Fluid and Electrolyte Balance

Dr. Manoranjan Shrestha

MBBS, MD
Department of Biochemistry
NAIHS- COM
Curricular Objectives

1) Describe water and sodium distribution in the body.

2) Describe the interrelationship between water, sodium, and
ECF osmolality.
3) Describe the causes of water and sodium excess.
4) Describe the causes of water and sodium depletion.
Distribution of body fluid-

Total body water (TBW)

~ 60% of total body weight (male)

~ 55% of total body weight (female)
~ 75% of total body weight (infant)

 Highest in
 Newborns
 Adult males

 Lowest in
 Adult females and obese
(large amount of adipose tissue)
Distribution of body fluid-

Intracellular fluid compartment (ICF)- 40% total body wt.

(2/3 of TBW).
Major cations: K+, mg2+.
Major anions: protein, phosphates (ATP, ADP, AMP).

Extracellular fluid compartment (ECF)- 20% total body wt.

(1/3 TBW)
 Interstitial and Intravascular (plasma) fluid-
 Major cation- Na+
 Major anions- Cl-, HCO3-
Extracellular fluid compartment (ECF)-

1. Interstitial fluid-
 3/4 of ECF
 1/4 of TBW (3/4 x 1/3)
 Same composition as plasma except it has little protein or
ultrafiltrate of plasma.

2. Plasma-
 1/4 of ECF
 1/12 of TBW
 Major component are plasma protein.
Distribution of body fluid-
60-40-20 rule:

1. TBW- 60% of body weight.

2. ICF- 40% of body weight.
3. ECF- 20% of body weight.

(Total body fluid)

Sodium Distribution

Adult man contains approximately 4000 mEq,

 50% is in bone,
 40% in ECF and
 10% in soft tissues.
The major contributors to the osmolality of the ECF.
 Normal ECF sodium concentration is 135-145 mmol/L, while
the ICF is only 4-10 mmol/L.

Most cell membranes are relatively impermeable to sodium

but some leakage into cells occurs and the gradient is
maintained by active pumping of sodium from the ICF to the
ECF by Na+,K+-ATPase.
Interrelationship between water, sodium, and ECF osmolality

Basic principles of shifts of water between compartments

 At steady state, ECF and ICF osmolarity are equal.

 To achieve this equality, water shifts between ECF and ICF
compartments.
 It is assumed that solutes such as sodium chloride and
mannitol do not cross cell membranes and are confined to
ECF.
 Osmolarity- concentration of solute (particles) per liter of
solution.
 Osmolarity- mOsmole/ L of solution.

 Osmolality- concentration of solute (particles) per kilogram

of water.
 Osmolality- mOsmole/kg of solution.
 Describe the causes of water and sodium excess.
 Describe the causes of water and sodium depletion.

Volume abnormalities in ECF volume:

Volume contraction/ expansion

1) Isosmotic volume contraction/expansion

2) Hyposmotic volume contraction/expansion
3) Hyperosmotic volume contraction/expansion
Loss of the isotonic fluid

Causes-
Diarrhea, vomiting, hemorrhage, burn (plasma exudate).

ECF volume decreases but no changes in osmolarity

 No shift of water between ICF and ECF compartments.
 Plasma protein concentration increase.
 Hct increase.
 RBC will not shrink or swell.
 Arterial BP decrease.

Isosmotic volume contraction.

Adrenocortical insufficiency- loss of NaCl

The osmolarity of ECF decrease (due to lack of

aldosterone, kidney excrete more NaCl than water) water
shift from ECF to ICF compartment ICF volume
increase ICF osmolarity decrease. ECF volume decrease.
 Plasma protein concentration increase.
 Hct increase, RBC swell.
 Arterial BP decrease.

Hyposmotic volume contraction.

Loss of water/Hyposmotic fluid
Causes-
Severe sweating (more water is lost than salt) in a desert, fever,
diabetes insipidus, diabetes mellitus, decrease intake of water.

ECF volume decrease because of loss of volume in sweat

The osmolarity of ECF increase (more water lost than salt)
water shift from ICF ICF osmolarity increase until it
equilibrate and ICF volume decrease.
 Plasma protein concentration increase.
 Hct unchanged.

Hyperosmotic volume contraction.

Administration of large volume of isotonic sodium chloride solution

ECF volume increase but no change occurs in the osmolarity

of ECF or ICF  no shift of water between ECF and ICF
compartments.

Increase in plasma volume

 Decrease in plasma protein concentration
 Decrease in hematocrit
 No change in RBCs
 Increase in arterial BP.

Isosmotic volume expansion

SIADH- gain of water

The osmolarity of ECF decrease (because of excess water)

ECF volume increase shift water ECF to ICF ICF
osmolarity decrease until it equilibrate and ICF volume
increase.
 Plasma protein concentration decrease.
 Hct unchanged.

Hyposmotic volume expantion.