Electrolytes Balance

By: Dr. Muhammad Adeel Arshad

Pankaja Naik page no. 479
Introduction
• Electrolytes are the inorganic substance which are readily dissociated
into positively charged (cations) and negatively charged (anions) ions.
• Normal cellular functions and survival requires electrolytes which are
maintained within narrow limits.
• Distribution of Electrolytes:
• Electrolytes are well distributed in the body fluids and play important
role in distribution and retention of body water by regulating the
osmotic equilibrium.
• Total concentration of cations and anions in extracellular fluids and
intracellular fluids is equal to maintain electrical neutrality.
• There is difference in composition between two fluids.
• Sodium is the principal cation of extracellular fluid and comprises over
90% of total cations but has low concentration in ICF and constitutes
only 8% of total cations.
• Potassium by contrast is the principal cation of ICF and has low
concentration in ECF.
• Similar difference exits between anions. Chloride and bicarbonate
predominate in the ECF and phosphate in the ICF.
• The term electrolytes applied in medicine to the four ions in plasma
(Na, K, Cl and HCO3) that exert greatest influence on water balance
and acid base balance.
• Ca, phosphate, Mg and trace element are also important in clinical.
• The water balance is closely linked to balance of dissolved
electrolytes, most important is Na and K.
• The osmatic pressure of extracellular fluids is determined by
concentration of Na, with its associated anions as it accounts for over
90% of osmolality and thus Na concentration determines the
extracellular fluid volume.
• K similarly determines intracellular osmolality to a large extent.
Regulation of water and electrolytes balance:
• Regulation of water and electrolytes occurs together which depends on the:
• Antidiuretic hormone
• Renin angiotensin aldosterone system
• Atrial natriuretic factor
• Kidney
• When water and sodium output exceed intake i.e. negative water and
sodium balance, the ECF volume contracts.
• The associated decrease in plasma volume results in decrease in cardiac
output.
• These cardiovascular changes produces following effects:
• Stimulation of water intake area of hypothalamus and thirst center.
• Stimulation water output area of hypothalamus and ADH secretion.
• Stimulation of renin angiotensin aldosterone system.
• Inhibition of release of atrial natriuretic factor.
• Retention of sodium and water by kidney.
Antidiuretic hormone:
• Water intake is normally controlled by sensation of thirst and its
output by action of hormone ADH.
• Major role of ADH is to increase the reabsorption of water from
kidney.
• An increase in plasma osmolality cause sensation of thirst and
stimulate hypothalamic thirst center which result in an increase in
water intake.
• An increase in plasma osmolality also stimulate hypothalamus to
release ADH. It then increase water reabsorption by kidney.
Renin angiotensin aldosterone system:
• Renin is secreted in response to reduction in supply of Na in the fluid
of distal tubule.
• It convert angiotensinogen in plasma to angiotensin-I, which in turn is
converted to angiotensin-II, which stimulate aldosterone secretion by
adrenal cortex, thirsting behavior and ADH secretion.
• Aldosterone stimulate Na reabsorption in the renal tubule in
exchange of H and K.
• As a result of Na reabsorption water is retained by body.
Atrial natriuretic factor:
• It is a polypeptide hormone secreted by right atrium of heart.
• It increase Na and water excretion by kidney.
• In negative sodium and water balance ANF is inhibited.
• The net result is water and sodium balance becomes positive.
Disorder of water and electrolytes balance:
• Dehydration and over-hydration are the disorders of water balance, which
are due to imbalance of water intake or output and sodium intake and
output.
• Dehydration:
• It is defined as state in which loss of water exceeds that of intake, as a result
body water content get reduced and body is in negative water balance.
• Dehydration id of two types:
• Due to pure water deficiency without loss of electrolytes called simple
dehydration.
• Due to combine deficiency of water and electrolytes
• Simple dehydration:
• It is decrease in total body water with relatively normal total body
sodium and may be due to failure of regulatory mechanisms that
promote conservation of water by kidney.
• Simple dehydration is associated with hypernatremia.
• Dehydration due to combine water and sodium deficiency:
• It is more common than simple dehydration.
• This results from the net negative balance of water and sodium.
• Over-hydration or water intoxication:
• It is increase in total body water, this condition is rarely achieved in
normal person. But some time may be happened due to:
• Renal failure
• Excessive parenteral fluid administration
• Hyper secretion of ADH