Nervous Disorder Circulation,

Body Liquids and Acid Bases

By group 6
 DEFINITION OF FLUID BALANCE
Fluid balance is one part of homeostatic physiology that involves the composition
and transfer of various body fluids.

Body fluids occupy several places, namely

fluids that are inside cells throughout the body (intracellular fluid) and fluids that
are outside the cell (extracellular fluid)

Extracellular fluid consists of three groups, namely:

1. Intravascular fluid (plasma)
Intravascular fluid (plasma) is fluid in the vascular system
2. Interstitial fluid
Intersitial fluid is fluid that is located between cells
3. Transcellular fluid.
Transcellular fluid is a special secretion fluid such as cerebrospinal fluid,
intraocular fluid.
In order for fluid balance to be maintained, the liquid must be
properly distributed. The distribution of fluids is divided into 2 groups
as follows:

1. Extrasel fluid (Extra celuller fluid)

Extracellular fluid consists of interstitial fluid, transcellular fluid and
intravascular fluid. Interstitial fluid fills the space between most cells
of the body and composes a large portion of body fluids. About 15%
of body weight is interstitial body fluid.

2. Intrasel fluid (Intra Celuller Fluid)

Intracellular fluid is the fluid in the cell membrane that contains
dissolved substances that are important for fluid balance. Intracellular
fluid has many of the same dissolved substances as liquids in
extracellular space.
DISORDERS OF LIQUID AND
ELECTROLIT BALANCE
A. Edema
Edema  increased volume of extra
cellular fluid, especially extra vascular
fluid that can be local or general.

If it occurs throughout the body it is

called anasic edema (dropsy) which is
accumulation of fluid in subcutaneous
tissue and body cavities.
Pathophysiology of edema
The process of edema can be explained based on the
cause.
1. Decreased osmotic pressure
Protein as a substance that functions to maintain
osmotic pressure if the level in plasma decreases which
means that the osmotic pressure decreases, it will cause
the transfer of fluid from the vascular to cells in the
tissue with higher osmotic pressure resulting in edema.
Example: nephrotic syndrome
Nefrotik syndrome
2. Increased hydrostatic pressure
Hydrostatic pressure is the pressure in a liquid that
comes from pressure in the vascular.
If hydrostatic pressure is greater than osmotic pressure,
it will cause fluid to move into the tissue so that edema
occurs.
Examples: edema in pregnant women and cardial
edema
3. Portal obstruction
In patients with cirrhosis, the disease will experience increased
venous pressure due to stunted blood flow to the liver. As a
result, fluid in the vein portae will come out of and enter the
peritonium cavity and ascites occurs.
4. Postural edema
Someone who does not move like standing a long time, sitting a
long time while riding a long distance car then the lymph flow
will slow down and cause Edema in the legs and wrist. If the
person moves then the muscle activity and lymph flow will be
smooth so that the edema will disappear by itself.
5. Excess sodium and body fluids
Sodium is a substance that plays a role in regulating fluid
volume in the body with the kidneys. When the body
experiences excess sodium and the kidneys are unable to
excrete it through urine, fluid imbalances occur. The fluid will
move from the vascular and cells enter the tissue which results
in edema.
6. Increased capillary permeability
Capillary endothelium is a semipermeable membrane that can be
traversed by water and electrolytes, but to get through the
protein is very difficult. In conditions where capillary permeability
increases as the effect of the toxin during infection or allergy, the
protein will come out through the capillary as a result of
decreased osmotic pressure of the blood and the liquid will exit
the capillary and enter the tissue and edema will occur. For
example in the case of an anaphylactic reaction.
7. Lymphatic obstruction
In the post mastectomy and filaria will experience a dam
of lymph flow which causes accumulation of fluid resulting
in edema called limfedama. In filaria lymphedema occurs
in the inguinal area which causes edema in the legs and
scrotum.
 B. Dehydration
Dehydration  impaired water balance
where output exceeds the intake so that the
amount of water in the body decreases.
When dehydrated, what is lost is
body fluids, but basically when
dehydration, electrolytes in the
liquid also decrease. Thus any
disruption of fluid balance such as
dehydration, most likely will also be
accompanied by electrolyte balance
disorders.
 Causes of Dehydration
1. Primary Dehydration (water depletion)
Primary dehydration can occur due to the entry of water
into the body is very limited.
Example  for people who sweat very much but don't get
water replacement.
The initial stage of dehydration of sodium and chlorine disappears with
body fluids. As a result extracellular contains excessive sodium and
chlorine and there is a fluid balance disorder called extracellular
hypertension. To compensate for this, there is reabsorption of ions and
water in the kidney tubules and besides that the water will come out of
the cell into the extracellular to have a balance between intra and
extracellular. As a result the fluid in the cell decreases so that intracellular
dehydration occurs and this is what causes thirst.
Symptoms of primary dehydration:
a) Thirsty.
b) A little saliva so that the mouth is dry.
c) Oliguria.
d) Lemas.
e) The occurrence of mental disorders such as
hallucinations or delirium.
Very heavy fluid loss if more than 15% or 22% of the
total body water will cause a disruption of fluid balance
which has an impact on the body's metabolic disorders.
2. Secondary Dehydration (Sodium Depletion)
Secondary dehydration occurs when the body loses
electrolyte fluid through the digestive tract when
people with vomiting and diarrhea are very severe. The
amount of fluid ccompanied by electrolytes coming out
of the body results in not only the fluid balance being
disturbed, but the electrolyte balance is disrupted. Such
conditions will disrupt the body's metabolism and
circulation, causing signs and symptoms such as
nausea, vomiting, seizures, headaches, lethargy and
fatigue
Type of dehydration
1. Isotonic dehydration (isonatremic)
isotonic water loss is proportional to the amount of
sodium lost, and usually does not result in extracellular
fluid moving into the intracellular space. The blood
sodium level in this type of dehydration is 135-145
mmol / L and effective osmolarity is serum 275-295
mOsm / L.
2. Hypotonic (hyponatremic) dehydration
More sodium is lost than water.
3. Hypertonic (hypernatremic) dehydration
More water loss than sodium.
The mechanism of dehydration
Dehydration causes three main responses.
• First receptors in the mouth detect dryness and
stimulate thirsty mechanisms to make you want to drink
water.
• Second, low blood volume causes a decrease in blood
flow to the kidneys causing the rate of glomerular
fltration to decrease. this causes the body to respond by
decreasing the quantity of water in urine (ADH).
• third, you will have low blood pressure and this will be
detected by baroreceptors and they will cause pressure
by vasoconstriction.
 C. HYPER/HIPOKALEMIA
The potassium needed by the body is 3.5 - 5 mEq / L

Hyperkalemia is a condition where the concentration of

potassium levels is more than 5 mEq / L.

Delivery:
1. Exit potassium from intracellular to extra cells
2. Decreased potassium excretion through the kidneys
Can be inhibited by
1. Giving intravenous potassium can inhibit
the effects of hyperkalemia on the
conduction system and repolarization of
the heart muscle
2. increase the uptake of potassium by
cells.
3. Potassium Removal
Hypokalemia is a condition where the
blood potassium concentration is less than
3.5 mEq / L.

Cause:
1. Less potassium intake
2. Excessive potassium expenditure
3. Potassium enters cells
Hypokalemia treatment

1. Giving K via oral or intravenous for severe patients

2. Giving 40-60 mEq can increase potassium levels by 1-1.5 mEq /
L, giving 135-160 mEq can increase potassium levels by 2.5-3.5
mEq / L.
3. Monitor potassium levels every 2-4 hours to avoid hyperkalemia
especially in intravenous administration
4. Intravenous administration of K in the form of a KCl solution is
suggested through a large vein at a speed of 10-20 mEq / hour,
unless accompanied by arrhythmias or respiratory muscle
paralysis, given at speeds of 40-100 mEq / hour. KCl is dissolved
as much as 20 mEq in 100 cc isotonic NaCl
5. Acetazolamide to prevent attacks
6. Triamterene or spironolactone if acetazolamide does not work
 D. HYPER/HIPONATREMIA
Sodium needed in the body is: 135 - 145 mEq / L

Hypernatremia is a condition where blood sodium levels

are more than 145 mEq / L blood (high sodium level in the
blood)

Hypernatremia patients are grouped into 3

categories:
1. Mild, serum levels of 151 to 155 mEq / L.
2. Moderate, 156 to 160 mEq / L.
3. Weight, above 160 mEq / L.
Causes
The main causes of hypernatremia:
1. Head injury or nerve surgery involving the
pituitary gland
2. Other electrolyte disorders (hypercalcemia and
hypokalemia)
3. Drug use (lithium, demeclocycline, diuretic)
4. Excessive fluid loss (diarrhea, vomiting, fever,
excessive sweating)
5. Sickle cell disease
6. Diabetes insipidus.
Common causes:
1. Hypovolemia
2. Euvolemia
3. Hypervolaemia
Hyponatremia is a disorder where the plasma
sodium concentration is lower than normal,
which is below 135 meq / L.

Cause:
1. Low levels of sodium in the blood
2. Excessive water consumption. For example during heavy training,
without adequate sodium replacement.
3. when sodium is lost from the body. For example during prolonged
sweating and severe vomiting or diarrhea.
4. Adrenal deficiency, hypothyroidism and liver cirrhosis.

Drugs that can reduce the level of sodium in the blood, for example,
are diuretics, vasopressin, and sulfonylurea.
E. HYPER/HYPOPHOSPATE
hyperphosphatemia is a condition of
phosphate that is too high in the blood.
This condition can be dangerous for the
health of the bones and heart if it is not
treated quickly.
Phosphate is a mineral that has many functions in the body, including
helping to maintain the strength of bones and teeth. Phosphate levels in
the body are regulated by the kidneys. Excess phosphate is usually
excreted in the urine. If the kidneys are disrupted and cannot function
properly, the kidneys cannot possibly remove the remaining phosphate
from the body. As a result, phosphate levels become too high in the
blood.
Other conditions that can also cause hyperphosphatemia are:
• Uncontrolled diabetes. Uncontrolled diabetes causes high blood sugar
levels which can trigger damage in the body's organs, one of which is
the kidneys.
• Diabetic acidosis
• Low parathyroid hormone
• Excess vitamin D
• Hypokalemia
• Serious infections throughout the body
• Take high-dose phosphate supplements (> 250 mg) every day
As a result of hyperphosphatemia in the
body
In blood, phosphate binds to calcium. So, the effect of
hyperphosphatemia is a decrease in calcium in the blood.
When calcium in your blood decreases, the body will take
supplies of bone as. Over time, deposits of calcium in the
bones will be depleted due to it and can cause bone loss.
In addition, the risk of calcification in the walls of blood
vessels, tissues and other organs also increases.
Calcification is the deposition of calcium salt plaque in the
soft tissues of the body which then hardens. Hardening of
the heart artery wall, for example, is atherosclerosis which
is the beginning of a stroke.
Hypophosphatemia

Phosphate absorption is affected by 1,25 (OH) 2D3

and renal phosphate excretion is affected by PTH.
Thus vitamin D deficiency, intestinal malabsorption,
and hyperparathyroidism cause hypophosphatmeia.
Hyposphatemia can be associated with reduced ATP in
erythrocytes, leukocytes, and platelets, because it
reduces the function and time of survival of these
cells.
The most common cause of hypophosphatemia is the
long and intense hypervenytilation that causes
respiratory alkalosis. Examples of clinical conditions
that cause respiratory alkalosis are gram-negative
baketeremia, alcohol withdrawal, heat attack, and
acute salicylate poisoning.

Severe hypophosphatemia is common in people with

severe burns. Almost all sufferers of burns who are
obedient experience hyperventilation, possibly
caused by respiratory alkalosis and acceleration of
glycolysis.
Hypophosphatemia occurs in about half of patients
treated as a result of stopping alcohol abuse. Some
factors that cause phosphate depletion in alcohol
drinkers are poor dietary intake, vomiting, diarrhea,
antacid ingestia, and hypomagnesemia. Chronic
alcoholism causes magnesium deficiency, which in turn
causes phosphaturia. this patient can also be given a
glucose infusion, so that the phosphate moves from the
ECF into the cell.

Hypophosphatemia causes calcium and phosphate to

move from bones and muscles and cause hypercalciuria.
Long-term reduction in phosphate can cause rickets or
osteomalacia.