Detoxification

what is detoxification?

removal of toxic substance from the human organism to promote homeostasis

what are the attributes of detox?

hepatic and renal

what is the scope of detox

← impaired detox — normal function — hyperfunction (too good in metabolizing)

What does renal function regulate?

• fluid volume

• acid-base balance

• electrolytes

• removes of wastes and urine production

what else can renal function affect?

hormones and immune regulation

what does hepatic function regulate?

• breakdown of toxins, chemicals, medications, hormones

• metabolism of cards, fats, proteins

• production of clotting factors → storage of vitamins

• bile secretions

What is nitrogenous waste?

ammonia → urea (excreted) → uric acid (excreted)

azotemia

build up of BUN and creatinine

uremia

buildup of all wastes

Liver → detox and convert

• ammonia → urea

• drugs → metabolites

• hemoglobin → bilirubin

  • into water-soluble wastes

bloodstream → filter and remove

• filter blood (glomerulus

• keep what body needs

• sends waste to urine

if problem is in the liver:

toxins not converted, findings:

• high ammonia → confusion

• high bilirubin → jaundice

if problem is in the kidneys

wastes NOT excreted, findings:

• high BUN/creatinine

• low urine output

if both fail in liver and kidneys

• rapid toxin build up → emergency

  • no → liver problem

• is the toxin being eliminated

  • no → kidney problem

problems with the liver

ammonia accumulates → not converted to urea

problems with the kidneys

urea and creatinine accumulate → not eliminated from the body

waste products can be

toxic to the body in high concentrations

infants/toddlers/ children

• immature systems, may see jaundice

• child dosing of meds, some meds avoid

older adults

• organ function declines at 40 yrs

• increase r/o of issues with meds (nephro and hepatotoxicity)

what are diseases of liver or the kidneys

cirrhosis, hepatitis and chronic kidney disease

Chronic conditions that may damage liver/kidneys

• heart failure, diabetes → kidneys

• medications (nephro and hepato toxicity)

• chronic alcohol use

Ammonia is easy to cross

blood-brain barrier and cause neuron dysfunction (hepatic encephalopathy)

Ammonia can cause

asterixis, changes in personality, agitation, restlessness, impaired judgement, slurred speech → incoherence, confusion, disorientation

early signs of uremia?

nausea, apathy, weakness, fatigue

what can urea/creatinine lead to

mental status changes, decline in cell/organ function, and multisystem effect