Subject: PATHOPHYSIOLOGY

Place: Department of General and Experimental Pathology, room 371

Division: FACULTY OF MEDICINE

YEAR: 3

CLASS no: 13

Alterations in fluid, electrolyte and acid-base homeostasis

Goal: to explain etiology, pathogenesis, manifestations and consequences of selected water, electrolyte and acid-base disorders

Time: 4 hours

Didactic tools: multimedia presentation

Before the classes students should also revise regulation of fluid and electrolyte homeostasis: intake and absorption; distribution, excretion, loss, as well as regulation of acid-base homeostasis.

Topics:

1. Etiopathogenesis and consequences of fluid volume deficit.
2. Etiopathogenesis and consequences of fluid volume excess.
3. Types, etiopathogenesis and consequeces of edemas.
4. Sodium balance alterations:
   - etiopathogenesis and consequences of hyponatremia
   - etiopathogenesis and consequences of hypernatremia
5. Potassium balance alterations:
   - etiopathogenesis and consequences of hypokalemia
   - etiopathogenesis and consequences of hyperkalemia
6. Calcium balance alterations:
   - etiopathogenesis and consequences of hypocalcemia
   - etiopathogenesis and consequences of hypercalcemia
7. Phosphorus balance alterations:
   - etiopathogenesis and consequences of hypophosphatemia
   - etiopathogenesis and consequences of hyperphosphatemia
8. Magnesium balance alterations:
   - etiopathogenesis and consequences of hypomagnesemia
   - etiopathogenesis and consequences of hypermagnesemia
9. Etiopathogenesis and consequences of metabolic and respiratory acidosis.
10. Etiopathogenesis and consequences of metabolic and respiratory alkalosis.
11. Compensatory mechanisms in acid-base disorders.

References:

Porth's Pathophysiology: Concepts of Altered Health States - Tommie L Norris; Wolters Kluwer; 10^th Edition, International, (November 3, 2018), chapter 8.
Color Atlas of Pathophysiology - Stefan Silbernagl, Florian Lang, Thieme; 3rd Edition, 2016.

Problems:

Water and electrolyte imbalances
Causes and clinical manifestations of isotonic fluid volume deficit (isotonic dehydration).
How osmolality and volume of the ECF and ICF change in isotonic dehydration? Why?
How osmolality and volume of the ECF and ICF change in hypotonic dehydration? Why?
How osmolality and volume of the ECF and ICF change in hypertonic dehydration? Why?
Causes and clinical manifestations of isotonic fluid volume excess (isotonic overhydration).
How osmolality and volume of the ECF and ICF change in isotonic overhydration? Why?
How osmolality and volume of the ECF and ICF change in hypotonic overhydration? Why?
How osmolality and volume of the ECF and ICF change in hypertonic overhydration? Why?
What is edema?
Mechanisms contributing to edema formation.

What are the differences between transudate and exude and what mechanism are associated with their formation?
Pitting edema vs non-pitting edema. Examples.
Compensation of decreased effective circulating volume in edema.
What is hyponatremia and what types of hyponatremia can be distinguished?
Etiopathogenesis of hypotonic hyponatremia with hypovolemia.
Etiopathogenesis of hypotonic hyponatremia with euvolemia.

Etiopathogenesis of hypotonic hyponatremia with hypervolemia.
Etiopathogenesis of isotonic hyponatremia.
Etiopathogenesis of hypertonic hyponatremia.

Clinical manifestations of hyponatremia.
Acute vs chronic hyponatremia and complication of hyponatremia treatment.
What is hypokalemia and what are its causes?
Clinical manifestations of hypokalemia.
Pathogenesis of nephrogenic diabetes insipidus/ polyuria in hypokalemia.
What is hyperkalemia and what are its causes?
Clinical manifestations of hyperkalemia?
What is hypocalcemia and what are its causes?
Clinical manifestations of hypocalcemia?
Pathogenesis of tetany.
What is hypercalcemia and what are its causes?
Clinical manifestations of hypercalcemia.
Pathogenesis of nephrogenic diabetes insipidus/ polyuria in hypercalcemia.
What is hypophosphatemia and what are its causes?
Clinical manifestations of hypophosphatemia.
What is hyperphosphatemia and what are its causes?
Clinical manifestations of hyperphosphatemia.
What is hypomagnezemia and what are its causes?
Clinical manifestations of hypomagnesemia.
What is hypermagnezemia and what are its causes?
Clinical manifestations of hypermagnezemia.

Acid-base disturbances
Types of primary acid-base disorders
Mixed acid-base disorders.
Etiology of metabolic acidosis.
Anion gap in metabolic acidosis.
Compensatory mechanisms in metabolic acidosis.
ABG parameters for uncompensated, partially compensated and fully compensated metabolic acidosis.
Etiology of metabolic alkalosis.
Compensatory mechanisms in metabolic alkalosis.
ABG parameters for uncompensated, partially compensated and fully compensated metabolic alkalosis.
Etiology of respiratory acidosis.
Compensatory mechanisms in respiratory acidosis.
ABG parameters for uncompensated, partially compensated and fully compensated respiratory acidosis.
Etiology of respiratory alkalosis.
Compensatory mechanisms in respiratory alkalosis.
ABG parameters for uncompensated, partially compensated and fully compensated respiratory alkalosis.
Clinical manifestations of acid-base disturbances.