FLUID AND ELECTROLYTE

BALANCE
dr. Ardiana Ekawanti
Fluid Compartments
Figure 26.1
Composition of Body Fluids
Water is the universal solvent
Solutes are broadly classified into:
Electrolytes inorganic salts, all acids and
bases, and some proteins
Nonelectrolytes examples include glucose,
lipids, creatinine, and urea
Electrolytes have greater osmotic power
than nonelectrolytes
Water moves according to osmotic
gradients
Water
Water is an essential substance:
99% of fluid outside cells (extracellular
fluid)
an essential ingredient of cytosol
(intracellular fluid)
All cellular operations rely on water:
as a diffusion medium for gases, nutrients,
and waste products
Extracellular and Intracellular
Fluids
Each fluid compartment of the body has a
distinctive pattern of electrolytes
Extracellular fluids are similar (except for
the high protein content of plasma)
Sodium is the chief cation
Chloride is the major anion
Intracellular fluids have low sodium and
chloride
Potassium is the chief cation
Phosphate is the chief anion
Cations and Anions
In ECF:
sodium, chloride, and bicarbonate
Another anions: anions gap
In ICF:
potassium, magnesium, and phosphate ions
negatively charged proteins
Cations and Anions in Body Fluids
Figure 272 (1 of 2)
Cations and Anions in Body Fluids
Figure 272 (2 of 2)
Fluid and Electrolyte
Balance
The body must maintain normal volume
and composition of:
extracellular fluid (ECF)
intracellular fluid (ICF)
Fluid balance:
Is a daily balance between:
amount of water gained
amount of water lost to environment

Electrolytes
Are ions
Homeostasis = balancing rates of
absorption across digestive tract with
rates of loss at kidneys and sweat glands

Exchange Among
Subdivisions of ECF
Occurs primarily across endothelial lining
of capillaries
From interstitial spaces to plasma:
through lymphatic vessels that drain into the
venous system
ECF: Solute Content
Types and amounts vary regionally:
electrolytes
proteins
nutrients
waste products
Membrane Functions
Cell membranes are selectively permeable
Ions enter or leave via specific membrane
channels
Carrier mechanisms move specific ions in
or out of cell
Osmosis
Osmosis
Hypertonic Solution
0.9%
NaCl
3% NaCl
Cells Crenate in a
Hypertonic Solution
Hypotonic Solution
0.9%
NaCl
0.5% NaCl
Cells in a Hypotonic Solution
Swell and May Lyse
Isotonic Solution
0.9%
NaCl
0.9% NaCl
How does fluid move
within the ECF? Between
ECF and ICF? Between
ECF and the environment?
The Osmotic Concentration
of ICF and ECF
Is identical
Osmosis eliminates minor differences in
concentration:
because cell membranes are permeable to
water
4 Principles of Fluids and
Electrolyte Regulation
1. All homeostatic mechanisms that monitor
and adjust body fluid composition
respond to changes in the ECF, not in
the ICF
2. No receptors directly monitor fluid or
electrolyte balance

3. Cells cannot move water molecules by
active transport
4. The bodys water or electrolyte content
will rise if dietary gains exceed
environmental losses, and will fall if
losses exceed gains

Fluid Balance and
Electrolyte Balance
When the body loses water:
plasma volume decreases
electrolyte concentrations rise
When the body loses electrolytes:
water is lost by osmosis

Continuous Mixing of Body Fluids
Figure 26.3
Fluid Balance (1 of 3)
Water circulates freely in ECF
compartment
At capillary beds, hydrostatic pressure
forces water:
out of plasma
into interstitial spaces
Fluid Balance cont
Water is reabsorbed:
along distal portion of capillary bed when it
enters lymphatic vessels
Fluid Balance cont
ECF and ICF are normally in osmotic
equilibrium:
no large-scale circulation between
compartments
Plasma-Interstitial
Fluid Exchange
Net hydrostatic pressure:
pushes water out of plasma
into interstitial fluid
Net colloid osmotic pressure:
draws water out of interstitial fluid
into plasma
Plasma-Interstitial
Fluid Exchange cont
ECF fluid volume is redistributed:
from lymphatic system
to venous system (plasma)
Plasma-Interstitial
Fluid Exchange cont
Interaction between opposing forces:
results in continuous filtration of fluid
ECF volume:
is 80% in interstitial fluid and minor fluid
compartments
is 20% in plasma
Fluid Gains and Losses
Figure 273
Fluid Shifts (1 of 4)
Are rapid water movements between ECF
and ICF:
in response to an osmotic gradient
Fluid Shifts (2 of 4)
If ECF osmotic concentration increases:
fluid becomes hypertonic to ICF
water moves from cells to ECF
Fluid Shifts (3 of 4)
If ECF osmotic concentration decreases:
fluid becomes hypotonic to ICF
water moves from ECF to cells
Fluid Shifts (4 of 4)
ICF volume is much greater than ECF
volume:
ICF acts as water reserve
prevents large osmotic changes in ECF
Dehydration
Also called water depletion
Develops when water loss is greater than
gain
Allocation of Water Losses
If water is lost, but electrolytes retained:
ECF osmotic concentration rises
water moves from ICF to ECF
net change in ECF is small
Distribution of Water Gains
If water is gained, but electrolytes are
not:
ECF volume increases
ECF becomes hypotonic to ICF
fluid shifts from ECF to ICF
may result in overhydration
Overhydration
Also called water excess
Occurs when excess water shifts into ICF:
distorting cells
changing solute concentrations around
enzymes
disrupting normal cell functions
Causes of Overhydration
Ingestion of large volume of fresh water
Injection into bloodstream of hypotonic
solution
Endocrine disorders:
excessive ADH production
Causes of Overhydration
Inability to eliminate excess water in
urine:
chronic renal failure
heart failure
cirrhosis
Electrolyte Balance
Requires rates of gain and loss of each
electrolyte in the body to be equal
Primarily involves balancing rates of
absorption across digestive tract with
rates of loss at kidneys and sweat glands

Sodium
Is the dominant cation in ECF
Sodium salts provide 90% of ECF osmotic
concentration:
sodium chloride (NaCl)
sodium bicarbonate
2 Rules of Electrolyte Balance
1. Most common problems with electrolyte
balance are caused by imbalance
between gains and losses of sodium ions
2 Rules of Electrolyte Balance
2. Problems with potassium balance are
less common, but more dangerous than
sodium imbalance
Sodium Balance in ECF
1. Sodium ion uptake across digestive
epithelium
2. Sodium ion excretion in urine and
perspiration
Sodium Balance in ECF
Typical Na
+
gain and loss:
is 48144 mEq (1.13.3 g) per day
If gains exceed losses:
total ECF content rises
If losses exceed gains:
ECF content declines
Changes in ECF Na
+
Content
Do not produce change in concentration
Corresponding water gain or loss keeps
concentration constant
Fluid Volume Regulation
and Na
+
Concentrations
Figure 275 (1 of 2)
Fluid Volume Regulation
and Na
+
Concentrations
Figure 275 (2 of 2)
ECF Volume
If ECF volume is inadequate:
blood volume and blood pressure decline
reninangiotensin system is activated
water and Na
+
losses are reduced
ECF volume increases
Plasma Volume
If plasma volume is too large:
venous return increases:
stimulating natriuretic peptides (ANP and BNP)
reducing thirst
blocking secretion of ADH and aldosterone
salt and water loss at kidneys increases
ECF volume declines
Abnormal Na
+

Concentrations in ECF
Hyponatremia:
body water content rises (overhydration)
ECF Na
+
concentration < 130 mEq/L
Hypernatremia:
body water content declines (dehydration)
ECF Na
+
concentration > 150 mEq/L
Potassium Balance
98% of potassium in the human body is in
ICF
Cells expend energy to recover potassium
ions diffused from cytoplasm into ECF
Electrolyte Balance
Table 272 (1 of 2)
Hypercalcemia
Is usually caused by hyperparathyroidism:
resulting from oversecretion of PTH
Other causes:
malignant cancers (breast, lung, kidney, bone
marrow)
excessive calcium or vitamin D supplementation
URINE COMPOTITION
Organic:
- Urea
- Uric acid
- Kreatinin
- Hormon
- urochrome
Inorganic : Na+, K+, Ca+, Mg2+, NH4+, SO42-,
HPO42-.

URINE PRODUCTION
Water excretion
3 Primary Regulatory Hormones
Affect fluid and electrolyte balance:
1. antidiuretic hormone
2. aldosterone
3. natriuretic peptides
URINE PRODUCTION AND
EXCRETION
Proton secretion and Amoniac excretion
Proton secretion and ammoniac
excretion
Ammoniac excretion