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Chapter 15

Fluid and Acid-Base Balance

Human Physiology by Lauralee Sherwood 2007 Brooks/Cole-Thomson Learning


Balance Concept
Internal pool the quantity of any particular
substance in the ECF
If quantity is to remain stable within the body
Input must be balanced with output

Ingestion Excretion
Metabolic Metabolic
consumption consumption

Chapter 15 Fluid and Acid-Base Balance


Human Physiology by Lauralee Sherwood 2007 Brooks/Cole-Thomson Learning
Balance Concept
Input must equal output to maintain a stable balance
in ECT.
Positive balance exists when input exceeds
output
Negative balance exists when output exceeds
input
Input
Input of substances into plasma is poorly controlled or
not controlled
Eating habits are variable
Output
Compensatory adjustments usually occur on output
side by urinary excretion

Chapter 15 Fluid and Acid-Base Balance


Human Physiology by Lauralee Sherwood 2007 Brooks/Cole-Thomson Learning
Balance Concept

Chapter 15 Fluid and Acid-Base Balance


Human Physiology by Lauralee Sherwood 2007 Brooks/Cole-Thomson Learning
Fluid Balance
Water
Most abundant substance in body
Amount varies in different kinds of tissues
Content remains fairly constant within an individual
Minor ECF components
Lymph
Transcellular fluid
Cerebrospinal fluid
Intraocular fluid
Synovial fluid
Pericardial, intrapleural, and peritoneal fluids
Digestive juices

Chapter 15 Fluid and Acid-Base Balance


Human Physiology by Lauralee Sherwood 2007 Brooks/Cole-Thomson Learning
Classification of Body Fluids

Chapter 15 Fluid and Acid-Base Balance


Human Physiology by Lauralee Sherwood 2007 Brooks/Cole-Thomson Learning
Barriers Separating Body-Fluid Compartments

Barrier between plasma and interstitial fluid


Blood vessel walls
Barrier between ECF and ICF
Cellular plasma membranes
Major differences between ECF and ICF
Presence of cell proteins in ICF that cannot permeate
the cell membrane to leave the cells
Unequal distribution of Na+ and K+ and their attendant
ions as a result of the action of the membrane-bound
Na+ - K+ ATPase pump present in all cells

Chapter 15 Fluid and Acid-Base Balance


Human Physiology by Lauralee Sherwood 2007 Brooks/Cole-Thomson Learning
Ionic Composition of the Major Body-Fluid
Compartments

Chapter 15 Fluid and Acid-Base Balance


Human Physiology by Lauralee Sherwood 2007 Brooks/Cole-Thomson Learning
Fluid Balance
ECF serves as an intermediary between the cells
and external environment
Two factors are regulated to maintain fluid balance
in the body
ECF volume must be closely regulated to help
maintain blood pressure
Maintaining salt balance is very important in long-term
regulation of ECF volume
ECF osmolarity must be closely regulated to
prevent swelling or shrinking of cells
Maintaining water balance is very important in
regulating ECF osmolarity

Chapter 15 Fluid and Acid-Base Balance


Human Physiology by Lauralee Sherwood 2007 Brooks/Cole-Thomson Learning
Salt Balance
Very important in regulating ECF volume
Salt input occurs by ingestion
Often not well controlled
Salt balance maintained by outputs in urine
Salt also lost in perspiration and in feces
Kidneys keep salt constant in ECF
Glomerular filtration rate (GFR)
Tubular reabsorption of sodium

Chapter 15 Fluid and Acid-Base Balance


Human Physiology by Lauralee Sherwood 2007 Brooks/Cole-Thomson Learning
Daily Salt Balance

Chapter 15 Fluid and Acid-Base Balance


Human Physiology by Lauralee Sherwood 2007 Brooks/Cole-Thomson Learning
Osmolarity
Measure of the concentration of individual solute
particles dissolved in a fluid
Circumstances that result in a loss or gain of free
H2O lead to changes in ECF osmolarity
Deficit of free water in ECF
Osmolarity becomes hypertonic
Often associated with dehydration
Excess of free water in ECF
Osmolarity becomes hypotonic
Usually associated with overhydration

Chapter 15 Fluid and Acid-Base Balance


Human Physiology by Lauralee Sherwood 2007 Brooks/Cole-Thomson Learning
Osmolarity
Hypertonicity
Cells tend to shrink
Causes
Insufficient water intake
Excessive water loss
Diabetes insipidus
Symptoms and effects
Shrinking of brain neurons
Confusion, irritability, delirium, convulsions, coma
Circulatory disturbances
Reduction in plasma volume, lowering of blood pressure,
circulatory shock
Dry skin, sunken eyeballs, dry tongue

Chapter 15 Fluid and Acid-Base Balance


Human Physiology by Lauralee Sherwood 2007 Brooks/Cole-Thomson Learning
Osmolarity
Hypotonicity
Cells tend to swell
Causes
Patients with renal failure who cannot excrete a dilute urine
become hypotonic when they consume more water than
solutes
Can occur in healthy people when water is rapidly ingested
and kidneys do not respond quickly enough
When excess water is retained in body due to inappropriate
secretion of vasopressin
Symptoms and effects
Swelling of brain cells
Confusion, irritability, lethargy, headache, dizziness, vomiting,
drowsiness, convulsions, coma, death
Weakness (due to swelling of muscle cells)
Circulatory disturbances (hypertension and edema)
Water intoxication

Chapter 15 Fluid and Acid-Base Balance


Human Physiology by Lauralee Sherwood 2007 Brooks/Cole-Thomson Learning
H2O Input and Output
In order to maintain stable
water balance, water input
must equal water output.
Input
Drinking liquids
Eating solid foods
Metabolically produced
water
Output
Insensible loss
Lungs
Nonsweating skin
Sensible loss
Sweating
Feces
Urine excretion

Chapter 15 Fluid and Acid-Base Balance


Human Physiology by Lauralee Sherwood 2007 Brooks/Cole-Thomson Learning
Vasopressin
Produced by hypothalamus
Stored in posterior pituitary gland
Released on command from hypothalamus
Also location of thirst center
Hypothalamic osmoreceptors
Located near vasopressin-secreting cells and
thirst center
Osmolarity increase vasopressin secretion and
thirst stimulated
Osmolarity decrease vasopressin secretion
decreased and thirst suppressed
Chapter 15 Fluid and Acid-Base Balance
Human Physiology by Lauralee Sherwood 2007 Brooks/Cole-Thomson Learning
Vasopressin
Left atrial receptors
Monitor pressure of blood flowing through
(reflects ECF volume)
Upon detection of major reduction in arterial
pressure, receptors stimulate vasopressin
secretion and thirst
Upon detection of elevated arterial pressure,
vasopressin and thirst are both inhibited
Angiotensin II
Stimulates vasopressin secretion and thirst when
renin-angiotensin-aldosterone mechanism is
activated to conserve Na+

Chapter 15 Fluid and Acid-Base Balance


Human Physiology by Lauralee Sherwood 2007 Brooks/Cole-Thomson Learning
Nonregulatory Factors Not Linked to Vasopressin
and Thirst
Regulatory factors that do not link vasopressin and
thirst
Dryness of mouth stimulates thirst but not
vasopressin
Oral metering
Some animals will rapidly drink only enough H2O
to satisfy its H2O deficit
Mechanism is less effective in humans
Nonphysiologic influences on fluid intake
Fluid intake often influenced by habit and
sociological factors

Chapter 15 Fluid and Acid-Base Balance


Human Physiology by Lauralee Sherwood 2007 Brooks/Cole-Thomson Learning
Acid-Base Balance
Refers to precise regulation of free H+ concentration in body
fluids
Acids
Group of H+ containing substances that dissociate in
solution to release free H+ and anions
Bases
Substance that can combine with free H+ and remove it
from solution
pH
Designation used to express the concentration of H+
pH 7 neutral
pH less than 7 acidic
pH greater than 7 basic

Chapter 15 Fluid and Acid-Base Balance


Human Physiology by Lauralee Sherwood 2007 Brooks/Cole-Thomson Learning
pH

Chapter 15 Fluid and Acid-Base Balance


Human Physiology by Lauralee Sherwood 2007 Brooks/Cole-Thomson Learning
Comparison of pH Values of
Common Substances

Chapter 15 Fluid and Acid-Base Balance


Human Physiology by Lauralee Sherwood 2007 Brooks/Cole-Thomson Learning
Acid-Base Balance
Arterial pH less than 6.8 or greater than 8.0 is not
compatible with life
Acidosis
Exists when blood pH falls below 7.35
Alkalosis
Occurs when blood pH is above 7.45

Chapter 15 Fluid and Acid-Base Balance


Human Physiology by Lauralee Sherwood 2007 Brooks/Cole-Thomson Learning
Acid-Base Balance
Consequences of fluctuations in pH
Changes in excitability of nerve and muscle cells
Marked influence on enzyme activity
Changes influence K+ levels in body
Sources of H+ in the body
Carbonic acid formation
Inorganic nutrients produced during breakdown of
nutrients
Organic acids resulting from intermediary
metabolism

Chapter 15 Fluid and Acid-Base Balance


Human Physiology by Lauralee Sherwood 2007 Brooks/Cole-Thomson Learning
Lines of Defense Against pH Changes
Chemical buffer systems
Respiratory system
Kidneys

Chapter 15 Fluid and Acid-Base Balance


Human Physiology by Lauralee Sherwood 2007 Brooks/Cole-Thomson Learning
Chemical Buffer Systems
Minimize changes in pH by binding with or yielding
free H+
First line of defense
Body has four buffer systems
H2CO3-, HCO3- buffer system
Primary ECF buffer for noncarbonic acids
Protein buffer system
Primary ICF buffer; also buffers ECF
Hemoglobin buffer system
Primary buffer against carbonic acid changes
Phosphate buffer system
Important urinary buffer; also buffers ICF

Chapter 15 Fluid and Acid-Base Balance


Human Physiology by Lauralee Sherwood 2007 Brooks/Cole-Thomson Learning
Respiratory System
Second line of defense again changes in pH
Acts at a moderate speed
Regulates pH by controlling rate of CO2 removal

Chapter 15 Fluid and Acid-Base Balance


Human Physiology by Lauralee Sherwood 2007 Brooks/Cole-Thomson Learning
Kidneys
Third line of defense against change in hydrogen ion
concentration
Kidneys require hours to days to compensate for
changes in body-fluid pH
Control pH of body fluids by adjusting
H+ excretion
HCO3- excretion
Ammonia secretion

Chapter 15 Fluid and Acid-Base Balance


Human Physiology by Lauralee Sherwood 2007 Brooks/Cole-Thomson Learning
Acid-Base Imbalances
Can arise from either respiratory dysfunction or
metabolic disturbances
Deviations divided into four general categories
Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis

Chapter 15 Fluid and Acid-Base Balance


Human Physiology by Lauralee Sherwood 2007 Brooks/Cole-Thomson Learning
Respiratory Acidosis
Result of abnormal CO2 retention arising from hypoventilation
Possible causes
Lung disease
Depression of respiratory center by drugs or disease
Nerve or muscle disorders that reduce respiratory muscle
activity
Holding breath
Compensations
Chemical buffers immediately take up additional H+
Kidneys are most important in compensating for
respiratory acidosis

Chapter 15 Fluid and Acid-Base Balance


Human Physiology by Lauralee Sherwood 2007 Brooks/Cole-Thomson Learning
Respiratory Alkalosis
Primarily due to excessive loss of CO2 from body as result of
hyperventilation
Possible causes
Fever
Anxiety
Aspirin poisoning
Physiologic mechanisms at high altitude
Compensations
Chemical buffer systems liberate H+
If situation continues a few days, kidneys compensate by
conserving H+ and excreting more HCO3-

Chapter 15 Fluid and Acid-Base Balance


Human Physiology by Lauralee Sherwood 2007 Brooks/Cole-Thomson Learning
Metabolic Acidosis
Includes all types of acidosis other than those caused by
excess CO2 in body fluids
Causes
Severe diarrhea
Diabetes mellitus
Strenuous exercise
Uremic acidosis
Compensations
Buffers take up extra H+
Lungs blow off additional H+ generating CO2
Kidneys excrete more H+ and conserve more HCO3-

Chapter 15 Fluid and Acid-Base Balance


Human Physiology by Lauralee Sherwood 2007 Brooks/Cole-Thomson Learning
Metabolic Alkalosis
Reduction in plasma pH caused by relative
deficiency of noncarbonic acids
Causes
Vomiting
Ingestion of alkaline drugs
Compensations
Chemical buffer systems immediately liberate H+
Ventilation is reduced
If condition persists for several days, kidneys
conserve H+ and excrete excess HCO3- in the
urine
Chapter 15 Fluid and Acid-Base Balance
Human Physiology by Lauralee Sherwood 2007 Brooks/Cole-Thomson Learning