13 Fluid and Electrolyte Balance

24
Fluid,
Electrolyte,
and Acid-Base
Balance
PowerPoint® Lecture Presentations prepared by
Alexander G. Cheroske
Mesa Community College at Red Mountain
© 2011 Pearson Education, Inc.

Section 1: Fluid and Electrolyte Balance
• Learning Outcomes
• 24.1 Explain what is meant by fluid balance, and
discuss its importance for homeostasis.
• 24.2 Explain what is meant by mineral balance, and
discuss its importance for homeostasis.
• 24.3 Summarize the relationship between sodium
and water in maintaining fluid and
electrolyte balance.
• 24.4 CLINICAL MODULE Explain factors that
control potassium balance, and discuss
hypokalemia and hyperkalemia.

Section 1: Fluid and Electrolyte Balance
• Fluids constitute ~50%–60% of total body

composition
• Minerals (inorganic substances) are dissolved
within and form ions called electrolytes
• Fluid compartments
• Intracellular fluid (ICF)
• Water content varies most here due to variation in:
• Tissue types (muscle vs. fat)
• Distinct from ECF due to plasma membrane transport
• Extracellular fluid (ECF)
• Interstitial fluid volume varies
• Volume of blood (women < men)
Total body composition of adult males
Total body composition of adult males and females
ICF
ECF
Intracellular Interstitial
fluid 33% fluid 21.5%
Plasma 4.5%
Solids 40% Other

(organic and inorganic materials) body
fluids
(≤1%)
Adult males
Total body composition of adult females
ICF ECF
Intracellular Interstitial
fluid 27% fluid 18%
Plasma 4.5%
Other
body
Solids 50% fluids
(organic and inorganic materials) (≤1%)
Adult females
Figure 24 Section 1 1
The solid components of a 70-kg (154-pound)
individual with a minimum of body fat
SOLID COMPONENTS
(31.5 kg; 69.3 lbs)
Kg
Proteins Lipids Minerals Carbohydrates Miscellaneous
Module 24.1: Fluid balance
• Fluid balance
• Water content stable over time
• Gains
• Primarily absorption along digestive tract
• As nutrients and ions are absorbed, osmotic gradient
created causing passive absorption of water
• Losses
• Mainly through urination (over 50%) but other routes as well
• Digestive secretions are reabsorbed similarly to ingested

fluids

Figure 24.1 1
Dietary Input Digestive Secretions
Food and drink 2200 mL Saliva 1500 mL
The digestive tract sites of water gain

through ingestion or secretion, or water
reabsorption, and of water loss
Gastric secretions 1500 mL
5200 mL
Liver (bile) 1000 mL
Pancreas (pancreatic
juice) 1000 mL
Water Reabsorption
Intestinal secretions 2000 mL
9200 mL
Small intestine
reabsorbs 8000 mL
1200 mL
Colonic mucous secretions

200 mL
Colon reabsorbs 1250 mL 1400
mL
150 mL lost
in feces
Figure 24.1 2
Module 24.1: Fluid balance
• ICF and ECF compartments balance

• Very different composition
• Are at osmotic equilibrium
• Loss of water from ECF is replaced by water in ICF
• = Fluid shift
• Occurs in minutes to hours and restores osmotic equilibrium
• Dehydration
• Results in long-term transfer that cannot replace ECF water
loss
• Homeostatic mechanisms to increase ECF fluid volume will
be employed

Water absorbed across
digestive epithelium
The major factors that affect ECF volume (2000 mL)
Water vapor lost
in respiration and
evaporation from
moist surfaces
(1150 mL)
Metabolic Water lost in

ICF water ECF feces (150 mL)
(300 mL)
Water secreted
by sweat glands
(variable)
Plasma membranes Water lost in urine

(1000 mL)
Figure 24.1 3
Changes to the ICF and ECF when water losses outpace water gains
Intracellular Extracellular The ECF and ICF are in

fluid (ICF) fluid (ECF) balance, with the two
solutions isotonic.
ECF water loss Water loss from ECF

reduces volume and
makes this solution
hypertonic with respect
to the ICF.
An osmotic water shift

Decreased ICF volume Increased from the ICF into the
ECF volume ECF restores osmotic
equilibrium but
reduces the ICF
volume.
Figure 24.1 4
Module 24.1 Review
a. Identify routes of fluid loss from the body.
b. Describe a fluid shift.
c. Explain dehydration and its effect on the

osmotic concentration of plasma.

Module 24.2: Mineral balance
• Mineral balance
• Equilibrium between ion absorption and excretion
• Major ion absorption through intestine and colon
• Major ion excretion by kidneys
• Sweat glands excrete ions and water variably
• Ion reserves mainly in skeleton

Mineral balance, the balance between ion absorption (in the digestive tract) and ion excretion (primarily at the kidneys)
Ion Absorption Ion reserves (primarily Ion Excretion
in the skeleton)
Ion absorption occurs across the Sweat gland
epithelial lining of the small intestine secretions
and colon. (secondary
site of ion loss)
Ion pool in body fluids
Kidneys
(primary site
of ion loss)
ICF ECF
Figure 24.2 1
Figure 24.2 2
Figure 24.2 3
Figure 24.2 3
Module 24.2 Review
a. Define mineral balance.
b. Identify the significance of two important body

minerals: sodium and calcium.
c. Identify the ions absorbed by active transport.

Module 24.3: Water and sodium balance
• Sodium balance (when sodium gains equal losses)

• Relatively small changes in Na+ are accommodated
by changes in ECF volume
• Homeostatic responses involve two parts
1. ADH control of water loss/retention by kidneys and thirst
2. Fluid exchange between ECF and ICF

The mechanisms that regulate sodium balance ADH Secretion Increases
when sodium concentration in the ECF changes Recall of Fluids
The secretion of ADH
Because the ECF
restricts water loss and
osmolarity increases,
stimulates thirst, promoting
water shifts out of the
additional water
ICF, increasing ECF
Rising plasma consumption.
volume and lowering
sodium levels
ECF Na concentrations.
Osmoreceptors
in hypothalamus
stimulated
HOMEOSTASIS
HOMEOSTASIS RESTORED
If you consume large DISTURBED
amounts of salt without Decreased Na
adequate fluid, as when Increased Na 
levels in ECF
you eat salty potato levels in ECF
chips without taking a
drink, the plasma Na
concentration rises HOMEOSTASIS
temporarily.
Start
Normal Na
concentration
in ECF
Figure 24.3 1
The mechanisms that regulate sodium balance
when sodium concentration in the ECF changes
HOMEOSTASIS
Start
Normal Na
concentration
in ECF
HOMEOSTASIS HOMEOSTASIS
DISTURBED RESTORED
Decreased Na
Increased Na
levels in ECF
levels in ECF
Osmoreceptors Water loss reduces

in hypothalamus ECF volume,
inhibited ADH Secretion concentrates ions
Decreases
As soon as the osmotic
concentration of the ECF
drops by 2 percent or
more, ADH secretion
Falling plasma decreases, so thirst is
sodium levels suppressed and water
losses at the kidneys
increase.
Figure 24.3 1
• Sodium balance (continued)

• Exchange changes in Na+ are accommodated by
changes in blood pressure and volume
• Hyponatremia (natrium, sodium)
• Low ECF Na+ concentration (<136 mEq/L)
• Can occur from overhydration or inadequate salt intake
• Hypernatremia
• High ECF Na+ concentration (>145 mEq/L)
• Commonly from dehydration

• Sodium balance (continued)

• Exchange changes in Na+ are accommodated by
changes in blood pressure and volume (continued)
• Increased blood volume and pressure
• Natriuretic peptides released
• Increased Na+ and water loss in urine
• Reduced thirst
• Inhibition of ADH, aldosterone, epinephrine, and
norepinephrine release
• Decreased blood volume and pressure
• Endocrine response
• Increased ADH, aldosterone, RAAS mechanism
• Opposite bodily responses to above
The mechanisms that regulate water balance Responses to Natriuretic Peptides Combined
when ECF volume changes Effects
Increased Na loss in urine
Reduced
Rising blood Increased water loss in urine blood
pressure and Natriuretic peptides volume
volume released by cardiac Reduced thirst
muscle cells Reduced
Inhibition of ADH, aldosterone, blood
epinephrine, and norepinephrine pressure
release
Increased blood
volume and
atrial distension
HOMEOSTASIS
HOMEOSTASIS
RESTORED
DISTURBED
Rising ECF volume by fluid Falling ECF

gain or fluid and Na gain volume
HOMEOSTASIS
Start
Normal ECF
volume
Figure 24.3 2
The mechanisms that regulate water balance
when ECF volume changes
HOMEOSTASIS
Start
Normal ECF
HOMEOSTASIS volume HOMEOSTASIS
DISTURBED RESTORED
Falling ECF volume by fluid Rising ECF
loss or fluid and Na loss volume
Decreased blood
volume and Endocrine Responses Combined Effects
blood pressure
Increased renin secretion Increased urinary Na retention
and angiotensin II
activation Decreased urinary water loss
Increased aldosterone
Falling blood Increased thirst
release
pressure and
volume Increased ADH release Increased water intake
Figure 24.3 2
Module 24.3 Review
a. What effect does inhibition of osmoreceptors have

on ADH secretion and thirst?
b. What effect does aldosterone have on sodium ion

concentration in the ECF?
c. Briefly summarize the relationship between sodium

ion concentration and the ECF.

CLINICAL MODULE 24.4: Potassium
imbalance
• Potassium balance (K+ gain = loss)
• Major gain is through digestive tract absorption
• ~100 mEq (1.9–5.8 g)/day
• Major loss is excretion by kidneys
• Primary ECF potassium regulation by kidneys since intake fairly
constant
• Controlled by aldosterone regulating Na+/K+ exchange pumps in
DCT and collecting duct of nephron
• Low ECF pH can cause H+ to be substituted for K+
• Potassium is highest in ICF due to Na +/K+ exchange pump
• ~135 mEq/L in ICF vs. ~5 mEq/L in ECF

The major factors involved in potassium balance
Factors Controlling Potassium Balance
Approximately 100 Roughly The K concentration in the When potassium
mEq (1.9–5.8 g) of 98 percent of the ECF is relatively low. The rate balance exists,
potassium ions are potassium of K entry from the ICF the rate of urinary
absorbed by the content of the through leak channels is K excretion
digestive tract each human body is in balanced by the rate of K matches the rate
day. the ICF, rather recovery by the Na/K of digestive tract
than the ECF. exchange pump. absorption.
The potassium ion

concentration in the
ECF is approximately
5 mEq/L.
KEY
 Absorption The potassium ion
Renal K losses
 Secretion concentration of the
are approximately

ICF is approximately
Diffusion through 100 mEq per day
leak channels 135 mEq/L.
Figure 24.4 1
The role of aldosterone-sensitive exchange pumps
in the kidneys in determining the potassium The primary mechanism of
concentration in the ECF potassium secretion involves
an exchange pump that
ejects potassium ions while
reabsorbing sodium ions.
Tubular ECF
fluid
KEY The sodium ions are then pumped out

of the cell in exchange for potassium
 Aldosterone- ions in the ECF. This is the same pump
sensitive that ejects sodium ions entering the
exchange
pump cytosol through leak channels.
 Sodium-potassium
exchange pump
Figure 24.4 2
Events in the kidneys that affect potassium balance
Under normal conditions, the

aldosterone-sensitive pumps
exchange K in the ECF for
Na in the tubular fluid. The
net result is a rise in plasma
Distal sodium levels and increased
convoluted K loss in the urine.
tubule
When the pH falls in the ECF
and the concentration of H is
relatively high, the exchange
Collecting pumps bind H instead of K.
duct This helps to stabilize the pH
of the ECF, but at the cost of
rising K levels in the ECF.
Figure 24.4 3
imbalance
• Disturbances of potassium balance
• Hypokalemia (kalium, potassium)
• Below 2 mEq/L in plasma
• Can be caused by:
• Diuretics
• Aldosteronism (excessive aldosterone secretion)
• Symptoms
• Muscular weakness, followed by paralysis
• Potentially lethal when affecting heart

imbalance
• Disturbances of potassium balance (continued)
• Hyperkalemia
• Above 8 mEq/L in plasma
• Can be caused by:
• Chronically low pH
• Kidney failure
• Drugs promoting diuresis by blocking Na+/K+ pumps
• Symptoms
• Muscular spasm including heart arrhythmias

CLINICAL MODULE 24.4 Review
a. Define hypokalemia and hyperkalemia.
b. What organs are primarily responsible for

regulating the potassium ion concentration of the
ECF?
c. Identify factors that cause potassium excretion.

Section 2: Acid-Base Balance
• Learning Outcomes
• 24.5 Explain the role of buffer systems in maintaining
acid-base balance and pH.
• 24.6 Explain the role of buffer systems in regulating
the pH of the intracellular fluid and the
extracellular fluid.
• 24.7 Describe the compensatory mechanisms
involved in the maintenance of acid-base
balance.
• 24.8 CLINICAL MODULE Describe respiratory
acidosis and respiratory alkalosis.
• Acid-base balance (H+ production = loss)

• Normal plasma pH: 7.35–7.45
• H+ gains: many metabolic activities produce
acids
• CO2 (to carbonic acid) from aerobic respiration
• Lactic acid from glycolysis
• H+ losses and storage
• Respiratory system eliminates CO2
• H+ excretion from kidneys
• Buffers temporarily store H+
The major factors involved in the maintenance
of acid-base balance
The respiratory system
plays a key role by
eliminating
carbon dioxide.
The kidneys play a major

role by secreting
hydrogen ions into the
Active tissues urine and generating
continuously generate buffers that enter the
carbon dioxide, which in Normal bloodstream. The rate of
solution forms carbonic plasma pH excretion rises and falls
acid. Additional acids, (7.35–7.45) as needed to maintain
such as lactic acid, are normal plasma pH. As a
produced in the course of Tissue cells result, the normal pH of
normal metabolic urine varies widely but
averages 6.0—slightly
operations. acidic.
Buffer Systems
Buffer systems can

temporarily store H
and thereby provide
short-term pH
stability.
• Classes of acids
• Fixed acids
• Do not leave solution
• Remain in body fluids until kidney excretion
• Examples: sulfuric and phosphoric acid
• Generated during catabolism of amino acids, phospholipids,
and nucleic acids
• Organic acids
• Part of cellular metabolism
• Examples: lactic acid and ketones
• Most metabolized rapidly so no accumulation
• Classes of acids (continued)

• Volatile acids
• Can leave body by external respiration
• Example: carbonic acid (H2CO3)

Module 24.5: Buffer systems
• pH imbalance
• ECH pH normally between 7.35 and 7.45
• Acidemia (plasma pH <7.35): acidosis (physiological
state)
• More common due to acid-producing metabolic activities
• Effects
• CNS function deteriorates, may cause coma
• Cardiac contractions grow weak and irregular
• Peripheral vasodilation causes BP drop
• Alkalemia (plasma pH >7.45): alkalosis (physiological
state)
• Can be dangerous but relatively rare
Figure 24.5 1
The narrow range of normal pH of the ECF, and the conditions that result from pH shifts outside the normal range
The pH of the ECF

(extracellular fluid)
normally ranges from
7.35 to 7.45.
When the pH of plasma falls below When the pH of plasma rises

7.5, acidemia exists. The above 7.45, alkalemia exists.
physiological state that results is The physiological state that
called acidosis. results is called alkalosis.
Extremely Extremely
acidic basic
pH
Severe acidosis (pH below 7.0) can be deadly Severe alkalosis is also
because (1) central nervous system function dangerous, but serious cases
deteriorates, and the individual may become are relatively rare.
comatose; (2) cardiac contractions grow weak and
irregular, and signs and symptoms of heart failure
may develop; and (3) peripheral vasodilation
produces a dramatic drop in blood pressure,
potentially producing circulatory collapse.
Figure 24.5 2
• CO2 partial pressure effects on pH

• Most important factor affecting body pH
• H2O + CO2  H2CO3  H+ + HCO3–
• Reversible reaction that can buffer body pH
• Adjustments in respiratory rate can affect body pH

The inverse relationship between the P CO2 and pH
PCO2 pH
40–45 7.35–7.45
mm Hg HOMEOSTASIS
If PCO2 rises If PCO2 falls
H2O  CO2 H2CO3 H  HCO3 H  HCO3 H2CO3 H2O  CO2
When carbon dioxide levels rise, more carbonic acid When the PCO2 falls, the reaction runs in reverse, and
forms, additional hydrogen ions and bicarbonate ions carbonic acid dissociates into carbon dioxide and
are released, and the pH goes down. water. This removes H ions from solution and
increases the pH.
PCO pH
2
pH P CO 2
Figure 24.5 3
• Buffer
• Substance that opposes changes to pH by removing
or adding H+
• Generally consists of:
• Weak acid (HY)
• Anion released by its dissociation (Y–)
• HY  H+ + Y– and H+ + Y–  HY

The reactions that occur when pH buffer systems function
A buffer system in body fluids generally Adding H to the Removing H from the
consists of a combination of a weak acid (HY) solution upsets the solution also upsets the
and the anion (Y) released by its dissociation. equilibrium and results equilibrium and results
The anion functions as a weak base. In solution, in the formation of in the dissociation of
molecules of the weak acid exist in equilibrium additional molecules of additional molecules of
with its dissociation products. the weak acid. HY. This releases H.
H H  HY H  Y
HY H  Y H Y
 
H  HY

H
Figure 24.5 4
Module 24.5 Review
a. Define acidemia and alkalemia.
b. What is the most important factor affecting the pH

of the ECF?
c. Summarize the relationship between CO2 levels

and pH.

Module 24.6: Major body buffer systems
• Three major body buffer systems

• All can only temporarily affect pH (H + not eliminated)
1. Phosphate buffer system

• Buffers pH of ICF and urine
2. Carbonic acid–bicarbonate buffer system
• Most important in ECF
• Fully reversible
• Bicarbonate reserves (from NaHCO3 in ECF) contribute

• Three major body buffer systems (continued)

3. Protein buffer systems (in ICF and ECF)
• Usually operate under acid conditions (bind H+)
• Binding to carboxyl group (COOH–) and amino group
(—NH2)
• Examples:
• Hemoglobin buffer system
• CO2 + H2O  H2CO3  HCO3– + Hb-H+
• Only intracellular system with immediate effects
• Amino acid buffers (all proteins)
• Plasma proteins

The body’s three major buffer systems
Buffer Systems
occur in
Intracellular fluid (ICF) Extracellular fluid (ECF)
Phosphate Buffer Protein Buffer Systems Carbonic Acid–

System Bicarbonate Buffer
Contribute to the regulation of pH in the ECF and ICF;
System
Has an important interact extensively with the other two buffer systems
role in buffering the Is most important in the
pH of the ICF and ECF
of urine
Hemoglobin Amino acid Plasma

buffer system buffers protein
(RBCs only) (All proteins) buffers
Figure 24.6 1
The reactions of the carbonic acid–bicarbonate buffer system BICARBONATE RESERVE
Body fluids contain a large reserve of
HCO3, primarily in the form of dissolved
molecules of the weak base sodium
bicarbonate (NaHCO3). This readily
CARBONIC ACID–BICARBONATE available supply of HCO3 is known as
BUFFER SYSTEM the bicarbonate reserve.
CO2 CO2  H2O H2CO3 H  HCO3 HCO3  Na NaHCO3
(carbonic acid) (bicarbonate ion) (sodium bicarbonate)
Lungs
The primary function of the carbonic

acid–bicarbonate buffer system is to
protect against the effects of the organic
Addition of H and fixed acids generated through
Start from metabolic metabolic activity. In effect, it takes the H 
activity released by these acids and generates
carbonic acid that dissociates into water
and carbon dioxide, which can easily be
eliminated at the lungs.
Figure 24.6 4
The events involved in the functioning of the hemoglobin buffer system
Tissue Plasma Plasma Lungs
cells
Red blood cells Red blood cells Released
with
exhalation
H2O H2O
CO2 H2CO3 HCO3  Hb H Hb H  HCO3 H2CO3 CO2
Figure 24.6 2
The mechanism by free amino acids function in
Start protein buffer systems
Increasing acidity (decreasing pH)
Normal pH
(7.35–7.45)
At the normal pH of If pH drops, the carboxylate ion (COO)

body fluids (7.35– and the amino group (—NH2) of a free
7.45), the carboxyl amino acid can act as weak bases and
groups of most amino accept additional hydrogen ions, forming a
acids have released carboxyl group (—COOH) and an amino
their hydrogen ions. ion (—NH3), respectively. Many of the
R-groups can also accept hydrogen ions,
forming RH.
Figure 24.6 3
• Disorders
• Metabolic acid-base disorders
• Production or loss of excessive amounts of fixed or
organic acids
• Carbonic acid–bicarbonate system works to counter
• Respiratory acid-base disorders
• Imbalance of CO2 generation and elimination
• Must be corrected by depth and rate of respiration
changes

Module 24.6 Review
a. Identify the body’s three major buffer systems.
b. Describe the carbonic acid–bicarbonate buffer

system.
c. Describe the roles of the phosphate buffer system.

Module 24.7: Metabolic acid-base disorders
• Metabolic acid-base disorders

• Metabolic acidosis
• Develops when large numbers of H+ are released by organic
or fixed acids
• Accommodated by respiratory and renal responses
• Respiratory response
• Increased respiratory rate lowers PCO2
• H+ + HCO3–  H2CO3  H2O + CO2
• Renal response
• Occurs in PCT, DCT, and collecting system
• H2O + CO2  H2CO3  H+ + HCO3–
 H+ secreted into urine
 HCO3– reabsorbed into ECF

The responses to metabolic acidosis Addition
Start
of H
CARBONIC ACID–BICARBONATE BUFFER SYSTEM BICARBONATE RESERVE

Lungs
Generation
Other of HCO3
Respiratory Response KIDNEYS
to Acidosis buffer
systems Renal Response to Acidosis
Increased respiratory absorb H
rate lowers PCO2, Kidney tubules respond by (1) secreting H 
ions, (2) removing CO2, and (3) reabsorbing
effectively converting
HCO3 to help replenish the bicarbonate
carbonic acid molecules Secretion
to water. of H reserve.
Figure 24.7 1
The activity of renal Tubular ECF Steps in CO2 removal and
Renal tubule cells
tubule cells in CO2 fluid HCO3 production
removal and HCO3
CO2 CO2 CO2 generated by the tubule
production CO2
 cell is added to the CO 2
H2O diffusing into the cell from
Carbonic the urine and from the ECF.
Na anhydrase
H Carbonic anhydrase
H2CO3 converts CO2 and water to
carbonic acid, which then
H H HCO3 HCO3
dissociates.
Cl
The chloride ions exchanged
H for bicarbonate ions are
Cl HCO3 excreted in the tubular fluid.
Na
Bicarbonate ions and
sodium ions are transported
into the ECF, adding to the
bicarbonate reserve.
Figure 24.7 2
• Metabolic alkalosis
• Develops when large numbers of H+ are removed
from body fluids
• Rate of kidney H+ secretion declines
• Tubular cells do not reclaim bicarbonate
• Collecting system transports bicarbonate into urine and
retains acid (HCl) in ECF

• Metabolic alkalosis (continued)

• Accommodated by respiratory and renal
responses
• Respiratory response
• Decreased respiratory rate raises PCO2
• H2O + CO2  H2CO3  H+ + HCO3–
• Renal response
• Occurs in PCT, DCT, and collecting system
• H2O + CO2  H2CO3  H+ + HCO3–
• HCO3– secreted into urine (in exchange for Cl–)
• H+ actively reabsorbed into ECF
The responses to metabolic alkalosis Removal
Start
of H
CARBONIC ACID–BICARBONATE BUFFER SYSTEM BICARBONATE RESERVE
Lungs CO2  H2O H2CO3 H  HCO3 HCO3  Na NaHCO3

Other Generation
Respiratory Response KIDNEYS
to Alkalosis buffer of H
systems
Decreased respiratory release H
Renal Response to Alkalosis
rate elevates PCO2,
effectively converting Kidney tubules respond by
CO2 molecules to conserving H ions and
Secretion secreting HCO3.
carbonic acid.
of HCO3
Figure 24.7 3
CO2 generated by the tubule
The events in the cell is added to the CO 2
Tubular Renal tubule cells ECF
secretion of bicarbonate fluid diffusing into the cell from the
ions into the tubular tubular fluid and from the ECF.
fluid along the PCT, DCT, CO2 CO2 CO2
and collecting system 
H2O Carbonic anyhydrase converts
Carbonic CO2 and water to carbonic
anhydrase acid, which then dissociates.
H2CO3
HCO3 HCO3 H H The hydrogen ions are actively

transported into the ECF,
Cl Cl accompanied by the diffusion
of chloride ions.
HCO3 is pumped into the

tubular fluid in exchange for
chloride ions that will diffuse
into the ECF.
Figure 24.7 4
Module 24.7 Review
a. Describe metabolic acidosis.
b. Describe metabolic alkalosis.
c. lf the kidneys are conserving HCO3– and

eliminating H+ in acidic urine, which is
occurring: metabolic alkalosis or metabolic
acidosis?

CLINICAL MODULE 24.8: Respiratory
acid-base disorders
• Respiratory acid-base disorders
• Respiratory acidosis
• CO2 generation outpaces rate of CO2 elimination at lungs
• Shifts bicarbonate buffer system toward generating more
carbonic acid
• H2O + CO2  H2CO3  H+ + HCO3–
• HCO3– goes into bicarbonate reserve
• H+ must be neutralized by any of the buffer systems
• Respiratory (increased respiratory rate)
• Renal (H+ secreted and HCO3– reabsorbed)
• Proteins (bind free H+)

The events in respiratory acidosis
CARBONIC ACID–BICARBONATE
BUFFER SYSTEM BICARBONATE RESERVE

Lungs
When respiratory activity does not keep As bicarbonate ions and hydrogen ions To limit the pH effects of
pace with the rate of CO2 generation, are released through the dissociation of respiratory acidosis, the excess
carbonic acid, the excess bicarbonate H must either be tied up by
alveolar and plasma PCO2 increases.
ions become part of the bicarbonate other buffer systems or excreted
This upsets the equilibrium and drives at the kidneys. The underlying
the reaction to the right, generating reserve.
problem, however, cannot be
additional H2CO3, which releases H eliminated without an increase in
and lowers plasma pH. the respiratory rate.
Figure 24.8 1
Responses to Acidosis
The integrated homeostatic responses
Respiratory compensation
to respiratory acidosis
Stimulation of arterial and CSF
chemoreceptors results in
Increased increased respiratory rate.
PCO2
Renal compensation
H ions are secreted and
HCO3 ions are generated. Combined Effects
Respiratory Acidosis Decreased PCO2
Buffer systems other than the
Elevated PCO2 results carbonic acid–bicarbonate Decreased H and
in a fall in plasma pH system accept H ions. increased HCO3
HOMEOSTASIS HOMEOSTASIS
DISTURBED RESTORED
Hypoventilation
HOMEOSTASIS Plasma pH
causing increased PCO2 Start returns to normal
Normal acid-
base balance
Figure 24.8 2
CLINICAL MODULE 24.8: Respiratory
acid-base disorders
• Respiratory alkalosis
• CO2 elimination at lungs outpaces CO2 generation rate
• Shifts bicarbonate buffer system toward generating more
carbonic acid
• H+ + HCO3–  H2CO3  H2O + CO2
• H+ removed as CO2 exhaled and water formed
• Buffer system responses
• Respiratory (decreased respiratory rate)
• Renal (HCO3– secreted and H+ reabsorbed)
• Proteins (release free H+)

The events in respiratory alkalosis
CARBONIC ACID–BICARBONATE
BUFFER SYSTEM BICARBONATE RESERVE

Lungs
If respiratory activity exceeds the rate of CO 2 As bicarbonate ions and hydrogen

generation, alveolar and plasma P CO2 decline, ions are removed in the formation of
carbonic acid, the bicarbonate ions—
and this disturbs the equilibrium and drives
but not the hydrogen ions—are
the reactions to the left, removing H  and
replaced by the bicarbonate reserve.
elevating plasma pH.
Figure 24.8 3
The integrated homeostatic responses to
respiratory alkalosis
HOMEOSTASIS
HOMEOSTASIS Start HOMEOSTASIS
DISTURBED Normal acid- RESTORED
base balance
Hyperventilation Plasma pH
causing decreased PCO2 returns to normal
Combined Effects
Respiratory Alkalosis Responses to Alkalosis
Increased PCO2
Lower PCO2 results Respiratory compensation
in a rise in plasma pH Inhibition of arterial and CSF Increased H and
chemoreceptors results in a decreased HCO3
decreased respiratory rate.
Renal compensation
Decreased H ions are generated and
PCO2 HCO3 ions are secreted.
Buffer systems other than the

carbonic acid–bicarbonate system
release H ions.
Figure 24.8 4
CLINICAL MODULE 24.8 Review
a. Define respiratory acidosis and respiratory

alkalosis.
b. What would happen to the plasma PCO2 of a patient

who has an airway obstruction?
c. How would a decrease in the pH of body fluids

affect the respiratory rate?

13 Fluid and Electrolyte Balance

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24

© 2011 Pearson Education, Inc.

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• Fluids constitute ~50%–60% of total body

Total body composition of adult males and females

Solids 40% Other

Total body composition of adult females

Proteins Lipids Minerals Carbohydrates Miscellaneous

• Digestive secretions are reabsorbed similarly to ingested

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The digestive tract sites of water gain

Gastric secretions 1500 mL

Colonic mucous secretions

• ICF and ECF compartments balance

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Metabolic Water lost in

Plasma membranes Water lost in urine

Intracellular Extracellular The ECF and ICF are in

ECF water loss Water loss from ECF

An osmotic water shift

a. Identify routes of fluid loss from the body.

b. Describe a fluid shift.

c. Explain dehydration and its effect on the

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© 2011 Pearson Education, Inc.

Ion pool in body fluids

a. Define mineral balance.

b. Identify the significance of two important body

c. Identify the ions absorbed by active transport.

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• Sodium balance (when sodium gains equal losses)

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Osmoreceptors Water loss reduces

• Sodium balance (continued)

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• Sodium balance (continued)

Rising ECF volume by fluid Falling ECF

a. What effect does inhibition of osmoreceptors have

b. What effect does aldosterone have on sodium ion

c. Briefly summarize the relationship between sodium

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© 2011 Pearson Education, Inc.

The potassium ion

KEY The sodium ions are then pumped out

Under normal conditions, the

© 2011 Pearson Education, Inc.

© 2011 Pearson Education, Inc.

a. Define hypokalemia and hyperkalemia.

b. What organs are primarily responsible for

c. Identify factors that cause potassium excretion.

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• Acid-base balance (H+ production = loss)

The kidneys play a major

Buffer systems can

• Classes of acids (continued)

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The pH of the ECF

When the pH of plasma falls below When the pH of plasma rises

• CO2 partial pressure effects on pH

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If PCO2 rises If PCO2 falls

H2O  CO2 H2CO3 H  HCO3 H  HCO3 H2CO3 H2O  CO2

© 2011 Pearson Education, Inc.