HOMEOSTASIS IMBALANCES-converted.pptx

HOMEOSTASIS IMBALANCES PHARMACOLOGY

1. H OM E O S T A SIS I M B A L A NCES

2. Objectives  Review the physiological mechanism responsible for the movement of fluid and electrolyte in the following body compartments. Between ICF & ECF Between Intravascular & interstitial.  Discuss the Starling ‟ s Hypothesis to describe the movement of fluid across the capillary wall. Discuss the classification of fluid electrolyte imbalance in terms of: Isotonic imbalance Osmotic imbalance Compositional imbalance

3. Objectives  Discuss the causes manifestation, and Pathophysiology of following isotonic imbalance: Hypovolemia Hypervolemia.  Discuss the causes, Pathophysiology and clinical manifestation of the following osmotic imbalance: Hyponateremia Hypernateremia

4. Objectives  Discuss the causes, Pathophysiology and clinical manifestation of compositional imbalance: Hypokalemia Hyperkalemia

5. HOMEOSTASIS IMBALANCES  Homeotic imbalance is the disability of the internal environment to remain in equilibrium in the face of internal , external and environmental influences.  Homeostatic imbalance occurs when cells in the body experience a deficiency, such as nutritional deficiencies resulting from an unhealthy diet or when cells are exposed to toxins.

6. HOMEOSTASIS IMBALANCES  Homeostatic imbalances may result from three main influences - Internal influences such as aging and genetics. External influences such as nutrition deficiencies, physical activity, mental health , drug and alcohol abuse. Environmental influences such as exposure to toxins.

7. ICF & ECF  Extracellular fluid (ECF) is the fluid in the body that is outside of cells. Intracellular fluid (ICF) is the fluid in the body that is inside of cells.

8. Body Water Content

9. ICF & ECF  Human beings are mostly water, ranging from about 75 percent of body mass in infants to about 50–60 percent in adult men and women, to as low as 45 percent in old age.

10. Intracellular Fluid  The ICF makes up about 60 percent of the total water in the human body, and in an average-size adult male, the ICF accounts for about 25 liters (seven gallons) of fluid.  This fluid volume tends to be very stable, because the amount of water in living cells is closely regulated.  If the amount of water inside a cell falls to a value that is too low, the cytosol becomes too concentrated with solutes to carry on normal cellular activities; if too much water enters a cell, the cell may burst and be destroyed.

11. Extracellular Fluid  Approximately 20 percent of the ECF is found in plasma.  Plasma travels through the body in blood vessels and transports a range of materials, including blood cells, proteins (including clotting factors and antibodies), electrolytes, nutrients, gases, and wastes.

12. Extracellular Fluid  The body has other water-based ECF. These include the cerebrospinal fluid that bathes the brain and spinal cord, lymph, the synovial fluid in joints, the pleural fluid in the pleural cavities, the pericardial fluid in the cardiac sac, the peritoneal fluid in the peritoneal cavity, and the aqueous humor of the eye.  Because these fluids are outside of cells, these fluids are also considered components of the ECF compartment.

13. Intravascular & interstitial  the interstitial compartment (also called "tissue space") surrounds tissue cells. It is filled with interstitial fluid.  Interstitial fluid provides the immediate microenvironment that allows for movement of ions, proteins and nutrients across the cell barrier.  This fluid is not static, but is continually being refreshed by the blood capillaries and recollected by lymphatic capillaries.

14. Intravascular & interstitial  The main intravascular fluid is blood, a complex mixture with elements of a suspension (blood cells), colloid (globulins), and solutes (glucose and ions).  The blood represents both the intracellular compartment (the fluid inside the blood cells) and the extracellular compartment (the blood plasma). The other intravascular fluid is lymph.

15. Isotonic imbalance Osmotic imbalance Compositional imbalance  Isotonic imbalance:  Intracellular fluid volume remains constant  External loss: vomiting, diarrhoea, haemorrhage, burning  Internal loss: ileus, ascites, pleural effusion  Therapy: volume replacement wiht isotonic solution

16. Osmotic imbalance  Osmoregulation is the process of maintenance of salt and water balance (osmotic balance) across membranes within the body’s fluids, which are composed of water, plus electrolytes and non-electrolytes.

17. Compositional imbalance  Fluid imbalance can arise due to hypovolemia, normovolemia with maldistribution of fluid , and hypervolemia.  Trauma is among the most frequent causes of hypovolemia, with its often profuse attendant blood loss.  Another common cause is dehydration, which primarily entails loss of plasma rather than whole blood.

18. Hypovolemia Hypervolemia  Hypovolemia , also known as volume depletion or volume contraction , is a state of decreased intravascular volume.  This may be due to either a loss of both salt and water or a decrease in blood volume

19. Signs and symptoms Hypovolemia  Early symptoms of hypovolemia include headache, fatigue, weakness, thirst, and dizziness.  The more severe signs and symptoms are often associated with hypovolemic shock

20. Causes  Loss of body sodium and consequent intravascular water (due to impaired reabsorption of salt and water in the tubules of the kidneys)  Loss of bodily fluids due to:Gastrointestinal losses; e.g. vomiting and diarrhea  Skin losses; e.g. excessive sweating and burns

21. P a t h o p h y s i olo gy  A decrease in circulating volume can lead to a decrease in blood perfusion to the brain, resulting in headache and dizziness. Altered mental status progresses as hypovolemia continues.

22. Diagnosis  full blood count, glucose, Urine output measurements (via urinary catheter)  Blood pressure,SpO2 oxygen saturation monitoring

23. Treatment  The following interventions are carried out:  IV access  Oxygen as required  Fresh frozen plasma or blood transfusion  Surgical repair at sites of bleeding

24. Hypervolemia  also known as fluid overload , is the medical condition where there is too much fluid in the blood.

25. Signs and symptoms  increase in weight  swelling in the legs and arms (peripheral edema)

26. Complications  Congestive heart failure is the most common result of fluid overload.

27. Causes  Excessive sodium and/or fluid intake  Sodium and water retention.

28. Treatment  One of the mostn common treatments for hypervolemia is diuretics

29. Hyponateremia H y p e r n a t e r e m i a  Two different disorders, known as hyponatremia and hypernatremia, may result from changes in the balance of water in the body and levels of sodium in the blood

30. Hyponatremia  Hyponatremia occurs when blood sodium goes below normal levels, which is 135 milliequivalents/liter (mEq/L).  When sodium levels in the blood are too low, extra water goes into body cells causing them to swell. This swelling can be especially dangerous for brain cells, resulting in neurological symptoms such as headache, confusion, irritability, seizures or even coma.

31.  symptoms of the disorder include muscle cramps or weakness, nausea, vomiting, tiredness and a lack of energy.

32. ca u s e s  some of the causes may include:  Severe vomiting or diarrhea.  Excessive fluid intake , such as during endurance activities or from excessive thirst.  Taking diuretics, medications that help flush excess water and sodium from the body.  Kidney failure, a condition in which the kidneys have difficulty eliminating extra fluid from the body.

33. Hypernatremia  Hypernatremia is a common electrolyte problem that is defined as a rise in serum sodium concentration to a value exceeding 145 mmol/L.

34. Signs and symptoms  confusion, muscle twitching or spasms. With severe elevations, seizures and comas may occur

35. Cause  nadequate intake of free water associated with total body sodium depletion.  Intake of a hypertonic fluid (a fluid with a higher concentration of solutes than the remainder of the body) with restricted free water intake.

36. Diagnosis  Hypernatremia is diagnosed when a basic metabolic panel blood test demonstrates a sodium concentration higher than 145 mmol/l.

37. Treatment  thiazide diuretics (e.g., chlorthalidone ) in congestive heart failure or corticosteroids in nephropathy also can be used.

38. Hypokalemia Hyperkalemia  Hypokalemia and hyperkalemia are common electrolyte disorders caused by changes in potassium intake, altered excretion, or transcellular shifts.  Diuretic use and gastrointestinal losses are common causes of hypokalemia , whereas kidney disease, hyperglycemia, and medication use are common causes of hyperkalemi