ELECTROLYTE AND FLUID BALANCE

Ions capable of carrying an electric charge Classified as cations and anions

ELECTROLYTES

Classification: including volume and osmotic regulation (sodium [Na], chloride [Cl], potassium [K]); Myocardial rhythm and contractility (K, magnesium [Mg2], calcium [Ca2]) cofactors in enzyme activation (e.g., Mg2, Ca2, zinc [Zn2]); regulation of adenosine triphosphatase (ATPase) ion pumps (Mg2); acid-base balance (bicarbonate [HCO3], K, Cl); blood coagulation (Ca2, Mg2); neuromuscular excitability (K, Ca2, Mg2); and the production and use of ATP from glucose (e.g., Mg2, phosphate [PO4]).

WATER
Content varies 40-755 of the total body weight Women have lower content than men Water is the solvent for all processes in the human body It transports nutrients to cells, determines cell volume by its transport into and out of cells, removes waste products by way of urine, and acts as the bodys coolant by way of sweating

WATER
Intracellular fluid (ICF) is the fluid inside the cells and accounts for about two thirds of total body water. Extracellular fluid (ECF) accounts for the other one third of total body water and can be subdivided into : - intravascular extracellular fluid (plasma) - interstitial cell fluid that surrounds the cells in the tissue.

MAINTENANCE OF ION IN THE PLASMA

Active

transport is a mechanism that requires energy to move ions across cellular membranes.

For example, maintaining a high intracellular concentration of K and a high extracellular (plasma) concentration of Na requires use of energy from ATP in ATPase-dependent ion pumps.

Diffusion is the passive movement of ions across a membrane. It depends on the size and charge of the ion being transported and on the nature of the membrane through which it is passing. The rate of diffusion of various ions also may be altered by physiologic and hormonal processes.

OSMOLALITY
is a physical property of a solution that is based on the concentration of solutes Increased osmolality triggers the response of bloodthe hypothalamus the responds with the sensation of thirst and arginine vasopressin hormone (AVP)

CLINICAL SIGNIFICANCE OF OSMOLALITY

Osmolality in plasma is important because it is the parameter to which the hypothalamus responds Regulation of osmolality also affects the Na concentration in plasma, largely because Na and its associated anions account for approximately 90% of the osmotic activity in plasma. normal plasma osmolality (275 295 mOsm/kg of plasma H2O)

CLINICAL SIGNIFICANCE OF OSMOLALITY

osmoreceptors in the hypothalamus respond quickly to small changes in osmolality. 1%2% increase in osmolality causes a fourfold increase in the circulating concentration of AVP AVP acts by increasing the reabsorption of water in the cortical and medullary collecting tubules. AVP has a half lifein the circulation of only 15 to 20 minutes. Renal water excretion is more important in controlling water excess, whereas thirst is more important in preventing water deficit or dehydration.

REGULATION OF BLOOD VOLUME

Changes in blood pressure are detected in this areas -Cardiopulmonary circulation, carotid sinus, aortic arch, and glomerular arterioles. Adequate blood volume is essential to maintain blood pressure and ensure good perfusion to all tissue and organs. Regulation of both Na and water are interrelated in controlling blood volume. The renin-angiotensinaldosterone system responds primarily to a decreased blood volume. Renin is secreted near the renal glomeruli in response to decreased renal blood flow (decreased blood volume or blood pressure). Renin converts angiotensinogen to angiotensin I, which then becomes angiotensin II. Angiotensin II causes vasoconstriction, which quickly increases blood pressure, and secretion of aldosterone, which increases retention of Na and the water that accompanies the Na.

FOUR OTHER FACTORS AFFECT BLOOD VOLUME:

(1) atrial natriuretic peptide (ANP), released from the myocardial atria in response to volume expansion, promotes Na excretion in the kidney (B-type natriuretic peptide [BNP] and ANP act together in regulating blood pressure and fluid balance) (2) volume receptors independent of osmolality stimulate the release of AVP, which conserves water by renal reabsorption; (3) glomerular filtration rate (GFR) increases with volume expansion and decreases with volume depletion; and (4) all other things equal, an increased plasma Na will increase urinary Na excretion and vice versa. The normal reabsorption of 98% to 99% of filtered Na by the tubules conserves nearly all of the 150 L of glomerular filtrate produced daily.

URINE OSMOLALITY
decreased in diabetes insipidus (inadequate AVP) and polydipsia (excessive H2O intake) and increased in conditions such as the syndrome of inappropriate ADH (AVP) secretion (SIADH) and hypovolemia (although urinary Na is usually decreased).

DETERMINATION OF OSMOLALITY
Specimen: serum or urine Methods: determining osmolality are based on properties of a solution that are related to the number of molecules of solute per kilogram of solvent. - An increase in osmolality decreases the freezing point temperature and the vapor pressure. Measurement of freezing point depression and vapor pressure decrease (actually, the dew point) are the two most frequently used methods of analysis.

DETERMINATION OF OSMOLALITY
Osmometers : - that operate by freezing point depression are standardized using sodium chloride reference solutions. - After calibration, the appropriate amount of sample is pipetted into the required cuvet or sample cup and placed in the analyzer. - The sample is then supercooled to 7C and seeded to initiate the freezing process. When temperature equilibrium has been reached, the freezing point is measured, with results for serum and urine osmolality reported as milliosmoles per kilogram. - Calculation of osmolality has some usefulness either as an estimate of the true osmolality or to determine the osmolal gap, which is the difference between the measured osmolality and the calculated osmolality.

OSMOLAL GAP

indirectly indicates the presence of osmotically active substances other than Na, urea, or glucose, such as ethanol, methanol, ethylene glycol, lactate, or hydroxybutyrate

THE ELECTROLYTES

SODIUM
Na is the most abundant cation in the ECF, representing largely determines the osmolality of the plasma. Na concentration in the ECF is much larger than inside the cells. Because a small amount of Na can diffuse through the cell membrane, the two sides would eventually reach equilibrium. Active transport systems, such as ATPase ion pumps, are present in all cells The Na,K-ATPase ion pump moves three Na ions out of the cell in exchange for two K ions moving into the cell as ATP is converted to ADP.

SODIUM
The plasma Na concentration depends greatly on the intake and excretion of water and, to a somewhat lesser degree, the renal regulation of Na. Three processes are of primary importance: (1) the intake of water in response to thirst, as stimulated or suppressed by plasma osmolality; (2) the excretion of water, largely affected by AVP release in response to changes in either blood volume or osmolality; (3) the blood volume status, which affects Na excretion through aldosterone, angiotensin II, and ANP (atrial natriuretic peptide).

CLINICAL APPLICATIONS
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Hyponatremia a serum/plasma level less than 135 mmol/L.4 most common electrolyte disorders in hospitalized and nonhospitalized patients. Levels below 130 mmol/L are clinically significant. assessed by the cause for the decrease or with the osmolality level. Decreased levels may be caused by increased Na loss, increased water retention, or water imbalance

CLINICAL APPLICATIONS
-

Hyponatremia Increased Na loss in the urine can occur with decreased aldosterone production, certain diuretics (thiazides), with ketonuria (Na lost with ketones), or a salt-losing nephropathy (with some renal tubular disorders). K deficiency also causes Na loss because of the inverse relationship of the two ions in the renal tubules. When serum K levels are low, the tubules will conserve K and excrete Na in exchange . Each disorder results in an increased urine Na level (20 mmol per day), which exceeds the amount of water loss. Prolonged vomiting or diarrhea or severe burns can result in Na loss. Urine Na levels are usually less than 20 mmol per day in these disorders, which can be used to differentiate among causes for urinary loss.

CLINICAL APPLICATIONS
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Hyponatremia Water imbalance can occur as a result of excess water intake,which must be chronic In a normal individual, excess intake will not affect Na levels. Syndrome of inappropriate AVP secretion (SIADH) causes an increase in water retention because of increased AVP (ADH) production

CLINICAL APPLICATIONS