Water and Electrolyte Imbalance and Homeopathy

BODY WATER IN HEALTH: - Water accounts for 60% of the body weight in the men and 50% in the women. The body water is distributed in two compartments ----

1. Intra-cellular (ICF).
2. Extra-cellular (ECF).

The proportion of Intracellular water to extra cellular water is 2:1. Extra cellular compartment has 2 components ----

1. Intra-vascular (i.e. Plasma).
2. Extra-vascular or Interstitial (i.e. tissue fluid, lymph).

The proportion of Interstitial to Intracellular water is 3:1. Taking all these facts into account the total body water in a male, weighting 72kg is 42 liters and its distribution ----

Total Body Weight	100%	70 kg
Total body water Intra cellular water Extra cellular water  Interstitial water Plasma	60% 40% 20% 15% 5%	42 liters 28 liters 14 liters 10.5 liters 3.5 liters

Water in these compartments continually interchanges positions but this interchange does not necessarily alter the net amount of water in each compartment. Infact, in health, this partition of water is remarkably constant. However body water is never stagnant as there are normal daily water losses (output) and allowances (intake). The daily turn over of water in health is about 2.5 litres as follows –----

1. Water Intake –
   1. Exogenous: -
      1. Water taken as drinks – 1200 ml.
      2. Water (moisture) in solid food – 1000 ml.
   2. Endogenous: - i.e. water librated during oxidation of food – 300 ml.
2. Water Output –
   1. Urine – 1500 ml.
   2. Fæces – 100 ml.
3. Insensible loss –
   1. Drying of Skin (insensible perspiration) – 500 ml.
   2. Drying of Respiratory Epithelium – 400 ml.

Several facts deserve special attention in this respect

1. The amount of water taken as liquid and that as solids is unknowingly, almost the same. Hence, a patient, kept on fluids only, should consume double the amount of his normal liquid intake.
2. In health and in the absence of visible sweating, a rough estimate of daily water turnover may be made by adding one litre to the urinary output.
3. Children require greater quantity of water in comparison to their body weight because of several reasons ----
   1. They have a large body surface area per unit of body weight.
   2. There is a greater metabolic activity because they are growing.
   3. Their immature kidneys (only the neonates) have poor concentrating ability.
4. About 8000 ml of fluid is secreted daily in the bowel lumen as digestive juices but almost the whole of this amount is reabsorbed from the gut, except a merge amount of 100 ml which is expelling stools.

ELECTROLYTE BALANCE IN HEALTH: - When inorganic salts are in solution (as in body fluid) they dissociates into two types of ions -----

1. Anions.
2. Cations; and these are collectively known as Electrolytes. Ions are charge particles and they may be ----
   1. Atom (e.g, Na+, Cl-).
   2. Larger Radicals.
   3. Molecules (e.g. Protein).

Cations are positively charged and Anions are negatively charged and one positive charge is equivalent to one negative charge.

Chemical composition of Body fluid components (mEq / L)

A N I O N	Component	Plasma	Interstitial fluid	Intracellular fluid
	Cl-	103	114	NIL
	HCO3-	27	30	10
	HPO4-	02	02	100
	SO4-	01	01	30
	Organic Acids	05	05	NIL
	Proteins	16	01	60
	TOTAL	154	153	200

 

C A T I O N	Component	Plasma	Interstitial fluid	Intracellular fluid
	Na+	142	144	10
	K+	04	04	150
	Ca++	05	03	NIL
	Mg+	03	01	30
	TOTAL	154	153	200

 

The maintenance of the volume and distribution of body fluid i.e. HOMŒOSTASIS.

SODIUM – It is predominant electrolytes of the extra cellular fluids, and has specific biological effects to conserve the isotoxic equillibrium. Thus it maintains the volume of fluid in the interstitial spaces and has been called “Osmotic Stuffing”. After any stress and injury, as a result of Adenocorticoid activity, the output of sodium is reduced to nil.                                                  
The average daily intake of sodium is 100 mEq, available from 6gm of common salt. The total body sodium amounts to 5000 mEq; of which 44% is in ECF, only 09% in the ICF and 47% in the bone.
A sodium depleted person must be dehydrated and he cannot be rehydrated unless sodium deficiency is simultaneously corrected. Conversely, retention of sodium is usually associated with over-hydration, manifested as œdema, necessitating the use of diuretics to increase elimination of sodium salts in the urine. In case of sodium retention, the plasma level is seldom above 150 mEq/litre.

Potassium – The total body potassium amounts to approximately 3,500 mEq. It is the predominant cation of the ICF. 98% of the body K+ is intra-celular and only 2% is extra-cellular; 75% of the potassium is in the muscles. The average daily intake of potassium is about 75 mEq/L – available from 03 gm of potassium chloride.                                                                               
Dietary potassium is chiefly derived from animal and plant tissue as well as fruits and milk. The normal functions of potassium are maintenance of ----

1. Water and electrolyte balance.
2. Osmotic balance.
3. Muscular Irritability. The most important vital action is its effects on moderating the contractility of the Heart muscle opposing the action of calcium, which enhances its contractility and helps on the conduction of Nerve impulses.  

Abnormal level of potassium may be result from various causes producing disturbances of normal Acid-base, water &electrolyte balance, e.g.

• Diabetic Keto-acidosis (DKA).
• Prolong vomiting.
• Diarrhœa.
• Hæmorrhage.
• Excessive loss of fluid from fistula.
• Adreno-cortical insufficiency.
• Renal failure etc.

DISTRIBUTION IN WATER & ELECTROLYTE BALANCE

In deciding the causes, effects and management of these disturbances certain basic facts require attention.

1. Of the three body fluid compartment viz. intravascular, interstitial and intracellular, body is primary aim is to maintain intravascular volume.
2. The intracellular fluid contains very little sodium; but very high amount of potassium and the ECF (both intracellular &interstitial) just the reverse.
3. The level of body water and sodium run hand in hand, potassium not so. Depletion of water (dehydration) is usually (but not always) associated with a fall in the sodium level and vice versa.

Taking into account all these facts, disturbances in water and electrolyte balance may be of the following types -----

Total body water depletion	–	DEHYDRATION.
Total body water excess	–	OVER HYDRATION.
Sodium depletion	–	HYPONATRÆMIA.
Sodium excess	–	HYPERNATRÆMIA.
Potassium depletion	–	HYPOKALÆMIA.
Potassium excess	–	HYPERKALÆMIA.

Total Body Water Depletion ( Dehydration)

"Dehydration or pure water deficiency is a state of deprivation of water without corresponding loss of Electrolyte”.  Pure water deficiency is less common than salt depletion but can occur in the following conditions ----

1. Deficient water intake e.g. in Dysphasia, Obstructive lesion in Œsophagus, Intense weakness, Coma.
2. Excessive loss of water e.g. in Diabetes Insidious, Hyperparathyroidism, Pyrexia, Hyperpnœa; and manifested as ----
   1. Intense thirst.
   2. Oliguria.
   3. Weakness.
   4. Fever – This may be important feature of children.
3. Plasma Changes
   1. The level of plasma constituents, viz. sodium and proteins, are raised.
   2. However, Hæmoglobin concentration and Packed Cell Volume (PCV) unchanged because of loss of water from the RBC.
   3. The plasma urea level rise because of increased re-absorption of Urea by the renal tubules (can not because of renal failure).

Total body water excess (Over-hydration)

This is also known as Water Intoxications. Healthy individuals can safely take large amount of water because they react by correction directive i.e. excreting water without electrolytes. This is done by the glomeruli – increasing the GFR and the distal tubeless producing dilute urine.              
    Over-hydration i.e. retention of water in the system without sodium retention may occur as -----

1. Over hydration with Peripheral Œdema
   • ARF and CRF.
   • CCF.
   • Cirrhosis of Liver with Ascites.
2. Over hydration without Peripheral Œdema
   • Sudden absorption of large volume of water in the intra-vascular compartment as in ---
     1. Irrigating with plain water during transurethral resection.
     2. Repeated colonic wash out with plain water especially is cases of mega colon, which has much higher capacity of aborting water than normal colon.
     3. Impaired water  excretion by the kidneys, as in ---
        1. Syndrome of Inappropriate secretion of Anti Diuretics Hormone (SIADH).
        2. ADH secreting tumors.

It is manifested as -----

1. The features of impaired cellular function are most predominant with the brain cells feature depend on the absolute plasma sodium concentration and its rate of decline. Initially there is apathy, dizziness & headache with plasma sodium level below 160 mEq / L. There is confusion and drowsiness with further decline (<110 mEq/litre), convulsions & coma set in.
2. Plasma sodium level below 100 mEq / L. causes ---- 
   • Cardiac arrhythmias.
   • Ventricular fibrillation.
3. Nausea and vomiting.
4. Plasma Changes
   1. The plasma level of all electrolytes falls progressively because of dilution.
   2. There is also reduction of plasma proteins level.
   3. The PCV is reduced.

Electrolytes are minerals that are normally in the body. They are present in the food we eat and the fluid we drink. Electrolytes are essential for nerve and muscle function; but during warm weather months a lot of people loose electrolytes viz. Magnesium, Sodium and Potassium through perspiration.

Normally, electrolytes are replaced through healthy eating; but sometimes we need a boost during a bout of illness, after an intense workout or if we are experiencing dehydration or suffering from an electrolyte imbalance due to disease.

Women are especially at risk of electrolyte imbalance because the high level of estrogen in women’s brain makes it less adaptive to upward or downward shifts in the body’s amount of electrolytes.

KEEP WATER & ELECTROLYTE BALANCE

Hydration: LOW Electrolytes HIGH Hypernatræmia with dehydration. Likelihood: moderate. Weight is down a few pounds or more. Thirst is high, and salty foods taste bad. Mouth and skin are dry. Food acceptance is poor. Absence of urination. Causes: no access to water or voluntary restriction of water intake, body electrolytes concentrated by loss of water. What to do: Get access to water and drink.  Restrict electrolytes until weight is near normal.	Hydration: OK Electrolytes HIGH Hypernatræmia Likelihood: rare, transitory if water available. Weight is normal. Thirst is high, and salty foods taste bad. Mouth is not very dry. Causes: no access to water, or voluntary restriction of water intake, body electrolytes concentrated by loss of water. What to do: Drink to satisfy thirst, so that excess electrolytes are removed by sweating and urination. Restrict salt intake until excess is urinated and sweated out.	Hydration: HIGH Electrolytes HIGH Hypernatræmia with over-hydration. Likelihood: very rare. Weight is up a few pounds or more. Thirst is high, and salty foods taste bad. Possible mental confusion. Hands may be puffy. Shortness of breath, rapid heart rate. Food acceptance is poor. Causes: over-consumption of salt, probably from a combination of sources. What to do: Stop electrolyte intake, drink only to wet mouth until weight is normal.
Hydration: LOW Electrolytes OK Dehydration. Likelihood: common. Weight is down a few pounds or more. Thirst is high, and salty foods taste normal. Mouth is dry, food acceptance is poor. Skin is dry and may tent if pinched. May have dizziness on standing up. May have cramping. Mental performance may be affected. Causes: insufficient fluid intake. What to do: Drink sports drink with electrolytes or water.	Hydration: OK Electrolytes OK Proper hydration and electrolyte balance. Likelihood: common. Weight is stable or slightly down. Stomach is fine, food acceptance is normal. Mouth is moist (can spit) and skin is normal. Cramps: none. Urination is normal. Causes: proper water and electrolyte intake. What to do: Continue with hydration and electrolyte practice unless conditions change.	Hydration: HIGH Electrolytes OK Over-hydrated. Likelihood: moderate. Weight is up a few pounds or more Wrists and hands are probably puffy Stomach is queasy Thirst is low, and salty foods taste normal. Mouth is moist – can spit. Causes: fluid intake in excess of needs. What to do: Drink only to wet mouth until weight is near normal.
Hydration: LOW Electrolytes LOW Hyponatræmia with dehydration. Likelihood:  rare. Weight is down a few pounds or more. Thirst is high, and salty foods taste good. Mouth is dry, can’t spit. May have cramping Skin is dry and may tent if pinched. May have dizziness on standing up. Causes: insufficient drinking, no electrolyte intake. What to do: Take electrolytes and drink sports-drink or water.	Hydration: OK Electrolytes LOW Hyponatræmia Likelihood: mild form is common. Weight is normal. Stomach is queasy, with poor food acceptance. Wrists may be puffy. Salty foods taste good. Thirst is normal. Mouth is moist – can spit. May have cramping. Causes: Insufficient electrolyte intake. What to do: Increase electrolyte intake until stomach feels ok. This information does not substitute for medical diagnosis or treatment.	Hydration: HIGH Electrolytes LOW Hyponatræmia with over-hydration. DANGEROUS! Likelihood: moderate. Weight is up a few pounds or more. Wrists and hands are puffy. Nausea, stomach sloshing, possible vomiting. Thirst is low and salty foods taste very good. Athlete may show mental confusion, odd behavior. Mouth is moist – can spit. Urination may be voluminous and crystal clear. Causes: over-hydration, insufficient sodium intake. What to do: Drink only to wet mouth until weight is normal, and then correct any sodium deficit.

 

 

Sodium Depletion (HyponatrÆmia)

• Because of the intimate relationship between salt and water balance, loss of sodium is usually associated with a reduction in the water content of the body.
• Hyponatræmia or sodium depletion is said to exist when the serum sodium level is < 130 mEq / L.

The causes are -----

1. GI loss – e.g.
   • Severe Vomiting.
   • Severe Diarrhœa.
   • Intestinal Fistulæ.
   • Gastric Aspiration.
   • Post-operative drainage.
   • Villainous Adenoma of Rectum.
2. Renal loss – e.g.
   • Nephritis.
   • Renal Tubular Acidosis.
   • Renal Failure.
   • Diabetes Mellitus.
   • Addition’s Disease.
   • Hypopituitarism.
   • Excessive diuretics.
   • Mannitol therapy.
3. Sick Cell Syndrome or Essential Hyponotræmia.
4. Cutaneous loss – e.g.
   • Excessive Sweating.
   • Burns.
   • Muco-viscidosis.

In normal individuals, about 8-10 litres of GI secretion take place in 24 hours with their electrolyte composition as -----

Type	Amount	Na+(mEg/L.)	K+(mEg/L.)	Cl- (mEg/L.)
Saliva	1500 cc	100	05	75
Gastric Juice	2500 cc	60	10	100
Bile	500 cc	140	20	100
Pancreatic Juice	700 cc	140	20	75
Intestinal Juice	3000 cc	100	20	100
Total	8200 cc	540	75	450

5. Excessive ADH stimulation by drugs viz. Barbiturates, Haloperidol, MAO inhibitors, Laxative, Imipromine, NSAIDS and disease viz.
   • Tuberculosis.
   • Lung Abscess.
   • Bronchogenic Carcinoma.
   • Cerebral Tumour.
   • Head Injury.
   • Encephalitis.
   • Carcinoma of Prostate & Pancreas.
   • Cirrhosis of Liver.
   • Heart Failure
   • Cyephritic Syndrome.
6. Through Lungs as in Pulmonary Ademmatosis.
7. Loss of Na+ through serous cavity by repeated Paracentesis.
8. Hypothyroidism.
9. Idiosyncratic reaction to diuretics & ACE inhibitors.
10. Beer potamania (intake at least 8 L /day).
11. Psychogenic Polydipsia (Urine Na+ is elevated > 20 mEg / L and urine osmolarity < 300 mosm per kg of body weight).

Hyponatræmia may be of 3 types ----- Isotonic Hyponatræmia, Hypotonic Hyponatræmia and Hypertonic Hyponotræmia.

Clinical Features: -

• Weakness.
• Extreme apathy.
• Tiredness.
• Lassitude.
• Nausea.
• Vomiting.
• Anorexia.
• Muscular cramps.
• Loss of elasticity of skin.
• Cold extremities.
• Fall of BP and fainting.
• Convulsive seizures.
• Mental confusion.
• Headache.
• Giddiness and finally coma may develop.
• Thirst absent.
• Skin tugour & elasticity may disappear.

Clinical symptoms are aggravated after drinking pure water.

Investigation: -

• There is hæmo-concentration; MCV high and MCHC level is low.
• Na+ level low; Blood Urea & K+ may rise.
• Urinary Na+ is low but in SIADH a high level may be seen.

Sodium Excess (HypernatrÆmia)
Hypernatræmia is said to exist when serum sodium is more than 145 mEq/L. It may result from less renal excretion of sodium or from various other causes of œdema originating from Renal, Cardiac, Hepatic or Nutritional disease. Decrease in body water and increase in body sodium; specific condition in which Hypernatræmia occurs are ------

1. Simple Dehydration: - This occurs as a result of excessive sweating with inadequate or no water replacement. Body is continuously losing water through lungs. There is a limit to which kidneys can con conserve the urine. Even under great restrictions 500 ml. of urine in lost. As the water loss keeps on increasing – kidneys cannot excrete more amount of Na+ in the urine and as a result serum Na+ level rises up. At this stage even though there is high sodium in urine; and total body sodium is low.
2. Diabetes Insipidus: - A special type of water loss occurs in diabetes insipidus. This disease is characterized by lack of ADH or failure of the hormone to act on its target cells. It occurs usually as a complication of pituitary surgery when hormone is not produce is adequate amount.
3. Miscellaneous: -
   • Hypokalæmia.
   • Hyperkalæmia.
   • Sickle Cell Anæmia.
   • Nephrogenic Diabetes Insipidus.
   • Premenstrual phase.
   • During Pregnancy.
   • Hypoproteinæmia.
   • Beri beri.
   • Idiopathic Cyclic Œdema.
   • Chronic Starvation.

Clinical Features: -

1. Swelling of the body.
2. Accumulation of fluid in various serous sacs.
3. Weakness.
4. Oliguria.
5. If there is severe hyperosmolarity, the manifestations may be -----
   • Delirium.
   • Hyperpyrexia.
   • Coma.

ROLE OF NATRUM MUR. & NATRUM SULPH. IN FLUID METABOLISM

Natrum Mur. (NaCl)

Natrum Sulph.

Attract water. It attracts water c is to be utilized in the system. Find insides the cells. By its action cells are multiplied. Nat. mur. is formed inside the cells by attracting nascent chlorine from outside.

Attract water. It attracts water which has been used up and is to be thrown out of system. Found not inside the cells but in ICF. By its action water is removed from outside fluids; thus, Hydamia etc. are prevented. Nat. sulph. has action on the nerves which carry the impression to the brain, as in passing urine, water is thrown out by muscular action. Without this salt, brain will not have the consiousness of throwing out excess quality of water in urine.

 

Potassium is the most important action of the cell 98% of the body potassium is actually intracellular at a concentration of about 160 mmol/L. Extra cellular concentration is about 3.5 to 5 mmol/L. Its major role is in the membrane activity of cell and muscle extraction.

POTASSIUM DEPLETION (HYPOKALÆMIA)

A total deficient of about 350 mEq results from decrease of each 1 mEq/L of serum concentration below a level of 4 mEq/L. The causes are ----

1. Gastro-intestinal:
   • Severe Diarrhœa.
   • Vomiting.
   • Fistula.
   • Continuous gastric or intestinal aspiration.
   • Anorexia nervosa.
   • Starvation.
   • Chronic Hepatic Failure (HE).
2. Renal:
   • Potassium loosing Nephropathy.
   • Nephrotic Syndrome.
   • Renal tubular Acidosis.
   • Cytotoxic drugs.
3. Metabolic:
   • Diabetes Mellitus.
   • Metabolic Alkalosis.
   • Hypomagnesæmia.
   • Respiratory Alkalosis.
4. Endocrinal:
   • Cushing’s Syndrome.

POTASSIUM EXCESS (HYPERKALÆMIA)

The causes are ----–

1. ARF.
2. Sickle Cell Anæmia.
3. Addison’s Disease.
4. Hypoaldosteronism
5. Depletion of Na+ or Ca++ salt.
6. Acidosis.
7. Circulatory Failure.
8. Burn.
9. Severe Exercise.
10. Hyper-osmolairty.

HOW TO PREVENT FLUID ELECTROLYTE IMBALANCE – INSTRUCTIONS

1. Incorporate proper hydration. Drink 6 to 8 glasses of fluid daily. This includes water, coffee, juices and other liquids. Either too much or too little fluid can result in an electrolyte imbalance. Don’t drink so much liquid that you dilute the concentration of sodium in the blood or so little that the concentration is elevated.
2. Do not ignore the need to replace electrolytes after an illness. Replace any electrolytes that you loss during your illness, especially when it prevented you from eating properly, exercising, or taking vitamins and mineral. A sickness that interferes with mobility and takes away the appetite causes a gradual depletion of electrolytes, such as sodium. Sodium is essential in maintaining a fluid balance in the cells; it also keeps the muscles in proper working order. Get a blood test to confirm suspicions of an electrolyte loss; ask the physician if it is okay to take an electrolyte supplement to restore balance.
3. Limit or avoid over the counter medications (OTC). These drugs deplete and/or reduce electrolytes in the body causing them to fall too low. A condition that causes an imbalance in electrolytes, which results in poor health. Stop taking aspirins and other OTCs if there is dizziness, cramping or nausea. Consult the physician right away to determine if these minerals are too low.
4. Do not drink too much or too little fluid during exercise or over-exertion. Consult physician about an electrolyte supplements if your exercise routine is intense, such as that of a weight lifter, runner or exercise instructor. Get regular checkups and follow physician’s advice.
5. Eat a balanced and healthy diet or foods that build the body, viz. whole grains, legumes, fresh fruits, vegetable and salmon. A proper diet enhances the electrolytes and maintains proper functioning of the electrolytes, e.g. pH balance, osmosis and minerals.
6. Take a good quality multivitamin and mineral to stay healthy and get the vitamins and mineral that your body needs to maintain an electrolyte balance. Make sure that sugar, starch, additives and corn are not among the ingredients in your supplements, as this is counter-productive. Take vitamin daily with food to promote health. If skip a day, get back on schedule, but do not double the dosage; many physicians consider vitamins medicine, so treat it like a medicine and take it as prescribed.
7. Magnesium sulphate or Epsom salt allows the minerals to soak directly into the body’s pores, instantly replenishing needed electrolytes. Use 2 cups of Epsom salt in a warm bath weekly.

 

Magnesium level in serum is about 1.9 – 2.5 mg% (1.5 – 1.8 mEq / L. of which 1/8 is bound to proteins and 2/3 remains as free cation.)

MAGNESIUM DEPLETION [HYPOMAGNESÆMIA]  
The causes are ----

• Prolonged Diarrhœa.
• Vomiting.
• Malabsorption Syndrome.
• Cirrhosis of Liver.
• Kwashiorkor.
• Alcohalism.
• Chronic Malnutrition.
• Hyperparathyroidism.
• Hungary Bone Syndrome.
• Diabetic Coma.
• Eclampsia.
• Convulsion.
• Epilepsy.

Clinical Feature: Neuro-muscular irritability, Muscle cramp, Tetany, Convulsion, Nystagmus, Depressed Babinski’s Sign.

MAGNESIUM EXCESS [HYPERMAGNESÆMIA]
The causes are ----

• ARF & CRF.
• Excess use of magnesium as cathartics.

Clinical Features:

• Apathy, drowsiness and coma may develop.
• Motor weakness, flaccid paralysis, urinary retention.

Importance of Magnesium Mineral as Homœopathic Medicine:

• Magnesium is the stress element. Under stress it fails to be recycled by the kidneys and is lost to urine.
• It is suggested that Natrum muriaticum restore Magnesium uptake in the distal kidney tubules; Calcarea carbonica in the proximal tubules and Magnesium muriticum in the loop of Henley.

These details need confirmation, but we believe that remedies regulating magnesium metabolism should be supported by Magnesium supplements whenever Magnesium loses are suspected and whether stress or physiological induced.

HOMŒOPATHIC MANAGEMENT

1. In most cases, replacing lost fluid to prevent dehydration is the only treatment necessary. Medicines that stop diarrhœa may be helpful in some cases, but they are not recommended for people whose diarrhœa is from a bacterial infection or parasite, stopping the diarrhœa traps the organism in the intestines, prolonging the problem. Instead, physicians usually prescribe antibiotics. Viral causes are either treated with medication or left to run their course, depending on the severity and type of the virus.
2. In adults with diarrhœa, it may help to drink plenty of fluids to avoid becoming dehydrated. Adding bulk to the diet may thicken the stool and decrease the frequency of stools. Certain foods thicken the stools, including rice, bananas, yogurt and cheese. An increase in fibre from whole-wheat grains and bran add bulk to the diet.
   

Preventing Dehydration – Dehydration occurs when the body has lost too much fluid and electrolytes (the salts potassium and sodium). The fluid and electrolytes lost during diarrhœa need to be replaced promptly, the body cannot function properly without them. Although water is extremely important in preventing dehydration, it does not contain electrolytes. To maintain electrolyte levels, one could have broth or soups, which contain sodium; and fruit juices, soft fruits or vegetables, which contain potassium.

Tips About Food – Until diarrhœa subsides, one should try to avoid milk products and foods that are greasy, high-fibre or very sweet. These foods tend to aggravate diarrhœa. When improved, one can add soft, bland foods to the diet, including bananas, plain rice, boiled potatoes, toast, cooked carrots and baked chicken without the skin or fat.

Traveller’s diarrhœa happens when one consumes food or water contaminated with bacteria, viruses or parasites. One can take the following precautions to prevent traveller’s diarrhœa when abroad ---

• Do not drink any tap water, not even when brushing your teeth.
• Do not drink unpasteurized milk or dairy products.
• Do not use ice made from tap water.
• Avoid all raw fruits and vegetables (including lettuce and fruit salad) unless they can be peeled or peel them oneself.
• Do not eat raw or rare meat and fish.
• Do not eat food from street vendors.

One can safely drink bottled water, carbonated soft drinks and hot drinks like coffee or tea. Depending on where one is going and the period of stay, the doctor may recommend some preventive medicines before leaving to protect one from possible infection.

Recommended Homœopathic Medicines

• Dehydration:
  1. Abrotanum.
  2. Arsenic album.
  3. Camphor.
  4. Carbo vegetabilis.
  5. China.
  6. Cuprumv metallicum.
  7. Phosphurus.
  8. Veratrum album.
     
     
• Hypokalæmia:
  1. Kali phos. – till the potassium reaches its normal level; in lower potencies.
  2. In dropsy, Digitalis, when Acetic acid and Blatta orientalis fails to improve.
  3. In Scarlatina & Albuminuriæ, Apis mellifica is the choice of remedy
     
     
• Hyperkalæmia: Gelsimium is the principle remedy.

“Never use salt of Potassium when there is a fever” – Dr. Timothy Field Allen.

The sphere of actions of Potassium group of medicines -----

1. It influences the muscular activity.
2. Involved in Acid Base Balance.
3. It has important role in cardiac functions.
4. It acts as a co-factor.
5. Involved in neuro-muscular irritability.

Dr. E. A. Farrington and Dr. C. Hering recommended their chief use in muscular weakness, paresis and exhaustion as accompanies convalescences from major diseases.

• Diarrhœa:
  • In Acute Diarrhœa (according to Raibahadur Bisamber Das) Aconite – if 2 or 3 doses fail, then, Ipecac. When it fails, Pulsatilla  and Nux vomica alternately. If still diarrhœa persists, Phosphorus is to be administered. When it fails, Arsenic album is to be prescribed. If Ars-alb. fails, Veratrum album is recommended.
  • In Chronic Diarrhoea; according to Dr. E. B. Nash, Nitric acid is the best medicine. According to Dr.  P. Banerjee, Chapparo 30, Nitric acid 30, Aloe Socotrina 30  four times daily is very effective.

ACID-BASE BALANCE

The intra cellular pH is about 7; but the pH of serum or interstitial fluid is about 7.4 (7.36 to 7.44) or 40 mmol/L. The latter is largely dependent on a closely integrated buffer system which consists of buffer acids and buffer alkalis.

• Disturbance  in Acid Base Balance 
  • Acidosis (Acidæmia).
  • Alkalosis (Baseæmia).
• Loss in the form of H2CO3
  • Respiratory Acidosis.
  • Respiratory Alkalosis.
• Loss of Hydrogen Gas
  • Metabolic Acidsis.
  • Metabolic Alkalosis.

ACIDOSIS	ALKALOSIS
An abnormal condition caused by the Accumulation in the body of excess acid or by loss of alkali from the body.	An abnormal condition caused by excess alkali accumulation or by loss of acid, in the body.
In Metabolic Acidosis, there is primary decrease of HCO3-. There is either no change or slight change in H2CO3 because of over-production and accumulation of non -volatile acids.	Metabolic Alkalosis. Increased of HCO3-.
Causes Uncontrolled DM with Ketosis. Renal Insufficiency. Anorexia. Hæmorrhage. Ether Aænsthesia. Prolonged Strenuous Exercise. HCO3- loss  by vomiting, renal diseases, poisoning, loss of intestinal fluid & electrolytes	Causes Excessive administrate of alkali. Intestinal Obstruction. Prolonged vomiting. Removal of Gastric Secretion. Cushing’s Syndrome. Cortisone administration (K+ deficiency).

 

RESPIRATORY ACIDOSIS	RESPIRATORY ALKALOSIS
Increased in carbonic acid content defect in respiratory system.	Decrease in carbonic acid content.
Causes   Morphine or Barbiturate poisoning.  Pulmonary Congestion or Fibrosis. Mechanical Obstruction of air passage. Breathing air with raised CO2 content. Pneumonia, Bronchial Asthma. Poor PFT.	Causes Prolonged Hyperventilation. Hysteria. Fever. Anorexia. High External Temperature. CNS diseases. Large dose of Sodium Salicylate.

HOMŒOPATHIC APPROACH IN THE WATER & ELECTROLYTE IMBALANCE

The Homœopathic system has curative medicine, though certain medicines have applied and the medicine proved their prophylactic effects too. The Homœopathy believes and practice on the dynamic plane. In certain cases it has also being proved that deficiency state can also be treated by the dynamic medicines i.e. Homœopathy.

Water and electrolyte imbalance are commonly seen in prolonged debilitated illness and in acute conditions, it is frequently found in loose motions, vomiting, pregnancy, high-grade fever etc. In such cases patient needs immediate care and the management and the quantitative replacement of electrolytes & water in the body.

Water loss can be resuscitate by the dehydration of the patient, either by the increasing oral intake; but if patient is not in condition to take fluid orally, parental route can be used for the replacement of fluids.

In the fluid therapy the following things should be carefully observed by the physician ----

1. How much fluid is required to the patient.
2. And the required quantity is given to the patient in how much time.

During the electrolyte imbalance and in the deficiency state, quantitative electrolyte replacement is needed.

But in the Homœopathic Practice it has been seen since long time that the Homœopathic medicines are competent to combat with this life threatening conditions successfully. The certain Homœopathic medicines which can be used during the electrolyte imbalance ------

1. Natrum muriaticum.
2. Kalium phosphoricum.
3. Natrum phosphoricum.
4. Magnesium phosphoricum.
5. Calcarea phsophorica.

These medicines are used in lower potency and with frequent repetition, till the requirement of patient become fulfilled.

These medicines are having tremendous result and capable to manage electrolyte imbalance in the body in the minimum time; and these medicines also help in the absorption of fluids in the body and thus prevents renal failure.

During the management and treatment of the electrolyte imbalance, the treatment of the causes is utmost important if the patient is suffering from electrolyte imbalance due to diarrhœal disease. In this case the treatment of the diarrhœa is simultaneously important with the management of the water and electrolyte imbalance. This principle is implemented with the every disease which are directly or indirectly causes of water & electrolyte imbalance in the body.

Quantitative loss is ever been treated by quantitative replacement of the deficient elements. By the medicines we can treat the disease which is responsible for the any sort of imbalance and the deficiency states.