WATER EXCESS and WATER

DEPLETION

Presenter: Yona Gandye (MD)

Facilitater: Dr. Ntogwisangu
OUTLINE:

OVERVIEW

DEFINITION

CAUSES

FEATURES

COMPESATION

REFERENCES
 OVERVIEW

ECF volume is mainly determined by

the balance between input and out
put of Water and Salts, in this case
therefore any disturbances that may
affect(input/output) depending on
the severity may lead to water
excess or depletion.
 WATER EXCESS

By definition: Water
excess is the retention
of water in excess of salts
 WATER EXCESS

Causes of water excess

Primary
Secondary
 Primary causes
Over hydration(Water intoxication)
-Water intoxication results when an individual attempt to consume large amount of
water. Water can be considered poisoning when over consumed like any other
substance. The recommendation from the medical field is to drink at least 1-2
lts/day,! Depending upon body mass. Water intoxication would only occur at
levels far higher than that.
-At the on set this fluid outside the cell has excessive amount of solute(sodium and
other electrolytes) in comparison to the inside of the cells, the fluid shift through
osmosis into the cells in order to balance its conc. This causes the cell to swell.
In the brain this swelling increases intracranial pressure. It is this increase in
pressure that leads to the first observable symptoms of water intoxication:
headache, nausea ,vomiting, confusion, irritability and drowsiness. This are
sometimes followed by difficult in breathing during exhaustion and reduce the
ability to interpret sensory information . The cells in the brain may swell to the
point where blood flow is interrupted leading to cerebral oedema and pressure
to the brain stem causing CNS dysfunction both of which m ay lead to seizures,
brain damage, coma and death
E.g: 1.Infants under six months of age get water intoxication by drinking several
bottles of diluted formula.
2.Athlete sweat heavily losing both water and electrolytes. Water intoxication
and hyponatremia results when a dehydrated person drinks too much water
without the accompanying electrolytes
 SECONDARY CAUSES
Addisons disease(excess
sodium loss)
Cortisol deficiency
Renal failure
Paraneoplastic syndrome
Trauma(Head injury)
 Physiological Disturbances
Water intoxication(Hyper-
hydration/poisoning)
Hyponatremia
Hypo-osmolarity
Increase in ICF Volume at the
expense of ECF Volume expansion.
Oedema
 Clinical Features
Skin tugor become doughy
Nause/vomiting
Headache, drowsiness and dizzness
Blurred vision, fits and coma
 COMPENSATORY
MECHANISMS
RAAS
ADH
THIRST
 WATER DEPLETION
By Definition: Water depletion is the
excess loss of pure water/water in excess
of salts from the ECF.
When the body loses water, it is usually
depleted from both the extracellular and
intracellular compartments, but it may not
necessarily be lost equally from each of
the fluid spaces. Loss of NaCl (the major
solute of the extracellular fluid) together
with water results in proportionately more
extracellular fluid being depleted than if
water alone is lost.
 Physiological disturbances
Increase in the osmolarity of ECF and
ICF
Reduction in the ICF volume.
 causes
Sweating
ADH deficiency
Renal irresponsiveness to ADH
DM
Cholera
Cushings syndrome
 Clinical Manifestation
As a result of lowering of the ECF
volume:
-BP reduction
-Signs of dehydration(reduced urine
vol.)
-Thirst
-Headache, confusion and coma
Compensatory Mechanisms
Aim is:
-Stimulation of the thirst centre
-Stimulation of the ADH
-RAAS activity
-Baroreceptor control of BP changes
-Synthesis of osmotically active cells in
the brain
 References.
Guyton and Hall textbook of medical
physiology 11th edition.
Harrisons principle of internal
medicine, 17E 2008
The Merck manual of diagnosis and
therapy b y Mark Beers.