1. Fluid, Electrolyte and Acid-Base Homeostasis Lecture Outline
Chapter 27
Fluid, Electrolyte and Acid-Base Homeostasis
Lecture Outline

2. Chapter 27 Fluid, Electrolyte and Acid-Base Homeostasis
Body fluid
all the water and dissolved solutes in the body’s fluid compartments
Mechanisms regulate
total volume
distribution
concentration of solutes and pH
Regulatory mechanisms insure homeostasis of body fluids since their malfunction may seriously endanger nervous system and organ functioning.
Principles of Human Anatomy and Physiology, 11e

3. FLUID COMPARTMENTS AND FLUID BALANCE
Principles of Human Anatomy and Physiology, 11e

4. Balance Between Fluid Compartments
Volume of fluid in each is kept constant. Since water follows electrolytes, they must be in balance as well
Only 2 places for exchange between compartments:
cell membranes separate intracellular from interstitial fluid.
only in capillaries are walls thin enough for exchange between plasma and interstitial fluids
Principles of Human Anatomy and Physiology, 11e

5. Introduction
In lean adults body fluids comprise about 55-60% (Figure 27.1) of total body weight.
Water is the main component of all body fluids.
About two-thirds of the body’s fluid is located in cells and is called intracellular fluid (ICF).
The other third is called extracellular fluid (ECF).
About 80% of the ECF is interstitial fluid and 20% is blood plasma.
Some of the interstitial fluid is localized in specific places, such as lymph; cerebrospinal fluid; gastrointestinal tract fluids; synovial fluid; fluids of the eyes (aqueous humor and vitreous body) and ears (endolymph and perilymph); pleural, pericardial, and peritoneal fluids between serous membranes; and glomerular filtrate in the kidneys.
Principles of Human Anatomy and Physiology, 11e

6. Membranes
Selectively permeable membranes separate body fluids into distinct compartments.
Plasma membranes of individual cells separate intracellular fluid from interstitial fluid.
Blood vessel walls divide interstitial fluid from blood plasma.
Although fluids are in constant motion from one compartment to another, the volume of fluid in each compartment remains fairly stable – another example of homeostasis.
Principles of Human Anatomy and Physiology, 11e

7. Fluid and Solute Balance
Fluid balance means that the various body compartments contain the required amount of water, proportioned according to their needs.
Fluid balance, then, means water balance, but also implies electrolyte balance; the two are inseparable.
Osmosis is the primary way in which water moves in and out of body compartments. The concentrations of solutes in the fluids is therefore a major determinant of fluid balance.
Most solutes in body fluids are electrolytes, compounds that dissociate into ions.
Principles of Human Anatomy and Physiology, 11e

8. Body Water Gain and Loss (Figure 27.2)
45-75% body weight
declines with age since fat contains almost no water
Gain from ingestion and metabolic water formed during aerobic respiration & dehydration synthesis reactions (2500 mL/day)
Normally loss = gain
urine, feces, sweat, breathe
Principles of Human Anatomy and Physiology, 11e

9. Dehydration Stimulates Thirst
Regulation of fluid gain is by regulation of thirst.
Principles of Human Anatomy and Physiology, 11e

10. Regulation of Water Gain
Metabolic water volume depends mostly on the level of aerobic cellular respiration, which reflects the demand for ATP in body cells.
The main way to regulate body water balance is by adjusting the volume of water intake.
When water loss is greater than water gain, dehydration occurs (Figure 27.3).
The stimulus for fluid intake (gain) is dehydration resulting in thirst sensations; one mechanism for stimulating the thirst center in the hypothalamus is the renin-angiotensin II pathway, which responds to decreased blood volume (therefore, decreased blood pressure) (Figure 27.3).
Drinking occurs  body water levels return to normal
Principles of Human Anatomy and Physiology, 11e

11. Regulation of Water and Solute Loss
Although increased amounts of water and solutes are lost through sweating and exhalation during exercise, loss of body water or excess solutes depends mainly on regulating how much is lost in the urine (Figure 27.4).
Under normal conditions, fluid output (loss) is adjusted by
antidiuretic hormone (ADH)
atrial natriuretic peptide (ANP)
aldosterone
all of which regulate urine production.
Table 27.1 summarizes the factors that maintain body water balance.
Principles of Human Anatomy and Physiology, 11e

12. Regulation of Water and Solute Loss
Elimination of excess water or solutes occurs through urination
Consumption of very salty meal demonstrates function of three hormones
Demonstrates how
“water follows salt”
excrete Na+ and water will follow and decrease blood volume
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13. Movement of Water Between Body Fluid Compartments
A fluid imbalance between the intracellular and interstitial fluids can be caused by a change in their osmolarity.
Most often a change in osmolarity is due to a change in the concentration of Na+.
When water is consumed faster than the kidneys can excrete it, water intoxication may result (Figure 27.5).
Repeated use of enemas can increase the risk of fluid and electrolyte imbalances. (Clinical Application)
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14. Hormone Effects on Solutes
Angiotensin II and aldosterone promote reabsorption of Na+ and Cl- and an increase in fluid volume
stretches atrial volume and promotes release of ANP
slows release of renin & formation of angiotensin II
increases filtration rate & reduces water & Na+ reabsorption
decreases secretion of aldosterone slowing reabsorption of Na+ and Cl- in collecting ducts
ANP promotes natriuresis or the increased excretion of Na+ and Cl- which decreases blood volume
Principles of Human Anatomy and Physiology, 11e

15. Hormone Regulation of Water Balance
Antidiuretic hormone (ADH) from the posterior pituitary
stimulates thirst
increases permeability of principal cells of collecting ducts to assist in water reabsorption
very concentrated urine is formed
ADH secretion shuts off after the intake of water
ADH secretion is increased
large decrease in blood volume
severe dehydration and drop in blood pressure
vomiting, diarrhea, heavy sweating or burns
Principles of Human Anatomy and Physiology, 11e

16. Movement of Water
Intracellular and interstitial fluids normally have the same osmolarity, so cells neither swell nor shrink
Swollen cells of water intoxication because Na+ concentration of plasma falls below normal
drink plain water faster than kidneys can excrete it
replace water lost from diarrhea or vomiting with plain water
may cause convulsions, coma & death unless oral rehydration includes small amount salt in water intake
Principles of Human Anatomy and Physiology, 11e

17. ELECTROLYTES IN BODY FLUIDS
Electrolytes serve four general functions in the body.
Because they are more numerous than nonelectrolytes, electrolytes control the osmosis of water between body compartments.
maintain the acid-base balance required for normal cellular activities.
carry electrical current, which allows production of action potentials and graded potentials and controls secretion of some hormones and neurotransmitters. Electrical currents are also important during development.
cofactors needed for optimal activity of enzymes.
Concentration expressed in mEq/liter or milliequivalents per liter for plasma, interstitial fluid and intracellular fluid
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18. Concentrations of Electrolytes in Body Fluids
To compare the charge carried by ions in different solutions, the concentration is typically expressed in milliequivalents/liter (mEg/Liter), which gives the concentration of cations or anions in a solution.
The chief difference between plasma and interstitial fluid
plasma contains quite a few protein anions
interstitial fluid has hardly any since plasma proteins generally cannot move out of impermeable blood vessel walls
plasma also contains slightly more sodium ions but fewer chloride ions than the interstitial fluid. In other respects, the two fluids are similar.
Principles of Human Anatomy and Physiology, 11e

19. Concentrations of Electrolytes in Body Fluids
Intracellular fluid (ICF) differs considerably from extracellular fluid (ECF), however.
Figure 27.6 compares the concentrations of the main electrolytes and protein anions in plasma, interstitial fluid, and intracellular fluid.
Principles of Human Anatomy and Physiology, 11e

20. Comparison Between Fluid Components
Plasma contains many proteins, but interstitial fluid does not
producing blood colloid osmotic pressure
Extracellular fluid contains Na+ and Cl-
Intracellular fluid contains K+ and phosphates (HPO4 -2)
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21. Sodium (Na+) is the most abundant extracellular ion.
accounts for 1/2 of osmolarity of ECF
Average daily intake exceeds normal requirements
Hormonal controls
aldosterone causes increased reabsorption Na+
ADH release ceases if Na+ levels too low--dilute urine lost until Na+ levels rise
ANP increases Na+ and water excretion if Na+ levels too high
Excess Na+ in the body can result in edema. Excess loss of Na+ causes excessive loss of water, which results in hypovolemia, an abnormally low blood volume. (Clinical Application)
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22. Edema, Hypovolemia and Na+ Imbalance
Sodium retention causes water retention
edema is abnormal accumulation of interstitial fluid
Causes of sodium retention
renal failure
hyperaldosterone
Excessive loss of sodium causes excessive loss of water (low blood volume)
due to inadequate secretion of aldosterone
too many diuretics
Principles of Human Anatomy and Physiology, 11e

23. Chloride (Cl-) is the major extracellular anion.
Regulation of Cl- balance in body fluids is indirectly controlled by aldosterone. Aldosterone regulate sodium reabsorption; the negatively charged chloride follows the positively charged sodium passively by electrical attraction.
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24. Chloride (Cl-) is the major extracellular anion.
Most prevalent extracellular anion
Moves easily between compartments due to Cl- leakage channels
Helps balance anions in different compartments
Regulation
passively follows Na+ so it is regulated indirectly by aldosterone levels
ADH helps regulate Cl- in body fluids because it controls water loss in urine
Chloride shift across red blood cells with buffer movement
It plays a role in forming HCl in the stomach.
Principles of Human Anatomy and Physiology, 11e

25. Potassium (K+) is the most abundant cation in intracellular fluid.
It is involved in maintaining fluid volume, impulse conduction, muscle contraction.
Exchanged for H+ to help regulate pH in intracellular fluid
The plasma level of K+ is under the control of mineralocorticoids, mainly aldosterone.
Helps establish resting membrane potential & repolarize nerve & muscle tissue
Control is mainly by aldosterone which stimulates principal cells to increase K+ secretion into the urine
abnormal plasma K+ levels adversely affect cardiac and neuromuscular function
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26. Bicarbonate (HCO3-) is a prominent ion in the plasma.
It is a significant plasma anion in electrolyte balance.
It is a major component of the plasma acid-base buffer system.
Concentration increases as blood flows through systemic capillaries due to CO2 released from metabolically active cells
Concentration decreases as blood flows through pulmonary capillaries and CO2 is exhaled
Kidneys are main regulator of plasma levels
intercalated cells form more if levels are too low
excrete excess in the urine
Principles of Human Anatomy and Physiology, 11e

27. Calcium (Ca+2), the most abundant ion in the body, is principally an extracellular ion.
It is a structural component of bones and teeth.
Important role in blood clotting, neurotransmitter release, muscle tone & nerve and muscle function
Regulated by parathyroid hormone
stimulates osteoclasts to release calcium from bone
increases production of calcitriol (Ca+2 absorption from GI tract and reabsorption from glomerular filtrate)
Principles of Human Anatomy and Physiology, 11e

28. Magnesium (Mg+2) is primarily an intracellular cation.
It activates several enzyme systems involved in the metabolism of carbohydrates and proteins and is needed for operation of the sodium pump.
It is also important in neuromuscular activity, neural transmission within the central nervous system, and myocardial functioning.
Several factors regulate magnesium ion concentration in plasma. They include hypo- or hypercalcemia, hypo- or hypermagnesemia, an increase or decrease in extracellular fluid volume, an increase or decrease in parathyroid hormone, and acidosis or alkalosis.
Principles of Human Anatomy and Physiology, 11e

29. Phosphate
Present as calcium phosphate in bones and teeth, and in phospholipids, ATP, DNA and RNA
HPO4 -2 is important intracellular anion and acts as buffer of H+ in body fluids and in urine
mono and dihydrogen phosphate act as buffers in the blood
Plasma levels are regulated by parathyroid hormone & calcitriol
resorption of bone releases phosphate
in the kidney, PTH increase phosphate excretion
calcitriol increases GI absorption of phosphate
Principles of Human Anatomy and Physiology, 11e

30. Review
Table 27.2 describes the imbalances that result from the deficiency or excess of several electrolytes.
Principles of Human Anatomy and Physiology, 11e

31. Clinical Application
Individuals at risk for fluid and electrolyte imbalances include those dependent on others for fluid and food needs; those undergoing medical treatment involving intravenous infusions, drainage or suction, and urinary catheters, those receiving diuretics, and post-operative individuals, burned individuals, individuals with chronic disease, and those with altered states of consciousness.
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32. Acid-Base Balance
The overall acid-base balance of the body is maintained by controlling the H+ concentration of body fluids, especially extracellular fluid.
Homeostasis of H+ concentration is vital
proteins 3-D structure sensitive to pH changes
normal plasma pH must be maintained between
diet high in proteins tends to acidify the blood
3 major mechanisms to regulate pH
buffer system
exhalation of CO2 (respiratory system)
kidney excretion of H+ (urinary system)
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33. Actions of Buffer Systems
Prevent rapid, drastic changes in pH
Change either strong acid or base into weaker one
Work in fractions of a second
Found in fluids of the body
3 principal buffer systems
protein buffer system
carbonic acid-bicarbonate buffer system
phosphate buffer system
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34. Protein Buffer System Abundant in intracellular fluids & in plasma
hemoglobin very good at buffering H+ in RBCs
albumin is main plasma protein buffer
Amino acids contains at least one carboxyl group (-COOH) and at least one amino group (-NH2)
carboxyl group acts like an acid & releases H+
amino group acts like a base & combines with H+
some side chains can buffer H+
Hemoglobin acts as a buffer in blood by picking up CO2 or H+
Principles of Human Anatomy and Physiology, 11e

35. Carbonic Acid-Bicarbonate Buffer System
Acts as extracellular & intracellular buffer system
bicarbonate ion (HCO3-) can act as a weak base
holds excess H+
carbonic acid (H2CO3) can act as weak acid
dissociates into H+ ions
At a pH of 7.4, bicarbonate ion concentration is about 20 times that of carbonic acid
Can not protect against pH changes due to respiratory problems
Principles of Human Anatomy and Physiology, 11e

36. Phosphate Buffer System
Most important intracellularly, but also acts to buffer acids in the urine
Dihydrogen phosphate ion acts as a weak acid that can buffer a strong base
Monohydrogen phosphate acts a weak base by buffering the H+ released by a strong acid
Principles of Human Anatomy and Physiology, 11e

37. Exhalation of Carbon Dioxide
The pH of body fluids may be adjusted by a change in the rate and depth of respirations, which usually takes from 1 to 3 minutes.
An increase in the rate and depth of breathing causes more carbon dioxide to be exhaled, thereby increasing pH.
A decrease in respiration rate and depth means that less carbon dioxide is exhaled, causing the blood pH to fall.
The pH of body fluids, in turn, affects the rate of breathing (Figure 27.7).
The kidneys excrete H+ and reabsorb HCO3- to aid in maintaining pH.
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38. Exhalation of Carbon Dioxide
pH modified by changing rate & depth of breathing
faster breathing rate, blood pH rises
slow breathing rate, blood pH drops
H+ detected by chemoreceptors in medulla oblongata, carotid & aortic bodies
Respiratory centers inhibited or stimulated by changes is pH
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39. Kidney Excretion of H+
Metabolic reactions produce 1mEq/liter of nonvolatile acid for every kilogram of body weight
Excretion of H+ in the urine is only way to eliminate huge excess
Kidneys synthesize new bicarbonate and save filtered bicarbonate
Renal failure can cause death rapidly due to its role in pH balance
Principles of Human Anatomy and Physiology, 11e

40. Regulation of Acid-Base Balance
Cells in the PCT and collecting ducts secrete hydrogen ions into the tubular fluid.
In the PCT Na+/H+ antiporters secrete H+ and reabsorb Na+ (Figure 26.13).
The apical surfaces of some intercalated cells include proton pumps (H+ ATPases) that secrete H+ into the tubular fluid and HCO3– antiporters in their basolateral membranes to reabsorb HCO3– (Figure 27.8).
Other intercalated cells have proton pumps in their basolateral membranes and Cl–/HCO3– antiporters in their apical membranes.
These two types of cells help maintain body fluid pH by excreting excess H+ when pH is too low or by excreting excess HCO3– when the pH is too high.
Table 27.3 summarizes the mechanism that maintains pH of body fluids.
Principles of Human Anatomy and Physiology, 11e

41. Acid-Base Imbalances
The normal pH range of systemic arterial blood is between
Acidosis is a blood pH below Its principal effect is depression of the central nervous system through depression of synaptic transmission.
Alkalosis is a blood pH above Its principal effect is overexcitability of the central nervous system through facilitation of synaptic transmission.
Principles of Human Anatomy and Physiology, 11e

42. Acid-Base Imbalances Compensation is an attempt to correct the problem
Acidosis---blood pH below 7.35
Alkalosis---blood pH above 7.45
Compensation is an attempt to correct the problem
respiratory compensation
renal compensation
Acidosis causes depression of CNS---coma
Alkalosis causes excitability of nervous tissue---spasms, convulsions & death
Principles of Human Anatomy and Physiology, 11e

43. Acid-Base Imbalances
Compensation refers to the physiological response to an acid-base imbalance.
Respiratory acidosis and respiratory alkalosis are primary disorders of blood PCO2.
metabolic acidosis and metabolic alkalosis are primary disorders of bicarbonate concentration.
A summary of acidosis and alkalosis is presented in Table 27.4.
Principles of Human Anatomy and Physiology, 11e

44. Diagnosis
Diagnosis of acid-base imbalances employs a general four-step process.
Note whether the pH is high or low relative to the normal range.
Decide which value of PCO2 or HCO3- could cause the abnormality.
Specify the problem source as respiratory or metabolic.
Look at the noncausative value and determine if it is compensating for the problem.
Principles of Human Anatomy and Physiology, 11e

45. Summary of Causes
Respiratory acidosis & alkalosis are disorders involving changes in partial pressure of CO2 in blood
Metabolic acidosis & alkalosis are disorders due to changes in bicarbonate ion concentration in blood
Principles of Human Anatomy and Physiology, 11e

46. Respiratory Acidosis Cause is elevation of pCO2 of blood
Due to lack of removal of CO2 from blood
emphysema, pulmonary edema, injury to the brainstem & respiratory centers
Treatment
IV administration of bicarbonate (HCO3-)
ventilation therapy to increase exhalation of CO2
Principles of Human Anatomy and Physiology, 11e

47. Respiratory Alkalosis
Arterial blood pCO2 is too low
Hyperventilation caused by high altitude, pulmonary disease, stroke, anxiety, aspirin overdose
Renal compensation involves decrease in excretion of H+ and increase reabsorption of bicarbonate
Treatment
breathe into a paper bag
Principles of Human Anatomy and Physiology, 11e

48. Metabolic Acidosis Blood bicarbonate ion concentration too low
loss of ion through diarrhea or kidney dysfunction
accumulation of acid (ketosis with dieting/diabetes)
kidney failing to remove H+ from protein metabolism
Respiratory compensation by hyperventilation
Treatment
IV administration of sodium bicarbonate
correct the cause
Principles of Human Anatomy and Physiology, 11e

49. Metabolic Alkalosis Blood bicarbonate levels are too high
Cause is nonrespiratory loss of acid
vomiting, gastric suctioning, use of diuretics, dehydration, excessive intake of alkaline drugs
Respiratory compensation is hypoventilation
Treatment
fluid and electrolyte therapy
correct the cause
Principles of Human Anatomy and Physiology, 11e

50. Diagnosis of Acid-Base Imbalances
Evaluate
systemic arterial blood pH
concentration of bicarbonate (too low or too high)
PCO2 (too low or too high)
Solutions
if problem is respiratory, the pCO2 will not be normal
if problem is metabolic, the bicarbonate level will not be normal
Principles of Human Anatomy and Physiology, 11e

51. Homeostasis in Infants
More body water in ECF so more easily disrupted
Rate of fluid intake/output is 7X higher
Higher metabolic rate produces more metabolic wastes
Kidneys can not concentrate urine nor remove excess H+
Surface area to volume ratio is greater so lose more water through skin
Higher breathing rate increase water loss from lungs
Higher K+ and Cl- concentrations than adults
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52. Impaired Homeostasis in the Elderly
Decreased volume of intracellular fluid
inadequate fluid intake
Decreased total body K+ due to loss of muscle tissue or potassium-depleting diuretics for treatment of hypertension or heart disease
Decreased respiratory & renal function
slowing of exhalation of CO2
decreased blood flow & glomerular filtration rate
reduced sensitivity to ADH & impaired ability to produce dilute urine
renal tubule cells produce less ammonia to combine with H+ and excrete as NH+4
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53. Questions?
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54. end
Principles of Human Anatomy and Physiology, 11e