Cairan tubuh dan

elektrolit
Dr.H.Hasrul Han
Bag: Patologi klinik FK Unsri

Body Fluids - distribution

Body fluids constitute 55-60%

of body mass
Higher in males due to greater
muscle mass and lower fat

Total body water declines

throughout life with changes
in muscle mass and fat
Water occupies 2 main fluid
compartments:
Intracellular (~2/3 of total
water)
Extracellular (~1/3 total
water)

plasma (20%)

interstitial fluid (80%)

Water balance

Normally body fluid volume

remains constant
water loss = water gain

Water gain:
~60% ingested liquids
~30% ingested in foods
~10% metabolic water (from
oxidation)

Water loss:
~4% faeces
~28% insensible water loss (skin
& lungs)
~8% perspiration
~60% urine

Additional fluid loss in menstrual

flow in females of reproductive age

Regulation of body water gain and

loss

Regulation of body water gain

depends mainly on regulating volume
of water intake
Thirst centre in hypothalamus governs
urge to drink

Thirst centre stimulated by :

Nerve impulses from osmoreceptors in
hypothalamus

in PV or in plasma osmolality

Hypothalamic osmoreceptors lose water to

plasma

Increased transmission of nerve

impulses to thirst centre

dry mouth and pharynx - less saliva

from blood plasma
in PV = BP

increased angiotensin II (via JGA)

stimulates thirst centre

Regulation of body water (and solute)

loss depends mainly on urinary
excretion

Fluid Balance

Water loss

Ambient air temperature

Solar and thermal radiation
Water vapor pressure (humidity)
Solutes and wastes to be excreted
Amount and timing of activity
Amount of water intake
Physiological, behavioral, and
anatomical adaptations to reduce
water loss

Insensible water loss

(unaware of)

Not precisely regulated

Evaporation (respiration and skin)

Independent of sweating (anhydrosis)

Minimized by cholesterol-filled
cornified layer of skin (barrier)
Increase loss in burn patients (10x)

Sweating

Highly variable
Dependent on physical activity and
environment temperature
water intake via thirst mechanism
Loss via feces
Normally small amount
Severe during diarrhea

Water loss via kidney

The most important regulator of water and

electrolyte balance
Several mechanisms controlling the rate of
excretion
water excretion (dehydration), excretion
with increased intake (same for electrolyte)
Kidneys adjust the excretion rate to match
intake and disease state

Body Fluid Compartments

Extracellular
Interstitial fluid and plasma (noncellular part of blood)
Transcellular (specialized type of
extracellular fluid)
Cerebrospinal fluid, intraocular fluid,
GI tract, potential fluid (peritoneal,
joint space)
Intracellular

Fluid and
electrolytes
come into the
plasma then
redistribute to
the other fluid
compartments
over time. Note
also the
lymphatics as a
recirculator of
plasma proteins

Body Fluid Compartments

Total body water - 50-60 % of body weight

decrease with age, gender and obesity
Intracellular water - 40% of body weight
75 trillion cells
Similar composition in different species
Extracellular water - 20% of body weight
% is important in fluid therapy
Transcellular accounts for ~ 1-2 liters

Plasma

Plasma is the liquid portion of the blood that is

separated from the blood cells by centrifugation.
One of the characteristics of plasma is that it clots
easily.
Serum plus clotting factors is plasma, and clotted
plasma yields serum (as an interesting aside,
"serum" is Latin for whey, the liquid portion of
clotted milk removed in making cheese).

Plasma

Exchanges substances with interstitial

fluid via pores of the capillary
membrane
Pores permeable to all solutes in
extracellular fluid, except proteins
Plasma have higher protein
concentration

Composition of extracellular and

intracellular fluids

These represent
the nonelectrolytes in
the plasma.
They also
contribute
osmolarity to
the plasma or
extracellular
fluid.

Intracellular volume
Can not be measured directly
Calculated as Total body water Extracellular volume

Plasma volume
Indicator can not permeate capillary
membrane
Most common 125I-albumin, also Evans
blue dye (T-1824)

Interstitial volume
Can not be measured directly
Calculated as Extracellular volume Plasma volume

Forces impacting fluid distribution

Plasma vs Interstitial Space

Balance between Hydrostatic and
Colloid Osmotic forces across the
capillary membranes
Intracellular vs Extracellular
Osmotic effect (e.g. electrolytes)

Osmosis
Osmosis is the net movement of
water molecules over a partially
permeable membrane from an area
of less osmotic potential to an area
of more negative osmotic potential.

Osmosis

1 Excessive loss of H2O from

ECF

(a) Mechanism of dehydration

ECF osmotic
pressure rises

3 Cells lose H2O

to ECF by
osmosis; cells
shrink

Osmosis

Excessive H2O enters

the ECF

(b) Mechanism of hypotonic hydration

ECF osmotic
pressure falls

3 H2O moves into

cells by osmosis;
cells swell

Osmotic Pressure

Determined by number of particles per

unit volume, not by mass! (Molar
Concentration)
1 molecule of Albumin (mw 70000) and 1
molecule of Glucose (mw 180) has same
osmotic effect

What is the osmotic pressure of a 0.9%

NaCl solution?

0.9 % NaCl solution= 0.9g in 100 ml of solution

or 9g/1L
MW of NaCl =58.5
X mM=X mg/mw x 1000ml/ X ml
X mM=900mg/58.5 x 1000/100
154 mM = 154 mOsm
But wait, NaCl dissociates. So 154 x 2=308
mOsm/L
Potential osmotic pressure would be 308 x 19.3
mm Hg/mOsm/L or 5944 mm Hg

What is the osmotic pressure of a 5%

glucose solution?
Glucose mw=180
5g of glucose in 100mL of solution
X mM=5000 mg/180 x 1000ml/100mL
278 mM = 278 mOsm
Potential osmotic pressure would be 278
x 19.3 mm Hg/mOsm/L or 5366 mm Hg

Osmolarity of body fluids

Interstitial fluid and plasma (80% Na+ and Clions)

Intracellular fluid (50% K+ ions)

Total osmolarity of each around 300 mOsm/L

Plasma 1 mOsm/L greater because of

osmotic affect of plasma proteins (20 mmHg
greater pressure in the capillaries)

Factors that impact intracellular and

extracellular volume

Ingestion of water
Dehydration
IV infusion of different
solutions
Loss of fluid via GI tract
Loss via sweat
Loss via kidneys

Important principles for fluid therapy

Water moves rapidly across cell

membranes
Osmolarity between compartments
will be almost exactly except for a few
minutes after one changes
Cell membranes are almost completely
impermeable to many solutes
Osmoles remains constant, unless
solutes are added or lost from the
extracellular compartment

Edema Formation
Excess fluid in body tissue
Most cases in the extracellular fluid
compartment
Can also occur in the intracellular fluid
compartment as well
Extracellular - pitting edema
Decreased kidney excretion of salt and
water

Disease state (acute glomerulonephritis) with failure to filtrate

adequate amounts of fluid

Decreased plasma proteins

Failure of body to produce normal amounts of proteins

Leakage of proteins from plasma

Decreased plasma proteins (cont)

1. Nephrotic syndrome (damage to the
membranes of the renal glomeruli). Serious
edema when plasma protein falls below
2.5g/100ml.
2. Cirrhosis of the liver (hepatic tissue fibrosis).
protein synthesis leading to colloid osmotic
pressure.

Elektrolit
1.
2.
3.

ion in the body fluid

Kation (Na,K,Ca,Mg)
Anion (Cl)
Penting pada perawatan penyakit
akut

Tujuan:
D/ dan Th/ gangguan elektrolit
Monitor hasil Th/
Mencegah komplikasi

Cara:

Flame emission spectrophotometry

Ion selective electrode (ISE)
Spectrofotometer kinetik

Fungsi Kation

Na :tek. Osmotik CES, aktifitas neuro

muskuler,mempengaruhi asam basa, Cl
dan K serta membantu pengeluar-an air.
K: tek.Osmotik CIS, aktifitas enzym dan
neuromuskuler, mempengaruhi asam basa
dan fungsi ginjal
Ca: aktifitas neuromuskuler,perkembangan rangka, pembekuan darah,
Mg: aktifitas intraseluler dan
mempengaruhi level Na,K,Ca dan fosfor

Fungsi Anion
Cl: mempengaruhi asam basa, menjaga tek.
Osmotik darah.
HCO3: sistem bufer yg mengatur pH
HPO4: mengatur level Ca, metabolisme
energi dan asam basa

Nilai Rujukan
Na: 135 145 mEq/L
K: 3,8 5,5 mEq/L
Ca: 8,9 10,1 mg/dL anak
Mg: 1,7 2,1 mg/dL
Cl: 100 108 mEq/L
PO4: 2,5 4,5 mg/dL anak

sp 10,6

7mg/dL