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Regulation of Electrolytes

Dr.Niranjan Murthy HL Asst Prof of Physiology SSMC, Tumkur

Electrolytes of importance
Sodium- osmolarity, action potential Potassium- RMP Calcium- second messenger, contractility Chloride Bicarbonate Magnesium Phosphate

Distribution of electrolytes

Basics
Osmosis- diffusion of water across a semipermeable membrane from region of high concentration to low concentration. Mole- gram molecular weight of a substance Osmole- mole / liter of water Osmolality- osmoles/Kg of water Osmolarity- osmoles/liter of solution Osmotic pressure- pressure required to prevent osmosis of water

Importance of ecf composition

Regulation of ECF Na+


140-145 mEq / L ECF osmolarity 280-295 mOsm / L P osm= 2.1 x Plasma [Na+] Na+ & associated ions contribute to 94% of P osm

Primary systems regulating ECF [Na+] : 1. Osmoreceptor-ADH feedback system 2. Thirst mechanism

Osmoreceptor-ADH feedback system

Osmoreceptorsspecial nerve cells in vicinity of AV3V & supra-optic nucleus

Thirst mechanism
Thirst is a conscious for water Thirst center: AV3V and a small area in preoptic nucleus

Osmolar threshold for thirst- 2 mEq / L of Na+ One of the mechanisms is adequate to regulate osmolarity & [Na+]

Role of angiotensin II and aldosterone: Little effect on [Na+] Effective only in extreme conditions Salt appetite mechanism

Control mechanisms fro regulating Na+ excretion


Sodium excretion is matched precisely to intake Controlled by altering GFR & tubular Na+ reabsorption rates - Glomerulotubular balance - Tubulo-glomerular feedback

Mechanisms of control: 1. Pressure natriuresis & diuresis 2. Nervous & hormonal factors(i) Sympathetic stimulation (ii) Role of Angiotensin II (iii) Role of Aldosterone (iv) Role of ADH (v) Role of ANP

Regulation of potassium
4.20.3 mEq/L 98% is intracellular Daily intake 50-200 mEq/day 5-10% excreted in feces

Renal K+ excretion

Secretion in distal tubule and cortical collecting duct is 1/3rd of intake Factors that control K+ secretion in principal cells: (i) Na+- K+ ATPase activity (ii) Electrochemical gradient for K+ (iii) Permeability of luminal membrane

K+ excretion is increased by: 1. Increased ECF K+ 2. Increased aldosterone 3. Increased tubular flow rate

Control of extracellular calcium by renal mechanisms


50% of plasma calcium is filtered and 99% of it is reabsorbed

Hyponatremia
Causes: Depletional & Dilutional c/f: nausea, malaise, lethargy, headache confusion, stupor, seizure, coma

Hypernatremia
Causes: central diabetes insipidus, hyperaldosteronism c/f- weakness, neuromuscular irritability, coma, seizures

Hypokalemia
Causes: insulin, alkalosis, hyperaldosteronism c/f- fatigue, muscular weakness, paralysis ECG changes- ST depression, prominent U wave, T inversion, prolonged PR interval

Hyperkalemia
Causes: insulin deficiency, hypoaldosteronism c/f- flaccid paralysis & hypoventilation ECG changes- tall T waves, prolonged PR & QRS

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