1、Disorders of Fluid and eletrolyte Metabolism2005-3-10Huashan Hospital,Fudan University1Water and Sodium MetabolismControl of water excretionControl of sodium excretionHyponatremia and hypernatremia2Control of Water ExcretionRegulation of thirstAntidiuretic hormone3Control of Sodium ExcretionNephron

2、segmental reabsorptionRegulation of sodium balance4Nephron Segmental reabsorptionGlomerulotubular balanceProximal tubuleHenles loopDistal convoluted tubuleCollecting tubule5Regulation of Sodium BalanceExtrarenal mechanismsintrarenal mechanisms6Extrarenal mechanismsRenal nervesRenin-angiotensin Syste

3、mAtrial natriuretic peptideVasopressinEndogenous Na-K-ATPase inhibitors7intrarenal mechanismsRenal hemodynamicsPhysical factorsProstaglandinsKallikrein-kinin systemEndothelium-derived factors8HyponatremiaEtiology and classificationClinical featuresTreatment9Etiology and ClassificationIsotonic hypona

4、tremiaHypertonic hyponatremiahypotonic hyponatremia10Isotonic hyponatremiaPseudo-hyponatremiaHyperlipidemiahyperproteinemia11Hypertonic hyponatremiaHyperglycemiaHypertonic infusion12hypotonic hyponatremiaHypovolemic hyponatremiaHypervolemic hyponatremiaIsovolemic hyponatremia13Hypovolemic hyponatrem

5、iaGI lossSkin loss3rd spaceRenal lossAdrenal insufficiency14Hypervolemic hyponatremiaCHFLiver damagenephrosis15Isovolemic hyponatremiaWater intoxRenal failureSIADHReset osmostat16Clinical FeaturesNeurologic manifestationHeadacheNauseaVomitingWeaknessSeizurescoma17Treatment Increase serum sodium by 1

6、-2mM/hDiuretic-people unable to excrete dilute urine18hypernatremiaEtiology and classificationClinical featuresTreatment19Etiology and ClassificationHypovolemic hypernatremiaHypervolemic hypernatremiaIsovolemic hypernatremia20Hypovolemic hypernatremiaGI lossSkin lossRenal lossAdrenal insufficiency21

7、Hypervolemic hypernatremiaIatrogenicMineralocort excess22Isovolemic hypernatremiadiabetReset osmostatIatrogenicSkin loss23Clinical FeaturesNeurologic manifesttationhypertoniahyperreflexiaIntracranial bleedinghigh feverSeizurescoma24Treatment decrease serum sodium by 0.5mM/hDiuretic25potassium Metabo

8、lismControl of potassium excretionHypokalemia and hyperkalemia26Control of potassium ExcretionRenal potassium handlingExtrarenal control of potassium27Renal Potassium HandlingPotassium-aldosterone feedback systemPlasma pHVolume expansion-increased urinary flow rateAntidiuretic hormone28Extrarenal Co

9、ntrol of PotassiumInsulinCatecholaminesAldosteroneParathyroid hormoneAcid-base balanceDrugs29hypokalemiaEtiologyClinical featuresTreatment30EtiologyHypokalemia secondary to transcellular redistributionHypokalemia with potassium depletion31Hypokalemia With Potassium depletionRenal lossInadequate intakeSweat lossGastrointestinal tract los