follows

ELECTROLYTES

bull Na+

bull Cl-

bull K+

bull These electrolytes maintain the balance between intracellular and extracellular fluid

bull

bull Intravascular amp Interstitial

Potassium K+

bull Is the principal electrolyte in INTRAcellular fluid

Sodium Na+

bull Is the principal electrolyte in extracellular fluid

Why we get thirsty

bull If the cell (1st space) becomes dehydrated as in the body lost water we become thirsty

Why else can you become thirsty

bull When the electrolytes in the extracellular fluid are increased (hypertonic solution as in the

consumption of high sugar or salt) the intracellular fluid moves out of the cell to the extracellular fluid to try and dilute it or push the particles away from each other

bull This causeshellip

Osmosis

bull The water from the inside of the cell (intracellular) to move out of the cell (osmosis) shrinking the cell = dehydration of the cell occurs

= thirst

Is there any safety mechanism in the body to prevent this from

happening

bull YEShelliphellip 2 mechanisms try and prevent the body from getting dehydrated

bull 1) ADH

bull 2) Aldosterone

The hypothalamus saves the day

bull It is responsible for regulating appetite

and thirst

bull The hypothalamus

is located at the

base of the brain

During this timehellip

bull When the cell (1st space) releases all of its water to the extracellular fluid to try and separate those particles to dilute them the cell shrinks and the body says ldquought ohhhhrdquo

bull The hypothalamus sends a message to the pituitary gland to secrete ADH (antidiuretic hormone) when the electrolytes become too concentrated in the blood

PITUITARY GLAND

bull Known as the ldquoMaster Glandrdquobull It helps keep water in the blood via the kidneysbull It controls growth by sending growth hormonesbull It aids in releasing pitocin and sending breastmilk

out of the breastsbull It aids in reproduction by sending sex hormones

out to make a baby

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Sensible vs insensible loss

bull SENSIBLE LOSS ndash is noticeable loss of water as in urine losshellipnormal loss

bull INSENSIBLE LOSS ndash unnoticed water loss is in feces perspiration and respiration

Normal daily water loss

bull The body must excrete 500ml of water as urine each day in order to get rid of the waste products of metabolism

bull This is 500 divided by 24 hrs= 208cchrbull + what we sweat and breathe off therefore

bull We should be excreting at least 30cchr minimum

DEHYDRATION amp OSMOSIS

bull Water moves through the cell walls by this mechanism

bull Remember water likes to dilute ldquostuffrdquo

bull Therefore water moves from an area with less stuff to an area with lots of stuff to dilute it

bull Where salt or protein ishellipwater follows

ELECTROLYTES

bull Na+

bull Cl-

bull K+

bull These electrolytes maintain the balance between intracellular and extracellular fluid

bull

bull Intravascular amp Interstitial

Potassium K+

bull Is the principal electrolyte in INTRAcellular fluid

Sodium Na+

bull Is the principal electrolyte in extracellular fluid

Why we get thirsty

bull If the cell (1st space) becomes dehydrated as in the body lost water we become thirsty

Why else can you become thirsty

bull When the electrolytes in the extracellular fluid are increased (hypertonic solution as in the

consumption of high sugar or salt) the intracellular fluid moves out of the cell to the extracellular fluid to try and dilute it or push the particles away from each other

bull This causeshellip

Osmosis

bull The water from the inside of the cell (intracellular) to move out of the cell (osmosis) shrinking the cell = dehydration of the cell occurs

= thirst

Is there any safety mechanism in the body to prevent this from

happening

bull YEShelliphellip 2 mechanisms try and prevent the body from getting dehydrated

bull 1) ADH

bull 2) Aldosterone

The hypothalamus saves the day

bull It is responsible for regulating appetite

and thirst

bull The hypothalamus

is located at the

base of the brain

During this timehellip

bull When the cell (1st space) releases all of its water to the extracellular fluid to try and separate those particles to dilute them the cell shrinks and the body says ldquought ohhhhrdquo

bull The hypothalamus sends a message to the pituitary gland to secrete ADH (antidiuretic hormone) when the electrolytes become too concentrated in the blood

PITUITARY GLAND

bull Known as the ldquoMaster Glandrdquobull It helps keep water in the blood via the kidneysbull It controls growth by sending growth hormonesbull It aids in releasing pitocin and sending breastmilk

out of the breastsbull It aids in reproduction by sending sex hormones

out to make a baby

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Normal daily water loss

bull The body must excrete 500ml of water as urine each day in order to get rid of the waste products of metabolism

bull This is 500 divided by 24 hrs= 208cchrbull + what we sweat and breathe off therefore

bull We should be excreting at least 30cchr minimum

DEHYDRATION amp OSMOSIS

bull Water moves through the cell walls by this mechanism

bull Remember water likes to dilute ldquostuffrdquo

bull Therefore water moves from an area with less stuff to an area with lots of stuff to dilute it

bull Where salt or protein ishellipwater follows

ELECTROLYTES

bull Na+

bull Cl-

bull K+

bull These electrolytes maintain the balance between intracellular and extracellular fluid

bull

bull Intravascular amp Interstitial

Potassium K+

bull Is the principal electrolyte in INTRAcellular fluid

Sodium Na+

bull Is the principal electrolyte in extracellular fluid

Why we get thirsty

bull If the cell (1st space) becomes dehydrated as in the body lost water we become thirsty

Why else can you become thirsty

bull When the electrolytes in the extracellular fluid are increased (hypertonic solution as in the

consumption of high sugar or salt) the intracellular fluid moves out of the cell to the extracellular fluid to try and dilute it or push the particles away from each other

bull This causeshellip

Osmosis

bull The water from the inside of the cell (intracellular) to move out of the cell (osmosis) shrinking the cell = dehydration of the cell occurs

= thirst

Is there any safety mechanism in the body to prevent this from

happening

bull YEShelliphellip 2 mechanisms try and prevent the body from getting dehydrated

bull 1) ADH

bull 2) Aldosterone

The hypothalamus saves the day

bull It is responsible for regulating appetite

and thirst

bull The hypothalamus

is located at the

base of the brain

During this timehellip

bull When the cell (1st space) releases all of its water to the extracellular fluid to try and separate those particles to dilute them the cell shrinks and the body says ldquought ohhhhrdquo

bull The hypothalamus sends a message to the pituitary gland to secrete ADH (antidiuretic hormone) when the electrolytes become too concentrated in the blood

PITUITARY GLAND

bull Known as the ldquoMaster Glandrdquobull It helps keep water in the blood via the kidneysbull It controls growth by sending growth hormonesbull It aids in releasing pitocin and sending breastmilk

out of the breastsbull It aids in reproduction by sending sex hormones

out to make a baby

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

DEHYDRATION amp OSMOSIS

bull Water moves through the cell walls by this mechanism

bull Remember water likes to dilute ldquostuffrdquo

bull Therefore water moves from an area with less stuff to an area with lots of stuff to dilute it

bull Where salt or protein ishellipwater follows

ELECTROLYTES

bull Na+

bull Cl-

bull K+

bull These electrolytes maintain the balance between intracellular and extracellular fluid

bull

bull Intravascular amp Interstitial

Potassium K+

bull Is the principal electrolyte in INTRAcellular fluid

Sodium Na+

bull Is the principal electrolyte in extracellular fluid

Why we get thirsty

bull If the cell (1st space) becomes dehydrated as in the body lost water we become thirsty

Why else can you become thirsty

bull When the electrolytes in the extracellular fluid are increased (hypertonic solution as in the

consumption of high sugar or salt) the intracellular fluid moves out of the cell to the extracellular fluid to try and dilute it or push the particles away from each other

bull This causeshellip

Osmosis

bull The water from the inside of the cell (intracellular) to move out of the cell (osmosis) shrinking the cell = dehydration of the cell occurs

= thirst

Is there any safety mechanism in the body to prevent this from

happening

bull YEShelliphellip 2 mechanisms try and prevent the body from getting dehydrated

bull 1) ADH

bull 2) Aldosterone

The hypothalamus saves the day

bull It is responsible for regulating appetite

and thirst

bull The hypothalamus

is located at the

base of the brain

During this timehellip

bull When the cell (1st space) releases all of its water to the extracellular fluid to try and separate those particles to dilute them the cell shrinks and the body says ldquought ohhhhrdquo

bull The hypothalamus sends a message to the pituitary gland to secrete ADH (antidiuretic hormone) when the electrolytes become too concentrated in the blood

PITUITARY GLAND

bull Known as the ldquoMaster Glandrdquobull It helps keep water in the blood via the kidneysbull It controls growth by sending growth hormonesbull It aids in releasing pitocin and sending breastmilk

out of the breastsbull It aids in reproduction by sending sex hormones

out to make a baby

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

ELECTROLYTES

bull Na+

bull Cl-

bull K+

bull These electrolytes maintain the balance between intracellular and extracellular fluid

bull

bull Intravascular amp Interstitial

Potassium K+

bull Is the principal electrolyte in INTRAcellular fluid

Sodium Na+

bull Is the principal electrolyte in extracellular fluid

Why we get thirsty

bull If the cell (1st space) becomes dehydrated as in the body lost water we become thirsty

Why else can you become thirsty

bull When the electrolytes in the extracellular fluid are increased (hypertonic solution as in the

consumption of high sugar or salt) the intracellular fluid moves out of the cell to the extracellular fluid to try and dilute it or push the particles away from each other

bull This causeshellip

Osmosis

bull The water from the inside of the cell (intracellular) to move out of the cell (osmosis) shrinking the cell = dehydration of the cell occurs

= thirst

Is there any safety mechanism in the body to prevent this from

happening

bull YEShelliphellip 2 mechanisms try and prevent the body from getting dehydrated

bull 1) ADH

bull 2) Aldosterone

The hypothalamus saves the day

bull It is responsible for regulating appetite

and thirst

bull The hypothalamus

is located at the

base of the brain

During this timehellip

bull When the cell (1st space) releases all of its water to the extracellular fluid to try and separate those particles to dilute them the cell shrinks and the body says ldquought ohhhhrdquo

bull The hypothalamus sends a message to the pituitary gland to secrete ADH (antidiuretic hormone) when the electrolytes become too concentrated in the blood

PITUITARY GLAND

bull Known as the ldquoMaster Glandrdquobull It helps keep water in the blood via the kidneysbull It controls growth by sending growth hormonesbull It aids in releasing pitocin and sending breastmilk

out of the breastsbull It aids in reproduction by sending sex hormones

out to make a baby

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Potassium K+

bull Is the principal electrolyte in INTRAcellular fluid

Sodium Na+

bull Is the principal electrolyte in extracellular fluid

Why we get thirsty

bull If the cell (1st space) becomes dehydrated as in the body lost water we become thirsty

Why else can you become thirsty

bull When the electrolytes in the extracellular fluid are increased (hypertonic solution as in the

consumption of high sugar or salt) the intracellular fluid moves out of the cell to the extracellular fluid to try and dilute it or push the particles away from each other

bull This causeshellip

Osmosis

bull The water from the inside of the cell (intracellular) to move out of the cell (osmosis) shrinking the cell = dehydration of the cell occurs

= thirst

Is there any safety mechanism in the body to prevent this from

happening

bull YEShelliphellip 2 mechanisms try and prevent the body from getting dehydrated

bull 1) ADH

bull 2) Aldosterone

The hypothalamus saves the day

bull It is responsible for regulating appetite

and thirst

bull The hypothalamus

is located at the

base of the brain

During this timehellip

bull When the cell (1st space) releases all of its water to the extracellular fluid to try and separate those particles to dilute them the cell shrinks and the body says ldquought ohhhhrdquo

bull The hypothalamus sends a message to the pituitary gland to secrete ADH (antidiuretic hormone) when the electrolytes become too concentrated in the blood

PITUITARY GLAND

bull Known as the ldquoMaster Glandrdquobull It helps keep water in the blood via the kidneysbull It controls growth by sending growth hormonesbull It aids in releasing pitocin and sending breastmilk

out of the breastsbull It aids in reproduction by sending sex hormones

out to make a baby

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Sodium Na+

bull Is the principal electrolyte in extracellular fluid

Why we get thirsty

bull If the cell (1st space) becomes dehydrated as in the body lost water we become thirsty

Why else can you become thirsty

bull When the electrolytes in the extracellular fluid are increased (hypertonic solution as in the

consumption of high sugar or salt) the intracellular fluid moves out of the cell to the extracellular fluid to try and dilute it or push the particles away from each other

bull This causeshellip

Osmosis

bull The water from the inside of the cell (intracellular) to move out of the cell (osmosis) shrinking the cell = dehydration of the cell occurs

= thirst

Is there any safety mechanism in the body to prevent this from

happening

bull YEShelliphellip 2 mechanisms try and prevent the body from getting dehydrated

bull 1) ADH

bull 2) Aldosterone

The hypothalamus saves the day

bull It is responsible for regulating appetite

and thirst

bull The hypothalamus

is located at the

base of the brain

During this timehellip

bull When the cell (1st space) releases all of its water to the extracellular fluid to try and separate those particles to dilute them the cell shrinks and the body says ldquought ohhhhrdquo

bull The hypothalamus sends a message to the pituitary gland to secrete ADH (antidiuretic hormone) when the electrolytes become too concentrated in the blood

PITUITARY GLAND

bull Known as the ldquoMaster Glandrdquobull It helps keep water in the blood via the kidneysbull It controls growth by sending growth hormonesbull It aids in releasing pitocin and sending breastmilk

out of the breastsbull It aids in reproduction by sending sex hormones

out to make a baby

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Why we get thirsty

bull If the cell (1st space) becomes dehydrated as in the body lost water we become thirsty

Why else can you become thirsty

bull When the electrolytes in the extracellular fluid are increased (hypertonic solution as in the

consumption of high sugar or salt) the intracellular fluid moves out of the cell to the extracellular fluid to try and dilute it or push the particles away from each other

bull This causeshellip

Osmosis

bull The water from the inside of the cell (intracellular) to move out of the cell (osmosis) shrinking the cell = dehydration of the cell occurs

= thirst

Is there any safety mechanism in the body to prevent this from

happening

bull YEShelliphellip 2 mechanisms try and prevent the body from getting dehydrated

bull 1) ADH

bull 2) Aldosterone

The hypothalamus saves the day

bull It is responsible for regulating appetite

and thirst

bull The hypothalamus

is located at the

base of the brain

During this timehellip

bull When the cell (1st space) releases all of its water to the extracellular fluid to try and separate those particles to dilute them the cell shrinks and the body says ldquought ohhhhrdquo

bull The hypothalamus sends a message to the pituitary gland to secrete ADH (antidiuretic hormone) when the electrolytes become too concentrated in the blood

PITUITARY GLAND

bull Known as the ldquoMaster Glandrdquobull It helps keep water in the blood via the kidneysbull It controls growth by sending growth hormonesbull It aids in releasing pitocin and sending breastmilk

out of the breastsbull It aids in reproduction by sending sex hormones

out to make a baby

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Why else can you become thirsty

bull When the electrolytes in the extracellular fluid are increased (hypertonic solution as in the

consumption of high sugar or salt) the intracellular fluid moves out of the cell to the extracellular fluid to try and dilute it or push the particles away from each other

bull This causeshellip

Osmosis

bull The water from the inside of the cell (intracellular) to move out of the cell (osmosis) shrinking the cell = dehydration of the cell occurs

= thirst

Is there any safety mechanism in the body to prevent this from

happening

bull YEShelliphellip 2 mechanisms try and prevent the body from getting dehydrated

bull 1) ADH

bull 2) Aldosterone

The hypothalamus saves the day

bull It is responsible for regulating appetite

and thirst

bull The hypothalamus

is located at the

base of the brain

During this timehellip

bull When the cell (1st space) releases all of its water to the extracellular fluid to try and separate those particles to dilute them the cell shrinks and the body says ldquought ohhhhrdquo

bull The hypothalamus sends a message to the pituitary gland to secrete ADH (antidiuretic hormone) when the electrolytes become too concentrated in the blood

PITUITARY GLAND

bull Known as the ldquoMaster Glandrdquobull It helps keep water in the blood via the kidneysbull It controls growth by sending growth hormonesbull It aids in releasing pitocin and sending breastmilk

out of the breastsbull It aids in reproduction by sending sex hormones

out to make a baby

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Osmosis

bull The water from the inside of the cell (intracellular) to move out of the cell (osmosis) shrinking the cell = dehydration of the cell occurs

= thirst

Is there any safety mechanism in the body to prevent this from

happening

bull YEShelliphellip 2 mechanisms try and prevent the body from getting dehydrated

bull 1) ADH

bull 2) Aldosterone

The hypothalamus saves the day

bull It is responsible for regulating appetite

and thirst

bull The hypothalamus

is located at the

base of the brain

During this timehellip

bull When the cell (1st space) releases all of its water to the extracellular fluid to try and separate those particles to dilute them the cell shrinks and the body says ldquought ohhhhrdquo

bull The hypothalamus sends a message to the pituitary gland to secrete ADH (antidiuretic hormone) when the electrolytes become too concentrated in the blood

PITUITARY GLAND

bull Known as the ldquoMaster Glandrdquobull It helps keep water in the blood via the kidneysbull It controls growth by sending growth hormonesbull It aids in releasing pitocin and sending breastmilk

out of the breastsbull It aids in reproduction by sending sex hormones

out to make a baby

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Is there any safety mechanism in the body to prevent this from

happening

bull YEShelliphellip 2 mechanisms try and prevent the body from getting dehydrated

bull 1) ADH

bull 2) Aldosterone

The hypothalamus saves the day

bull It is responsible for regulating appetite

and thirst

bull The hypothalamus

is located at the

base of the brain

During this timehellip

bull When the cell (1st space) releases all of its water to the extracellular fluid to try and separate those particles to dilute them the cell shrinks and the body says ldquought ohhhhrdquo

bull The hypothalamus sends a message to the pituitary gland to secrete ADH (antidiuretic hormone) when the electrolytes become too concentrated in the blood

PITUITARY GLAND

bull Known as the ldquoMaster Glandrdquobull It helps keep water in the blood via the kidneysbull It controls growth by sending growth hormonesbull It aids in releasing pitocin and sending breastmilk

out of the breastsbull It aids in reproduction by sending sex hormones

out to make a baby

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

The hypothalamus saves the day

bull It is responsible for regulating appetite

and thirst

bull The hypothalamus

is located at the

base of the brain

During this timehellip

bull When the cell (1st space) releases all of its water to the extracellular fluid to try and separate those particles to dilute them the cell shrinks and the body says ldquought ohhhhrdquo

bull The hypothalamus sends a message to the pituitary gland to secrete ADH (antidiuretic hormone) when the electrolytes become too concentrated in the blood

PITUITARY GLAND

bull Known as the ldquoMaster Glandrdquobull It helps keep water in the blood via the kidneysbull It controls growth by sending growth hormonesbull It aids in releasing pitocin and sending breastmilk

out of the breastsbull It aids in reproduction by sending sex hormones

out to make a baby

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

During this timehellip

bull When the cell (1st space) releases all of its water to the extracellular fluid to try and separate those particles to dilute them the cell shrinks and the body says ldquought ohhhhrdquo

bull The hypothalamus sends a message to the pituitary gland to secrete ADH (antidiuretic hormone) when the electrolytes become too concentrated in the blood

PITUITARY GLAND

bull Known as the ldquoMaster Glandrdquobull It helps keep water in the blood via the kidneysbull It controls growth by sending growth hormonesbull It aids in releasing pitocin and sending breastmilk

out of the breastsbull It aids in reproduction by sending sex hormones

out to make a baby

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

PITUITARY GLAND

bull Known as the ldquoMaster Glandrdquobull It helps keep water in the blood via the kidneysbull It controls growth by sending growth hormonesbull It aids in releasing pitocin and sending breastmilk

out of the breastsbull It aids in reproduction by sending sex hormones

out to make a baby

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

ADH (anti-diuretic hormone)

bull By the hypothalamus sending the pituitary gland a message to excrete ADH the ADH goes to the kidney tubule and tells it to hold water and to reabsorb that water back into the bloodstream rather than to excrete it or urinate it out ADH is (against diuresis) anti-diuretic

bull If you didnrsquot have ADH then the water that was in the cells would now move out into the extracellular space to help dilute the high sugar or high salt you ate the cells become dehydrated then the kidney would pee out the water in the extracellular fluid and the body would be empty of waterhellipvery bad

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

What do you say when this process happens in the body

bull When the cell becomes empty of water because the ICF moved to the ECF to push particles apart your mouth and tongue know your cells are empty of water and your hypothalamus knows you are thirstyhellipso you say ldquoboy am I thirstyrdquo and you drink water

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

So what does ADH do for the body

bull When that ADH stops the water from leaving the renal tubule it can then be absorbed back into the blood and extracellular space and help push fluid and salts back into the bloodstream

bull It puts back just enough Na+ and K+ and that gets added to the water that wasnrsquot allowed to leave and it gets returned to circulation

bull Itrsquos the bodyrsquos way of getting its own drink of water from itself

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

2nd method of homeostasis our body has to prevent from dehydration

bull When you get dehydrated the hypothalamus sends a 2nd message to the pituitary to send a messenger known as ACTH (adrenocorticotropic hormone)

bull The pituitary sends the messenger ACTH to the adrenal glands that sit on the kidneys to wake up aldosterone

bull The hormone aldosterone ( a salt hormone) is sent out to help increase the Na+ reabsorption in the kidneys tubule and to send the salt to the blood stream so that nowhellipwhere there is extra Na+ water follows

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Hopefullyhellip

bull With the hormones ADH amp Aldosterone any dehydration can be fixed and the body will resume its normal pattern of having

bull fluid in the cells 1st

bull Fluid in the blood and interstitial area 2nd

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

What if another problem occurshellip

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

ADH gone wild (part I)

bull Heyyy-ooooo

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

bull There are times when the bodybrain cannot control ADH

bull If a patient has a tumor on the pituitary gland ADH may not be able to be made at allhellip

bull This is a serious condition and leads to serious results

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Fancy word for this conditionhellip

bull Diabetes Insipidous (DI)bull NOT DIABETES MELLITUS ndash inadequate production of insulin

causing difficulty in carbohydrate metabolism

bull Diabetes ndash a general term for diseases marked by excessive urination

bull DI ndash polyuria amp polydipsia caused by inadequate secretion of ADH from the pituitary

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Symptoms of darr ADH

bull Now itrsquos like all you have is DH = diuretic hormone = lots of urinehellipyou need the ldquoArdquo back

bull Polyuriabull Extreme thirstbull Extreme dehydration ldquoDehydrated Danrdquobull Hypotensionbull Tachycardiabull Tenting of skinbull Pt continues to urinate and urinate and urinatebull Specific gravity of lt1010can be as low as 1005

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Treatment for DI

bull To return the ldquoArdquo and give ADH to the body via a drug called vasopressin or Pitressin

bull Comes in a vial that pt can spray into nose

bull This helps concentrate urine again

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

ADH gone wild (part II)

bull What if you had a tumor to the pituitary gland and too much ADH was made

bull You would have too much against urination and you would hold fluidhellipyou would have ldquoagainst urinationrdquo

bull This disease is called SIADH = (uarrADH)bull Symptom of inappropriate ADHitrsquos

inappropriately madehellipitrsquos too much

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Aldosterone bull Any time the body has too much fluid on board it

spreads out the Na+ particles in the extracellular spaces Now the cell appears to be concentrated and the extracellular space looks diluted This triggers the nervous system to try and help

bull Hypothalamus calls to the pituitary to send ACTH to wake up the adrenals to send Aldosterone to the bloodstream

bull Because aldosterone is salt when salt reaches the bloodstream it will now appear that there are many particles in the extracellular space and now the normal cell moves some of its normal amt of water into the extracellular space to dilute the Na particles This now causes the cell to shrink and to re-balance things out

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Symptoms of SIADH

bull Too much fluid

bull Soggy and overloaded ldquoSoggy Sidrdquo

bull Extremely high HTN

bull Tachycardia

bull Specific gravity gt1020 more like 1030

bull Dark dark urine

bull Pt needs a fluid restriction

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Treatment of SIADH

bull Diuretics such as Lasix (furosemide)

bull Fluid restriction

bull Wt QD

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

How much water does the body need

bull The amt varies according to

bull activity heat and humidity age size and physical condition

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

bull We need 1ml for every calorie consumedbull If you eat 2100 calories in a day then you

need 2100ml water for that day

bull It is recommended that we drink 13 8ounce glasses of fluid day

bull This is 8 glasses of H20 and at least 5 glasses of other fluids

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

What increases your needs for water

bull Youth

bull Fever

bull Diarrhea

bull Unusual perspiration

bull Vomiting

bull Hemorrhage (loss of blood = loss of fluids)

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Another balancing mechanism - Acid Base Balance

bull Fluid and electrolyte balance are not the only things to be maintained in the bloodhellip

bull The body must maintain acid-base balance by using a buffer system

bull Your kidneys do this by regulating the hydrogen ions in the body (chemistry)

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

bull Acids and bases have + and ndash chargesbull All organs need these charges especially

the heart to workbull If they become unbalanced your body

knows it and fixes ithellipsends bicarb outbull Your kidneys are responsible to decide

which ions to keep and which to excrete out in the urine

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Normal ph

bull 7 is neutral

bull 1--------------7-------------14

bull acid neutral base

bull (acidic) (alkaline)

bull Blood plasma is 735-745

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Buffer system

bull Helps keep the acid-base balance in line

bull Example If too much HCL is removed from the body when vomiting your kidneys fix the body to balance out the now base solution

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Conditions that cause dehydration

bull Heat illness ndash caused by the excessive perspiration of body fluids with failure to drink sufficient amts of water to replace the lost

bull There are 4 stages of heat illnesshellip

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

4 stages of heat illness

bull Heat fatigue ndash causes thirst weakness fatigue one should go to a cool place rest and drink fluids

bull Heat cramp ndash dt loss of Na+ and K+ causes leg cramps and thirst one should go to a cool place rest and drink fluids

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

4 stages of heat illness

bull Heat exhaustion ndash causes thirst dizziness nv headache and profuse sweating one should get into a tub of cool water 2-3 days of rest and the ingestion of a great deal of water

bull Heat stroke ndash involves fever could produce brain and kidney damage call 911 put pt in chilled water and go to hospital Pt can die of heat stroke

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Excess water intake

bull Can be caused by

1 CHF heart pump isnrsquot working properly fluid gets all backed up

2 Hypoproteinemia (not enough protein water 3rd spaces to peritoneal cavity=big belly

3 Some infections4 Some cancers5 uarr ADH = SIADH Soggy Sid

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

In Reviewhellip

bull Our body is very smart

bull It knows how to balance out problems that occur with water

bull Osmosis hypothalamus pituitary ADH aldosterone and the kidneys is what balances the water in the body

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

Question

bull When one become dehydrated what happens to the concentration of the extracellular fluid compartment

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

QUESTION

bull When one can not eliminate fluid from the body but is still consuming more than enough water What happens to fluid in the extracellular fluid compartment

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

QUESTION

bull Water is lost or gained in what fluid compartment first

bull 2nd space then 1st space to protect the 1st space

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

QUESTION

bull What is fluid volume deficitbull What might cause a fluid volume deficitbull What happens to the concentration of

solute in the extracellular fluid compartment when one is lacking fluid or in a fluid volume deficit

bull What hormones tells the kidneys to conserve what ever water is left

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

What is this a picture of

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END

THE END

bull The need to replace body fluids is greaterbull than the need to replace electrolytesbull 1048714 Our thirst mechanism does not match ourbull hydration state so it is best to consumebull more fluid than thirst dictatesbull Replacing Fluid Lossesbull 1048714 Water intake during prolonged exercisebull reduces the risk of dehydration andbull optimizes performancebull 1048714 Drinking too much fluid can result inbull hyponatremia (low levels of plasmabull sodium) which can cause confusionbull disorientation and seizures

• CHPT 9 WATER
• Water
• Why is water important
• Other functions of water
• Slide 5
• Body Water Content Obese Normal Muscular 40 60 70
• Slide 7
• 2 compartment of body water
• What do these compartments mean
• Slide 10
• Slide 11
• Cell = 1st space Extracellular (interstitial amp intravascular) = 2nd space Abdomen and feet = 3rd space (ascites)
• Best source of water
• Estimated daily fluid intake for adults
• HOMEOSTASIS
• Fluid amp electrolyte balance
• Specific Gravity (SG)
• Urine Specific Gravity
• Equipment to test SG
• Vomiting amp Diarrhea
• Symptoms of dehydration
• Treatment of this water loss
• Sensible vs insensible loss
• Normal daily water loss
• DEHYDRATION amp OSMOSIS
• ELECTROLYTES
• Potassium K+
• Sodium Na+
• Why we get thirsty
• Why else can you become thirsty
• Osmosis
• Is there any safety mechanism in the body to prevent this from happening
• The hypothalamus saves the day
• During this timehellip
• PITUITARY GLAND
• ADH (anti-diuretic hormone)
• What do you say when this process happens in the body
• So what does ADH do for the body
• 2nd method of homeostasis our body has to prevent from dehydration
• Hopefullyhellip
• What if another problem occurshellip
• ADH gone wild (part I)
• Slide 43
• Fancy word for this conditionhellip
• Symptoms of darr ADH
• Treatment for DI
• ADH gone wild (part II)
• Aldosterone
• Symptoms of SIADH
• Treatment of SIADH
• How much water does the body need
• Slide 52
• What increases your needs for water
• Another balancing mechanism - Acid Base Balance
• Slide 55
• Normal ph
• Buffer system
• Conditions that cause dehydration
• 4 stages of heat illness
• Slide 60
• Excess water intake
• In Reviewhellip
• Question
• QUESTION
• Slide 65
• QUESTION
• What is this a picture of
• Slide 68
• THE END