Fluids and Acid Base Physiology

Dr. Meg-angela Christi Amores

• maintenance of a relatively constant volume
and a stable composition of the body fluids is
essential for homeostasis
• Daily Intake of Water:
• (1) it is ingested in the form of liquids or water in the
food, which together normally add about 2100 ml/day
to the body fluids
• (2) it is synthesized in the body as a result of oxidation
of carbohydrates, adding about 200 ml/day
– variable
• Daily Loss of water
– Insensible water loss – 700 mL/day
• cannot be precisely regulated
• continuous loss of water by evaporation from the
respiratory tract and diffusion through the skin
– Sweating – 100 mL/day
– Feces – 100 mL/day
– Urine - variable
 Water in the body
• Total body water (TBW) - ~42 liters
– Compartments:
1. Intracellular Fluid - 75%
2. Extracellular Fluid (ECF) – 25%
– Plasma 25%
– Interstitial Fluid 75%
 Body Fluid Compartments
– extracellular fluid compartment is balanced
between the principal cation—sodium and the
principal anions—chloride and bicarbonate
– intracellular fluid compartment is comprised
primarily of the cations, potassium and
magnesium, and of the anions, phosphate and
proteins
 Fluid Electrolyte
• primary measurement that is readily available
to the clinician for evaluating a patient's fluid
status is the plasma sodium concentration

• Na (Sodium)
– Hyponatremia – when plasma Na concentration
falls below 142 mEq/L
– Hypernatremia
 Hyponatremia
• Causes:
– Loss of NaCl – diarrhea and vomiting, diuretics
• Addison's disease
– excess water retention
• excessive secretion of antidiuretic hormone
 Hypernatremia
• Causes:
– loss of water
• Dehydration due to prolonged sweating or exercise
– excess sodium in the extracellular fluid
 pH
• Precise H+ regulation is essential
because the activities of almost all
enzyme systems in the body are
influenced by H+ concentration
• Acids - molecules containing hydrogen
atoms that can release hydrogen ions in
solutions
• Bases - molecules that can accept an H+
 pH
• alkalosis refers to excess removal of H+ from
the body fluids
• in contrast to the excess addition of H+, which
is referred to as acidosis

• pH is inversely related to the H+ concentration

 pH
• normal pH of arterial blood is 7.4
• The lower limit of pH at which a person can
live more than a few hours is about 6.8, and
the upper limit is about 8.0
 Regulators of H concentration
• 1) the chemical acid-base buffer systems of the body
fluids, which immediately combine with acid or base
to prevent excessive changes in H+ concentration;
• (2) the respiratory center, which regulates the
removal of CO2 (and, therefore, H2CO3) from the
extracellular fluid; and
• (3) the kidneys, which can excrete either acid or
alkaline urine, thereby readjusting the extracellular
fluid H+ concentration toward normal during acidosis
or alkalosis
 Acid Base Disturbances
• Acidosis
• Alkalosis

• Metabolic
• Respiratory
 Respiratory Acidosis
• pH below 7.4 caused by respiratory problems
• Decreased Ventilation and Increased PCO2
– Increased H2CO3 and H+ concentration, thus
resulting in acidosis
• Conditions that damage the respiratory
centers or that decrease the ability of the
lungs to eliminate CO2
• What are possible causes of decreased
ventilatory rate?

• Central area of respiratory control

• Peripheral
• Voluntary
 Respiratory Acidosis
– damage to the respiratory center in the medulla
oblongata
– obstruction of the passageways of the respiratory
tract
– pneumonia, emphysema, or decreased pulmonary
membrane surface area
• compensatory responses:
– (1) the buffers of the body fluids and
– (2) the kidneys
 Respiratory Alkalosis
• caused by overventilation by the lungs
• major means for compensation are the
chemical buffers of the body fluids and the
ability of the kidneys to increase HCO3-
excretion
 Metabolic Acidosis
• (1) failure of the kidneys to excrete metabolic
acids
• (2) formation of excess quantities of metabolic
acids in the body
• (3) addition of metabolic acids to the body by
ingestion or infusion of acids
• (4) loss of base from the body fluids
 Metabolic Acidosis
• Renal Tubular Acidosis
– defect in renal secretion of H+ or in reabsorption of
HCO3
– impairment of renal tubular HCO3- reabsorption
– inability of the renal tubular H+ secretory
mechanism
– renal failure, insufficient aldosterone secretion
(Addison's disease),
 Metabolic Acidosis
• Severe diarrhea
• loss of large amounts of sodium bicarbonate into the
feces
• Vomiting of intestinal contents
• Diabetes Mellitus
• Ingestion of Acids
• Chronic Renal Failure
 Metabolic Alkalosis
• excess retention of HCO3- or loss of H+ from
the body
• Administration of Diuretics
• Excess Aldosterone
• Vomiting of Gastric Contents
• Ingestion of Alkaline Drugs