Normal Water Balance

And Electrolytes

Dr. Davis

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 Dehydration

 Potassium

 Sodium

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 Extracellular fluid Intracellular fluid
15L 25L
Interstitial fluid 12 L Plasma Red cell
Volume
3L 2L

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Dehydration
The water leaves the extracellular fluid compartment, but on doing so,
some of the intracellular water passes immediately into the extracellular
compartment by osmosis.

OSMOSIS – The process of net movement of water caused by a concentration

difference.

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Constituents of Extracellular and Intracellular
Fluids
Extracellular Fluid Intracellular Fluid

Plasma Interstitial

Na+ High High Low

K+ Low Low High

Protein “High” Less protein High (x4 plasma)

Phosphate Low Low High

Cl- High High Low

Ca2+ Low Low ≈ NIL

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Reference Values

Na+ 135 – 145 mmol/L

K + 3.4 – 4.9 mmol/L

Cl- 95 – 105 mmol/L

Low extracellular concentration of

potassium ions is important for normal
neuromuscular activity and cardiac action.

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Daily Loss of Water (in milliliters)
Normal Hot Weather Prolonged Heavy
Temperature Exercise
Insensible loss:
Skin 350 350 350
Respiratory 350 250 650
Tract
Urine 1400 1200 500
Sweat 100 1400 5000
Feces 100 100 100
Total 2300 3300 6600
Daily input Oral fluids 1400
(Average) Food 700
Metabolism 400
Total 2500 7
Feature Dehydration Over hydration

Pulse Increased Normal

Bp Decreased Normal or increased

Skin Turgor Decreased Increased

Eye balls Soft/ sunken Normal

Mucous membranes Dry Normal

Urine output Decreased May be normal or

decreased
Consciousness Decreased Decreased

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9
AVP - Argenine Vasopressin
(also called antidiuretic hormone ADH)

- A peptide produced by the hypothalamus and

secreted by the posterior pituitary gland.

- A rising osmolality promotes the secretion of AVP, a declining

osmolality switches the secretion off.

ACTION
- It increases the permeability of the cells of the collecting ducts
passive water reabsorption.

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Hypothalamic regulation of body water

 Cells in the hypothalamus sense the differences

between their intracellular osmolality and that of the
extracellular fluid.

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THIRST
Hypertonicity Hypovolemia

Osmoreceptors Baroreceptors
Angiotensin II

Thirst

Water Intoxication
- an increase in total body water with normal total body sodium.
results from the intake of water beyond the ability of the kidney to
excrete it or the impairment of the ability of the kidney to excrete
free water
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SIADH

Syndrome of inappropriate antidiuretic hormone

secretion -Patients have non-osmotic AVP
stimulation

e.g.
- Pain
- Trauma
- Infection
- Central nervous system disorders e.g.
meningitis,stroke
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DIABETES INSIPIDUS ( DI )
DI – Persistent excretion of excessive quantities of dilute urine.
- constant thirst

Diabetes Insipidus

Cranial Nephrogenic
Deficient production Renal Tubules
of ADH unresponsive to
vasopressin
Clinical Features
- polyuria Pass 5 – 20 or more
litres of urine in 24 hrs
- polydipsia

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Potassium Disorders
 Total body potassium 3655 mmol - ALMOST ALL
IS INSIDE CELLS

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 Approximate Potassium Concentrations in
body fluids (mmol/L)
Total body potassium
3655mmol

Plasma Gastric Biliary and Small Ileal

pancreatic intestine
4 10 5 5 5

New Ileostomy Diarrhoea Sweat

15 40 10

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Potassium content

Tomato Juice 82 mmol/L

Canned Orange Juice 42 mmol/L

Fresh Orange Juice 30 mmol/L

Bananas 8 mmol/L

Slow K 8 mmol/L

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Causes of Hyperkalaemia
 Renal Failure – The kidneys may not be able
to excrete a potassium load when
the glomerular filtration rate is very
low.

 Mineralocorticoid deficiency
-Seen in Addison’s Disease
 Patients receiving aldosterone antagonists

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Causes of Hyperkalaemia

 Acidosis – Redistribution of potassium from

the intercellular to the extracellular
fluid space.

 Potassium release from damaged cells

 Haemolysis
 Trauma
 rhabdomyolysis

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 Cellular uptake of potassium is stimulated by insulin.

Treatment of Hyperkalaemia
 Infusion of insulin and glucose to move potassium
ions into cells
 Infusion of calcium gluconate to counteract the
effects of hyperkalaemia
 Dialysis (severe cases)

 Oral administration of a cation exchange resin such

as Resoniun A (for slow rise in plasma potassium)

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Causes of Hypokalaemia
 Gastrointestinal losses
 Vomiting
 Diarrhoea
 Surgical fistula
 Renal losses
 Renal disease
 Diuretics
 Increased aldosterone production
 Drug Induced
 Thiazide diuretics
 corticosteroids
 Alkalosis
 Shift of potassium from the ECF to the ICF

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Treatment of Hypokalaemia

 Oral intake of potassium salts

 Intravenous potassium (severe potassium

depletion)

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Control of Sodium

 Aldosterone
A major stimulus to aldosterone secretion
is the volume of the ECF.

 Atrial natriuretic peptide

A polypeptide hormone secreted by the
cardiocytes of the right atrium of the heart.

(It increases urinary sodium excretion)

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 Renin – Angiotensin – Aldosterone System

Renin – a proteolytic enzyme secreted by the

juxtagolmerular apparatus
- acts on angiotensinogen to form angiotensin I
(A decapeptide)
- in the lungs it is converted to Angiotensin II

Vasoconstriction
Angiotensin II
Stimulates the zona
glomerulosa to secrete
aldosterone

In the distal renal tubule, aldosterone increases sodium reabsorption from

the glomerular filtrate in exchange for potassium and hydrogen ions.
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CONN’S SYNDROME
 Overproduction of aldosterone by either an adenoma (60% of
cases) or bilateral zona glomerulosa hyperplasia

Adrenal Adenoma

Aldosterone Secretion

Hypokalaemia Sodium retention

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 The causes of hypernatraemia
Hypernatraemia

Na+ content normal Na+ content Na+ content

H2O decreased H2O very decreased H2O normal

H2O Excessive
Na+
intake sweating or administration
diarrhea in
children

Urine is maximally Conn’s Syndrome

Renal water loss (DI) concentrated, low Cushing’s Syndrome
volume

Osmotic diuresis (DM)

Urine may be concentrated,

normal or increased volume
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 References
 Clinical biochemistry an illustrated text.
 Clinical chemistry in diagnosis and treatment.
 Clinical biochemistry for medical students.

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Year 1

Review
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Urine specimens collected in sterile containers for C & S testing
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Technician comparing urine reagent strip with chart
on reagent strip container
 Urinalysis

Urine dipstick Automated urinalysis machine

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 Two types of phlebotomy trays:
covered phlebotomy tray and phlebotomy tray with drawer

Several styles of sharps containers