Water, water, everywhere,

And all the boards did shrink;

Water, water, everywhere
Nor any drop to drink.
Samuel Taylor Coleridge,
“The Rime of the Ancient Mariner”

Fluid and Electrolyte

 Body fluid
• The fluids are distributed throughout the
body in various compartments.
• Body fluid is composed primarily of water
• Water is the solvent in which all solutes in
the body are either dissolved or suspended
• Body fluids move constantly between
compartments by passive and active
transport mechanisms
Total body water and its major subdivisions as a function of age
 Fluids movement
● Primarily by two forces: hydrostatic pressure
(fluid) and osmotic pressure (substances)
● Plasma leaves bloodstream and becomes interstitial
fluid
● The interstitial fluid, enters the lymphatic vessels
(lymph)
● Lymph returned to the bloodstream to become
plasma
● Transcellular fluids derived from the plasma and
return to the bloodstream
● The osmotic pressure between the EC and IC
compartments is at equilibrium
● Fluid exchange occurs between the two if the
osmotic pressure in either compartment changes
 Fluids movement
• Hydrostatic pressure (volume/pressure)
• Osmotic pressure (substances)
Exchange of fluid at the capillary level
Water Balance
Regulation of extracellular water volume by
thirst and antidiuretic hormone
 Role of thirst
● Hypertonicity the most potent stimulus for
thirst
● Arises with a 2–3 percent increase in serum
tonicity
● Tonicity sensors residing anterior
hypothalamus
● Additional control mechanism of thirst
mediated by low-pressure baroreceptors in
cardiac atria
Antidiuretic hormone (ADH) is formed primarily
in the supraoptic nucleus
 Antidiuretic hormone (Vasopressin)
● Synthesized in hypothalamus
● Transported to the neural lobe/posterior
pituitary
● Stored as secretory granules within the nerve
terminals of neurohypophysis
● Depolarization of nerve terminal releases
vasopressin into the circulation
● Hypertonicity/decreased ECF volume-arterial
blood pressure stimulate secretion
● Vasopressin leads to water retention by the
kidney
Osmotic regulation of ADH release and thirst

Robertson GL, Aycinena P, Zerbe RL. Am J Med 1982; 72:339

 Hypovolemic stimulus to ADH release

Dunn FL, Brennan TJ, Nelson AE, et al. J Clin Invest 1973; 52:3212.
 Vasopressin effects
on the collecting duct principal cell

Water channel (aquaporin-2, AQP2)

insertion in the apical membrane.
The basolateral membrane contains
a different constitutive water channel
(aquaporin-3, AQP3)
Agre, P., M. Bonhivers, and M. J.
Borgnia. (1998).The aquaporins,
blueprints for cellular plumbing
systems. Journal of Biological
Chemistry, 273, 14659–14662
 Electrolytes
● Dissolved in the body fluids;
● Chemicals that can carry an electrical
charge;
● Fluid and electrolyte levels are
interdependent (electrolyte increases,
water is added; electrolyte levels low,
water is removed
Concentrations of Extracellular and
Intracellular Electrolytes
 Positive ions
EC IC Electrical
Electrolyte Function
mEq/L mEq/L charge
fluid balance,
Sodium 142 10 osmotic 1+
pressure
neuromuscular
K+ 5 100 excitability 1+
acid-base balance
bones, blood
Calcium 5 - 2+
clotting
Magnesium 2 123 enzymes 2+
Total 154 205
 Negative ions
EC IC Electrical
Electrolyte Function
mEq/L mEq/L charge
fluid balance, osmotic
Chloride 105 2 1-
pressure
neuromuscular
Bicarbonate 24 8 excitability 1-
acid-base balance
Proteins 16 55 bones, blood clotting
Phosphate 2 149 enzymes 3-
Sulfate 1 - protein metabolism 2-
Total 154 205
 Solutes (electrolytes) movement
Passive Movement
Diffusion: Movement of a solute down a gradient, be it a
concentration or electrical potential difference.
Net solute flux a K* x mobility x [absolute] x gradient

* K = permeability coefficient x surface area

Convection (Solvent Drag): The process of solute being

dragged with H20, proportional to hydrostatic oncotic
pressure or osmotic pressure
J = K* x ∆P

* K = permeability coefficient x surface area

J is the flux of the solute and water movement.
∆P is derived from Starling's Law where ∆P= Phydrostatic - Poncotic
 Solutes (electrolytes) movement
Active Movement
● The movement of a solute against a gradient
(concentration or electrical)
● Requires energy
● Unidirectional
● May be competitive
● May have limitations
Primary Active Transport (Na+/K+ ATPase)

Secondary Active Transport (Facilitated Transport): The action of

a Primary Active Transport System creates energy for the movement
of other solutes against a concentration or electrical gradient (Na+-
glucose symport )
 Primary Active Transport
Outside
(Na+/K+ ATPase)

Carbohydrates

b b
aa Lipid Bilayer

Protein Subunit

ATP
Inside
 The sodium-K+ pump

b b
a a
Na+
ATP ATP
Na+ Na+
3 Na+ ADP
ATP
Inside
K+ K+ +Pi
Na+ Na+
K+ Na+
K+

Na+ Na+
Outside Na+ 2 K+

Sweadner KJ, Goldin SM; N Engl J Med 1980; 302:777-783

Secondary Active (Facilitated Transport)
(Na+-glucose symport)
 Nephron Function
● Filtration of plasma by the glomerulus
● Reabsorption of solute and water
● Secretion of solute
● Excretion of urine
 Filtration (glomerulus) and
final urine (excretion)
Daily urine
Daily filtration
excretion
120 ml/min (GFR)
Volume 1-2 L
= ~ 180 L
140 mmol/L (plasma)
Na+ ~150 mmol
= 25.000 mmol
4.5 mmol/L (plasma)
K+ 100 mmol
= 810 mmol
Conclusion: There must be massive reabsorption of solutes
and water between the point of filtration (glomerulus) and
final urine (excretion)
 Solute concentration
● Measurement of solute concentration (the
number of dissolved particles per liter) in body
fluid is based on the fluid’s osmotic pressure,
expressed as either osmolality or osmolarity
● Osmolality is the number of osmols (the
standard unit of osmotic pressure) per
kilogram of solution
● Osmolarity refers to the number of osmols per
liter of solution
 Osmolality
● Physical property of solutions
● The forces generated by solutes that reduce
the random movement of water molecules
● The forces depend only on the concentration,
not the nature, of all particles in the solution
● Some of the solutes are regularly or
frequently present in body fluids (urea and
ethanol) but permeate cell membranes as
freely as water These solutes contribute to
osmolality but have no impact on tonicity
● This distinction made the term effective
osmolality = tonicity
 Osmolality

Water
Solutes

Serum osmolality, mOsm/kg H2O

[Na+, mmol/l] x 2 + [glucose, mg/dl]/18 + [BUN, mg/dl]/2.8

270 + 6 + 9 = 285 mOsm/kg H2O

 Tonicity
● The forces that determine the net flux of
water between two solutions separated by a
membrane permeable to water but
impermeable to certain solutes contained in
the solutions
● Water flows from the more dilute to the more
concentrated solution
The effect of serum effective osmolality
on the red blood cell

Water move into Water move out

the cell of the cell

Cell swells Cell shrinks

Hypoosmolar Isoosmolar Hyperosmolar

The basic disorders of water and sodium balance

● Hypovolemia (too little sodium, the main

extracellular solute = volume contraction )
● Hypervolemia (too much sodium, the main
extracellular solute = expansion of the effective
arterial blood volume and hypertension ); Edema =
hypervolemia = too much sodium with associated
water retention in interstitial spaces
● Hyponatremia (too much water = overhydration)
● Hypernatremia (too little water = dehydration)