Fluids & Electrolytes

Nutrition Concepts and

Controversies (FNH 250)

I. Introduction: Water
l

water is essential to life

need more water each

day than any other
nutrient

~50-70% of body weight;

%body fat %water

is the body's transport,

reactive, and solvent
medium

I. Introduction: Water
l

there are different compartments of fluid in the

body
l INTRACELLULAR = inside cells (~25 Ltr)
l EXTRACELLULAR = outside cells
l INTERSTITIAL = between cells (~14 Ltr)
l INTRAVASCULAR = within bloodstream (~3
Ltr)
l DIGESTIVE JUICES

I. Introduction: Water
l

l
l
l

interstitial fluid is important for supplying nutrients

from the bloodstream to the cells and for removing
waste products from the cells to the bloodstream
if too much water enters cells, they rupture
if cells lose too much water, they collapse
water flows freely through cell membranes, following
minerals (ions)
ions and other nutrients easily dissolve in water
allowing the body to move fluids between body fluid
compartments

I. Introduction: Minerals
l
l

l
l

minerals represent about 4% of our body weight

some minerals act as CO-FACTORS = a mineral
element that, like a coenzyme, works with an
enzyme to facilitate a chemical reaction
when a mineral salt (e.g. NaCl) dissolves in water, it
separates into 2 ions (Na+ & Cl-); each ion is
surrounded by water molecules
an ion is a charged particle (ex. Calcium-Ca2+, IronFe2+, Chloride-Cl-, Fluoride-F-)
positively charged ions are called
negatively charged ions are called
5

I. Introduction: Minerals
l

common characteristics of minerals

l only source of inorganic nutrients in our diet
(aside from water)
l they retain their chemical identity, meaning they
don't change from the point of ingestion to the
point of excretion (no breakdown products)
l cannot be destroyed by heat, air, acid, or mixing
l they do not directly provide energy for the body

I. Introduction: Minerals
l

some minerals are readily absorbed, transported

freely and are excreted by the kidneys (e.g.,
Potassium-K); other minerals need special carriers
to be absorbed and transported (e.g., Calcium-Ca)

minerals taken in excess can be toxic

I. Introduction: Minerals
l

minerals have variable BIOAVAILABILITY the

ease at which a nutrient is absorbed
l

"binders" in food such as phytic acid in whole

grains and legumes and oxalic acid in vegetables
and fibres may combine with minerals (e.g.
Calcium and Iron) to inhibit their absorption

digestive tract conditions

I. Introduction: Minerals
l

some minerals interact and compete with each other

for absorption, therefore, consuming an excess of
one mineral may affect the absorption, metabolism,
and/or excretion of another
l

calcium and iron argument against single

nutrient supplements

I. Introduction: Minerals
l

minerals are involved in many varied and important

metabolic roles, including:
l electrolytes that help maintain fluid balance
l essential components of certain compounds
l proper bone growth, development and structural
integrity (e.g., Ca, P, Mg)
l nerve transmission and muscle contraction
l release of energy from the macronutrients
minerals found free in nature in water (rivers,
streams, oceans), topsoil, and beneath the earth's
surface
10

I. Introduction: The Balancing Act of

Water &Ions in the Body
a. Cell Membranes
l

most cations are under controlled flow across

membranes by the action of protein 'pumps' in the
membranes (e.g. Sodium/Potassium ATPase);
anions follow cations

however, water flows freely between body

compartments, following the ions to the more
concentrated solution

11

I. Introduction: The Balancing Act of

Water &Ions in the Body
a. Cell Membranes
l ions in water conduct electricity, thus are called
ELECTROLYTES
l all body fluids that contain water and ions are
examples of electrolyte solutions
l important electrolytes for maintaining fluid balance
in the body are Sodium (Na+), Potassium (K+),
Chloride (Cl-) and Phosphorus (PO43-)

12

I. Introduction: The Balancing Act of

Water &Ions in the Body
b. Osmosis
l

the amount of water in each fluid compartment is

controlled by the ion concentration in each
compartment and the selective movement of ions
across cell membranes

water flows easily across cell membranes; ions dont

concentrations of cations and anions in the various

body fluid compartments are normally held within a

13

I. Introduction: The Balancing Act of

Water &Ions in the Body
b. Osmosis
l when cells pump electrolytes in or out, water follows
by flowing to the more concentrated solution, altering
the fluid volume on either side of the semi-permeable
cell membrane, until there is electrical neutrality and a
similar concentration exists on each side of the cell
membrane
l the process of moving water across a membrane
toward the more concentrated solution is called

14

I. Introduction: The Balancing Act of

Water &Ions in the Body
b. Osmosis
l

water volume inside cells depends primarily on

intracellular Potassium (K +) and Phosphate (HPO42-)
concentrations

water volume outside cells depends primarily on

extracellular Sodium (Na+) and Chloride (Cl-)
concentrations

15

II. Water
1. FUNCTIONS OF WATER
l

Necessity of Water
l

water is vital to life

different tissues contain varying amounts of water

a. Transport function takes nutrients to cells

b. Reactive function for example, involved in

16

II. Water
1. FUNCTIONS OF WATER
l Necessity of Water
c. Solvent function
l the major waste product from the body is UREA
l a healthy urine volume:
1-2 Litres/day
l control of urine production determined by the
following nutrients:
l protein intake -urea
l sodium intake -salt
l fluid intake
17

II. Water
1. FUNCTIONS OF WATER
Maintenance of Blood Volume and Blood Pressure
l kidneys constantly adjusting blood volume and
concentration of the urine
l extreme losses of water from the body (skin,
lungs, feces, urine) lead to a decrease in blood
volume and blood pressure
l hormones, enzymes and blood proteins are all
involved in maintaining blood volume & pressure
l Antidiuretic Hormone
secreted from pituitary gland in response to
high salt concentration in the blood

18

II. Water
1. FUNCTIONS OF WATER
hormones,
l Renin/Angiotensin
renin enzyme secreted by kidneys in
response to reduced blood flow
activates angiotensin from inactive
angiotensinogen
angiotensin protein that signals adrenal
gland to release aldosterone (hormone)
causes blood vessels to constrict,
19

II. Water
1. FUNCTIONS OF WATER
hormones,
l

Aldosterone hormone that causes kidneys to

retain Sodium in the blood and water follows
sodium, increasing blood volume

when blood volume increases, blood pressure

increases, when blood volume decreases,

20

II. Water
1. FUNCTIONS OF WATER
Temperature Regulation
l

our body has a high water content which benefits

us by allowing us to warm up or cool down slowly

the body loses fluids via perspiration, evaporation

must occur to cool the body temperature

1 litre of perspiration = ~600 kcal energy

21

II. Water
1. FUNCTIONS OF WATER
l

Lubrication/Shock Absorption Roles

l

water is the primary constituent of lubricants

found in knees and joints; this helps to reduce
friction in the joints

shock absorber (e.g. behind the eyes, amniotic

fluid);

22

II. Water
1. FUNCTIONS OF WATER
l Fluid and Electrolyte Balance
l electrolytes are the primary regulator of fluid
balance in different fluid compartments in the body
l Sodium and Chloride (ECF) are the first electrolytes
lost from body due to sweating, blood loss or
excretion

23

II. Water
1. FUNCTIONS OF WATER
l

Fluid and Electrolyte Balance

l

regulation of electrolyte concentrations occurs at:

GI Tract: primary site of electrolyte regulation

8 Litres of fluid and minerals enter the GI tract

each day from all sources providing lots of
opportunity for the body to maintain electrolyte
balance
Kidneys: major regulating organ of fluid and

24

II. Water
1.
l

FUNCTIONS OF WATER
Acid/Base Balance (pH)
l careful acid/base balance is maintained in the
body with the goal of controlling the blood pH
level within a narrow range of 7.35-7.45, mostly
achieved by the action of the kidneys, buffers in
the blood, and respiration
l when blood pH shifts outside this range, can
damage proteins (e.g. Hb, enzymes)
l some electrolytes act to accept or donate
hydrogens to maintain a normal and constant
body pH = buffers
25

II. Water
1.
l

FUNCTIONS OF WATER
Acid/Base Balance (pH)
l through excretion, the lungs, skin and kidneys
control acid/base balance
l lungs depending upon acidic or basic conditions,
increased or decreased respiration (respectively)
can help maintain a normal blood pH
l skin we excrete acids through our skin
l Kidneys select which ions to retain (can be
exchanged with H+) and which to excrete,
maintaining a nearly constant overall body acid
load;
26

II. Water
2. WATER NEEDS
l Water Balance
l estimated need: 11.5 mL/kcal energy expended
l healthy urine volume = 1-2 Litres/day
l @ <600mL/day forces kidneys to concentrate
urine increased tendency to form kidney
stones
l @>600mL/day output proportional to intake
l INSENSIBLE LOSSES of water =

27

II. Water
2. WATER NEEDS
l Water Balance
l get ~1200-2500mL from foods and beverages
each day
l lose 500-1400mL in urine, 950-1400mL in feces
and ~1450-2800mL overall/day
l if you sweat a lot loss of extracellular fluid (i.e.
Na, Cl), therefore, may desire salty foods
l insensible losses can account for about half of all
water losses each day when a person is not
visibly sweating
l an air traveler can lose ~0.5 litre water/hour of
travel time through
28

II. Water
2. WATER NEEDS
l Thirst
l when blood loses water, it becomes more
concentrated than normal
l mouth becomes dry; brain and neural signals help
initiate drinking
l thirst appears when total body water drops by 12%
l thirst is not a reliable signal of dehydration
because it lags behind the bodys need
l athletes -can take weight before and after
exercise to determine water needs
l 1 mL water weighs 1 gram; 1000mL = 1 kg water

29

II. Water
2. WATER NEEDS
l

Continued Thirst
l

body begins to conserve water

the brain releases AntiDiuretic Hormone (ADH)

which forces kidneys to reabsorb water rather
than excrete it

30

II. Water
2. WATER NEEDS
l Dehydration due to lack of intake or increased
losses
l loss of 1-2% of body weight in fluids: thirst, fatigue
l loss of 3-5% of body weight in fluids: dry mouth,
decreased urine production
l loss of 6-8% of body weight in fluids: difficulty
concentrating, headache, impaired temperature
regulation
l loss of >8% of body weight in fluids: heat
intolerance, exhaustion, collapse
l loss of 20% of body weight in fluids: coma & death
31

II. Water
2. WATER NEEDS
l

Can You Drink Too Much Water?

l

when kidneys' ability to excrete water is

exceeded, results in a condition of
HYPONATREMIA, low circulating levels of
Sodium

extreme cases of water toxicity can lead to death

(e.g., marathon runners)

symptoms: headache, blurred vision, diarrhea,

exhaustion, mental confusion, fainting
32

II. Water
3. WATER IN FOODS
l water hard water contains Mg, Ca; soft water
contains Na, K
l beverages
l foods:
l nearly all foods contain water
l fruits & vegetables - up to 95% water
l meats & cheeses - ~50% water

33

II. Water
90--99%
90

80--89% 60
80
60--79%

Beverages

skim
milk

Fruit
juice

Fruits

tomato

Apple

banana

Vegetables

lettuce

Carrots

Potato

Eggs/Dairy

Egg
white

Meals &
Alternatives

Oils/Fats
Other

Sugar
gelatin

20--39%
20

10--19% 1-9%
10

raisin

Egg yolk
Shrimp

Grain
Products

40--59%
40

Cheddar
cheese

Sausage

Bacon

Cooked
spaghetti

pancake

Ready to
Cooked
eat
rice
cereals

calorie
mayo.

Diet
marg.

ketchup

Bread

butter
cake

Popcorn
34

II. Water
4. RECOMMENDATIONS
l adults: 1-1.5 mL/kcal expended
l infants: 1.5 mL/kcal expended
l DRI AI
l adults:
l males 3.7 litre/day
l females 2.7 litre/day
l caffeinated beverages can count toward water
needs,

35

III. Fluid & Electrolyte Balance Major

Minerals
2 categories of minerals: depending upon the amount we need
each day in our diet
l MAJOR MINERALS = needed in amounts =100mg/day
l Sodium (Na), Potassium (K), Chloride (Cl), Calcium (Ca),
Phosphorus (P), Magnesium (Mg), Sulphur (S)
l TRACE (or MINOR) MINERALS = needed in amounts
<100mg/day
l Iron (Fe), Zinc (Zn), Selenium (Se), Iodide (I), Copper (Cu),
Fluoride (F), Chromium (Cr), Manganese (Mn),
Molybdenum (Mo),
FLUID BALANCE & MAJOR MINERALS
l Sodium, Potassium, Chloride, Phosphorus
l Functions of these nutrients are not exclusive to
36

III. Fluid & Electrolyte Balance Major

Minerals: Sodium (Na)
1. FUNCTIONS OF SODIUM
l Extracellular Fluid (ECF)
l major cation in the ECF, therefore, main
electrolyte regulator of ECF volume
l table salt (NaCl) is 60% Chloride, 40% Sodium
l 1 teaspoon salt (5 g) = 2 g Sodium
Dill pickle (1731 mg) low sodium pickle (23 mg)
Cured ham (1023 mg) pork roast (54 mg)
Canned soup (695 mg) low sodium soup (480 mg)
Potato chips (168 mg) baked potato (14 mg)
37

III. Fluid & Electrolyte Balance Major

Minerals: Sodium (Na)
1. FUNCTIONS OF SODIUM
l Sodium stimulates neural conduction
l Sodium stimulates muscle action

38

III. Fluid & Electrolyte Balance Major

Minerals: Sodium (Na)
1. FUNCTIONS OF SODIUM
l Blood Acid/Base Balance
l kidneys filter all Na+ out of the blood and return
only the amount of Sodium the body needs
(analogy: cleaning the car)
l instead of the kidneys excreting Na + ions, the
kidneys can swap H+ ions for Na+ ions, keeping
the Na+ ions in the body and excreting H + ions in
the urine, thus reducing the acid load in the body
l Nutrient Absorption
l active transport of some nutrients (e.g., GLU) into
the intestinal cells requires

39

III. Fluid & Electrolyte Balance Major

Minerals: Sodium (Na)
2. SODIUM DEFICIENCY
l HYPONATREMIA, unlikely due to high intakes of
Sodium in North American diets, but may occur with
prolonged vomiting, diarrhea and/or heavy sweating
l symptoms: muscle cramps, dizziness, mental
apathy, can lead to shock and coma
l athletes participating in endurance events should
consume sports drinks/gels containing sodium salts
l at 3-5% of total body weight loss as perspiration

40

III. Fluid & Electrolyte Balance Major

Minerals: Sodium (Na)
3. SODIUM TOXICITY
l HYPERNATREMIA, not usually a problem except
with salt-sensitive people in whom it is likely to lead
to hypertension, or if you have renal (kidney)
problems
l if you have a high sodium intake, you should ensure
you drink enough water
l note: water intake will not decrease your sodium
intake, but will help reduce risk of hypernatremia

41

III. Fluid & Electrolyte Balance Major

Minerals: Sodium (Na)
4. SODIUM and HEALTH
l Urine Output
l urine production is proportional to Na + intake
l Hypertension
l ~10-15% of population is sensitive to Sodium
Chloride (salt)
l people with kidney disease are more likely to be saltsensitive
l salt intakes =2 g/d can lead to decreased blood
pressure (reduces risk of heart disease) in all people
l replace salt with herbs, spices, garlic, lemon juice
42

III. Fluid & Electrolyte Balance Major

Minerals: Sodium (Na)
4. SODIUM and HEALTH
l Calcium Loss in Urine
l high Sodium intakes can increase Calcium
excretion in the urine
l only a concern with higher Sodium (>2g/d) and
low Calcium (<DRI) intakes

43

III. Fluid & Electrolyte Balance Major

Minerals: Sodium (Na)
5. SODIUM IN FOODS
l Sources
l ~75% obtained from processed foods
l ~15% added during cooking or at table as table
salt
l ~10% from unprocessed foods -

44

III. Fluid & Electrolyte Balance Major

Minerals: Sodium (Na)
6.DRIAI
l

l
l
l

Adults
l (19-50 yrs)
1500mg/d
l (51-70 yrs)
1300mg/d
l (70+ yrs)
1200mg/d
DRI-UL all adults: 2300 mg/day
~100 mg/d minimum needed by body
AIl based on obtaining a nutritionally adequate diet
for other nutrients and for replacing losses of sodium
in sweat in moderately active people
average intake ~3000 mg/d (3 g) = 7.5 g salt/day
45

III. Fluid & Electrolyte Balance Major

Minerals: Sodium (Na)
6.DRIAI
l

DASH-type diet (Dietary Approaches to Stop

Hypertension low fat, high fibre, ~3g sodium/day)

46

III. Fluid & Electrolyte Balance Major

Minerals: Potassium (K)
1. FUNCTIONS OF POTASSIUM
l Intracellular Fluid (ICF)
l major cation inside cells (95%), therefore, main
electrolyte regulator of ICF volume
l Nerve Conduction/Muscle Contraction
l Potassium contributes to nerve impulse
transmission and muscle contraction by trading
places with Sodium before being pumped back to
the appropriate fluid compartments
l a proper K+ concentration is required for a
47

III. Fluid & Electrolyte Balance Major

Minerals: Potassium (K)
1. FUNCTIONS OF POTASSIUM
l

Reduced Blood Pressure

l

adequate Potassium intake is associated with

lower blood pressure and lower stroke-related
mortality rates (lowers ECF & blood volume)

48

III. Fluid & Electrolyte Balance Major

Minerals: Potassium (K)
2. POTASSIUM DEFICIENCY
l HYPOKALEMIA unlikely, although we absorb ~90%
of Potassium intake, we should still meet the daily
DRI
l most likely occurs due to excessive losses (rather
than low intakes), with the exception of alcoholics
with poor dietary habits
l caused by prolonged vomiting, dehydration,
diarrhea, regular use of diuretics, steroids, strong
laxatives and some drugs

49

III. Fluid & Electrolyte Balance Major

Minerals: Potassium (K)
2. POTASSIUM DEFICIENCY
l low (and high) blood Potassium levels are life
threatening affecting the heart beat
l symptoms:
l loss of appetite, muscle weakness and cramping,
confusion
l irregular heart beat decreased ability to pump
blood and nourish the body cells

50

III. Fluid & Electrolyte Balance Major

Minerals: Potassium (K)
3. POTASSIUM TOXICITY
l typical food intakes non-toxic
l HYPERKALEMIA if poor kidney performance
increased Potassium in blood (hyperkalemia)
inhibits heart leading to a slowing of the heart
beat and may lead to cessation of heart beat

51

III. Fluid & Electrolyte Balance Major

Minerals: Potassium (K)
4. POTASSIUM IN FOODS
l fresh foods of all kinds because K + remains in food
until it is processed
l fresh fruits, vegetables, legumes, whole grains
l milk, yogurt
l meat

52

III. Fluid & Electrolyte Balance Major

Minerals: Potassium (K)
5. DRIAI
l

adults: 4700 mg/d

Eating Well with Canada's Food Guide recommends

a healthy intake of fruits and vegetables
consuming ~5-9 servings of fruit and vegetables
should meet AI

DRIUL None

53

III. Fluid & Electrolyte Balance Major

Minerals: Chloride (Cl-)
Chloride ion (NOT = chlorine gas) is not poisonous
and is required in diet
1. FUNCTIONS OF CHLORIDE
l Extracellular Fluid (ECF)
l major anion in ECF, therefore, along with Na +, a
major regulator of ECF volume
l Chloride ion (NOT = chlorine gas) is not
poisonous and is required in diet
l Chloride can move freely across membranes and
associates with Sodium in ECF and
l

54

III. Fluid & Electrolyte Balance Major

Minerals: Chloride (Cl-)
1. FUNCTIONS OF CHLORIDE
l Stomach Acidity
l Chloride ion forms part of hydrochloric acid (HCl)
in the stomach
l HCl needed to activate pepsin, helps solubilize
minerals

55

III. Fluid & Electrolyte Balance Major

Minerals: Chloride (Cl-)
1. FUNCTIONS OF CHLORIDE
l Other Functions
l Nerve Conduction
l Chloride ion used for nerve impulse conduction
l Immune System
l Chloride ion used during immune responses as
white blood cells (WBC) attack foreign
substances

56

III. Fluid & Electrolyte Balance Major

Minerals: Chloride (Cl-)
2. CHLORIDE DEFICIENCY
l unlikely due to consumption of salt, convenience
foods
l may be seen with prolonged vomiting, heavy
sweating
l symptoms:

57

III. Fluid & Electrolyte Balance Major

Minerals: Chloride (Cl-)
3. CHLORIDE TOXICITY
l rare, usually only due to dehydration
4. CHLORIDE IN FOODS
l mostly processed foods (e.g., soy sauce) and table
salt
l small quantities in some fresh fruits and vegetables

58

III. Fluid & Electrolyte Balance Major

Minerals: Chloride (Cl-)
5. DRIAI
l

Adults
l

(19-50 yrs)

2300mg/d

(51-70 yrs)

2000mg/d

(70+ yrs)

1800mg/d

DRIUL adults: 3600mg/day

l

Chloride plentiful in diet

59

III. Fluid & Electrolyte Balance Major

Minerals: Phosphorus (P)
1. INTRODUCTION
l

Phosphorus represents the second most abundant

mineral in body, after Calcium

~1% of total body weight

plant sources of Phosphorus mostly come in the form

of phytic acid found predominantly in legumes, some
in whole grains

60

III. Fluid & Electrolyte Balance Major

Minerals: Phosphorus (P)
1. INTRODUCTION
l

Phosphorus teams up with Calcium in many of its

roles in the body

efficient absorption at 60-90% depending on body

needs, and wide availability

like Calcium, vitamin D enhances Phosphorus

absorption

generally, kidney excretion regulates

61

III. Fluid & Electrolyte Balance Major

Minerals: Phosphorus (P)
2. FUNCTIONS OF PHOSPHORUS
l
Fluid Balance
l
major intracellular anionic electrolyte that works
with Potassium to regulate fluid volume inside
cells
l
Bone
l
~85% of all body Phosphorus is found with
Calcium in the hydroxyapatite crystal found in
bones and teeth

62

III. Fluid & Electrolyte Balance Major

Minerals: Phosphorus (P)
2. FUNCTIONS OF PHOSPHORUS
l
Blood and Tissue Phosphorus
l
~15% of all body Phosphorus
l
the phosphorus salt, phosphate, is found free in
cells and the bloodstream and acts as a
BUFFER

63

III. Fluid & Electrolyte Balance Major

Minerals: Phosphorus (P)
2. FUNCTIONS OF PHOSPHORUS
l
Blood and Tissue Phosphorus
l
Phosphorus functions inside cells as part of:
l
very high energy phosphate bonds (ATP)
l
phospholipids in cell membranes
l
phospholipids in lipoproteins (ex. LDL, HDL)
used to transport fat-soluble nutrients in the
body
l
many enzyme reactions many B-vitamins
become active when a phosphate group is
added (coenzymes needed in energy
metabolism)
l
DNA & RNA

64

III. Fluid & Electrolyte Balance Major

Minerals: Phosphorus (P)
3. PHOSPHORUS DEFICIENCY
l
unlikely - readily available in foods
4. PHOSPHORUS TOXICITY
l
no true effect of high phosphorus intake alone in
healthy individuals more to do with low calcium
intake in conjunction with high Phosphorus intakes,

65

III. Fluid & Electrolyte Balance Major

Minerals: Phosphorus (P)
5. PHOSPHORUS IN FOODS
l
animal protein foods -meat, fish, poultry
l
milk & milk products (e.g. yogurt, cheese)
l
legumes, cereal, bran, nuts
l
soft drinks (~75 mg/355 mL) lower Ca (milk)
intake

66

Phosphorus Content of Foods (mg)

Food
Milk, 2% fat, 1 cup

P
Food
(mg)
232 Almonds, cup

Cheese, Swiss, 1 oz

216

Oatmeal, 1 cup

178

Cheese, cottage, cup

170

Lentils, cooked, cup

178

Ham, 3 oz
Sole, baked, 3 oz

210
248

Baked beans, white, cup

137

Potato, baked, with skin, 1

115

Shrimp, boiled, 2 large

137

Bread, whole wheat, 1 slice

74

Ground beef, cooked, 3 oz

Egg, 1
Tofu, regular, cup

135
86

Lettuce, romaine, 1 cup

Cauliflower, fresh. cup
Orange, 1

25

120

P
(mg)
184

23
18
67

III. Fluid & Electrolyte Balance Major

Minerals: Phosphorus (P)
6. DRI-RDA
l
adults:
l
DRIUL
l
adults:

700mg/day
4000mg/day

68