Water, Electrolytes, and

Acid-Base Balance, RAA

System
Iin Novita N M
Internal
Medicine
Departement

FK UMS
27-1
 Body Fluids
• Intracellular
– All fluids inside cells of body
– About 40% of total body weight
• Extracellular
– All fluids outside cells
– About 20% of total body weight
– Subcompartments
• Interstitial fluid and plasma; lymph, CSF, synovial
fluid
27-2
Body Fluid Compartments

27-3
 Water Content Regulation
• Content regulated so • Sources of water
total volume of water in – Ingestion
body remains constant – Cellular metabolism
• Kidneys primary
regulator of water • Routes of water loss
excretion
– Urine
• Regulation processes
– Evaporation
– Osmosis
• Perspiration
– Osmolality • Respiratory passages
– Baroreceptors
– Feces
– Learned behavior

27-4
 Extracellular Fluid Osmolality

• Osmolality • Decreased osmolality

– Adding or removing – Inhibits thirst and
water from a solution ADH secretion
changes this

• Increased osmolality
– Triggers thirst and
ADH secretion

27-5
Hormonal Regulation of
Blood Osmolality

27-6
 Regulation of ECF Volume

• Increased ECF results in

• Mechanisms – Decreased aldosterone secretion
– Neural – Increased ANH secretion
– Decreased ADH secretion
– Renin-angiotensin-
– Decreased sympathetic
aldosterone
stimulation
– Atrial natriuretic
hormone (ANH)
• Decreased ECF results in
– Increased aldosterone secretion
– Antidiuretic hormone
– Decreased ANH secretion
(ADH)
– Increased ADH secretion
– Increased sympathetic stimulation

27-7
Hormonal Regulation of
Blood Volume

27-8
Hormonal Regulation of
Blood Volume

27-9
Regulation of ECF Volume

27-10
Regulation of ICF and ECF

27-11
Regulation of Electrolytes in ECF
• Na+ Ions
• Electrolytes – Dominant ECF cations
– Molecules or ions with – Responsible for 90-95% of
an electrical charge osmotic pressure
• Water ingestion adds • Regulation of Na+ ions
electrolytes to body – Kidneys major route of
• Kidneys, liver, skin, excretion
lungs remove from – Small quantities lost in
body sweat
– Concentration changes • Terms
only when growing,
– Hypernatremia
gaining or losing
– Hyponatremia
weight

27-12
Mechanisms Regulating Blood Sodium

27-13
Mechanisms Regulating Blood Sodium

27-14
Abnormal Plasma Levels of
Sodium Ions

27-15
 Regulation of Chloride,
Potassium, Magnesium Ions
• Chloride ions • Potassium ions
– Predominant anions in – Maintained in narrow
ECF range
• Magnesium ions – Affect resting
– Capacity of kidney to membrane potentials
reabsorb is limited – Aldosterone increases
– Excess lost in urine amount secreted
– Decreased extracellular • Terms
magnesium results in
greater degree of – Hyperkalemia
reabsorption – Hypokalemia

27-16
Potassium Ion Regulation in ECF

27-17
Abnormal Concentration of Potassium
Ions

27-18
Abnormal Plasma Levels of
Magnesium Ions

27-19
Regulation of Blood Magnesium

27-20
 Regulation of Calcium Ions
• Regulated within • PTH increases Ca2+
narrow range extracellular levels
– Elevated extracellular and decreases
levels prevent extracellular
membrane
depolarization phosphate levels
– Decreased levels lead • Vitamin D stimulates
to spontaneous action Ca2+ uptake in
potential generation
intestines
• Terms
– Hypocalcemia
• Calcitonin decreases
– Hypercalcemia extracellular Ca2+
levels
27-21
Regulation of Calcium Ions

27-22
 Regulation of Phosphate Ions

• Under normal conditions, reabsorption of phosphate occurs

at maximum rate in the nephron
• An increase in plasma phosphate increases amount of
phosphate in nephron beyond that which can be
reabsorbed; excess is lost in urine
27-23
Regulation of Blood Phosphate

27-24
 Acids and Bases
and Buffers
• Buffers: Resist changes in
• Acids pH
– Release H+ into – When H+ added, buffer
solution removes
• Bases – When H+ removed, buffer
replaces
– Remove H+ from
solution • Types of buffer systems
– Carbonic acid/bicarbonate
• Acids and bases
– Protein
– Grouped as strong or
– Phosphate
weak

27-25
Regulation of Acid-Base Balance

27-26
Regulation of Acid-Base Balance

27-27
Buffer Systems

27-28
 Respiratory Regulation of
Acid-Base Balance
• Respiratory regulation of pH is achieved
through carbonic acid/bicarbonate buffer
system
– As carbon dioxide levels increase, pH decreases
– As carbon dioxide levels decrease, pH increases
– Carbon dioxide levels and pH affect respiratory
centers
• Hypoventilation increases blood carbon dioxide levels
• Hyperventilation decreases blood carbon dioxide levels

27-29
Respiratory Regulation of
Acid-Base Balance

27-30
 Renal Regulation of Acid-Base
Balance
• Secretion of H+ into filtrate and reabsorption of
HCO3- into ECF cause extracellular pH to
increase
• HCO3- in filtrate reabsorbed
• Rate of H+ secretion increases as body fluid pH
decreases or as aldosterone levels increase
• Secretion of H+ inhibited when urine pH falls
below 4.5
27-31
Kidney Regulation of
Acid-Base Balance

27-32
Hydrogen Ion Buffering

27-33
 Acidosis and Alkalosis
• Acidosis: pH body fluids below 7.35
– Respiratory: Caused by inadequate ventilation
– Metabolic: Results from all conditions other
than respiratory that decrease pH
• Alkalosis: pH body fluids above 7.45
– Respiratory: Caused by hyperventilation
– Metabolic: Results from all conditions other
than respiratory that increase pH
• Compensatory mechanisms
27-34
Acidosis and Alkalosis

27-35
Water regulation in the kidney
 The loop of Henle
• The descending limb of the loop of Henle is
permeable to water
• The ascending limb is impermeable.
• Na+ and Cl- ions are actively transported out of the
ascending limb and passively move into the
descending limb.
• This creates a concentration gradient across the
medulla.
• There is a lower ion concentration gradient at the
top of the ascending limb and a much higher ion
concentration gradient at the bottom.
 The Role of ADH
• The water potential of the tissue fluid in the medulla is
always more negative than that of the filtrate in the
collecting duct.
• Whether the water actually leaves the collecting duct (by
osmosis) is determined by the hormone ADH (anti-diuretic
hormone)
• Osmoreceptors in the hypothalamus detect the low levels
of water,so the hypothalamus sends an impulse to the
pituitary gland which releases ADH into the bloodstream.
• ADH makes the wall of the collecting duct more
permeable to water.
• Therefore, when ADH is present more water is reabsorbed
and less is excreted.