REGULATION OF FLUID AND

ELECTROLYTE BALANCE

• Body Fluids and Fluid Compartments

• Body Fluid and Electrolyte Balance –
9781429208567

fluid and electrolyte homeostasis

Why do we care about this?

ECF volume
Osmolarity
 T h e B o d y a s a n O p e n S y s te m
 “O p e n S y s te m ”. T h e b o d y e x c h a n g e s
m a te r ia l a n d e n e r g y w ith it s
s u r r o u n d in g s .
 Water Steady State
• Amount Ingested = Amount Eliminated

• Pathological losses
vascular bleeding (H20, Na+)
vomiting (H20, H+)
diarrhea (H20, HCO3-).
 Electrolyte (Na+, K+, Ca++)
Steady State
• Amount Ingested = Amount Excreted.
• Normal entry: Mainly ingestion in food.
• Clinical entry: Can include parenteral
administration.
 Electrolyte losses

• Renal excretion
• Stool losses
• Sweating
• Abnormal routes: e.g.. vomit and
diarrhea
 Body Fluids and Fluid
Compartments
• The percentage of total body water: 45-75%
• Intracellular compartment
– 2/3 of body water (40% body weight)
• Extracellular compartment
– 1/3 of body water (20% body weight)
– the blood plasma (water=4.5% body weight)
– interstitial fluid and lymph (water=15% body weight)
– transcellular fluids: e.g. cerebrospinal fluid, aqueous
humor (1.5% BW)
• Distribution of substances within the body is NOT
HOMOGENEOUS.
 Body Water Distribution
•Individual variability (lean body mass)
–55 - 60% of body weight in adult males Input
–50 - 55% of body weight in adult female
–~42 L For a 70 Kg man.

RBC PLASMA WATER

5% 3L ECF
20% 14 L
CELL WATER INTERSTITIAL
FLUID
40% 28 L COMPARTMENT
15% 10 L

TRANSCELLULAR WATER

1% 1L
Electrochemical Equivalence

• Equivalent (Eq/L) = moles x valence

• Monovalent Ions (Na+, K+, Cl-):
– 1 milliequivalent (mEq/L) = 1 millimole
• Divalent Ions (Ca++, Mg++, and HPO42-)
– 1 milliequivalent = 0.5 millimole
Solute Overview:
Intracellular vs. Extracellular

• Ionic composition very different

• Total ionic concentration very similar
• Total osmotic concentrations virtually
identical
Summary of Ionic composition
Protein
Organic Phos.
400 Inorganic Phos.
Bicarbonate
300 Chloride
Magnesium
200 Calcium
Potassium
100 Sodium

0
Plasma Interstitial Cell
H2O H2O H2O
 Net Osmotic Force
Development
• Semipermeable membrane
• Movement some solute obstructed
• H2O (solvent) crosses freely
• End point:
– Water moves until solute concentration on
both sides of the membrane is equal
– OR, an opposing force prevents further
movement
 Osmotic Pressure ()

• The force/area tending to cause water

movement.
= p

S S S
S
S S S
S S S
S S S
 Glucose Example

Initial Gl Gl Gl Gl
10 L 10 L

Final Gl Gl Gl Gl
15 L 5L
 Osmotic Concentration
• Proportional to the number of osmotic
particles formed: Osm/L = moles x n (n, # of
particles in solution) e.g. 1 M NaCl = 2 M Glu in Osm/L
• Assuming complete dissociation:
– 1mole of NaCl forms a 2 osmolar solution in 1L
– 1mole of CaCl2 forms a 3 osmolar solution in 1L
• Physiological concentrations:
– milliOsmolar units most appropriate
– 1 mOSM = 10-3 osmoles/L
 Principles of Body Water
Distribution
• Body control systems regulate ingestion
and excretion:
– constant total body water
– constant total body osmolarity
• Osmolarity is identical in all body fluid
compartments (steady state conditions)
– Body water will redistribute itself as
necessary to accomplish this
 Intra-ECF Water
Redistribution
Plasma vs. Interstitium

• Balance of Starling Forces acting

across the capillary membrane
– osmotic forces
– hydrostatic forces
 Intracellular Fluid Volume

• ICFV altered by: changes in

extracellular fluid osmolarity.
• ICFV NOT altered by: iso-osmotic
changes in extracellular fluid volume.
• ECF undergoes proportional changes
in:
– Interstitial water volume
– Plasma water volume
 Primary Disturbance:
Increased ECF Osmolarity
• Water moves out of cells
– ICF Volume decreases (Cells shrink)
– ICF Osmolarity increases
• Total body osmolarity remains higher
than normal
 Primary Disturbance:
Decreased ECF Osmolarity

• Water moves into the cells

– ICF Volume increases (Cells swell)
– ICF Osmolarity decreases
• Total body osmolarity remains lower
than normal.
Plasma Osmolarity Measures
ECF Osmolarity
• Plasma is clinically accessible
• Dominated by [Na+] and the associated
anions
• Under normal conditions, ECF
osmolarity can be roughly estimated as:

POSM = 2 [Na+]p 270-290 mOSM

 SOLUTIONS USED CLINICALLY
FOR VOLUME REPLACEMENT
THERAPY
• Isotonic Solutions --> n.c. ICF
• Hypertonic Solutions --> Decrease ICF
• Hypotonic --> Increase ICF
 Type of solutions
• Saline solutions
– Come in a variety of concentrations: hypotonic (eg., 0.2%),
isotonic (0.9%), and hypertonic (eg. 5%).
• Dextrose in Saline
– Glucose is rapidly metabolized to CO2 + H2O
– The volume therefore is distributed intracellularly as well as
extracellularly
– Again available in various concentrations
– Used for simultaneous volume replacement and caloric
supplement
• Dextran, a long chain polysaccharide
– Solutions are confined to the vascular compartment and
preferentially expand this portion of the ECF
 Body Fluid and Electrolyte
Balance
• Water input and output
The role of the kidneys in maintaining
balance of water and electrolytes
The regulation of body water balance
 thirst sensation
 control of renal water excretion by ADH
 Thirst centers in the hypothalamus
 relay information to the cerebral cortex where thirst
becomes a conscious sensation
 controls the release of ADH

 Stimuli for thirst sensation

 Baroreceptors and stretch receptors as detectors
 impulses sent to the thirst control centers in the
hypothalamus

 Effect of ADH (vasopressin)

Factors affecting
ADH release
• Sodium balance
 The kidneys - the major site of
control of sodium output
 Influence of dietary input on
appropriate changes in sodium
excretion by the kidneys
 Effector mechanisms include
changes in:
- glomerular filtration rate
- plasma aldosterone levels
- peritubular capillary Starling forces
 - renal sympathetic nerve activity
- intrarenal blood flow distribution
- plasma atrial natriuretic factor (ANF

 Effects of aldosterone

 The renin-angiotensin system

 release of renin
 action of renin on the formation of angiotensin II
 effects of angiotensin II: a.blood pressure; b.
synthesis and release of aldosterone; c. stimulation
of the hypothalamic thirst centers; d. release of
ADH
Pathway of RAAS
Principal cells & aldosterone
 Net reabsorption of salt and water by the proximal
convoluted tubule
 peritubular capillary hydrostatic forces
 colloid osmotic pressure

 Decrease in renal sodium excretion by stimulation

of renal sympathetic nerves
 Release of Atrial natriuretic peptide (ANP)
 in response to an increase in blood volume
 increase sodium excretion by increasing GFR and
inhibiting sodium reabsorption
 • Atrial natriuretic peptide

• Decreased blood pressure

stimulates renin secretion
 The regulated variable affecting sodium
excretion - effective arterial blood volume
 Changes in effective arterial blood volume
can elicit the appropriate renal response by
three possible mechanisms
 a change in blood volume  glomerular blood flow
and capillary pressure  GFR
 a change in blood volume detected by an
intrarenal baroreceptor  release of renin
 a change in blood volume could change
peritubular capillary Starling forces
 Other factors affecting sodium excretion
include:
 glucocorticoids
 estrogen
 osmotic diuretics
 poorly reabsorbed anions
 diuretic drugs
Homeostasis:severe dehydration
• Potassium balance
 Potassium plays a number of important
roles in the body
 electrical excitability of cells
 major osmotically active solute in cells
 acid-base balance
 cell metabolism

 The kidneys are the major site in control of

potassium balance
 Factors affecting the distribution of potassium
between cells and extracellular fluid include:
 activity of the sodium-potassium pump
 acid-base status of body fluids
 availability of insulin
 cellular breakdown due to trauma, infection,
ischemia, and heavy exercise

 The regulation of plasma potassium by

hormones
 insulin
 epinephrine
 aldosterone,
 Factors affecting potassium excretion include:
 intracellular potassium concentration
 aldosterone
 excretion of anions
 urine flow rate