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1 營養學營養學 Nutrition ~ Electrolytes~ 謝明哲 M.J.Shieh 臺北醫學大學公共衛生暨營養學院保健營養學系研究所 clark@tmu.edu.tw 1

2 Outline Classification Function Digestion, absorption and metabolism Assessment Deficiency syndrome 2

3 The Electrolytes K + HPO 2-4 Na + Cl - Mg 2+ Cl - Ca 2+ HCO 3- Na + SO 2-4 K + HPO 2-4 Ca 2+ HCO 3- Mg 2+ SO 2-4 ICF ECF 3

4 I. Sodium (Na) Natrium 1 gm NaCl = 400 mg Na 1 meq = 23 mg Na 4

5 Na 2.5 = NaCl ( 40% Na ) NaCl 0.4 = Na ng Na 23 = meqna 1 meqna = 23 ng meqna 23 =mg Na meqna 58.5 = ng NaCl 1 tsp NaCl =5 gm NaCl 5

6 Absorption & Metabolism 1. Small portion is absorbed in the 1 stomach, most of it is absorbed rapidly from the 2 small intestine by 3 active process (energy requiring) 6

7 Absorption & Metabolism 2. Absorbed Na is carried through the blood stream to the 4 kidneys, where it is filtered out & returned to the blood stream in amounts that maintain the blood levels within the narrow range required by the body. 7

8 Absorption & Metabolism 3. The control of the whole body content of Na is regulated by the hormone 5 aldosterone. This hormone comes from the 6 adrenal glands and acts on the tubules of the kidney 7 nephrons to increase the retention or reabsorption of Na by the body. 8

9 Absorption & Metabolism 4. When dietary intake is low or need is high, the secretion of this hormone 8 increases stimulates the kidneys to resorb more Na. Conversely, when blood Na levels are high, the secretion of the hormone is 9 diminished and 10 less Na is retained. 9

10 腦下視腦下視腦下視腦下視丘 osmorecept or 腎上腺髓質腎上腺髓質腎上腺髓質腎上腺髓質部 Aldosterone 釋放釋放釋放釋放省血鈉量節省血鈉量節省血鈉量省血鈉量 * ** 10 or thirst Na Addision s disease 量

11 * Aldosterone 分泌過多過度喪失水分如 : 1) 尿崩症 2) 流汗過多食鹽或重碳酸鈉攝取過多 ** 嚴重腹瀉嘔吐 Aldosterone 分泌過少高溫下運動, 持續性流汗 11

12 當血漿 Na + conc 高血漿 K + conc 刺激腎絲球體細胞分泌 renin 控制 renin 生成量活化 angiotensinogen ( 由肝分泌 ) Angiotensin Ⅰ Angiotensin Ⅱ 血漿體積增加血漿 Na + 濃度水的再吸收 Na + 的再吸收 K + 的排出增加遠側腎小管的滲透性分泌 Aldosterone* ( 留鹽激素 ) 刺激腎上腺 12

13 * Diet 中 Na 的攝取少 aldosterone 分泌增加 Na 保留尿 Na 排出 * Diet 中 Na 的攝取多 aldosterone 分泌減少 Na 再吸收尿 Na 排出 13

14 Liver Angiotensinoge n Renin Jutaglomerular apparatus Angiotensin 近腎小球體 Ⅰ Converting Lung enzyme Angiotensin Aldosterone Adrenal Ⅱ Hypothalamu s ADH Sodium retention Potassium excretion Water retention 14

15 The renin-angiotensin-aldosterone system Kidneys Liver Lungs 合作對之調節 Adrenals Hypothalamus 合作對 fluid homeostasis 15

16 Absorption & Metabolism 5. Another influence on Na excretion is 11 prostaglandins (hormone-like chemicals formed from a fatty acid precursor). 6. Some Na is also deposited in 12 bone, becoming a reservoir available in timeof need. 16

17 Absorption & Metabolism 7. Na is an integral part of digestive secretions such as 13 bile 14 pancreatic and 15 intestinal juices, which contain Na 3000 mg of Na/1 of secretion. 8. In addition to urinary excretion, Na can be lost from the body through 16 GI secretion and 17 perspiration. 17

18 Functions 1. Principal cation of ECF for the maintenance of normal 18 osmotic pressure water balance and 19 acid-base balance. 2. Regulating nerve irritability, muscle contraction and cell 20 permeability. 3. Essential for the absorption of 21 glucose and in the transport of other nutrients across membranes. 18

19 Sodium deficiency symptoms Loss of 22 appetite, loss of thirst, severe muscle cramps and 23 weakness, lethargy, vomiting, 24 irritability, low serum sodium (hyponatremia) and ultimately confusion, circulatory collapse, 25 coma, and death. 19

20 Acute toxicity of NaCl - subarachnoid 26 hemorrhage - Multiple small intracerebral hemorrhage - Shrinkage of the convoluted tubular cells from the basement membrane of the kidneys - Diffuse reddening of the mucosa of the 27 stomach and small intestine *Vomiting, 28 diarrhea, peripheral circulatory failure, respiratory 29 depression death. 20

21 Sodium & Hypertension 1. The consumption of high 30 sodium levels form infancy in genetically susceptible individuals can increase the risk of 31 hypertension. 2. Data from various epidemiologic studies have shown that among populations there is a direct correlation between the incidence of hypertension and the average daily salt intake. 21

22 *Development of hypertension may involve a variety of factors: - genetic predisposition - 32 obesity - smoking - 33 stress - cardiovascular and renal pathology - a life-time history of high Na intake 22

23 To avoid too much sodium - learn to enjoy the unsalted flavors of foods - cook with only small amounts of added salt - add little or no salt to food at the table - limit your intake of salty foods - read food labels carefully to determine the amount of sodium in processed foods 23

24 II. Potassium (K) Kalium potash Distribution The total K content of the adult body is about gm. Of this, about 35 97% is within the tissue cells with the remainder being distributed in the ECF. 24

25 Metabolism - Readily absorbed from the GI tract - The amount of K in the blood reflects the nature of 36 cellular metabolism rather than 37 body reserves. 25

26 K levels in blood (hyperkalemia) 1. Body tissue protein catabolism Glycogenolysis 3. Dehydration Acidosis 26

27 K levels in blood (hypokalemia) 1. Protein synthesis 2. Glycogen formation 3. Cellular hydration Alkalosis 27

28 The body is less efficient in conserving or reabsorbing K than it is for many other body constituents --- excess K is excreted by the kidney. 41 Aldosterone secretion increase K excretion. 28

29 Function - Required for 42 growth - ICF as a catalyst in many biological reactions - Release of 43 energy - Protein synthesis - Glycogen synthesis 29

30 Maintenance of osmotic pressure, water balance and acid-base balance. - ECF regulating nerve irritability, 44 muscle contraction and in the release of insulin from the pancreas. 30

31 K deficiency Causes: 1. Food intake: severe malnutrition, chronic alcoholism, and 45 anorexia nervosa, low CHO diet for weight reduction. 2. Absorption: prolonged 46 vomiting, gastric drainage, 47 diarrhea 31

32 K deficiency Causes: 3. loss: 48 adrenal tumors, severe tissue injury (surgery, burns, and prolonged fevers). Use of diuretics, excessive adrenocortical steroid therapy. DM acidosis therapy. 32

33 Symptoms: low plasma levels of K 49 nausea, vomiting, 50 listlessness, apprehension, muscle weakness, paralytic ileus, hypotension, tachycardia, arrhythmia and an altered electrocardiogram. The heart may stop in diastole. 33

34 K excess --- Hyperkalemia A frequent complication in renal failure, in severe 51 dehydration, following too rapid parenteral administration of K and in adrenal 52 insufficiency. 34

35 Symptoms: parenthesis of the scalp, face, tongue and extremities; muscle weakness; poor respiration; 53 cardiac arrhythmia; and changes in the electrocardiogram. Therapy: Low K Low protein Liberal CHO diet 35

36 K 正常成人經由每天排泄陽離子的量等於攝取的量減去糞便和汗液流失的量, 來維持體內鉀離子平衡調節鉀在體內的機制 1. 細胞內的鉀含量常攝取高鉀飲食, 在細胞中的鉀濃度會上升, 36

37 2. Aldosterone 刺激遠曲小管 Na 的再吸收, 同時增加鉀的排泄刺激 Aldosterone 的生成和釋放 1) 血漿中鉀濃度的增加 2) 減少腎臟灌注壓 3) 腎素 - 血管收縮素 -Aldosterone 途徑 37

38 3. 集尿管為腎臟對鉀保留的第 3 個機制在此區域會主動的再吸收成對的 H +, 並且將其分泌 K + 從尿液移動進入到集尿管細胞, 並且經由 H + /K + - ATPase 將 H + 移動到相對的位置 38

39 Food sources meats, poultry, fish fruits--- bananas, oranges, tomatoes, grapefruit vegetables--- potatoes, carrots, celery whole--- grain cereal 39

40 III. Chloride (Cl - ) Absorption: rapidly, almost complete Excretion: chiefly in urine, parallels intake and parallels the excretion of Na 40

41 *Chloride shift: Between the RBC and the plasma is a mechanism whereby changes in 54 ph are minimized. 41

42 Functions 1. Chief anion of 55 ECF. It is important in the regulation of osmotic pressure water balance and acid-base balance. 42

43 2. As a part of 56 HCl. Cl is necessary to maintain the normal acidity of stomach contents. 43

44 3. Enzyme activator 44

45 Deficiency symptoms Causes: repeated vomiting 57 diarrhea heavy perspiration diet) decreased intake ( on severe Na-reduced 45

46 Symptoms: metabolic 58 alkalosis low level of Cl in the blood failed to 59 gain weight constipation 46

47 Acid Formers and Base Formers Acid-forming On oxidation Phosphorus Sulfur Chloride Foods Meats, poultry, fish Eggs Cereal products Bread Corn Some fruits, plums Base-forming On oxidation Elements Sodium Potassium Calcium Magnesium Most fruits 60 Vegetables 61 Milk Nuts 47

48 Summary Electrolytes is an essential and major component of all living matter 48

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