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 Pathophysiology
Zhaoming Yao (Jasper)
Department of pothophysiology
Medical College
Zhengzhou University
zmy66@zzu.edu.cn; 66658160(O)
 Preface to Pathophysiology

1. What is it ？
2. Why to study it ？
3. How to study it ？
4. What is it consisted of in our
textbook?
 1.What is pathophysiology?

Explore the rule of origin and evolution

of disease processes and the underlying
mechanisms.
Basing on physiology and biochemistry
 2. Why to study Pathophysiology ？

bridge
Clinical
Basic
medicine
medicine

explain “Why and How” of diseases

3. How to study pathophysiology ？

(1)Control concept and mechanism

(2)Strengthen ability to
1 ） active study
2 ） scientific thinking
3 ） create
4 ） do experiment and observe
patient
5 ） molecular pathology
4.Content of pathophysiology
in this textbook
Generalization on disease

Pathological process

Systemic and organic ~

Cellular and molecular ~

Disorder of water and sodium
 background
Section 1
Water and sodium in body

Balance in intake and removement

in body per day
 Why are water and
electrolytes so important
for life?
Requirement of
structure
metabolism
function
in body
(1)body fluid distributes in 3 different pools of body

TOTAL BODY FLUIDS

(40) liters; 60% TBW

Plasma volume Red cell volume

(3 liters;5%) (2 liters)

Extracellular Intracellular
(15 liters;20%) blood volume (25 liters;40%)
(5 liters)
 Osmolality of the body fluid
Acquaporin , AQP1~11

ECF ICF

[Na+] 140mmol/L

K+ 4.5 mmol/L
K+ 150mmol/L

Direction of water shifting

 Mechanism for regulating body
fluid and electrolyte balance
 1.the sensation of thirsty
 2.Hormones
new hormone the guanylin family
guanylin, uroguanylin, lymphoguanylin
 Endogenous & exogenous Guanylin

Endogenous Guanylin and uro~ in

gastrointestinal tract
Lymphoguanylin in kidney,
myocardium and lymphoid-immune
system
 Effect of Guanylin

Pathway: Guanylin receptors with

GC( guanylate cyclase) in
enterocytes(or kidney) cGMP
Cl- and HCO3- secretion

Effect: excreting Na+, Cl+ and K+

H2O, Na+, K+ regulated by hormones

H2O, Na+, K+

?-sparing ?-excreting
hormones hormones
vs

maintain homeostasis of water and sodium

Section 2. Types of disorders of water
and sodium metabolism

fluid serum Na+ status

volume (mmol/L) Na+ & water

normal normal normal

↓ ↓ ↓

↑ ↑ ↑

There are 9 types of grouping and arrangement

 fluid serum Na+ status
volume (mmol/L) Na+ & water
normal normal normal

↓ ↓ hypotonic
dehydration

↑ ↑ hypertonic
hypervolemia
nor + ↓=normovolemic hyponatremia(SIADH)
nor + ↑= normovolemic hypernatremia(syndrome
of reset osmostat)
↓ + nor =isotonic dehydration
↓ + ↑ = hypertonic dehydration
↑+ nor = edema
↑+ ↓ = water intoxication
 Part 1 Hyponatremia

[Na+] serum ↓ <130mmol/L

with ECF volume↓ or ↑ or normal

hypotonic dehydration

Water intoxication
1. Hypotonic dehydration

Definition: Salt loss > water loss

serum Na+ concentration ↓
plasma crystal osmolality ↓
(1) Causes

Salt loss through

kidney
or gastrointestinal tract
or skin
 Specially, supply only
water (GS) without salt
(NaCl) following hyper-
or isotonic dehydration
(2) Effects on body

ECF ↓+ [Na+] serum ↓ water shifting

*orthostatic hypotension, shock

*urine volume and quality
*skin turgor↓
*CNS (metabolism, cerebrocellular edema)
(3) Principle of treatment for
hypotonic dehydration

 Fluid replacement

salt first, glucose second

hypertonic fluid (Na+ 0.5mmol/h
→120 mmol/L. infusion velocity !)
during serious ~

isotonic salt solution administered

 2.Water intoxication
 renal water-excreting ↓ （ renal failure or ADH ↑ ）＋
water intake ↑ （ not controled ）
Water retention
Diluted hyponatremia
 Pulmonary edema or cerebral hernia
 * Restriction of water intake
* diuresis
*↓intracranial pressure
part 2. Hypernatremia

[Na+] serum ↑ >150mmol/L

with ECF volume↓ or ↑

hypertonic dehydration
1. hypertonic dehydration

(1) Definition: water loss > salt loss

serum Na+ concentration ↑

plasma crystal osmolality ↑

(2) Causes

water loss through

kidney
or gastrointestinal tract
or skin
(3) Effects on body
*thirsty
*urine volume and quality
*intracellular fluid ↓
(dehydration fever)
*CNS (metabolism, intracranial
bleeding)
(4)Principle of treatment for
hypertonic dehydration

 Fluid replacement
glucose first, salt second
hypotonic solution(1/2~2/3 tonic)
part 3. Isotonic dehydration

(1)Definition
Salt loss ,water loss in normal ratio
serum Na+ concentration & plasma
crystal osmolality are normal

(2)Causes
Salt and loss through
gastrointestinal tract
skin
kidney
(3) Effects on body

thirsty ( ? )
shock （？）

Hormone change
2006-02-11