FLUID, ELECTROLYTE, and

ACID-BASE BALANCE
 Introduction
Good Health
• Delicate balance of fluids, electrolytes, acids
and bases maintains the body
Homeostasis (balance)
• Depends on multiple physiological processes
that regulate:
fluid intake and output
 movement of water and substances dissolved in
it between body compartments
 Body Fluids and Electrolytes
• The human body is almost composed of fluid
• 60% water
- Healthy adult’s average weight
- In good health volume remains relatively constant
- Person’s weight varies by >0.2kg in 24 hrs. regardless
of fluid ingested
• 70% to 80% water
– infants
• 50% water
– Older than 60 years old

• Women generally have lower % of body

water than Men
affects the total body water
Why is water vital to health and normal
cellular function?
 Because it serves as:
• Medium for metabolic reaction within cells
• Transporter for nutrients, waste products, and
other substances
• Lubricant
• Insulator and shock absorber
• Means of regulating & maintaining body
temperature
Distribution of Body Fluids
 Two Major Compartments
INTRACELLULAR FLUID (ICF)
• Found within the cells of
the body
• 2/3 of the total body fluid in
adults
• Vital to normal cell
functioning
• Contains solutes
• Medium which cell
metabolic processes of cell
take place
EXTRACELLULAR FLUID (ECF)
• Found outside the cells
• 1/3 of total body fluid
• Smaller than ICF
• Transport system that
carries oxygen and
nutrients to, and waste
products from, body cells
 ECF two main Compartments

Intravascular fluid (plasma) Interstitial fluid

• 20% of ECF • 75% of ECF
• Found within vascular • Surrounds the cells
system

Other components of ECF

• Lymph
• Trancellular fluid
 Composition of Body Fluid
• Extracellular and intracellular fluids contain:
– Oxygen from the lungs
– Dissolve nutrients from the GI tract
– Excretory products of metabolism such as carbon
dioxide
– Charged particles called ions
 2 types of Ions
CATION ANION
• Positive charge ions • Negative charge ions
• Examples: • Examples:
– Sodium – Chloride
– Potassium – Bicarbonate
– Calcium – Phosphate
– Magnesium – Sulfate
• Electrolytes
– cMeasured in milliquivalents per liter
(mEq/L) or milligrams per 100 milliliters
(mg/100 mL)
– charged particles
– Capable of conducting electricity
*Milliquevalent refers to the chemical combining
power of the ion or the capacity of cations to
combine with anions to form molecules, whereas
the term milligram refers to the weight of the ion
 composition of fluids varies from one body
compartment to another
 ECF principal component are sodium, chloride
and bicarbonate
 Potassium, calcium and magnesium are
present in small quantities
 Plasma and interstitial fluid contain the solute
and electrolytes
 Gastric and intestinal secretions contains
electrolytes
Movement of Body fluids and Electrolytes

• Body fluid compartments are separated by

cell membranes and capillary membranes
which are selectively permeable
SOLUTES SOLVENTS

• Dissolved in liquid • Component of a

solution that can
• Can be crystalloids or
dissolve a solute
colloids
– Crystalloids are salts
that dissolve readily in
true solutions
– Colloids are substances
that does not readily
dissolve in true solutions
 OSMOLALITY
• Expresses the concentration of solutes in body
fluids
• Determined by total solute concentration
within a fluid compartment and is measured
as parts per kilogram of water
• Milliosmoles per kilogram (mOsm/kg)
• Plasma/ Serum Osmolality
• osmolality determinant is sodium and glucose
together with urea also contribute
• Osmolality of Intracellular Fluid
– The primary determinants are potassium, glucose
and urea
• Tonicity
– Osmolality of one solution in relation to another
solution
Solutions may be….
 Osmotic Pressure
• power of a solution to pull water across a
semipermiable membrane
• In the body: Plasma Proteins also exert
osmotic pressure called colloid osmotic
pressure or oncotic pressure that is important
in maintaining vascular volume

• Example: Infusing of hypertonic Iv solution

METHODS BY WHICH WATER AND SOLUTES
MOVE IN THE BODY

• Diffusion
• Osmosis
• Filtration
• Active Transport
 Diffusion
• Two solutes of different concentrations are
separated by semipermeable membrane
• Rate of diffusion varies according to:
– Size of the molecules
– Concentration of the solution
– Temperature of the solution
 OSMOSIS
• Specific kind of diffusion which water moves
across cell membranes, from less
concentrated solution to more concentrated
solution
• Osmosis occurs in the body when the
concentration of solutes is higher on e side
than on the other side
• Example: Marathon runner
 FILTRATION
• Process whereby fluid and
solutes moves together across
a membrane
• From an area of higher
pressure to an area of
lower pressure
• Filtration pressure and
Hydrostatic pressure
• Filtration pressure – movement of fluid and
solutes out of a compartment
– Example: movement of fluid and nutrients
• Hydrostatic pressure – pressure exerted by a
fluid within a closed system on the walls of the
container which it is contained
– Example : blood and blood vessels
– Osmotic pressure opposes and balances
hydrostatic pressure and holds fluid in vascular
compartment to maintain vascular volume
– When hydrostatic pressure is higher than osmotic
pressure , fluid filters out of the blood vessel
 ACTIVE TRANSPORT
• Movement of solutes across cell membranes
from less concentrated solution to a more
concentrated
• A substance combines with a carrier on the
outside of a cell membrane and moves inside
the surface of a cell membrane
• A specific carrier is required for each
substance
 ACTIVE TRANSPORT
• Particular importance of
maintaining the
differences in sodium and
potassium ion
concentrations of ECF
and ICF
 REGULATING BODY FLUIDS

• Fluid intake
• Fluid Output
• Maintaining Homeostasis
• In a healthy person, the volumes and chemical
composition of the fluid compartments stay
within a specific and narrow limits.

• Normally, fluid intake and fluid loss are

balanced

• Illness can upset this balance

 FLUID INTAKE
• Average adult drinks about
1,500 mL/day
• An average adult needs 2,500 mL/day for
normal functioning wherein the additional
1000mL is from foods and oxidation of foods
during metabolic process
• Thirst mechanism is the primary regulator of
fluid intake
What is the thirst mechanism?
• It is located in the hypothalamus
• Stimuli that triggers thirst center:
– Osmotic pressure of body fluids
– Vascular volume
– Angiotesin
• It is relieved by drinking a small amount of
liquid but returns after 15 mins.
• 30 mins. – 1 hour for fluid to be absorbed and
distributed
 FLUID OUTPUT
• Fluid losses counteract fluid intake
• Routes for fluid output:
– Urine
– Feces
– Insensible losses

• Total fluid output 1,300 mL/day

URINE Urine output 1,400 – 1,500 mL/ 24
increases as fluid hr or 0.5 kg/ hr
intake increases output for an adult

FECES Chyme that passes 1,500 mL/day

form S.I. to L.I. 100 mL is reabsorbed
contains water and in proximal half of
electrolytes L.I.

INSENSIBLE LOSSES • Skin

-Perspiration • 100 mL/day
- Diffusion • 300-400 mL/day
• Lungs • 300-400 mL/day
• Obligatory losses • 500mL/day
Routes for fluid output
MAINTAINING HOMEOSTASIS
• The volume and composition of body fluids
are regulated through several homeostatic
mechanisms
• Organs and systems contribute to this
regulation (kidneys, lungs, cardiovascular and
systems)
• Hormones (ADH and Renin-Angiotensin-Aldosterone
system) are mechanisms to monitor and maintain
vascular volume
 MAINTAINING HOMEOSTASIS:KIDNEYS

– Primary regulator of body fluids and

electrolyte balance
– Regulate volume and osmolality of
ECF through water and electrolyte
excretion
– 135 to 180 L of plasma per day is normally filtered
but only 1.5 L is excreted
– Plays a significant role in Acid-Base balance
regulation
MAINTAINING HOMEOSTASIS: HORMONES

– Antidiuretic Hormone (ADH)

– Renin-Angiotensin-Aldosterone system
– Atrial Natriuretic Factor (ANF)
 ADH / Antidiuretic Hormone
– Regulates water excretion from kidneys
– When serum osmolality rises , ADH is produced
causing the collecting ducts to be more permeable
to water causing urine output to decrease
– Allows more water to be reabsorbed
– If serum osmolality decreases, ADH is suppressed
then urine output increases because ducts are less
permeable
What affects production of ADH???
 Renin-Angiotensin-Aldosterone System

• Neuroendocrine control that contributes to

maintaining fluid balance
• Specialized receptor in the kidneys respond to
changes in renal perfusion that stimulates RAAS
• When blood flow pressure in kidneys decreases
renin is released
• Renin causes conversion of angiotensinogen to
angiotensin I that is converted to Angiotensin II
 Atrial Natriuretic Factor
– Released from cells in the atrium of the heart in
response to excess blood volume and stretching of
atrial walls
– Promotes sodium washing and acts potent diuretic
– Inhibits thirst, reducing fluid intake
REGULATING ELECTROLYTES
 Importance of Electrolytes
• Maintain fluid balance
• Contributing to acid-base regulation
• Facilitating enzyme reaction
• Transmitting neuromuscular reaction
• Most electrolytes enter the body through
dietary intake and are excreted through urine
• Sodium chloride and potassium are not stored
by the body
• Electrolytes such as calcium is stored in the
body
ACID – BASE BALANCE
 Regulation of Acid-Base Balance
• Buffers
• Respiratory Regulation
• Renal Regulation
 Buffers
– Prevents excessive changes in pH by binding or
releasing H ions
– If body fluids become too acidic = excess H ions
and buffers bind with H ions
– If body fluids become too alkaline =not enough H
ions, buffers can release H ions
– Action of a buffer is immediate but limited in its
capacity to maintain or restore balance
– Major buffer in ECF is bicarbonate
– 20 parts of bicarbonate to 1 part of carbonic acid,
pH remains within normal range(7.35 to 7.45)
 Acidosis
• When a strong acid is added
to ECF it changes the ratio
because bicarbonate is
depleted in neutralizing the
acid
Alkalosis
• When a strong base is
added to ECF, depleting
carbonic acid as it combines
with the base then the pH
rises
 RESPIRATORY REGULATION
• Lungs help regulate acid base balance
by:
– Eliminating or retaining Carbon Dioxide
– Altering the rate and depth of respirations

• Response of respiratory system to

changes in pH is rapid
 Carbon dioxide
• is a power stimulator of the respiratory center
in the brain
• Levels in the blood are measured as:
– PCO₂ - partial pressure of CO₂ in venous blood
– PaCO₂ - partial pressure of dissolved CO₂ in arterial
blood
– PaCO₂, normal is 35 to 45 mmHg
CO₂ and H₂CO₃ rises
• Respiratory center is
stimulated
• results to increasing of the
depth of respiration
• Increase amount of Carbon
dioxide exhaled and
carbonic levels fall
CO₂ and H₂CO₃ fall
• Respiratory center is
stimulated
• rate and depth of
respiration decrease
• Increased level of carbon
dioxide to be retained and
carbonic acid level rise
 RENAL REGULATION
• Kidneys are the ultimate long term regulator
of acid-base balance
– Slower to respond to changes
– Requires hours to days to correct imbalances and
their response is more permanent and selective
How kidneys maintain acid –base balance?

• Selectively excreting or conserving

bicarbonate and excrete Hydrogen ions
• Excess hydrogen and pH fall
– Kidneys reabsorb and regenerate bicarbonate and
excrete H ions
• Insufficient Hydrogen ions and pH rises
– Excess bicarbonate is excreted and H ions are
retained
*normal serum bicarbonate level = 22 to 26 mEq/L