Diuretics

Chemicals that enhance the urinary output include:

Any substance not reabsorbed
Substances that exceed the ability of the renal tubules to
reabsorb it
Substances that inhibit Na+ reabsorption
Diuretics
Osmotic diuretics include:
High glucose levels carries water out with the
glucose
Alcohol inhibits the release of ADH
Caffeine and most diuretic drugs inhibit
sodium ion reabsorption
Lasix and Diuril inhibit Na+-associated
symporters
Fluid, Electrolyte, & Acid/Base Balance

High potassium High Sodium

Movement of fluids based on ionic balance (hydrostatic

pressure) & plasma proteins (colloidal osmotic pressure)
Starling Capillary Forces

Two forces regulate bulk flow across capillaries:

Hydrostatic (HP) and osmotic pressure (OP)
These forces exist in two fluid compartments:
Blood (B) and interstitial fluid (IF)

IFOP IFOP
Arterial End Venous End

BOP BOP

BHP BHP

IFHP IFHP

Net Net
Mechanisms and consequences of aldosterone release
Mechanisms and consequences of ADH release.
Water & Sodium Balance in Blood Pressure Homeostasis
Mechanisms & consequences of ANP release.
Regulation of Acids & Bases

1. Buffer Systems

2. Mechanisms for Excretion

a. Respiratory System Regulation

CO2 + H2O H+ + H2CO3

b. Renal Mechanisms of Acid-Base Balance

Pendekatan Henderson-Hasselbalch

Reaksi Hidrasi CO2

-
CO2+ H2O H2CO3 HCO3 + H+

-
CO2 HCO3
Acid Base Balance Disorder
Henderson-Hasselbalch Approach

DISORDER pH PRIMER COMPENSATI

ON
METABOLIC HCO3- pCO2
ACIDOSIS
METABOLIC HCO3- pCO2
ALKALOSIS
RESPIRATORY pCO2 HCO3-
ACIDOSIS
RESPIRATORY pCO2 HCO3-
ALKALOSIS
 Approach for analysis of simple acid-base disorders

Arterial blood sample

pH <7,40 pH> 7,40

Acidosis
Alkalosis
HCO3 <24 mEq/L Pco2>40 mmHg HCO3 > 24mEq/L Pco2 < 40 mmHg

Metabolic acidosis Respiratory acidosis Metabolic .alkalosis respiratory alkalosis

Pco2 < 40 mmHg HCO3 > 24 mEq/L Pco2 > 40 mmHg HCO3 < 24 mEq/L

Respiratory compensation renal compensation respiratory compensation renal compensation

Stewarts Approach
The Henderson-Hasselbalch equation
describes the relationship of 3 linked variables but
does not say which is dependent and which
independent
The solvent (H2O) not the solutes is the largest source
of hydrogen ions
Stewarts Approach

pCO2 SID [weak acid]

H2O

H+ OH-
Stewarts Approach

pH atau [H+] DALAM PLASMA

DITENTUKAN OLEH

DUA VARIABEL

VARIABEL DEPENDENT
INDEPENDEN VARIABLES

Stewart PA. Can J Physiol Pharmacol 61:1444-1461, 1983.

Stewarts Approach
VARIABEL INDEPENDEN

CO2 STRONG ION DIFFERENCE WEAK ACID

pCO2 SID Atot

Stewarts Approach
DEPENDENT VARIABLES

H+ HCO3-

OH- AH

CO3- A-
 Acid base disorder classification (Stewarts)
ACIDOSIS ALKALOSIS
I. Respiratory PCO2 PCO2
II. Nonrespiratory (metaboli
c)
1. Abnormal SID
a. Water excess/deficit SID, [Na+] SID, [Na+]
b. Imbalance of strong
anions
b.1. Chloride SID, [Cl-] SID, [Cl-]
excess/deficit
b.2. Unidentified anion SID, [XA-]
excess
2. Non-volatile acids
a. Serum albumin [Alb] [Alb]
b. Inorganic phosphate [Pi] [Pi]