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Increase in bp can lead to increase in glomerular filtration rate Fluid output regulated by aldosterone and vasopressin.

They help the kidney absorb water. Our total fluid intake is modified by the induction of the sensation of thirst. This is produced by a reaction of cells in the hypothalamus to the increased osmotic pressure of the blood passing through this region. Another stimulus of thirst would be the degree of dryness of the oral mucosa. One of the primary functions of the kidney is to regulate extracellular fluid pressure. There are two components of extracellular fluid pressure: . !ydrostatic "blood# pressure $ %lood pressure depends on: a. The volume of the extracellular fluids b. The diameter of the peripheral blood vessels &. Osmotic pressure $ depends on the a. levels of non$diffusing proteins in plasma and interstitial fluids. b. the concentration of electrolytes' especially (a) .

The kidneys are essential for regulating the volume and composition of bodily fluids. This page outlines key regulatory systems involving the kidneys for controlling volume' sodium and potassium concentrations' and the p! of bodily fluids. A most critical concept for you to understand is how water and sodium regulation are integrated to defend the body against all possible disturbances in the volume and osmolarity of bodily fluids. *imple examples of such disturbances include dehydration' blood loss' salt ingestion' and plain water ingestion. Water balance +ater balance is achieved in the body by ensuring that the amount of water consumed in food and drink "and generated by metabolism# e,uals the amount of water excreted. The consumption side is regulated by behavioral mechanisms' including thirst and salt cravings. +hile almost a liter of water per day is lost through the skin' lungs' and feces' the kidneys are the ma-or site of regulated excretion of water. One way the the kidneys can directly control the volume of bodily fluids is by the amount of water excreted in the urine. .ither the kidneys can conserve water by producing urine that is concentrated relative to plasma' or they can rid the body of excess water by producing urine that is dilute relative to plasma. /irect control of water excretion in the kidneys is exercised by vasopressin' or anti$diuretic hormone "A/!#' a peptide hormone secreted by the

hypothalamus. A/! causes the insertion of water channels into the membranes of cells lining the collecting ducts' allowing water reabsorption to occur. +ithout A/!' little water is reabsorbed in the collecting ducts and dilute urine is excreted. A/! secretion is influenced by several factors "note that anything that stimulates A/! secretion also stimulates thirst#: 1. %y special receptors in the hypothalamus that are sensitive to increasing plasma osmolarity "when the plasma gets too concentrated#. These stimulate A/! secretion. 2. %y stretch receptors in the atria of the heart' which are activated by a larger than normal volume of blood returning to the heart from the veins. These inhibit A/! secretion' because the body wants to rid itself of the excess fluid volume. 3. %y stretch receptors in the aorta and carotid arteries' which are stimulated when blood pressure falls. These stimulate A/! secretion' because the body wants to maintain enough volume to generate the blood pressure necessary to deliver blood to the tissues. Sodium balance In addition to regulating total volume' the osmolarity "the amount of solute per unit volume# of bodily fluids is also tightly regulated. .xtreme variation in osmolarity causes cells to shrink or swell' damaging or destroying cellular structure and disrupting normal cellular function. 0egulation of osmolarity is achieved by balancing the intake and excretion of sodium with that of water. "*odium is by far the ma-or solute in extracellular fluids' so it effectively determines the osmolarity of extracellular fluids.# An important concept is that regulation of osmolarity must be integrated with regulation of volume' because changes in water volume alone have diluting or concentrating effects on the bodily fluids. For example' when you become dehydrated you lose proportionately more water than solute "sodium#' so the osmolarity of your bodily fluids increases. In this situation the body must conserve water but not sodium' thus stemming the rise in osmolarity. If you lose a large amount of blood from trauma or surgery' however' your loses of sodium and water are proportionate to the composition of bodily fluids. In this situation the body should conserve both water and sodium.

As noted above' A/! plays a role in lowering osmolarity "reducing sodium concentration# by increasing water reabsorption in the kidneys' thus helping to dilute bodily fluids. To prevent osmolarity from decreasing below normal' the kidneys also have a regulated mechanism for reabsorbing sodium in the distal nephron. This mechanism is controlled by aldosterone, a steroid hormone produced by the adrenal cortex. Aldosterone secretion is controlled two ways: 1.The adrenal cortex directly senses plasma osmolarity. +hen the osmolarity increases above normal' aldosterone secretion is inhibited. The lack of aldosterone causes less sodium to be reabsorbed in the distal tubule. 0emember that in this setting A/! secretion will increase to conserve water' thus complementing the effect of low aldosterone levels to decrease the osmolarity of bodily fluids. The net effect on urine excretion is a decrease in the amount of urine excreted' with an increase in the osmolarity of the urine. 2. The kidneys sense low blood pressure "which results in lower filtration rates and lower flow through the tubule#. This triggers a complex response to raise blood pressure and conserve volume. *peciali1ed cells "juxtaglomerular cells# in the afferent and efferent arterioles produce renin' a peptide hormone that initiates a hormonal cascade that ultimately produces angiotensin II. Angiotensin II stimulates the adrenal cortex to produce aldosterone. 2(ote that in this setting' where the body is attempting to conserve volume' A/! secretion is also stimulated and water reabsorption increases. %ecause aldosterone is also acting to increase sodium reabsorption' the net effect is retention of fluid that is roughly the same osmolarity as bodily fluids. The net effect on urine excretion is a decrease in the amount of urine excreted' with lower osmolarity than in the previous example.
Fluids account for blood volume. 3 %lood volume is the amount of fluid in the blood 3 Increased blood volume can cause blood pressure to rise "hypertension# 3 /ecreased blood volumes can cause low blood pressure+ater follows the movement of electrolytes' moving by osmosis to areas where the concentration of electrolytes is high4ovement of (a) and 5) across the membranes of nerve cells changes the electrical charge across the membrane 3 This change in electrical charge carries the nerve impulse along the nerve cellFluid and electrolyte balance

3 Associated with blood pressure and p! balance in the bodyFunctions of potassium 3 Fluid and electrolyte balance 3 6ery important in muscle contractions and transmission of nerve impulses 3 !igh potassium intake helps to maintain a lower blood pressure 3 !elps to maintain acid$base balance

The body7s fluids and electrolytes make up the internal environment of the body. (ot only do these make up the external environment of each living cell but the internal environment as well. These constituents must stay in balance: each compartment with one another and each component one with another' i.e.' homeostasis. Although the kidneys play the larger role in maintaining this balance' the respiratory' digestive' cardiovascular and other systems make vital contributions. 8athological conditions exist when either the compartments or the components get of balance with one another. The body7s fluids and electrolytes are always moving: imbalances occur when input is not e,ual to output. +e need to remember the close relationship between (a ) and !&O: one follows the other.

BO ! "#$I I%B&#&'() ehydration "-ust water without ma-or electrolyte changes# is reduced "below normal9ideal#. +e are considering total body water with minimal changes in total body (a). In contrast' *ater intoxication is increased body water with minimal changes in total body (a). /.!:/0ATIO( occurs from lower water input than output. ;ncontrolled diabetics' sick9weak adults' and children are especially vulnerable. (ormally' however' the thirst mechanism$$triggered by increased .<F osmolarity or reduced blood pressure$$is enough. The body fluids develop a relative hy+ernatremia. +AT.0 I(TO=I<ATIO( occurs from higher input than output. This happens in individuals with failed diuresis "increased compensatory urine output# subse,uent to renal failure or excessive A/! secretion "e.g.' <(* trauma' infection' hemorrhage' pain#. Also the lungs may secrete A/! e.g.' in oat cell carcinoma of lung' <O8/' tuberculosis' and asthma. Also' brain' pancreatic' and intestinal tumors may secrete A/!. <ertain drugs also stimulate

hypothalamic secretion of A/!: chlorpropamide "used by diabetics#' carbama1epine "antiepileptic# and clofibrate "antihyperlipidemic#. The body fluids develop a relative hy+onatremia.

,ains or #osses o- Water and Sodium >ains or losses of water and sodium occur when there are corresponding increases in body water "volume# and body (a ). +e should remember that one tends to increase:decrease more than the other. +AT.0 /.8?.TIO( occurs when both water and electrolytes are lost from the .<F. For example' heavy perspiration' vomiting or diarrhea may promote water depletion. Also' volume depletion occurs when there is impaired (a) reabsorption by the kidney' e.g.' reduced adrenal aldosterone output. 8atients with extensive skin burns are susceptible to water$sodium depletion in that both are lost' in excess' from the body surface. +ater depletion may also be a se.uestration state' rather than a total body water depletion' e.g.' hemorrhage and acute peritonitis@ these are usually rapid acting causes. %ecause edema and ascites are slow to develop and compensation mechanisms have time to work' these are not typically water depletion se,uestration states. 6O?;4. .=<.** occurs when both water and electrolytes are retained within the body. For example' renal disease "(a ) is not removed#' hepatic disease "cirrhosis#' or cardiac disease "<!F# may work through various mechanisms to produce water$electrolyte retention. Also aldosterone hypersecretion can also cause fluid volume excesses.

(onse.uences o- "luid Imbalance and /hera+eutic &++roaches %O/: F?;I/ 6O?;4. I(<0.A*.* A(/ /.<0.A*.* are typically accompanied by osmotically$driven changes in volume between the fluid compartments. Fluid volume increases tend to promote increased blood pressure@ decreases' reduced blood pressure and even shock. !ere' the relative hypernatremia wall draw water from the intracellular compartment@ relative hyponatremia' draw water into the intracellular compartment. The volume$ depleted patient will likely experience feeling thirsty' dry mucous membranes' reduced perspiration' reduced urinary output and reduced skin turgor. For example' as plasma9interstitial fluid volume decreases' intracellular water tends

to move "for osmotic reasons# to these compartments to produce reduced skin turgor. Also' changes in these volumes can also affect <*F volume with altered in <(* function. !ere' with <(*$cell shrinkage' the patient feels weak and irritable and may progress to sei1ures' coma and even death@ <(*$cell volume increases may produce cerebral edema' headache' nausea' vomiting' malaise' lethargy' sei1ures and coma. T!.0A8: I( F?;I/ I4%A?A(<. 6olume depletion due to hemorrhage can often be restored with normal saline "isotonic#@ if the kidneys are working properly' they will ,uickly restore electrolyte$water balance. 6olume excess can usually be corrected with diuretics.

)#)(/0O#!/) I%B&#&'() This is an artificial' simplistic look at electrolyte balance. In the body' it is not so absolute: ions react to one another producing electrical$polarity$driven shifts and osmotic pressure differences which shift body water location. !ere' we consider imbalances in sodium' potassium' chloride' and calcium. Also' these imbalance states are defined by their levels in blood but the extra$blood compartments are typically affected as part of the larger picture. Sodium Imbalance *odium imbalance includes hyponatremia and hypernatremia. !:8O(AT0.4IA typically arise from excessive loss rather than inade,uate intake. This is most likely to occur when the kidneys do not ade,uately retain sodium or when aldosterone levels are inade,uate. /o you see how this may be manifest' in the patient' as a loss of turgor in the skin and other body tissuesA !:8.0(AT0.4IA typically arises from excessive water loss relative to sodium loss. +hen absolute amounts of systemic sodium are increased' it is typically accompanied with increased fluid volumes as well. /o you see how this would produce tissue edemaA 1otassium Imbalance 8otassium imbalance includes hypokalemia and hyperkalemia " kalium: potassium#. +e need to keep in mind that the blood potassium levels are normally very low in comparison to blood sodium levels. Also potassium is the

predominant intracellular cation@ BCD of the body7s potassium is se,uestered within its living cells. In the cells it is a ma-or contributor to intracellular osmotic pressure and to membrane potential formation. 4ost of the body7s potassium exits the body through the urinary system. This is driven by local renal interstitium potassium levels and aldosterone which reduces renal reabsorption of potassium. !:8O5A?.4IA may be due to a whole body deficit or to shifts between the .<F and I<F. 8atients with hypokalemia "whole body or hypokalemic shift# present with: neuromuscular disfunction' weakness "loss of tone#' twitching and depressed responses. Also' .5> patterns are different with a reduced "flatter# T wave and a definite ; wave "immediately following the T wave#. Inade,uate dietary potassium may occur in appetite depression "e.g.' elderly# and psychogenic aversion to eating. Also' it may be due to increased loss: vomiting' heavy perspiration and chronic diarrhea "e.g.' laxative abusers#. 0educed renal absorption may also occur subse,uent to long$term diuretic use "e.g.' thia1ides' furosemide' and ethacrynic acid# or from aldosterone hypersecretion. *hifts may be promoted by hyperinsulinemia' hyperglycemia and adrenergic drugs all of which stimulate intracellular uptake. Alkalosis also promotes hypokalemic shifts. !:8.05A?.4IA be due to whole body deficit or to locali1ed potassium shifts. 8atients with hyperkalemia tend to also have neuromuscular disorders but particularly myocardial .5> abnormalities. For example' the *$T segment is depressed and the T wave is increased with the 8 wave lost "flattened# and a broader E0* complex. +hole body hyperkalemia may be due to aldosterone hyposecretion. Trauma such as from crushing in-uries and extensive hemolysis will also pour large ,uantities of potassium into the bloodstream. For example' stored blood tends to leach potassium out of the stored erythrocytes and into the plasma. *hifts may also be driven by hypoinsulinemia and beta blocking adrenergic agents.

(hloride Imbalance

<hloride ions tend to passively follow the sodium ions and imbalances tend to correspond to sodium levels in the same compartments. !:8O<!?O0.4IA may occur subse,uent to >I fluid loss' excessive perspiration or renal failure. 8atients are likely to present with symptoms of dehydration. !:8.0<!?O0.4IA is usually subse,uent to increased chloride intake such as from intravenous infusions of (a<l. 8atients are likely to present with edema and acute weight gain.

(alcium Imbalance <alcium is twice as concentrated in the .<F than the I<F and is present in two forms in e,uilibrium with one another: ioni1ed calcium and bound to the citrate ion or to protein. %lood increases are mediated by parathyroid hormone "and 6itamin /# and decreases by thyroidal calcitonin. !:8O<A?<.4IA promotes tetany' i.e.' hyperactive neuromuscular reflexes and excessive nerve$muscle irritability. !ypocalcemia may be due to actual dietary deficiency' a lack of ade,uate vitamin / needed for absorption' or even lack of ade,uate stomach9intestinal acidity. Also' hypoparathyroidism and9or hypercalcitoninism may produce hypocalcemia. !:8.0<A?<.4IA may be due to hyperparathyroidism or hypothyroidism "hypocalcitoninism#. .xcessive intake of vitamin / may also produce hypercalcemia. !ypercalcemia often promotes hypophosphatemia because the calcium and phosphate ions are in a teeter$totter relationships in the renal nephrons "renal blood#. 8atients may present with nephrolithiasis' muscle cramps or pain along with >I hyperactivity promoting nausea' abdominal cramps and diarrhea. <hronic hypercalcemia may produce metastatic calci-ication' the widespread deposition of calcium salts.

iuretic $se and )lectrolyte Balance In promoting increased water loss' electrolytes may become imbalanced. For example' many diuretics promote sodium loss "hyponatremia# but the kidneys then promote potassium retention "hyperkalemia#. *ome diuretics work by

reducing <l$ nephron intratubular reabsorption' altering the osmotic balance by increasing the osmolarity of the filtrate to reduce water reabsorption by the peritubular capillaries. *till other diuretics work by reducing the effect of A/! on the distal tubule and collecting tubule.
:our blood pressure is a ma-or part of your cardiovascular health. :our dietary choices' even the amount of electrolytes you consume' can influence your blood pressure. The electrolytes sodium and potassium play a ma-or role in regulating your blood pressure. Following ;*/A recommendations for your diet can help you maintain a healthy blood pressure.

Electrolytes
.lectrolytes are compounds that influence many aspects of your body7s functions. One of these functions is the balance of fluid in and around your cells. .lectrolytes partially break down in water to form an ion. +hen this occurs' they influence where the fluids inside your body go. *odium boosts water retention' leading to excess fluid in blood vessels and higher blood pressure.
SODIUM

*odium is an electrolyte that is found in high amounts in the average American diet. It also accounts largely for increases in blood pressure. +hen you eat a large amount of sodium' your body must balance out the electrolytes with water. :our brain sends a signal to drink to increase fluids inside your body. This increase in fluid also increases your blood volume' which leads to an increase in blood pressure. POTASSIUM 8otassium is a helpful electrolyte because it works to counteract the effect that sodium has on your blood pressure. In fact' according to a study published in F!ypertensionF in &GGH' increasing your potassium intake might even help reduce blood pressure in those with high blood pressure' or hypertension. For participants of this study' regular intake of potassium citrate' the same potassium found in most foods' was enough to reduce the average blood pressure reading from H 9BI mm!g to IC9CC mm!g.

Sodium balance
The largest portion of the body's sodium reserves is in the extracellular fluid, which includes the blood plasma. The kidneys function to control the sodium excreted in the urine; thus the level of sodium in the body is relatively constant on a daily basis. An upset between intake of sodium (through dietary consumption and output (in urine and sweat creates an imbalance, affecting the total amount of sodium in the body. !ariations in the total amount of sodium are related to the volume of water found in the blood. A decrease in the overall amount of sodium does not necessarily cause the concentration of blood sodium to fall, but may decrease blood volume. "ow blood volume, such as occurs with hemorrhage, signals the kidneys to conserve both water and sodium through stimulation of aldosteone. This helps to return blood volume toward normal, by increasing the amount of

extracellular fluid sodium. #ith an excess of sodium in the body, blood volume may rise. This increase in blood volume initiates an accumulation of extracellular fluid, often in the feet, ankles, and lower legs, resulting in a condition known as edema. The body maintains extracellular fluid sodium concentration homeostasis through the thirst mechanism and regulation of kidney water excretion by antidiuretic hormone (A$% . #hen sodium concentrations opposed to too much total sodiums too high, thirst prompts water intake and, at the same time, the A$% signals to the kidneys to conserve water, by increasing water absorption by the organs and passing less water into the excretory system.

Common disorders
The electrolytes involved in disorders of salt balance are most often sodium, potassium, calcium, phosphate, and magnesium. The concentration of blood chloride is usually similar to the blood sodium concentration, while bicarbonate is related to acid-base balance.

Sodium balance
HYPONATREMIA. The most common electrolyte disorder is hyponatremia, it occurs in almost &' of all patients hospital admissions. %yponatremia is a condition characteri(ed by low sodium in the blood, below &)* m+, per liter of blood. -n hyponatremia, the sodium concentration has been overdiluted by an excess of water or a loss of sodium in the body. %yponatremia may result from intraveous administration of water to hospitali(ed patients or can also occur with small amounts of water consumption in those who have impaired kidney function and several other conditions such as liver cirrhosis, hear !ail"re, underactive adrenal #lands as with Addison's disease, and various antidiuretic hormone disorders. .ver /0' of hospitali(ed patients with AI$% have been reported to suffer from hyponatremia. "ethargy and confusion are typically the first signs of hyponatremia. 1uscle twitching and sei(ures may occur as hyponatremia progresses with risk of stupor, coma, and death in the most severe cases. $ue to the effects on the cen ral nervo"s sys em, mortality risk is considerably greater in acute hyponatremia than in chronic hyponatremia. .ther factors that reduce survival are the presence of debilitating illnesses such as alcoholism, hepatic cirrhosis, hear failure, or malignancy. HYPERNATREMIA. %ypernatremia is a condition characteri(ed by a high concentration of sodium in the blood, above &2/ m+, per liter of blood. There is too little water compared to the amount of sodium in the blood, often resulting from a low intake of water. 3rofuse sweating, vomiting, !ever,diarrhea, or abnormal kidney function may result in hypernatremia. #ith age, there is a decreased thirst sensation; therefore, hypernatremia is more common in the elderly. Aging reduces the kidney's ability to concentrate urine; therefore, taking diuretics may further exacerbate hypernatremia. %ypernatremia is very serious, particularly in the elderly. Almost half of individuals hospitali(ed for this condition will die, although it is often secondary to other illnesses. 1a4or causes of high sodium levels include5

limited water access, particularly when combined with any other cause

excess water loss due to profuse sweating, vomiting, fever, diarrhea disorders of other electrolytes head trauma or neurosurgery involving the pituitary gland use of drugs including lithium, diuretics, demeclocycline diabetes insipidus sickle cell disease

As with hyponatremia, the ma4or symptoms of hypernatremia result from brain dysfunction. 6evere hypernatremia can lead to confusion, muscle twitching, sei(ures, coma, and death. The effects on central nervous system hyperosmolality and the seriousness of the under7 lying illness lead to greater mortality in acute hypernatremia compared to chronic hypernatremia.

Calcium balance
The body's calcium reserves are predominately stored in bones, although the blood and cells also contain calcium. 8alcium is necessary for proper functioning in many areas of the body including nerve conduction, m"scle con rac ion, and en(yme functions. "ike other electrolytes, the body controls calcium levels both in blood and cells. 8alcium from the diet is absorbed in the gastrointestinal tract while the excess is excreted in the urine. A minimum of /007&000 mg of calcium is re,uired daily in order to maintain a normal calcium concentration. 9ormally, the body transfers calcium to the blood from the bones to maintain calcium homeostasis. -f calcium intake falls short of the re,uirement, too much calcium will be mobili(ed from the bones, weakening the bones and contributing to os eo&orosis. 3arathyroid hormone and calcitonin regulate the amount of calcium in the blood. There are four&ara hyroid #lands located in the neck that increase secretion of parathyroid hormone when the calcium concentration falls too low. 8onse,uently, the gastrointestinal tract is stimulated to absorb more calcium from the blood, release a greater amount of calcium from the bones, and to excrete less in the urine. At the same time, parathyroid hormone induces the kidneys to activate vi amin $which increases uptake of calcium from the gastrointestinal tract. 8alcitonin is a hormone produced by the parathyroid, thyroid, and thymus glands. -t acts to lower the calcium concentration in blood by enhancing uptake of calcium into the bones.

Common disorders
Calcium balance
HYPOCA'CEMIA. A low calcium blood level is referred to as hypocalcemia. 8alcium is measured in extracellular fluid in two forms5 total calcium concentration and ioni(ed calcium concentration. About /0' of the total calcium concentration in the plasma exists in ioni(ed form, which is the form that has biological activity at cell membranes. The remainder is either bound to the plasma&ro eins (about 20' or complexed in the non7ioni(ed form (about &0' with anions such as phosphate. -n hypocalcemia the total calcium concentration falls below :.2 m+,;l in the extracellular fluid. %ypocalcemia can result from a number of

problems. The most common reason is an inability to mobili(e calcium from the bones or a chronic loss of calcium in the urine. .ther causes of hypocalcemia include5

low blood albumin concentration hypoparathyroidism vitamin $ deficiency renal failure magnesium depletion acute pancreatitis hypoproteinemia septic shock hyperphosphatemia drugs such as those used to treat hypercalcemia; anti7convulsants excessive secretion of calcitonin

An abnormally low blood calcium concentration may not produce any symptoms. %owever, over time the lack of calcium in the blood can affect brain function causing neurologic symptoms such as memory loss, depression, confusion, delirium, and hallucinations. .nce calcium levels return to normal, these symptoms are reversible. !ery severe cases of hypocalcemia can lead to sei(ures, tetany, and muscle spasms in the throat, affecting breathing. The condition is usually first discovered during routine blood tests because often there are no symptoms evident. HYPERCA'CEMIA. A high calcium blood level is referred to as hypercalcemia. The blood calcium concentration rises above &0./ mg per deciliter of blood. -ncreased gastrointestinal tract absorption or increased intake of calcium may lead to hypercalcemia. -ndividuals who consume large amounts of calcium or who take calcium containing an acids can develop hypercalcemia. Absorption of calcium can be increased in the gastrointestinal tract with an overdose of vitamin $. The condition is usually first discovered during routine blood tests because hypercalcemia often doesn't have any symptoms at all. -f symptoms occur, typically the earliest are5

constipation loss of appetite nausea and vomiting abdominal pain

"arge amounts of urine may be produced by the kidneys. $ue to excess urine production, fluid levels in the body decrease and may lead to dehydration. 6evere hypercalcemia may induce brain dysfunction symptoms such as weakness, confusion, emotional disturbances, delirium, hallucinations, and coma. Additionally, abnormal heart rhythms and death may follow. -n chronic conditions, kidney s ones or calcium7containing crystals that can cause permanent damage may form.

Potassium balance
3otassium plays a ma4or part in cell me abolism and in nerve and muscle cell function. 1ost of the body's potassium is located intracellularly, not extracellularly or in the blood. Too high or low concentrations of blood potassium can have serious effects such as an abnormal heart rhythm or cardiac arrest. The potassium concentration in the blood is maintained with the assistance of intracellular potassium. "ike other electrolytes, potassium balance is regulated through gastrointestinal tract absorption of potassium in food, and by excretion of potassium by the kidneys. 6ome potassium is lost in the gastrointestinal tract, but most is lost through urine. 6ome conditions and drugs influence potassium balance intracellularly, also affecting blood concentrations. %igh sources of dietary potassium are5

bananas melons tomatoes oranges potatoes and sweet potatoes green leafy vegetables such as spinach, turnip greens, collard greens, kale etc. most peas and beans potassium supplements salt substitutes (potassium chloride

Common disorders
Potassium balance
HYPO(A'EMIA. A low potassium blood level is referred to as hypokalemia. -t occurs when the blood potassium concentration falls below ).< m+, per liter of blood. %ypokalemia is common in the elderly. 8ommon causes include decreased intake of potassium during acute illness, nausea and vomiting, and treatment with thia(ide or loop diuretics. About :0' of patients receiving thia(ide diuretics develop hypokalemia, which is dose7dependent but usually mild. 6ince several foods contain potassium, hypokalemia is not typically due to a low intake. -t is usually due to malfunction of the kidneys or abnormal loss through the gastrointestinal tract. 3eople with heart disease have to be especially cautious regarding hypokalemia (particularly when taking digoxin , because they are prone to developing abnormal heart rhythms. 3otassium usually can be replaced relatively easily by eating foods rich in potassium or by taking potassium salts (potassium chloride orally. HYPER(A'EMIA. A high level of potassium in the blood is referred to as hyperkalemia. -t occurs when the blood potassium concentration rises above /.0 m+, per liter of blood. %yperkalemia typically results when the kidneys excrete too little potassium. 6ome common causes are due to5

drugs which block potassium excretion (angiotensin converting en(yme =A8+> inhibitors, triamterene, and spironolactone Addison's disease kidney failure

(EY TERM%
An idi"re ic hormone )A$H* hormone that encourages the kidney to retain water when body stores are low. +icarbona e salt of carbonic acid produced by neutrali(ing a hydrogen ion. $ehydra ion deficit of body water that results when the output of water exceeds intake. $i"re icn agent or drug that eliminates excessive water in the body by increasing the flow of urine. Edeman increase in blood volume instigates an accumulation of extracellular fluid resulting in swelling of the feet, ankles, and lower legs. Elec roly e substance such as an acid, bases, or salt. An electrolyte's water solution will conduct an electric current and ioni(es. Acids, bases, and salts are electrolytes. Homeos asisn organism's regulation of body processes to maintain internal e,uilibrium in temperature and fluid content. Hy&o&ara hyroidism condition resulting from an absence or deficiency in parathyroid hormone. -t is characteri(ed by hypocalcemia and hyperphosphatemia. Te any general stiffening and spasms of the muscles that can occur in severe cases of hypocalcemia.

a sudden release of potassium from the cell reservoir in such cases as when a large amount of muscle tissue is destroyed (crush in4ury or severe burn in4uries, or an

overdose on crack cocaine The kidney's ability to excrete potassium is over7whelmed due to a rapid influx into the blood, resulting in life7threatening hyperkalemia. ?enerally, hyperkalemia is more dangerous than hypokalemia. A blood potassium concentration above /./ m+,;liter starts to affect the electrical conducting system in the heart. -f the concentration continues to increase, the heart rhythm becomes irregular which may cause the heart to eventually stop. 1ild hyperkalemia often may not produce any symptoms. 6ymptoms may include an irregular heartbeat that could be experienced as palpitations. %yperkalemia is typically first diagnosed during a routine blood test or by examining changes in an electrocardiogram. 6evere deficiencies may lead to muscular weakness, twitches, and &aralysis.

Magnesium balance
1agnesium influences the function of many en(ymes. $ietary intake is essential to maintain normal levels. The body's magnesium stores are predominately found in bone with little appearing in the blood. +xcess is excreted in the urine or stool.

Common disorders

Magnesium balance
HYPOMA,NE%EMIA. A low level of magnesium in the blood is known as hypomagnesemia. The level of magnesium in the blood decreases below &.* m+, per liter of blood. 1etabolic and nutritional disorders are usually the culprit of hypomagnesemia, most often when intake of magnesium is decreased during starvation or intestinal malabsorption compounded with greater kidney excretion. 6ymptoms of hypomagnesemia may include5

loss of appetite nausea and vomiting sleepiness weakness personality changes muscle spasms tremors

#hen hypomagnesemia occurs along with hypocalcemia, the magnesium must be replaced before successful treatment of the calcium disorder. HYPERMA,NE%EMIA. A high level of magnesium in the blood is referred to as hypermagnesemia. The blood magnesium concentration rises above :.& m+, per liter of blood. %ypermagnesemia is ,uite rare unless people with kidney failure are given magnesium salts or consume magnesium7containing drugs such as antacids. #eakness, low blood &ress"re, and impaired breathing can result and the heart may stop if the concentration increases above &: to &/ m+, per liter.

Phosphate regulation
Phos&hor"s occurs in the body almost solely in the form of phosphate, which is composed of one phosphorus and four oxygen atoms. 3hosphate is found mostly in bones, although a significant amount is found intracellularly. -t plays a role in energy metabolism and acid7base regulation, and it is used as a building block for $9A. 3hosphate is excreted in the urine and stool. 8hloride is one of the most important minerals in the blood, along with sodium, potassium, and calcium. 8hloride helps keep the amount of fluid inside and outside of cells in balance. -t also helps maintain proper blood volume, blood pressure, and p% of body fluids. 8hloride is a binary compound of chlorine; a salt of hydrochloric acid. -n health, blood serum contains &00 to &&0 mmol;" of chloride ions. 8hloride is the ma4or extracellular anion and contributes to many body functions including the maintenance of osmotic pressure, acid7 base balance, muscular activity, and the movement of water between fluid compartments. -t is associated with sodium in the blood and was the first electrolyte to be routinely measured in the blood. 8hloride ions are secreted in the gastric 4uice as hydrochloric acid, which is essential for the digestion of food. 1ost of the chloride in the body comes from table salt (sodium chloride in the diet. 8hloride is absorbed by the intestine during food digestion. Any excess chloride is passed out of the

body through the urine. 8hloride levels in the blood generally rise and fall along with sodium levels in the blood. The amount of chloride in the blood is indirectly regulated by the hormone aldosterone, which also regulates the amount of sodium in the blood. The amount of chloride decreases when the amount of sodium in the blood decreases, and vice versa. The level of chloride in the blood is also related to the level of bicarbonate. #hen the amount of bicarbonate decreases, the amount of chloride normally increases, and vice versa. A test for chloride is usually done on a blood sample taken from a vein. Tests for sodium, potassium, and bicarbonate are usually done at the same time as a blood test for chloride. .ccasionally, a test for chloride can be done on a sample of all the urine collected over a :2 hour period (called a :27hour urine sample to evaluate how much chloride is being released into the urine. A test for chloride may be done to5 +valuate the electrolyte balance in the body. Too little chloride can cause muscle twitching, muscle spasms, or shallow breathing. Too much chloride can be associated with rapid deep breathing, weakness, confusion, and coma. %elp determine whether a problem with the kidneys or adrenals is present. %elp determine the cause for high blood p%. A condition called metabolic alkalosis can be caused by a loss of acid from the body (for example, from a loss of electrolytes through prolonged vomiting or diarrhea . 1etabolic alkalosis can also result when the body loses too much sodium or from eating excessive amounts of baking soda (sodium bicarbonate . 8hloride is an important component of salt, which is actually sodium chloride. 3eople who have congestive heart failure, kidney disease, or high blood pressure would benefit from decreasing their salt consumption. @our body maintains a closely regulated concentration of sodium in your body. -f you eat a lot of salt (sodium chloride , then the concentration of sodium increases. To bring it back to normal, your body has two options5 excrete the excessive sodium in your urine, or hold onto more water so you can dilute the concentration of sodium in your blood. -f you hold onto more water, then you may feel more bloated. Also, your blood pressure may increase, because you have more volume in a closed blood vessel system. .ne of the conse,uences of high blood pressure is progressive kidney damage, as with every beat of your heart, your blood hits the kidney tubules with excessive force. As your kidneys become more damaged, they lose the ability to excrete salt into your urine, so you hold onto more water to dilute the concentration of sodium. This increased volume increases your blood pressure, causing more kidney damage, and this vicious cycle continues and gets progressivly worse. Aor people who need to restrict their intake of salt, you might also try substituting potassium chloride (available in most groceries for sodium chloride. #hile it doesn't taste as good as regular salt to most people, some studies indicate that potassium may actually lower your blood pressure. 8hloride is also used as 8alcium chloride. 8alcium chloride in water dissociates to provide calcium (8aBB and chloride (8l7 ions. Coth are normal constituents of the body fluids and are dependent on various physiological mechanisms for maintenance of balance between intake and output.
Although the kidney cannot directly sense blood, long7term regulation of blood pressure predominantly depends upon the kidney. This primarily occurs through maintenance of the extracellular

fluid compartment, the si(e of which depends on the plasma sodium concentration. Denin is the first in a series of important chemical messengers that make up the renin7angiotensin system. 8hanges in renin ultimately alter the output of this system, principally the hormones angiotensin -- and aldosterone. +ach hormone acts via multiple mechanisms, but both increase the kidney's absorption of sodium chloride, thereby expanding the extracellular fluid compartment and raising blood pressure. #hen renin levels are elevated, the concentrations of angiotensin -- and aldosterone increase, leading to increased sodium chloride reabsorption, expansion of the extracellular fluid compartment, and an increase in blood pressure. 8onversely, when renin levels are low, angiotensin -- and aldosterone levels decrease, contracting the extracellular fluid compartment, and decreasing blood pressure.

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