Fluid and Electrolyte

Imbalance.

Course Teacher:

Dr Suguna Rao
Professor
Dept of Vet. pathology
Speaker: Shravankumar Gaddi
MVHK 1040

Water

Sources

of water

Preformed

water - water taken into body as liquids and

contained in solid foods

Water

of oxidation - water derived from oxidation of

foods to carbon dioxide and water
a.Continues to be formed from endogenous
sources even though no exogenous water
might be available
b.Produces about 12 ml of water from the
metabolism of each 100 calories.

Fluid

compartments of the body

Intracellular

water - consists of approximately 50%

of the body weight

Extracellular

water - 20% of body weight and is

further divided into:
a.Interstitial water - 15%; water in the
tissues between the vascular spaces and
the cells
b.Intravascular water - 5%

Major body fluid compartments and the membranes

that separate these compartments.

Transcellular
This

fluid.

compartment includes fluid in the

synovial,
peritoneal,
pericardial,
intraocular spaces and cerebrospinal fluid.

Water

lost from body - boundary organs

Kidneys

- urine accounts for slightly more than half

the total fluid output of the body

Lungs
Skin

- perspiration

Gastrointestinal

saliva

tract - minimal loss in feces and

Major sources of water intake and output.

Electrolytes

Electrolytes

- substances that become

ionized when placed in water.

Cations

of plasma and interstitial fluid

Sodium - chief cation of the plasma and
interstitial fluid
Potassium Small amount
Calcium
Magnesium

Cations

of the intracellular fluid

Potassium
chief
cation
of
the
intracellular fluid
Sodium - small amount
Calcium
Magnesium - relatively large concentration

Anions

of plasma and interstitial fluid

Chloride - chief anion of plasma and interstitial
fluid
Bicarbonate
Phosphate
Sulfate
Organic acids
Proteinate - the significant difference between the
plasma and the interstitial fluid is the much greater
quantity of proteinate contained in the plasma

Anions

of intracellular fluid
Phosphate chief anion of intracellular
fluid
Chloride
Bicarbonate
Sulfate
Proteinate

The

total concentration of cations always

equals that of the anions in all fluids.

milliequivalent is the number of grams

of solute contained in 1 cc of a normal
solution, and thus can combine equally
with a similar portion of another normal
solution.

Major cations and anions of the intracellular

and extracellular fluids.

Concentration of cations and anions.

Conc of cations and anions

Normal blood electrolytes

Nonelectrolytes of the plasma.

Osmosis

is the net diffusion of water across a selectively permeable

membrane from a region of high water concentration to one that has a
lower water concentration.

The

total number of particles in a solution is measured in osmoles.

One

osmole (osm) is equal to 1 mole (mol) (6.02 1023) of solute

particles.

If

a molecule dissociates into two ions (giving two particles), such as

sodium chloride ionizing to give chloride and sodium ions, then a
solution containing 1 mol/L will have an osmolar concentration of 2
osm/L.

milliosmole

(mOsm), which equals 1/1000 osmole, is commonly used.

Using

van't Hoff's law, one can calculate the potential

osmotic pressure of a solution, assuming that the cell
membrane is impermeable to the solute.

For

example, the osmotic pressure of a 0.9 percent sodium

chloride solution is calculated as follows:
A 0.9 percent solution means that there is 0.9 gram of
sodium chloride per 100 milliliters of solution, or 9 g/L.
Because the molecular weight of sodium chloride is 58.5
g/mol, the molarity of the solution is 9 g/L divided by 58.5
g/mol, or about 0.154 mol/L.
Because each molecule of sodium chloride is equal to 2
osmoles, the osmolarity of the solution is 0.154 2, or
0.308 osm/L. Therefore, the osmolarity of this solution is
308 mOsm/L. The potential osmotic pressure of this
solution would therefore be 308 mOsm/L 19.3 mm
Hg/mOsm/L, or 5944 mm Hg.

Regulation

of extracellular fluid osmolarity

and sodium concentration are closely
linked because sodium is the most
abundant
ion
in
the
extracellular
compartment.
Estimating
Plasma
Osmolarity
from
Plasma Sodium Concentration

Osmolar Substances in Extracellular,

Intracellular Fluids and plasma.

Basic renal-body fluid feedback mechanism for control of blood

volume, extracellular fluid volume, and arterial pressure.

Summary

of Tubule CharacteristicsUrine Concentration

0, minimal level of active transport or permeability;

+, moderate level of active transport or permeability;
++, high level of active transport or permeability;
+ADH, permeability to water or urea is increased by ADH

Formation of a concentrated urine when

antidiuretic hormone (ADH) levels are high.

Formation of dilute urine when antidiuretic

hormone (ADH) levels are very low

Two primary systems are especially involved in regulating the

concentration of sodium and osmolarity of extracellular fluid:
(1) Osmoreceptor-ADH system
(2) Thirst mechanism

Osmoreceptor-ADH

Feedback System

Regulation

of ADH Secretion

Mechanisms and consequences of ADH release

Control

of Thirst

The thirst mechanism

Abnormality

Cause

Plasma
Na+
Concent
ration

Extracel
lular
Fluid
Volume

Intracel
lular
Fluid
Volume

Hyponatremia
dehydration

Adrenal insufficiency;
overuse of diuretics

Hyponatremia
overhydration

Excess ADH ;
bronchogenic tumors

Hypernatremia Diabetes insipidus;

dehydration
excessive sweating

Hypernatremia Cushing's disease;

overhydration Primary aldosteronism

Abnormalities of Body Fluid Volume

Regulation

Edema:

Excess Fluid in the Tissues

Presence of excess fluid in the body
tissues.
Intracellular

Edema

Hyponatremia
Depression

of the metabolic systems of

the tissues
Lack of adequate nutrition to the cells

Extracellular

Edema
Abnormal leakage of fluid from the plasma
to the interstitial spaces across the
capillaries.
Failure of the lymphatics to return fluid
from the interstitium back into the blood,
called lymphedema.

Increased

capillary pressure
A. Excessive kidney retention of salt and water
1. Acute or chronic kidney failure
2. Mineralocorticoid excess
B. High venous pressure and venous constriction
1. Heart failure
2. Venous obstruction
3. Failure of venous pumps
(a) Paralysis of muscles
(b) Immobilization of parts of the body
(c) Failure of venous valves
C. Decreased arteriolar resistance
1. Excessive body heat
2. Insufficiency of sympathetic nervous system
3. Vasodilator drugs

Decreased

plasma proteins
A. Loss of proteins in urine (nephrotic
syndrome)
B. Loss of protein from denuded skin areas
1. Burns
2. Wounds
C. Failure to produce proteins
1. Liver disease (e.g., cirrhosis)
2. Serious protein or caloric malnutrition

Increased

capillary permeability
A. Immune reactions that cause release of
histamine and other immune products
B. Toxins
C. Bacterial infections
D. Vitamin C deficiency
E. Prolonged ischemia
F. Burns

Blockage

of lymph return
A. Cancer
B. Infections (e.g., filaria nematodes)
C. Surgery
D. Congenital absence or abnormality of
lymphatic vessels

Acid-base balance

Precise

H+ regulation is essential because the

activities of almost all enzyme systems in
the body are influenced by H+ concentration.

0.00004

mEq/L

The

precision with which H+ is regulated

emphasizes its importance to the various cell
functions.

H+ Concentration Is Precisely Regulated

Molecules

containing hydrogen atoms that can

release hydrogen ions in solutions are
referred to as acids.
Carbonic acid (H2CO3) ionizes in water to
form H+ and bicarbonate ions (HCO3-).
A

base is an ion or a molecule that can accept

an H+.
Bicarbonate ion HCO3- is a base because it
can combine with H+ to form H2CO3.

Most

acids and bases in the extracellular

fluid that are involved in normal acid-base
regulation are weak acids and bases.

The

most important ones are H2CO3 and

HCO3- base.

Express

H+ concentration on a logarithm
scale, using pH units

pH

The pH scale and pH values of representative substances.

pH and H+ Concentration of Body

Fluids

Three

primary systems regulate the H+ concentration in

the body fluids to prevent acidosis or alkalosis:

The

chemical acid-base buffer systems of the body

fluids, which immediately combine with acid or base to
prevent excessive changes in H+ concentration;
The respiratory center, which regulates the removal of
CO2 (and, therefore, H2CO3) from the extracellular
fluid; and
The kidneys, which can excrete either acid or alkaline
urine, thereby readjusting the extracellular fluid H+
concentration toward normal during acidosis or alkalosis.

buffer is any substance that can

reversibly bind H+ and prevent change in
pH under limited conditions.

The

state of acid-base balance or imbalance of the extracellular fluid

depends primarily upon the relative quantities of carbonic acid and
base bicarbonate present in the extracellular fluid.

Normally

these are present in a ratio of 1 part of carbonic acid to 20

parts of bicarbonate.

When

this ratio is disturbed, the acid-base balance is also upset, and

there is a deviation from the normal pH (7.35 to 7.45) of the body
fluid.

Other

buffer systems play only a minor role in the regulation of

acid-base balance
Monosodium phosphate:disodium phosphate system
Plasma protein system
Monopotassium phosphate:dipotassium phosphate system
Oxyhemoglobin:reduced hemoglobin system

The major body buffer

systems

Bicarbonate

Buffer System
(1) Weak acid, H2CO3, and
(2) Bicarbonate salt, such as NaHCO3.

When

a strong acid is added

When

a strong base is added

Henderson-Hasselbalch Equation

Titration curve for bicarbonate buffer system showing

the pH of extracellular fluid when the percentages of
buffer in the form of HCO3- and CO2 (or H2CO3) are
altered.

Phosphate

Buffer System
Plays a major role in buffering renal
tubular fluid and intracellular fluids.
The main elements of the phosphate
buffer system are H2PO-4 and HPO-24.

Proteins

Are Important Intracellular

Buffers
Hemoglobin (Hb) is also an important
buffer

Respiratory Regulation of AcidBase Balance

The

kidneys control acid-base balance by

excreting either acidic or basic urine.

Excreting

acidic urine (H+)reduces the

amount of acid in extracellular fluid.

Excreting

basic urine (HCO-3) removes

base from the extracellular fluid.

Renal Control of Acid-Base Balance

Reabsorption
of
bicarbonate
in
different segments of the renal tubule.

Reabsorption of filtered HCO3 is coupled to

H+ secretion.

Cellular mechanisms for

(1) active secretion of H+ into the renal tubule
(2) tubular reabsorption of by combination with H+ to
form carbonic acid, which dissociates to form carbon
dioxide and water
(3) sodium ion reabsorption in exchange for H+
secreted.

Primary active secretion of H+ through the luminal

membrane of the intercalated epithelial cells of the late
distal and collecting tubules.

Buffering of secreted H+ by filtered phosphate

NaHPO-4

Production and secretion of ammonium ion

(NH+4) by proximal tubular cells.

Buffering of hydrogen ion secretion

ammonia (NH3) in the collecting tubules.

by

Factors That Increase or Decrease H+ Secretion and

Reabsorption by the Renal Tubules

Characteristics of Primary Acid-Base Disturbances

Respiratory

Acidosis
Decreased Ventilation
Increased Pco2
Respiratory

Alkalosis
Increased Ventilation
Decreased Pco2
Metabolic

Acidosis
Decreased Extracellular Fluid HCO3 Concentration
Metabolic

Alkalosis
Increased Extracellular Fluid HCO 3 Concentration

Acid base categories and related conditions

Pathological

conditions that damage the respiratory

centers or that decrease the ability of the lungs to
eliminate CO2.
For example
Damage to the respiratory center in the medulla
oblongata
Obstruction of the passageways of the respiratory
tract, pneumonia, emphysema, or decreased
pulmonary membrane surface area
Any factor that interferes with the exchange of
gases between the blood and the alveolar air.

Respiratory Acidosis

Psychoneurosis
High

altitude

Respiratory Alkalosis

Renal

Tubular Acidosis
Chronic renal failure
Addison's disease
Hereditary and acquired disorders that
impair tubular function (Fanconi's syndrome)
Diarrhea
Vomiting of Intestinal Contents
Diabetes Mellitus
Ingestion of Acids

Metabolic Acidosis

Administration

of Diuretics (Except the

Carbonic Anhydrase Inhibitors)
Excess Aldosterone
Vomiting of Gastric Contents
Ingestion of Alkaline Drugs

Metabolic Alkalosis

Analysis of simple acid-base disorders.

Measure of arterial blood gases

The

"anion gap" (which is only a

diagnostic concept) is the difference
between
unmeasured
anions
and
unmeasured cations.

Thank you