Fluid and Electrolyte Balance

M. Rasjad Indra Laboratorium Ilmu Faal FK. UNIBRAW

Body Fluid Compartment

5 liter in 70 kg young adult) Extracellular 20 % (14 liter in 70 kg young adult) Plasma 5% (3.5 liter in 70 kg young adult) Transcellular 1-3 % (Cerebrospinal) (Aqueous humor) .Body Fluid Volume Body fluid 60% (45-75) water Intracellular 40 % (42 liter in 70 kg young adult) Interstitial 15 % (10.

Electrolyte Composition of Body Fluid Electrolytes Plasma (mEq/L) Interstitial Fluid (mEq/Kg H2O) Intracellular Fluid (mEq/Kg H2O) 10 159 1 40 210 3 7 45 155 210 Cation: Na+ K+ Ca2+ Mg2+ Total Anion: ClHCO3Protein Others Total 142 4 5 2 153 103 25 17 8 153 145 4 3 2 154 117 28 9 154 .

Daily Intake and Output of Water (in ml/day) Normal Intake Fluid ingested From metabolism Total intake Output Insensible-Skin Insensible-Lungs Sweat Feces Urine Total output Prolonged Heavy Exercise ? 200 ? 350 650 5000 100 500 6600 2100 200 2300 350 350 100 100 1400 2300 .

300 mmHg.3mmHG .• Osmosis The net diffusion of water across the membrane from a region of high water concentration to one that has a lower water concentration The measurement of total number of particles in a solution 1 mole : 6. 1 mosm/L~19.02 x 1023 1 mole/L NaCl ~ 2 osmoles/L (Na+ & Cl-) • Osmoles (Osm): • Osmotic pressure: The precise amount of pressure required to prevent the osmosis 1 osm/L ~ 19.

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Add pure water • Normal • Add pure water ICF ECF ICF ECF .

Add isotonic saline • Normal • Add isotonic saline ICF ECF ICF ECF .

Add pure NaCl • Normal • Add pure NaCl ICF ECF ICF ECF .

Decreased ADH release from posterior pituitary Decreased plasma ADH Cardiovascular stretch receptor Osmoreceptor Decreased collecting duct water permiability Decreased plasma osmolarity Ingestion of 1L of water Increased extracellular fluid volume Normal fluid volume Increased water excretion Decreased water reabsorption .

Increased ADH release from posterior pituitary Increased plasma ADH Cardiovascular stretch receptor Osmoreceptors Increased collecting duct water permiability Dehydration Decreased extracellular fluid volume Increased plasma osmolarity Thirst Increased water intake Increased water reabsorption Normal fluid volume Decreased water excretion .

H2O reabsorption Water intake Normal effective arterial blood volume .Angiotensinogen Kidney Renin Angiotensin I Decreased effective arterial blood volume Liver Lungs Converting enzyme Angiotensin II Blood vessels Adrenal cortex Brain Vasoconstrictor Aldosteron secre. ADH secretion Thirst Blood pressure > Sodium reabs.

Increased potasium secretion Increased potasium excretion .Increased plasma [K+] Direct effect on adrenal cortex Increased aldosterone secretion Increased plasma aldosterone Increased [K+] in body cell (including kidney cells) Increased Potasium intake Normal potasium level Increase luminal membrane permiablility to Na+ and K+ & Increase basolateral membrane Na+/K+-ATPase activity in collecting duct principal cells.

ПIF= 3 mmHg Net Absorption= 15-0-28+3= -10 . ПIF= 3 mmHg Net Filtration= 35-0-28+3= 10 Venous end of capillary: Pc= 10 mmHg.Definition of Edema: An increase in the interstitial compartement of extracellular fluid volume (Harrison’s). PIF= 0 mmHg Пc= 28 mmHg. PIF= 0 mmHg Пc= 28 mmHg. Starling Hypothesis The balance of hydrostatic and oncotic pressures across the capillary endothelium Mean capillary hydrostatic pressure (Pc): 25 mmHg Interstitial fluid hydrostatic pressure (PIF): 0 mmHg Capillary oncotic pressure (Пc): 28 mmHg Interstitial fluid oncotic pressure (ПIF): 3 mmHg Arterial end of capillary: Pc= 40 mmHg.

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Increased capillary pressure – Excessive kidney retention – High venous pressure – Decreased arteriole resistance • 2.Causes of Extracellular Edema • 1. Decreased plasma proteins – Loss of protein in urine – Loss of protein from denuded skin – Failure of produce protein .

Vit C) • 4. Blockage of lymph return – Cancer – Paracyte infection (Filaria) – Surgery – Congenital absence or abnormal of Lymphatic vessels . Increased capillary permiability – Immune reaction – Toxin – Bacteria infection – Vitamin deficiency (exp.• 3.

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5-liter increase in intracellular fluid volume and a 0.5-liter increase in extracellular fluid volume . Cells c. Blood plasma b. Transcellular fluid • Intravenous infusion of 1 liter of isotonic saline will: a. A 1-liter increase in extracellular fluid volume c. A 0. Extracellular fluid d. A 1-liter increase in intracellular fluid volume b.Exercice • The greatest fraction of the body’s water is contained within: a.

All of the above . Collecting ducts b. A decrease in intracellular fluid volume b.• Intravenous infusion of 1 liter of hypertonic saline will cause: a. An increase in extracellular fluid volume c. An increase in plasma osmolality d. All of the above • Antidiuretic hormone increase epithelial water permiability of: a. Proximal tubules c. Thick ascending limbs d.

• ADH release from the posterior pituitary is stimulated by: a. Increase GFR d. Severe hemorrhage c. A fall in plasma osmolality b. Stretch of left arterial receptor • Which of the following produces a decrease in renal sodium excretion? a. Decrease plasma aldosterone level b. Increase plasma level of atrial natriuretic peptide c. Increase renal sympathetic nerve activity . Stimulation of arterial baroreceptors d.

Increase plasma estrgen levels d. Increase blood pressure in afferent arterioles b. Administration of glucocorticoids b. Uncontroled diabetes mellitus • Renin release is stimulated by: a. Stimulation of renal sympathetic nerves . Decrease peritbular capilary hydrostatic pressure c.• Which of the following produces an increase in renal sodium excretion? a. Increase effective arterial blood volume c. Increase NaCl transport by macula densa cells d.

Generalized edema c.• Which of the following are commonly seen in patients with severe congestive heart failure? a. All of the above • The most abundant intracellular cation is: a. Chloride c. Calcium b. Thirst e. Elevated plasma ADH levels b. Potasium d. Hyponatremia d. Sodium .

Inadequate blood flow d. Severe chronic renal failure (GFR=10 ml/min) d. Acute renal failure b. Lack of insulin e. All of the above • Which of the following produces excessive urinary excretion of potasium? a. Uncontroled diabetes mellitus .• Which of the following promotes a shift of potasium from cells to extracellular fluid? a. An overdose of digitalis c. Inadequate aldosterone secretion c. A fall in plasma pH b.

• The following measurement were obtained in 3.40 kg newborn infant: Total body water 2600 ml Extracellular water 1490 ml Plasma water 155 ml What are the volumes of (1) The intracellular water and (2) the interstitial fluid-lymph water? .

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