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Therapeutic Uses Post Date: Thu, 16 Oct 2008 14:49:05 +0000 Water is a true physiological diuretic. The mechanism of water diuresis is fully discussed in connection with the antidiuretic hormone of the posterior pituitary {see Chapter 40).Therapeutic Uses. Autor of the post: Undefined There are many other circumstances Post Date: Thu, 16 Oct 2008 14:29:09 +0000 Although one seldom regards water as a therapeutic agent, it is often essential to limit or to force fluid intake. The problems of water administration associated with parenteral alimenta-tion are discussed in Chapter 36. There are many other circumstances when one must regulate the volume of fluid intake. Autor of the post: Undefined On the other hand Post Date: Thu, 16 Oct 2008 14:10:15 +0000 For example, it is often de-sired to attain a given concentration of certain uri-nary antiseptics in the urine. This can be accom-plished by restricting the ingestion of water to a specified amount. On the other hand, when drugs irritating to the urinary tract or of limited solubility are being employed, a higher water intake permits their excretion in sufficiently low concentrations to avoid renal damage. Autor of the post: Undefined For a long time it Post Date: Thu, 16 Oct 2008 13:52:41 +0000 In addition, with many sub-stances, either endogenous such as urea, or exo-genous such as drugs or their metabolites, the rate of excretion is partially dependent on the rate of urine flow.A fundamental problem concerns water intake in edematous individuals. For a long time it was advo-cated that water should be restricted when edema fluid was present, in the belief that the ingestion of water contributed to edema formation. Autor of the post: Undefined Under certain circum-stances, the administration Post Date: Thu, 16 Oct 2008 13:34:30 +0000 It is now generally agreed that the intake of extracellular elec-trolyte rather than of water is of primary importance in this regard and that, if sodium salts are restricted, under most circumstances little is gained by the simultaneous restriction of water.SODIUM SALTSSodium salts occupy a unique position among diuretic salts. Under certain circum-stances, the administration of sodium salts plays an important and irreplaceable role inassuring and promoting an adequate flow of urine. Autor of the post: Undefined Thesource Post Date: Thu, 16 Oct 2008 13:15:26 +0000 However, in other situations, the re-striction of sodium intake is of paramount importance.Renal Excretion of Sodium Salts. Thesource of the glomerular filtrate is extracellular fluid. Autor of the post: Undefined Conversely, an excessive reabsorption Post Date: Thu, 16 Oct 2008 12:55:44 +0000 The predominant cation of extracellular fluid is sodium; the predominant anions are chloride and bicarbonate. If the kidneys were to excrete sodium salts excessively with a concomitant loss of water, a rapid reduction in extracellular fluid volume would result. Conversely, an excessive reabsorption of sodium salts and water would soon result in overwhelming edema. Autor of the post: Undefined The anionic compo-sition Post Date: Thu, 16 Oct 2008 12:37:25 +0000 The average intake of sodium chloride is approximately 10 g daily, and this amount must be excreted in the urine to maintain electrolyte balance and the constancy of the extracellular environment.The several processes by which sodium is reabsorbed have been outlined in the intro-duction to Section VIII. The anionic compo-sition of the tubular fluid may also be of importance. Autor of the post: Undefined Electro-neutrality is preserved Post Date: Thu, 16 Oct 2008 12:22:32 +0000 If there is a high concentration of anion to which the tubule is impermeable, the amount of cation reabsorbed necessarily decreases; a large fraction of this cationic component is usually sodium. Current inter-pretations of the electrochemical gradient indicate that active transport of Na+ is the primary event in most of the tubule except the ascending limb of the loop of Henle, where CI" is actively reabsorbed. Electro-neutrality is preserved by the diffusion of the oppositely charged ion, or in certain instances by cationic exchange. Autor of the post: Undefined The absolute amount reabsorbed Post Date: Thu, 16 Oct 2008 12:08:40 +0000 Since the mechanisms involve active transport, limitations in tubular capacities are presumed to exist. However, the exact relationship of filtered load to the amount reabsorbed is complex and incompletely understood. The absolute amount reabsorbed in the proximal tubule varies with the amount filtered, the plasma concentration, and the extracellular fluid volume. 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