ELECTROLYTES

DR WAIRIMU
 INTRODUCTION
Electrolytes are charged particles (ions) that are dissolved in body
fluids.
They are essential to the proper function of the heart, nerves and
muscle.
Because of this, it is important to maintain a precise and constant
balance of electrolytes.
 INTRODUCTION
Cation- positively charged electrolyte.
Anion- negatively charged electrolyte.
Cations= anions for homeostasis to exist in each
fluid compartment.
Electrolytes are measured in mEq/L.
 [Link]
Most abundant cation in the ECF.
Normal values : 135-145 mEq/L
Functions:
i. Determines the osmotic pressure of the ECF.
-Sodium has a pulling effect on water.
-Because there is more Na+ outside cells than inside, the water is pulled
out of cells into the ECF.
-Na+K+ ATPase pump – pumps 3 Na+ out of the cell and 2K+ into the cell.
-Without this pump the cells would fill with Na+ and rupture due to
increased osmotic pressure.
ii. Necessary for muscle contraction and nerve function.
Na+K+ATPase PUMP
 REGULATION OF Na +

LEVELS
Intake: Na+ intake is determined by intake through diet and
absorption in the colon and distal small bowel.
- Na+ is abundant in many foods, the modern diet incorporates an
excess of sodium in the form of salt (NaCl).
Output is predominantly via urinary excretion.
- Other output occurs via insensible losses, in the sweat and faeces.
Urinary sodium concentration is highly variable, depending on the
amount of reabsorption occurring in the nephrons.
This allows for the variable intake of water and sodium that
occurs day to day without drastically altering blood pressure or
 RENAL Na +

REABSORPTION
99% of the sodium ions that pass through the glomerulus are reabsorbed.
Sodium reabsorption varies at different parts of the nephron.
In each section, it is driven across the basolateral membrane by
Na+K+ATPase pumps.
PCT- 65% of Na+ is reabsorbed by the apical Na+/ amino acid
cotransporter & Na+ H+ antiporter.
Thick ascending loop of Henle- 20% of Na+ is reabsorbed by the apical
Na+/K+/ Cl¯ cotransporter.
Distal convoluted tubule- 10% of Na+ is reabsorbed by the apical Na+/Cl-
cotransporter.
Collecting duct -4% by the apical epithelial sodium channels.
 RENAL SYMPATHETIC
NERVE ACTIVITY
Hypotension detected by baroreceptors in the carotid and aortic
arch and hypovolaemia detected by reduced distension of atrial
myocytes stimulates activation of the sympathetic nervous system.
The effect of renal sympathetic nerve activity is increased
reabsorption of sodium in the PCT by activation of α1 and α2
adrenoceptors.
This increases fluid retention, thereby increasing intravascular
volume and blood pressure, maintaining homeostasis.
 REGULATION OF Na+ LEVELS
Hormones that increase sodium reabsorption:
i. Renin angiotensin II aldosterone system (RAAS)
-Renin is released from the juxtaglomerular apparatus of the
kidney
-The release of renin is due to:
i. Reduced sodium delivery to the distal convoluted tubule
ii. Reduced perfusion pressure in the kidney.
[Link] stimulation of the JGA.
-Renin cleaves angiotensinogen to form angiotensin I
 RAAS
Angiotensin I is converted to angiotensin II by angiotensin converting
enzyme (ACE).
ACE is predominantly found in the lungs.
Angiotensin II has several actions:
i. Vasoconstriction of arterioles, increases blood pressure.
ii. Stimulates Na+ reabsorption by the kidneys.
-60-70% of the reabsorption occurs along the proximal convoluted
tubule.
-- The ascending loop of Henle is impermeable to water.
iii. Stimulates the release of aldosterone from the adrenal gland
 RAAS
Angiotensin II actions:
iv. Increases thirst sensation & antidiuretic hormone(ADH) release
from the posterior pituitary.
- Increase in fluid consumption= increase in blood pressure.
-ADH causes increased water reabsorption in the kidney through
aqua porin 2 channels in the collecting duct.
Patients with syndrome of inappropriate ADH secretion with
excess ADH develop dilutional hyponatraemia.
Hypernatremia: excess aldosterone secretion, restricting fluid
intake, iatrogenic administration of ivfs.
 ALDOSTERONE
Is a steroid hormone secreted by the cortex of the adrenal glands.
Aldosterone binds to its receptor in both the distal convoluted tubules and
the collecting ducts.
Binding of aldosterone to its receptor increases synthesis of the Na+K+ atpase
pump and other Na+ transport proteins.
The Na+K+ atpase pump increases the reabsorption of Na+ and the secretion
of K+ across the basal membrane of tubule cells.
This results in an increased rate of Na+ reabsorption and a simultaneous
increase in K+ excretion.
Reabsorption of Na+ is accompanied by water reabsorption resulting in a
reduced urine volume.
 ALDOSTERONE
Aldosterone increases the number of Na+K+ atpase pumps & thus increases
the rate of K+ secretion.
-Increase in blood K+ levels stimulate aldosterone secretion.
-Conversely, decreases in blood K+ levels decrease aldosterone secretion.
Aldosterone increases the number of epithelial sodium channels in the
collecting duct.
RAAS
RAAS
 REGULATION OF Na +

LEVELS
Hormones increasing sodium excretion:
i. Atrial natriuretic peptide
-Produced from the atrial wall due to excessive stretch from
increased blood volume.
-Increases Na+ excretion by blocking its reabsorption at the proximal
convoluted tubule.
ii. Brain natriuretic peptide:
-Secreted by the hypothalamus
-Increases Na+ excretion by the kidney
 SODIUM
Normal serum ranges: 135-145 mEq/L
Hyponatraemia:<135 mEq/L
Hypernatremia: >145 mEq/L
 DIABETES
INSIPIDUS
Insufficient ADH secretion results in a condition called diabetes insipidus.
-It is characterised by the production of a large volume of urine that is clear,
tasteless, and dilute.
Patients who secrete insufficient ADH produce 10–20 L of urine per day and
develop dehydration and electrolyte imbalances.
In contrast patients with diabetes mellitus produce a large volume of urine
that contains a high concentration of glucose.
- This is due to the filtered load of glucose exceeding the renal threshold for
reabsorption it causes an osmotic drive that reduces water reabsorption.
- Patients present with polydipsia, polyuria, polyphagia.
SYNDROME OF
INAPPROPRIATE SECRETION
OF ADH
Is a disorder of impaired water excretion caused by the inability to suppress
the secretion of ADH.
Water intake exceeds the reduced urine output, the ensuing water retention
leads to hyponatraemia.
The hyponatraemia is dilutional in nature.
 [Link]
Major intracellular cation.
98% intracellular, 2% in the ECF.
K+ concentration inside cells is 20 times greater than it is outside
due to the Na+K+ATPase pump.
Functions:
i. Regulates neuromuscular excitability and cardiac muscle
contraction.
ii. Creates intracellular osmotic pressure.
 POTASSIUM
REGULATION
The kidney is responsible for maintaining total body K+
content.
It matches K+ intake with K+ excretion.
K+ intake is mainly through diet.
K+ reabsorption:
- Potassium is freely filtered at the glomerulus.
- 70% of the filtered K+ is reabsorbed in the PCT and 20% in the
loop of Henle
- The remaining 10% is reabsorbed in the DCT when the body
+
 POTASSIUM
REGULATION
Potassium excretion:
- 90% of excess K+ is excreted through the kidneys.
- Excretion occurs in the DCT and collecting duct.
Aldosterone: increases K+ secretion, elevated aldosterone levels
will cause hypokalaemia.
10% of excess K+ is excreted through sweat or stool.
Normal range= 3.5-5.5 mEq/L
Hypokalaemia < 3.5 mEq/L
Hyperkalaemia > 5.5 mEq/L- burns
 [Link]
Most abundant mineral in humans.
99 % is found in bones.
Remaining 1% is in tissues and body fluids
50% is bound to protein, mainly albumin, non diffusible, not
active.
5% bound to organic anions e.g. phosphate.
45% is free ionised calcium.
Ionised calcium is the active form.
Normal range: 2.2-2.7 mmol/L.
 CALCIUM
Functions of calcium include:
i. Formation of bones and teeth
ii. Excitability and conductivity of nerves
iii. Involved in muscle contraction
iv. Coagulation of blood
v. Secretion of hormones
Calcium levels are regulated by vitamin D, parathyroid hormone
and calcitonin.
 VITAMIN D
Is involved in the long term regulation of calcium.
Function: increases intestinal absorption of calcium.
Calcitriol stimulates intestinal epithelial cells to increase the
synthesis of calbindin-D proteins.
Calbindin-D proteins increase the intestinal absorption of calcium.
They facilitate the transport of calcium from the intestinal brush
border to the basolateral membrane, where it is released into the
bloodstream.
 CALCITONIN
32 amino acid peptide hormone, from the parafollicular cells of
the thyroid gland that is secreted due to increased serum calcium.
Calcitonin secretion leads to a rapid reduction in circulating
calcium levels, mainly through the inhibition of bone resorption.
Calcitonin decreases calcium levels by inhibiting osteoclasts, thus
reducing bone resorption.
 Binding of calcitonin to its receptors on osteoclasts causes cell
retraction, and the suppression of cell motility and bone
resorption.
 CALCITONIN
Other actions of calcitonin include:
i. Inhibits bone resorption by osteoclasts.
ii. Stimulates osteoblasts and deposition of calcium into bones.
iii. Inhibits calcium reabsorption in the kidneys.
iv. Inhibits calcium absorption by the intestines.
 PARATHYROID
GLANDS
The parathyroid glands are small endocrine glands located in the
anterior neck.
They are located on the posterior, medial aspect of each lobe of
the thyroid gland.
Anatomically, the glands can be divided into two pairs: the
superior and inferior parathyroid glands.
The chief cells are responsible for the production of parathyroid
hormone (PTH).
 PARATHYROID HORMONE
FUNCTION
Stimulus for its secretion: reduced calcium levels in blood.
PTH has three main actions, all of which act to increase calcium levels in the
body.
i. Increased bone resorption – PTH acts directly on bone to increase bone
resorption.
- It directly stimulates osteoblasts to increase bone formation.
-Its actions on osteoclasts is indirect & mediated by its actions on osteoblasts.
- PTH induces cytokine secretion from osteoblasts, the cytokines act on
osteoclasts to increase their activity.
-Osteoclasts are responsible for the breakdown of bone and thus an increase in
their activity leads to increased bone breakdown.
- This leads to an increase in calcium in the extracellular fluid.
 PARATHYROID HORMONE
FUNCTION
ii. Increased reabsorption of Ca2+ in the kidney.
PTH increases the amount of calcium absorbed from the loop of
Henle and distal tubules.
It also increases the rate of phosphate excretion which helps
prevent the formation of calcium phosphate kidney stones.
iii. Vitamin D synthesis.
PTH stimulates the formation of vitamin D through stimulation of
the enzyme 1α hydroxylase.
Vitamin D increases the absorption of calcium & phosphate from
the small intestine.
 4. MAGNESIUM
50-60% is located in bone.
30-40% in muscle and soft tissues.
1% in the extracellular fluid.
Normal range= 1.5-2.5 mEq/L.
Functions:
i. Necessary for muscle contraction and nerve function
ii. Co-factor for enzymes involved in ATP production
[Link]- factor in RNA &DNA synthesis
 [Link]
Major anion of the ECF.
Chloride moves passively with Na+ or against HCO3- to maintain
electrical neutrality.
Functions :
i. Part of hydrochloric acid in gastric juice
ii. Helps regulate osmotic pressure
Normal values= 95-105 mEq/L
 [Link] (HCO3 ) -

Most abundant intracellular anion.

Functions:
i. Buffering system of plasma
-The ability of the HCO3- to accept a hydrogen ion (H+) makes it an
efficient and effective means of buffering pH in the body.
-Makes up 95% of the buffering capacity of plasma.
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