Fluid, Electrolyte and Acid-Base

Balance
CHAPTER 27
 Introduction
• The maintenance of normal volume and normal
composition of the extracellular fluid is vital to life.
• Three types of homeostasis are involved in this
maintenance:fluid balance, electrolyte balance, and
acid-base balance.
• The ICF contains nearly2/3rd of total body
water;the ECF contains the rest.
• Exchange occurs between the ICF and ECF.
 Fluid compartments
• Body fluids includes water and solutes.
• About 2/3rd of the body’s fluid is located within cells
and is called intracellular fluid (ICF).
• The other 1/3rd called extracellular fluid (ECF) includes
interstitial fluid, plasma and lymph, GI tract fluids,
synovial fluid, fluids of the eyes and ears, CSF, pleural,
pericardial and peritoneal fluids and glomerular filtrate.
• The term fluid balance means that various body
compartments contain the normal amount of water.
 Fluid Balance
• An inorganic substance that dissociates into ions is called an
electrolyte. Fluid balance and electrolyte balance are interrelated.
• Water is the largest single constituent in the body-45-75% of total
body mass.
• Daily water gain and loss are about 2.5 L.
• sources of water gain are ingested liquids and foods, and water
produced by cellular respiration and dehydration synthesis
reactions.
• Water is lost by the process of urination, evaporation from the
skin surface, exhalation of water vapor, and defecation.in women
also menstrual flow.
 Fluid Balance
• The main way to regulate body water gain is by adjusting the
volume of water intake, mainly by drinking more or less
fluid. The thirst center in the hypothalamus governs the urge
to drink.
• Although increased amounts of water and solutes are lost
through sweating and exhalation during exercise, loss of
excess water or excess solutes depends mainly on regulating
excretion in the urine.
• The extent of urinary NaCl loss is the main determinant of
body fluid volume, whereas the extent of urinary water loss is
the main determinant of body fluid osmolarity.
 Fluid Balance
• Angiotensin II and aldosterone reduce urinary loss of Na + and
Cl- and thereby increase the volume of body fluids.
• ANP promotes natriuresis, elevated excretion of Na + (and Cl- ),
which decreases blood volume.
• The major hormone that regulates water loss and thus body
fluid osmolarity is ADH.
• An increase in the osmolarity of interstitial fluid draws water
out of cells and they shrink slightly. A decrease in the
osmolarity of interstitial fluid also causes cells to swell.
• When a person consumes water faster than the kidneys excrete
it or renal fn. Is poor-water intoxication,cells swell.
 Electrolytes in Body Fluids
• Ions formed when electrolytes dissolve in body fluids
control the osmosis of water between fluid compartments,
help maintain acid-base balance, and carry electrical current.
• Plasma, interstitial fluid and ICF contain varying kinds and
amounts of ions.
• The conc. Of ions is expressed as mEq/L.
• sodium ions are the most abundant ions in ECF: involved in
impulse transmission, muscle contraction, and fluid and
electrolyte balance. The level of sodium is controlled by
aldosterone, ADH and ANP.
 Electrolytes in Body Fluids
• Chloride ions are the major anions of the ECF. They play a
role in regulating osmotic pressure and forming HCl in gastric
juice. Cl- level is controlled indirectly by ADH and by process
that increase or decrease renal absorption of Na+.
• Potassium ions are the most abundant cations of ICF. They
play a key role in the resting membrane potential and action
potential of neurons and muscle fibers. Help maintain ICF
volume and contribute to regulation of pH. K+ level is
controlled by aldosterone.
• Bicarbonate ions (HCO3- )are the second most abundant anions
in the ECF. Most important buffer in the plasma.
 Electrolytes in Body Fluids
• Calcium is the most abundant mineral in the body. Calcium
salts are structural components of bones and teeth. Ca+2 which
are primarily extracellular cations, function in blood clotting,
neurotransmitter release, and contraction of muscle. Ca+2 level
is controlled by parathyroid and calcitrol.
• Phosphate ions are principally intracellular anions and their salts
are structural components of bones and teeth, also required for
the synthesis of nucleic acids and ATP and participate in buffer
reactions. Level is controlled by PTH and calcitrol.
• Mg+2 ions -intracelluar cations that act as cofactors for enzymes.
 Acid-Base Balance
• The normal pH of systemic arterial blood is 7.35-7.45.
• pH is maintained by buffers. The important buffer systems
include proteins, carbonic acid-bicarbonate buffers and
phosphates.
• Homeostasis of pH is maintained by buffer systems, via
exhalation of carbon dioxide, and via kidney excretion of
H+ and reabsorption of HCO3- .
• The overall acid-base balance is maintained by controlling
the H+ conc. Of body fluids, especially ECF.
 Mechanisms that maintain pH of
body fluids
• Buffer systems-made of a weak acid or base and its salt. Prevent
drastic changes in body fluid pH.
• Proteins:the most abundant buffers in body and cells. His and
Cys are the two main acids and Hb in RBC’s.
• Carbonic acid-bicarbonate: important regulator of blood pH.
The most abundant buffers in the ECF.
• Phosphates:important buffer in ICF and in urine.
• Exhalation of CO2:increased exhalation-inc pH and decreased
exhalation dec. pH.
• Kidneys: renal tubules secrete H+ into the urine and reabsorb
HCO3- , so it is not lost in the urine.
 Acid-Base Balance
• An increase in exhalation of carbon dioxide results in inc. blood pH
and a decrease in exhalation causes dec. in blood pH.
• The kidneys excrete H+ and reabsorb HCO3- .
• Acidosis is a systemic arterial blood pH of below 7.35; its principal
effect is depression of CNS. Alkalosis is a systemic arterial blood
pH over 7.45 and its principal effect is overexcitability of CNS.
• Respiratory acidosis and alkalosis are disorders due to changes in
blood Pco2 ,(compensated by renal mechanisms) whereas metabolic
acidosis and alkalosis are disorders associated with changes in blood
HCO3- concentration. Can be compensated by respiratory
mechanisms.