Week 2

Sodium and Water Balance

Learning Objectives
Body Fluid Compartments and Principles of IV Fluid Replacement
1. Identify the major body fluid compartments and the membrane barriers between
the body fluid compartments
2. Compare the volume and composition of the major body fluid compartments
3. Evaluate the mechanisms and processes that act to maintain the differences in
composition between body fluid compartments
a. Examine the properties of the barriers that impede net movement of
water and solute between body fluid compartments
b. Examine the properties of the barriers that allow net movement of water
and solute between body fluid compartments
c. Assess the driving forces for movement of water and solute across the
barriers, and review the Starling forces
4. Evaluate basic principles of intravenous fluid replacement
a. Examine the composition of IV solutions commonly employed in the
treatment of disturbances in body fluid volume
b. Analyze how water and solute from a given IV fluid will partition into the
body fluid compartments
c. Deduce appropriate IV fluid therapy based on volume status and serum
electrolyte values
Renal Sodium Handling
1. Evaluate renal sodium handling, and identify the fraction of filtered sodium
reabsorbed in the different nephron segments
2. Examine the cellular mechanisms involved in renal tubule sodium transport, and
discuss the driving forces necessary for function of the various renal sodium
transport processes, including the WNK system
3. Evaluate neurohumoral regulation of renal sodium handling, discuss which
cellular processes are regulated, and explain the mechanism(s) by which these
processes are regulated
a. Analyze how changes in renal sympathetic nervous system activity
regulate glomerular filtration and renal tubule sodium transport processes
b. Examine activation of the renin-angiotensin-aldosterone system (RAAS),
and assess the effects of RAAS on glomerular filtration and renal tubule
sodium transport processes
c. Examine generation and release of natriuretic peptides, and explain the
effects of natriuretic peptides on renal tubule sodium transport processes
Renal Water Handling and Urinary Concentration and Dilution
1. Identify the most frequent causes of alterations in water balance
2. Evaluate renal tubule water handling, and identify the fraction of filtered water
reabsorbed in the different nephron segments
3. Examine the cellular transport mechanisms involved in renal tubule water
transport
4. Assess the neurohumoral regulation of renal water handling
a. Evaluate the role of thirst
b. Evaluate mechanisms for release of antidiuretic hormone (ADH), and discuss
the cellular mechanisms responsible for the effects of ADH on water transport
5. Diagram renal mechanisms responsible for forming a concentrated or dilute
urine, and assess the role of counter current multiplier in these processes
6. Appraise the role of urea in the formation of a concentrated urine
a. Describe renal urea handling
b. Explain how renal urea transporters are regulated by ADH

Volume Regulation
1. Appraise the major routes of gain and loss for sodium and for water
2. Diagram the most frequent causes of alteration in sodium and water balance
3. Examine the concept of effective circulating volume, and explain the difference(s)
between effective circulating volume and extracellular fluid volume
4. Identify the receptors responsible for sensing the effective circulating volume,
and assess the role of these sensors in volume regulation
5. Examine the relationship between total body sodium and effective circulating
volume
a. Compare the difference between total body sodium and the sodium
concentration in body fluid compartments
b. Evaluate the relationship between alterations in plasma sodium
concentration and sodium balance
c. Evaluate the relationship between alterations in plasma sodium
concentration and water balance
d. Examine how renal sodium excretion is determined by the effective
circulating volume
6. Evaluate the mechanisms of edema formation and discuss the role of renal
sodium retention in edema formation
7. Examine the pharmacology of diuretics
a. Identify the sites of action of furosemide, thiazide diuretics,
spironolactone, and triamterene/amiloride, and compare the mechanisms
by which these pharmaceutical agents affect diuresis
b. Evaluate the use of diuretics in the treatment of generalized edema
c. Evaluate the use of diuretics in other pathophysiological conditions
(hypertension, renal failure, hypercalcemia or hypercalciuria)