I. INTRODUCTION
A. DEFINITION - Fluid balance is the state in which the total amount of water in the body is normal and remains
relatively constant. However, not only must the total volume remain relatively constant, but the distribution of the
fluid in the fluid compartments must also be correct.
The body contains about 40 L of water, which makes up roughly 60% of our total body weight. This is
distributed as follows:
1. Intracellular fluid (ICF) - The water located within the cells of the body makes up about 2/3 of the total fluid
(about 25 L). Its function is to facilitate the chemical reactions in the cells that maintain life.
2. Extracellular fluid (ECF) - The water located outside of the cells makes up about 1/3 of the total fluid
(about 15 L). It is distributed in the following compartments:
* Extracellular fluid serves two important functions: (1) it provides a constant environment for the cells,
and (2) it transports substances to and from the cells.
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C. GENERAL PRINCIPLES
1. Balance can be maintained only if intake equals output. Obviously, if more water is entering the body
than leaving, fluid volume will increase and an imbalance will occur. Conversely, if more water is being
excreted than is entering the body, the fluid volume will decrease and, again, we have an imbalance.
2. When more water enters the body than leaves we have a positive water balance. On the other hand,
when more water is excreted than is taken in we have a negative water balance.
3. Mechanisms for controlling fluid output so that it matches fluid intake are very crucial and we will study
these in some detail. Mechanisms to control intake also operate but are less elaborate.
4. The amount of fluid in a given individual is directly proportional to his or her total body surface area.
1. Obligatory water loss - even under ideal conditions the body will lose about 700 mL per day through the
lungs and skin. An additional 500 mL per day is lost as urine in order to rid the body of waste
products. These are minimum values that occur even if we do not sweat or defecate.
Intake Output
Water & other beverages 1500 ml Lungs 550 ml
Water in solid foods 750 ml Skin 150 ml
Water of oxidation 250 ml Sweat 200 ml
(from cellular metabolism) 2500 ml Feces 100 ml
Urine 1500 ml
2500 ml
To Do: Tell if each of these is part of or refers to the intracellular (I) or the extracellular fluid compartment E).
Contains most of the body’s water Fluid located between tissue cells
If you urinate more than you drink, you are in: a) positive water balance; b) negative water balance
Obligatory water loss is: a) the amount of water we lose after vigorous exercise as sweat;
b) loss that results in a negative water balance; c) the minimum amount of water lost each day.
Other than urine, most water is lost through the: a) skin; b) lungs; c) sweat; d) feces.
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E. MECHANISMS FOR MAINTAINING NORMAL FLUID DISTRIBUTION
a. To move between the plasma and the interstitial fluid compartment, fluid must pass across the wall of
the capillaries. This movement is controlled by:
1) Hydrostatic pressure (blood pressure) – tends to force fluid out of the capillary
2) Osmotic pressure due to plasma proteins – tends to draw fluid into the capillary.
b. This creates a "tug of war" – If the hydrostatic pressure is greater than the osmotic pressure, fluid will
move into the interstitial fluid. If the osmotic pressure is greater, then fluids will move into the plasma.
c. Any factor that causes a change in either the hydrostatic or osmotic pressure will affect the movement
of fluid between these compartments. Examples:
1) Liver damage can cause fewer plasma proteins to be made, so the osmotic pressure in the capillary
will decrease, causing more fluid to enter the interstitial fluid.
2) A drop in blood pressure allows more fluid to flow into the plasma from the interstitial space,
which helps to restore the blood pressure.
a. To move between the interstitial fluid and the intracellular fluid compartments, fluid must cross the
cell membrane.
b. Movement is mainly controlled by the osmotic pressure in the two compartments. This will be
determined by the electrolyte concentration in each compartment.
c. Cells normally pump sodium out of the cell and potassium in, which causes excess sodium to accumulate
in the interstitial fluid.
d. A higher than normal sodium concentration in the interstitial fluid will draw water out of the cells, and a
lower than normal sodium concentration will cause more water to flow into the cells.
To Do: For each of the following statements, decide which direction fluid would tend to move. Use these choices:
B = into the blood I = into the interstitial fluid C = into the cells
1. Two Problems – The body must deal with two separate problems when maintaining fluid balance:
a. It must keep the concentration of body fluids in the correct range.
b. It must keep the total volume of fluid in the correct range.
These are controlled by two different but interrelated systems.
a. The total concentration of dissolved material in the blood plasma must be maintained in a fairly
narrow range to assure proper functioning. Thus when the body senses that the plasma is becoming
either too dilute or too concentrated it makes adjustments to correct the imbalance.
b. Nervous control – when the plasma becomes too concentrated, the vagus nerve stimulates feelings
of dryness in the mouth and throat, causing us to drink fluids.
c. Antidiuretic hormone (ADH) is the main hormone involved in this process. ADH causes the
kidneys to reabsorb more water from the filtrate, thus increasing the amount of water in the plasma
and diluting the solutes.
plasma concentration
stimulates (too little water, too much sodium)
osmoreceptors negative
in hypothalamus water balance
positive osmoreceptors
water balance in hypothalamus
inhibits
plasma concentration
(more water, less sodium)
To Do: Mark whether each of these occurs when the plasma is too dilute (D) or too concentrated (C).
To Do: Indicate whether each of the following would occur when fluid volume is too high (H) or too low (L).
Usually ADH and aldosterone work together to keep fluid balance correct. Both help water to be
reabsorbed and so maintain the proper amount of fluid in the body. But by having two separate systems
it allows the body to fine tune the substances reabsorbed in the kidneys according to the body’s needs.
a. Sodium depletion due to excess water intake – When a person drinks a large amount of fluid but
does not consume sodium, the body needs to eliminate the excess water while at the same time
reabsorbing as much sodium as possible. In this situation aldosterone will be secreted to stimulate
sodium reabsorption, but very little ADH will be secreted so the excess water will be excreted in the
urine.
b. Sodium excess – In some situations there is too much sodium in the body. This can occur either
from eating too much salt, or as part of the dehydration process when a person takes in little or no
water. In this case aldosterone secretion declines while
ADH secretion increases. Sodium is not reabsorbed in the kidneys, but water is conserved.
a. Hyperventilation for an extended period of time - The patient is breathing rapidly with shallow
breaths. Each time air is expelled from the lungs, fluid is lost as water vapor.
b. Vomiting, diarrhea, etc. - These cause a loss of fluid, which can lead to an imbalance.
A. DEFINITION – Electrolyte balance is when the total concentration of electrolytes in the body as a whole and
in each of the fluid compartments is normal and remains relatively constant. However, electrolyte
balance also implies that the concentration of each individual electrolyte is normal and remains relatively
constant in each fluid compartment.
Extracellular
Intracellular Interstitial Plasma
Cations
Sodium (Na+) 10 145 142
Potassium (K+) 160 4 5
Magnesium (Mg+2) 35 2 3
Calcium (Ca+2) -- 3 5
Anions
Chloride (Cl-) 2 115 103
Bicarbonate (HCO3-) 8 30 27
Phosphate (HPO3-2) 140 2 2
Sulfate (SO4-2) -- 1 1
Protein- 55 1 16
Organic acids- -- 5 6
5. Calcium (Ca+2) - found almost exclusively in the extracellular fluid (a little is stored in muscle).
a. Functions:
Structural component of bones and teeth.
Needed for muscle contraction and nerve impulse conduction.
Involved in nearly all steps of blood clotting.
b. Notes – Calcium levels are regulated primarily by parathyroid hormone, and to a lesser extent by
calcitonin, which control release and storage of calcium from bone.
Calcium is a depressing ion, so if the concentration is low, excitability of nerve and skeletal
muscle tissue is increased, and if the concentration is high, excitability is decreased.
Write the symbols for Na+, K+, Cl-, HPO4-2, Ca+2, and Mg+2 either inside or outside the cell to show where most is found.
Which two fluid compartments are most similar in terns of the amounts of electrolytes found there?
a) extracellular and intracellular b) interstitial and intracellular c) plasma and interstitial
Edema could be caused by: a) lots of salt; b) too much potassium; c) too little sodium
True or False: A change in the amount of fluid in a compartment could cause an electrolyte imbalance.
Match the electrolytes with the statements below. Choices: Na+, K+, Cl-, HPO4-2, Ca+2, and Mg+2.
Forms bones & teeth, needed for blood clotting Helps maintain blood pressure
Maintains electrical potential of cells Forms gastric acid, helps transport O2 and CO2
Depressing ion found in chlorophyll Part of ATP, forms a buffer system for pH
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IV. FLUID AND ELECTROLYTE IMBALANCES
A. INTRODUCTION
The fluid and electrolyte balance of the body can be thrown off in a number of ways. General examples are:
1. Loss of water without loss of electrolytes (usually by evaporation from lungs and skin).
2. Loss of isotonic fluid (both water and electrolytes) through sweating, bleeding, vomiting or diarrhea,
either with no replacement or with replacement of the water only.
3. Intake of excessive amounts of water or salt.
4. Abnormal retention of electrolytes (usually sodium) by the body.
In the following descriptions, ECF = extracellular fluid and ICF = intracellular fluid
1. Simple water depletion occurs when water is lost from the body without an accompanying loss of
electrolytes. An example is loss of water vapor from the lungs without replacement by ingestion. (This
often occurs when water is unavailable, or in bedridden patients or infants who cannot obtain water for
themselves).
2. Process: As water is lost, the concentration of electrolytes in the ECF (plasma and interstitial fluid) increases.
Water is then osmotically drawn from the cells until the osmotic pressure in both compartments is equal.
Because the volume of the ICF is twice that of the ECF, 2/3 of the water loss will be from the ICF and 1/3 will
be from the ECF (i.e. cells suffer more than plasma and interstitial fluid).
3. Result: The volume of fluid both inside and outside of the cells is less than normal and the electrolyte
concentration of both compartments is greater than normal. This condition is called dehydration.
C. SALT DEPLETION
1. Salt depletion occurs when isotonic fluid is lost from the body (through sweating, diarrhea, bleeding,
etc.) and the lost fluid is replaced by drinking water alone.
2. Process: Ingestion of water lowers the electrolyte concentration of the ECF. This causes water to
osmotically flow into the cells until the concentration of both compartments is equal.
3. Result: The volume of the ECF is decreased, while the volume of the ICF is now greater than normal.
Meanwhile, the electrolyte concentrations of both compartments will be decreased. The cells become
overhydrated, a condition sometimes referred to as hypotonic hydration or “water intoxication.”
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D. SALT POISONING
1. Salt poisoning occurs when excess salt is ingested without drinking water along with it.
2. Process: Ingestion of salt increases the electrolyte concentration in the ECF. This causes water to
osmotically flow out of the cells into the ECF until the concentration in both compartments is equal.
3. Result: The volume of the ECF is greater than normal and that of the ICF is less than normal, while the
electrolyte concentration of both compartments is greater than normal. Cellular dehydration results.
1. More sodium than normal will be retained in the body. This can be caused by hyperaldosteronism and
edema related to congestive heart failure.
2. Process: As more sodium is retained by the kidneys, water will be retained as well, causing expansion of
the ECF with fluid containing normal concentrations of sodium (isotonic expansion).
3. Result: the volume of the ECF increases, but that of the ICF remains normal, since there is no difference
in the osmotic pressure between the two compartments. The electrolyte concentration will be unchanged.
The result is edema.
To Do: Match the statements with the imbalance they apply to. (Letters match the sections above)
b. Simple water depletion d. Salt poisoning
c. Salt depletion e. Abnormal sodium retention
1. Explain what is meant by fluid balance and describe the normal distribution of fluid in the different fluid
compartments and the functions of the fluid in each compartment.
2. Describe the general principles of fluid balance including the terms positive water balance and negative
water balance.
3. Explain what is meant by obligatory water loss, know the sources of water intake and output, and know
what source represents the largest intake or output.
4. Describe the factors that control movement of fluid between the plasma and interstitial fluid and between
the interstitial and intercellular fluid.
5. Explain how the body maintains the proper concentration of body fluids, including the role of ADH.
6. Explain how the body maintains the proper total volume of body fluid, including the role of aldosterone.
7. Describe the relative amounts of aldosterone and ADH that would be secreted when there is sodium
depletion due to excess water intake and when there is sodium excess.
8. Explain what is meant by electrolyte balance and know the general principles of electrolyte distribution.
9. Describe the importance of electrolyte balance and how it is related to fluid balance.
10. For each of the following ions, know the functions, and notes given on them, and where they are
predominantly found in the extracellular or intracellular fluid compartment: Na+, K+, Cl-, HPO4-2, Ca+2,
and Mg+2.
11. Identify the possible causes, the process that occurs and the end result for each of the following: simple
water depletion, salt depletion, salt poisoning, and abnormal sodium retention.
The following CD-ROM, while not required, may help you to visualize the material covered in this lecture. This
is available on reserve in the LRC. It is also part of the Interactive Physiology CD that was packaged with new
editions of the textbook, and is available online at www.interactivephysiology.com. Use the same user name
(login) and password as for the MyA&P website that goes along with the textbook (the course ID is
quale12450):
Page 2 - Tell if each of these is part of or refers to the intracellular (I) or the extracellular fluid compartment E).
I Contains most of the body’s water E Fluid located between tissue cells
B If you urinate more than you drink, you are in: a) positive water balance; b) negative water balance
C Obligatory water loss is: a) the amount of water we lose after vigorous exercise as sweat;
b) loss that results in a negative water balance; c) the minimum amount of water lost each day.
B Other than urine, most water is lost through the: a) skin; b) lungs; c) sweat; d) feces.
Page 3 - For each of the following statements, decide which direction fluid would tend to move. Use these choices:
B = into the blood I = into the interstitial fluid C = into the cells
Page 4 - Mark whether each of these occurs when the plasma is too dilute (D) or too concentrated (C).
Page 5 - Indicate whether each of the following would occur when fluid volume is too high (H) or too low (L).
Write the symbols for Na+, K+, Cl-, HPO4-2, Ca+2, and Mg+2 either inside or outside the cell to show where most is found.
Na+ Ca+2 K+ HPO4-2
Cl - Mg+2
C Which two fluid compartments are most similar in terns of the amounts of electrolytes found there?
a) extracellular and intracellular b) interstitial and intracellular c) plasma and interstitial
A Edema could be caused by: a) lots of salt; b) too much potassium; c) too little sodium
T True or False: A change in the amount of fluid in a compartment could cause an electrolyte imbalance.
Match the electrolytes with the statements below. Choices: Na+, K+, Cl-, HPO4-2, Ca+2, and Mg+2.
Ca+2 Forms bones & teeth, needed for blood clotting Na+ Helps maintain blood pressure
+ -
K Maintains electrical potential of cells Cl Forms gastric acid, helps transport O2 and CO2
+2
Mg Depressing ion found in chlorophyll HPO4-2 Part of ATP, forms a buffer system for pH
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Page 11 - Match the statements with the imbalance they apply to. (Letters match the sections above)
b. Simple water depletion d. Salt poisoning
c. Salt depletion e. Abnormal sodium retention