Fluid & Electrolytes

Homeostasis
homeostasis- state of equilibrium in the internal
environment of the body, naturally maintained by
adaptive responses that promote healthy survival.
Water content of the body
Water accounts for 50-60% of body weight in the adult.
The percentage of body weight is greater in men than women
because men have more lean body mass.
body fluid compartments:
intracellular space- inside the cell
2/3 of body water located inside cells is called intracellular fluid

extracellular space- outside the cells

Extracellular fluid- interstitial fluid (fluid in the interstitium, lymph,
plasma, and small amounts of CSF, GI fluid, and pleural, synovial,
peritoneal, intraocular, and pericardial fluid.
Transcellular fluid- fluid in specialized cavities.

Electrolytes
electrolytes- substances whose molecules disassociate, or
split into ions, when placed in water.
ions- electrically charged particles
cations- positively charged ions Na+, K+, Ca2+, Mg2+.
anions- negatively charged ions HCO3-, Cl-, PO43-.
proteins have a negative charge and are thus anions.
Valence- the degree of combining power of an ion.
Measurement of electrolytes
mEq is how we measure electrolytes.
Electrolytes are active chemicals that unite in carying
combinations. Iy is more practical to express their
concentration as a measure of chemical activity rather than
a measure of weight.
Electrolyte Composition of Fluid Compartments
Electrolyte composition varies between ICF & ECF.
ECF-Main cation is Na+, small amounts of K+, Ca2+, and
Mg2+.
ECF-Main anions are Cl-, small amounts of HCO3, SO4-,
PO4-.
ICF- Main cation is K+, with small amounts of Mg2+ and
Na+.
ICF- Main anion is PO4, with some protein and a small
amount of HCO3-.
Mechanisms controlling fluid and electrolyte movement
Diffusion- movement of molecules from an area of high
concentration to one of low concentration.
liquids, gasses, solids.
simple diffusion requires no external energy.
Facilitated Diffusion- movement of molecules from an area of
high concentration to one of low concentration
requires no energy other than the concentration gradient.
Glucose into a cell.
Active Transport- Molecules move against the concentration
gradient.
 External energy is required.
Na+, K+ pump is an example.
Osmosis- Movement of water between two compartments
separated by a semipermeable membrane where water
moves from an area of low solute concentration to high
solute concentration.
Osmotic Pressure- the amount of pressure that is required
to stop the osmotic flow of water.
Osmolarity- A measure of the total solute concentration per
liter of solution.
Osmolality- A measure of the total solute concentration per
kg of solvent.
Isotonic- Fluids with the same osmolality.
Hypotonic- Solutions with solutes less concentrated than
the cells.
Hypertonic- Solutions with solutes more concentrated than
the cells.
Hydrostatic Pressure- for within a fluid compartment.
Oncotic Pressure- Osmotic pressure exerted by colloids in
solution.
Fluid movement in capillaries
direction of movement is determined by
capillary hydrostatic pressure
plasma oncotic pressure
interstitial hydrostatic pressure
interstitial oncotic pressure
 capillary hydrostatic pressure and interstitial oncotic pressure
move water out of the capillaries
plasma oncotic pressure and interstitial hydrostatic pressure
move fluid into the capillaries
Edema occurs when venous hydrostatic pressure rises, plasma
oncotic pressure decreases, or interstitial oncotic pressure
rises.
Fluid spacing
first spacing- describes more distribution of fluid in the ICF
and ECF compartments.
second spacing- abnormal fluid accumulation if interstitial
fluid (edema)
third spacing- occurs when fluid accumulates in a portion of
the body (transcellular fluid) from which it is not easily
exchanged with the rest of the ECF. This fluid is not
available for functional use.

Regulation of Water Balance

Hypothalamic Regulation
Fluid deficit or increase in plasma osmolality is sensed by
osmoreceptors in the hypothalamus which stimulate thirst
and antidiuretic hormone release.
Pituitary Regulation
The posterior pituitary releases ADH, which regulates water
retention by the kidneys.
ADH can also be released by stress, nausea, nicotine, and
morphine.
 Syndrome of inappropriate antidiuretic hormone secretion
(SIADH) causes- abnormal ADH production in CNS
disorders.
Adrenal Cortical Regulation
Glucocorticoids and mineralocorticoids secreted by the
adrenal cortex help regulate both water and electrolytes.
Renal Regulation
primary organ for water and electrolyte balance is the kidneys.
adjust urine volume
Cardiac Regulation
ANP and BNP natural antagonist of RAAS.
produced in response to increased arterial pressure and
high sodium levels.
Gastrointestinal Regulation
Daily H2O intake is between 2000-3000mL.
Insensible water loss
vaporization from the lungs and skin assists in regulating body
temperature.

Extracellular fluid imbalances

ECF volume deficit (hypovolemia) and ECF volume
excess (hypervolemia) typically accompanied by one or
more electrolyte imbalances, particularly changes in
serum Na+.
Fluid volume deficit
occurs with abnormal loss of body fluids, inadequate intake, or
a shift of fluid from plasma into interstitial
 Treatment of fluid vol. deficit
replace both water and any needed electrolytes.

Fluid volume Excess

Results from excessive intake of fluids, abnormal retention of
fluids (CHF, renal failure), or shift of fluid from interstitial
fluid into plasma.
Result in changes to intravascular volume.
treatment for fluid vol. excess
removal of fluid without producing abnormal changes in the electrolyte
composition or osmolality of ECF.
Diuretics and fluid restriction primary therapy
Restricted Na+ intake.