Disorders of Body Water Homeostasis in Critical Illness

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Overview of normal water metabolism

Whereas sodium metabolism is predominately regulated by the renin-angiotensin-aldosterone system (RAAS), water metabolism is controlled primarily by arginine vasopressin (AVP). AVP is a nine-amino acid peptide produced by the cell bodies of magnocellular neurons located in the hypothalamic supraoptic and paraventricular nuclei and secreted into the bloodstream from axon terminals located in the posterior pituitary. The primary inputs to these hypothalamic neurons are via hypothalamic

Hyponatremia

Hyponatremia is a common electrolyte abnormality that varies greatly in its clinical presentation. It has been estimated that approximately 1% of patients have acute symptomatic hyponatremia, 4% acute asymptomatic hyponatremia, 15% to 20% chronic symptomatic hyponatremia, and 75% to 80% chronic asymptomatic hyponatremia [13]. The incidence of hyponatremia (serum [Na+] ≤134 mmol/L) in the intensive care unit was prospectively found to be approximately 30% [14]. The in-hospital mortality rate for

Hypernatremia

Similar to hyponatremia, hypernatremia can be induced by several illnesses in the critical care setting. Hypernatremia is generally categorized according to the causal factors involved: hypervolemic, hypodipsic, and increased free water losses (Box 4) [4].

Summary

Disorders of sodium and water metabolism are commonly encountered in the intensive care setting predominantly owing to the large number of varied disease states that can disrupt the balanced mechanisms that control the intake and output of water and solute. Disorders of body water homeostasis can be divided into hypoosmolar disorders, in which there is an excess of body water relative to body solute, and hyperosmolar disorders, in which there is a deficit of body water relative to body solute.

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