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Fluid and Electrolyte
Balance
M. Rasjad Indra
Laboratorium Ilmu FaalFK. UNIBRAW
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Body Fluid Compartment
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Body Fluid Volume
Intracellular 40 %
(42 liter in 70 kg
young adult)
Interstitial 15 %
(10.5 liter in 70 kg
young adult)
Plasma
5 %
(3.5 liter in 70 kg
young adult)
Transcellular 1-3 %
(Cerebrospinal) (Aqueous humor)
Extracellular 20 %
(14 liter in 70 kg
young adult)
Body fluid
60% (45-75) water
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Electrolyte Composition of Body Fluid
Electrolytes Plasma(mEq/L)
Interstitial Fluid(mEq/Kg H2O)
IntracellularFluid (mEq/Kg
H2O)
Cation:
Na+ 142 145 10
K+ 4 4 159Ca2+ 5 3 1
Mg2+ 2 2 40
Total 153 154 210
Anion:
Cl- 103 117 3HCO3- 25 28 7
Protein 17 - 45
Others 8 9 155
Total 153 154 210
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Daily Intake and Output of Water(in ml/day)
Normal Prolonged
Heavy Exercise
Intake
Fluid ingested 2100 ?
From metabolism 200 200Total intake 2300 ?
Output
Insensible-Skin 350 350
Insensible-Lungs 350 650
Sweat 100 5000
Feces 100 100
Urine 1400 500
Total output 2300 6600
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• OsmosisThe net diffusion of water across the
membrane from a region of high water
concentration to one that has a lowerwater concentration
• Osmoles (Osm):The measurement of total number of
particles in a solution1 mole : 6.02 x 1023
1 mole/L NaCl ~ 2 osmoles/L (Na+ & Cl-)
• Osmotic pressure:The precise amount of pressure required to
prevent the osmosis1 osm/L ~ 19,300 mmHg; 1 mosm/L~19.3mmHG
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Add pure water
• Normal • Add pure water
ICF ECFICF ECF
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Add isotonic saline
• Normal • Add isotonic saline
ICF ECF ICF ECF
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Add pure NaCl
• Normal • Add pure NaCl
ICF ECF ICF ECF
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Ingestion of 1L
of water
Increased
extracellular
fluid volume
Cardiovascular
stretch receptor
Decreased ADH
release from
posterior
pituitary
Osmoreceptor
Decreased
plasma
osmolarity
Decreased
collecting duct
water
permiability
Decreased water
reabsorption
Increased water
excretion
Normal fluid
volume
Decreasedplasma ADH
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Extracellularfluid volume
(effective
arterial blood
volume)
Kidneys,
cardiovascular
sensor
Kidneys
1. GFR
2. Aldosterone
3. Peritubular capillary Starlingforces
4. Sympathetic nerve activity
5. Intrarenal blood flow
distribution
6. Arterial natriuretic peptide
Renal
sodium
excretion
Sensor
Regulated
variabel
(-)
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Decreased
effective
arterial blood
volume
Kidney
Angiotensinogen
Renin
Angiotensin I
Liver
Converting
enzyme
Lungs
Angiotensin II
Blood vessels Adrenal cortex Brain
Vasoconstrictor Aldosteron secre.
Sodium reabs.Blood pressure > H2O reabsorption
ADH secretion Thirst
Water intake
Normal effective arterial blood volume
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Increased
Potasium intake
Increased plasma
[K+]Direct effect on adrenal
cortex
Increased [K+] in body cell
(including kidney cells)
Increased aldosterone
secretion
Increased plasmaaldosterone
Increase luminal membrane permiablility to
Na+ and K+ & Increase basolateral
membrane Na+/K+-ATPase activity in
collecting duct principal cells.
Increased potasium
secretion
Increased potasiumexcretion
Normal potasium
level
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Definition of Edema:
An increase in the interstitial compartement of extracellularfluid volume (Harrison’s).
Starling Hypothesis
The balance of hydrostatic and oncotic pressures across thecapillary endothelium
Mean capillary hydrostatic pressure (Pc): 25 mmHg
Interstitial fluid hydrostatic pressure (PIF): 0 mmHg
Capillary oncotic pressure (Пc): 28 mmHg
Interstitial fluid oncotic pressure (ПIF): 3 mmHg
Arterial end of capillary:
Pc= 40 mmHg; PIF= 0 mmHg
Пc= 28 mmHg; ПIF= 3 mmHg
Net Filtration= 35-0-28+3= 10
Venous end of capillary:
Pc= 10 mmHg; PIF= 0 mmHg
Пc= 28 mmHg; ПIF= 3 mmHg
Net Absorption= 15-0-28+3= -10
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Causes of Extracellular Edema
• 1. Increased capillary pressure
– Excessive kidney retention
– High venous pressure
– Decreased arteriole resistance
• 2. Decreased plasma proteins
– Loss of protein in urine
– Loss of protein from denuded skin
– Failure of produce protein
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• 3. Increased capillary permiability
– Immune reaction
– Toxin
– Bacteria infection
– Vitamin deficiency (exp. Vit C)
• 4. Blockage of lymph return
– Cancer
– Paracyte infection (Filaria)
– Surgery
– Congenital absence or abnormal of Lymphatic vessels
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Exercice
• The greatest fraction of the body’s water iscontained within:
a. Blood plasma
b. Cells
c. Extracellular fluid
d. Transcellular fluid
• Intravenous infusion of 1liter of isotonic saline will:
a. A 1-liter increase inintracellular fluid volume
b. A 1-liter increase inextracellular fluid volume
c. A 0.5-liter increase in intra-cellular fluid volume and a0.5-liter increase inextracellular fluid volume
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• Intravenous infusion of 1liter of hypertonic saline willcause:
a. A decrease in intracellularfluid volume
b. An increase in extracellularfluid volume
c. An increase in plasmaosmolality
d. All of the above
• Antidiuretic hormoneincrease epithelial waterpermiability of:
a. Collecting ducts
b. Proximal tubules
c. Thick ascending limbs
d. All of the above
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• ADH release from theposterior pituitary isstimulated by:
a. A fall in plasma osmolality
b. Severe hemorrhage
c. Stimulation of arterialbaroreceptors
d. Stretch of left arterialreceptor
• Which of the followingproduces a decrease inrenal sodium excretion?
a. Decrease plasmaaldosterone level
b. Increase plasma level of atrial natriuretic peptide
c. Increase GFR
d. Increase renal sympa-thetic nerve activity
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• Which of the followingproduces an increase in renalsodium excretion?
a. Administration of glucocorticoids
b. Decrease peritbular capilaryhydrostatic pressure
c. Increase plasma estrgenlevels
d. Uncontroled diabetesmellitus
• Renin release is stimulatedby:
a. Increase blood pressure inafferent arterioles
b. Increase effective arterialblood volume
c. Increase NaCl transport bymacula densa cells
d. Stimulation of renalsympathetic nerves
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• Which of the following arecommonly seen in patientswith severe congestive heart
failure?
a. Elevated plasma ADH levels
b. Generalized edema
c. Hyponatremia
d. Thirst
e. All of the above
• The most abundantintracellular cation is:
a. Calcium
b. Chloride
c. Potasium
d. Sodium
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• Which of the followingpromotes a shift of potasium from cells to
extracellular fluid?
a. A fall in plasma pH
b. An overdose of digitalis
c. Inadequate blood flow
d. Lack of insulin
e. All of the above
• Which of the followingproduces excessive urinaryexcretion of potasium?
a. Acute renal failure
b. Inadequate aldosteronesecretion
c. Severe chronic renal failure(GFR=10 ml/min)
d. Uncontroled diabetesmellitus
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• The following measurement were obtained in3.40 kg newborn infant:
Total body water 2600 ml
Extracellular water 1490 ml
Plasma water 155 ml
What are the volumes of (1) The intracellular water and
(2) the interstitial fluid-lymph water?