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Symptoms of disease - violation of the water-exchange

Water content in the body of the adult person is on average 60% of the mass of the body, ranging from 45 (in obese older people) to 70% (young men). Most of the water (35-45% of body weight) is located inside the cells (intracellular liquid). Extracellular (extracellular) liquid is 15-25% of body weight and is divided into intravascular (5%), and cell-cell (12-15%) and transcellular (1-3%).

During the day a person consumes about 1.2 litres of water, in his organism with food comes about 1 litre, about 300 ml of water is formed by the oxidation of food substances. In the normal water balance of the same amount of water (about 2.5 l) is excreted from the body: the kidneys (1-1, 5 l), by means of the evaporation of the skin (0,5-1 l) and light (400 ml) and is excreted in the feces (50-200 ml).

There were two forms of violation of water exchange: dehydration of the body (dehydration) and the delay fluid in the body (excessive accumulation of it in the tissue and serous cavities).

Which diseases there is violation of the water-exchange

I. Dehydration
Dehydration develops due to the limitations of water intake or excessive allocating it from the body in case of insufficient compensation of lost fluids (dehydration from lack of water). Dehydration may also occur due to excessive losses and insufficient reserves of mineral salts (dehydration from a lack of electrolytes).

1. Dehydration from a lack of water entering
In healthy people, restriction or complete cessation of the flow of water in the body is in a state of emergency: the lost in the wilderness, by the covered from falls, and earthquakes, in shipwrecks, etc. But much more often the water deficit is seen at different pathological States:

- with difficulty swallowing (narrowing of the esophagus after the poisoning of caustic alkalis, tumors, atresia of the esophagus, etc.);
- in seriously ill patients and handicapped persons (coma, severe forms of malnutrition, etc.);
- in premature and critically ill children;
- in some diseases of the brain (the idiot, microcephaly), accompanied by a lack of sense of thirst.

In these cases, develops dehydration of the body from the absolute lack of water.
In the course of the life of a man continuously loses water. Mandatory, irreducible water expenses the following: the minimum amount of urine, determined by the concentration of substances in the blood, subject to the removal, and concentrate ability kidney; loss of water through the skin and lungs (Latin perspiratio insensibilis - intangible perspiration); loss from faeces.

In the state of water fasting the body uses water from the water depot (muscles, skin, liver). The adult weight of 70 kg in them contains up to 14 litres of water. The duration of the adult life with an absolute fast without water under normal conditions of temperature amounts to 7 to 10 days.

The child's body much harder to tolerate dehydration compared with adults. Under the same conditions babies per unit of body surface per 1 kg of body weight, lose through the skin and lungs in 2-3 times more fluid. Saving water kidneys in infants expressed very bad (the concentration ability of the kidneys in them low), and the functional reserves of water in a child 3½ times less than that of an adult. The intensity of metabolic processes in children is much higher. Consequently, the demand for water, as well as sensitivity to the lack of the above in comparison with the adult organism.

2. Dehydration from hyperventilation. In adults, a daily loss of water through the skin and lungs can rise up to 10-14 l (in normal circumstances, this number shall not exceed 1 litre). Especially a large amount of fluid is lost through the lungs in children under the so-called hyperventilation syndrome (deep rapid breathing, continued for a considerable time). This condition is accompanied by the loss of large quantities of water without electrolytes, gas alkalosis. As a result of dehydration and hyperkalemia (increase the concentration of salts in liquid environments of an organism) in these children violated function of the cardiovascular system, increases body temperature, suffers from kidney function. There arises a life-threatening condition.

3. Dehydration from polyuria can occur, for example, in nesharnom diabetes, congenital form polyuria, some forms of chronic nephritis, pyelonephritis, etc.

In nesharnom diabetes daily amount of urine with low relative density in adults may reach 40 l and more. If the loss is compensated by liquid, the water exchange remains in equilibrium, there is no dehydration and disorders of osmotic concentration of liquid environments of an organism. If the loss of liquid is not compensated, then within a few hours there comes a severe dehydration with collapse, fever and hyperkalemia.

4. Dehydration from a lack of electrolytes
Electrolytes organism, in addition to other important properties, have the capacity to absorb and retain water. Especially active in this respect sodium ions, potassium, chlorine, etc. Therefore, when the body loses and insufficient supplies of minerals, develops dehydration. Dehydration continues to develop as with the free reception of the water and cannot be eliminated only by the introduction of water without the restoration of normal electrolyte composition of liquid environments of an organism. With this form of dehydration is the loss of water organism occurs mainly due to the extracellular fluid (up to 90% of the volume of liquid lost and only 10% is lost due to intracellular fluid), which is extremely disadvantageous effect on hemodynamics of the rapidly coming thickening of the blood.

- Loss of electrolytes and water through the gastro-intestinal tract. As a result of increased discharges and losses of the digestive secretions body loses a large amount of electrolytes. When the indomitable vomiting and diarrhea (gastroenteritis, toxicosis of pregnancy, etc.) the body of an adult may daily lose up to 15% of the total amount of sodium, up to 28% of the total number of chlorine and up to 22% of the extracellular fluid. Great loss of salts and water arise in case of repeated washing stomach fluid does not contain electrolytes, with the continuous pump-down of the digestive juices, as well as in intestinal, biliary and pancreatic fistulas. Open the extensive wounds, burns, weeping eczema and other pathological conditions may lead to significant loss of salts in the body.

- Loss of electrolytes and water by the kidneys. Experimentally to achieve large losses of salt and water by the kidneys can be by deleting the adrenal glands, multi-introduction of diuretics, «osmotic» diurezom (introduction urea, hypertonic solutions of glucose, sucrose, mannitol, etc.) and in other ways. Large amounts of salt and water can be lost in some forms of nephritis, when Addison's disease, etc.

- Loss of electrolytes and water through the skin. The content of electrolytes in the sweat of relatively low. However, with abundant sweating loss of them can reach significant values. Daily amount of sweat in a healthy person, depending on the temperature factors of external environment and muscle load can vary from 800 ml up to 10 l. The sodium may be lost more than 420 mmol/l and chlorine - more than 150 mmol/l. Therefore, when heavy sweating without the reception of salt and water is observed as hard and fast dehydration, as in severe gastroenteritis and intractable vomiting. If you try to compensate for the lost water salt-free liquid, the extracellular hyposphresia and the transition of water into the cells with subsequent cell swelling. Develop symptoms of intracellular edema.

II. Water retention in the body
Water retention in the body (gipergidratation) can be observed for excessive introduction of water (water intoxication), or with restriction of the allocation of fluid from the body. The develop swelling and edema.

1. Water intoxication
Experimental water poisoning can cause a variety of animals, weighing down their excessive quantity of water (exceeding the excretory function of the kidneys) with the simultaneous introduction of antidiuretic hormone (ADG). For instance, in dogs, when re-multiple (up to 10-12 times) the introduction into the stomach of water in the 50 ml per 1 kg of weight with intervals of 0.5 hour comes the water intoxication. When this occurs vomiting, muscle apnoea, convulsions, coma and is often fatal.
From excessive water stress increases the volume of circulating blood (the so-called oligocythemic hypervolemia, there arises a relative decrease in the content of protein and electrolytes blood, hemoglobin, hemolysis of erythrocytes and hematuria. Diuresis initially increases, then starts on pace with the number of incoming water, and the development of hemolysis and haematuria is the true decrease in urination.

Water poisoning can occur in a person, if the flow of water exceeds the ability of the kidneys to the allocation of, for example, when some kidney diseases (hydronephrosis, etc.), as well as in the States, accompanied by a sharp reduction or termination of office of urine (in surgical patients in the postoperative period, the patients in a state of shock, etc.). Described the occurrence of water poisoning in patients insipidus diabetes, continued to receive a large amount of fluid on the background of treatment antidiuretic hormones.

2. Edema
Edema is called pathological accumulation of fluid in the tissues and interstitial spaces due to violation of water exchange between the blood and tissues. The fluid may be delayed also inside the cells. If this is violated exchange of water between the extracellular space and cells. Such swelling is called intracellular. Abnormal accumulation of fluid in the serous cavities of the body is called dropsy. Fluid accumulation in the abdominal cavity is called ascites, pleural cavity - hydrothorax, in pericardial bag.

Accumulated in the various cavities and tissues non-inflammatory liquid called transudate. The physico-chemical properties differ from those of the properties of the exudate - inflammatory effusion.
The total content of water in the body depends on the age, body weight, gender. In the adult, it is about 60% of body weight. Almost 3/4 of the volume of water is inside the cells, the rest outside of the cells. The child's body contains a relatively large amount of water, however, from the functional point of view of the body of the child is poor of water because of the loss of her through the skin and lungs from him in 2-3 times more than that of an adult, and the demand for water in the newborn is 120-160 ml per 1 kg of weight, as in the adult, 30 - 50 ml/kg.

Body fluids have a pretty constant concentration of electrolytes. The constancy of electrolytic composition supports the constancy of volume of liquids of the organism and of a certain their distribution by sector. Change of electrolyte composition leads to redistribution of the fluids inside the body shifts (water) or to increased excretion, or to delay them in the body. The increase of the total content of water in the body may occur while maintaining its normal osmotic concentration. In this case, there is an isotonic hyperhydration. In the case of decrease or increase of osmotic concentration of the liquid speak of Hypo - or hypertonic hyperhydration. Reduced osmolarity biological liquids of an organism below 300 mOsm on 1 l is called hypoospheresia, increased osmolarity above 330 mOsm/l - hyperospheresia.

The mechanisms of edema. The exchange of fluids between vessels and tissues takes place through the capillary wall. This wall is quite difficult to built a biological structure, which is relatively easy to transport water, electrolytes, some organic compounds (urea), but delays proteins, resulting in the concentration of the latter in the blood plasma and tissue fluid is not the same (respectively 60-80 and 15-30 g/l). According to the classical theory of Sterling exchange of water between the capillaries and tissues is determined by the following factors:
1. the hydrostatic pressure of the blood in the capillaries and the amount of tissue resistance;
2. colloid-osmotic pressure of blood plasma and tissue fluid;
3. the permeability of the capillary wall.

Blood moves in capillaries with a certain speed, and under a certain pressure, as a result of which are created by hydrostatic forces seeking to bring water from the capillaries into the surrounding tissue. The effect of hydrostatic forces will be greater, the higher the blood pressure, the less the resistance of the tissues, located near the capillaries. It is known, that the resistance of muscle tissue is more than skin, especially on the face.

The value of the hydrostatic pressure of blood in the blood the end of the capillary amounts on the average to 32 mm Hg, and in the end of the ductus - 12 mm Hg. Tissue impedance is approximately 6 mm Hg. Therefore, effective filtration pressure in the blood-the end of a capillary will be 32-6 = 26 mm Hg, and venous the end of the capillary - 12 - 6 = 6 mm Hg.

Retain water in the vessels of the proteins that create a certain amount oncotic pressure of the blood (22 mm Hg). Textile oncotic pressure is equal to the average of 10 mm Hg. Oncotic pressure proteins of blood and tissue fluid has the opposite direction of action: blood proteins retain water in the vessels, tissue proteins in the tissues. Therefore, the effective force (effective oncotic pressure), which keeps the water in the vessels, will be: 22-10=12 mm Hg. Filtration pressure (the difference between the effective filtration and effective oncotic pressure) provides for the process of ultrafiltration fluid from the vessel into the fabric. In blood the end of the capillary it will be: 26-12=14 mm Hg. Venous the end of the capillary effective oncotic pressure exceeds the effective filtration pressure and creates a force equal to 6 mm Hg. (6-12 = -6 mm Hg), leading the process of transition of interstitial fluid back into the blood. The Sterling there must be a balance: the amount of fluid, leaving the vessel in arterial part of a capillary, should be equal to the amount of fluid passing the vessel venous the end of the capillary. However, part of the interstitial fluid is transported to the overall flow through the lymphatic system, which did not take into account the sterling. This is quite a significant mechanism of return of fluid in the bloodstream, the damage which may occur the so-called lymph edema.

Depending on the reasons and mechanism of occurrence of the distinguished swelling of the heart, kidney, liver, cachectic, inflammatory, toxic, neurogenic, allergic, lymphogenous and etc.

The heart, or stagnant, swelling occurs mainly in venous stagnation and increase of venous pressure, which is accompanied by increasing filtering of blood plasma and the reduction of the resorption of the liquid in the capillary vessels. Developing in the stagnation of blood hypoxia leads to disturbance of trophism and increased permeability of the walls of blood vessels. Of great importance in the occurrence of heart swelling with blood circulation insufficiency has also secondary aldosteronism.

Developing in heart failure increased venous pressure and blood stagnation contribute to the development of edema. Increase of pressure in the upper hollow vein cause spasm of the lymph vessels, leading to the lymphatic insufficiency, which further aggravates the swelling. The growing frustration of the General circulation of the blood may be accompanied by disorder of the liver and kidneys. This leads to a decrease in the synthesis of proteins in the liver and increasing excretion of them through the kidneys, with a consequent reduction oncotic pressure of the blood. Along with this, in heart failure increases the permeability of the capillary walls, and blood proteins transferred to meztkanevu fluid, increasing its oncotic pressure. All this contributes to the accumulation and retention of water in the tissues of the heart failure.

Kidney edema. In the pathogenesis of edema in glomerulonephritis primary importance to the reduction of glomerular filtration, which leads to water retention in the body. This also increases reabsorption of sodium in the bone nephrons, which, apparently, well-known role belongs to the secondary hyperaldosteronism, as an antagonist of aldosterone - spironolactone (synthetic steroid) gives glomerulonephritis dioreticeski and natriyureticeski effect. A certain role in the mechanism of the development of edema in glomerulonephritis also plays an increase of permeability of the walls of the capillary blood vessels.
If there face nefroticski syndrome at the forefront factor gipoproteinemii (as a result of proteinuria), combined with hypovolaemia, which stimulates the secretion of aldosterone.

Nephritic swelling. In blood of patients with jade is high concentration of aldosterone and Malawi. Believe that Hyper secretion of aldosterone is caused by the violation of intrarenal hemodynamics with the subsequent inclusion of the renin-angiotensin system. Formed under the influence of the renin through a number of intermediate products angiotensin-2 directly activates the secretion of aldosterone. Thus mobilized aldosterone the mechanism of delay sodium in the body. Hypernatriemia (exacerbated by reduction of filtration ability of kidneys with nephritis) through OSMO receptors activates the secretion of Malawi, under the influence of which increases the hyaluronidase activity, not only epithelium of the renal tubules and collective tubules of the kidneys, but also an extensive part of the capillary system of the organism (generalized capillaritis). The decrease excretion of water through the kidneys and system increased capillary permeability, in particular, for the proteins of blood plasma. Therefore a distinctive feature of nephritic edema is the high content of protein in the interstitial fluid and increased hydrophily tissues.

Hydration tissues also contributes to the increase in them it is an osmotically active substances (mainly salts) by reducing the excretion from the organism.

In the development of liver edema in liver plays an important role hypoproteinemia, caused by violation of the synthesis of proteins in the liver. A certain importance in this case is improving the products or violation of inactivation of plasma aldosterone. In the development of ascites in cirrhosis of the liver decisive role belongs to the difficulty of hepatic blood circulation and increase of hydrostatic pressure in the portal vein.

Ascites and swelling with cirrhosis of the liver. With cirrhosis of the liver, along with the local accumulation of fluid in the abdominal cavity (ascites) increases the total volume of extracellular fluid (liver function swelling). The primary point of ascites in cirrhosis of the liver is the difficulty of intrahepatic circulation with the subsequent increase of hydrostatic pressure in the portal vein. Gradually accumulating inside the abdominal cavity fluid increases intra-abdominal pressure to such an extent that it prevents the development of ascites. Oncotic blood pressure when this is not reduced until not compromised function of the liver to synthesize proteins of the blood. However, when this happens, ascites, edema develop much faster. Protein content in ascitic fluid is usually very low. With the increase of hydrostatic pressure in the portal vein increases sharply lymph flow in the liver. With the development of ascites humor transsudation exceeds the transport capacity of the lymphatics (dynamic lymphatic insufficiency).

An important role in the mechanism of development of the common accumulation of fluid with cirrhosis of the liver plays an active delay sodium in the body. It was noted that the concentration of sodium in the saliva and sweat with ascites low, the concentration of potassium same high. In the urine contains a large quantity of aldosterone. All of this points to either increase the secretion of aldosterone, or the lack of inactivation of it in the liver with the subsequent delay of sodium. Available experimental and clinical observations allow us to admit the possibility of having both mechanisms.

In violation of the capacity of the liver to synthesize albumins reduced oncotic blood pressure due to growing hypoalbuminemia, and to the listed above factors, participating in the mechanism of the development of edema, which attaches still oncotic.

Hungry, swelling develops when the alimentary dystrophy (fasting), malnutrition in children, malignant tumors and other debilitating diseases. The most important factor of its pathogenesis is hypoproteinemia, caused by violation of the synthesis of proteins, and the increased permeability of the walls of the capillary blood vessels, associated with the violation of the trophic system.

In the pathogenesis of inflammatory and toxic edema (by the action of the EXTRACT, the bite of bees and other poisonous insects) the primary role of disturbance of microcirculation in the lesion and increase of permeability of the walls of the capillary blood vessels. In the development of these violations of the important role belongs to the freeing vasoactive substances-betweens-biogenic amines (histamine, serotonin), kinin (bradykinin, etc.), adenosine phosphate acid, a derivative of arachidonic acid (prostaglandins, leukotrienes), etc.

Neurogenic edema develops as a result of the disturbance of nervous regulation of water metabolism, trophism of tissues and vessels (angiotrophoneurosis). These include swelling of the limbs when hemiplegia and syringomyelia, face edema in the chamber troinicnogo nerve, etc. In the origin of neurogenic tumors of the important role belongs to improve the permeability of the walls of blood vessels and the metabolism in the injured tissues.

Allergic swelling occurs in connection with sensitization of the body and allergic reactions (urticaria, Kwinke swelling, allergic rhinitis, swelling of the mucous membrane of the respiratory tract in bronchial asthma, etc.). The mechanism of development of allergic edema in many ways similar to the pathogenesis of inflammatory and neurogenic. In the event when the violations of the microcirculation and the permeability of the walls of the capillary blood vessels leading role played by the release of biologically active substances.
In the development of edema of different origin should distinguish between two stages. In the first excessive fluid flowing into the fabric accumulates mainly in the gel-like structures (collagen fibers and the main substance of the connective tissue), increasing the mass of immobile, fixed tissue fluid. When the mass of a fixed fluid will increase by approximately 30%, and the pressure reaches air, starts the second stage, characterized by the accumulation of free intercellular fluid. This liquid is capable of moving under the action of gravity and gives a "symptom of the fovea" when pressure is applied to the tissue edema.

Which doctor should I contact if there is a violation of the water-exchange

• Cardiologist
• Otolaryngologist
• Allergist
• Hepatologist

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