10/4/2019

DISTRIBUTION OF BODY FLUIDS

• INTRACELLULAR
– INSIDE THE CELL
Keseimbangan cairan • EXTRACELLULAR
– OUTSIDE THE CELL
dan elektrolit • INTRAVASCULAR
– INSIDE THE VESSELS (ARTERIES AND VEINS)
• INTERSTITIAL
– NOT IN THE CELL, NOT IN THE VESSELS
– BETWEEN THE CELL (contains LYMPH)
• TRANSCELLULAR
MODUL BS1 FK USAKTI – CSF, PLEURAL FLUID, INTRAOCCULAR, GI, PERITONEAL,
SYNOVIAL

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ELECTROLYTES IN BODY FLUIDS

BODY FLUID COMPARTMENTS • NORMAL VALUES
– SODIUM (Na+) 135–145 mEq/L
135–
– POTASSIUM (K+) 3.5 – 5.0 mEq/L
– IONIZED CALCIUM (Ca++) 4.5 – 5.5mg/dl
– BICARBONATE (HCO3) 22 – 26 mEq/L
– CHLORIDE (Cl--) 95 – 105mEq/L
– MAGNESIUM (Mg++) 1.5 – 2.5mEq/L
– PHOSPHATE (PO4---) 2.8 – 4.5mg/dl

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MEASUREMENTS OF
ELECTROLYTES VOCABULARY REVIEW
• mEq/L • ANIONS [-] Cl-, HCO3-, PO4 3-
– MILLIEQUIVALENTS PER LITER • CATIONS [+]; Na+, K+ Ca+, Mg
– THE NUMBER OF GRAMS OF A GIVEN • SOLUTE e.g. electrolyte
ELECTROLYTE DISSOLVED IN A LITER OF • SOLVENT e.g. water
PLASMA • DIFFUSION: random movement of solute
equalizes distribution of solute
• FILTRATION: water and ‘lytes move together
across membrane under pressure; capillaries
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VOCABULARY REVIEW
OSMOSIS
• OSMOSIS: movement of H2O across membrane
[less to more] to equalize ion concentration • MOVEMENT OF A SOLVENT (WATER)
• OSMOTIC PRESSURE: drawing power to H2O; ACROSS A SEMIPERMEABLE MEMBRANE
albumin pulls H2O into intravascular space
• ISOTONIC: same osmolarity as plasma; NS • MOVES FROM AN AREA OF LESSER
• HYPERTONIC: higher osmotic pressure – pulls SOLUTE CONCENTRATION
fluid from cells
(ELECTROLYTE) TO AN AREA OF
• HYPOTONIC: low osmotic pressure; 0.45% NS
moves fluid into cells GREATER SOLUTE CONTRATION
• HYDROSTATIC PRESSURE: determines direction
of filtration – high to low [capillaries]
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OSMOTIC PRESSURE
• THE DRAWING POWER OF WATER
– A HIGHLY CONCENTRATED FLUID HAS HIGH
OSMOTIC PRESSURE – DRAWS WATER TO IT
• WORKS TO ATTAIN EQUILIBRIUM (BALANCE)
• OSMOLARITY
– DESCRIBES THE CONCENTRATION OF
SOLUTIONS – THE NUMBER OF MOLECULES
PER LITER OF SOLUTION

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IV SOLUTIONS DIFFUSION
• ISOTONIC SOLUTIONS • RANDOM MOVEMENT OF A SOLUTE
– THE SAME CONCENTRATION (OSMOLARITY) AS
BLOOD PLASMA e.g. NS 0.9% no change; ↑volume (ELECTROLYTE, GAS) ACROSS A SEMI-
SEMI-
• HYPOTONIC SOLUTION PERMEABLE MEMBRANE
– A SOLUTION OF LOWER OSMOTIC PRESSURE –
LOWER CONCENTRATION OF SOLUTES THAN BLOOD – CREAM IN COFFEE
PLASMA e.g. ½ NS 0.45%, push fluid into cells – OXYGEN, CARBON DIOXIDE BETWEEN
• HYPERTONIC SOLUTION ALVEOLI AND BLOOD VESSELS
– A SOLUTION OF HIGHER OSMOTIC PRESSURE
(MORE CONCENTRATED THAN BLOOD PLASMA) e.g. • MOVES FROM AREAS OF HIGH CONCENTRATION
D5NS – pulls fluid from cells TO AN AREA OF LOWER CONCENTRATION
ACROSS A CONCENTRATION GRADIENT
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ACTIVE TRANSPORT
• REQUIRES METABOLIC ACTIVITY AND
USES ENERGY TO MOVE SUBSTANCES
ACROSS CELL MEMBRANES.
– ENABLES LARGER SUBSTANCES TO MOVE
INTO CELLS
– MOLECULES CAN ALSO MOVE TO AN AREA
OF HIGHER CONCENTRATION (UPHILL)
– SODIUM, POTASSIUM PUMP
• POTASSIUM PUMPED IN
• SODIUM PUMPED OUT
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FILTRATION
• WATER AND SUBSTANCES MOVE
TOGETHER ACROSS A MEMBRANE
BECAUSE OF FLUID PRESSURE
– OCCURS IN CAPILLARY BEDS
– MOVEMENT FROM AN AREA OF HIGHER
PRESSURE TO AN AREA OF LOWER
PRESSURE (HYDROSTATIC PRESSURE)
– B/P changes – e.g. hemorrhage, ICP
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REGULATION OF BODY FLUIDS

• HOMEOSTASIS IS MAINTAINED
THROUGH
– FLUID INTAKE
– HORMONAL REGULATION
– FLUID OUTPUT

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FLUID INTAKE FLUID INTAKE

• Thirst control center located in the • AVERAGE ADULT INTAKE
hypothalamus – 2200 – 2700 ml PER DAY
– Osmoreceptors monitor serum osmolarity • ORAL 1100 – 1400 ml PER DAY
– When osmolarity increases [blood more • SOLID FOODS 800 – 1000 ml PER DAY
concentrated] thirst sensation • OXIDATIVE METABOLISM – 300 ml PER DAY
• Salt increases serum osmolarity
– Protective against dehydration
• High glucose also increases serum osmolarity
– Symptoms of diabetes
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HORMONAL REGULATION
• ADH (ANTIDIURETIC HORMONE)
– STORED IN THE POSTERIOR PITUITARY AND
RELEASED IN RESPONSE TO SERUM
OSMOLARITY
– Prevents diuresis – saves water
– PAIN, STRESS, CIRCULATING BLOOD
VOLUME AFFECT THE RELEASE OF ADH
HORMONAL REGULATION
• RENIN
RENIN--ANGIOTENSIN
ANGIOTENSIN--ALDOSTERONE
– INITIATED BY A CHANGE IN RENAL PERFUSION
• RENIN, PRODUCED BY KIDNEYS, IS RELEASED IN
RESPONSE TO LOW PERFUSION RELATED TO A
DECREASE IN EXTRACELLULAR VOLUME
– RENIN PRODUCES ANGIOTENSIN I
– ANGIOTENSIN I QUICKLY COVERTED TO ANGIOTENSIN II
– ANGIOTENSIN II IS A POTENT selective
VASOCONSTRICTOR
– ALSO INCREASES RENAL PERFUSION

• ↑ IN ADH = ↓ IN URINE OUTPUT • ↑ blood flow to kidneys

• Stimulate release of Aldosterone
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HORMONAL REGULATION
HORMONAL REGULATION
• ALDOSTERONE
– ACTS ON THE DISTAL PROTION OF THE • ATRIAL NATRIURETIC PEPTIDE (ANP)
RENAL TUBLES TO INCREASE THE – ANP IS A HORMONE SECRETED FROM
REABSORPTION OF SODIUM AND THE ATRIAL CELLS OF THE HEART IN RESPONSE
SECRETION AND EXCRETION OF POTASSIUM TO ATRIAL STRETCHING AND AN INCREASE
AND HYDROGEN IN CIRCULATING BLOOD VOLUME
– WATER IS RETAINED BECAUSE SODIUM IS
– ANP acts as a diuretic, causes Na+ loss,
RETAINED
inhibits thirst decreased blood volume
– Sodium & water retained → restored blood
volume [protective] • Protective if blood volume high
• Not protective in cardiac disease [Na+ imbalance]
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FLUID OUTPUT REGULATION FLUID OUTPUT REGULATION

• ORGANS OF WATER LOSS • KIDNEYS
– MAJOR REGULATORY ORGANS OF FLUID
– KIDNEY BALANCE
– LUNGS • RECEIVE ABOUT 180 LITERS OF PLASMA TO
– SKIN FILTER EACH DAY
• 1200 – 1500 ml OF URINE PRODUCED EACH DAY
– GI TRACT • URINE VOLUME CHANGES RELATED TO
VARIATION ON THE AMOUNT AND TYPE OF
FLUIDS INGESTED
• Minimum volume of urine to excrete wastes [e.g.
urea] is about 400 ml/ day
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FLUID OUTPUT REGULATION FLUID OUTPUT REGULATION

• SKIN • LUNGS
– INSENSIBLE WATER LOSS – EXPIRE APPROXIMATELY 500 ml OF WATER
• OCCURS THROUGH THE SKIN AND LUNGS DAILY
– SENSIBLE WATER LOSS • INCREASE IN WATER LOSS RELATED TO
ADMINISTRATION OF OXYGEN
• EXCESS PERSPIRATION (CAN BE SENSIBLE OR
INSENSIBLE) • Clients on high O2 need extra fluids to compensate
– INSENSIBLE + SENSIBLE FLUID LOSS
THROUGH THE SKIN
– 500 – 600ml EACH DAY
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REGULATION OF
FLUID OUTPUT REGULATION ELECTROLYTES
• GI TRACT • MAJOR CATIONS IN BODY FLUIDS
– 3 – 6 LITERS OF ISOTONIC FLUID MOVES – SODIUM (Na+)
INTO THE GI TRACT AND THEN RETURNS TO – POTASSIUM (K+)
THE EXTRACELLULAR FLUID SPACE – CALCIUM (Ca++)
• Vomiting increases GI losses + electrolytes
– MAGNESIUM (Mg++)
– 200 ml OF FLUID IS LOST IN THE FECES
EACH DAY
• DIARRHEA CAN INCREASE THIS LOSS

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REGULATION OF REGULATION OF
ELECTROLYTES ACID--BASE BALANCE
ACID
• ANIONS • VOCABULARY
– CHLORIDE (Cl-) – BUFFER
• A SUBSTANCE THAT CAN EITHER ABSORB OR RELEASE A
– BICARBONATE (HCO3-) HYDROGEN ION (H+)
– PHOSPHATE (PO4---) – ARTERIAL pH REFLECTS THE CONCENTRATION
OF HYDROGEN IONS IN THE BLOOD
– THE pH SCALE
• MEASURES THE ACIDITY OR ALKALINITY OF A FLUID
• NORMAL RANGE FOR ARTERIAL BLOOD 7.35 – 7.45

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REGULATION OF REGULATION OF
ACID--BASE BALANCE
ACID ACID--BASE BALANCE
ACID
• BIOLOGICAL REGULATION OF Ph • PHYSIOLOGICAL: Lungs, Kidneys
– BUFFERING SYSTEMS – LUNGS Early response
• HYDROGEN IONS ARE ABSORBED OR RELEASED • ↑ HYDROGEN & CARBON DIOXIDE [acidosis]
BY THE CELLS Stimulates ↑ Respiratory rate, depth → exhaled
– SWITCH PLACES WITH POTASSIUM CO2
• HEMOGLOBIN
HEMOGLOBIN--OXYHEMOGLOBIN SYSTEM • ↓ Co2 & H+ [alkalosis] → retain CO2 by ↓RR
• CHLORIDE SHIFT WITHIN RBCs • EXAMPLES
– DIABETIC KETOACIDOSIS
– CO2 RETAINING PATIENTS WITH COPD
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Acid – Base Regulation - Kidneys

• Takes longer/lasts longer
– Hours to days
• Increased or decreased production of
Bicarb, excretion of H+ by ammonia
formation, phosphoric acid
THANK YOU
• Acid excess [acidosis] → reabsorption of
bicarb,
• Phosphate + H+ = H3PO4 and NH3-NH3- +
H+ = NH4 → excretion of H+, lowers acid

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