Fluid and Electrolyte Balance

M. Rasjad Indra Laboratorium Ilmu Faal FK. UNIBRAW

Body Fluid Compartment

Body Fluid Volume

Body fluid 60% (45-75) water Intracellular 40 % (42 liter in 70 kg young adult) Interstitial 15 % (10.5 liter in 70 kg young adult) Extracellular 20 % (14 liter in 70 kg young adult) Plasma 5% (3.5 liter in 70 kg young adult) Transcellular 1-3 % (Cerebrospinal) (Aqueous humor)

Electrolyte Composition of Body Fluid

Electrolytes Plasma (mEq/L) Interstitial Fluid (mEq/Kg H2O) Intracellular Fluid (mEq/Kg H2O) 10 159 1 40 210 3 7 45 155 210

Cation: Na+ K+ Ca2+ Mg2+ Total Anion: ClHCO3Protein Others Total

142 4 5 2 153 103 25 17 8 153

145 4 3 2 154 117 28 9 154

Daily Intake and Output of Water (in ml/day)

Normal Intake Fluid ingested From metabolism Total intake Output Insensible-Skin Insensible-Lungs Sweat Feces Urine Total output Prolonged Heavy Exercise ? 200 ? 350 650 5000 100 500 6600

2100 200 2300 350 350 100 100 1400 2300

 Osmosis
The net diffusion of water across the membrane from a region of high water concentration to one that has a lower water concentration
The measurement of total number of particles in a solution 1 mole : 6.02 x 1023 1 mole/L NaCl ~ 2 osmoles/L (Na+ & Cl-)

Osmoles (Osm):

Osmotic pressure:

The precise amount of pressure required to prevent the osmosis

1 osm/L ~ 19,300 mmHg; 1 mosm/L~19.3mmHG

Add pure water

Normal Add pure water

ICF

ECF ICF ECF

Add isotonic saline

Normal Add isotonic saline

ICF

ECF

ICF

ECF

Add pure NaCl

Normal Add pure NaCl

ICF

ECF

ICF

ECF

Decreased ADH release from posterior pituitary

Decreased plasma ADH Cardiovascular stretch receptor Osmoreceptor Decreased collecting duct water permiability Decreased plasma osmolarity

Ingestion of 1L of water

Increased extracellular fluid volume

Normal fluid volume Increased water excretion

Decreased water reabsorption

Increased ADH release from posterior pituitary Increased plasma ADH

Cardiovascular stretch receptor Osmoreceptors

Increased collecting duct water permiability

Dehydration

Decreased extracellular fluid volume Increased plasma osmolarity

Thirst

Increased water intake

Increased water reabsorption

Normal fluid volume Decreased water excretion

Kidneys, cardiovascular sensor

Sensor

Kidneys 1. GFR 2. Aldosterone Extracellular fluid volume (effective arterial blood volume) 3. Peritubular capillary Starling forces Regulated variabel 4. Sympathetic nerve activity 5. Intrarenal blood flow distribution 6. Arterial natriuretic peptide

(-)

Renal sodium excretion

Angiotensinogen Kidney Renin Angiotensin I Decreased effective arterial blood volume

Liver

Lungs Converting enzyme

Angiotensin II

Blood vessels

Adrenal cortex

Brain

Vasoconstrictor

Aldosteron secre.

ADH secretion

Thirst

Blood pressure >

Sodium reabs.

H2O reabsorption

Water intake

Normal effective arterial blood volume

Increased plasma [K+]

Direct effect on adrenal cortex Increased aldosterone secretion Increased plasma aldosterone

Increased [K+] in body cell (including kidney cells)

Increased Potasium intake Normal potasium level

Increase luminal membrane permiablility to Na+ and K+ & Increase basolateral membrane Na+/K+-ATPase activity in collecting duct principal cells.

Increased potasium secretion

Increased potasium excretion

Definition of Edema:
An increase in the interstitial compartement of extracellular fluid volume (Harrisons).

Starling Hypothesis
The balance of hydrostatic and oncotic pressures across the capillary endothelium
Mean capillary hydrostatic pressure (Pc): 25 mmHg
Interstitial fluid hydrostatic pressure (PIF): 0 mmHg Capillary oncotic pressure (c): 28 mmHg Interstitial fluid oncotic pressure (IF): 3 mmHg Arterial end of capillary: Pc= 40 mmHg; PIF= 0 mmHg c= 28 mmHg; IF= 3 mmHg Net Filtration= 35-0-28+3= 10 Venous end of capillary: Pc= 10 mmHg; PIF= 0 mmHg c= 28 mmHg; IF= 3 mmHg Net Absorption= 15-0-28+3= -10

Causes of Extracellular Edema

1. Increased capillary pressure

Excessive kidney retention High venous pressure Decreased arteriole resistance

2. Decreased plasma proteins

Loss of protein in urine Loss of protein from denuded skin Failure of produce protein

 3. Increased capillary permiability

Immune reaction Toxin Bacteria infection Vitamin deficiency (exp. Vit C)

4. Blockage of lymph return

Cancer Paracyte infection (Filaria) Surgery Congenital absence or abnormal of Lymphatic vessels

Exercice
The greatest fraction of
the bodys water is contained within: a. Blood plasma b. Cells c. Extracellular fluid d. Transcellular fluid

Intravenous infusion of 1

liter of isotonic saline will: a. A 1-liter increase in intracellular fluid volume b. A 1-liter increase in extracellular fluid volume c. A 0.5-liter increase in intracellular fluid volume and a 0.5-liter increase in extracellular fluid volume

 Intravenous infusion of 1

liter of hypertonic saline will cause: a. A decrease in intracellular fluid volume b. An increase in extracellular fluid volume c. An increase in plasma osmolality d. All of the above

Antidiuretic hormone

increase epithelial water permiability of: a. Collecting ducts b. Proximal tubules c. Thick ascending limbs d. All of the above

 ADH release from the

posterior pituitary is stimulated by: a. A fall in plasma osmolality b. Severe hemorrhage c. Stimulation of arterial baroreceptors d. Stretch of left arterial receptor

Which of the following

produces a decrease in renal sodium excretion? a. Decrease plasma aldosterone level b. Increase plasma level of atrial natriuretic peptide c. Increase GFR d. Increase renal sympathetic nerve activity

 Which of the following

produces an increase in renal sodium excretion? a. Administration of glucocorticoids b. Decrease peritbular capilary hydrostatic pressure c. Increase plasma estrgen levels d. Uncontroled diabetes mellitus

Renin release is stimulated

by: a. Increase blood pressure in afferent arterioles b. Increase effective arterial blood volume c. Increase NaCl transport by macula densa cells d. Stimulation of renal sympathetic nerves

 Which of the following are

commonly seen in patients with severe congestive heart failure? a. Elevated plasma ADH levels b. Generalized edema c. Hyponatremia d. Thirst e. All of the above

The most abundant

intracellular cation is: a. Calcium b. Chloride c. Potasium d. Sodium

 Which of the following

promotes a shift of potasium from cells to extracellular fluid? a. A fall in plasma pH b. An overdose of digitalis c. Inadequate blood flow d. Lack of insulin e. All of the above

Which of the following

produces excessive urinary excretion of potasium? a. Acute renal failure b. Inadequate aldosterone secretion c. Severe chronic renal failure (GFR=10 ml/min) d. Uncontroled diabetes mellitus

 The following measurement were obtained in

3.40 kg newborn infant:
Total body water 2600 ml Extracellular water 1490 ml Plasma water 155 ml What are the volumes of (1) The intracellular water and (2) the interstitial fluid-lymph water?