FOUNDATIONAL

CONCEPT OF
FLUIDS AND
ELECTROLYTES
By: CHARLEMAGNE B. PULGAN, RN
CELL
 smallest autonomous functional
unit of the body
 in its fetal form it is
undifferentiated , but as growth
continues the cell differentiates
into specific tissue types,
forming organs and systems
 Cell discovered by ROBERT
HOOKE
 A. KEY ELEMENTS UNDERLYING FLUID
AND ELECTROLYTE IMBALANCE

THE CELL MEMBRANE

 also called the plasma membrane, is found in all
cells and separates the interior of the cell from the
outside environment (outer most part of the cells)
 The cell membrane consists of a lipid bilayer that
is semi-permeable.
 The cell membrane regulates the transport of
materials entering and exiting the cell
 a semi-permeable membrane
that separates the intracellular
from the extracellular
components
 allowing for an exchange in an
effort for the cell to obtain
energy, synthesize complex
molecules, participate in
electrical events, and replicate.
COMPOSITION of Cell Membrane
A. PHOSPHOLIPIDS
It plays a major role in the transportation and removal of cholesterol from the
cells.
It forms the structural components of the cell membrane with the association
of proteins
arranged in one end hydrophilic and the other end hydrophobic
o Hydrophilic head (loving water) faces the outside of the membrane,
retaining water and adhering to the neighboring cell
o Hydrophobic tail (hating water) associates with other fatty groups to
exclude the hydrophilic groups
B. CHOLESTEROL
 another important part of the cell membrane where it helps to stabilize the
membrane and make it better at controlling what can pass through it

C. PROTEINS
 second major component of the cell membrane where most of the functions
of the cellular membrane occur
 They transport lipid-insoluble particles acting as carriers to pass these
compounds directly through the membrane.
Some proteins form ion channels for the exchange of electrolytes. The type of
protein involved depends on the cell’s function.
D. Cell Coat (Carbohydrates)
 long chains of complex carbohydrates make up glycoproteins,
glycolipids and lectins that form the outside surface of the cell
 This intricate coat helps in cell-to-cell recognition or identification ( e.g
blood types – are result of membrane carbohydrates attached to proteins; it
identify blood that belongs to you and distinguish )
 It protects the plasma membrane. It is sometimes also called glycocalyx since
it contains sugar units in glycoprotein and polysaccharides
 B. BODY FLUID COMPOSITION
1.WATER

• Water is the primary component of body fluids and functions in

several ways to maintain normal cellular function
• Total body water constitutes about 60% of the total body weight, but
this amount varies with age, gender, and the amount of body fat.
• Total body water decreases from 45% to 50% of total body weight
with obesity and with aging
• Fat cells contain comparatively little water
 in the person who is obese, the proportion of water to total body
weight is less than in the person of average weight;
 in a person who is very thin, the proportion of water to total body
weight is greater than in the person of average weight
Adult females have a greater ratio of fat to lean tissue mass than
adult males; therefore, they have a lower percentage of total body
water
FUNCTIONS OF WATER
1. Regulates body temperature
2. Transport and exchange of materials (nutrients and other substances such as
oxygen and CO2 to and from cells)
3. Provides a medium for metabolic reactions within cells
4. Assist in food digestion (hydrolysis)
5. Acts as solvent in which solute are available for cell function
6. Maintain blood volume (plasma)
7. Medium of waste excretion
8. Cushion body parts from injury
 
Factors affecting body water distribution are:
1) AGE
 In Infants, 80% of their body weight is water. Most of their body
fluids are found in the ECF. Fluids in the ECF can easily be lost.
Therefore, the fluid-electrolyte balance of an infant can easily be
upset
Infant = 70-80%
Adult = 50-60%
Elderly = 45-50%
 
2. SEX
In males, 60% of their body weight is water. There is greater amount
of water in the male body than in the female body. This is because
males are more muscular than females. Muscles can store more water
In females, 50% of their body weight is water. Females have more
adipose tissues than males. Fats do not store water
3. BODY FATS
Fat cells contains little H2O

!!! To maintain normal fluid balance, body water intake and output should be
approximately equal. The average fluid intake and output is about 2500ml over
a 24-hour period.
 Approximate Values Of 24 hour
Fluid Gain And Loss Of An Adult
Intake (Gain) vs Output (Loss)

H2O (orally) 1,200 Urine 1500

Water in Food 1,000 Feces 200
Oxidation 300 Perspiration 500
Respiration 300

Total 2,500 ml Total 2,500 ml

INSENSIBLE WATER LOSS
Insensible fluid loss is the amount of body fluid lost daily that is not
easily measured
estimated to be between 600 to 900 mL/day in the average adult
without comorbidities
 occurs through the respiratory system, skin, and water in the excreted
stool
can increase significantly during
• Exercise
• High environmental temperatures
• During illnesses that respiratory rate, perspiration or GI losses
2. ELECTROLYTES
• Body fluids contain both water molecules and chemical compounds.
• These chemical compounds can either remain intact in solution or dissociate
into discrete particles.
• Electrolytes are substances that dissociate in solution to form charged particle
called ions.
• Cations are positively charged electrolytes
• Anions are negatively charged electrolytes
• electrically charged particles and is expressed in terms of milliequivalent per liter
(mEq/L)
4 MAJOR FUNCTIONS OF ELECTROLYTES
1. Assisting with regulation of water balance
 The constant work of the sodium-potassium pump maintains
the solute equilibrium and consequently, water distribution
between intracellular and extracellular fluids
 The unequal movement of the positively charged sodium and
potassium ions makes intracellular fluid more negatively charged
than the extracellular fluid
SODIUM-POTASSIUM PUMP
The sodium-potassium pump moves sodium ions out of and potassium ions into
the cell. This pump is powered by ATP. For each ATP that is broken down, 3 sodium
ions move out and 2 potassium ions move in.
2. Regulating and maintaining acid-base balance

When your electrolyte levels are out of balance due to

dehydration, you experience an acid/base (pH) imbalance.
Specifically, your pH levels decrease, creating metabolic
acidosis
3. Contributing to enzyme reactions

• Weak electrolytes, used as buffers, set the pH, while strong

electrolytes regulate the ionic strength.
• The interplay between pH and ionic strength has been
assumed to be the determinant of enzymatic activity
4. Essential for neuromuscular activity (muscle contraction and
relaxation)
Magnesium is mainly involved in ATP metabolism, contraction and relaxation
of muscles, proper neurological functioning, and neurotransmitter release
Electrolytes conduct nerve signals and regulate fluid balance in the brain.
Sodium is critical for brain health. Hyponatremia (low serum sodium) symptoms
include headaches, fatigue, lethargy, and seizures
Body fluid contains electrolytes, chemicals which, when they dissolve in
water, produce charged ions. These ions enable the flow of electrical signals
through the body.
Electrolytes play an important role in the body to maintain the function of muscle
and nerve cells
 Major Electrolyte Per Body Compartment

A. EXTRACELLULAR FLUID
ANIONS CATIONS
1. CHLORIDE (Cl-) - most 1. SODIUM (Na+) – most
abundant abundant

2. BICARBONATE (HCO3 -) 2. CALCIUM (Ca++)

3. MAGNESIUM (Mg++)
 Major Electrolyte Per Body Compartment
B. INTRACELLULAR FLUID
ANIONS CATIONS

1. PHOSPORUS/ 1. POTASSIUM(K+) – most

PHOSPHATE (PO4-) most abundant
abundant
2. SULFATE (SO4-) 2. MAGNESIUM (Mg++)

3. PROTEINS
 ELECTROLYTE DISTRIBUTION IN BASIC FUNCTIONS DIETARY
ION BODY FLUID SOURCES
  ECF ICF    
(mEq/L) (mEq/L)
1. Sodium (Na+) 135-154 15-20 -regulates fluid volume within -table salt
  ECF compartment -cheese, milk,
  -controls water distribution processed meat,
between ECF and ICF poultry, shellfish,
compartments fish, eggs and
-participates in conduction of foods preserved
nerve impulses with salt (e.g
ham and bacon)
-maintains neuromuscular
excitability
2. Potassium 3.5-5 150-155 -participates in -Fruits,
transmission of nerve especially
impulses bananas,
-promotes contraction oranges, and
of skeletal and smooth dried fruits
muscles -vegetables
-regulates acid-base -meats
balance by cellular -nuts
exchange of hydrogen
ions
3. Calcium 4.5-5.5 1-2 -provides strength and -dairy products
durability to bones and teeth (milk, cheese,
-establishes thickness and and yogurt
strength of cell membranes -sardines, whole
-promotes transmission of grains and
nerve impulses green leafy
-maintains neuromuscular vegetables
excitability  
-essential for blood
coagulation
-activates enzyme reactions
and hormone secretions
4.Magnesium 4.5-5.5 27-29 -activates enzyme -green leafy
systems, mainly those vegetables,
associated with vit. B whole grains,
metabolism and the use fish and nuts
of potassium calcium
and protein.
 
-promotes regulation of
serum calcium,
phosphorus and
potassium levels
-promotes
neuromuscular activity
 Serum Component
SERUM COMPONENT VALUES
CONVENTIONAL SI

Sodium 135-145 mEq/L 135-145 mmol/L

Chloride 98-106 mEq/L 98-106 mmol/L
Bicarbonate 22-26 mEq/L 22-26 mmol/L
Calcium 8.5- 10.0 mEq/L 2.1-2.6 mmol/L
Potassium 3.5-5.0 mEq/L 3.5-5.0 mmol/L
Phosphate/inorganic phosphorus 1.7-2.6 mEq/L (2.5-4.5 mg/dl) 0.8-1.5 mmol/L

Magnesium 1.6-2.6 mg/dl (1.3-2.1 mEq/L) 0.8-1.3 mmol/L

Serum osmolality 275-295 mOsm/kg 275-295 mmol/kg

 REGULATIONS OF
ELECTROLYTES
1. Sodium (Na+) and Water Regulation

a. Thirst – is the major control of actual fluid intake. The thirst center
(hypothalamus) is activated once the body loses at least 2% of fluids
b. Kidneys – The major organ controlling output. It excretes an
average of 1,500ml of fluids per day in the form of urine
c. ADH (anti-diuretic hormone) – retains water in the renal tubule
d. RAAS- Aldosterone retains sodium and water

!!! Sodium primarily determines the osmolality (concentration) of

body fluids.
2. Potassium(K+) Regulation

a. Aldosterone and hydrogen ions- regulates potassium level; the

aldosterone retains sodium and excretes potassium.
 Aldosterone is (pro-Na+ and anti-K+)
 Increased aldosterone secretion: HYPOKALEMIA
 Decreased aldosterone secretion: HYPERKALEMIA

b. Alkalosis: increases potassium excretion (HYPOKALEMIA)

Acidosis: decreases potassium excretion (HYPERKALEMIA)

!!! Potassium is necessary in the conduction of nerve impulses and

promotion of skeletal and cardiac muscle activity
3. Calcium (Ca+) Regulation

a. Calcium: 99% found in the bones and teeth, 1%in the blood
b. Calcium and Phosphorus have inverse relationship
c. Low total CHON (Protein) and albumin – Low total serum Calcium
d. Parathormone, Thyrocalcitonin and Vitamin D regulates calcium level
1. Parathormone – elevates calcium levels through withdrawal of
calcium from the bones or bone resorption
 increased PTH- increased serum calcium
decreased PTH – decreased serum calcium

2. Thyrocalcitonin - lowers serum calcium levels by depositing

calcium into the bones
 increased Thyrocalcitonin – decreased serum calcium
 decreased Thyrocalcitonin – Increased serum calcium
3. Vitamin D promotes calcium absorption

!!! Calcium Promotes neuromuscular irritability; bone and teeth

development and blood clotting . It can also cause vasoconstriction
 BODY FLUID COMPARTMENT
(DISTRIBUTION)
Body Fluid is classified by its location inside or outside the cells.
Capillary and cell membranes separate total body fluids into two
main compartments: the intracellular and extracellular.
Total body water is the equivalent of the fluids that exist in all the
fluid compartments. This approximately 60% of the body weight of
an average adult.
1.) INTRACELLULAR FLUID (ICF) (40%)
Intracellular fluid (ICF) is found within cells.
ICF is essential for normal cell function, providing a medium
for metabolic processes.
Make’s up 2/3 of the body’s water or 40% of Body weight
Larger of the two compartments
Rich in electrolytes, potassium, magnesium, inorganic and
organic phosphates and proteins
 Major Electrolyte Per Body Compartment
B. INTRACELLULAR FLUID
ANIONS CATIONS

1. PHOSPORUS/ 1. POTASSIUM(K+) – most

PHOSPHATE (PO4-) most abundant
abundant
2. SULFATE (SO4-) 2. MAGNESIUM (Mg++)

3. PROTEINS
2. EXTRACELLULAR FLUID (ECF) (20%)
Extracellular fluid (ECF) is located outside of cells
contains all the fluid outside the cells
accounts for 20% of Body weight
rich in electrolytes: sodium, chloride and bicarbonate
 Major Electrolyte Per Body Compartment

A. EXTRACELLULAR FLUID

ANIONS CATIONS
1. CHLORIDE (Cl-) - most 1. SODIUM (Na+) – most
abundant abundant

2. BICARBONATE (HCO3 -) 2. CALCIUM (Ca++)

3. MAGNESIUM (Mg++)
3. PROTEINS (PLASMA) 3. MAGNESIUM (Mg++)
ECF is further classified by location:

a. INSTERSTITIAL FLUID (15%)

 located in the spaces between most cells of the body
 accounts for approximately 15% of Body weight
b. INTRAVASCULAR FLUID (5%)
 blood vessel compartments
 called “plasma”, is contained within the arteries, veins, and
capillaries
 MECHANISM OF FLUID TRANSPORT
• Four chemical and physiologic processes control the movement of fluid,
electrolytes, and other molecules across membranes between the
intracellular and interstitial space and the interstitial space and plasma.
• These processes are
• Active transport
• Passive Transport
• Osmosis
• Diffusion
• Filtration
1. ACTIVE TRANSPORT
• Active transport allows molecules to move across cell membranes
and epithelial membranes against a concentration gradient.
• This movement requires energy (adenosine triphosphate [ATP]) and a
carrier mechanism to maintain a higher concentration of a substance
on one side of the membrane than on the other.
 Complex sugar, ions, large cells, proteins, and other particles are
transported in this process.
TYPES OF ACTIVE TRANSPORT
1.Primary Active Transport-uses the initial source of energy to carry
the substance
2.Secondary Active Transport (cotransport)- harnesses the energy
obtained from the primary active transport and uses it as a
cotransporter of a secondary substance
EXAMPLES OF PRIMARY ACTIVE TRANSPORT

1. SODIUM-POTASSIUM PUMP
• The sodium-potassium pump moves sodium ions out of and
potassium ions into the cell.
• This pump is powered by ATP. For each ATP that is broken down, 3
sodium ions move out and 2 potassium ions move in.
2. ENDOCYTOSIS
 plasma membrane surrounds the substance being transported and transport the substance
into the cell
3 MAIN KINDS OF ENDOCYTOSIS
A. Phagocytosis or cellular eating
• Occurs when the dissolved materials enter the cell. The plasma membrane engulfs the solid
material, forming a phagocytic vesicle.
B. Pinocytosis or cellular drinking
• Occurs when the plasma membrane folds inward to form a channel allowing dissolved
substances to enter the cell. When the channel is closed, the liquid is encircled within a
pinocytic vesicle.
C. Receptor-mediated endocytosis (RME)
• also called clathrin-mediated endocytosis, is a process by which cells absorb metabolites,
hormones, proteins – and in some cases viruses – by the inward budding of the plasma
3. EXOCYTOSIS

• manufactured substances are pack in the secretory vesicles that fuse

with the plasma and are released outside the cell
2. PASSIVE TRANSPORT
• In these biological process, there is no need for any energy for transporting
the molecules, as the biochemicals move from higher to the lower
concentration.
• This process is carried out to maintain the balance and the equilibrium
level in a cell. All the wastes molecules including, water and carbon
dioxide is separated and moved out of the cell using passive transport.
3 TYPES OF PASSIVE TRANSPORT
a. Osmosis
b. Diffusion
c. Filtration
A. OSMOSIS
•Osmosis is the process by which water moves across a
selectively permeable membrane from an area of
lower solute concentration to an area of higher solute
concentration.
•A selectively permeable membrane allows water
molecules to cross but is relatively impermeable to
dissolved substances (solutes).
Osmosis continues until the solute concentration on both
sides of the membrane is equal.
the distribution of water from a lesser area of solute
concentration to a higher area of solute concentration
the direction is determined by the concentration of particles on
either side of the cell membrane
osmosis stops when the concentration of solutes on both sides of
the membrane becomes equalized
osmosis the primary process that controls body fluid movement
between the ICF and ECF compartments
OSMOLE
An osmole is 1 mole of any fully dissociated substance dissolved in
water (solute once dissolved in a solution)
OSMOLALITY
 Osmolality, or concentration of a solution, refers to the number of
solutes per kilogram of water (by weight); it is reported in
milliosmoles per kilogram (mOsm/kg).

OSMOLARITY
 the number of solutes per Liter of fluid (mOsm/L)
OSMOTIC PRESSURE
 the power of a solution to draw water across a membrane
ONCOTIC PRESSURE
 also called colloid osmotic pressure (COP)
 osmotic pressure exerted by plasma proteins in the vessels (e.g.,
albumin)
 proteins in the bloodstream exert oncotic pressure to pull fluid out
of the interstitial space into the intravascular space to maintain
fluid balance and osmolality
 average COP is 28mmHg, a pressure that remains constant across
the capillary
TONICITY
 refers to the effect a solution’s osmotic pressure has on water
movement across the cell membrane of cells within that solution
1. ISOTONIC SOLUTION
 have the same concentration of solutes as plasma
 cells placed in an isotonic solution will neither shrink nor swell
because there is no net gain or loss of water within the cell, and no
change in cell volume
2. HYPERTONIC SOLUTION
 have a greater concentration of solutes than plasma
 in their presence, water is drawn out of a cell, causing it to shrink
3. HYPOTONIC SOLUTION
 have a lower solute concentration than plasma
 when red blood cells are placed in a hypotonic solution, water
moves into the cells, causing them to swell
 rupture (hemolysis) of cells may occur with extremely hypotonic
solutions
B. DIFFUSION
• Diffusion is the process by which solute molecules move from an area of
high solute concentration to an area of low solute concentration to
become evenly distributed.
2 TYPES OF DIFFUSION

1. SIMPLE DIFFUSION
• Simple diffusion occurs by the random movement of particles through a
solution. Water, carbon dioxide, oxygen, and solutes move between
plasma and the interstitial space by simple diffusion through the capillary
membrane. Water and solutes move into the cell by passing through
protein channels or by dissolving in the lipid cell membrane.
2. FACILITATED DIFFUSION
• Facilitated diffusion, also called carrier-mediated diffusion, allows
large water-soluble molecules, such as glucose and amino acids, to
diffuse across cell membranes. Proteins embedded in the cell
membrane function as carriers, helping large molecules cross the
membrane. The rate of diffusion is influenced by a number of
factors, such as the concentration of solute and the availability of
carrier proteins in the cell membrane.
C. FILTRATION
• Filtration is the process by which water and dissolved substances (solutes)
move from an area of high hydrostatic pressure to an area of low hydrostatic
pressure. This usually occurs across capillary membranes.
HYDROSTATIC PRESSURE
 created by the pumping action of the heart and gravity against the capillary
wall
 filtration occurs in the glomerulus of the kidneys, as well as at the arterial end
of capillaries