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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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