Fluid and Electrolyte Balance Muse Lecture #10 3/23/11.
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Transcript of Fluid and Electrolyte Balance Muse Lecture #10 3/23/11.
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Fluid and Electrolyte Balance
MuseLecture #103/23/11
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Fluid, Electrolyte, and Acid–Base Balance
Fluid Balance
Is a daily balance between
Amount of water gained
Amount of water lost to environment
Involves regulating content and distribution of
body water in ECF and ICF
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Fluid, Electrolyte, and Acid–Base Balance
The Digestive System
Is the primary source of water gains
Plus a small amount from metabolic activity
The Urinary System
Is the primary route of water loss
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Fluid, Electrolyte, and Acid–Base Balance
Electrolytes
Are ions released through dissociation of inorganic
compounds (Na+ , K+, Cl-, CO3- )
Can conduct electrical current in solution
Electrolyte balance
When the gains and losses of all electrolytes are equal
Primarily involves balancing rates of absorption across
digestive tract with rates of loss at kidneys and sweat glands
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Fluid, Electrolyte, and Acid–Base Balance
Acid–Base Balance
Precisely balances production and loss of
hydrogen ions (pH)
The body generates acids during normal
metabolism
Tends to reduce pH
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Fluid, Electrolyte, and Acid–Base Balance
The Kidneys
Secrete hydrogen ions into urine
Generate buffers that enter bloodstream
In distal segments of distal convoluted tubule (DCT)
and collecting system
The Lungs
Affect pH balance through elimination of carbon
dioxide
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Fluid Compartments
Water Exchange
Water exchange between ICF and ECF
occurs across plasma membranes by
Osmosis
Diffusion
Carrier-mediated transport
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Body Fluid Compartments In lean adults, body fluids constitute 55% of female and 60%
of male total body mass
Intracellular fluid (ICF) inside cells
About 2/3 of body fluid
Extracellular fluid (ECF) outside cells
Interstitial fluid between cell is 80% of ECF
Plasma in blood is 20% of ECF
Also includes lymph, cerebrospinal fluid, synovial fluid, aqueous humor,
vitreous body, endolymph, perilymph, and pleural, pericardial, and peritoneal
fluids
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Body Fluid Compartments
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Daily Water Gain and Loss
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Fluid Compartments
Major Subdivisions of ECF
Interstitial fluid of peripheral tissues
Plasma of circulating blood
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Fluid Compartments
Minor Subdivisions of ECF
Lymph, perilymph, and endolymph
Cerebrospinal fluid (CSF)
Synovial fluid
Serous fluids (pleural, pericardial, and peritoneal)
Aqueous humor
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Fluid Compartments
Figure 27–1a The Composition of the Human Body.
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Fluid Compartments
Figure 27–1a The Composition of the Human Body.
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Fluid Movement
Edema
The movement of abnormal amounts of water
from plasma into interstitial fluid
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Regulation of body water gain
Mainly by volume of water intake/ how much you drink
Dehydration – when water loss is greater than gain Decrease in volume,
increase in osmolarity of body fluids
Stimulates thirst center in hypothalamus
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Regulation of water and solute loss
Elimination of excess body water through urine
Extent of urinary salt (NaCl) loss is the main factor that determines
body fluid volume
Main factor that determines body fluid osmolarity is extent of urinary
water loss
3 hormones regulate renal Na+ and Cl- reabsorption (or not)
Angiotensin II and aldosterone promote urinary Na+ and Cl- reabsorption
of (and water by osmosis) when dehydrated
Atrial natriuretic peptide (ANP) promotes excretion of Na+ and Cl- followed
by water excretion to decrease blood volume
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Fluid Compartments
An Overview of the Primary Regulatory
Hormones
Affecting fluid and electrolyte balance:
– Antidiuretic hormone
– Aldosterone
– Natriuretic peptides
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Fluid Compartments
ADH Production
Osmoreceptors in hypothalamus
Monitor osmotic concentration of ECF
Change in osmotic concentration
Alters osmoreceptor activity
Osmoreceptor neurons secrete ADH
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Major hormone regulating water loss is antidiuretic hormone (ADH)
Also known as vasopressin
Produced by hypothalamus, released from
posterior pituitary
Promotes insertion of aquaporin-2 into principal
cells of collecting duct
Permeability to water increases
Produces concentrated urine
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Hormonal Regulation of Na+ and Cl-
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Fluid Compartments
Aldosterone
Is secreted by suprarenal cortex in response
to
Rising K+ or falling Na+ levels in blood
Activation of renin–angiotensin system
Determines rate of Na+ absorption and K+ loss
along DCT and collecting system
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Fluid Compartments
“Water Follows Salt” salt pumps in PCT and ALOH
High aldosterone plasma concentration
Causes kidneys to conserve salt
Conservation of Na+ by aldosterone
Also stimulates water retention
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Concentrations in body fluids
Concentration of ions typically expressed in
milliequivalents per liter (mEq/liter)
Na+ or Cl- number of mEq/liter = mmol/liter
Ca2+ or HPO42- number of mEq/liter = 2 x mmol/liter
Chief difference between 2 ECF compartments
(plasma and interstitial fluid) is plasma contains
many more protein anions
Largely responsible for blood colloid osmotic pressure
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Fluid Movement
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ICF differs considerably from ECF
ECF most abundant cation is Na+, anion is Cl-
ICF most abundant cation is K+, anion are
proteins and phosphates (HPO42-)
Na+ /K+ pumps play major role in keeping K+
high inside cells and Na+ high outside cell
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Electrolyte and protein anion concentrations
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Electrolytes in body fluids
Ions form when electrolytes dissolve ad dissociate
4 general functions
Control osmosis of water between body fluid
compartments
Help maintain the acid-base balance
Carry electrical current
Serve as cofactors
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Sodium Na+
Most abundant ion in ECF
90% of extracellular cations
Plays pivotal role in fluid and electrolyte balance because
it account for almost half of the osmolarity of ECF
Level in blood controlled by
Aldosternone – increases renal reabsorption
ADH – if sodium too low, ADH release stops
Atrial natriuretic peptide – increases renal excretion
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Potassium K+
Most abundant cations in ICF
Key role in establishing resting membrane potential in
neurons and muscle fibers
Also helps maintain normal ICF fluid volume
Helps regulate pH of body fluids when exchanged for
H+
Controlled by aldosterone – stimulates principal cells in
renal collecting ducts to secrete excess K+
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Chloride Cl-
Most prevalent anions in ECF
Moves relatively easily between ECF and ICF because most
plasma membranes contain Cl- leakage channels and
antiporters
Can help balance levels of anions in different fluids
Chloride shift in RBCs
Regulated by
ADH – governs extent of water loss in urine
Processes that increase or decrease renal reabsorption of Na+ also
affect reabsorption of Cl-
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Bicarbonate HCO3-
Second most prevalent extracellular anion
Concentration increases in blood passing through systemic capillaries
picking up carbon dioxide
Carbon dioxide combines with water to form carbonic acid which
dissociates
Drops in pulmonary capillaries when carbon dioxide exhaled
Chloride shift helps maintain correct balance of anions in ECF and ICF
Kidneys are main regulators of blood HCO3-
Can form and release HCO3- when low or excrete excess
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Calcium Ca2+
Most abundant mineral in body 98% of calcium in adults in skeleton and teeth In body fluids mainly an extracellular cation Contributes to hardness of teeth and bones Plays important roles in blood clotting,
neurotransmitter release, muscle tone, and excitability of nervous and muscle tissue
Regulated by parathyroid hormone Stimulates osteoclasts to release calcium from bone – resorption Also enhances reabsorption from glomerular filtrate Increases production of calcitrol to increase absorption for GI tract
Calcitonin lowers blood calcium levels
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Phosphate
About 85% in adults present as calcium phosphate salts in bone and teeth
Remaining 15% ionized – H2PO4-, HPO4
2-, and PO43- are important
intracellular anions
HPO42- important buffer of H+ in body fluids and urine
Same hormones governing calcium homeostasis also regulate HPO42- in
blood
Parathyroid hormone – stimulates resorption of bone by osteoclasts
releasing calcium and phosphate but inhibits reabsorption of phosphate
ions in kidneys
Calcitrol promotes absorption of phosphates and calcium from GI tract
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Magnesium
In adults, about 54% of total body magnesium is part of bone
as magnesium salts
Remaining 46% as Mg2+ in ICF (45%) or ECF (1%)
Second most common intracellular cation
Cofactor for certain enzymes and sodium-potassium pump
Essential for normal neuromuscular activity, synaptic
transmission, and myocardial function
Secretion of parathyroid hormone depends on Mg2+
Regulated in blood plasma by varying rate excreted in urine
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Acid-base balance
Major homeostatic challenge is keeping H+ concentration (pH) of body fluids at appropriate level
3D shape of proteins sensitive to pH Diets with large amounts of proteins produce
more acids than bases which acidifies blood Several mechanisms help maintain pH of
arterial blood between 7.35 and 7.45 Buffer systems, exhalation of CO2, and kidney
excretion of H+
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Acid–Base Balance
Figure 27–6 The Basic Relationship between PCO2and Plasma pH.
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Acid–Base Balance
Three Major Buffer Systems
Protein buffer systems:
Help regulate pH in ECF and ICF
Interact extensively with other buffer systems
Carbonic acid–bicarbonate buffer system:
Most important in ECF
Phosphate buffer system:
Buffers pH of ICF and urine
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Acid–Base Balance
Figure 27–7 Buffer Systems in Body Fluids.
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Acid–Base Balance
Figure 27–8 The Role of Amino Acids in Protein Buffer Systems.
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Buffer systems
Act to quickly temporarily bind H+
Raise pH but do not remove H+
Most consist of weak acid and salt of that acid functioning as weak
base
Protein buffer system
Most abundant buffer in ICF and blood plasma
Hemoglobin in RBCs
Albumin in blood plasma
Free carboxyl group acts like an acid by releasing H+
Free amino group acts as a base to combine with H+
Side chain groups on 7 of 20 amino acids also can buffer H+
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Buffer Systems Carbonic acid- bicarbonate buffer system
Based on bicarbonate ion (HCO3-) acting as weak base and carbonic acid (H2CO3)
acting as weak acid
HCO3- is a significant anion in both ICF and ECF
Because CO2 and H2O combine to form this buffer system cannot protect against
pH changes due to respiratory problems in which there is an excess or shortage of
CO2
Phosphate buffer system
Dihydrogen phosphate (H2PO4-) and monohydrogen phosphate (HPO4
2-)
Phosphates are major anions in ICF and minor ones in ECF
Important regulator of pH in cytosol
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Acid–Base Balance
The Hemoglobin Buffer System
CO2 diffuses across RBC membrane
No transport mechanism required
As carbonic acid dissociates
Bicarbonate ions diffuse into plasma
In exchange for chloride ions (chloride shift)
Hydrogen ions are buffered by hemoglobin
molecules
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Exhalation of carbon dioxide
Increase in carbon dioxide in body fluids lowers
pH of body fluids
Because H2CO3 can be eliminated by exhaling
CO2 it is called a volatile acid
Changes in the rate and depth of breathing can
alter pH of body fluids within minutes
Negative feedback loop
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Acid–Base Balance
The Hemoglobin Buffer System
Is the only intracellular buffer system with an
immediate effect on ECF pH
Helps prevent major changes in pH when
plasma PCO2 is rising or falling
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Acid–Base Balance
Carbonic Acid–Bicarbonate Buffer System
Carbon Dioxide
Most body cells constantly generate carbon dioxide
Most carbon dioxide is converted to carbonic acid, which
dissociates into H+ and a bicarbonate ion
Is formed by carbonic acid and its dissociation
products
Prevents changes in pH caused by organic acids and
fixed acids in ECF
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Acid–Base Balance
Figure 27–9 The Carbonic Acid–Bicarbonate Buffer System
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Acid–Base Balance
Phosphate Buffer System
Consists of anion H2PO4- (a weak acid)
Works like the carbonic acid–bicarbonate
buffer system
Is important in buffering pH of ICF
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Acid–Base Balance
Limitations of Buffer Systems
Provide only temporary solution to acid–base
imbalance
Do not eliminate H+ ions
Supply of buffer molecules is limited
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Acid–Base Balance
Renal Responses to Acidosis
1. Secretion of H+
2. Activity of buffers in tubular fluid
3. Removal of CO2
4. Reabsorption of NaHCO3
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Kidney excretion of H+
Metabolic reactions produce nonvolatile acids One way to eliminate this huge load is to excrete
H+ in urine In the proximal convoluted tubule, Na+ /H+
antiporters secrete H+ as they reabsorb Na+
Intercalated cells of collecting duct include proton pumps that secrete H+ into tubule fluid
Urine can be up to 1000 times more acidic than blood
2 other buffers can combine with H+ in collecting duct HPO4
2- and NH3
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Secretion of H+ by intercalated cells in the collecting duct
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Metabolic alkalosis Abnormally high HCO3
- in systemic arterial blood
Nonrespiratory loss of acid - vomiting of acidic stomach
contents, gastric suctioning
Excessive intake of alkaline drugs (antacids)
Use of certain diuretics
Severe dehydration
Hypoventilation can help
Give fluid solutions to correct Cl-, K+ and other electrolyte
deficiencies and correct cause of alkalosis
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Respiratory alkalosis
Abnormally low PCO2 in systemic arterial blood
Cause is hyperventilation due to oxygen deficiency
from high altitude or pulmonary disease, stroke or
severe anxiety
Renal compensation can help
One simple treatment to breather into paper bag
for short time
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Regulation of blood pH by the respiratory system
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Acid–Base Balance
Renal Responses to Alkalosis
1. Rate of secretion of H+ at kidneys declines
2. Tubule cells do not reclaim bicarbonates in
tubular fluid
3. Collecting system transports HCO3- into
tubular fluid while releasing strong acid
(HCl) into peritubular fluid
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Acid–Base Balance Disturbances
Figure 27–15 A Diagnostic Chart for Acid–Base Disorders.