NCM 112 – Fluids & Electrolytes
Richard L. Bartolata, Ph.D
Body Fluids
- The human body continually strives
for homeostasis (state of equilibrium
or balance that can only be achieved
through the complex balancing of
the body’s fluids and electrolytes)
- In healthy people it's a naturally
occurring self-regulating process,
however in people with such
disorders as heart failure, cancer, and
hyperthyroidism, achieving
homeostasis is difficult in fact it's a
daunting challenge that requires the
utmost quality patient care.
Percentage of Water to Body Weight
The greatest single constituent of the body
is water.
• Average adult: 60%
• Older adult: 45-55%
• New born infant: 70-80%
• Human embryo: 97%
Fluid Changes with Aging
• Skeletal muscle mass declines
• Proportion of fat increases
• Water content drops to 45% at age
60
• Distribution changes
Total Body Weight of Fluid
The total body weight in the adult is 60%
water.
• Extracellular fluid is 20% of total
body weight.
• Intracellular fluid is 40% of total body
weight.
Types of Body Fluid Compartments
Body water is distributed among three
types of compartments:
• Cells
• Blood vessels
• Tissue spaces – between blood
vessels and cells that are separated
by semipermeable membranes
Understanding Fluid Compartments
• Extracellular compartments are
further divided into interstitial (space
between the blood vessels and other
tissues) and intravascular
compartments (inside a vessel).
• Capillary walls and cell membranes
separate intracellular fluids from
extracellular fluids.
Body Fluid Distribution
• Intracellular fluid – fluid inside the cell
• Intravascular fluid – fluid inside the
blood vessel
• Interstitial fluid – fluid in the tissue
space between blood vessels and
cells and other tissues.
Function of Body Fluid
• Transportation – Water provides
transportation of nutrients,
electrolytes, and gases like oxygen,
carbon dioxide to the cells. Plasma
and lymph are examples of water
that perform this function.
• Excretion – Water is used in the
excretion of waste products.
Example: Urine
• Regulation – Water is used in the
regulation of body temperature.
These are body fluids inside the cells
and even outside the cells, tissue
spaces and even in the intravascular
space
• Lubrication – Water provides
lubrication of joints and membranes.
Ex: synovial fluid that promotes the
movement of joints. Intrapleural fluid
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NCM 112 – Fluids & Electrolytes
Richard L. Bartolata, Ph.D
that prevents friction between the
parietal and visceral pleurae
• Medium – Water serves as a medium
for food digestion. (Gastrointestinal
fluids – facilitate food digestion,
assimilation, and excretion)
Water Intake and Loss
Intake (Daily total intake: 2,600 ml)
• Liquid: 1,000 – 1,200 ml (water, clear
liquids such as water, soft drinks,
coffee, soup)
• Food: 800 – 1,000 ml
• Oxidation – 200 – 300 ml
Output (Daily total output: 1,200 – 2,500 ml)
• Skin: 300 – 500 ml (perspiration)
• Lungs: 400 – 500 ml (through
breathing)
• Urine: 1,000 – 5,000 ml
• Feces: 100 ml
Fluid movement
• Fluids and solutes constantly move
• Helps maintain homeostasis across
intracellular, interstitial, and
intravascular compartments. (These
compartments are separated by semi
permeable membranes that allows
the passage or the passing through
of water and solute)
At the Cellular Level
• Cell membranes allow select solutes
through semipermeable
• Different ways fluids and solutes can
move through membranes at cellular
level called diffusion, osmosis and
active transport.
Understanding OSMOSIS
• In osmosis, fluid moves passively
from areas with more fluid (and fewer
solutes) to areas with less fluid (and
more solutes). Remember: In
osmosis, fluid moves; In diffusion,
solutes move.
Understanding Diffusion
• Diffusion is the movement of
molecules/solutes across a
selectively permeable membrane
along their own pathway, irrespective
of all other molecules.
• Large molecules move less rapidly
than small molecules.
• Molecules move faster from an area
of higher concentration to an area of
lower concentration.
• It occurs when solutes moves from
area of higher concentration to area
of lower concentration.
• It results in equal distribution of
solutes
• Form of passive transport.
Understanding Active Transport
• During active transport, energy from
the molecule adenosine triphosphate
(ATP) moves solutes from an area of
lower concentration to an area of
higher concentration.
Within the Vascular System
• Only capillaries have walls thin (and
semipermeable) enough to let water
and solutes through.
• It is impossible for larger vessels to
allow water and solute to pass
through their walls like arteries,
arterioles, veins and venules.
• Water and solutes may escape or be
absorbed back inside a capillary.
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NCM 112 – Fluids & Electrolytes
Richard L. Bartolata, Ph.D
• Capillary filtration – the movement of
fluids and solutes through capillary
walls or capillary membrane.
Capillary Filtration
• Results from hydrostatic (fluid
pushing) pressure.
- Pressure exerted by a non-
moving water or fluid and that
exerts a pushing force to allow
fluid and solutes to escape
from the capillary.
• Reabsorption – prevents too much
fluid from leaving capillaries.
• Plasma colloid osmotic pressure –
osmotic (pulling force) of albumin in
intravascular space.
• If hydrostatic pressure exceed
plasma colloid osmotic pressure,
water and solutes leave capillaries
and enter interstitial space. (Capillary
Filtration)
• If plasma colloid osmotic pressure
exceeds hydrostatic pressure, water
and solutes return to capillaries.
(Reabsorption)
Starling’s Law
- Earnest H. Starling states that
equilibrium exists at the
capillary membrane when the
fluid leaving circulation and
the amount of fluid returning
to circulation are exactly
equal.
Four Measurable Pressures
The flow of fluid between the intravascular
and interstitial spaces are determined by
the following:
• The colloid osmotic pressure in the
vessel. (exerts the pulling force to
keep water and solute inside the
capillary)
• The hydrostatic pressure in the
vessel. (pushing force that allow
water and solute to escape)
• The colloid osmotic pressure in the
tissue spaces.
• The hydrostatic pressure in the tissue
spaces.
REGULATORS OF FLUID BALANCE
• Inadequate fluid intake: Thirst
• Electrolytes and Nonelectrolytes:
Sodium, Protein, Albumin
• Hormones and enzymes: ADH,
Aldosterone, Renin
• Body tissues and organs: Lymphatics,
Skin, Lungs, Kidneys
Electrolytes & Nonelectrolytes
- The brain has specialized cells
called osmoreceptors that
detect changes in osmotic
pressure or the concentration
of body fluids. These cells
found in the hypothalamus
and kidneys sends signal to
the thirst center. The areas of
the brain that contribute to the
sense of thirst located in the
midbrain and the high brain
specifically, the hypothalamus
appears to play a key role in
the regulation of thirst.
• Thirst: an indicator of fluid need
• Sodium
- Sodium the most plentiful
electrolyte in the extracellular
compartment. With a normal
range or serum sodium is 135-
145 mEq/L.
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NCM 112 – Fluids & Electrolytes
Richard L. Bartolata, Ph.D
-Sodium attracts water and
where sodium goes water
flows into. When sodium is
retained in the body, and so is
water
• (Nonelectrolytes) - Protein (Plasma
protein or Colloid), Albumin
- Albumin is the most abundant
which exerts a pulling force or
colloid osmotic pressure to
prevent excessive escape of
plasma
Hormones and Enzymes
- Hormones are chemical
messengers that are secreted
by ductless glands directly
into the blood stream which
carries them in organs and
tissues of the body to exert
their functions.
- Enzymes are proteins that act
as biological catalysts that
accelerate chemical reactions.
• Anti-diuretic hormone – regulates
fluid balance
• Aldosterone – secreted from the
adrenal cortex; promotes sodium,
chloride, and water reabsorption
from the renal tubules.
• Renin – decreased renal blood flow
increases the release of renin, an
enzyme from the juxtaglomerular
cells of the kidneys.
How Antidiuretic hormone works
- Antidiuretic Hormone (ADH) is
produced by the
hypothalamus and stored in
the posterior pituitary gland of
the hormone secreting glands
or ductless glands. This
hormone get secreted when
there is an extracellular fluid
volume deficit or decreased
water in the body or low blood
volume or dehydration or an
increase osmolality or plasma
concentration.
- When ADH reaches the
kidneys it promotes water
reabsorption from the distal
tubule of the kidneys as a
result there is a decreased
urine output.
- Water is retained that
decreases blood volume or
the amount of plasma in the
circulation and it also
decreases blood
concentration or serum
osmolality.
Understanding Aldosterone Production
- Helps to regulate fluid balance
through the renin-angiotensin-
aldosterone system. (RAAS)
- This is another hormone that
regulates body fluid, which is
secreted by the adrenal
cortex. This hormone
promotes water and
electrolytes, specifically
sodium and chloride
reabsorption from the renal
tubules.
- When there is decreased
blood flow to the kidneys, less
oxygen is delivered to the
glomeruli or there is altered
renal tissue perfusion. The
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NCM 112 – Fluids & Electrolytes
Richard L. Bartolata, Ph.D
specialized cells in the
glomeruli called
Juxtaglomerular cells get
excited releasing a renal
enzyme called Renin into the
bloodstream.
- Then, the renin travels to the
liver and converts
angiotensinogen (liver
enzyme) to Angiotensin 1 an
inactive form of Angiotensin
which goes to the lungs and is
converted into Angiotensin 2
by Angiotensin converting
enzyme or ACE. Angiotensin 2
stimulates the adrenal glands
to produce aldosterone.
- Aldosterone is released into
the blood stream and
promotes reabsorption of
water and sodium and
chloride from the renal
tubules.
Aldosterone, produced as a result of the
renin-angiotensin-aldosterone-system,
regulates fluid volume.
- As a result of RAAS, the active
form of Angiotensin or
Angiotensin 2 is released into
the blood stream and
stimulates the adrenal cortex
to secrete aldosterone which
promotes water and
electrolytes, specifically
sodium and chloride
reabsorption from the
convoluted tubules of the
kidneys.
- Water and electrolytes are
retained that leads to
increased fluid volume and
sodium in the body.
Atrial Natriuretic Peptide
• Cardiac hormone stored in atrial cells
• Released when atrial pressure
increases
• Suppresses serum renin levels
• Decreased aldosterone release
• Increases glomerular filtration
• Decreased ADH release
• Causes vasodilation
As check and balance, when there is over
secretion or over production of hormones
and enzymes that lead to fluid retention or
fluid volume excess, Atrial natriuretic
peptide is released from the cardiac tissues
to suppress serum renin levels, decreased
ADH and aldosterone and increased
glomerular filtration. As a result there is less
reabsorption of water from the renal
tubules thus increase urine production.
Body Tissues and Organs
Lymphatic System – a sub system of the
circulatory system that consist of a complex
network of vessels, like efferent or afferent
lymphatic vessels, lymphoid tissues, organs
like lymph nodes and spleen. The lymphatic
system helps maintain fluid balance in the
body by collecting excess fluids and solutes
from tissue spaces and returning them via
the lymphatic vessels to the blood stream
and thus prevents a fluid imbalance.
Lymphatics
- Plasma protein that shifts to
the tissue spaces cannot be
reabsorbed into the blood
vessels. Thus, the lymphatic
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NCM 112 – Fluids & Electrolytes
Richard L. Bartolata, Ph.D
system promotes the return of
water and protein from the
interstitial spaces to the
vascular spaces.
Skin
- Due to the tight packing of
cells and the outermost layer
of the epidermis the stratum
corneum layer, the skin helps
to retain the necessary body
fluids and moisture and
protects the body from the
absorption of the external
fluids and liquids. This
protection is provided by the
melanin pigmentation in the
epidermis and both carotene
and glycolipids are
hydrophobic so this layer of
the skin is waterproof.
- Waterproof layer prevents
excessive loss of body fluids
because water is enable to
leave the body by passing
through the skin.
- Excretes approximately 300-
500 ml of water daily through
normal perspiration.
Lungs
- Excretes approximately 400-
500 ml of water daily through
normal breathing.
- A normal breathing losses
approximately 350 – 400 ml of
water daily.
Kidneys
- Excrete 1000-1500 ml of body
water daily. The amount of
water excretion may vary
according to the balance
between fluid intake and fluid
loss.
- Chief regulators of fluids and
electrolytes.
- A nephron filters blood,
produces urine, and excreted
excess solutes, electrolytes,
fluids and metabolic waste
products while keeping blood
composition and volume
constant. The nephrons
consist of Glomeruli, that
filters blood and the tubules,
proximal and distal tubules
that end in collecting ducts.
The Bowman’s capsule
surround the glomerulus.
The nephron has been stretched to show
where and how fluids and electrolytes are
regulated.
- The glomeruli filter blood and
produce filtrate which is
normally protein free and red
blood cell free because these
substances are non-diffusible
so they should not be present
in the filtrate or urine. It flows
into the proximal tubules for
most electrolytes are
reabsorbed except sodium
and chloride.
- This tubule also concentrates
the filtrate by reducing its
water content by 70% so water
in the filtrate, when it passes
through the proximal tubules
is reduced or reabsorbed by
at least 70%. Most fluids
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NCM 112 – Fluids & Electrolytes
Richard L. Bartolata, Ph.D

actually in the filtrate are - Under secretion of these

reabsorbed via the proximal hormones may lead to water
convoluted tubules. loss while the over secretion
- Since most fluids have been may result in water excess.
reabsorbed back to the - Alteration in the function of
circulation of filtrate that tissues, Organs and systems
passes through the loop of may result in problems in
Henle. It contains high homeostasis or imbalances
concentration of salts, mostly such as fluid volume deficit, or
sodium which pulled out from fluid volume excess.
the filtrate and reabsorbed in
the ascending limb of the loop
of Henle.
- The absorption of the forced
electrolytes causes the filtrate
to become less concentrated
as it moves into the distal
tubules where more water,
sodium and chloride
reabsorbed because of the
action of antidiuretic hormone
(ADH) and aldosterone.
- The collecting ducts may
reabsorbed or excrete
potassium, sodium, urea,
hydrogen ions, and ammonia
according to the body’s
needs.
- The kidneys know exactly how
much to excrete and how
much to retain to meet the
body’s needs.
Synthesis
- The levels of electrolytes and
nonelectrolytes in the body
may regulate body fluids.
There are hormones and
enzymes that promote water
retention or reabsorption.

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