Human electrolyte balance and predicting the consequences of its violation. 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, there will be serious problems. Along with the loss of fluid, a person also loses useful salts, so it is important to maintain their amount in the norm, making up for the deficiency through or special medicines.

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, among which is the transmission of nerve impulses. In addition, they perform the following functions:

maintain water-salt balance
regulate important body systems

Each electrolyte performs its function. There are the following types:

magnesium
sodium

There are norms for the content of electrolytes in the blood. If there is a lack or excess of substances, problems arise with the body. The salts influence each other, thereby creating a 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 in the work of the heart muscle and brain. Sodium helps the body's muscles respond to nerve impulses and do their job. The normal amount of chlorine in the body helps the digestive system to 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 content in the body. Lack or excess of one of the substances leads to serious pathologies that lead to health problems in the future.

Electrolytes are strongly lost along with the liquid. If a person, he must keep in mind that it will be necessary to replenish not only water, but also salt. There are special drinks that restore the water and electrolyte balance in the human body. They are used to avoid dangerous pathologies due to the loss of a large amount of salts and fluids.

Symptoms of pathology

If there is a deficiency or excess of electrolytes, then this will necessarily affect human health. Arise various symptoms which must be paid attention to. Deficiency occurs due to a large loss of fluids, disease and malnutrition. An excess of substances occurs due to the use of foods that contain salts in large quantities ah, as well as with lesions of certain 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. With its help, the amount of salts that affect the water and electrolyte balance in the body at the time of blood donation is determined.

natural loss

A person daily loses a percentage of electrolytes along with sweat. The loss process is the norm. If a person goes in for sports, he loses much more of the necessary substances. It is desirable 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. With severe physical activity use special water enriched with the main electrolytes: potassium, magnesium and chlorine.

It is also desirable, which is rich in one element or another. It should be understood that you need to act this way only when playing sports or similar activities. Just because you do not need to increase the intake of food containing magnesium, chlorine or potassium.

What happens when you lose?

Loss of electrolytes naturally arises general weakness and a decrease in performance. It is very difficult to bring the body to complete exhaustion, so there are no dangerous pathologies. 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 the 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 doctor, performs large volumes of exhausting workouts without consequences. If, when playing sports, the main goal of a person is to maintain health, he must follow the principle - do not train in failure.

An ordinary person should also strive to maintain an ideal water and electrolyte balance. In this state, each organ works efficiently and without wear and tear. When each element is found, 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 the deficit

There are two options for obtaining salts: naturally and with the help of medicines. To do this naturally, you will need to significantly increase the consumption 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 a diet it is necessary to take an analysis of electrolytes in the blood. Thus, it becomes clear how to proceed further.

If there is one or another element, assigned special medicines. Pharmacies have drugs with all the necessary elements in a convenient form. They are used in severe deficit or if you do not want to keep a specialized diet. Eliminating 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 food, but there is a list of foods in which their amount rolls over. They will need to be used to eliminate the deficiency of potassium, magnesium, sodium, calcium or chlorine. It is important to cook them properly or consume them raw (if possible) to get the most nutrients:

Bean plants. The necessary substances are found in many legumes. People single out white beans as the most electrolyte-rich food among legumes. They contain large amounts of potassium.
Simple beet. Beets have sodium, which contributes to the functioning of human organs.
Nutritious nuts. Sunflower seeds also have magnesium, which contributes to the work of the heart. 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 opt for other products. To understand what exactly to pay attention to, you need to visit a doctor and undergo an examination. The doctor will make a diet taking into account individual features organism. If necessary, he will appoint special preparations, which will get rid of a strong deficit.

Medicines

Severe deficiency requires specialized therapy. The lack of electrolytes manifests itself most different symptoms. It is extremely rare that a cut of all elements is not enough, therefore, after passing the diagnosis, a specific medicine is prescribed to a person.

Pharmacies have enough various additives, so the choice will not be a problem. It is not necessary to independently assign the reception of one or another element. In addition to the salts themselves, drugs can be prescribed that contribute to better accumulation and use. Such drugs normalize the electrolyte balance. The most common supplement is considered simple magnesium. Asparkam is also often prescribed, which contains magnesium and potassium.

Drugs for treatment are available without a prescription, but it is not recommended to prescribe them yourself. Often they are 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 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 an overabundance of one or another healthy salt in organism. It is advisable to undergo examinations in order to understand the state of the water-electrolyte balance. Monitoring this indicator is as important as a blood test or any organ.

A deficit or surplus is due to wrong image life or disease progression. All body systems are closely related to each other. If one part fails, it affects the work of another. This means that the lack or excess of one or another element is sometimes a symptom of a dangerous disease. The therapist prescribes a detailed examination if a serious non-compliance with the norms is found.

Water-salt exchange- a set of processes for the entry of water and salts (electrolytes) into the body, their absorption, distribution in internal environments and excretion. The daily human consumption of water is about 2.5 l, of which about 1 l he gets from food. In the human body, 2/3 of the total amount of water is in the intracellular fluid and 1/3 in the extracellular fluid. 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, it is an interstitial (interstitial), or tissue, fluid (about 15% of body weight). In addition, a distinction is made between free water, 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 proportions 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.

Systems of regulation V. - page. O. ensure the maintenance total concentration electrolytes (sodium, potassium, calcium, magnesium) and the ionic composition of the 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 interstitial 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. Exact regulation of V. - page. O. in a healthy person, it allows maintaining not only a constant composition, but also a constant volume of body fluids, maintaining almost the same concentration osmotically active substances And acid-base balance.

V.'s regulation - page. O. carried out with the participation of several physiological systems. Signals coming from special inaccurate 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 excretion of water and salts from the body and their consumption by the body changes accordingly. So, 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. An increase in 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. The pathological hydremia is a consequence of V.'s disturbance - page. o., for example, with 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 hormones. In V.'s regulation - page. O. physiologically active substances produced in the kidney are also involved - derivatives of vitamin D 3, renin, kinins, etc.

The content of sodium in the body is regulated mainly by the kidneys under the control of central nervous system. through specific natrioreceptors. responding to changes in the sodium content in body fluids, as well as volumoreceptors and osmoreceptors, responding to changes in the volume of circulating fluid and the osmotic pressure of the extracellular fluid, respectively. The sodium balance in the body is also controlled by the renin-angiotensin system, aldosterone, and natriuretic factors. With a decrease in the water content in the body and an increase in the osmotic pressure of the blood, the secretion of vasopressin (antidiuretic hormone) increases, which causes an increase in the reabsorption of water in renal tubules. An increase in sodium retention by the kidneys causes aldosterone (see. adrenal glands ), and increased sodium excretion - natriuretic hormones, or natriuretic factors. These include atriopeptides synthesized in the atria and have a diuretic, natriuretic effect, as well as some prostaglandins , an 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. Membrane resting 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 inaccurate 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 membrane potential and excitability of the nervous and muscle tissue. The participation of potassium in maintaining the acid-base balance in the body is based on competitive interactions between the ions K + and Na +, as well as K + and H +. An increase in the protein content in the cell is accompanied by an increased consumption of K + ions by it. The regulation of potassium metabolism in the body is carried out by the central nervous system. with the participation of a number of hormones. Corticosteroids, in particular aldosterone, and insulin play an important role in potassium metabolism.

With a deficiency of potassium in the body, cells suffer, and then comes hypokalemia. In case of impaired renal function, hyperkalemia may develop, accompanied by a severe disorder of cell functions and acid-base balance. Often, hyperkalemia is combined with hypocalcemia, hypermagnesemia and hyperazotemia.

V.'s condition - page. O. V to a large extent determines the content of Cl - ions in the extracellular fluid. Chlorine ions are excreted from the body mainly with urine. The amount of excreted sodium chloride depends on the diet, active reabsorption of sodium, the state of the tubular apparatus of the kidneys, 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 chloride ions from the body. Some saluretic diuretics inhibit sodium reabsorption in the renal tubules and cause a significant increase in urinary chloride excretion. Many diseases are accompanied by a loss of chlorine. If its concentration in the blood serum drops sharply (with cholera, acute intestinal obstruction, etc.), the prognosis of the disease worsens. Hyperchloremia is observed with excessive consumption of salt, acute e, urinary tract obstruction, chronic circulatory failure, hypothalamic-pituitary insufficiency, prolonged hyperventilation of the lungs, etc.

The exchange of calcium, magnesium, etc. - see. Mineral exchange.

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 introduced into the blood (for example, Evans blue dye or labeled 131 I albumin). Knowing the amount of the substance introduced into the bloodstream, and after determining its concentration in the blood after a while, the volume of circulating fluid is calculated. The content of the extracellular fluid is determined using substances that do not penetrate into the 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 (THO), or antipyrine. Water containing tritium or deuterium mixes evenly with all the water contained in the body. Volume of intracellular water is equal to the difference between the total volume of water and the volume of extracellular fluid.

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

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 indomitable vomiting, profuse diarrhea, intestinal obstruction, e, e, and through the skin with increased sweating (at high air temperature, 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 done 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. The most common loss of sodium 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, followed by a 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.

Kidneys are capable to excrete more sodium, than it is necessary for V.'s constancy maintenance - pages. o., in violation of the mechanisms of regulation of sodium reabsorption in the renal tubules or in the inhibition of sodium transport into the cells of the renal tubules. 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 the introduction of diuretics. When kidney function is impaired (for example, in chronic renal failure), the loss of sodium by the body occurs 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 is overheated or in 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 starvation - with insufficient water supply to patients who are in an unconscious state and receiving forced nutrition, in violation of swallowing, and in infants- with insufficient consumption of milk and water. 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.

Restoration of the amount of water and isotonicity of the fluid in case of pathological dehydration of the body is achieved by drinking large amounts of water or by intravenous administration of an isotonic solution of sodium chloride and glucose. Loss of water and sodium with increased sweating is compensated by drinking salted (0.5% sodium chloride solution) water.

Excess water and electrolytes manifest as edema. The main reasons for their occurrence include an excess of sodium in the intravascular and interstitial spaces, more often with kidney disease, chronic liver failure, increased permeability of the vascular walls. In heart failure, excess sodium in the body may exceed excess water. Disturbed water and electrolyte balance is restored by sodium restriction in the diet and the appointment of natriuretic diuretics.

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

At water poisoning hyponatremia, hypokalemia develops, the volume of extracellular fluid increases. Clinically, this is manifested by nausea and vomiting, aggravated after drinking fresh water, and vomiting does not bring relief; Visible mucous membranes in patients are excessively 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 a hypertonic sodium chloride solution and a sharp restriction of water intake.

Potassium deficiency is mainly the result of its insufficient intake with food and loss during 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 associated to a large extent with the hypochloremia developing in these diseases, in which the total amount of potassium excreted in the urine increases sharply. Significant quantities potassium is lost by patients suffering from repeated bleeding of any etiology. Potassium deficiency occurs in patients treated for a long time with corticosteroids, cardiac glycosides, diuretics and laxatives. Losses of potassium are great during operations on the stomach and small intestine. IN postoperative period hypokalemia is more often noted with the infusion of isotonic sodium chloride solution, tk. Na + ions are antagonists of K + ions. The output of K + ions from cells into the extracellular fluid increases sharply, followed by their excretion through the kidneys with increased protein breakdown; a significant potassium deficiency develops in diseases and pathological conditions accompanied by a violation of 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 the content of potassium in tissues and cells by determining its amount in the material obtained from a muscle biopsy, determining the concentration of potassium in erythrocytes, the level of its excretion with daily urine, because. hypokalemia does not reflect the full degree 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 the 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. In case of insufficiency of a potassium-enriched diet, 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 a rapid loss of potassium, its replacement should be carried out at a pace close to the rate of excretion of K + ions from the body. The main symptoms of a potassium overdose: arterial on the background of bradycardia, an increase and sharpening of the T wave on the ECG,. In these cases, the introduction of potassium preparations is stopped and calcium preparations are prescribed - a physiological potassium antagonist, diuretics, liquid.

Hyperkalemia develops when there is a violation of potassium excretion by the kidneys (for example, with anuria of any genesis), severe hypercortisolism, after adrenalectomy, with traumatic e, extensive skin and other tissues, massive hemolysis (including after massive blood transfusions), as well as with increased protein breakdown, for example, during hypoxia, ketoacidotic coma, with sugar e, etc. Clinically, hyperkalemia, especially with its rapid development, which has great importance, is manifested by a characteristic syndrome, although the severity individual features depends on the genesis of hyperkalemia and the severity of the underlying disease. There are drowsiness, confusion, pain in the muscles of the limbs, abdomen, pain in the tongue is characteristic. Observe flaccid muscle and, incl. smooth muscles of the intestine, decreased blood pressure, bradycardia, conduction and heart rhythm disorders, heart sounds are muffled. In the phase of diastole, cardiac arrest may occur. Treatment for hyperkalemia consists of a potassium-restricted diet and intravenous sodium bicarbonate; shown intravenous administration 20% or 40% glucose solution with simultaneous administration of insulin and calcium preparations. The most effective treatment for hyperkalemia is hemodialysis.

V.'s violation - page. O. plays a big role in e acute radiation sickness. Under the influence of ionizing radiation, the content of Na + and K + ions in the nuclei of the cells of the thymus and spleen decreases. A characteristic reaction of the body to the impact of high doses of ionizing radiation is the movement of water, Na + and Cl - ions from the tissues into the lumen of the stomach and intestines. In acute radiation sickness, potassium excretion in the urine increases significantly, due to the decay of radiosensitive tissues. With the development of the gastrointestinal syndrome, there is a "leakage" of fluid and electrolytes into the intestinal lumen, which is deprived of the epithelial cover as a result of the action of ionizing radiation. In the treatment of these patients, the whole complex of measures aimed at restoring the water and electrolyte balance is used.

Features of water-salt metabolism in children. Distinctive feature V.-s. O. in young children, there is more than in adults, the release of water 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). The loss of water during breathing and evaporation from the surface of the child's skin is 1.3 g/kg body weight in 1 h(in adults - 0.5 g/kg body weight in 1 h). The daily need for water in a child of the first year of life is 100-165 ml/kg, which is 2-3 times higher than the need for water in 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.

The need for water in children 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 its daily diuresis is 2-3 times higher than in adults. In young children, the so-called physiological hyperaldosteronism is noted, which is obviously one of the factors that determine the distribution of intracellular and extracellular fluid in the child's body (up to 40% of all water in young children falls on the extracellular fluid, approximately 30% - on the intracellular , with a total relative water content in the body of a child of 65-70%; in adults, extracellular fluid accounts for 20%, intracellular - 40-45% with a total relative water content of 60-65%). The composition of electrolytes in the extracellular fluid and blood plasma in children and adults does not differ significantly, only in newborns there is a slightly more 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 are equalized (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 of the first six months of life right amount receives water and salts with mother's milk, however, the growing need for minerals determines the need for the introduction of additional amounts of liquid and complementary foods already at the 4-5th month of life. In the treatment of intoxication in infants, when a large amount of liquid is introduced into the body, the risk of developing water poisoning is likely. The treatment of water intoxication in children is not fundamentally different from the treatment of water intoxication in adults.

V.'s regulation system - page. 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 the restriction of water for drinking or the excessive introduction of salts with the so-called salt fever. The hydrolability of tissues in children causes their tendency to develop a symptom complex of dehydration of the body (exicosis). Most severe disorders V.-s. O. in children occur with diseases of the gastrointestinal tract, neurotoxic syndrome, pathology of the adrenal glands. At children of advanced age V. - page. O. it is especially strongly broken at x and a circulatory insufficiency.

Bibliography: Bogolyubov V.M. Pathogenesis and clinic of water and 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 research methods in the clinic, ed. V.V. Menshikov, p. 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 in order to avoid shortages. Find out which foods contain particles and what they cause here.

A balanced water balance is important to prevent electrolyte depletion.

The human body contains over 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 an important role is played sodium, potassium, chloride, magnesium and calcium. Because of their electrical charge and because they dissolve in the 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 discussed over and over again. The Nutrition Society recommends daily consumption at least 1.5 liters. In addition, one more liter that we take with us on the road, as well as 350 milliliters (ml) of oxidative water that is formed during the metabolism of food.

However, water in the body is also returned to the environment:

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

Excessive sweating, while playing sports or in the sauna, or diarrheal diseases, provide additional fluid loss. Of course, this should be compensated by an increase in fluid intake.

The lack of electrolyte during sports?

With fluid, we also lose the minerals it contains, which play an important role in metabolism as electrolytes. To maintain all bodily functions, these minerals must be returned to the body. This is especially important for athletes, because these substances regulate muscles and nerve cells. is 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 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 covers most of their fluid needs. The risk of diarrhea is high, especially among children, because they make up 70 percent of the water.

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

What foods contain electrolytes?

Electrolytes are different forms in many foods and drinks:

sodium and chloride

This duo is better known as table salt. Important: Too much can negatively affect your Featured daily dose at six grams should be increased by increasing perspiration, 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 additive. But also in wholemeal foods, nuts, legumes, and fresh fruits are an energy mineral. often manifested in fatigue.

Potassium

Unlike sodium, potassium is barely lost through sweat. However, potassium should be supplemented for 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 in terms of behavior. Both play an important role in fluid balance, control muscle contractions, and transmit nerve signals to the muscles.

Calcium

Dairy products, especially parmesan, are the best-known sources of calcium. 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 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. In addition, the mineral - just like magnesium - is important for muscle contraction.

Water-electrolyte balance. Acid-alkaline 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 the external environment, but they also have their own internal environment, which washes all the cells of the body. Special physiological systems monitor to ensure the constancy of the volume and composition of the liquids of the internal environment. K. Bernard also owns the statement, which 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 liquids of the internal environment of the body is, of course, the determining factor efficient operation all organs and systems of the human body. In those clinical situations that are so often encountered by resuscitators, there is a constant need to take into account and use the possibilities of modern physiology and medicine to restore and maintain the basic physicochemical parameters of blood plasma at a constant, standard level, i.e. indicators of the composition and volume of blood, and thus other fluids of the internal environment.

The amount of water in the body and its distribution. The human body is mainly made up of water. Its relative content is highest in newborns - 75% total weight body. With age, it gradually decreases and amounts to 65% during the completion of growth, and in the elderly - only 55%.

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

Water balance. The internal exchange of fluid depends on the balance of its intake and excretion from the body at the same time. Typically, a person's daily fluid requirement does not exceed 2.5 liters. This volume is made up of water that is part of food (about 1 l), drink (about 1.5 l) and oxidation water, which is formed during the oxidation of mainly fats (0.3-0.4 l.). "Waste fluid" 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). The regulation of water and ion exchange is carried out by a complex of neuroendocrine reactions aimed at maintaining the constancy of the 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 in the body, and hypohydration (or dehydration), which consists in a decrease in the total volume of fluid.

Hypohydration. This form violations occur due to either a significant decrease in the intake of water in the body, or its excessive loss. The extreme degree of dehydration is called exsicosis.

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

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

Hyperosmolar hypohydration- develops due to the loss of body fluid, depleted in electrolytes. It can occur due to diarrhea, vomiting, polyuria, profuse sweating. Prolonged hypersalivation or polypnea can lead to hyperosmolar dehydration, as fluid with a low salt content is lost. Among the causes, diabetes mellitus should be especially noted. Under 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 immediately in both the cellular and non-cellular sectors.

Hyperhydration. This form of violation occurs due to either excessive intake of water in the body, or insufficient excretion. In some cases, these two factors act simultaneously.

Isoosmolar hypohydration- can be reproduced by introducing into the body an excess volume of saline, such as sodium chloride. The hyperhydria that develops in this case is temporary and is usually quickly eliminated (provided that the system of regulation of water metabolism is working 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 gross violations of the ionic and acid-base balance, membrane potentials cells. With water poisoning, nausea, repeated vomiting, convulsions, coma may develop.

Hyperosmolar overhydration- may occur 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 plasmalemma does not let excess ions 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 in hyperosmolar dehydration.

Edema. A typical pathological process, which is characterized by an increase in the water content in the extravascular space. Its development is based on a violation of the exchange of water between blood plasma and perivascular fluid. Edema is a widespread form of water metabolism disorders 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 department capillaries. This reduces the amount of fluid reabsorption while continuing to filter it.

2. Oncotic. Edema develops as a result of either a decrease in oncotic pressure of the blood, or its increase in the interstitial fluid. Hypoonkia of the blood is most often due to a decrease in the level of protein and mainly albumin.

Hypoproteinemia can result from:

a) insufficient intake of protein in the body;

b) violations of 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 its increase in the interstitial fluid. Fundamentally, hypoosmia of the blood can occur, but severe homeostasis disorders that quickly form in this case “leave no time” for the development of its pronounced form. Hyperosmia of tissues, as well as their hyperonkia, is often limited.

It may occur due to:

a) impaired leaching of electrolytes and metabolites from tissues in violation of 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) increase in the degree of dissociation of salts in acidosis.

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

In a few words to 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 liquids of the internal environment. These include the osmolality of blood plasma, the concentration in it of such ions as sodium, potassium, calcium, magnesium, a complex of indicators of the acid-base state (pH), and finally the volume of blood and extracellular fluid. Conducted studies of blood serum of healthy individuals, subjects under extreme conditions and patients with various forms pathologies showed that of all the studied physicochemical parameters, the most strictly maintained, have the lowest coefficient of variation, three - 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%. What has been said can find a simple and clear explanation. The volume of each cell, and therefore the functional state of the cells of all organs and systems, depends on the osmolality of 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 inside the cell of substances in its cytoplasm, and the permeability of the membrane to water. Ceteris paribus, an increase in blood osmolality will lead to dehydration, cell shrinkage, and hypoosmia will cause cell swelling. It is hardly necessary to explain to what adverse consequences for the patient both conditions can lead.

The kidneys play the leading role in the regulation of blood plasma osmolality, 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 momentary maintenance of the required level of calcium concentration also depends on the internal depot of Ca 2+ in the body, which is a huge bone surface. The system of regulation of osmolality, 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.

Water makes up about 60% of body weight healthy man(about 42 liters with a body weight of 70 kg). IN female body the total amount of water is about 50%. Normal deviations from the average values approximately within 15%, in both directions. In children, the water content in the body is higher than in 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 liters). The extracellular fluid consists of interstitial water, which also includes ligament and cartilage water (about 15-16% of body weight, or 10.5 liters), plasma (about 4-5%, or 2.8 liters) and lymph and transcellular water (0.5-1% of body weight), usually not actively involved in metabolic processes (cerebrospinal fluid, intraarticular fluid and the contents of the gastrointestinal tract).

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

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, providing its osmolarity, are sodium and chloride 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 the 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 meq units are used when they want to reflect the electrical relationships in a solution; the unit "mmol" is used to express the molar concentration, i.e. total number particles in solution, whether or not they carry electric charge or neutral; mOsm units are convenient for showing the osmotic strength of a solution. Essentially, the concepts of "mOsm" and "mmol" for biological solutions are identical.

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

The anions inside the cell are usually polyvalent and through cell membrane do not enter 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 quantity 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 chloride anion is also an extracellular component, but its potential penetrating ability through the cell membrane is relatively high, it is not realized mainly because the cell has a fairly constant composition of fixed cellular anions, which create a predominance of negative potential in it, displacing chlorides. The energy of the sodium pump is provided by the hydrolysis of adenosine triphosphate (ATP). The same energy promotes the movement of potassium into the cell.

Control elements of 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 is the so-called imperceptible loss. Thus, the total daily water excretion (urine and perspiration loss) 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. The normal balanced daily human need for water is from 1000 to 2500 ml and depends on body weight, age, gender and other circumstances. In surgical and resuscitation practice, there are three options for determining diuresis: collection of daily urine (in the absence of complications and in mild patients), determination of diuresis every 8 hours (in patients receiving infusion therapy of any type during the day) and determination of hourly diuresis (in patients with severe disorder of water and electrolyte balance, in shock and suspected renal failure). Satisfactory diuresis for a seriously ill patient, which ensures the electrolyte balance of the body and the complete removal of toxins, should be 60 ml / h (1500 ± 500 ml / day).

Oliguria is considered diuresis less than 25-30 ml / h (less than 500 ml / day). Currently, prerenal, renal and postrenal oliguria are distinguished. The first occurs as a result of blockage of the 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 balance disorders. At frequent vomiting or diarrhea should suggest a significant water-electrolyte imbalance. Thirst indicates that the patient's volume of water in the extracellular space is reduced relative to the content of salts in it. A patient with true thirst is able to quickly eliminate the lack of water. A loss pure water possible in patients who cannot drink on their own (coma, etc.), as well as in patients who are severely restricted from drinking without appropriate intravenous compensation Loss also occurs with profuse sweating (high temperature), diarrhea and osmotic diuresis ( high level glucose in diabetic coma, the use of mannitol or urea).

Dryness in the axillary 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 (need for sodium). The tongue under normal conditions has a single more or less pronounced median longitudinal groove. With dehydration, additional furrows appear, parallel to the median.

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

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

Edema always reflects an increase in the volume of interstitial fluid 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 a high protein gradient between these media. The appearance of a barely noticeable pressure pit in the region of the anterior surface of the lower leg with a normal protein balance indicates that there is an excess of at least 400 mmol sodium in the body, 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 CVP, which in some cases becomes negative. IN clinical practice it is customary to consider 60-120 mm of water as normal figures for the CVP. Art. With water overload (hyperhydration), CVP indicators can significantly exceed these figures. However, excessive use of crystalloid solutions can sometimes be accompanied by fluid overload of the interstitial space (including interstitial pulmonary edema) without a significant increase in CVP.

Loss of fluid and its pathological movement in the body. External fluid and electrolyte losses 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 a change in the osmolarity of fluid media - accumulation of fluid in the pleural and abdominal cavities with pleurisy and peritonitis, blood loss in tissues with extensive fractures, and plasma movement into injured tissues with crush syndrome , burns, or to the area of a wound.

A special type of internal fluid movement 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 the liquid temporarily moves is commonly called the "third space" (the first two spaces are the cellular and extracellular water sectors). Such movement of fluid, 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 depletion) occurs as a result of an intensive loss 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 an elementary restriction of water intake in patients in a 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 a coma, sometimes convulsions. Thirst appears when water loss reaches 2% of body weight.

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

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

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

Laboratory determine the signs of some thickening of the blood, 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 develops rapidly. If the patient does not receive special infusion treatment, the sodium content in the plasma remains normal. With the loss of a large number gastric juice(for example, with repeated vomiting), a decrease in the level of plasma chlorides is observed with a compensatory increase in the content of bicarbonate and the inevitable development of metabolic alkalosis.

Lost fluid must be replaced quickly. The basis of transfused solutions should be isotonic saline solutions. With a compensatory excess of HCO 3 in plasma (alkalosis), an isotonic glucose solution with the addition of proteins (albumin or protein) is considered an ideal replacement solution. If the cause of dehydration was diarrhea or small bowel fistula, then, obviously, the content of HCO 3 in plasma will be low or close to normal and the replacement fluid should consist of 2/3 of isotonic sodium chloride solution and 1/3 of 4.5% solution sodium bicarbonate. To the ongoing therapy, the introduction of a 1% solution of KO is added, up to 8 g of potassium is administered (only after the restoration of diuresis) and isotonic glucose solution, 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 in chronic phase and is characterized by a general dilutional hypotension of the extracellular fluid and plasma. Clinically characterized by oliguria, general weakness, sometimes fever. Thirst is almost never there. Laboratory determined low content sodium in the blood with normal or slightly elevated hematocrit. The content of potassium and chlorides in plasma tends to decrease, especially with prolonged loss of electrolytes and water, for example, from the gastrointestinal tract.

Treatment with hypertonic sodium chloride solutions is aimed at eliminating the deficiency of electrolytes in the extracellular fluid, eliminating extracellular fluid hypotension, restoring the osmolarity of plasma and interstitial fluid. Sodium bicarbonate is prescribed only for metabolic acidosis. After restoration of 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 with water deficiency. Most often it develops in patients with tube or tube feeding, who are in an inadequate or unconscious state. Hemodynamics remains undisturbed for a long time, diuresis remains normal, in some cases moderate polyuria (hyperosmolarity) is possible. There is a high level of sodium in the blood with sustained normal diuresis, a decrease in hematocrit and an increase in the level of crystalloids. The relative density of urine is normal or slightly increased.

Treatment consists of limiting the amount of salts administered and introducing additional water through the mouth (if possible) or parenterally in the form of a 5% glucose solution while reducing the amount of tube or tube feeding.

The primary excess of water (water intoxication) becomes possible with the erroneous introduction of excess amounts of water (in the form of isotonic glucose solution) into the body 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, diuresis decreases, in later stages coma and convulsions occur. Laboratory determined hyponatremia and hypoosmolarity of plasma, however, natriuresis remains normal for a long time. It is generally accepted that when the sodium content decreases to 135 mmol / l in 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 the complete cessation of water therapy. With 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 CVP, 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(injury of the bone skeleton and soft tissues, burns, postoperative sequestration of fluids).

3. Loss of sodium in the non-renal way (repeated vomiting, diarrhea, the formation of a "third space" in acute intestinal obstruction, enteric fistulas, profuse sweating).

4. Uncontrolled use of diuretics.

Since hyponatremia is almost always a secondary condition in relation to the main pathological process, there is no unambiguous treatment for it. Hyponatremia due to diarrhea, repeated vomiting, small bowel fistula, acute intestinal obstruction, postoperative fluid sequestration, and forced diuresis should be treated with sodium-containing solutions and, in particular, isotonic sodium chloride solution; with hyponatremia, which has developed in conditions of decompensated heart disease, the introduction of additional sodium into the body is not advisable.

Hypernatremia (plasma sodium content above 150 mmol / l). 1. Dehydration due to water depletion. An excess of every 3 mmol/l of sodium in plasma above 145 mmol/l means a deficiency of 1 liter 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. The concomitant loss of chlorides deepens the 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).

With hypokalemia, a solution of potassium chloride 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 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. Major trauma, burns or major surgery.

4. Severe metabolic acidosis and shock.

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

With hyperkalemia, the following sequence of measures is possible and appropriate.

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

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

3. To eliminate acidosis - about 40-50 mmol sodium bicarbonate (about 3.5 g) in 200 ml of 5% glucose solution; in the absence of effect, another 100 mmol is administered.

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

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

Hypercalcemia (plasma calcium level above 11 mg%, or more than 2.75 mmol / l, on multiple studies) usually occurs with hyperparathyroidism or with cancer metastasis to bone tissue. 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 a deficiency of magnesium in the body. Treatment - intravenous administration of calcium preparations.

Hypochloremia (plasma chlorides below 98 mmol/l).

1. Plasmodilution with an increase in the volume of the 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 associated with hyponatremia and hypokalemia. Treatment is the introduction of chlorine-containing salts, mainly KCl.

3. Uncontrolled diuretic therapy. Associated with hyponatremia. Treatment is discontinuation of diuretic therapy and saline replacement.

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

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