Fluid, Electrolyte, and Acid-

Base Balance
Magalasin
Marcera
Masbod
Morden
• Fluid surrounds all the cells in the body and is also inside cells. Body fluids contain electrolytes such as sodium and
potassium and also have a degree of acidity. Fluid, electrolyte, and acid-base balances within the body maintain the
health and function of all body systems. The characteristics of body fluids influence body system function because of
their effects on cell function. These characteristics include the fluid amount (volume), concentration (osmolality),
composition (electrolyte concentration), and degree of acidity (pH).
Location and Movement of Water and Electrolytes
Water is a substantial proportion of body weight. In fact, about 60% of the body weight of an adult man is
water. This proportion decreases with age; approximately 50% of an older man's weight is water. Women
typically have less water content than men. Obese people have less water in their bodies than lean people
because fat contains less water than muscle
Fluid Distribution.
Body fluids are located in two distinct compartments:
extracellular fluid (ECF) outside the cells, and
intracellular fluid (ICF) inside the cells. In adults ICF is
approximately two thirds of total body water. ECF is
approximately one third of total body water. ECF has
two major divisions (intravascular fluid and interstitial
fluid) and a minor division (transcellular fluids).
Intravascular fluid is the liquid part of the blood (i.e., the
plasma). Interstitial fluid is located between the cells
and outside the blood vessels. Transcellular fluids such
as cerebrospinal, pleural, peritoneal, and synovial fluids
are secreted by epithelial cells
Composition of Body Fluids

Fluid in the body compartments contains mineral

salts known technically as electrolytes. An electrolyte
is a compound that separates into ions (charged
particles) when it dissolves in water. Ions that are
positively charged are called cations; ions that are
negatively charged are called anions. Fluid that
contains a large number of dissolved particles is more
concentrated than the same amount of fluid that
contains only a few particles. Osmolality of a fluid is a
measure of the number of particles per kilogram of
water. A fluid with the same tonicity as normal blood
is called isotonic. A hypotonic solution is more dilute
than the blood, and a hypertonic solution is more
concentrated than normal blood

Movement of Water and Electrolytes. Active transport,
diffusion, osmosis, and filtration are processes that move water
and electrolytes between body compartments. These processes
maintain equal osmolality in all compartments while allowing
for different electrolyte concentrations.
Active Transport.
Fluids in different body compartments have different
concentrations of electrolytes that are necessary for normal
function. Cells maintain their high intracellular electrolyte
concentration by active transport. Active transport requires
energy in the form of adenosine triphosphate (ATP) to move
electrolytes across cell membranes against the concentration
gradient (from areas of lower concentration to areas of higher
concentration).
Diffusion.
Diffusion is passive movement of electrolytes or other particles
down a concentration gradient (from areas of higher
concentration to areas of lower concentration).
Osmosis.
Water moves across cell membranes by osmosis, a
process by which water moves through a membrane
that separates fluids with different particle
concentrations. Cell membranes are semi-permeable,
which means that water crosses them easily, but they
are not freely permeable to many types of particles,
including electrolytes such as sodium and potassium.
These semi permeable cell membranes separate
interstitial fluid from ICF. The fluid in each of these
compartments exerts osmotic pressure, an inward-
pulling force caused by particles in the fluid
Filtration.
Fluid moves into and out of capillaries (between the vascular
and interstitial compartments) by the process of filtration.
Hydrostatic pressure is the force of the fluid pressing outward
against a surface. Similarly, capillary hydrostatic pressure is a
relatively strong outward-pushing force that helps move fluid
from capillaries into the interstitial area.

Blood contains albumin and other proteins known as colloids.

These proteins are much larger than electrolytes, glucose, and
other molecules that dissolve easily. Most colloids are too large
to leave capillaries in the fluid that is filtered; thus they remain
in the blood. Because they are particles, colloids exert osmotic
pressure. Blood colloid osmotic pressure, also called oncotic
pressure, is an inward-pulling force caused by blood proteins
that helps move fluid from the interstitial area back into
capillaries. Interstitial fluid colloid osmotic pressure normally is
a very small opposing force
Fluid Balance
Fluid homeostasis is the dynamic interplay of three processes:
fluid intake and absorption, fluid distribution, and fluid output
Fluid Intake
Fluid intake occurs orally through drinking but also through
eating because most foods contain some water. Food
metabolism creates additional water. Average fluid intake from
these routes for healthy adults is about 2300 mL, although this
amount can vary widely, depending on exercise habits,
preferences, and the environment
Fluid Distribution.
The term fluid distribution means the movement
of fluid among its various compartments. Fluid
distribution between the extracellular and
intracellular compartments occurs by osmosis.
Fluid distribution between the vascular and
interstitial parts of the ECF occurs by filtration.
Fluid Output.
Fluid output normally occurs through four organs:
the skin, lungs, gastrointestinal (GI) tract, and
kidneys
 Antidiuretic Hormone
The kidneys are the major regulator of fluid output because
ADH regulates the osmolality of the body fluids by
they respond to hormones that influence urine production.
influencing how much water is excreted in urine. It
When healthy adults drink more water, they increase urine
is synthesized by neurons in the hypothalamus
production to maintain fluid balance. If they drink less water,
that release it from the posterior pituitary gland.
sweat a lot, or lose fluid by vomiting, their urine volume
ADH circulates in the blood to the kidneys, where
decreases to maintain fluid balance.
it acts on the collecting ducts

Renin-Angiotensin-Aldosterone System
The RAAS regulates ECF volume by influencing how
much sodium and water are excreted in urine. It also
contributes to regulation of blood pressure.
Specialized cells in the kidneys release the enzyme
renin, which acts on angiotensinogen, an inactive
protein secreted by the liver that circulates in the
blood. Angiotensin II has several 2069 functions, one
of which is vasoconstriction in some vascular beds.
The important fluid homeostasis functions of
angiotensin II include stimulation of aldosterone
release from the adrenal cortex. Aldosterone
circulates to the kidneys, where it causes resorption of
sodium and water in isotonic proportion in the distal
renal tubules
Atrial Natriuretic Peptide
ANP also regulates ECV by influencing how much sodium and
water are excreted in urine. Cells in the atria of the heart
release ANP when they are stretched (e.g., by an increased
ECV)
Fluid Imbalances
If disease processes, medications, or other factors disrupt fluid
intake or output, imbalances
sometimes occur. There are two major types of fluid
imbalances: volume imbalances and osmolality imbalances
Extracellular Fluid Volume Imbalances.
In an ECV imbalance there is either too little (ECV deficit) or too
much (ECV excess) isotonic fluid.
ECV deficit is present when there is insufficient isotonic fluid in
the extracellular compartment. The term hypovolemia means
decreased vascular volume and often is used when discussing
ECV deficit. ECV excess occurs when there is too much isotonic
fluid in the extracellular compartment. Intake of sodium-
containing isotonic fluid has exceeded fluid output.
Osmolality Imbalances.
In an osmolality imbalance body fluids become
hypertonic or hypotonic, which causes osmotic
shifts of water across cell membranes. The
osmolality imbalances are called hypernatremia
and hyponatremia
Clinical Dehydration.
ECV deficit and hypernatremia often occur at
the same time; this combination is called
clinical dehydration. The ECV is too low, and
the body fluids are too concentrated. Clinical
dehydration is common with gastroenteritis or
other causes of severe vomiting and diarrhea
when people are not able to replace their fluid
output with enough intake of dilute sodium-
containing fluids
Electrolyte Balance
You can best understand electrolyte balance by considering the
three processes involved in electrolyte homeostasis: electrolyte
intake and absorption, electrolyte distribution, and electrolyte
output. Electrolyte output occurs through normal excretion in
urine, feces, and sweat. Output also occurs
through vomiting, drainage tubes, or fistulas. When electrolyte
output increases, electrolyte intake
must increase to maintain electrolyte balance. Similarly, if
electrolyte output decreases such as with
oliguria, electrolyte intake must also decrease to maintain
balance
Electrolyte Imbalances
Factors such as diarrhea, endocrine disorders, and medications
that disrupt electrolyte homeostasis cause electrolyte
imbalances. Electrolyte intake greater than electrolyte output
or a shift of electrolytes from cells or bone into the ECF causes
plasma electrolyte excess.
Potassium Imbalances.
Hypokalemia is abnormally low potassium
concentration in the blood. It results from
decreased potassium intake and absorption, a
shift of potassium from the ECF into cells, and an
increased potassium output. Hyperkalemia is
abnormally high potassium ion concentration in
the blood. Its general causes are increased
potassium intake and absorption, shift of
potassium from cells into the ECF, and decreased
potassium output.
Calcium Imbalances
Hypocalcemia is abnormally low calcium concentration in the
blood. The physiologically active form of calcium in the blood is
ionized calcium. Total blood calcium also contains inactive
forms that are bound to plasma proteins and small anions such
as citrate. Hypercalcemia is abnormally high calcium
concentration in the blood. Hypercalcemia results from
increased calcium intake and absorption, shift of calcium from
bones into the ECF, and decreased calcium output

Magnesium Imbalances.
Hypomagnesemia is abnormally low magnesium concentration
in the blood. Its general causes are decreased magnesium
intake and absorption, shift of plasma magnesium to its inactive
bound form, and increased magnesium output.
Hypermagnesemia is abnormally high magnesium
concentration in the blood