FLUID, ELECTROLYTE, (ACID-BASE) BALANCE

dr. Sophie Yolanda, MBiomed Department of Physiology Faculty of Medicine Universitas Indonesia

OUTLINE
Body Compartments Regulation of Fluid & Electrolyte Balance
Volume Osmolarity Disturbance Potassium Balance

Acid-Base Balance

Body Compartments

Body Compartments

Fluid Movement
Fluid compartments are separated by membranes that are freely permeable to water Movement of fluids due to: hydrostatic pressure osmotic pressure Starling forces

Starling Forces

Edema
Swelling of tissues due to excess interstitial fluid Causes:
Increased venous pressure (e.g. heart failure) Increased capillary permeability leak of plasma proteins to interstitial fluid (e.g. anaphylactic shock) Decreased plasma proteins (e.g. liver disease, malnutrition) Inadequate lymph drainage (e.g. filariasis)

Body Compartments

Regulation of Fluid & Electrolyte Balance

All homeostatic mechanisms that monitor and adjust composition of body fluids respond to changes in ECF, not ICF No receptors directly monitor fluid or electrolyte balance plasma volume & osmotic concentration Cells cannot move water by active transport water follows salt

Regulation of ECF
Osmolarity Tonicity
Through water balance

Volume Blood Pressure

Through salt balance

Tonicity

Water Balance

Water Output

Regulation of Fluid Intake Thirst

Regulation of Fluid Output Urine

Regulation of Fluid Output Urine

Kidneys conserve water by regulating urine concentration/osmolarity: 50-1200 mOsM
Countercurrent mechanism producing vertical osmotic gradient Vasopressin/Antidiuretic Hormone (ADH) controls water reabsorption

Obligatory urine volume: 500 mL

Countercurrent Mechanism

Countercurrent Mechanism

Vasopressin/ADH

Vasopressin/ADH

Vasopressin/ADH

Regulation of Blood Pressure

Short-term:
Baroreceptor reflex cardiac output and total peripheral resistance Fluid shifts due to Starling forces

Long-term: ECF volume salt balance

Salt Balance
Sodium account for >90% of ECFs osmotic activity conservation of salt = conservation of water (water follows salt) primary determinant of ECF volume

Salt Balance
Intake: Poorly regulated; usually >> Output:
Obligatory loss in sweat and feces (0.5 g/day) Urine: controlled, very precise
Filtration: GFR Reabsorption: Renin-Angiotensin-Aldosterone (RAA) system; Atrial Natriuretic Peptide (ANP)

Salt Balance

RAA System

RAA System - Aldosterone

RAA System - Aldosterone

ANP

Integration of Fluid & Electrolyte Balance

Integration of Fluid & Electrolyte Balance

Disturbances of Fluid and Electrolyte Balance

Potassium Balance
98% in ICF Intake: Dietary Output: Urine Disturbances in Potassium balance are less common than sodium balance, but significantly more dangerous

Potassium Balance
Factors affecting rate of K+ tubular secretion:
K+ concentration in ECF (from dietary intake) Aldosterone levels (promotes secretion) pH of ECF (acidosis: decreases secretion, vice versa)

Potassium Balance

Acid-Base Balance

Buffer System

Buffer System Lungs

Buffer System - Renal

Buffer System - Renal

Buffer System - Renal

Buffer System - Renal

Acid-Base Balance

Disturbances of Acid-Base Balance

SUMMARY

REFERENCES
Guyton AC, Hall JE. Textbook of medical physiology.11th ed. Philadelphia. Elsevier, Inc. 2006. Martini FH, Nath JL, Bartholomew EF. Fundamentals of anatomy & physiology. 9th ed. Boston. Benjamin Cummings. 2012 Sherwood L. Human Physiology from cells to system, 7th ed. Australia. Brooks/Cole Cengange Learning. 2011. Silverthorn DU. Human physiology: an integrated approach. 5th ed. San Francisco. Pearson Education, Inc. 2010. Tortora GJ, Derrickson B. Principles of anatomy and physiology. 12th ed. USA. John Wiley & Sons, Inc. 2009.

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