체액의 수분 및 나트륨 균형
Water and Sodium Balance of Body Fluid
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초록
1. 나트륨은 세포외액의 유효삼투압을 형성하는 가장 중요한 용질이며, 수분 밸런스의 이상은 혈중 삼투압의 변화와 혈중 나트륨농도의 이상(hyponatremia, hypernatremia)으로 발현된다. 2. 수분의 출입의 조절에 의하여 체액의 농도변화에 대처하는 과정을 수분 밸런스(water balnce) 혹은 수분 대사(water metabolism)라 하며, 세포외액량 특히 유효혈장량의 변화에 대처하여 체내 총 나트륨량의 출입을 조절하는 과정을 나트륨 밸런스(Na+ balance) 혹은 나트륨 대사(Na+ metabolism) 라 하고 그 차이점을 정리하면 Table 1과 같다. 3. 수분 밸런스의 가장 중요한 두가지 요소는 갈증반응에 의한 수분섭취와 항이뇨호르몬(AVP)에 의한 소변으로의 수분 배출이며, AVP의 분비의 강력한 자극은 삼투압의 변화와 유효혈장량의 변화이다. 4. 나트륨 밸런스는 나트륨 섭취욕구에 의해서는 큰 영향을 받지 못하며, 주로 신장에 의한 염분배출 조절에 의하며 이루어지고, 사구체 여과율과 알도스테론 분비가 신장의 나트륨 배설량을 결정하는 가장 중요한 인자이다.
Abstract
The maintenance of the osmolality of body fluids within a very narrow physiologic range is possible by water balance mechanisms that control the intake and excretion of water. Main factors of this process are the thirst and antidiuretic hormon arginine vasopressin (AVP), secretion regulated by osmoreceptors in the hypothalamus. Body water is the primary determinant of the osmolality of the extracellular fluid (ECF), disorders of body water homeostasis can be divided into hypo-osmolar disorders, in which there is an excess of body water relative to body solute, and hyperosmolar disorders, in which there is a deficiency of body water relative to body solute. The sodium is the predominant cation in ECF and the volume of ECF is directly proportional to the content of sodium in the body. Disorders of sodium balance, therefore, may be viewed as disorders of ECF volume. This reviews addresses the regulatory mechanisms underlying water and sodium metabolism, the two major determinants of body fluid homeostasis for a good understanding of the pathophysiology and proper management of disorders with disruption of water and sodium balance.
참고문헌 (24)
- Berl T, "Disorders of water metabolism in Renal and Electrolyte Disorders, 4th ed", pp.54~ (1997), Lippincott-Raven
- Vokes T, "Water homeostasis", Ann Rev Nutr, 7, pp.383~406 (1987)
- Fanestil DD, "Compartmentation of body water in Clinical Disorders of Fluid and Electrolyte Metabolism", pp.3~20 (1994), McGraw-Hill
- Verbalis JG, "Disorders of body water homeostasis", Best Pract Res Clin Endocrinol Metab, 17, pp.471~503 (2003)
- Ruth JL, "Body composition salt and water", Pediatr Rev, 27, pp.181~187 (2006)
- Verbalis JG, "Body water and osmolality in Nephrology", pp.89~94 (1997), Chapman & Hall Medical
- Simpson FO, "Sodium intake, body sodium, and sodium excretion", Lan, 2, pp.25~29 (1990)
- Fitzsimons JT, "Physiology and pathophysio–logy of thirst and sodium appetite in The kidney, Physiology and Pathophysiology", pp.1615~1648 (1992), Raven Press
- Stricker EM, "Water intake and body fluids in Fundamental Neuroscience", pp.1111~1126 (1999), Academic Press
- Robertson GL, "Thirst and vasopressin function in normal and disordered states of water balance", J Lab Clin Med, 101, pp.351~371 (1983)
- Thompson CJ, "The osmotic thresholds for thirst and vasopressin release are similar in healthy man", Clin Sci, 71, pp.651~656 (1986)
- Nielsen S, "Physiology and pathophysiology of renal aquaporins", J Am Soc Nephrol, 10, pp.647~663 (1990)
- Knepper MA, "Molecular physiology of urinary concentrating mechanism: regulation of aquaporin water channels by vasopressin", Am J Physiol, 272, pp.F3~F12 (1997)
- Phillips PA, "Angiotensin II-induced thirst and vasopressin release in man", Clin Sci, 68, pp.669~674 (1985)
- Robertson GL, "Posterior pituitary in Endocrinology and Metabolism", pp.385~432 (1995), McGraw-Hill
- Rowe JW, "Influence of the emetic reflex on vasopressin release in man", Kid International, 16, pp.729~735 (1979)
- Robertson GL, "The regulation of vasopressin function in health and disease", Recent Prog Horm Res, 33, pp.333~385 (1976)
- Dunn FL, "The role of blood osmolality and volume in regulating vasopressin secretion in the rat", J Clin Invest, 52, pp.3212~3219 (1973)
- Verbalis JG, "Body sodium and extracellular fluid volume in Nephrology", pp.95~101 (1997), Chapman & Hall Medical
- Wilkins L, "A great craving for salt by a child with cortico-adrenal insufficiency", JAMA, 114, pp.866~868 (1940)
- Orth DN, "The adrenal cortex in Williams Textbook of Endocrinology", pp.517~664 (1998), W.B. Saunders
- Baylis C, "Glomerular filtration in Nephrology", pp.25~33 (1997), Chapman & Hall
- Kirchner KA, "Sodium metabolism in Clinical Disorders of Fluid and Electrolyte Metabolsim", pp.45~80 (1994), McGraw-Hill
- Reeves WB, "Tubular sodium transport in Diseases of the Kidney and Urinary Tract", pp.135~175 (2001), Lippincott Williams and Wilkins