Fluids, Electrolytes, Acid-Base Balance

I) Body Fluid
A) Body Water Content
-- variable: infants ~75%
adult males ~60%
adult females ~50%
B) Fluid Compartments
C) Composition of Body Fluids
Water
Electrolytes -- chemical compounds that dissociate in water into ions (can carry electric current)

Nonelectrolytes -- chemicals that do NOT dissociate in water into ions

milliequivalents/liter (mEq/L) -- measure of # charges in soln

= (Molarity x charge of the electrolyte)

- Ex. 1: What is the mEq/L of a 140 mM NaCl soln?

- Ex. 2: What is the mEq/L of a 5 mM Ca2+ soln?

- Ex. 3: What is the mEq/L of a 100mM CaCl2 soln?

C) Composition of Body Fluids (continued)
D) Fluid Movements
water can move compartment compartment
-- attempt to maintain homeostasis (osmolarity & volume)
D) Fluid Movements (alternate portrayal)
water can move compartment compartment
-- attempt to maintain homeostasis (osmolarity & volume)
D) Fluid Movements (continued)
-- water loss from one compartment draws H2O from other compartments to replace
-- Ex: excessive sweating during exercise
II) Water Balance
Water Intake = Water Output
A) Regulation of Water Intake
Thirst Mechanism = driving force
-- responds to small change (2-3%) in bld plasma osmolality
B) Regulation of Water Output
Obligatory Water Loss unavoidable outputs of H2O
-- at least 500 mL/day via urine
ability to retain or excrete H2O tied to Na+

C) Disorders of Water Balance

1) Dehydration loss of water
-- common causes: profuse sweating
water deprivation
diuretic abuse
diabetes
2) Volume Depletion loss of water AND Na+; Osmolarity same
-- common causes: hemorrhage
prolonged vomiting or diarrhea
severe burns

3) Hypotonic Hydration overhydration (too much H2O)

-- ECF diluted Na+ conc lowered

4) Edema accumulation of fluid in interstitial space (ECF)

-- incr fluid filtration from bld or hindered reabsorption
III) Electrolyte Balance: Na+
A) Na+
-- central electrolyte the major cation of ECF
-- responsible for nearly all osmotic pressure of ECF
~140 mEq/L in plasma & ECF
-- primary role in controlling ECF volume and water distribution in the body
B) Regulation of Na+ Balance: Aldosterone, Baroreceptors, ANP
-- Na+ is freely filtered in kidneys

In brief..
1) Aldosterone (hormone from renal cortex)
incr Na+ reabsorbtion from DCT, coll. duct
also incr K+ secretion from collecting duct

2) Cardiovascular Baroreceptors
incr bld volume/pressure incr Na+ and H2O filtration
decr bld volume/pressure decr Na+ and H2O filtration
3) Atrial Natriuretic Peptide (ANP)
hormone from heart atria in response to stretch
causes more Na+ (and hence, H2O) remain in urine
inhibits release of Aldosterone and Renin vasodilation
4) Estrogen
hormone enhances Na+ (and H2O) reabsorption by renal tubules
1) Aldosterone Mechanism:
Low Na+ content in bld plasma;
High K+ conc in bld plasma
2) Cardiovascular Baroreceptor Mechanism:
a) Increased bld volume increased bld pressure stim. baroreceptors in aorta & carotid arteries

decr sympathetic activity HR & contractility, vasoconstriction

incr NFP incr GFR

b) Decreased bld volume decreased bld pressure inhib. baroreceptors in aorta & carotid arteries
incr sympathetic activity HR & contractility, vasoconstriction
decr NFP decr GFR
3) Atrial Natriuretic Peptide (ANP) Mechanism:
-- hormone produced by certain cells in heart atria in response to stretch (hi bld vol; hi bld press.)

ANP

Inhibits Aldosterone Inhibits ADH Inhibits Renin

Release Release Release
IV) Electrolyte Balance: K+
A) K+
-- major cation of ICF
-- very strongly influences membrane resting potential
-- slight changes in ECF K+ conc can have major effects on cells

-- coordinates with H+ concs:

During ACIDOSIS During ALKALOSIS

B) Regulation of K+ Balance
-- K+ freely filtered in kidneys reabsorbed, and at times secreted into filtrate
When ECF K+ is high
-- more K+ moves into principal cells of cortical collecting duct more secreted into filtrate
When ECF K+ is low
-- less K+ moves into principal cells of cortical collecting duct less secreted into filtrate

Aldosterone Influence
-- enhances K+ secretion while enhancing Na+ reabsorption
V) Electrolyte Balance: Ca2+ and PO43-
-- most Ca2+ stored in bones
-- kidneys reabsorb 98% Ca2+ and 75% phosphate from filtrate
-- control by PTH:
VI) Acid-Base Balance
A) pH of Body Fluids
-- arterial blood = pH 7.4 -- interstitial fluid & venous bld = pH 7.35

B) Acid-base Basics
1) Acid

2) Base

3) Strong Acid vs Weak Acid (same for bases)

C) Buffering Systems of Body
-- most H+ produced in body from metabolic by-products or end products
-- sequential regulation of H+ conc in blood by:
1) Chemical Buffers
2) Respiratory System
3) Renal System
1) Chemical Buffers: Bicarbonate, Phosphate, Protein
-- one or more compounds that resist changes in pH when acid/base added

a) Bicarbonate Bfr System: H2CO3 and NaHCO3 together in soln; buffers ECF

-if add HCl

-if add NaOH

b) Phosphate Bfr System: NaH2PO4 and Na2HPO4 together in soln; buffers ICF & urine

-if add HCl

-if add NaOH

c) Protein Bfr System: buffers ICF and plasma

-- consider what happens to H+s

-if add H+

-if add OH-

2) Respiratory Buffering of H+
-- physiological buffering of blood
-- between 1x and 2x buffring power of all bodys chemical bfrs
-- disposes of volatile acid
3) Renal Mechanism for Acid-Base Balance
-- disposes of metabolic/fixed acids (phosphoric acid, lactic acid, uric acid, ketone bodies)
a) Secretion of H+ into filtrate urine
b) Excretion H+ via NH4+ in filtrate urine
-- kidneys conserve or excrete filtered HCO3-
-- kidneys generate new HCO3-
VII) Dealing with Acid-Base Imbalances
-- acidosis or alkalosis can be classified as: 1) respiratory 2) metabolic

A) Respiratory Acidosis/Alkalosis: Respiratory Alkalosis < 35-45 mmHg CO2 < Acidosis

1) Respiratory Acidosis CO2 buildup

-- often from inadequate breathing or gas exchange problem (e.g. pneumonia, cystic fibrosis)

2) Respiratory Alkalosis CO2 deficiency

-- often due to hyperventilation (e.g. stress, pain, high altitude)

B) Metabolic Acidosis/Alkalosis: Metabolic Acidosis < 22-26 mEq/L < Alkalosis

-- pH imbalance NOT due to bld CO2 levels
-- relates to HCO3- levels in bld; normal range 22-26 mEq/L

1) Metabolic Acidosis low bld pH and HCO3- levels

-- typical causes: too much alcohol; loss of HCO3- from diarrhea; lactic acid; keto acid buildup
during starvation; kidney failure

2) Metabolic Alkalosis high bld pH and HCO3- levels

-- typical causes: vomiting (lose H+); overdose on base (e.g antacids)
C) Respiratory and Renal Compensations for Acidosis/Alkalosis
-- when one system is failing, other system tries to rectify acid-base imbalance
if compensation successful, persons pH appears normal, but underlying problem still exists

1) Metabolic Acidosis with Respiratory Compensation

-- metabolic acid buildup bld pH decr (too much H+ conc)
-- low bld pH stimulates respiratory centers incr breathing rate & depth

2) Metabolic Alkalosis with Respiratory Compensation

-- bld pH too high (too much HCO3- or too little H+)
-- high bld pH inhibits respiratory centers slower, shallow breathing
3) Respiratory Acidosis with Renal Compensation
-- person hypoventilating (pneumonia) not expelling CO2 well enough over time

4) Respiratory Alkalosis with Renal Compensation

-- person hyperventilating (ex: high altitude) bld CO2 low (bld pH is high)
 Blood Acidosis/Alkalosis Diagnostic Approach
Normal Range in Plasma
1) 7.357.45
2) 3545 mmHg
3) 2226 mEq/L

Ex 1: Blood readings: pH = 7.5, PCO2= 24 mmHg, HCO3- = 23 mEq/L

Ex 2: Blood readings: pH = 7.3, PCO2= 32 mmHg, HCO3- = 18 mEq/L

Ex 3: Blood readings: pH = 7.45, PCO2= 46 mmHg, HCO3- = 33 mEq/L