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 – Ingestion
in body remains – Cellular
constant metabolism
• Kidneys primary
regulator of water • Routes of water
excretion
loss
• Regulation processes
–Urine
– Osmosis
– Evaporation
– Osmolality
• Perspiration
– Baroreceptors 27-4
• Respiratory
– Learned behavior
 Extracellular Fluid Osmolality

• Decreased
Osmolalityosmolality
– Menghambat
Adding or removing
kehausan
water
danfrom
sekresi
a solution
ADH
changes this

• Increased osmolality
– Memicu kehausan dan sekresi ADH

27-5
Hormonal Regulation of
Blood Osmolality

27-6
 Regulation of ECF Volume

 Increased ECF results

• Mechanisms in
– Neural – Penurunan sekresi aldosteron
– Renin-angiotensin- – Peningkatan sekresi ANH
– Berkurangnya sekresi ADH
aldosterone – Berkurangnya stimulasi simpatik
– Atrial natriuretic Decreased ECF results in
hormone (ANH) – Peningkatan sekresi aldosteron
– Antidiuretic – Berkurangnya sekresi ANH
– Peningkatan sekresi ADH
hormone (ADH) – Meningkatnya stimulasi simpatik

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 – Responsible for 90-95% of
osmotic pressure
with an electrical
charge • Regulation of Na+
• Water ingestion ions
adds electrolytes to – Kidneys major route of
excretion
body
– Small quantities lost in
• Kidneys, liver, skin, sweat
lungs remove from • Terms
body
– Hypernatremia
– Concentration – Hyponatremia
changes only when 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 – Maintained in
in ECF narrow range
• Magnesium ions – Affect resting
– Capacity of kidney membrane
to reabsorb is potentials
limited – Aldosterone
– Excess lost in urine
increases amount
– Decreased secreted
extracellular
magnesium results • Terms
27-16
in greater degree of – Hyperkalemia
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 and decreases
extracellular levels extracellular
prevent membrane
depolarization phosphate levels
– Decreased levels • Vitamin D
lead to spontaneous stimulates Ca2+
action potential
generation
uptake in intestines
• Terms • Calcitonin
– Hypocalcemia decreases 27-21
2+
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
• Acids
changes in pH
– Release H+ into solution– When H+ added, buffer
• Bases removes
– Remove H+ from solution – When H+ removed,
buffer replaces
• Acids and bases
• Types of buffer
– Grouped as strong or weak
systems
– Carbonic
acid/bicarbonate
– Protein 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.