Fluid and Electrolyte Balance

1. Fluid and Electrolyte Balance Muse Lecture #9 6/28/12

2. Fluid, Electrolyte, and Acid–Base Balance • Fluid Balance • Is a daily balance between • Amount of water gained • Amount of water lost to environment • Involves regulating content and distribution of body water in ECF and ICF

3. Fluid, Electrolyte, and Acid–Base Balance • The Digestive System • Is the primary source of water gains • Plus a small amount from metabolic activity • The Urinary System • Is the primary route of water loss

4. Fluid, Electrolyte, and Acid–Base Balance • Electrolytes • Are ions released through dissociation of inorganic compounds (Na+ , K+, Cl-, CO3- ) • Can conduct electrical current in solution • Electrolyte balance • When the gains and losses of all electrolytes are equal • Primarily involves balancing rates of absorption across digestive tract with rates of loss at kidneys and sweat glands

5. Fluid, Electrolyte, and Acid–Base Balance • Acid–Base Balance • Precisely balances production and loss of hydrogen ions (pH) • The body generates acids during normal metabolism • Tends to reduce pH

6. Fluid, Electrolyte, and Acid–Base Balance • The Kidneys • Secrete hydrogen ions into urine • Generate buffers that enter bloodstream • In distal segments of distal convoluted tubule (DCT) and collecting system • The Lungs • Affect pH balance through elimination of carbon dioxide

7. Fluid Compartments • Water Exchange • Water exchange between ICF and ECF occurs across plasma membranes by • Osmosis • Diffusion • Carrier-mediated transport

8. Body Fluid Compartments • In lean adults, body fluids constitute 55% of female and 60% of male total body mass • Intracellular fluid (ICF) inside cells • About 2/3 of body fluid • Extracellular fluid (ECF) outside cells • Interstitial fluid between cell is 80% of ECF • Plasma in blood is 20% of ECF • Also includes lymph, cerebrospinal fluid, synovial fluid, aqueous humor, vitreous body, endolymph, perilymph, and pleural, pericardial, and peritoneal fluids

9. Body Fluid Compartments

10. Daily Water Gain and Loss

11. Fluid Compartments • Major Subdivisions of ECF • Interstitial fluid of peripheral tissues • Plasma of circulating blood

12. Fluid Compartments • Minor Subdivisions of ECF • Lymph, perilymph, and endolymph • Cerebrospinal fluid (CSF) • Synovial fluid • Serous fluids (pleural, pericardial, and peritoneal) • Aqueous humor

13. Fluid Compartments Figure 27–1a The Composition of the Human Body.

14. Fluid Compartments Figure 27–1a The Composition of the Human Body.

15. Fluid Movement • Edema • The movement of abnormal amounts of water from plasma into interstitial fluid

16. Regulation of body water gain Mainly by volume of water intake/ how much you drink Dehydration – when water loss is greater than gain Decrease in volume, increase in osmolarity of body fluids Stimulates thirst center in hypothalamus

17. Regulation of water and solute loss • Elimination of excess body water through urine • Extent of urinary salt (NaCl) loss is the main factor that determines body fluid volume • Main factor that determines body fluid osmolarity is extent of urinary water loss • 3 hormones regulate renal Na+ and Cl- reabsorption (or not) • Angiotensin II and aldosterone promote urinary Na+ and Cl- reabsorption of (and water by osmosis) when dehydrated • Atrial natriuretic peptide (ANP) promotes excretion of Na+ and Cl- followed by water excretion to decrease blood volume

18. Fluid Compartments • An Overview of the Primary Regulatory Hormones • Affecting fluid and electrolyte balance: • Antidiuretic hormone • Aldosterone • Natriuretic peptides

19. Fluid Compartments • ADH Production • Osmoreceptors in hypothalamus • Monitor osmotic concentration of ECF • Change in osmotic concentration • Alters osmoreceptor activity • Osmoreceptor neurons secrete ADH

20. Major hormone regulating water loss is antidiuretic hormone (ADH) • Also known as vasopressin • Produced by hypothalamus, released from posterior pituitary • Promotes insertion of aquaporin-2 into principal cells of collecting duct • Permeability to water increases • Produces concentrated urine

21. Hormonal Regulation of Na+ and Cl-

22. Fluid Compartments • Aldosterone • Is secreted by suprarenal cortex in response to • Rising K+ or falling Na+ levels in blood • Activation of renin–angiotensin system • Determines rate of Na+ absorption and K+ loss along DCT and collecting system

23. Fluid Compartments • “Water Follows Salt” salt pumps in PCT and ALOH • High aldosterone plasma concentration • Causes kidneys to conserve salt • Conservation of Na+ by aldosterone • Also stimulates water retention

24. Concentrations in body fluids • Concentration of ions typically expressed in milliequivalents per liter (mEq/liter) • Na+ or Cl- number of mEq/liter = mmol/liter • Ca2+ or HPO42- number of mEq/liter = 2 x mmol/liter • Chief difference between 2 ECF compartments (plasma and interstitial fluid) is plasma contains many more protein anions • Largely responsible for blood colloid osmotic pressure

25. Fluid Movement

26. ICF differs considerably from ECF • ECF most abundant cation is Na+, anion is Cl- • ICF most abundant cation is K+, anion are proteins and phosphates (HPO42-) • Na+ /K+ pumps play major role in keeping K+ high inside cells and Na+ high outside cell

27. Electrolyte and protein anion concentrations

28. Electrolytes in body fluids • Ions form when electrolytes dissolve ad dissociate • 4 general functions • Control osmosis of water between body fluid compartments • Help maintain the acid-base balance • Carry electrical current • Serve as cofactors

29. Sodium Na+ • Most abundant ion in ECF • 90% of extracellular cations • Plays pivotal role in fluid and electrolyte balance because it account for almost half of the osmolarity of ECF • Level in blood controlled by • Aldosternone – increases renal reabsorption • ADH – if sodium too low, ADH release stops • Atrial natriuretic peptide – increases renal excretion

30. Potassium K+ • Most abundant cations in ICF • Key role in establishing resting membrane potential in neurons and muscle fibers • Also helps maintain normal ICF fluid volume • Helps regulate pH of body fluids when exchanged for H+ • Controlled by aldosterone – stimulates principal cells in renal collecting ducts to secrete excess K+

31. Chloride Cl- • Most prevalent anions in ECF • Moves relatively easily between ECF and ICF because most plasma membranes contain Cl- leakage channels and antiporters • Can help balance levels of anions in different fluids • Chloride shift in RBCs • Regulated by • ADH – governs extent of water loss in urine • Processes that increase or decrease renal reabsorption of Na+ also affect reabsorption of Cl-

32. Bicarbonate HCO3- • Second most prevalent extracellular anion • Concentration increases in blood passing through systemic capillaries picking up carbon dioxide • Carbon dioxide combines with water to form carbonic acid which dissociates • Drops in pulmonary capillaries when carbon dioxide exhaled • Chloride shift helps maintain correct balance of anions in ECF and ICF • Kidneys are main regulators of blood HCO3- • Can form and release HCO3- when low or excrete excess

33. Calcium Ca2+ • Most abundant mineral in body • 98% of calcium in adults in skeleton and teeth • In body fluids mainly an extracellular cation • Contributes to hardness of teeth and bones • Plays important roles in blood clotting, neurotransmitter release, muscle tone, and excitability of nervous and muscle tissue • Regulated by parathyroid hormone • Stimulates osteoclasts to release calcium from bone – resorption • Also enhances reabsorption from glomerular filtrate • Increases production of calcitrol to increase absorption for GI tract • Calcitonin lowers blood calcium levels

34. Phosphate • About 85% in adults present as calcium phosphate salts in bone and teeth • Remaining 15% ionized – H2PO4-, HPO42-, and PO43- are important intracellular anions • HPO42- important buffer of H+ in body fluids and urine • Same hormones governing calcium homeostasis also regulate HPO42- in blood • Parathyroid hormone – stimulates resorption of bone by osteoclasts releasing calcium and phosphate but inhibits reabsorption of phosphate ions in kidneys • Calcitrol promotes absorption of phosphates and calcium from GI tract

35. Magnesium • In adults, about 54% of total body magnesium is part of bone as magnesium salts • Remaining 46% as Mg2+ in ICF (45%) or ECF (1%) • Second most common intracellular cation • Cofactor for certain enzymes and sodium-potassium pump • Essential for normal neuromuscular activity, synaptic transmission, and myocardial function • Secretion of parathyroid hormone depends on Mg2+ • Regulated in blood plasma by varying rate excreted in urine

36. Acid-base balance • Major homeostatic challenge is keeping H+ concentration (pH) of body fluids at appropriate level • 3D shape of proteins sensitive to pH • Diets with large amounts of proteins produce more acids than bases which acidifies blood • Several mechanisms help maintain pH of arterial blood between 7.35 and 7.45 • Buffer systems, exhalation of CO2, and kidney excretion of H+

37. Acid–Base Balance Figure 27–6 The Basic Relationship between PCO2and Plasma pH.

38. Acid–Base Balance • Three Major Buffer Systems • Protein buffer systems: • Help regulate pH in ECF and ICF • Interact extensively with other buffer systems • Carbonic acid–bicarbonate buffer system: • Most important in ECF • Phosphate buffer system: • Buffers pH of ICF and urine

39. Acid–Base Balance Figure 27–7 Buffer Systems in Body Fluids.

40. Acid–Base Balance Figure 27–8 The Role of Amino Acids in Protein Buffer Systems.

41. Buffer systems • Act to quickly temporarily bind H+ • Raise pH but do not remove H+ • Most consist of weak acid and salt of that acid functioning as weak base • Protein buffer system • Most abundant buffer in ICF and blood plasma • Hemoglobin in RBCs • Albumin in blood plasma • Free carboxyl group acts like an acid by releasing H+ • Free amino group acts as a base to combine with H+ • Side chain groups on 7 of 20 amino acids also can buffer H+

42. Buffer Systems • Carbonic acid- bicarbonate buffer system • Based on bicarbonate ion (HCO3-) acting as weak base and carbonic acid (H2CO3) acting as weak acid • HCO3- is a significant anion in both ICF and ECF • Because CO2 and H2O combine to form this buffer system cannot protect against pH changes due to respiratory problems in which there is an excess or shortage of CO2 • Phosphate buffer system • Dihydrogen phosphate (H2PO4-) and monohydrogen phosphate (HPO42-) • Phosphates are major anions in ICF and minor ones in ECF • Important regulator of pH in cytosol

43. Acid–Base Balance • The Hemoglobin Buffer System • CO2 diffuses across RBC membrane • No transport mechanism required • As carbonic acid dissociates • Bicarbonate ions diffuse into plasma • In exchange for chloride ions (chloride shift) • Hydrogen ions are buffered by hemoglobin molecules

44. Exhalation of carbon dioxide • Increase in carbon dioxide in body fluids lowers pH of body fluids • Because H2CO3 can be eliminated by exhaling CO2 it is called a volatile acid • Changes in the rate and depth of breathing can alter pH of body fluids within minutes • Negative feedback loop

45. Acid–Base Balance • The Hemoglobin Buffer System • Is the only intracellular buffer system with an immediate effect on ECF pH • Helps prevent major changes in pH when plasma PCO2 is rising or falling

46. Acid–Base Balance • Carbonic Acid–Bicarbonate Buffer System • Carbon Dioxide • Most body cells constantly generate carbon dioxide • Most carbon dioxide is converted to carbonic acid, which dissociates into H+ and a bicarbonate ion • Is formed by carbonic acid and its dissociation products • Prevents changes in pH caused by organic acids and fixed acids in ECF

47. Acid–Base Balance Figure 27–9 The Carbonic Acid–Bicarbonate Buffer System

48. Acid–Base Balance • Phosphate Buffer System • Consists of anion H2PO4- (a weak acid) • Works like the carbonic acid–bicarbonate buffer system • Is important in buffering pH of ICF

49. Acid–Base Balance • Limitations of Buffer Systems • Provide only temporary solution to acid–base imbalance • Do not eliminate H+ ions • Supply of buffer molecules is limited

50. Acid–Base Balance • Renal Responses to Acidosis • Secretion of H+ • Activity of buffers in tubular fluid • Removal of CO2 • Reabsorption of NaHCO3