Chapter 26

Fluid, Electrolyte, and Acid Base Homeostasis

James F. Thompson, Ph.D.

Fluid Compartments
Body Fluids are separated by semipermeable membranes into various physiological (functional) compartments Two Compartment Model
Intracellular = Cytoplasmic (inside cells) Extracellular (outside cells)

The Two Compartment Model is useful clinically for understanding the distribution of many drugs in the body

Fluid Compartments

Three Compartment Model

[1] Intracellular = Cytoplasmic (inside cells)

[Extracellular compartment is subdivided into:]

The Three Compartment Model is more useful for understanding physiological processes

[2] Interstitial = Intercellular = Lymph (between the cells in the tissues) [3] Plasma (fluid portion of the blood)

Other models with more compartments can sometimes be useful, e.g., consider lymph in the lymph vessels, CSF, ocular fluids, synovial and serous fluids as separate compartments

Fluid Compartments
Total Body Water (TBW) - 42L, 60% of body weight
Intracellular Fluid (ICF) 28L, 67% of TBW Extracellular Fluid (ECF) 14L, 33% of TBW
Interstitial Fluid - 11L, 80% ECF Plasma - 3L, 20% of ECF

Fluid Balance
Fluid balance
When in balance, adequate water is present and is distributed among the various compartments according to the bodys needs Many things are freely exchanged between fluid compartments, especially water Fluid movements by:

bulk flow (i.e., blood & lymph circulation) diffusion & osmosis in most regions

Water
General
Largest single chemical component of the body: 45-75% of body mass Fat (adipose tissue) is essentially water free, so there is relatively more or less water in the body depending on % fat composition Water is the solvent for most biological molecules within the body Water also participates in a variety of biochemical reactions, both anabolic and catabolic

Water
Water balance
Sources for 2500 mL - average daily intake
Metabolic Water Preformed Water
Ingested Foods Ingested Liquids

Balance achieved if daily output also = 2500 mL

GI tract Lungs Skin

Kidneys

evaporation perspiration

Regulating Fluid Intake - Thirst

Recall the role of the Renin-Angiotensin System in regulating thirst along with the Autonomic NS reflexes diagramed below

Regulating Fluid Intake Thirst Quenching

Wetting the oral mucosa (temporary) Stretching of the stomach Decreased blood/body fluid osmolarity = increased hydration (dilution) of the blood is the most important

Regulation of Fluid Output

Hormonal control
AntiDiuretic Hormone (ADH) [neurohypophysis] Aldosterone [adrenal cortex] Atrial Natriuretic Peptide (ANP) [heart atrial walls]

Physiologic fluid imbalances

Dehydration: blood pressure, GFR Overhydration: blood pressure, GFR Hyperventilation - water loss through lungs Vomiting & Diarrhea - excessive water loss Fever - heavy perspiration Burns - initial fluid loss; may persist in severe burns Hemorrhage if blood loss is severe

 Non-electrolytes Electrolytes

Concentrations of Solutes
molecules formed by only covalent bonds do not form charged ions in solution Molecules formed with some ionic bonds; Disassociate into cations (+) & anions (-) in solutions (acids, bases, salts) 4 important physiological functions in the body
essential minerals in certain biochemical reactions control osmosis = control the movement of water between compartments maintain acid-base balance conduct electrical currents (depolarization events)

Distribution of H2O & Electrolytes

Recall Starlings Law of the Capillaries which explains fluid and solute movements from Ch. 19

Distribution of Electrolytes

Distribution of Major Electrolytes

Na+ and CL- predominate in extracellular fluids (interstitial fluid and plasma) but are very low in the intracellular fluid (cytoplasm) K+ and HPO42- predominate in intracellular fluid (cytoplasm) but are in very low concentration in the extracellular fluids (interstitial fluid and plasma) At body fluid pH, proteins [P-] act as anions; total protein concentration [P-] is relatively high, the second most important anion, in the cytoplasm, [P-] is intermediate in blood plasma, but [P-] is very low in the interstitial fluid

Distribution of Minor Electrolytes

HCO3- is in intermediate concentrations in all fluids, a bit lower in the intracellular fluid (cytoplasm); it is an important pH buffer in the extracellular comparments Ca++ is in low concentration in all fluid compartments, but it must be tightly regulated, as small shifts in Ca++ concentration in any compartment have serious effects Mg++ is in low concentration in all fluid compartments, but Mg++ is a bit higher in the intracellular fluid (cytoplasm), where it is a component of many cellular enzymes

Electrolyte Balance
Aldosterone [Na+] [Cl-] [H2O] [K+] Atrial Natriuretic Peptide (opposite effect) Antidiuretic Hormone [H2O] ( [solutes]) Parathyroid Hormone [Ca++] [HPO4-] Calcitonin (opposite effect) Female sex hormones [H2O]

Electrolytes
Sodium (Na+) - 136-142 mEq/liter
Most abundant cation
major ECF cation (90% of cations present) determines osmolarity of ECF

Regulation
Aldosterone ADH ANP

Homeostatic imbalances
Hyponatremia - muscle weakness, coma Hypernatremia - coma

Electrolytes
Chloride (Cl-) - 95-103 mEq/liter
Major ECF anion
helps balance osmotic potential and electrostatic equilibrium between fluid compartments plasma membranes tend to be leaky to Cl- anions

Regulation: aldosterone Homeostatic imbalances

Hypochloremia - results in muscle spasms, coma [usually occurs with hyponatremia] often due to prolonged vomiting elevated sweat chloride diagnostic of Cystic Fibrosis

Electrolytes
Potassium (K+)
Major ICF cation
intracellular 120-125 mEq/liter plasma 3.8-5.0 mEq/liter

Very important role in resting membrane potential (RMP) and in action potentials Regulation:

Homeostatic imbalances

Direct Effect: excretion by kidney tubule Aldosterone

Hypokalemia - vomiting, death Hyperkalemia - irritability, cardiac fibrillation, death

Electrolytes
Calcium (Ca2+)
Most abundant ion in body
plasma 4.6-5.5 mEq/liter most stored in bone (98%)

Regulation:
Parathyroid Hormone (PTH) - blood Ca2+ Calcitonin (CT) - blood Ca2+

Homeostatic imbalances:
Hypocalcemia - muscle cramps, convulsions Hypercalcemia - vomiting, cardiovascular symptoms, coma; prolonged abnormal calcium deposition, e.g., stone formation

Electrolytes
Phosphate (H2PO4-, HPO42-, PO43-)
Important ICF anions; plasma 1.7-2.6 mEq/liter
most (85%) is stored in bone as calcium salts also combined with lipids, proteins, carbohydrates, nucleic acids (DNA and RNA), and high energy phosphate transport compound important acid-base buffer in body fluids

Regulation - regulated in an inverse relationship with Ca2+ by PTH and Calcitonin Homeostatic imbalances
Phosphate concentrations shift oppositely from calcium concentrations and symptoms are usually due to the related calcium excess or deficit

Electrolytes
Magnesium (Mg2+)
2nd most abundant intracellular electrolyte, 1.3-2.1 mEq/liter in plasma

Excretion of Mg2+ caused by hypercalcemia, hypermagnesemia Homeostatic imbalance

more than half is stored in bone, most of the rest in ICF (cytoplasm) important enzyme cofactor; involved in neuromuscular activity, nerve transmission in CNS, and myocardial functioning

Hypomagnesemia - vomiting, cardiac arrhythmias Hypermagnesemia - nausea, vomiting

Acid-Base Balance

Normal metabolism produces H+ (acidity) Three Homeostatic mechanisms:

Buffer Systems

Buffer systems - instantaneous; temporary Exhalation of CO2 - operates within minutes; cannot completely correct serious imbalances Kidney excretion - can completely correct any imbalance (eventually) Consists of a weak acid and the salt of that acid which functions as a weak base Strong acids dissociate more rapidly and easily than weak acids

Acid-Base Balance

Carbonic Acid - Bicarbonate Buffer

A weak base (recall carbonic anhydrase) H+ + HCO3- H2CO3 H2O + CO2 NaOH + NaH2PO4 H2O + Na2HPO4 HCl + Na2HPO4 NaCl + NaH2PO4

Phosphate Buffer

Protein Buffer (esp. hemoglobin & albumin)

Most abundant buffer in body cells and plasma Amino acids have amine group (proton acceptor = weak base) and a carboxyl group (proton donor = weak acid)

Acid-Base Balance
CNS and peripheral chemoreceptors note changes in blood pH Increased [H+] causes immediate hyperventilation and later increased renal secretion of [H+] and [NH4+] Decreased [H+] causes immediate hypoventilation and later decreased renal secretion of [H+] and [NH4+]

Acid-Base Imbalances
Acidosis
High blood [H+] Low blood pH, <7.35

Alkalosis
Low blood [H+] High blood pH, >7.45

Acid-Base Imbalances
Acid-Base imbalances may be due to problems with ventilation or due to a variety of metabolic problems
Respiratory Acidosis (pCO2 > 45 mm Hg) Respiratory Alkalosis (pCO2 < 35 mm Hg) Metabolic Acidosis (HCO3- < 23 mEq/l) Metabolic Alkalosis (HCO3- > 26 mEq/l)

Compensation: the physiological response to an acid-base imbalance begins with adjustments by the system less involved

Causes of Acid-Base Imbalances

Respiratory Acidosis
Chronic Obstructive Pulmonary Diseases e.g., emphysema, pulmonary fibrosis Pneumonia

Respiratory Alkalosis
Hysteria Fever Asthma

Causes of Acid-Base Imbalances

Metabolic Acidosis
Diabetic ketoacidosis, Lactic acidosis Salicylate poisoning (children) Methanol, ethylene glycol poisoning Renal failure Diarrhea Prolonged vomiting Diuretic therapy Hyperadrenocortical disease Exogenous base (antacids, bicarbonate IV, citrate toxicity after massive blood transfusions)

Metabolic Alkalosis

End Chapter 26