Water, Na++, K+ and Cl-

Water Functions

• Water roles in the body

– Chemical reactions
– Body temperature regulation
– Lubrication and protection
– Solvent and transport medium
– Maintenance of blood volume (decreased water intake ->
decrease BV, which can lead to a stroke)
– Acid-base balance
 Body Water Content and Distribution

• Body water typically contributes over one-half of

body weight (>50% of BW)
– Amount varies based on age, gender, body size, and
composition
– Body water decreases with age and body size
 Body Water Content and Distribution
• Extracellular fluid functions
– Interstitial fluid directly bathes the cells
 Provides medium for exchange of nutrients and metabolic
products to and from plasma and cells
– Plasma
 Fluid portion of the blood
– Lymph
Body Water Content and Distribution
 Water Losses, Sources, and Absorption

• Most water lost through urine

– Smaller amount in feces
– Varying amounts lost from respiratory tract and skin
• Major sources of water: beverages and foods
– About 25% from foods (especially plant foods)
– Minor source from metabolism
 Formed from cellular biochemical reactions
 Recommended Water Intake

• Adequate Intakes (need to know!)

– Adult women: 2.7 L (almost 2.85 quarts)
– Adult men: 3.7 L (almost 1 gallon)
• Large variation in individual needs based on activity
level and energy intake
• Recommendation based on body weight
– 25–40 mL of water per kg body weight
 Water (Fluid) and Sodium Balance

• Osmosis
– Movement of water across semipermeable membrane in
response to differences in solute concentrations (low to
high concentration)
• Osmolarity (how much matter is in the solution)
– Solute (particle) concentration of a fluid
• Potassium major cation ICF
• Sodium major cation in ECF
 Water (Fluid) and Sodium Balance

• Hyponatremia
– Diluted plasma due to overconsumption of water
• Hypernatremia
– Losses of water without solutes
Water (Fluid) and Sodium Balance
 The Kidneys: A Brief Review

• Kidney made up of nephrons

– Tubular components of the nephron (solutes travel within
the tubular components)
 Bowman’s capsule
 Loop of Henle
 Distal tubule
 Collecting duct
– Vascular components (blood)
 Glomerulus
 Afferent and efferent arterioles
 Peritubular capillaries
The Kidneys
 Renin-Angiotensin-Aldosterone System
and Sodium Balance

• RAAS system enhances reabsorption sodium and

chloride
• Aldosterone promotes reabsorption sodium and
excretion of potassium
• When BP and plasma fluid volume are low renin
released
– Hydrolyzes angiotensinogen
– Angiotensin II increases BP
Renin-Angiotensin-Aldosterone System
and Sodium Balance
 Sodium

• Most abundant extracellular cation

• 30–40% on bone surface
• Major source: salt in processed foods
– Naturally occurring sources account for 10% of consumed
sodium
• Label terms: free, very low, low, reduced, or light
• DV for food labels = 2400 mg
– Over two-thirds of adults consume more than
recommended
 Sodium
Table 12.3 Electrolytes

Mineral Selected Deficiency symptoms Selected food Al

physiological sources
functions

Sodium Water, pH, and Anorexia Table salt,processed 1,500 mg,

electrolyte nausea and snack food,cured 19-50 years
regulation; nerve muscle artrophy meats,seafoods,
transmission. muscle poor growth condiments,milk,
contraction weight loss cheese,and bread

Potassium Water,electrolyte,and Muscular weakness Fruits, vegetables, 4,700 mg.

pH balances; cell cardiac arrhythmias legumes,nuts,and 19+ years
membrane paralysis dairy products
polarization

Chloride Fluid and Weakness Table salt 2,300mg

pH balance lethargy Seafood 19-50 years
component of gastric Hypokalemia Meat and eggs
hydrochloric acid metabolic acidosis
 Sodium Absorption

• 95–100% absorbed from small intestine and

proximal colon
• Mechanisms
– Na+/glucose cotransporter
 Small intestine
– Electroneutral Na+ and Cl− cotransport exchange
transporter
 Small intestine (mostly) and colon
 Sodium Transport

• Free in blood
• Serum sodium concentration maintained in narrow
range
– 135–145 mEq/L
Sodium Transport (2 of 2)
 Sodium Functions and Interactions

• Maintenance of osmotic pressure

• Nerve transmission/impulse conduction
• Muscle contraction

• sodium intake urinary Ca++ excretion

 Sodium Functions and Interactions

• Excreted by kidneys and sweat

– Aldosterone controls excretion
• Deficiencies are rare
– May occur with excessive sweating
• AI: 1,500 mg/day
• Tolerable Upper Intake Level
– 2,300 mg/day
• Measured routinely in labs
– 24-hour urinary sodium excretion level
 Potassium

• Major intracellular cation

• Widespread in foods
– Abundant in fruits and vegetables
– Legumes, nuts, nut butters, and seeds
– Milk and yogurt
– May be added to processed foods
• Amounts generally consumed below recommended
levels
 Potassium Absorption

• Over 85% absorption

– Occurs throughout the small intestine
 To lesser extent in the colon
• Absorbed by passive diffusion or by a K+/H+-
ATPase
• Stimulated by insulin
• Muscles release potassium back into the plasma
between meals
 Potassium Functions and Interactions

• Proper intercellular to extracellular ratio needed to

maintain cell’s resting membrane potential
• Water and acid-base balance
• Needed for cellular metabolism
• excretion of ca++
 Potassium Functions and Assessment

• Excretion mainly via the kidneys

– Small amounts in feces and sweat
• Adequate Intake: 4,700 mg/day
• Deficiencies result from profound loss of fluids and
electrolytes
– Hypokalemia
• Assessed by plasma/serum potassium
concentrations
 Chloride

• Most abundant anion in ECF

• Primary source is sodium chloride
• Almost completely absorbed in intestines
 Chloride Absorption

• Chloride follows sodium

– Na+/glucose cotransport system: chloride follows actively
absorbed Na+
– Electroneutral Na+/Cl- cotransport absorption: chloride
absorbed in exchange for bicarbonate as sodium is
absorbed in exchange for H+
– Electrogenic Na+ absorption: chloride follows the
absorbed sodium passively
Chloride Absorption
 Chloride Functions

• Formation of gastric hydrochloric acid

• Released by white blood cells to help destroy
foreign substances
• Exchange anion for HCO3- in red blood cells
– Chloride shift
 Chloride Functions

• Excreted through GI tract, skin, and kidneys

– Losses reflect those of sodium
• Adequate Intake: 2,300 mg/day
• Deficiency is rare
• Evaluated through serum concentrations