Fluid, electrolit and acid

base Homeostasis
Dr. Huda Marlina Wati

Fungsi Ginjal

Kepentingan klinis Air..

1. Mpkn 70 75 % massa tubuh mns
2. Zat essensial bagi seluruh makhluk hidup
3. Ditemukan pada SEMUA sel & mrpk
medium tempat terjadinya SELURUH
aktivitas seluler
4. Dibutuhkan utk kerja enzim & transport
zat terlarut
5. Mengatur temperatur tubuh
6. Mempercepat rx mll penyediaan ion
7. Masalah klinis : dehidrasi & edema

Body fluid compartement

Composition of the major body fluid

Fluid & electrolit balance

Yet the volume of fluid in each compartment
remains remarkably stable.
Because osmosis is the primary means of water
movement between ICF & ECF, the
concentration of solutes in these fluids
determines the direction of water movement.
Because most solutes in body fluids are
electrolytes, inorganic compounds that
dissociate into ions, fluid balance is closely
related to electrolyte balance.
Because intake of water and electrolytes rarely
occurs in exactly the same proportions as their
presence in body fluids, the ability of the
kidneys to excrete water (dilute urine), or to

Two factors are regulated to

maintain fl uid balance
both being dependent on the relative NaCl and H2O
load in the body, the reasons why and the
mechanisms by which they are closely controlled are
signifi cantly diff erent:
1. ECF volume must be closely regulated to
help maintain
blood pressure. Maintaining salt balance is of primary
importance in the long-term regulation of ECF
volume.
2. ECF osmolarity must be closely regulated to
prevent swelling or shrinking of cells. Maintaining
water balance is of primary importance in regulating
ECF osmolarity.

Sources of BodyWater Gain and Loss

Water Gain :
1. Ingestion (2300
ml/day)
2. Metabolic (200
ml/day)
. transpor electron
. Rx dehidrasi

Water Loss :
1. Kidney (urine)
2. Skin evaporate
3. Lungs exhalation
4. GIT (feses)

400 ml as
insesible wate
loss from skin

Regulation of
Body Water Gain
when body loss > body
gain (>2% BM)
dehydration stimulate
thirst center in
hypothalamus
the sensation of thirst does
not occur quickly enough
to restricted fluid
This happens most often in
elderly people, in infants,
and who are in a confused
mental state

Regulation of Water and Solute

Loss
Mainly control from excrete urin
The extent of urinary salt (NaCl) loss is the
main factor that determines body fluid volume.
The reason for this is that water follows solutes
in osmosis,
2 main solutes in ECF (and urin) : Na+ & Cl Urinary excretion of Na and Cl must also vary
to maintain homeostasis.
Hormonal changes regulate the urinary loss of
these ions, which in turn affects blood volume

Hormonal regulation of Na+ & Clreabsorption in renal

The three main hormones that
regulate renal Na and Cl reabsorption
(and thus the amount lost in the
urine) are :
1. angiotensin II,
2. aldosterone, and
3. atrial natriuretic peptide.

1. ACTIVATION OF THE RENIN

ANGIOTENSINALDOSTERONE
SYSTEM (RAAS)
Th e granular cells of the juxtaglomerular
Apparatus secrete renin, into the blood in
response to a fall in NaCl/ ECF volume/blood
pressure.
3 inputs to the granular cells increase renin
secretion:
1. The granular cells themselves function as intrarenal
baroreceptors.
2. Macula densa cells in the tubular portion of the
juxtaglomerular apparatus are sensitive to the NaCl
moving past them through the tubular lumen
3. Th e granular cells are innervated by the
sympathetic nervous system.

Juxtaglomerular apparatus

Function of RAAS

Regulating
Na+ & K+
by
aldosteron

2. Atrial natriuretic peptide

inhibits Na reabsorption.
blood pressureraising system is opposed by a Nalosing, blood pressurelowering system that
involves the hormones atrial natriuretic peptide
(ANP) and brain natriuretic peptide (BNP)
ANP produced by atrial myocard, BNP produce by
ventricular myocard
ANP and BNP are stored in granules and released
when the myocardium are mechanically stretched
by an expansion of the circulating plasma volume
Th e main action of ANP and BNP is to directly
inhibit Na reabsorption in the distal parts of the
nephron, thus increasing Na and accompanying
osmotic H2O excretion in the urine

Functio
n of
ANP &
BNP

So, Factor maintain fluid

balance
1.
2.
3.
4.

Thirst center in hypothalamus

Angiotensin II
Aldosteron
Atrial natriuretic peptide & Brain
natriuretic peptide
5. Antidiuretic hormon (vasopressin)

IONS RESPONSIBLE FOR ECF AND

ICF OSMOLARITY Osmosis occurs
across the cellular plasma membranes only when a diff
erence in concentration of nonpenetrating solutes exists
between the ECF and ICF.
Solutes that can penetrate a barrier separating two fl uid
compartments quickly become equally distributed
between the two compartments and thus do not
contribute to osmotic differences.

Normally, the osmolarities of the ECF and ICF are the

same because the total concentration of K and
other eff ectively nonpenetrating solutes inside the
cells is equal to the total concentration of Na and
other eff ectively onpenetratingsolutes in the fl uid
surrounding the cells.

During ECF hypertonicity, the

cells shrink as H2O leaves them.
Hypertonicity of the ECF, the excessive
concentration of ECF solutes, is usually
associated with dehydration, or a negative
free H2O balance.
1. Insuffi cient H2O intake, such as might
occur during desert
travel or might accompany diffi culty in
swallowing
2. Excessive H2O loss, such as might occur
during heavy sweating, vomiting, or diarrhea
3. Diabetes insipidus

During ECF hypotonicity, the

cells swell as H2O enters them
Hypotonicity of the ECF is usually associated with
overhydration; that is, excess free H2O. When a positive
free H2O balance exists, the ECF is less concentrated (more
dilute) than normal.
1. Patients with renal failure who cannot excrete a
dilute urine become hypotonic when they consume
relatively more H2O than solutes.
2. Hypotonicity can occur transiently in healthy people
if H2O is rapidly ingested to such an excess that the kidneys
cannot respond quickly enough to eliminate the extra H2O.
3. Hypotonicity can occur when excess H2O without
solute is retained in the body as a result of the syndrome of
inappropriate vasopressin secretion.

Control of
water balance
by means
of vasopressin
is important in
Regulating
ECF
osmolarity.
Vasopressin
increased number
of Aqusaporin 2 in
distal tubule&
collecting duct

Homeostasis PH
3 sistem yg berperan dlm menjaga
homeostasis PH :
Sistem buffer dr plasma, cairan tubuh & sel
(eritrosit)
Paru
Ginjal

Review ....PH darah normal???

Peran ginjal dlm homeostasis as - ba

1.

Mengabsorbsi ion bikarbonat yg difiltrasi

. Ion bikarbonat direabsorpsi dlm bentuk CO2 krn membran lumen
impermiabel thd HCO3. Mekanismenya : ion HCO3- di dalam lumen akan berikatan dg
ion H+ membentuk H2CO3 yg akan didehidrasi mjd CO2 & H2O
. CO2 berdifusi ke tubuli proximal dan direhidrasi kembali mjd
H2CO3 oleh enzim carbonic anhidrase
. Dlm sel tubulus, H2CO3 akan berdisosiasi mjd ion HCO3- & ion
H+. Ion HCO3- akan berdifusi ke dlm darah bersamaan dg ion
Na+

Ginjal dpt menyediakan cadangan

alkali (basa)

2. Sekresi H+

Intercalalated cell of distal

tubule
Proton pump (H+ATP ase)
HCO3
produced by dissociation
And H2CO3 inside
intercalated cells crosses
the basolateral membrane
by means of Cl/HCO3
antiporters and then
diffuses into peritubular
capillaries

2. Sekresi H+

Some H secreted into the

tubular fluid of the
collecting duct are
buffered, but not by
HCO3
The most plentiful buffer
in the tubular fluid of the
collecting duct is HPO42(monohydrogen
phosphate ion).
Small amount of
ammonia (NH3) also
present

Peran ginjal dlm homeostasis as - ba

3.

Pembentukan & Ekskresi Amoniak

. Amoniak dibentuk dr glutamin (asam amino) yg diektraksi ke
tubuli renal dari darah
. Di tubuli tdpt enzim glutamase yg menghidrolisis glutamin
glutamat + amoniak
. Amoniak yg terbentuk akan berdifusi ke lumen
. Ion H+ ditranspor ke lumen dr tubuli mll pompa transpor aktif
. Di lumen, amoniak berikatan dg H+ mbtk NH4+

Ion NH4+ jg berkontribusi urin basa

Review
Persamaan HendersonHasselbach
pH = pK + log

HCO30,03 x Pco2

Sistem bikarbonat pK = 6,1 HCO3

pH = 6,1 + log
0,03 x Pco2
pH bila bikarbonat
atau bila Pco2

Gangguan keseimbangan asam - basa

1.
2.
3.
4.

Asidosis metabolik
Alkalosis metabolik
Asidosis respirtorik
Alkalosis respiratorik

Gangguan keseimbangan asam - basa

Asidosis
metabolik

Tjd bila kadar HCO3plasma

Alkalosis
metabolik

Tjd bila kadar HCO3plasma

Asidosis
respiratorik

Tjd bila tekanan CO2

plasma

Alkalosis
respiratorik

Tjd bila tekanan CO2

plasma

Selamat
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