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By Douglas C. Neckers, David H. Volman, Günther von Bünau

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These categories in turn reflect a total body Na+ that is low, normal or increased, respectively. The value of this classification Sea water (drowning), salt tablets, hypertonic NaCl administration (this is rare) Post-operatively, infusion of hypertonic NaCl Acute and chronic renal failure, primary and secondary hyperaldosteronism, Cushing’s syndrome is two-fold. First, the clinical history and examination often indicate the ECF volume and therefore the total body Na+ status. Secondly, treatment often depends on the total body Na+ status rather than the [Na+].

2 Renal hydrogen ion excretion. with H+ to form NH+4 . This does not pass across cell membranes, so passive reabsorption is prevented. Glutaminase is induced in chronic acidoses, stimulating increased ammonia production and therefore increased H+ excretion in the form of NH+4 ions. Buffering of hydrogen ions The lungs and the kidneys together maintain the overall acid–base balance. However, the ECF needs to be protected against rapid changes in [H+]. This is achieved by various buffer systems. A buffer system consists of a weak (incompletely dissociated) acid in equilibrium with its conjugate base and H+.

Bartter’s syndrome The syndrome consists of persistent hypokalaemia with secondary hyperaldosteronism in association with a metabolic alkalosis; patients are normotensive. There is increased delivery of Na+ to the distal tubule, caused by an abnormality of chloride reabsorption in the loop of Henle. • Excessive sweating Sweat [K+] is higher than ECF concentrations, so excessive sweat losses can result in potassium depletion and hypokalaemia. Other causes of hypokalaemia Artefact: Collection of a blood sample from a vein near to a site of an IV infusion, where the fluid has a low [K+].

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