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Symptoms of disease - violation of salt exchange

Water-salt exchange - a combination of the proceeds of water and salts (electrolytes) in the body, their absorption, distribution in the interior environments and selection. Daily consumption of water is about 2.5 l, of which about 1 liter he receives from food. In the human body 2/3 of the total quantity of water falls on the interstitial fluid and 1/3 on the intracellular. Part of the extracellular water is in sossoudistom (about 5% of body weight), the greater part of the extracellular water is out of the vascular bed, this interim (interstitial), or tissue, fluid (about 15% of body weight). In addition, there are free water, water, held colloids in the form of the so-called water swelling, i.e., bound water, and constitutional (intramolecular) water that is included in the molecules of proteins, fats and carbohydrates, and releasing at their oxidation. Different tissues are characterized by different ratios free-related constitutional and water. During the day the kidneys displayed 1-1, 4 l of water, bowels - about 0.2 l; with sweat, and evaporation through the skin of a person loses about 0.5 liters, with the exhaled air is about 0.4 l.

The system of regulation of water-salt metabolism maintain the total concentration of electrolytes (sodium, potassium, calcium, magnesium) and ionic composition of intracellular and extracellular fluid on the same level. In human blood plasma concentration of ions is supported with a high degree of consistency and is in (mmol/l): sodium - 130-156, potassium - 3,4-5,3, calcium - 2,3-of 2.75 (including ionized, not associated with a protein - 1,13), magnesium - 0,7-1,2, chlorine - 97-108.

Compared to the plasma of blood and intercellular fluid cells have a high content of potassium, magnesium, phosphate and low concentration of sodium, calcium, chlorine and bicarbonate ions. Differences in the salt composition of blood plasma and tissue fluid due to low permeability, capillary wall for proteins. The exact regulation of water-salt metabolism in healthy people, allows you to maintain not only the permanent composition, but also a constant volume of liquids of the body, keeping almost the same concentration it is an osmotically active substances and acid-base balance.

Regulation of water-salt exchange is carried out with the participation of several physiological systems. The signals coming from the special inaccurate receptors, reacting to the change in the concentration of it is an osmotically active substances, ions, and the volume of the liquid are transferred to the Central nervous system, after which the allocation of water from the body and salts and their consumption organism is changing accordingly. So, with increasing the concentration of electrolytes and decrease of the volume of circulating fluid (hypovolemia) appears the feeling of thirst, and with an increase in the volume of circulating fluid (hypervolemia) it decreases. The increase in the volume of circulating fluid due to the increased water content in the blood (polyplasmia) can be compensatory, arising after the massive blood loss.

Polyplasmia is one of the mechanisms of recovery of conformity of volume of circulating fluid capacity of the vascular bed. Pathological polyplasmia is a consequence of a breach of a water-salt exchange, for example in case of renal failure, etc. In a healthy person can develop short-term physiological polyplasmia after reception of the large quantities of liquid. The removal of water and ions of electrolyte kidneys is controlled by the nervous system, and a number of hormones. In the regulation of water-salt metabolism participate and produced in the kidney of physiologically active substances - derivatives of vitamin D3, renin, and kinin, etc.

The content of sodium and the body is regulated mainly kidneys under the control of the Central nervous system through specific natrioretseptory. reacting to the changing content of sodium in the body fluids, as well as volume-receptors and OSMO receptors, reacting on change of volume of circulating fluid and osmotic pressure of the extracellular fluid, respectively. Sodium balance in the body is controlled and renin-angiotensin system, Mr .. aldosterone, natriuretic factors. When reducing the water content in the body and increasing the osmotic pressure of the blood increases the secretion of vasopressin (antidiuretic hormone), which causes an increase in back intake water in the kidney tubules. Increases the delay sodium in the kidneys cause aldosterone, and an increased excretion of sodium - natriuretic hormones, or natriuretic factors. These include atriopeptidy, synthesized in the Atria and possessing diuretic, natriuretic effect, as well as some prostaglandins.

Which diseases there is violation of salt exchange

The reasons for violations of the salt metabolism in the body - a sedentary lifestyle, hormonal changes, excessive nutrition, frequent use of meat, spicy foods and legumes, alcohol abuse, Smoking and systematic temperature of the body or individual joints of the extremities.

The main manifestation of violation of salt exchange - diseases of the joints: the restriction of mobility, in them, crunch and crack, pain at rest and in motion, deformation, bone growths in the form of «spikes», «spurs», «whiskers» and etc.

Violations of water-salt metabolism manifest accumulation of fluid in the body, the appearance of edema or deficit of liquid, a decrease or an increase of osmotic pressure of the blood, violation of elektrolitnogo balance, i.e. the decrease or increase in the concentration of individual ions (hypokalemia and hyperkalemia, gipocalziemiei and gipercalziemiei, etc.), the change of the acid-base equilibrium - acidosis or alkalosis. Knowledge of pathological conditions, under which changes ion composition of blood plasma or the concentration in it of certain ions, it is important for differential diagnosis of various diseases.

Deficit of water and ions of electrolyte, mainly ions of Na+, K+ and Cl -, occurs when the loss of body fluids containing electrolytes. The negative balance of sodium develops when the removal of excess of receipts, for a long time. The loss of sodium, leading to pathology, can be extrarenal and renal. Extrarenal the loss of sodium occurs mainly through the gastro-intestinal tract with the indomitable vomiting, profuse diarrhea, intestinal obstruction, pancreatitis, peritonitis and through the skin to the increased sweating (at high temperature, fever, etc.), burns, cystic fibrosis, massive blood loss.

Most of the gastro-intestinal juices almost isotonicity blood plasma, so if the compensation of the fluids lost through the gastrointestinal tract, is carried out correctly, change osmollnosti the extracellular fluid is usually not observed. However, if the fluid is lost in vomiting or diarrhea, shall be compensated isotonic solution of glucose, develops hypotonic state and as a related phenomenon is the decrease in the concentration of ions K+ in the intracellular fluid. Most often, the loss of sodium through the skin occurs in burns. Loss of water in this case is relatively higher than the loss of sodium, which leads to the development of the hetero osmolality extracellular and intracellular fluids with a further decrease of their volumes. Burns and other skin damage is accompanied with increase in the permeability of capillaries, which leads to the loss not only of sodium, chlorine and water, but also the plasma proteins.
The kidneys are able to excrete more sodium than is necessary to maintain the constancy of a water-salt exchange, in violation of the mechanisms regulating the reabsorption of sodium in the kidney tubules or the oppression of sodium transport in the cells of the renal tubules. A significant renal loss of sodium with healthy kidneys can occur with the increase in urine output of endogenous or exogenous origin, including in low-synthesis mineralocorticoids adrenal glands or the introduction of diuretics. In violation of the kidney (eg, patients with chronic renal insufficiency) loss of sodium organism occurs mainly due to the violation of its reabsorption in the renal tubules. The most important deficit of sodium are circulatory disorders, including collapse.

Deficit of water with relatively little loss of electrolytes arises due to the enhanced sweating when overheating of the body or with heavy physical work. Water is lost when long term hyperventilation of the lungs after taking a mochegonnah funds, non-saluretic effect.

Relative abundance of electrolytes in the blood plasma is formed in the period of water deprivation - when there is insufficient water supply patients, unconscious and receiving the forced feeding, in violation of swallowing, and the baby - the insufficient consumption of their milk and water. A relative or absolute excess of electrolytes in reduction of the total volume of water in the body leads to an increase in the concentration of it is an osmotically active substances in the extracellular fluid and dehydration of cells. It stimulates the secretion of aldosterone, which inhibits the excretion of sodium in the kidneys and restricts the removal of water from the body.

Recovery of the water and izotonicnosti fluid in pathological dehydration is achieved by drinking large quantities of water or intravenous izotoniceski solution of sodium chloride and glucose. Loss of water and sodium in increased sweating reimburse drink salted (0.5% solution of sodium chloride and water.

The excess of water and electrolytes is manifested in the form of swelling. One of the principal reasons of their occurrence belongs excess sodium in intravascular and the interstitial spaces, often at diseases of kidneys, chronic liver disease, increasing the permeability of vascular walls. In heart failure excess sodium in the body can exceed the excess of water. Broken vodno-elektrolitny balance restore the restriction of sodium in the diet and the appointment of the natriuretic mochegonnah funds.

Excess water in the body with the relative shortage of electrolytes (the so-called water poisoning, or water intoxication, hypo osmolar, hyper hydria) is formed when introduced into the body of a large amount of fresh water or glucose solution when there is insufficient allocation of the fluid; an excessive amount of water can be absorbed into the body also in the form of hypoosmotic fluid in the kidney. When the water intoxication develops giponatriemia, gipokaliemia, increases the volume of extracellular fluid. Clinically it is manifested nausea and vomiting, increased after drinking fresh water, and vomiting does not bring relief; the visible mucous membranes in patients overly wet. Hydration of cellular structures of the brain manifests itself drowsiness, headache, twitch muscle cramps. In severe cases, water poisoning develop swelling of the lungs, liver, gidrotoraks. Water intoxication can be eliminated intravenous injection of hypertonic sodium chloride solution and a sharp restriction of consumption of water.

The shortage of potassium is mainly the result of his lack of revenue from food and the loss in case of vomiting, protracted lavage stomach, profuse diarrhea. The loss of potassium in the gastrointestinal tract diseases (tumors of the esophagus and stomach, stenoses privratnika, intestinal obstruction, fistulas, etc.) connected to a large degree with growing at these diseases hypochloremia, in which sharply increases the total amount of potassium, excreted in the urine. Significant amounts of potassium lose patients suffering from repetitive bleeding of any etiology. The shortage of potassium occurs in patients, long-lasting treated with corticosteroids, cardiac glycosides, diuretic and laxative means. High potassium loss from the operations in the stomach and small intestine. In the postoperative period gipokaliemia often noted at the bringing of isotonic sodium chloride solution, because the ions Na+ are antagonists ions K+. Dramatically increases the release of ions To+ of cells in the intracellular fluid, with subsequent excretion of them through the kidneys with reinforced the decay of proteins; essential deficiency of potassium the development of diseases and pathological conditions involving the violation of trophism of tissues and cachexy (extensive burns, peritonitis, empyema, malignant tumors). The shortage of potassium in the body has no specific clinical signs. Hypokalemia accompanied by lethargy, apathy, disorders of the nervous and muscular excitability, decreased muscle strength and reflexes, hypotonia the cross-striated and smooth muscle (atony bowel, bladder, etc.). It is important to evaluate the degree of reduction of the content of potassium in the tissues and cells by determining the quantity of the material obtained by biopsy muscles, determine the concentration of potassium in the red blood cells, the level of its excretion with daily urine, because gipokaliemia does not reflect the extent of the deficit of potassium in the body. Hypokalemia has a relatively clear manifestations of the ECG (decrease interval Q-T, elongation of the segment Q-T and zubza T-wave flattening of the T).

The shortage of potassium compensate for the introduction in a diet of foods rich in potassium: dried apricots, prunes, raisin, apricot, peach and cherry juice. With the failure of enriched with potassium diet potassium assign inwards in the form of potassium chloride, panangin, asparcamum), intravenous injections of drugs potassium (in the absence of anurii or oliguria). The rapid loss of potassium his compensation should be conducted at a pace close to the rate of excretion of ion K+ from the body. The main symptoms of overdose of potassium: arterial gipotenzia on the background of bradikardii, enhancing and sharpening zubza T on ECG, arrythmia. In these cases, stop the introduction of potassium products and prescribe drugs calcium - physiological antagonist of potassium, diuretics, liquid.

Hyperkalemia develops when the violation of the allocation of potassium kidneys (for example, anurii of any Genesis), expressed hypercorticoidism, after adrenalektomii, in traumatic toxicosis, extensive burns of the skin and other tissues, massive hemolysis (including after massive blood transfusions), as well as in cases of increased the decay of proteins, such as during hypoxia, ketoatsidoticheskoy a coma, diabetes mellitus and others. Clinically hyperkalemia, especially during its rapid development, which is of great importance, is manifested characteristic syndrome, although the severity of individual characteristics depends on the Genesis of giperkaliemii and severity of the underlying disease. There are drowsiness, sputannosti consciousness, the pain in the muscles of the limbs, abdomen, characterized by pain in the language. Watch sluggish muscle paralysis, including paresis smooth muscle of the bowel, postural hypotension, bradycardia, disorders of the conductance and heart rhythm, heart tones are muted. In diastole phase may occur stop the heart. Treatment of hyperkalemia is in the diet with restriction of foods rich in potassium, and intravenous administration of sodium bicarbonate; it is shown intravenous administration of 20% or 40% glucose solution with the simultaneous introduction of insulin and calcium preparations. The most effective in the giperkaliemii Hepatology.

Sodium is the principal cation of plasma and extracellular-regular fluid and largely determines their osmotic pressure. It is excreted mainly with urine. Reabsorption of sodium in the distal tubules of the kidneys increases aldosterone. True giponatriemia observed in kidney disease and overdose diuretics, as well as in severe diarrhea, vomiting, adrenal insufficiency. In these cases reveals a lack of sodium in the tissue and tissue fluid.

A different situation is observed in patients with the development of ascites, before treatment sodium-urine. In such cases, giponatriemia does not reflect the true balance of sodium, because he was in large quantities accumulates in the tissue fluid.

The introduction of such patients by intravenous injection of large amounts of sodium dangerous because of the possibility of pulmonary edema. Successful treatment of ascites often leads to the disappearance of hyponatraemia in these patients.

Giponatriemia observed in some patients with acute alcoholic hepatitis, significantly less frequently - in patients with acute viral hepatitis. In the terminal stage of liver disease giponatriemia frequently. Significant decrease in concentrations of sodium in the tissue fluid can cause serious damage of hepatocytes.

Potassium plays an important role in metabolic processes. The content of potassium in the blood serum are primarily regulated by hormones. Hypokalemia is often observed in the far included cirrhosis, as well as in malignant tumors of the liver. Gipokaliemia expressed contributes to the development of encephalopathy in patients with severe liver damage. This form encephalopathy called false coma Tracing paper.

Calcium plays an important role in the metabolism of bone and unite a large cloth. Hypercalcemia is observed in a number of diseases of the liver, proceeding with jaundice. Expressed disorders of calcium metabolism, leading to osteoporosis, are identified in the primary and secondary of biliary cirrhosis of the liver.
Hypocalcemia occurs when a blinding viral hepatitis, especially in cases of co-existing pancreatitis and hypoalbuminemia.

Magnesium. Hypomagnesaemia occurs with severe chronic (especially alcohol) diseases of the liver and can contribute to the development of encephalopathy. Along with this, it was noted that the purifying enemas with sulphate of magnesium in some patients with hepatic encephalopathy caused the development of hypermagnesaemia.

Which doctor should I contact if there is a violation of salt exchange

• Resuscitator
• Anesthesiologist

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Do you feel disrupted salt-exchange? You should be very careful approach to your health in general. People pay not enough attention to the symptoms of the disease and don't realize that these diseases can be critically dangerous. There are many diseases that in the beginning didn't manifest in our body, but in the end it turns out, unfortunately, it have already been treated too late. Every disease has its own specific features typical symptoms - called symptoms of the disease. Definition of symptoms is the first step in the diagnosis of diseases in general. You just need a few times a year to be screened by a doctor, not only to prevent a terrible disease, but also to maintain a healthy spirit in a body and the organism in general.

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