Electrolytes b.
Extracellular fluid compartment
• Accounts 1/3 of water (16 L)
• Charged ions: capable of carrying electric charge (cation, anion)
1. Intravascular
3– –
• Major: Na, K, Cl, Ca, PO4 , Mg, HCO3 • 3.5 L (75%)
3
• Trace: Fe, Cu • Plasma: 1300-1800 mL/m
o 93% – water (0.930 kg/L)
• Functions o 7% – CHON & lipids, affecting the amount of electrolytes
1. Volume and osmotic regulation (Na, Cl, K) dissolved in plasma
2. Myocardial rhythm and contractility (K, Mg, Ca) § Lipemic and proteinemic samples: falsely decreased
3. Cofactor of enzyme activation (Mg, Ca, Zn) K, Na due to competition for solvent – electrolyte
4. Regulation of ATPase pump (Mg) exclusion effect
5. Acid-base balance (HCO3, K, Cl) • Lymph
6. Blood coagulation (Ca, Mg) • CSF
7. Neuromuscular contractility (K, Mg, Ca) • Ions: Na, Cl, 50% of Ca
8. Use of ATP and production from glucose (Mg, PO4)
2. Interstitial
• Regulatory mechanism • 25%
1. Buffer system • Filtrate of plasma
2. Respiratory compensatory • No proteins
3. Renal compensatory • Bicarbonate-chloride shift
• Factors affecting electrolyte level • Clinical Significance
1. Gender o In pathologic conditions such as septic shock, the permeability of vascular
2. Age capillaries is increased, allowing seepage of cells and fluids out of the
3. Water vessels. Therefore reducing circulating fluid volume resulting into
• 40-75% of body W/V reduced oncotic pressure
o 60% for 1 year old
o 50% for males o ECF loss of water
o 45% for females § Acute blood loss (bleeding, burns)
• Daily requirement: 1-1.5 L § Water loss (diarrhea, vomiting, burn, diuretics)
§ Pancreatitis
• Sources of loss: § Peritonitis
a. Renal – 1.2 L / day o Symptoms of water loss:
b. Insensible loss (i.e. sweating, crying) – 200 mL / day § Thirst
c. Activities and presence of diseases: insensible loss § Anorexia
§ Nausea
• Functions: § Lightheadedness
a. Transports nutrients to cells § Hypotension
b. Determines cell volume by its transport into and out of cells § Syncope
c. Removes waste products by way of urine § Tachycardia
d. Acts as body’s coolant by way of sweating § Oliguria
• Location: compartments o ECF gain of water
a. Intracellular fluid compartment § Iatrogenic patient: overtreatment of intravascular fluid
• Accounts 2/3 of water (24 L) § Congestive heart failure
• Cytoplasm § Symptom: ↑ BP
• Ions: K, Mg, trace elements, 50% of Ca
Gibbs-Donnan Equilibrium & Transport Mechanisms 2. Antidiuretic hormone (ADH)
• Gibbs-Donnan Equilibrium • Response: acts on the cell of the collecting tubules to increase water
o 2 solutions separated by semi permeable membrane establish an equilibrium so absorption
that all ions are distributed in body fluid compartments • Result: decreased renal loss
o State of equilibrium
§ Total ion = total concentration of osmotically active particles • Maintenance of osmolality
o Water is balanced between 2 compartments through a semi-permeable 1. Osmoreceptors
membrane. Diffusible ions will also balance between the 2 compartments. • Cells sensitive to slight changes in osmolality
However, if one compartment has 1 non-diffusible component (proteins), it won’t • In case of polydipsia both ADH and thirst are suppressed resulting in increased
be balanced in the other compartment. To compensate for this, anions such as water and therefore plasma osmolality lowers
chloride (most important ion) are used to balance. • 1-2% increase in osmolality: fourfold increase in circulating concentration of
AVP (arginine vasopressin hormone)
• Passive diffusion o AVP – important in reabsorption of water
o Passive movement of ions through a membrane from a high concentration § Absence: large volume of dilute urine to be excreted (10-20 L/day)
gradient to an area of low concentration • 1-2% decrease in osmolality: shuts off AVP production
o Rate of diffusion may be altered physiologically • Hyperosmolality and hypernatremia – major defense: thirst
§ Depends on size and charge of ions transported, and nature of membrane • Hypoosmolality and hyponatremia – occur only in patients with impaired
through which it is passing renal excretion of water
• Active transport 2. Regulation of blood volume
o Requirement of energy especially for anions entering the cell • To maintain blood pressure
o Ex. maintenance of (high intracellular) K concentration (and high extracellular Na • To ensure good perfusion of blood to all organs
concentration) • Renin
+
§ There is the Na-H exchange which actively pumps H from ICF in exchange for
Na from ECF 3. Regulation of Na & CHO
§ Critical for maintenance of: a. Renin-Angiotensin-Aldosterone System (RAAS)
• pH
• Volume
• Homeostasis
• Cell growth
o The osmotic pressure effects of Na, other ions, proteins and blood pressure lowers
the flow of water across a membrane
• Osmolality
o Amount of solute in mM in a kg of solvent
o Affects the colligative properties
§ Related to several changes in physical properties of a solution (i.e. freezing
point depression, vapor pressure decrease)
• Plasma osmolality
o Result of the presence of osmotically active substances (i.e. Na, glucose, urea)
o Parameter in which the hypothalamus responds to
o Reference value: 275-295 mOsm/kg plasma (mM/kg)
• Clinical manifestations of increased plasma osmolality • Renin – secreted near the renal glomeruli in response to decreased blood
1. Thirst flow (↓ BP, ↓ blood volume)
• Response: increase intake of fluids o Converts angiotensinogen à angiotensin I
• Result: increase ECF content à dilution of elevated solutes o Angiotensin I à angiotensin II
• Angiotensin II
o Vasoconstriction à quick increase in BP
o Secretion of aldosterone
§ ↑ Na retention
§ ↑ H2O retention
§ ↑ K excretion
• Net effect: correction of BP and BV
b. Atrial Natriuretic Peptide
• ANP is released from myocardial atrial tissue in response to expansion
• Stimulus: hypovolemia
• Effect: promotes Na excretion in the kidneys
• Regulates fluid balance & osmolality
c. Release of Antidiuretic Hormone (ADH)
• Promote water reabsorption
• Plays a central role in water balance
• Vasopressin receptors at ascending loop of Henle and collecting tubules
• Coupled with adenylate cyclase and once activated, insertion of
aquaphorin-2 to the tubular terminal membrane allowing water passage
• Effect:
o Blood clotting
o Promotes release of factor T of blood coagulation protein
o Factor VIII
• Receptors are also coupled with phospholipase C
• Osmoreceptors and baroreceptors – responsible for detecting changes in
pressure, stored in the posterior pituitary glands
o When released, they stimulate ADH release
• Threshold: 284 mOsm/kg
• Clinical significance:
o Diabetes insipidus
o Syndrome of inappropriate ADH secretion
d. Glomerular filtration rate
• ↑ with volume expansion
• ↓ with volume depletion
e. Sodium concentration
