Metabolic%20%26%20Toxic%20Disorders%20v5%20-%20Student%20Copy

Metabolic%20%26%20Toxic%20Disorders%20v5%20-%20Student%20Copy

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10/8/09 1 1 Metabolic & Toxic Disorders of the Nervous System Anthony D. Nicholson BSc. (Qld.), M.Chiro. (Macq.), DACNB. Spine Partners Wahroonga Wahroonga Specialist Centre 13/176 Fox Valley Road Wahroonga NSW 2076 www.spinepartners.com.au Chief Executive Officer Chiropractic Development International 13/176 Fox Valley Road Wahroonga NSW 2076 www.cdi.edu.au 2 Topic Overview 1. Overview of neurophysiology 2. Respiratory alkalosis & acidosis 3. Neurological complications of blood disease 4. Neurological complications of liver disease 5. Neurological complications of renal disease 6. Neurological complications of thyroid disease 7. Neurological complications of parathyroid disease 8. Neurological complications of diabetes 9. Neurological complications of collagen disease 10. Summary 11. Clinical Cases
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10/8/09 2 3 Learning Objectives 1. Understand and explain the effect of changes in electrolytes and ion balance in the ECF and blood on neurological function 2. Understand the major determinants of the firing threshold of neurons 3. Understand the explain the mechanisms and neurological effects of respiratory alkalosis & acidosis 4. Understand specifically the relationship between Calcium levels and neural activation 5. Develop a basic understanding of the neurological complications of disease of the blood, liver, kidneys, thyroid and parathyroid glands, and pancreas (such as diabetes) 4 Concepts To function neurons need: 1. Oxygen 2. Glucose 3. Activation
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10/8/09 3 5 Concepts Neuronal function can be impaired by: Physical compression Ischemia Change in ionic concentration of EC fluids Decreased activation Decreased fuel supply - glucose 6 Overview of Neurophysiology Nernst looked at individual ions EP for Na+ is +60mV EP for K+ is –90mV Goldman asserted that relationship between ions must be taken into consideration as they don’t exist in isolation
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10/8/09 4 7 Overview of Neurophysiology Goldman equation gives rise to 2 rules: Membrane potential at rest most closely resembles the Nernst EP for the most permeable ion (which is K+) Membrane potential (at any time) will be affected most by changing the concentration of the most permeable ion (K+ at rest & Na+ during activation) 8 Overview of Neurophysiology Changing the concentration of ions in the system will affect neural summation So at rest neurons are most sensitive to changes in [K+] If we decrease EC [K+] what will happen to the membrane potential? More K+ will try an exit to re-establish equilibrium – causing hyperpolarization This becomes relevant for patients on diuretics – need K supplements else could fall into coma
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10/8/09 5 9 Overview of Neurophysiology If increase EC [K+] inside of cell shifts towards positive state – neuron activates more easily (hypopolarized) If shifted too close to threshold MP can be obliterated causing failure of the system – e.g. KCL injection causing heart failure [Na] has no impact at rest 10
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Metabolic%20%26%20Toxic%20Disorders%20v5%20-%20Student%20Copy

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