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Examination of Body Fluids

Water and Electrolytes
by
Dr. Ali H. Sadiek
Prof. of Internal Veterinary Medicine
and Clinical Laboratory Diagnosis
Faculty of Veterinary Medicine, Assiut University
E-mail: Sadiek59@yahoo.com
 Course Objectives
1. What are the body fluid
compartments and distribution?
2. Causes, signs, and
management of disorders in :
• Body fluid Concentration,
• Electrolyte composition
• Acid-base balance
 What are the Body fluids ?
• Intracellular Fluid (ICF):
65-75 % of B. Fluids and 35-45 % of B. weight.
• Higher % of P, K and lowered % of Na, Cl.
• Extra cellular fluids (ECF):
25 % of B. Fluids and 15 % of body weight.
• In plasma, lymph, interstitial tissue, intercellular,
CSF, Synovial, GIT.
• Higher % of Na, Cl and lowered % of P, K.
• Electrolytes moves freely bet. ICF and ECF
according its homeostasis.
 Fluid Compartments
1/3 2/3

I
N
EXTRACELLULAR

V T
A E
S R
C S INTRACELLULAR
U T
L I
A T
R I
A
L
 Fluid Compartments
Extracellular Intracellular

Na+ K+

Mg2+
Cl-
Ca 2+
Phosphates
HCO3-
Proteins
•H2O freely permeable
mmol cations = mmol anions
Water Balance
2%
3%
13 %

32 % 25 %

65 % 60 %
 Water and electrolyte balance
• It is correlated with levels of fluid and
electrolytes (Na, K, Cl) in plasma
• Loss of Na followed by loss of water.
• Kidney compensate imbalance by:
 Decreased urine secretion in
dehydration and vice versa in edema
under control of Levels of electrolytes
and ADH.
 Water and Electrolyte Imbalance
I- Water Imbalance.
• It occurs when water gain exceed
water loss or vice versa
• Signs of water Imbalance:
• Dehydration: Water loss > water
gain.
• Edema: Water gain > water loss
 1- Dehydration
• Dehydration occurs when water
loss exceed water gain without
compensation.
• Rare in adult animals, common in
neonates.
• Kidney is very sensitive to the level
of body water, so it reduce water
loss according to the body needs
(ADH).
 Cause of dehydration
1. Diarrhea: Acute, continuous in neonates
2. Vomiting for long periods
3. Fever: continuous fever
4. Sweating: severe in race horse, accompany
colic.
5. Severe burns and severe hemorrhage.
6. Polyuria and renal failure.
7. Ruminal impaction, obstructed bowel and
Schok
8. Water deprivation
9. Fasting for a long period.
Dehydration and water balance

oligouria
 Clinical Evaluation of Dehydration
• Character of feces:
 Very loose or runny feces are at a high risk
of being dehydrated.
3. Classic signs of dehydration:
 Sunken eyes,
 Dry mouth and nose,
 Fast or very slow pulse, polypnea
 Cold extremities (ears /or legs)
 Oliguria and constipation.
 Weight loss, emaciation and recumbency
 Clinical Evaluation of Dehydration
1. Skin tenting check or skin elasticity
test.
• Firmly pinch the loose folds of skin on
the neck of the calf and check to see
how long the skin remains tented.
• If it remains tented for 2 to 6 seconds,
the calf is moderately dehydrated and
• Longer than 6 seconds indicates that
the calf is severely dehydrated.
Signs of Dehydtaion in calves and adult cattle
Laboratory assessment of Dehydtaion
1. Increased RBCs count.
2. Increased PCV.
3. Increased Hb.
4. Increased plasma proteins.
5. Increase urea in blood.
6. Increased Sp. Gravity of urine
 Clinical and lab. Assessment of dehydration

Water loss % Skin Sunken PCV Total Fluids

tinting eye % solids required
check (g/l) Ml/kg

6-4 - + 45-40 80-70 25-20

8-6 4-2 ++ 50 90-80 50-30

10-8 10-6 +++ 55 100-90 80-50

12-10 45-20 +++ 60 120 120-80

 Treatment of dehydration
• Fluid and electrolyte therapy: should be
formulated on the basis of % of bwt loss,
PCV, Hb, protein, blood pH.
• It should contain all of the following
ingredients:
 Glucose for energy;
 An alkalinizing agent to treat acidosis, such
as bicarbonate, acetate, citrate or lactate;
 Na, K, and Cl- to replenish lost electrolytes.
• It may include other ingredients such as
glutamine, glycine and gelling agents.
Oral Rehydration Therapy
 Oral Rehydration Solution
Ingredient M/W Mmol/l g/l
Glucose 180 <200 <36
Na 23 <145 <3.3
Glycine 75 <145 <10.9
Na HCO3- 84 50-80 4.2-6.7
Na citrate 294 50-80 14.7-23.5
Na acetate 136 50-80 6.8-10.9
K 39 50-100 0.8-1.2
Cl- 35 50-100 1.8-3.2
 2- Increased Total Body Water (Edema)
• Increased body stores of water
• It may be local, general
• Inflammatory or none.
Causes of edema
5. Hyponutritional edema.
6. Decreased serum albumin assoc. renal, hepatic,
parasitic infections.
7. Long lasting protein loss (Johnes, fasciola,
hemonchus) .
8. Renal edema: Loss of albumin
 Breaskt edema
Right sided heart failure
Distended Jugular vein
Right sided heart failure
3-Hepatic edema:
- Decreased alb. Synthesis
4- Cardiac:
- Right sided heart failure (Generalized
edema)
- Left sided heart failure (pulm. Edema)
5- Obstructive:
- Lymph vessel obst.
(pregnancy and filariasis)
Pregnancy (obstructive edema)
Bottle jaw in hypoalbuminic cow
Bottle jaw in hypoalbuminic sheep
 Water intoxication
• Consumption of excess water
specially after long period of
deprivation.
• Administration of excess hypotonic
fluid via stomach tube, IV Infusion
• It is ch, by swelling and rupture of
RBCs, hb uria, anemia
 Electrolyte of Body Fluids (mmol/l)
Electrolytes ICF ECF Interstitial
+
Na 15 147 142
+
K 155 4 5
Cations +
Ca 2 2.5 -

Mg+ 27 1 2

HCO3- 10 30 27

Cl- 1 114 103

Anions PO4- 100 2 2

SO4- 20 1 1

Organic acids 1 7.5 -

proteins 62 - 16

AnionGap: It is about 8-12 mmol/L

AG= ( [Na+]+[K+] ) - ( [Cl-]+[HCO3-] ) AG= ( [Na+] ) - ( [Cl-]+[HCO3-
Electrolyte of Body Fluids (mmol/l)
Fluids Na+ Cl- K+ HCO3- H+ Ca2+

Serum 140 105 4 25 0 9

Gastric 60 90 10 0 90 0
Pancreas 140 70 5 90 0 0
Ileum 130 110 10 30 0 0
Colon 50 40 30 20 0 0
AnionGap: It is about 8-12 mmol/L
AG= ( [Na+]+[K+] ) - ( [Cl-]+[HCO3-] ) AG= ( [Na+] ) - ( [Cl-]
+[HCO3-]
Sodium Homeostasis:
135-145 mmol/L
The Kidney’s Priorities
2. Conserve sodium
3. Excrete free water
4. Conserve free water
 Sodium Homeostasis
Extracellular Intracellular

Na+

↑free free
H2O H2O
 Hyponatremia:
Na+ < 135 mmol/L
More prevalent than
hypernatremia, It Associate:
2.Acute hypertonic diarrhea and
vomiting
3.Surgery and accidents.
4.Diuretic therapy
5.Tubular nephritis.
6.Bacterial and viral infection
7.Heart failure.
8.Hyperglycemia
Hypernatremia
Na+ >145 mmol/L
Rarely occurred and
associate:
2.Excess dietary Na.
3.Water deprivation.
4.Hypotonic diarrhea
5.Chronic renal failure.
6.Severe burns and fever.
7.Hyperaldosteronism
 Signs of Hyponatremia:ٍ Signs of Hypernatremia
Na+ < 135 mmol/L Na+ >145 mmol/L
Signs vary acording to degree Symptoms dependent on rate of
and acuteness of change change, level and
Severe (< 120 meq/L): volume status
neuropsychiatric Neuropsychiatric
 Anorexia, Nausea and vomiting  Restlessness
 Lethargy and Fatigue  Hyperreflexia
 Restlessness and irritability  Weakness
 Muscle weakness, spasms  Delirium
or cramps
 Seizures
 Decreased consciousness
or coma
 Chloride Homeostais
Normal range: 95-110 mmol/L
• Maintains tonicity
• Promotes renal reabsorption of Na+
• Helps regulation of acid via reciprocal
relationship with HCO3-
• Renal acid excretion depends
bicarbonate reabsorption with
chloride excretion
Causes of Hypochloremia Causes of Hyperchloremia
(Cl < 95 mmol/l) ( (Cl > 110mmol/l

• Associate Metabolic and Endocrine

hyponatremia in most 2. Hyperparathyrodism
cases. 3. Rebal tubular acidosis
• Hypochloremia 4. Metabolic Acidosis
without hypnatremia 5. Hypernatremia
are seen in
 Vomition, Gastrointestinal
 Sequestration of 8. Dehydration
abomasal secretions 9. Prolonged diarrhea
in abomasal torsion 10.Loss of pancreatic
displacement and secretion
impaction
Potassium Homeostasis:
3.5-4.5 mmol/L

20 meq intravascular

K +

4200 meq
Intracellular
 Function of Potassium (K)
• It plays an important role in controlling
activity of smooth muscle (such as the
muscle found in the digestive tract) and
skeletal muscle as well as the muscles of the
heart.
• Both hypokalemia and hyperkalemia can lead
to abnormal heart rythm.
• It is also important for normal transmission
of electrical signals throughout the nervous
system within the body.
Causes of Hypokalemia Causes of Hyperkalemia
(K< 3.5 mmol/l) ( (K > 6.5 mmol/l

Potassium loss • Poor renal excretion

2.Diuresis • K+-sparing diuretics
3.Tubular renal failure • Renal failure with
4.Gastrointestinal loss acidosis
Intracellular displacement • Cell death
(Alkalosis) • Burns, Crush
Inadequate intake injury/tissue necrosis
Hyperaldosteronism • IV K infusion
• Hypoaldosteronism
• Dehydration and hemolysis
 Signs of Hypokalemia Signs of Hyperkalemia
(K< 3.5 mmol/l) ( (K > 6.5 mmol/l

1. Irregular heartbeat, 1. It may be a symptomatic

2. Extreme thirst; 2. Nausea
3. Frequent urination; and 3. Fatigue,
confusion. 4. Muscle weakness,
4. Muscle weakness, 5. Slow heartbeat and weak
cramping, or flaccid pulse.
paralysis; 6. Severe hyperkalemia can
5. Severe cases can result result in fatal cardiac
in cardiac arrest and arrest
paralysis of the lungs.
 Hypokalemic ECG: P waves become peaked and PR
interval increased. depression of ST segment, T waves
flattened and U wave more prominent.

Hyperkalemia ECG: shortened PR interval , prominent U waves , inverted

T waves , increased R wave amplitude , increase QRS duration
 Tissues and cellular osmolality
• Osmolality is a count of the number of
particles in a fluid sample intra and
extracellular
• It is affected by the levels of electrolyte, fine
particles e.g glucose, urea, plasma proteins.
• In ECF it is about 300 mosmol (Isoosmolality)
• More than 300 mosmol ( Hyeprosmolality)
• Less than 300 mosmol ( Hypoosmolality)
• Water moves towerd hyperosmolalit
 Tissues and cellular osmolality
Serum Osmolality:
• It is measured via levels of NA, K, Urea,
sugar as follow:
• mOsm/kg= 2 (Na + K mmol/l) in normal
blood sugar and urea levels
• mOsm/kg= 2 {Na + K mmol/l)} +
{glucose (mg/dl) / 18} + BUN (mg/dl) /
28. in increased blood sugar and urea
levels
 Hyperosmolality
• It occurs when levels of Na, glucose,
urea, ketones increased in blood.
• Hyperosmolaity (Counted osmolitity
increased by > 30 mosmol
• It indicated the presence of fine toxic
molecules in blood (ethyl glycol, ethyl
propylene) that results in moving fluids
into extracellular fluids and shrinkage
of cells and hiding of dehydration
 Hypo-osmolality
• It associate hyponatremia
• Hypo-osmolality leads to moving fluids
from extracellular to intracellular space
resulting in swelling and rupture of cells
• Swelling of RBCs lead to its hemolysis,
nervous signs, Hburia
• Hypo-osmolality with dehydration worsen
the condition because of fluid retention
intracellular that may lead to Circulatory
collapse.
Fluid Movements