Polio Biochemical changes in Urine
- 1. Biochemical Alterations and Mechanism for Changes in Urinary pH, Sodium, Potassium, Calcium and Phosphorous in Patients of Acute Poliomyelitis By: Samyek Napit Roll No. 66 NAIHS-COM, KTM
- 2. Urinary pH Normal pH of urine: 4.6 – 8 Average pH = 6 In poliomyelitis(spinal, bulbar, bulbospinal), pH of the urine drops below average values Hence, acidic
- 3. Mechanism of alteration of Urine pH: Tightness of intercoastal muscles, failure of diaphragm muscles, hypoventilation due to depression of respiratory centers Retention of CO2 in blood Respiratory Acidosis
- 4. • Acidity of the blood • more H+ ions are excreted in the urine ALSO,
- 5. Other factors responsible for increasing the pH:- 1. High phosphate level (excreted as NaH2PO4 ) 2. High NH4+ being secreted
- 6. K+ levels in urine Normal level of K+ ( on a regular diet ) 25 to 125 mEq/ liter per day In acute poliomyelitis: Rise in K+ until the serum K+ is low
- 7. Destruction of tissues Discharge of intracellular deposit of K+ into the extracellular fluid Blood is brought to the kidney In Kidney, K+ is conserved via Potassium- Hydrogen exchanger
- 8. BUT, K+ levels are too high Result: Potassium concentration in urine is high
- 9. Poliomy • Bulbar elitis Blood • Increase Pressur e • More conservation K+ or Na+
- 10. Na+ Levels in Urine Normal Values 40-220 mEq/liter/day BUT, Varies with diet and level of aldosterone hormone
- 11. In Acute Poliomyelitis Marked drop in excretion of Na+ via urine (however, Na+ is lost via extra- renal channels) But depends on the hydration of the patient
- 12. In case of poliomyelitis, the serum Na+ is elevated only slightly Blood reaching the kidney is only slightly elevated in Na+ level Furthermore, the Na+ is conserved by the kidney by using Na+-H+ exchanger RESULT: Na+ excretion is low
- 13. Ca++ Levels in Urine Normal On normal diet = 100-300 mg/day On calcium low diet= 50-150 mg/day In Poliomyelitis: gradual increase in Ca++ level
- 14. Changes in Calcium level and Phosphorous level Acute Poliomyelitis is at times accompanied by paralysis(flaccid) Disuse of the part (esp. limbs) Loss of balance between the osteoblastic and osteoclastic activity
- 15. Demineralization
- 16. Left:X-Ray of pelvis and femur on the first month of onset of disease Right:X-ray of pelvis and femur after the six months of illness
- 17. Left:X-Ray of tibiae on the first month of onset of disease Right:X-ray of tibiae after the two months of illness
- 18. Increase in serum Ca++ and PO4- Other causes for Ca++ -Hypoalbuminemia Increased excretion of Ca++ and PO4- in urine
- 19. High levels of Ca++ can lead to renal stones, Nephrocalcinosis Loss of Ca++ and PO4-leads to loss of flexibility of bone(loss of water via hydroxyapatite) and osteoporosis Further complications of Poliomyelitis
- 20. Knowing about the levels of Na+, K+ ,Ca++, PO4-can help in learning about the stage of the disease
- 21. References: Nelson’s Textbook of Pediatrics, 19th Edition
- 22. THANK YOU!