Fluid, Electrolyte, and

Acid-Base Balance
Prof. Yasmeiny Yazir
Dr. Eka Roina Megawati
Dept. Physiology
University of Sumatera Utara
 Introduction to Body Fluids
 Body fluids is the fluids in the body that is
composed of water & dissolved
substances, including electrolytes, which
are crucial for body function.
 Body Water Content
 Infants have low body fat, low bone mass,
and are 73% or more water
 Total water content declines throughout
life
 Healthy males are about 60% water;
healthy females are around 50%
 This difference reflects females’:
 Higher body fat
 Smaller amount of skeletal muscle
 In old age, only about 45% of body
weight is water
 Functions of Body Water
 Regulating body temperature
 As protective cushion & lubricant
 As reactant
 As solvent
 As transporter
 Fluid Compartments
 Water occupies two main fluid
compartments
 Intracellular fluid (ICF) – about two thirds
by volume, contained in cells
 Extracellular fluid (ECF) – consists of two
major subdivisions
 Plasma – the fluid portion of the blood
 Interstitial fluid (IF) – fluid in spaces
between cells
 Other ECF – lymph, cerebrospinal
fluid, eye humors, synovial fluid,
serous fluid, and gastrointestinal
secretions
 Fluid Compartments
The plasma and the cellular elements of
the blood, principally red blood cells, fill
the vascular system, and together they
constitute the total blood volume.
 The interstitial fluid is that part of the ECF
that is outside the vascular system,
bathing the cells.
 Abouta third of the total body
water (TBW) is extracellular; the
remaining two-thirds are intracellular
(intracellular fluid).
 Body fluid
compartments
 Body Composition
The intracellular component of the body
water accounts for about 40% of body
weight and the extracellular component
for about 20%.
 Approximately 25% of the extracellular
component is in the vascular system
(plasma = 5% of body weight) and 75%
outside the blood vessels (interstitial fluid
= 15% of body weight).
 The total blood volume is about 8% of
body weight.
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
Units for Measuring Concentration
of Solutes
 Moles
 A mole is the gram-molecular weight of a
substance, ie, the molecular weight of the
substance in grams.
 Each mole (mol) consists of approximately
6 × 1023 molecules.
 The millimole (mmol) is 1/1000 of a mole,
and the micromole (mmol) is 1/1,000,000
of a mole.
 Thus, 1 mol of NaCl = 23 + 35.5 g = 58.5
g, and 1 mmol = 58.5 mg.
 The mole is the standard unit for
expressing the amount of substances in
the SI unit system
Units for Measuring Concentration
of Solutes
 Equivalents
 The concept of electrical equivalence is
important in physiology because many of
the important solutes in the body are in
the form of charged particles.
 One equivalent (eq) is 1 mol of an ionized
substance divided by its valence.
 One mole of NaCl dissociates into 1 eq of
Na+ and 1 eq of Cl-. One equivalent of
Na+ = 23 g; but 1 eq of Ca2+ = 40 g/2 =
20 g.
 The milliequivalent (meq) is 1/1000 of 1
eq.
 Electrolyte Concentration
 Expressed in milliequivalents per liter
(mEq/L), a measure of the number of
electrical charges in one liter of solution
 mEq/L = (concentration of ion in
[mg/L]/the atomic weight of ion) 
number of electrical charges on one ion
 For single charged ions, 1 mEq = 1 mOsm
 For bivalent ions, 1 mEq = 1/2 mOsm
 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
 Extracellular and Intracellular
Fluids
 Sodium and potassium concentrations in
extra- and intracellular fluids are nearly
opposites
 This reflects the activity of cellular ATP-
dependent sodium-potassium pumps
 Electrolytes determine the chemical and
physical reactions of fluids
 Extracellular and Intracellular
Fluids
 Proteins, phospholipids, cholesterol, and
neutral fats account for:
 90% of the mass of solutes in plasma
 60% of the mass of solutes in interstitial
fluid
 97% of the mass of solutes in the
intracellular compartment
Electrolyte Composition of Body Fluids

Figure 26.2
 Major functions of electrolytes :
 Cofactors for enzymes
 Action potential in neuron and muscle cells
 Secretion & action of hormones &
neurotransmitters
 Muscle contraction
 Acid/base balance
 Osmosis
 Fluid Movement Among
Compartments
 Compartmental exchange is regulated by
osmotic and hydrostatic pressures
 Net leakage of fluid from the blood is
picked up by lymphatic vessels and
returned to the bloodstream
 Exchanges between interstitial and
intracellular fluids are complex due to the
selective permeability of the cellular
membranes
 Two-way water flow is substantial
 OSMOSIS
 When a substance is dissolved in water,
the concentration of water molecules in
the solution is less than that in pure water,
since the addition of solute to water
results in a solution that occupies a
greater volume than does the water alone.
 If the solution is placed on one side of a
membrane that is permeable to water but
not to the solute and an equal volume of
water is placed on the other, water
molecules diffuse down their concentration
gradient into the solution.
 Diagrammatic representation of osmosis

 Water molecules are represented by small open

circles, solute molecules by large solid circles.
 In the diagram on the left, water is placed on one
side of membrane permeable to water but not to
solute, and an equal volume solution of the solute is
placed on the other.
 Diagrammatic representation of osmosis

 Water molecules move down their concentration

gradient into the solution, and, as shown in the
diagram on the right, the volume of the solution
increases.
 As indicated by the arrow on the right, osmotic
pressure is the pressure that would have to be
applied to prevent the movement of the water
 OSMOSIS
 This process—the diffusion of solvent
molecules into a region in which there is a
higher concentration of a solute to which
the membrane is impermeable—is called
osmosis.
 It is an important factor in physiologic
processes.
 OSMOTIC PRESSURE
 The tendency for movement of solvent
molecules to a region of greater solute
concentration can be prevented by
applying pressure to the more
concentrated solution.
 The pressure necessary to prevent solvent
migration is the osmotic pressure of the
solution.
 The osmolarity is the number of osmoles
per liter of solution—eg, plasma—whereas
the osmolality is the number of osmoles
per kilogram of solvent. Therefore,
osmolarity is affected by the volume of the
various solutes in the solution and the
temperature, while the osmolality is not.
 Osmotically active substances in the body
are dissolved in water, and the density of
water is 1, so osmolal concentrations can
be expressed as osmoles per liter (osm/L)
of water.
 OSMOSIS
 Diffusion of water trough a semipermeable
membrane from higher water
concentration (lower solute concentration)
to a lower water concentration (higher
solute concentration)
 Tonicity: a measure of the ability of a
solution to cause a change in cell shape by
promoting osmotic flow
 Osmotic pressure is defined as the
external pressure applied to the top of the
fluid to prevent osmosis from occuring
Osmolal Concentration of Plasma:
Tonicity
 The term tonicity is used to describe the
osmolality of a solution relative to plasma.
Solutions that have the same osmolality as
plasma are said to be isotonic; those
with greater osmolality are hypertonic;
and those with lesser osmolality are
hypotonic.
 All solutions that are initially isosmotic
with plasma—ie, that have the same
actual osmotic pressure or freezing-point
depression as plasma—would remain
isotonic if it were not for the fact that
some solutes diffuse into cells and others
are metabolized.
 Thus, a 0.9% saline solution remains
isotonic because there is no net
movement of the osmotically active
particles in the solution into cells and the
particles are not metabolized.
 On the other hand, a 5% glucose solution
is isotonic when initially infused
intravenously, but glucose is metabolized,
so the net effect is that of infusing a
hypotonic solution.
 Osmosis & IV fluids
 Hypotonic IV solutions  if too much
water enters the cells eventually it coud
undergo hemolysis or break open
 Hypertonic IV solutions  there is a net
flow of water out of the cell and that
cause the cell to shrink
 Extracellular and Intracellular
Fluids
 Ion fluxes are restricted and move
selectively by active transport
 Nutrients, respiratory gases, and wastes
move unidirectionally
 Plasma is the only fluid that circulates
throughout the body and links external
and internal environments
 Osmolalities of all body fluids are equal;
changes in solute concentrations are
quickly followed by osmotic changes
 Movements of fluids in the body
 Absorption; Fluids are absorbed into the
plasma in the intestine
 Circulation; The fluids circulate within the
plasma bathing the cells in the body
 Excretion; The kidney remove excess ions
and water from the body through urine
Continuous Mixing of Body Fluids
 Summary:
 Fluids are composed of water and all the
substances (solutes) dissolved in the
water in the body
 Most fluids within the body exist in three
major compartment: intracellular, plasma
and interstitial. The interstitial
compartment and the plasma are the
extracellular compartment
 Within a solution, positive and negative
charges must balance of the number of
ions present
 The concentration of dissolved ions, or
electrolytes, in the intracellular
compartment is very different than the
concentration of electrolytes in the
extracellular compartment
 Both water and electrolytes have many
important function in the body
 Osmosis is the movement of water across
a membrane from the side that has more
water to the side that has loss water
 Fungsi Ginjal
1. Ekskresi/Pembentukan Urine
 Mempertahankan homeostasis
 Mengatur osmolalitas ECF
 Mengatur volume ECF
 Mengatur pH ECF
2. Endokrin/Hormon (Non Ekskresi)
 Menghasilkan renin  mengatur TD
 Menghasilkan erythropoeitin 
stimulasi eritropoeisis oleh sumsum
tulang
 Mengaktifkan vitamin D absorbsi
Ca dalam usus dipermudah
 Menghasilkan prostaglandin