Human electrolyte balance and predicting the consequences of its disturbance. Physiology and disorders of water-salt metabolism (methodological materials for practical and seminar classes)

Electrolytes are substances that allow the transmission of electrical impulses. They also perform many other functions, so they play a special role in the human body. There are several essential electrolytes for humans. If there is a shortage of them, serious problems will arise. Along with the loss of fluid, a person also loses useful salts, so it is important to maintain their amount at normal levels, replenishing the deficiency through special medications.

What it is?

Not all people understand what it is. Human electrolytes are salts that are capable of conducting electrical impulses. These substances perform several important functions, including the transmission of nerve impulses. In addition, they perform the following functions:

maintain water-salt balance
regulate important body systems

Each electrolyte performs its own function. The following types are distinguished:

magnesium
sodium

There are standards for the content of electrolytes in the blood. If there is a deficiency or excess of substances, problems arise with the body. The salts influence each other, thereby creating balance.

Why are they so important?

In addition to the fact that they affect the transmission of nerve impulses, each electrolyte has an individual function. For example, it helps with the functioning of the heart muscle and brain. Sodium helps the body's muscles respond to nerve impulses and do their jobs. A normal amount of chlorine in the body helps the digestive system function properly. Calcium affects the strength of bones and teeth.

Based on this, it becomes clear that electrolytes perform many functions, so it is important to maintain their optimal levels in the body. A lack or excess of one of the substances leads to serious pathologies that lead to health problems in the future.

Electrolytes are rapidly lost along with the liquid. If a person, he should keep in mind that he will need to replenish not only water, but also salts. There are special drinks that restore water and electrolyte balance in the human body. They are used to prevent dangerous pathologies due to the loss of large amounts of salts and fluid.

Symptoms of pathology

If there is a deficiency or excess of electrolytes, this will certainly affect human health. will arise various symptoms, which you definitely need to pay attention to. Deficiency occurs due to large loss of fluids, disease and poor nutrition. An overabundance of substances occurs due to the consumption of foods that contain salts. large quantities ah, and also in case of damage to some organs by diseases.

If an electrolyte deficiency occurs, the following symptoms occur:

weakness
arrhythmia
tremor
drowsiness
kidney damage

If these symptoms occur, you should consult a doctor. A blood test for electrolytes will help determine the exact cause of their appearance. It is used to determine the amount of salts that affect the water-electrolyte balance in the body at the time of blood donation.

Natural loss

A person loses a percentage of electrolytes every day through sweat. The process of loss is the norm. If a person plays sports, he loses much more essential substances. It is advisable to provide the body with sufficient amounts of magnesium and potassium salts to prevent dehydration.

It is the loss of electrolytes that is a dangerous pathological condition and main reason symptoms of dehydration occur. For severe physical activity drink special water enriched with the main electrolytes: potassium, magnesium and chlorine.

It is also desirable that it is rich in one or another element. It is worth understanding that this should only be done when playing sports or similar activities. There is no need to simply increase the consumption of food containing magnesium, chlorine or potassium.

What happens when you lose?

Loss of electrolytes naturally arises general weakness and decreased performance. It is very difficult to bring the body to complete exhaustion, so dangerous pathologies do not arise. To fully recover, it is enough to consume a special drink or food containing nutrients and electrolytes.

Do not constantly disturb the water-electrolyte balance. During a lack of electrolytes, many organs suffer. There is a possibility of wear due to a lack of necessary substances. Only a professional athlete, under the supervision of a sports physician, performs large volumes of exhausting training without consequences. If a person’s main goal when playing sports is to maintain health, he should follow the principle of not training in refusal.

An ordinary person should also strive to maintain an ideal water and electrolyte balance. In this state, each organ works efficiently and without wear. When each element is present, it is believed that the person is in good health. Not all people correct ratio salts in the body. To achieve the norm, you will need to adjust your diet and add more active activities to your life.

Getting rid of deficit

There are two options for obtaining salts: naturally and with the help of medications. To do this the natural way, you will need to significantly increase your intake of foods that contain the right salts. Products that contain:

magnesium
potassium

Sometimes a person suffers only from a deficiency of one electrolyte, so before the diet it is necessary to take a test for electrolytes in the blood. Thus, it becomes clear how to proceed.

If there is one or another element, they are assigned special medications. Pharmacies have medications with all the necessary elements in a convenient form. They are used for severe shortage or if you do not want to keep a specialized diet. Correcting the deficiency naturally is preferable as it helps a person to be disciplined and maintain a proper diet on an ongoing basis.

Grocery list

One way or another, electrolytes are present in all foods, but there is a list of foods in which their amounts are off the charts. They will need to be consumed to eliminate a deficiency of potassium, magnesium, sodium, calcium or chlorine. It is important to cook them properly or eat them raw (if possible) to get the maximum nutrients:

Leguminous plants. The necessary substances are found in many legumes. People highlight white beans as the most electrolyte-rich legume. They contain a large amount of potassium.
Simple beets. Beets contain sodium, which contributes to the functioning of human organs.
Nutritious nuts. Sunflower seeds also contain magnesium, which promotes heart function. Its deficiency causes serious problems with the cardiovascular system.

It is advisable to choose an individual diet. For some people, it will be better to choose other products. To understand what exactly to pay attention to, you need to visit a doctor and undergo an examination. The doctor will create a diet taking into account individual characteristics body. If necessary, he will appoint special drugs, which will allow you to get rid of severe deficits.

Medicines

Severe deficiency requires specialized therapy. Electrolyte deficiency manifests itself most different symptoms. It is extremely rare that a cross-section of all elements is missing, so after passing the diagnosis, a person is prescribed a specific medicine.

There is a sufficient quantity in pharmacies various additives, so there will be no problems with the choice. There is no need to prescribe a particular element yourself. In addition to the salts themselves, drugs may be prescribed that promote better accumulation and use. Such medications normalize electrolyte balance. The most common supplement is simple magnesium. Also quite often prescribed is Asparkam, which contains magnesium and potassium.

Treatment medications are available without a prescription, but it is not recommended to prescribe them yourself. They are often used by people who do not have any problems with their water and electrolyte balance. Taking in excess of the norm leads to side effects and also causes the development of various complications due to an excess of salts in the human body.

Hidden Current

A person does not always feel that there is a shortage or excess of one or another healthy salt in organism. It is advisable to undergo examinations to understand the state of the water and electrolyte balance. Monitoring this indicator is as important as a blood or organ test.

Deficiency or surplus occurs due to wrong image life or disease development. All body systems are closely connected with each other. If one part fails, it affects the operation of the other. This means that a deficiency or excess of one or another element is sometimes a symptom of a dangerous disease. The therapist prescribes a detailed examination if a serious discrepancy with the norms is detected.

Water-salt metabolism- a set of processes of water and salts (electrolytes) entering the body, their absorption, distribution in internal environments and excretion. Human daily water consumption is about 2.5 l, of which about 1 l he gets it from food. In the human body, 2/3 of the total amount of water is intracellular fluid and 1/3 is extracellular. Part of the extracellular water is in the vascular bed (about 5% of body weight), while most of the extracellular water is outside the vascular bed, this is interstitial (interstitial) or tissue fluid (about 15% of body weight). In addition, a distinction is made between free water and water retained by colloids in the form of so-called swelling water, i.e. bound water, and constitutional (intramolecular) water, which is part of the molecules of proteins, fats and carbohydrates and is released during their oxidation. Different tissues are characterized by different ratios of free, bound and constitutional water. Per day, the kidneys excrete 1-1.4 l water, intestines - about 0.2 l; with sweat and evaporation through the skin, a person loses about 0.5 l, with exhaled air - about 0.4 l.

V.-s. regulation systems O. provide maintenance total concentration electrolytes (sodium, potassium, calcium, magnesium) and ionic composition of intracellular and extracellular fluid at the same level. In human blood plasma, the concentration of ions is maintained with a high degree of constancy and is (in mmol/l): sodium - 130-156, potassium - 3.4-5.3, calcium - 2.3-2.75 (including ionized, not associated with proteins - 1.13), magnesium - 0.7 -1.2, chlorine - 97-108, bicarbonate ion - 27, sulfate ion - 1.0, inorganic phosphate - 1-2 . Compared to blood plasma and intercellular fluid, cells have a higher content of potassium, magnesium, phosphate ions and a low concentration of sodium, calcium, chlorine and bicarbonate ions. Differences in the salt composition of blood plasma and tissue fluid are due to the low permeability of the capillary wall for proteins. Precise regulation of V.-s. O. in a healthy person allows you to maintain not only a constant composition, but also a constant volume of body fluids, maintaining almost the same osmotically concentration active substances And acid-base balance.

Regulation of V.-s. O. carried out with the participation of several physiological systems. Signals coming from special imprecise receptors that respond to changes in the concentration of osmotically active substances, ions and fluid volume are transmitted to the central nervous system, after which the release of water and salts from the body and their consumption by the body changes accordingly. Thus, with an increase in the concentration of electrolytes and a decrease in the volume of circulating fluid (hypovolemia), a feeling appears thirst, and with an increase in the volume of circulating fluid (hypervolemia), it decreases. Increasing the volume of circulating fluid due to high content water in the blood (hydremia) can be compensatory, occurring after massive blood loss. Hydremia is one of the mechanisms for restoring the correspondence of the volume of circulating fluid to the capacity of the vascular bed. Pathological hydremia is a consequence of a violation of V.-s. o., for example, in case of renal failure, etc. A healthy person may develop short-term physiological hydremia after taking large amounts of liquid. The excretion of water and electrolyte ions by the kidneys is controlled by the nervous system and a number of hormones. In the regulation of V.-s. O. Physiologically active substances produced in the kidney also participate - vitamin D3 derivatives, renin, kinins, etc.

The sodium content in the body is regulated mainly by the kidneys under the control of the central nervous system. through specific natrioreceptors. responding to changes in sodium content in body fluids, as well as volume receptors and osmoreceptors, responding to changes in the volume of circulating fluid and osmotic pressure of extracellular fluid, respectively. The sodium balance in the body is also controlled by the renin-angiotensin system, aldosterone, and natriuretic factors. When the water content in the body decreases and the osmotic pressure of the blood increases, the secretion of vasopressin (antidiuretic hormone) increases, which causes an increase in the reabsorption of water into the body. renal tubules. Increased sodium retention by the kidneys is caused by aldosterone (see. Adrenal glands ), and increased sodium excretion - natriuretic hormones, or natriuretic factors. These include atriopeptides, synthesized in the atria and having a diuretic, natriuretic effect, as well as some prostaglandins , ouabain-like substance formed in the brain, etc.

The main intracellular heap osmotically active cation and one of the most important potential-forming ions is potassium. Resting membrane potential, i.e. the potential difference between the cellular contents and the extracellular environment is recognized due to the ability of the cell to actively absorb K + ions from the external environment with the expenditure of energy in exchange for Na + ions (the so-called K + , Na + -pump) and due to the higher permeability of the cell membrane for ions K + than for Na + ions. Due to the high permeability of the imprecise membrane for ions, K + gives small shifts in the potassium content in the cells (normally this is a constant value) and the blood plasma leads to a change in the value of the membrane potential and the excitability of the nervous and muscle tissue. The participation of potassium in maintaining acid-base balance in the body is based on competitive interactions between K + and Na + ions, as well as K + and H +. An increase in protein content in a cell is accompanied by an increased consumption of K + ions. Regulation of potassium metabolism in the body is carried out by central nervous system. with the participation of a number of hormones. Corticosteroids, in particular aldosterone, and insulin play an important role in potassium metabolism.

When there is a deficiency of potassium in the body, the cells suffer, and then comes hypokalemia. If renal function is impaired, hyperkalemia may develop, accompanied by severe disruption of cell function and acid-base status. Often hyperkalemia is combined with hypocalcemia, hypermagnesemia and hyperazotemia.

State of V.-s. O. V to a large extent determines the content of Cl - ions in the extracellular fluid. Chlorine ions are excreted from the body mainly through urine. The amount of excreted sodium chloride depends on the diet, active reabsorption of sodium, the state of the renal tubular apparatus, acid-base state, etc. The exchange of chlorides is closely related to the exchange of water: a decrease in edema, resorption of transudate, repeated vomiting, increased sweating, etc. are accompanied by an increase in excretion chlorine ions from the body. Some diuretics with saluretic action inhibit sodium reabsorption in the renal tubules and cause a significant increase in urinary chlorine excretion. Many diseases are accompanied by a loss of chlorine. If its concentration in the blood serum decreases sharply (with cholera, acute intestinal obstruction, etc.), the prognosis of the disease worsens. Hyperchloremia is observed with excessive consumption of table salt, acute evacuation, urinary tract obstruction, chronic circulatory failure, hypothalamic-pituitary insufficiency, prolonged hyperventilation, etc.

Metabolism of calcium, magnesium, etc. - see. Mineral metabolism.

In a number of physiological and pathological conditions, it is often necessary to determine the volume of circulating fluid. For this purpose, special substances are injected into the blood (for example, Evans blue dye or 131I-labeled albumin). Knowing the amount of a substance introduced into the bloodstream and determining its concentration in the blood after some time, the volume of circulating fluid is calculated. The content of extracellular fluid is determined using substances that do not penetrate into cells. The total volume of water in the body is measured by the distribution of “heavy” water D 2 O, water labeled with tritium [pH] 2 O (TNO), or antipyrine. Water containing tritium or deuterium mixes evenly with all the water contained in the body. Volume of intracellular water equal to the difference between the total volume of water and the volume of extracellular fluid.

Clinical aspects of the disorder water-salt metabolism . Violations of V.-s. O. manifested by the accumulation of fluid in the body, the appearance swelling or fluid deficiency (see Dehydration ), a decrease or increase in blood osmotic pressure, electrolyte imbalance, i.e. decrease or increase in the concentration of individual ions (hypokalemia and hyperkalemia, hypocalcemia and hypercalcemia, etc.), changes in the acid-base state - acidosis or alkalosis. Knowledge of pathological conditions in which the ionic composition of the blood plasma or the concentration of individual ions in it changes is important for differential diagnosis various diseases.

A deficiency of water and electrolyte ions, mainly Na + , K + and Cl - ions, occurs when the body loses fluids containing electrolytes. A negative sodium balance develops when sodium excretion exceeds intake for a long time. The loss of sodium leading to pathology can be extrarenal and renal. Extrarenal loss of sodium occurs mainly through the gastrointestinal tract with uncontrollable vomiting, profuse diarrhea, intestinal obstruction, and through the skin with increased sweating (at high temperatures, fever, etc.), ah, e, massive blood loss.

Most gastrointestinal juices are nearly isotonic with blood plasma, so if replacement of fluid lost through the gastrointestinal tract is carried out correctly, changes in extracellular fluid osmolality are usually not observed. However, if the fluid lost during vomiting or diarrhea is replaced with an isotonic glucose solution, a hypotonic state develops and, as a concomitant phenomenon, a decrease in the concentration of K + ions in the intracellular fluid. Most often, sodium loss through the skin occurs with ah. The loss of water in this case is relatively higher than the loss of sodium, which leads to the development of heterosmolality of extracellular and intracellular fluids with a subsequent decrease in their volumes. Burns and other skin injuries are accompanied by an increase in capillary permeability, leading to the loss of not only sodium, chlorine and water, but also plasma proteins.

The kidneys are able to excrete more sodium than is necessary to maintain the constancy of V.-s. Thus, when the mechanisms regulating sodium reabsorption in the renal tubules are disrupted or when sodium transport into the cells of the renal tubules is inhibited. Significant renal loss of sodium in healthy kidneys can occur with an increase in diuresis of endogenous or exogenous origin, incl. with insufficient synthesis of mineralocorticoids by the adrenal glands or administration of diuretics. When renal function is impaired (for example, in chronic renal failure), the body loses sodium mainly due to impaired reabsorption in the renal tubules. The most important signs of sodium deficiency are circulatory disorders, including collapse.

Water deficiency with a relatively small loss of electrolytes occurs due to increased sweating when the body overheats or during severe physical work. Water is lost during prolonged hyperventilation of the lungs, after taking diuretics that do not have a saluretic effect.

A relative excess of electrolytes in the blood plasma is formed during the period of water fasting - with insufficient water supply to patients who are unconscious and receiving forced nutrition, with swallowing disorders, and in infants- if they do not consume enough milk and water. A relative or absolute excess of electrolytes with a decrease in the total volume of water in the body leads to an increase in the concentration of osmotically active substances in the extracellular fluid and cell dehydration. This stimulates the secretion of aldosterone, which inhibits the excretion of sodium by the kidneys and limits the excretion of water from the body.

Restoring the amount of water and isotonicity of the fluid in case of pathological dehydration of the body is achieved by drinking large quantities of water or intravenously administering an isotonic solution of sodium chloride and glucose. The loss of water and sodium due to increased sweating is compensated by drinking salted (0.5% sodium chloride solution) water.

Excess water and electrolytes manifests itself in the form of edema. The main reasons for their occurrence include excess sodium in the intravascular and interstitial spaces, more often with kidney disease, chronic liver failure, and increased permeability of the vascular walls. In heart failure, excess sodium in the body may exceed excess water. The disturbed water-electrolyte balance is restored by limiting sodium in the diet and prescribing natriuretic diuretics.

Excess water in the body with a relative deficiency of electrolytes (so-called water poisoning, or water intoxication, hypoosmolar hyperhydria) is formed when a large amount is introduced into the body fresh water or glucose solution if there is insufficient fluid secretion; excess water can also enter the body in the form of hypoosmotic fluid during hemodialysis.

At water poisoning hyponatremia and hypokalemia develop, and the volume of extracellular fluid increases. Clinically, this is manifested by nausea and vomiting, which worsens after drinking fresh water, and vomiting does not bring relief; visible mucous membranes in patients are highly moist. Hydration of the cellular structures of the brain is manifested by drowsiness, headache, muscle twitching, and convulsions. In severe cases of water poisoning, pulmonary edema and hydrothorax develop. Water intoxication can be eliminated by intravenous administration of hypertonic sodium chloride solution and sharp limitation of water consumption.

Potassium deficiency is mainly a consequence of its insufficient intake from food and loss through vomiting, prolonged gastric lavage, and profuse diarrhea. The loss of potassium in diseases of the gastrointestinal tract (tumors of the esophagus and stomach, pylorus, intestinal obstruction, etc.) is largely associated with hypochloremia developing in these diseases, in which the total amount of potassium excreted in the urine sharply increases. Significant quantities Patients suffering from repeated bleeding of any etiology lose potassium. Potassium deficiency occurs in patients treated for a long time with corticosteroids, cardiac glycosides, diuretics and laxatives. Potassium losses are high during operations on the stomach and small intestine. IN postoperative period hypokalemia is more often noted with the infusion of isotonic sodium chloride solution, because Na + ions are antagonists of K + ions. The release of K+ ions from cells into the extracellular fluid increases sharply, followed by their excretion through the kidneys with increased protein breakdown; significant potassium deficiency develops in diseases and pathological conditions accompanied by impaired tissue trophism and cachexia (extensive and malignant tumors). Potassium deficiency in the body has no specific clinical signs. Hypokalemia is accompanied by drowsiness, apathy, disorders of nervous and muscle excitability, decreased muscle strength and reflexes, hypotension of striated and smooth muscles (intestinal atony, Bladder etc.). It is important to assess the degree of decrease in potassium content in tissues and cells by determining its amount in the material obtained from muscle biopsy, determining the concentration of potassium in erythrocytes, and the level of its excretion in daily urine, because hypokalemia does not reflect the full extent of potassium deficiency in the body. Hypokalemia has relatively clear manifestations on the ECG (decrease in the Q-T interval, lengthening of the Q-T segment and T wave, flattening of the T wave).

Potassium deficiency is compensated by introducing potassium-rich foods into the diet: dried apricots, prunes, raisins, apricot, peach and cherry juice. If a potassium-enriched diet is insufficient, potassium is prescribed orally in the form of potassium chloride, panangin (asparkam), intravenous infusions of potassium preparations (in the absence of anuria or oliguria). With rapid loss of potassium, its replacement should be carried out at a rate close to the rate of removal of K + ions from the body. The main symptoms of potassium overdose: arterial bradycardia, increased and sharpened T wave on the ECG,. In these cases, the administration of potassium preparations is stopped and calcium preparations, a physiological potassium antagonist, diuretics, and fluids are prescribed.

Hyperkalemia develops when there is a violation of the excretion of potassium by the kidneys (for example, with anuria of any origin), severe hypercortisolism, after adrenalectomy, with traumatic injury, extensive damage to the skin and other tissues, massive hemolysis (including after massive blood transfusions), as well as with increased breakdown of proteins, for example, with hypoxia, ketoacidotic coma, with sugar, etc. Clinically, hyperkalemia, especially with its rapid development, which has great importance, manifests itself with a characteristic syndrome, although the severity individual signs depends on the genesis of hyperkalemia and the severity of the underlying disease. Drowsiness, confusion, pain in the muscles of the limbs and abdomen are noted, and pain in the tongue is characteristic. Flaccid muscles are observed, incl. intestinal smooth muscles, decreased blood pressure, bradycardia, cardiac conduction and rhythm disorders, muffled heart sounds. In the diastole phase, cardiac arrest may occur. Treatment of hyperkalemia consists of a diet limited in potassium-rich foods and intravenous sodium bicarbonate; shown intravenous administration 20% or 40% glucose solution with simultaneous administration of insulin and calcium supplements. Hemodialysis is most effective for hyperkalemia.

Violation of V.-s. O. plays an important role in acute radiation sickness. Under the influence of ionizing radiation, the content of Na + and K + ions in the nuclei of cells of the thymus and spleen decreases. A characteristic reaction of the body to exposure to large doses of ionizing radiation is the movement of water, Na + and Cl - ions from tissues into the lumen of the stomach and intestines. In acute radiation sickness, the excretion of potassium in the urine increases significantly, associated with the breakdown of radiosensitive tissues. With the development of gastrointestinal syndrome, a “leakage” of fluid and electrolytes occurs into the intestinal lumen, which is deprived of epithelial cover as a result of ionizing radiation. In the treatment of these patients, the entire range of measures aimed at restoring water and electrolyte balance is used.

Features of water-salt metabolism in children. Distinctive feature V.-s. O. in young children there is a greater release of water than in adults with exhaled air (in the form of water vapor) and through the skin (up to half of the total amount of water introduced into the child’s body). Water losses during breathing and evaporation from the surface of a child’s skin are 1.3 g/kg body weight in 1 h(in adults - 0.5 g/kg body weight in 1 h). The daily water requirement for a child of the first year of life is 100-165 ml/kg, which is 2-3 times higher than the water requirement of adults. Daily diuresis in a child aged 1 month. is 100-350 ml, 6 months - 250-500 ml, 1 year - 300-600 ml, 10 years - 1000-1300 ml.

Water requirements for children of different ages and teenagers

Body mass ( kg)	Daily water requirement
Body mass ( kg)		ml/kg body weight
0




0

In the first year of a child's life relative value his daily diuresis is 2-3 times higher than that of adults. In young children, so-called physiological hyperaldosteronism is noted, which is obviously one of the factors that determines the distribution of intracellular and extracellular fluid in the children's body (up to 40% of all water in young children is extracellular fluid, approximately 30% is intracellular , with the total relative water content in the child’s body being 65-70%; in adults, extracellular fluid accounts for 20%, intracellular fluid - 40-45%, with a total relative water content of 60-65%). The composition of electrolytes in extracellular fluid and blood plasma in children and adults does not differ significantly, only in newborns there is a slightly higher high content potassium ions in the blood plasma and a tendency to metabolic acidosis. Urine in newborns and children infancy may be almost completely devoid of electrolytes. In children under 5 years of age, urinary excretion of potassium usually exceeds sodium excretion; by about 5 years of age, the values of renal excretion of sodium and potassium become equal (about 3 mmol/kg body weight). In older children, sodium excretion exceeds potassium excretion: 2.3 and 1.8 mmol/kg body weight respectively.

With natural feeding, a child in the first six months of life required quantity receives water and salts from mother's milk, however, the growing need for minerals determines the need to introduce additional amounts of liquid and complementary foods already at the 4-5th month of life. When treating intoxication in infants, when a large amount of liquid is introduced into the body, there is a likely risk of developing water poisoning. Treatment of water intoxication in children is not fundamentally different from the treatment of water intoxication in adults.

System of regulation of V.-s. O. in children it is more labile than in adults, which can easily lead to its disturbances and significant fluctuations in the osmotic pressure of the extracellular fluid. Children react to limited drinking water or excessive salt intake with so-called salt fever. The hydrolability of tissues in children determines their tendency to develop a symptom complex of body dehydration (exicosis). Most severe disorders V.-s. O. in children they occur due to diseases of the gastrointestinal tract, neurotoxic syndrome, and pathology of the adrenal glands. In older children, V.-s. O. especially severely impaired in cases of x and circulatory failure.

Bibliography: Bogolyubov V.M. Pathogenesis and clinic of water-electrolyte disorders, L., 1968; Zilva J.F. and Pannell P.R. Clinical chemistry in diagnosis and treatment, trans. from English, p. 46, M., 1988; Laboratory methods of research in the clinic, ed. V.V. Menshikova, s. 261, 275, M., 1987; Natochin Yu.V. Fundamentals of kidney physiology, L., 1982.

Electrolytes play an important role in our water balance and metabolism. Especially during sports and during diarrhea, the body loses a lot of fluid and therefore electrolytes, which must be returned to it to avoid shortages. Find out what foods contain particles and what they cause here.

Staying hydrated is important to prevent electrolyte depletion.

The human body contains more than 60% water. Most of it is found in cells, such as in the blood. There, with the help of electrically charged molecules that are located in cellular fluids, important physiological processes are controlled. Here they play an important role sodium, potassium, chloride, magnesium and calcium. Because of their electrical charge and because they dissolve in intracellular fluid, they are called electrolytes, which means the same as “electric” and “soluble.”

Electrolytes are charged particles that regulate and coordinate important functions in the body. This only works if the fluid balance is correct.

How much water do we need to prevent electrolyte deficiency?

How much fluid a person should take daily is debated over and over again. The Nutrition Society recommends daily consumption at least 1.5 liters. In addition, there is another liter that we take with us on the road, as well as 350 milliliters (ml) of oxidative water, which is formed during the metabolism of food.

However, water in the body also returns to the environment:

150 ml via stool
550 ml through the lungs
550 ml sweat
1600 ml with urine

Excessive sweating, during sports or in the sauna, or diarrheal diseases, provide additional fluid loss. Of course, this must be compensated by increasing fluid intake.

Lack of electrolytes when playing sports?

With liquid, we also lose the minerals it contains, which play an important role in metabolism as electrolytes. To maintain full body functions, these minerals must be returned to the body. This is especially important for athletes, because these substances regulate muscles and nerve cells. - an all too familiar symptom. This is why many athletes resort to isotonic drinks.

What role do electrolytes play in diarrhea?

However big loss fluid loss occurs not only due to sweating, but also during diarrhea. The fluid in the colon is then barely removed from the chyme, a process by which a healthy person meets most of his fluid needs. The risk of diarrhea is high, especially among children, because they are 70 percent water.

Electrolyte losses must be compensated. One possibility is mineral-fortified drinks. Quick and easy electrolyte solution: Dissolve five teaspoons of glucose and half a teaspoon of table salt in half a liter of water.

What foods contain electrolytes?

There are electrolytes different forms in many foods and drinks:

Sodium and chloride

This duo is better known as table salt. Important: Too much may negatively affect your Recommended daily dose six grams should be increased with increased sweating, for example through exercise.

Magnesium

Magnesium can only be taken through effervescent tablets? Wrong! The mineral is present in almost all products. Vegetable juices often contain magnesium as food additives. But also in wholemeal products, nuts, legumes and fresh fruits are an energy mineral. often manifests itself in fatigue.

Potassium

Unlike sodium, potassium is barely lost through sweat. However, potassium should be supplemented in cases of severe fluid loss. Wheat bran are valuable, as well as legumes, dried fruits and nuts.

Sodium and potassium can hardly be separated from each other from a behavioral point of view. Both play important roles in fluid balance, control muscle contractions, and transmit nerve signals to muscles.

Calcium

The best known sources of calcium are dairy products, especially Parmesan. But lactose intolerant people and vegans can also meet their calcium needs with foods such as fortified soy drinks, fruit juices, bottled water, whole grains, almonds, sesame seeds and green vegetables.

Promotes calcium absorption. The ideal is a combination of fruits and/or vegetables. Calcium, combined with vitamin D, helps build and maintain our bones. Additionally, the mineral—just like magnesium—is important for muscle contraction.

Water and electrolyte balance. Acid-base state.

Claude Bernard in the second half of the 19th century. substantiated the concept of the internal environment of the body. Man and highly organized animals are in an external environment, but they also have their own internal environment, which washes all the cells of the body. Special physiological systems care is taken to ensure a constant volume and composition of internal fluids. C. Bernard also owns a statement that has become one of the postulates of modern physiology - “The constancy of the internal environment is the basis of a free life.” The constancy of the physicochemical conditions of the fluids of the internal environment of the body is, of course, the determining factor effective activities all organs and systems of the human body. In those clinical situations that resuscitators so often encounter, there is a constant need to take into account and use the capabilities of modern physiology and medicine to restore and maintain the basic physical and chemical parameters of blood plasma at a constant, standard level, i.e. indicators of the composition and volume of blood, and thereby other fluids of the internal environment.

The amount of water in the body and its distribution. The human body is mainly composed of water. Its relative content is highest in newborns - 75% total mass bodies. With age, it gradually decreases and is 65% at the end of growth, and in older people it is only 55%.

The water contained in the body is distributed among several fluid sectors. 60% of its total quantity is located in the cells (intracellular space); the rest is extracellular water in the intercellular space and blood plasma, as well as in the so-called transcellular fluid (in the spinal canal, chambers of the eye, gastrointestinal tract, exocrine glands, renal tubules and urinary ducts).

Water balance. Internal fluid exchange depends on the balance of its intake and release from the body at the same time. Typically, a person's daily fluid requirement does not exceed 2.5 liters. This volume consists of water included in food (about 1 liter), drink (about 1.5 liters) and oxidative water formed during the oxidation of mainly fats (0.3-0.4 liters). “Waste liquid” is excreted through the kidneys (1.5 l), by evaporation with sweat (0.6 l) and exhaled air (0.4 l), with feces (0, 1). Regulation of water and ion exchange is carried out by a complex of neuroendocrine reactions aimed at maintaining a constant volume and osmotic pressure of the extracellular sector and, above all, blood plasma. Both of these parameters are closely interrelated, but the mechanisms for their correction are relatively autonomous.

Water metabolism disorders. All disorders of water metabolism (dyshydria) can be combined into two forms: hyperhydration, characterized by excess fluid content in the body, and hypohydration (or dehydration), which consists of a decrease in the total volume of fluid.

Hypohydration. This form disturbances occur due to either a significant decrease in the flow of water into the body, or its excessive loss. An extreme degree of dehydration is called exicosis.

Isoosmolar hypohydration- a relatively rare variant of the disorder, which is based on a proportional decrease in the volume of fluid and electrolytes, usually in the extracellular sector. Usually this condition occurs immediately after acute blood loss, but does not last long and is eliminated due to the inclusion of compensatory mechanisms.

Hypoosmolar hypohydration- develops due to loss of fluid enriched with electrolytes. Some conditions that occur with certain pathologies of the kidneys (increased filtration and decreased fluid reabsorption), intestines (diarrhea), pituitary gland (ADH deficiency), adrenal glands (decreased aldosterone production) are accompanied by polyuria and hypoosmolar hypohydration.

Hyperosmolar hypohydration- develops due to the loss of fluid by the body, depleted of electrolytes. It can occur due to diarrhea, vomiting, polyuria, profuse sweating. Prolonged hypersalivation or polypnea can lead to hyperosmolar dehydration, since this results in the loss of fluid with a low salt content. Among the causes, diabetes mellitus should be especially noted. In conditions of hypoinsulinism, osmotic polyuria develops. However, blood glucose levels remain high. It is important that in this case the state of hypohydration can occur simultaneously in both the cellular and non-cellular sectors.

Overhydration. This form of disorder occurs due to either excess water entering the body or insufficient excretion. In some cases, these two factors operate simultaneously.

Isoosmolar hypohydration- can be reproduced by injecting an excess volume of saline solution, such as sodium chloride, into the body. The hyperhydria that develops in this case is temporary and is usually quickly eliminated (provided that the system for regulating water metabolism is functioning normally).

Hypoosmolar overhydration is formed simultaneously in the extracellular and cellular sectors, i.e. refers to other forms of dyshydria. Intracellular hypoosmolar hyperhydration is accompanied by severe disturbances in ionic and acid-base balance, membrane potentials cells. In case of water poisoning, nausea, repeated vomiting, and convulsions are observed, and coma may develop.

Hyperosmolar overhydration- may arise in case of forced use of sea water as drinking water. A rapid increase in the level of electrolytes in the extracellular space leads to acute hyperosmia, since the plasma membrane does not allow excess ions to pass into the cell. However, it cannot retain water, and some of the cellular water moves into the interstitial space. As a result, extracellular hyperhydration increases, although the degree of hyperosmia decreases. At the same time, tissue dehydration is observed. This type of disorder is accompanied by the development of the same symptoms as with hyperosmolar dehydration.

Edema. A typical pathological process, which is characterized by an increase in water content in the extravascular space. Its development is based on a violation of water exchange between blood plasma and perivascular fluid. Edema is a widespread form of impaired water metabolism in the body.

There are several main pathogenetic factors in the development of edema:

1. Hemodynamic. Edema occurs due to increased blood pressure in venous section capillaries. This reduces the amount of fluid reabsorption as it continues to be filtered.

2. Oncotic. Edema develops due to either a decrease in the oncotic pressure of the blood or an increase in it in the intercellular fluid. Blood hypotonia is most often caused by a decrease in the level of protein and mainly albumin.

Hypoproteinemia can result from:

a) insufficient intake of protein into the body;

b) disturbances in albumin synthesis;

c) excessive loss of blood plasma proteins in the urine in certain kidney diseases;

3. Osmotic. Edema can also occur due to a decrease in the osmotic pressure of the blood or an increase in it in the intercellular fluid. In principle, blood hypoosmia can occur, but the rapidly developing severe disorders of homeostasis “leave” no time for the development of its pronounced form. Hyperosmia of tissues, like their hyperonkia, is often limited in nature.

It may occur due to:

a) disturbances in the leaching of electrolytes and metabolites from tissues due to impaired microcirculation;

b) reducing the active transport of ions through cell membranes during tissue hypoxia;

c) massive “leakage” of ions from cells during their alteration;

d) increasing the degree of dissociation of salts during acidosis.

4. Membraneogenic. Edema is formed due to a significant increase in the permeability of the vascular wall.

In a few words we should discuss modern ideas about the principles of physiological regulation, in an extremely concise form, consider the issue of clinical significance some physical and chemical indicators of internal fluids. These include the osmolality of the blood plasma, the concentration of ions in it such as sodium, potassium, calcium, magnesium, a set of indicators of the acid-base state (pH), and finally the volume of blood and extracellular fluid. Conducted studies of blood serum from healthy individuals, subjects under extreme conditions and patients with various forms pathology showed that of all the physicochemical parameters studied, the three most strictly maintained and have the smallest coefficient of variation are osmolality, concentration of free calcium ions and pH. For osmolality, this value is 1.67%, for free Ca 2+ ions - 1.97%, while for K + ions - 6.67%. There is a simple and clear explanation for what has been said. The volume of each cell, and therefore the functional state of the cells of all organs and systems, depends on the osmolality of the blood plasma. The cell membrane is poorly permeable to most substances, so the volume of the cell will be determined by the osmolality of the extracellular fluid, the concentration of substances inside the cell in its cytoplasm, and the permeability of the membrane to water. All other things being equal, an increase in blood osmolality will lead to dehydration and cell shrinkage, and hypoosmia will cause cell swelling. It is hardly necessary to explain what adverse consequences for the patient both conditions can lead to.

The leading role in the regulation of blood plasma osmolality is played by the kidneys, the intestines and kidneys participate in maintaining the balance of calcium ions, and the bone also takes part in the homeostasis of calcium ions. In other words, the balance of Ca 2+ is determined by the ratio of intake and excretion, and the immediate maintenance of the required level of calcium concentration also depends on the internal depot of Ca 2+ in the body, which is the huge surface of the bone. The system for regulating osmolality and the concentration of various ions includes several elements - a sensor, a sensitive element, a receptor, an integrating apparatus (a center in the nervous system) and an effector - an organ that implements the response and ensures the restoration of normal values of this parameter.

Oda makes up approximately 60% of body weight healthy man(about 42 l with a body weight of 70 kg). IN female body the total amount of water is about 50%. Normal deviations from the average values within approximately 15%, in both directions. Children have a higher water content in the body than adults; gradually decreases with age.

Intracellular water makes up approximately 30-40% of body weight (about 28 liters in men with a body weight of 70 kg), being the main component of the intracellular space. Extracellular water makes up approximately 20% of body weight (about 14 L). Extracellular fluid consists of interstitial water, which also includes water of ligaments and cartilage (about 15-16% of body weight, or 10.5 l), plasma (about 4-5%, or 2.8 l) and lymph and transcellular water (0.5-1% of body weight), usually not actively participating in metabolic processes (cerebrospinal fluid, intra-articular fluid and the contents of the gastrointestinal tract).

Aqueous media of the body and osmolarity. Osmotic pressure solution can be expressed by the hydrostatic pressure that must be applied to a solution to keep it in volumetric equilibrium with a simple solvent when the solution and solvent are separated by a membrane permeable only to the solvent. Osmotic pressure is determined by the number of particles dissolved in water and does not depend on their mass, size and valence.

The osmolarity of a solution, expressed in milliosmoles (mOsm), can be determined by the number of millimoles (but not milliequivalents) of salts dissolved in 1 liter of water, plus the number of undissociated substances (glucose, urea) or weakly dissociated substances (protein). Osmolarity is determined using an osmometer.

The osmolarity of normal plasma is a fairly constant value and is equal to 285-295 mOsm. Of the total osmolarity, only 2 mOsm is due to proteins dissolved in the plasma. Thus, the main component of plasma, ensuring its osmolarity, is sodium and chlorine ions dissolved in it (about 140 and 100 mOsm, respectively).

It is believed that the intracellular and extracellular molar concentrations should be the same, despite qualitative differences in the ionic composition inside the cell and in the extracellular space.

In accordance with the International System (SI), the amount of substances in a solution is usually expressed in millimoles per 1 liter (mmol/l). The concept of “osmolarity”, adopted in foreign and domestic literature, is equivalent to the concept of “molarity”, or “molar concentration”. The units “meq” are used when they want to reflect the electrical relationships in a solution; The unit "mmol" is used to express molar concentration, i.e. total number particles in solution, regardless of whether they carry electric charge or neutral; The units "mOsm" are useful for showing the osmotic strength of a solution. Essentially, the concepts of “mOsm” and “mmol” for biological solutions are identical.

Electrolyte composition of the human body. Sodium is predominantly a cation in extracellular fluid. Chloride and bicarbonate are the anionic electrolyte group of the extracellular space. In the cellular space, the dominant cation is potassium, and the anionic group is represented by phosphates, sulfates, proteins, organic acids and, to a lesser extent, bicarbonates.

Anions found inside the cell are usually polyvalent and through cell membrane do not penetrate freely. The only cellular cation for which the cell membrane is permeable and which is present in the cell in a free state in sufficient quantities is potassium.

The predominant extracellular localization of sodium is due to its relatively low penetrating ability through the cell membrane and a special mechanism for displacing sodium from the cell - the so-called sodium pump. The chlorine anion is also an extracellular component, but its potential penetration through the cell membrane is relatively high; it is not realized mainly because the cell has a fairly constant composition of fixed cellular anions, creating a predominance of negative potential in it, displacing chlorides. Energy for the sodium pump is provided by the hydrolysis of adenosine triphosphate (ATP). The same energy promotes the movement of potassium into the cell.

Elements for monitoring water and electrolyte balance. Normally, a person should consume as much water as is necessary to compensate for its daily loss through the kidneys and extrarenal routes. The optimal daily diuresis is 1400-1600 ml. Under normal temperature conditions and normal air humidity, the body loses through the skin and Airways from 800 to 1000 ml of water are the so-called intangible losses. Thus, the total daily excretion of water (urine and perspiration losses) should be 2200-2600 ml. The body is able to partially cover its needs through the use of metabolic water formed in it, the volume of which is about 150-220 ml. A person’s normal balanced daily need for water is from 1000 to 2500 ml and depends on body weight, age, gender and other circumstances. In surgical and intensive care practice, there are three options for determining diuresis: collecting daily urine (in the absence of complications and in mild patients), determining diuresis every 8 hours (in patients receiving infusion therapy of any type during the day) and determining hourly diuresis (in patients with severe water-electrolyte balance disorder, those in shock and suspected renal failure). Satisfactory diuresis for a seriously ill patient, ensuring the electrolyte balance of the body and complete removal of waste, should be 60 ml/h (1500 ± 500 ml/day).

Oliguria is considered to be diuresis less than 25-30 ml/h (less than 500 ml/day). Currently, oliguria is divided into prerenal, renal and postrenal. The first occurs as a result of a block of renal vessels or inadequate blood circulation, the second is associated with parenchymal renal failure and the third with a violation of the outflow of urine from the kidneys.

Clinical signs of water imbalance. At frequent vomiting or diarrhea, significant fluid and electrolyte imbalance should be assumed. Thirst indicates that the patient has a reduced volume of water in the extracellular space relative to the salt content in it. A patient with true thirst is able to quickly eliminate water deficiency. A loss clean water possible in patients who cannot drink on their own (coma, etc.), as well as in patients who are sharply limited in drinking without appropriate intravenous compensation. Loss also occurs with profuse sweating (high temperature), diarrhea and osmotic diuresis ( high level glucose in diabetic coma, use of mannitol or urea).

Dryness in the armpits and groin areas is an important symptom of water loss and indicates that its deficiency in the body is at least 1500 ml.

A decrease in tissue and skin turgor is considered as an indicator of a decrease in the volume of interstitial fluid and the body’s need for the introduction of saline solutions (sodium requirement). The tongue under normal conditions has a single, more or less pronounced median longitudinal groove. With dehydration, additional grooves appear parallel to the median.

Body weight changing over time short periods time (for example, after 1-2 hours), is an indicator of changes in extracellular fluid. However, the data for determining body weight should be interpreted only in conjunction with other indicators.

Changes in blood pressure and pulse are observed only with a significant loss of water from the body and are most associated with changes in blood volume. Tachycardia - quite early sign decrease in blood volume.

Edema always reflects an increase in interstitial fluid volume and indicates that the total amount of sodium in the body is increased. However, edema is not always a highly sensitive indicator of sodium balance, since the distribution of water between the vascular and interstitial spaces is normally due to the high protein gradient between these environments. The appearance of a barely noticeable pressure pit in the area of the anterior surface of the leg with normal protein balance indicates that the body has an excess of at least 400 mmol of sodium, i.e., more than 2.5 liters of interstitial fluid.

Thirst, oliguria and hypernatremia are the main signs of water deficiency in the body.

Hypohydration is accompanied by a decrease in central venous pressure, which in some cases becomes negative. IN clinical practice Normal values of central venous pressure are considered to be 60-120 mm of water. Art. With water overload (overhydration), CVP indicators can significantly exceed these figures. However, excessive use of crystalloid solutions can sometimes be accompanied by water overload of the interstitial space (including interstitial pulmonary edema) without a significant increase in central venous pressure.

Loss of fluid and its pathological movement in the body. External losses of fluid and electrolytes can occur with polyuria, diarrhea, excessive sweating, as well as with profuse vomiting, through various surgical drains and fistulas, or from the surface of wounds and skin burns. Internal movement of fluid is possible with the development of edema in injured and infected areas, but it is mainly due to changes in the osmolarity of fluid media - accumulation of fluid in the pleural and abdominal cavities with pleurisy and peritonitis, blood loss in the tissue with extensive fractures, movement of plasma into injured tissue with crush syndrome , burns or wound area.

A special type of internal movement of fluid is the formation of so-called transcellular pools in the gastrointestinal tract (intestinal obstruction, intestinal infarction, severe postoperative paresis).

The area of the human body where fluid temporarily moves is usually called the “third space” (the first two spaces are the cellular and extracellular water sectors). Such fluid movement, as a rule, does not cause significant changes in body weight. Internal fluid sequestration develops within 36-48 hours after surgery or after the onset of the disease and coincides with the maximum metabolic and endocrine shifts in organism. Then the process begins to slowly regress.

Disorder of water and electrolyte balance. Dehydration. There are three main types of dehydration: water depletion, acute dehydration and chronic dehydration.

Dehydration due to primary loss of water (water exhaustion) occurs as a result of intense loss by the body of pure water or liquid with a low salt content, i.e. hypotonic, for example, with fever and shortness of breath, with prolonged artificial ventilation of the lungs through a tracheostomy without adequate humidification of the respiratory mixture , with profuse pathological sweating during fever, with elementary limitation of water intake in patients in coma and critical conditions, as well as as a result of the separation of large quantities of weakly concentrated urine in diabetes insipidus. Clinically characterized by severe general condition, oliguria (in the absence of diabetes insipidus), increasing hyperthermia, azotemia, disorientation, turning into coma, and sometimes convulsions. Thirst appears when water loss reaches 2% of body weight.

Laboratory tests reveal an increase in the concentration of electrolytes in the plasma and an increase in plasma osmolarity. Plasma sodium concentration rises to 160 mmol/l or more. Hematocrit also increases.

Treatment consists of administering water in the form of an isotonic (5%) glucose solution. In the treatment of all types of water and electrolyte balance disorders using various solutions they are administered only intravenously.

Acute dehydration as a result of loss of extracellular fluid occurs with acute pyloric obstruction, small bowel fistula, ulcerative colitis, as well as with high small intestinal obstruction and other conditions. All symptoms of dehydration, prostration and coma are observed, initial oliguria is replaced by anuria, hypotension progresses, and hypovolemic shock develops.

Laboratory tests determine signs of some blood thickening, especially in the later stages. Plasma volume decreases slightly, plasma protein content, hematocrit and, in some cases, plasma potassium content increase; more often, however, hypokalemia quickly develops. If the patient does not receive special infusion treatment, the sodium content in plasma remains normal. If you lose a large amount gastric juice(for example, with repeated vomiting) a decrease in plasma chloride levels is observed with a compensatory increase in bicarbonate content and the inevitable development of metabolic alkalosis.

Lost fluid must be replaced quickly. The basis of transfused solutions should be isotonic saline solutions. When there is a compensatory excess of HC0 3 in the plasma (alkalosis), an isotonic glucose solution with the addition of proteins (albumin or protein) is considered the ideal replacement solution. If the cause of dehydration was diarrhea or small intestinal fistula, then, obviously, the content of HCO 3 in the plasma will be low or close to normal and the fluid for replacement should consist of 2/3 of isotonic sodium chloride solution and 1/3 of 4.5% solution sodium bicarbonate. Add to the therapy the introduction of a 1% solution of CO, up to 8 g of potassium (only after restoration of diuresis) and an isotonic glucose solution of 500 ml every 6-8 hours.

Chronic dehydration with loss of electrolytes (chronic electrolyte deficiency) occurs as a result of the transition of acute dehydration with loss of electrolytes to chronic phase and is characterized by general dilutional hypotension of extracellular fluid and plasma. Clinically characterized by oliguria, general weakness, and sometimes increased body temperature. There is almost never thirst. Laboratory determined low content sodium in the blood with normal or slightly increased hematocrit. Plasma potassium and chloride levels tend to decrease, especially with prolonged loss of electrolytes and water, for example from the gastrointestinal tract.

Treatment using hypertonic sodium chloride solutions is aimed at eliminating the deficiency of extracellular fluid electrolytes, eliminating extracellular fluid hypotension, and restoring plasma and interstitial fluid osmolarity. Sodium bicarbonate is prescribed only for metabolic acidosis. After restoring plasma osmolarity, a 1% solution of KS1 is administered up to 2-5 g/day.

Extracellular salt hypertension due to salt overload occurs as a result of excessive introduction of salt or protein solutions into the body during water deficiency. It most often develops in patients with tube or tube feeding who are in an inadequate or unconscious state. Hemodynamics remain undisturbed for a long time, diuresis remains normal, in some cases moderate polyuria (hyperosmolarity) is possible. High blood sodium levels with sustained normal diuresis, decreased hematocrit, and increased crystalloid levels are observed. The relative density of urine is normal or slightly increased.

Treatment consists of limiting the amount of salt administered and administering additional water orally (if possible) or parenterally in the form of a 5% glucose solution while reducing the volume of tube or tube feeding.

Primary excess water (water intoxication) becomes possible with the erroneous introduction of excess amounts of water into the body (in the form of an isotonic glucose solution) under conditions of limited diuresis, as well as with excessive administration of water through the mouth or with repeated irrigation of the large intestine. Patients develop drowsiness, general weakness, decreased diuresis, and in later stages coma and convulsions occur. Hyponatremia and hypoosmolarity of plasma are determined in the laboratory, but natriuresis remains normal for a long time. It is generally accepted that when the sodium content decreases to 135 mmol/l in the plasma, there is a moderate excess of water relative to electrolytes. Main danger water intoxication - swelling and edema of the brain and subsequent hypoosmolar coma.

Treatment begins with complete cessation of water therapy. In case of water intoxication without a deficiency of total sodium in the body, forced diuresis is prescribed with the help of saluretics. In the absence of pulmonary edema and normal central venous pressure, a 3% NaCl solution is administered up to 300 ml.

Pathology of electrolyte metabolism. Hyponatremia (plasma sodium content below 135 mmol/l). 1. Severe diseases that occur with delayed diuresis (cancer processes, chronic infection, decompensated heart defects with ascites and edema, liver disease, chronic starvation).

2. Post-traumatic and postoperative conditions(trauma of the bone skeleton and soft tissues, burns, postoperative sequestration of fluids).

3. Non-renal sodium loss (repeated vomiting, diarrhea, formation of a “third space” in acute intestinal obstruction, small intestinal fistulas, profuse sweating).

4. Uncontrolled use of diuretics.

Since hyponatremia is almost always a condition secondary to the main pathological process, there is no clear treatment for it. Hyponatremia caused by diarrhea, repeated vomiting, enteric fistula, acute intestinal obstruction, postoperative fluid sequestration, as well as forced diuresis, should be treated using sodium-containing solutions and, in particular, isotonic sodium chloride solution; in case of hyponatremia, which has developed in conditions of decompensated heart disease, the introduction of additional sodium into the body is inappropriate.

Hypernatremia (plasma sodium content above 150 mmol/l). 1. Dehydration due to water depletion. An excess of every 3 mmol/L sodium in plasma over 145 mmol/L means a deficiency of 1 L of extracellular water K.

2. Salt overload of the body.

3. Diabetes insipidus.

Hypokalemia (potassium content below 3.5 mmol/l).

1. Loss of gastrointestinal fluid followed by metabolic alkalosis. Concomitant loss of chlorides worsens metabolic alkalosis.

2. Long-term treatment osmotic diuretics or saluretics (mannitol, urea, furosemide).

3. Stressful conditions with increased adrenal activity.

4. Limitation of potassium intake in the postoperative and post-traumatic periods in combination with sodium retention in the body (iatrogenic hypokalemia).

For hypokalemia, a potassium chloride solution is administered, the concentration of which should not exceed 40 mmol/l. 1 g of potassium chloride, from which a solution for intravenous administration is prepared, contains 13.6 mmol of potassium. Daily allowance therapeutic dose- 60-120 mmol; Large doses are also used according to indications.

Hyperkalemia (potassium content above 5.5 mmol/l).

1. Acute or chronic renal failure.

2. Acute dehydration.

3. Extensive injuries, burns or major operations.

4. Severe metabolic acidosis and shock.

A potassium level of 7 mmol/l poses a serious threat to the patient’s life due to the risk of cardiac arrest due to hyperkalemia.

In case of hyperkalemia, the following sequence of measures is possible and advisable.

1. Lasix IV (from 240 to 1000 mg). A daily diuresis of 1 liter is considered satisfactory (with normal relative density of urine).

2. 10% intravenous glucose solution (about 1 l) with insulin (1 unit per 4 g of glucose).

3. To eliminate acidosis - about 40-50 mmol of sodium bicarbonate (about 3.5 g) in 200 ml of 5% glucose solution; if there is no effect, another 100 mmol is administered.

4. IV calcium gluconate to reduce the effect of hyperkalemia on the heart.

5. If there is no effect from conservative measures hemodialysis is indicated.

Hypercalcemia (plasma calcium level greater than 11 mg%, or greater than 2.75 mmol/L, on multiple studies) usually occurs with hyperparathyroidism or when cancer has metastasized to bone. Special treatment.

Hypocalcemia (plasma calcium level below 8.5%, or less than 2.1 mmol/l), observed with hypoparathyroidism, hypoproteinemia, acute and chronic renal failure, with hypoxic acidosis, acute pancreatitis, as well as with magnesium deficiency in the body. Treatment is intravenous administration of calcium supplements.

Hypochloremia (plasma chlorides below 98 mmol/l).

1. Plasmodilution with an increase in the volume of extracellular space, accompanied by hyponatremia in patients with severe diseases, with water retention in the body. In some cases, hemodialysis with ultrafiltration is indicated.

2. Loss of chlorides through the stomach with repeated vomiting, as well as with intense loss of salts at other levels without adequate compensation. Usually combined with hyponatremia and hypokalemia. Treatment is the introduction of chlorine-containing salts, mainly KCl.

3. Uncontrolled diuretic therapy. Combined with hyponatremia. Treatment is cessation of diuretic therapy and salt replacement.

4. Hypokalemic metabolic alkalosis. Treatment is intravenous administration of KCl solutions.

Hyperchloremia (plasma chlorides above 110 mmol/l) is observed with water depletion, diabetes insipidus and brainstem damage (combined with hypernatremia), as well as after ureterosigmostomy due to increased reabsorption of chlorine in the colon. Special treatment.