WATER BALANCE
Body Content
Constitute 60 70% of the total body weight
Less in woman and obese individual
Distribution
50% intracellular cell inside
15% interstitial in between cell
5% intravascular
Normal Losses
2,300 ml/day thru
Insensible evaporation 800 1,200ml/day
Urine 800 1500ml/day
Stool 100ml/day
Normal Replacement
Fluid drinks
Water in solid food
Water from product of metabolism
Metabolism of Control
Thru thirst control
Effect of ADH
Rennin angiotensin aldosterone system
Abnormal States
Dehydration
Edema
Abnormal accumulation in body cavities
ELECTROLYTE BALANCE
Importance
o
o
o
concentrations of different electrolytes
affects all metabolic processes
determines the osmolality of the body fluids
maintains electrochemical potential across
cell membrane w/c in turns effects
neurologic and muscular functions
CALCIUM (CA)
most of the calcium are bound to tissues
may be ionized/non-ionized:
unionized - circulating plasma CHON
ionized - unbound; active component of cations
mainly involved in blood circulation
for maintenance of nerve impulse in neural junction
direct parahormone secretion
Abnormal Condition
hypercalcemia==>calcium deposited in
other tissues of the body causing rapid
change of pH in lungs kidneys
hyperplasia of parathyroid gland involved all 4 parathyroid gland
hypocalcemia -sudden change in
light/sound stimulus
increased calcitonin secretion secondary to tumor
since tumor cells may also secrete calcitonin
(secretion of calcitonin==> hypocalcemia==>
hypocalcemic tetany)
calcium electrolyte may be measured directly by total
calcium (both ionized and unionized)
MAGNESIUM (Mg)
-present in trace amounts of body fluids
-involved in some enzymatic reaction
-helps maintain normal function of nervous system
-magnesium administration may cause sedative
effects
-in eclampsia = administer magnesium sulfate
POTASSIUM (K)
-
Important Electrolytes:
Cations
o Na
o K
o Ca
o Mg
Anions
o Cl
o HCO3
o Phosphate
SODIUM (Na)
-
major cations in the ECF
normal value in plasma or serum = 135-145 mmol/L
serum level is controlled by renal excretion or
reabsorption
Abnormal states:
1. Hyponatremia maybe due to Na loss or water
excess
e.g. Na loss diarrhea, diuretic use, nephrosis,
metabolic acidosis
e.g. Water excess (dilutional) inappropriate
ADH secretion, hyperglycemic state
2. Hypernatremia renal disease, polyuric states,
hyperaldosteronism
major intracellular cation
normal serum level = 3.8-5 mmol/L
NO renal threshold it is continuously excreted by
the kidneys even if serum level is low
Level is maintained by intake and excretions
Abnormal States:
1. Hypokalemia
o vomiting
o diarrhea
o diuretic therapy
o renal disease
o excess mineralocorticoids secretion
o alkalemia due to conservation of Na in
exchange for K in the kidneys
o heartbeat stops at diastole
2. Hyperkalemia
o acute or chronic renal disease
o extensive tissue injury with release of K
o cushing syndrome
o CHF
o Cirrhosis
o Nephritic syndrome
o Acidosis states (Diabetic acidosis)
o Heartbeat stops at the systole
therapy: fluid replacement combined with diuretics
to rid the body from extra Na and mineralocorticoid
-excretion: urine, feces
*when the blood is acidic, it may cause swelling
leading to an increase in K, and a decrease in NaCl
*KCl-used in lethal injection
*elevated or depressed levels affect the neuromuscular
system causing paralysis and arrythmia
CHLORIDE (Cl)
-
major extracellular anion
normal serum conc. = 98-106 mmol/L
maintained by a balance between intake usually in
the form of salt of Na, K, Ca and the urinary
excretion also in the form of salt
Abnormal states:
1. Hypochloremia- occurs in prolonged vomiting
due to loss of HCl
o in metabolic acidotic states due to
accumulation of organic aions
o Addisonian crisis
o salt-losing nephritis
2. Hyperchloremia seen in acidotic states
associated with prolonged diarrhea
o in respiratory alkalosis due to retention of
chloride
Measurement in concentration in sweat is useful in
the dx of mucoviscidosis in w/c case its conc. 2-5
times elevated
o disease in infancy
o sweat test
Buffer System:
-
Kidneys
-
controls the elimination of CO2 by the depth and rate
of respiration
Abnormal states of acid-base balance:
1.
2.
usually measured in serum as total CO2
Normal value = 24-30 mmol/L in venous blood (1925 in arterial blood)
Abnormal states:
1. Decreased in metabolic acidosis and respiratory
alkalosis
2. Increased in respiratory acidosis
acidifies urine by exchanging H+ w/ Na
Prodn of ammmonia - H+ combines w/ NH3tp form
NH4
excretion of organic acids
Lungs
BICARBONATE (HCO3)
-
soaks-up the H+ w/ very little change in pH
Buffers are salt of weak acids
1. HCO3/ H2CO3 system
2. Hemoglobin binds w/ H+ thru its histidine
residue
3. Protein the carboxyl and amino group binds H +
4. Inorganic and organic phosphates
Acidemia/Acidosis
a. Respiratory acidosis
b. Metabolic acidosis
o due to excess loss of base
o accumulation of organic acids
Alkalemia/Alkalosis
a. Respiratory (primary CO2 deficit)
b. Metabolic (primary alkali deficit)
Laboratory parameters for Evaluation
1.
2.
3.
4.
Blood pH
Total CO2
Na, K, Cl
Blood gases - PCO2 & PO2
ACID-BASE BALANCE
-
normal pH of body fluids is maintained w/in the very
narrow range of 7.35 7.45
metabolic processes of the body are catalyzed by
enzymes and enzyme activity is very sensitive to pH
changes
a large quantity of acids are normally produced in the
body as a by-pdt of normal metabolism
the body is in continuous production of acids
oxidative processes:
CO2 and H2O then converted by carbonic
anhydrase
sulfur containing:
sulfuric acids
phosphorus containing:
phosphoric acid
anaerobic process:
lactic acid
volatile acids:
1. H2CO3 from CO2
2. Keto acids from incomplete metabolism of lipids
non-volatile acids:
1. Sulfuric acid- from oxidation of sulfur
containing amino acids
2. Phosphoric acid - from phosphorus containing
compounds
3. Organic acids lactic acid
Maintenance of normal pH is accomplished by 3
mechanisms:
buffer systems
kidneys
lungs
Mechanisms that control body pH:
1. buffer system -most important
Main Buffer Systems:
o carbonic acids -bicarbonate system soaks up excess
acid
o hemoglobin- because of quantity it can absorb CO2
and prevent /maintain pH levels
o protein-adding weak acids
o lungs-controls the elimination of CO2
-with excess carbonic acid
increases the rate depth of
respiration eliminating excess
CO2 thus eliminating carbonic
acid
o urine-kidneys produce ammonia=ammonium salts are
eliminated thru the urine
Derangement in acid-base balance:
o pH >7.45 body fluids become acidic =acidosis
o pH <7.35 body fluids become alkaline =alkalosis
inhibition of normal respiration
=>breathing becomes shallow and slow=>air from
lungs does not reach
<=excess CO2 in the body<=no elimination of
CO2<=outside environment converted back to
carbonic acid=> respiratory acidosis
hysteria=>rapid deep breathing=>excessive elimination of
CO2=>assess basic conjugates=>[Link]
drugs that affect normal lung function *aspirin
Abnormalities in kidney function:
cardiac arrest
severe hypotension
prolonged shock
=profusion of blood in capillaries=>metabolism
shifts to anaerobic process=>lactic acid
production=>metabolic acidosis
starvation
=>due to exudation of fat=>inc. Production of ketone
acids=>metabolic acidosis
vomiting
=>increased loss of HCO3=>metabolic alkalosis
uncontrolled diabetes
=>diabetic coma may cause metabolic acidosis due
to ketone acid excess
diarrhea
=>loss of electrolyte=>may be alkalosis/acidosis
*in minor cases of acidosis/alkalosis the 3 major mechanisms
that control body pH may compensate the change in
pH=compensated acidosis/alkalosis
*pH correction=determines cause on change of pH then treats
the cause
