Chapters 27: Fluid / Electrolyte / Acid-Base Balance

Composition of Body Fluids:

1) Water: (universal solvent)
• Fluid compartments:

Total body water volume = 40 L (60% BW)

Intracellular Fluid Interstitial Plasma

Compartment Fluid (3 L)
(25 L - 40% BW) (12 L)

Extracellular Fluid
Compartment
(15 L - 20% BW)

Chapters 27: Fluid / Electrolyte / Acid-Base Balance

Composition of Body Fluids:

2) Solutes:
A) Non-electrolytes (do not dissociate in solution – neutral)
• Organic molecules (e.g., glucose, lipids, urea)
B) Electrolytes (dissociate into ions in solution – charged)
• Inorganic salts (e.g., NaCl)
• Inorganic & organic acids (e.g., carbonic acid)
Figure 27.2
• Proteins

Although individual [solute] are

are different between
compartments, the osmotic
concentrations of the
ICF and ECF are identical…

1
 Chapters 27: Fluid / Electrolyte / Acid-Base Balance

Principles of Fluid / Electrolyte Balance:

1) All homeostatic mechanisms controlling composition of body fluids
respond to changes in the ECF, not the ICF

* * * * * * * * * *
* * * * * * * * *
* * * * * * * * * *

2) No receptors directly monitor fluid / electrolyte balance

• Monitor plasma volume and osmotic concentration
3) Cells can not move water molecules via active transport (water follows salt…)

Chapters 27: Fluid / Electrolyte / Acid-Base Balance

Water Balance: ICF functions as

a reservoir
For proper hydration: Waterintake = Wateroutput

Water Output
Water Intake
Feces (2%)
< 0
Metabolism (10%) Sweat (8%)
Osmolarity rises
Solid Skin / • Thirst
(30%)
foods lungs (30%) • ADH release

Ingested > 0
Urine
liquids Osmolarity lowers
(60%)
(60%)
• Thirst
• ADH release

2500 ml/day 2500 ml/day = 0

2
 Chapters 27: Fluid / Electrolyte / Acid-Base Balance

Water Balance:
Regulation of Water Balance - Thirst Mechanism:
 osmolarity /
(-)  volume
of extra. fluid
Osmoreceptors
stimulated
(Hypothalamus)

 volume /
 osmolarity of
Sensation Drink
extracellular fluid of thirst

 Saliva
secretion Dry mouth

Chapters 27: Fluid / Electrolyte / Acid-Base Balance

Water Balance:
Water Balance Disorders:
1) Dehydration = Long-term water deficiency
a) Injury (e.g. burn, hemorrhage)
b) Exercise (profuse sweating)
c) Drugs (diuretic abuse)
2) Hypotonic hydration (water intoxication) = Over-hydration of cells
• Electrolyte dilution (neurons)
3) Edema = Accumulation of fluid in interstitial space

3
 Chapters 27: Fluid / Electrolyte / Acid-Base Balance

Electrolyte Balance:
• Importance:
1) Total [electrolyte] directly affects water balance
2) Individual [electrolyte] affect cell functions (e.g., neuromuscular activity – Na+ / K+)

Sodium Balance:
Uptake:
Across digestive epithelium
Release:
Kidney / Perspiration Eat salty
potato chips

• Most common ion associated with

electrolyte balance problems
Hyponatremia =  [Na+] Sweat
profusely
Hypernatremia =  [Na+] and
drink pure
water

Figure 27.4

Chapters 27: Fluid / Electrolyte / Acid-Base Balance

Electrolyte Balance:
• Importance:
1) Total [electrolyte] directly affects water balance
2) Individual [electrolyte] affect cell functions (e.g., neuromuscular activity – Na+ / K+)

Potassium Balance:
Uptake:
Across digestive epithelium
Release:
Kidney
• Rate lost at kidney depends on:
1) Changes in [K+] of ECF (  [K+] =  rate of secretion)
2) Changes in pH ( pH =  rate of secretion)
3) Aldosterone levels (  aldosterone =  rate of secretion)
• Problems with [K+] less common but significantly more dangerous
Hypokalemia =  [K+]
Hyperkalemia =  [K+]

4
 Chapters 27: Fluid / Electrolyte / Acid-Base Balance

Acid-Base Balance:
• Important to maintain pH between 7.35 – 7.45:
1) Disrupts stability of cell membranes
Acidosis = pH < 7.35
2) Alters protein structure
Alkalosis = pH > 7.45
3) Changes enzymatic activity

Types of acids in body:

1) Volatile Acids: Acids that can leave solution and enter the atmosphere

CO2 + H2O H2CO3 HCO3- + H+

carbonic
acid

2) Fixed Acids: Acids that does not leave solution (e.g., phosphoric acid)
• Must be eliminated by kidney
3) Organic Acids: Participate in / result from aerobic metabolism (e.g., citric acid)
• Metabolized quickly; rarely build up (but think lactic acid…)

Chapters 27: Fluid / Electrolyte / Acid-Base Balance

Acid-Base Balance:
• Mechanisms of pH control
H+ Gain: Distant from H+ Loss:
• Across digestive epithelium one another • Secretion into urine
• Cell metabolic activities • Release at lungs

• Buffering Systems: Dissolved compounds that neutralize H+ during transport

1) Protein Buffer System: (ECF / ICF)

• Amino acids respond to pH change by
releasing / accepting H+

Figure 27.7

5
 Chapters 27: Fluid / Electrolyte / Acid-Base Balance

Acid-Base Balance:
• Mechanisms of pH control
H+ Gain: Distant from H+ Loss:
• Across digestive epithelium one another • Secretion into urine
• Cell metabolic activities • Release at lungs

• Buffering Systems: Dissolved compounds that neutralize H+ during transport

2) Carbonic Acid – Bicarbonate Buffer System: (ECF)

• Carbon dioxide reacts with water to form
carbonic acid

• Limitation:
• Can’t protect system from pH changes resulting
from elevated / depressed CO2 levels
Respiratory system must be working normally Figure 27.7

Chapters 27: Fluid / Electrolyte / Acid-Base Balance

Acid-Base Balance:
• Mechanisms of pH control
H+ Gain: Distant from H+ Loss:
• Across digestive epithelium one another • Secretion into urine
• Cell metabolic activities • Release at lungs

• Buffering Systems: Dissolved compounds that neutralize H+ during transport

3) Phosphate Buffer System: (ICF)

H2PO4- HPO42- + H+
dihydrogen monohydrogen
phosphate phosphate

Figure 27.7

6
 Chapters 27: Fluid / Electrolyte / Acid-Base Balance

Maintenance of Acid-Base Balance:

• Long-term, H+ ions must be removed from system (buffers = short-term fix)
1) Respiratory Compensation:
• Change in respiratory rate stabilized pH (carbonic acid – bicarbonate buffer system)

•  respiratory rate =  CO2 levels =  pH

•  respiratory rate =  CO2 levels =  pH

2) Renal Compensation:
• Change in secretion / reabsorption rate of H+ / HCO3- at kidney
• Metabolic acids buffer tubular fluid (minimum pH of tubular fluid ~ 4.5)
• w/o buffers, ~ 1% of acids produced by body daily could be cleared

Chapters 27: Fluid / Electrolyte / Acid-Base Balance

Disturbances of Acid-Base Balance:

Acute (e.g., drowning) vs. Chronic (e.g., emphysema)
1) Respiratory Acid/base Disorders:
• Mismatch between CO2 generation in tissues and clearance at lungs
A) Respiratory Acidosis: (Most common acid/base disorder)
• Respiratory system fails to eliminate all CO2 generated by tissues
• Cause: Hypoventilation (abnormally low respiratory rate…)

B) Respiratory Alkalosis:
• Respiratory system clears too much CO2 from system
• Cause: Hyperventilation (abnormally high respiratory rate – physical / psychological stress)

Rarely persists long enough to cause clinical emergency…

7
 Chapters 27: Fluid / Electrolyte / Acid-Base Balance

Disturbances of Acid-Base Balance:

2) Metabolic Acid/base Disorders:
• Generation of organic / fixed acids or by shifts in HCO 3- concentrations
A) Metabolic Acidosis: (Second most common acid/base disorder)
1. Production of fixed / organic acids (e.g., lactic acid (exercise) / ketone bodies (starvation))
• H+ release from acids overload carbonic acid – bicarbonate system
2. Impaired ability to secrete H+ at kidney
3. Severe HCO3- loss (e.g., chronic diarrhea)

Figure 27.13

Chapters 27: Fluid / Electrolyte / Acid-Base Balance

Disturbances of Acid-Base Balance:

2) Metabolic Acid/base Disorders:
• Generation of organic / fixed acids or by shifts in HCO 3- concentrations
A) Metabolic Alkalosis:
• HCO3- concentrations become elevated (rare in body…)
• Cause: Repeated vomiting (alkaline tide amped…)

Figure 27.14