NMD2024

DAVAO MEDICAL SCHOOL FOUNDATION

INTESTINAL FLUID AND ELECTROLYTE
MOVEMENT
Dr. Connie Manzano Salumbides, FPAFP | March 2, 2021

OUTLINE
I. Functional Anatomy of GIT in Relation to Fluid
and Electrolyte Movement in the Intestine
II. Physiology of Fluid and Electrolyte Movement
III. Cellular Mechanism of
a. Sodium Absorption
b. Chloride Absorption and Secretion
c. Potassium Absorption
IV. Regulation of Intestinal Ion Transport
a. Secretagogues – increase secretion
b. Absorptagogues – increase absorption

I. FUNCTIONAL ANATOMY OF GIT

Sources of fluid in the intestines are:

Secretion of Fluid in the Intestine:

1. Food (mouth, esophagus) 2.0 L/day
2. Saliva (mouth, esophagus) 1.5 L/day
3. Gastric Secretion 2.0 L/day
4. Pancreatic Secretion 1.5 L/day
5. Bile 0.5 L/day
6. Intestinal Secretions
a. Small Intestine 1.0 L/day
b. Large Intestine

Reabsorption of Fluid in the Intestine:

1. Small Intestine 6.5 L/day
2. Colon 1.9 L/day

Excretion of Fluid in the Intestine: ANATOMY AND PHYSIOLOGY

1. Anus (in feces) ~ 0.1 L/day Small Intestine Large Intestine
Absorb, Secrete Fluid, Electrolyte Fluid, Electrolyte
Absorb Nutrients Fluid, Short Chain Fatty Acid
Structure Villus, Crypt Surface Epithelium, Crypt
Amplification Villi, Microvilli, Folds No Villi, Less Fold
Amt. Absorbed 6.5 L / 8.5 L per day 1.9 L / 2.0 L per day

CELLS IN THE WALLS OF INTESTINE

ANATOMY OF INTESTINAL CYLINDER

The intestine is a cylinder with the following covering

from inner to outer:
1. Mucosa – columnar epithelia
2. Muscularis Mucosa
3. Submucosa
4. Muscularis Externa
a. Inner Circular Muscle
b. Outer Longitudinal Muscle
5. Serosa

1. Villus-Crypt Organization in the Small Intestine

2. Surface Epithelial Cells-Crypts in the Colon
3. Progenitor Cells – Stem Cells that differentiate
into specialized cells
4. Cell Proliferation to sloughing is 49 to 96 hours
 NMD2024
DAVAO MEDICAL SCHOOL FOUNDATION
INTESTINAL FLUID AND ELECTROLYTE
MOVEMENT
Dr. Connie Manzano Salumbides, FPAFP | March 2, 2021

a. decrease turnover during starvation

b. increase turnover during feeding and
lactation

WATER AND ELECTROLYTE ROUTES

1. Paracellular or Cellular/Transcellular Routes
through epithelial cells
a. Paracellular Pathway
- Needs to overcome the tight
junctions or the transcellular
pressure
b. Transcellular Pathway
- Needs transporter to transport
fluid and electrolyte from lumen to
blood or epithelial cells
ELECTROLYTES IN SMALL AND LARGE INTESTINE

NET ABSORPTION NET SECRETION

Small Intestine Water Bicarbonate
Sodium
Chloride
Potassium (Solvent Drag)
Nutrients
Colon Sodium Potassium
Water Bicarbonate
Chloride
Potassium (Distal Segment)

2. Tight Junctions
a. impermeable in colon, transepithelial
resistance is increased
b. leaky in small intestines and gall
bladder, transepithelial resistance is
reduced
ELECTROLYTES
 The N-K pump in the basolateral membrane
moved the sodium out of the cell keeping the
inside of the cell more electronegative.
 Thus, SGLT1 transporter, Transport sodium into
the cell with glucose and/or amino acids.
TRANSPORTERS IN THE GIT

ABSORPTION, SECRETION, ELIMINATION

1. Absorption
- absorptive mechanism – villi
- from lumen to intestinal cell to blood
2. Secretion
- secretory mechanism – crypts
- from blood to cell to lumen
3. Elimination
- water with fecal material

ELECTROLYTE TRANSPORT IN SMALL INTESTINE

 NMD2024
DAVAO MEDICAL SCHOOL FOUNDATION
INTESTINAL FLUID AND ELECTROLYTE
MOVEMENT
Dr. Connie Manzano Salumbides, FPAFP |
CONCEPT IN FLUID AND ELECTROLYTE MOVEMENT
 Heterogeneity in Fluid and Electrolyte Movement:
o Segmental Heterogeneity
 along the length of intestine
 ion transport along longitudinal
axis of intestine (small and large)
is different
o Crypt – Villus / Surface Heterogeneity
 leads to difference in transport
function along the radial axis of
intestine wall
 example in small intestine
 Absorption - in villous cells
 Secretory - in crypt cells
o Cellular Heterogeneity
 specific transport mechanism
restricted different cells
 Transepithelial Movement of Solute
o can be ABSORPTIVE or SECRETORY
o in each case, movement can be either
transcellular or paracellular
 Transepithelial Resistance of Intestinal Epithelia
o primarily determined by resistance of
tight junctions
o inc. permeability = decrease resistance
o intestinal permeability
 essentially a function of tight
junctions
o vary greatly throughout the intestine
o resistance increases in the aboral
direction (away from mouth)
 resistance of jejunum is lower
than distal end of colon
o permeability of tight junction:
 crypt greater than villus
 Paracellular Movement
o solute moves passively bet. adjacent
epithelial cells through tight junction
 Sodium Gradient created by Na-K Pump
o transcellular Na+ absorption
 mediated by Na-K pump-ATPase
 Osmotic Coupling of Fluid Movement
 Solvent Drag
March 2, 2021
o water drags the potassium
 Secondary Active Transport
o Entry of Na into the cell with the use of
ATP while glucose co-transport
 Electroneutral NaCl- absorption with
o Na-H Exchanger
o DRA – mediated Cl-HCO3 exchange
SAMPLE QUESTIONS:
1. Which of the following is the correct management of Diarrhea
secondary to Acute Gastroenteritis?
a. Antibiotics can be given if diarrhea lasts more than 24
hours
b. None of the choices
c. Stop feeding to rest the intestines
d. Intravenous fluid is required to replace losses of fluids and
electrolytes
e. All of the choices are Correct
Ratio: Most common cause of AG is viral. ORS is best
over IV fluid.
2. An increase in stool water can be prevented physiologically by
the following mechanisms
a. Increase in absorptive capacity of the small intestines
b. Amplification of the surface area for absorption of both
small intestines and colon
c. None of the choices
d. Increase in absorptive capacity of the large intestines to 5
liters
e. All of the choices
Ratio:
3. A patient with diarrhea due to viral gastroenteritis has signs and
symptoms of mild dehydration. Which of the electrolytes is
easily lost from the GIT?
a. Bicarbonate
b. Sodium
c. Potassium
d. Chloride
Ratio: Water pull Potassium (solvent drag)
4. The load of fluid in the small intestines is about 8.5 to 9.0 L/day.
Most of this fluid is reclaimed by both small and large intestines
to prevent dehydration. Which of the following is more efficient
in absorbing intestinal fluid?
a. Large intestine
b. Small intestine
c. Jejunum
d. all options are correct
Ratio: Large - 1.9L absorbed out of 2L/day - 95 %
Small - 6.5L absorbed out of 8.5L/day - 73%
5. What is/are the differences between sodium absorption after
meal and in between meals?
a. Sodium transport after meals uses sodium/glucose co-
transporter, moving sodium transcellularly.
b. DRA mediated Cl-HCO3 transporter is important in
electroneutral sodium absorption.
c. Absorption of sodium needs an acidic lumen
d. All options are important in moving sodium into the cells
immediately after and in between meals. Electrogenic
sodium absorption is an important mechanism of
transporting sodium into the cells.
 NMD2024
DAVAO MEDICAL SCHOOL FOUNDATION
INTESTINAL FLUID AND ELECTROLYTE
MOVEMENT
Dr. Connie Manzano Salumbides, FPAFP | March 2, 2021

Ratio: Absorption of sodium need ALKALINE lumen.

Na-H Exchanger.

6. Which of the following is NOT TRUE regarding sodium

absorption in the distal colon? TABANG
a. ENaCs can be blocked by millimolar concentration of
diuretics, Amiloride.
b. Sodium absorption in this part of the GIT is very efficient.
c. Aldosterone enhances sodium absorption by its effect on
ENaCs and on the synthesis of Na-K pumps. Sodium
absorption is not affected by luminal glucose, bicarbonate
not cyclic nucleotides.
d. Absorption of sodium through ENaCs is important in
sodium conservation because sodium is absorbed against
large concentration gradient.
Ratio: micromolar instead of millimolar

7. The following are categorized as Secretagogues, EXCEPT:

a. Bacterial exotoxins
b. Laxatives
c. Products of cells of the immune system
d. None of the above
e. Hormone and neurotransmitters

8. These 3 substances are called absorptagogues because they

increase sodium absorption. Which of the following absorb
sodium by sodium electrogenic mechanism?
a. Somatostatin
b. Glucocorticoid
c. None of the options
d. Mineralocorticoid

9. Which of the following intestinal segments absorb the most

amount of fluid, sodium and nutrients?
a. duodenum
b. proximal colon
c. jejunum
d. ileum

10. A pediatric patient was brought to the ER because of moderate

to severe dehydration due to lactose intolerance. Which of the
following mechanisms is not TRUE to this type of diarrhea?
a. The epithelial cells are structurally normal so are the
sodium/glucose/amino acids transporters.
b. Chloride is secreted to the lumen in this type of diarrhea.
c. The fluid and electrolyte moved to the lumen.
d. This is an example of osmotic type of diarrhea.