Gus-k4_bakul Blok Gus K-4
Transcript of Gus-k4_bakul Blok Gus K-4
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Fluid, Electrolyte, andFluid, Electrolyte, and
Acid-Base BalanceAcid-Base BalanceProf. Yasmeiny Yazir
Dr. Eka Roina MegawatiDept. Physiology
University of Sumatera Utara
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Introduction to Body FluidsIntroduction to Body Fluids
Body fuids is the fuids in the bodyBody fuids is the fuids in the body
that is composed o water &that is composed o water &
dissolved substances, includingdissolved substances, including
electrolytes, which are crucial orelectrolytes, which are crucial or
body unction.body unction.
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Body Water ContentBody Water Content
Inants have low body at, low boneInants have low body at, low bonemass, and are !" or more watermass, and are !" or more water#otal water content declines#otal water content declines
throughout liethroughout lie$ealthy males are about %" water'$ealthy males are about %" water'
healthy emales are around ("healthy emales are around ("#his di)erence refects emales*+#his di)erence refects emales*+
$igher body at$igher body atmaller amount o s-eletal musclemaller amount o s-eletal muscle
In old age, only about (" o bodyIn old age, only about (" o bodyweight is waterweight is water
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Functions o Body WaterFunctions o Body Water
/egulating body temperature/egulating body temperature
0s protective cushion & lubricant0s protective cushion & lubricant
0s reactant0s reactant0s solvent0s solvent
0s transporter0s transporter
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Fluid CompartmentsFluid Compartments
Water occupies two main fuidWater occupies two main fuidcompartmentscompartments
Intracellular fuid 1ICF2 3 about twoIntracellular fuid 1ICF2 3 about two
thirds by volume, contained in cellsthirds by volume, contained in cells45tracellular fuid 14CF2 3 consists o45tracellular fuid 14CF2 3 consists o
two ma6or subdivisionstwo ma6or subdivisions
7lasma 3 the fuid portion o the7lasma 3 the fuid portion o thebloodblood
Interstitial fuid 1IF2 3 fuid in spacesInterstitial fuid 1IF2 3 fuid in spacesbetween cellsbetween cells
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8ther 4CF 3 lymph, cerebrospinal8ther 4CF 3 lymph, cerebrospinal
fuid, eye humors, synovial fuid,fuid, eye humors, synovial fuid,
serous fuid, and gastrointestinalserous fuid, and gastrointestinalsecretionssecretions
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Fluid CompartmentsFluid Compartments
#he plasma and the cellular elements#he plasma and the cellular elements
o the blood, principally red bloodo the blood, principally red blood
cells, 9ll the vascular system, andcells, 9ll the vascular system, and
together they constitute thetogether they constitute the totaltotal
blood volume.blood volume.
#he interstitial fuid is that part o#he interstitial fuid is that part o
the 4CF that is outside the vascularthe 4CF that is outside the vascularsystem, bathing the cells.system, bathing the cells.
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0bout a third o the0bout a third o the total bodytotal body
water (TBW)water (TBW)is e5tracellular'is e5tracellular'
the remaining two:thirds arethe remaining two:thirds areintracellularintracellular (intracellular(intracellular
fuid).fuid).
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Body fuidBody fuid
compartmecompartme
ntsnts
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Body CompositionBody Composition
#he intracellular component o the#he intracellular component o the
body water accounts or about " obody water accounts or about " o
body weight and the e5tracellularbody weight and the e5tracellular
component or about ;".component or about ;".0ppro5imately ;(" o the e5tracellular0ppro5imately ;(" o the e5tracellular
component is in the vascular systemcomponent is in the vascular system
1plasma < (" o body weight2 and ("1plasma < (" o body weight2 and ("outside the blood vessels 1interstitialoutside the blood vessels 1interstitial
fuid < =(" o body weight2.fuid < =(" o body weight2.
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Fluid CompartmentsFluid Compartments
Figure 26.1
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@nits or Aeasuring@nits or Aeasuring
Concentration o olutesConcentration o olutes
MolesMoles
0 mole is the gram:molecular weight o0 mole is the gram:molecular weight o
a substance, ie, the molecular weight oa substance, ie, the molecular weight o
the substance in grams.the substance in grams.
4ach mole 1mol2 consists o4ach mole 1mol2 consists o
appro5imately % =appro5imately % =;!;!molecules.molecules.
#he millimole 1mmol2 is == o a#he millimole 1mmol2 is == o amole, and the micromole 1mmol2 ismole, and the micromole 1mmol2 is
==,, o a mole.==,, o a mole.
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#hus, = mol o ?aCl < ;! D !(.( g .( g, and = mmol < (>.( mg.(>.( g, and = mmol < (>.( mg.
#he mole is the standard unit or#he mole is the standard unit or
e5pressing the amount o substancese5pressing the amount o substances
in the I unit systemin the I unit system
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@nits or Aeasuring@nits or Aeasuring
Concentration o olutesConcentration o olutesEquivalentsEquivalents
#he concept o electrical eEuivalence#he concept o electrical eEuivalence
is important in physiology becauseis important in physiology because
many o the important solutes in themany o the important solutes in the
body are in the orm o chargedbody are in the orm o charged
particles.particles.
8ne eEuivalent 1eE2 is = mol o an8ne eEuivalent 1eE2 is = mol o anionied substance divided by itsionied substance divided by its
valence.valence.
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8ne mole o ?aCl dissociates into =8ne mole o ?aCl dissociates into =
eE o ?aD and = eE o Cl:. 8neeE o ?aD and = eE o Cl:. 8ne
eEuivalent o ?aD < ;! g' but = eE oeEuivalent o ?aD < ;! g' but = eE o
Ca;D < g; < ; g.Ca;D < g; < ; g.
#he millieEuivalent 1meE2 is ==#he millieEuivalent 1meE2 is ==
o = eE.o = eE.
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4lectrolyte Concentration4lectrolyte Concentration
45pressed in millieEuivalents per liter45pressed in millieEuivalents per liter
1m4EG2, a measure o the number o1m4EG2, a measure o the number o
electrical charges in one liter o solutionelectrical charges in one liter o solution
m4EG < 1concentration o ion inm4EG < 1concentration o ion inHmgGthe atomic weight o ion2HmgGthe atomic weight o ion2 numbernumber
o electrical charges on one iono electrical charges on one ion
For single charged ions, = m4E < = m8smFor single charged ions, = m4E < = m8sm
For bivalent ions, = m4E < =; m8smFor bivalent ions, = m4E < =; m8sm
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45tracellular and Intracellular45tracellular and Intracellular
FluidsFluids4ach fuid compartment o the body4ach fuid compartment o the body
has a distinctive pattern ohas a distinctive pattern o
electrolyteselectrolytes
45tracellular fuids are similar45tracellular fuids are similar
1e5cept or the high protein content1e5cept or the high protein content
o plasma2o plasma2
odium is the chie cationodium is the chie cation
Chloride is the ma6or anionChloride is the ma6or anion
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Intracellular fuids have low sodiumIntracellular fuids have low sodium
and chlorideand chloride7otassium is the chie cation7otassium is the chie cation
7hosphate is the chie anion7hosphate is the chie anion
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45tracellular and Intracellular45tracellular and Intracellular
FluidsFluidsodium and potassium concentrationsodium and potassium concentrations
in e5tra: and intracellular fuids arein e5tra: and intracellular fuids are
nearly oppositesnearly opposites
#his refects the activity o cellular#his refects the activity o cellular
0#7:dependent sodium:potassium0#7:dependent sodium:potassium
pumpspumps
4lectrolytes determine the chemical4lectrolytes determine the chemicaland physical reactions o fuidsand physical reactions o fuids
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45tracellular and Intracellular45tracellular and Intracellular
FluidsFluids7roteins, phospholipids, cholesterol,7roteins, phospholipids, cholesterol,
and neutral ats account or+and neutral ats account or+
J" o the mass o solutes inJ" o the mass o solutes in
plasmaplasma
%" o the mass o solutes in%" o the mass o solutes in
interstitial fuidinterstitial fuid
J" o the mass o solutes in theJ" o the mass o solutes in the
intracellular compartmentintracellular compartment
l l i i d4l t l t C iti B d
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4lectrolyte Composition o Body4lectrolyte Composition o Body
FluidsFluids
Figure 26.2
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Aa6or unctions oAa6or unctions o
electrolytes +electrolytes +Coactors or enymesCoactors or enymes
0ction potential in neuron and0ction potential in neuron and
muscle cellsmuscle cells
ecretion & action o hormones &ecretion & action o hormones &
neurotransmittersneurotransmitters
Auscle contractionAuscle contraction0cidbase balance0cidbase balance
8smosis8smosis
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Fluid Aovement 0mongFluid Aovement 0mong
CompartmentsCompartmentsCompartmental e5change isCompartmental e5change is
regulated by osmotic and hydrostaticregulated by osmotic and hydrostatic
pressurespressures
?et lea-age o fuid rom the blood is?et lea-age o fuid rom the blood is
pic-ed up by lymphatic vessels andpic-ed up by lymphatic vessels and
returned to the bloodstreamreturned to the bloodstream
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45changes between interstitial and45changes between interstitial and
intracellular fuids are comple5 dueintracellular fuids are comple5 due
to the selective permeability o theto the selective permeability o the
cellular membranescellular membranes#wo:way water fow is substantial#wo:way water fow is substantial
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8A8I8A8I
When a substance is dissolved inWhen a substance is dissolved in
water, the concentration o waterwater, the concentration o water
molecules in the solution is less thanmolecules in the solution is less than
that in pure water, since the additionthat in pure water, since the additiono solute to water results in a solutiono solute to water results in a solution
that occupies a greater volume thanthat occupies a greater volume than
does the water alone.does the water alone.
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I the solution is placed on one sideI the solution is placed on one side
o a membrane that is permeable too a membrane that is permeable to
water but not to the solute and anwater but not to the solute and an
eEual volume o water is placed oneEual volume o water is placed onthe other, water molecules di)usethe other, water molecules di)use
down their concentration gradientdown their concentration gradient
into the solution.into the solution.
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Kiagrammatic representation oKiagrammatic representation o
osmosisosmosis
Water molecules are represented by smallWater molecules are represented by small
open circles, solute molecules by large solidopen circles, solute molecules by large solidcircles.circles.
In the diagram on the let, water is placed onIn the diagram on the let, water is placed on
one side o membrane permeable to water butone side o membrane permeable to water but
not to solute, and an eEual volume solution onot to solute, and an eEual volume solution o
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Water molecules move down their concentration gradientWater molecules move down their concentration gradientinto the solution, and, as shown in the diagram on the right,into the solution, and, as shown in the diagram on the right,the volume o the solution increases.the volume o the solution increases.
0s indicated by the arrow on the right, osmotic pressure is0s indicated by the arrow on the right, osmotic pressure isthe pressure that would have to be applied to prevent thethe pressure that would have to be applied to prevent themovement o the water molecules.movement o the water molecules.
Kiagrammatic representation oKiagrammatic representation o
osmosisosmosis
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8A8I8A8I
#his processLthe di)usion o#his processLthe di)usion o
solventsolventmolecules into a region inmolecules into a region in
which there is a higher concentrationwhich there is a higher concentration
o ao a solutesoluteto which the membraneto which the membraneis impermeableLis calledis impermeableLis called osmosis.osmosis.
It is an important actor inIt is an important actor in
physiologic processes.physiologic processes.
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8A8#IC 7/4@/48A8#IC 7/4@/4
#he tendency or movement o#he tendency or movement o
solvent molecules to a region osolvent molecules to a region o
greater solute concentration can begreater solute concentration can be
prevented by applying pressure to theprevented by applying pressure to themore concentrated solution.more concentrated solution.
#he pressure necessary to prevent#he pressure necessary to prevent
solvent migration is thesolvent migration is the osmoticosmoticpressurepressureo the solution.o the solution.
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#he#he osmolarityosmolarityis the number ois the number o
osmoles per liter o solutionLeg,osmoles per liter o solutionLeg,
plasmaLwhereas theplasmaLwhereas the osmolalityosmolalityisis
the number o osmoles per -ilogramthe number o osmoles per -ilogramo solvent. #hereore, osmolarity iso solvent. #hereore, osmolarity is
a)ected by the volume o the variousa)ected by the volume o the various
solutes in the solution and thesolutes in the solution and thetemperature, while the osmolality istemperature, while the osmolality is
not.not.
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8smotically active substances in the8smotically active substances in the
body are dissolved in water, and thebody are dissolved in water, and the
density o water is =, so osmolaldensity o water is =, so osmolal
concentrations can be e5pressed asconcentrations can be e5pressed asosmoles per liter 1osmG2 o water.osmoles per liter 1osmG2 o water.
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8smotic pressure is de9ned as the8smotic pressure is de9ned as the
e5ternal pressure applied to the tope5ternal pressure applied to the top
o the fuid to prevent osmosis romo the fuid to prevent osmosis rom
occuringoccuring
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8smolal Concentration o8smolal Concentration o
7lasma+ #onicity7lasma+ #onicity#he term#he term tonicitytonicityis used to describeis used to describe
the osmolality o a solution relativethe osmolality o a solution relative
to plasma. olutions that have theto plasma. olutions that have the
same osmolality as plasma are saidsame osmolality as plasma are saidto beto be isotonic;isotonic;those with greaterthose with greater
osmolality areosmolality are hypertonic;hypertonic;andand
those with lesser osmolality arethose with lesser osmolality arehypotonic.hypotonic.
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0ll solutions that are initially0ll solutions that are initially
isosmotic with plasmaLie, that haveisosmotic with plasmaLie, that have
the same actual osmotic pressure orthe same actual osmotic pressure or
reeing:point depression as plasmareeing:point depression as plasmaLwould remain isotonic i it were notLwould remain isotonic i it were not
or the act that some solutes di)useor the act that some solutes di)use
into cells and others are metabolied.into cells and others are metabolied.
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#hus, a .J" saline solution remains#hus, a .J" saline solution remains
isotonic because there is no netisotonic because there is no net
movement o the osmotically activemovement o the osmotically active
particles in the solution into cells andparticles in the solution into cells and
the particles are not metabolied.the particles are not metabolied.
8n the other hand, a (" glucose8n the other hand, a (" glucose
solution is isotonic when initiallysolution is isotonic when initially
inused intravenously, but glucose isinused intravenously, but glucose is
metabolied, so the net e)ect is thatmetabolied, so the net e)ect is thato inusing a hypotonic solution.o inusing a hypotonic solution.
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8smosis & IM fuids8smosis & IM fuids
$ypotonic IM solutions$ypotonic IM solutions i too muchi too much
water enters the cells eventually itwater enters the cells eventually it
coud undergo hemolysis or brea-coud undergo hemolysis or brea-
openopen$ypertonic IM solutions$ypertonic IM solutions there is athere is a
net fow o water out o the cell andnet fow o water out o the cell and
that cause the cell to shrin-that cause the cell to shrin-
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45tracellular and Intracellular45tracellular and Intracellular
FluidsFluids Ion fu5es are restricted and moveIon fu5es are restricted and move
selectively by active transportselectively by active transport?utrients, respiratory gases, and?utrients, respiratory gases, and
wastes move unidirectionallywastes move unidirectionally7lasma is the only fuid that7lasma is the only fuid that
circulates throughout the body andcirculates throughout the body andlin-s e5ternal and internallin-s e5ternal and internalenvironmentsenvironments
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8smolalities o all body fuids are8smolalities o all body fuids areeEual' changes in soluteeEual' changes in soluteconcentrations are Euic-ly ollowedconcentrations are Euic-ly ollowed
by osmotic changesby osmotic changes
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Aovements o fuids in theAovements o fuids in the
bodybody0bsorption' Fluids are absorbed into0bsorption' Fluids are absorbed into
the plasma in the intestinethe plasma in the intestine
Circulation' #he fuids circulate withinCirculation' #he fuids circulate within
the plasma bathing the cells in thethe plasma bathing the cells in the
bodybody
45cretion' #he -idney remove e5cess45cretion' #he -idney remove e5cess
ions and water rom the bodyions and water rom the body
through urinethrough urine
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Water $omeostasisWater $omeostasis
#he body maintains a balance o water#he body maintains a balance o water
inta-e and output by a series ointa-e and output by a series o
negative eedbac- loop involving thenegative eedbac- loop involving the
endocrine system and autonomicendocrine system and autonomicnervous systemnervous system
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Water Balance and 4CFWater Balance and 4CF
8smolality8smolality
#o remain properly hydrated, water#o remain properly hydrated, water
inta-e must eEual water outputinta-e must eEual water output
Water inta-e sourcesWater inta-e sources
Ingested fuid 1%"2 and solid oodIngested fuid 1%"2 and solid ood
1!"21!"2
Aetabolic water or water oAetabolic water or water o
o5idation 1="2o5idation 1="2
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Water Balance and 4CFWater Balance and 4CF
8smolality8smolality
Water output
Urine (60%) and feces (4%)
Insensible losses (28%) s!eat (8%)
Increases in plas"a os"olalit# trigger t$irst
and release of antidiuretic $or"one (&')
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Water Inta-e and 8utputWater Inta-e and 8utput
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