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F & E Part I Lecture Notes

Fluid & Electrolytes
Human life is suspended in a salt solution (concentration 0.9%)
For life to continue and cells to properly function, body fluids must maintain constant composition of water
and electrolytes
Homeostasis: Essential to Life
Maintenance of stable environment for body cells
Internal environment: narrow range of normal values
Ongoing process: changes constantly occurring in the body
Keys to Homeostasis
Constancy: steady state
Prevent or compensate for unacceptable changes
Fluid volume, electrolyte concentrations remain the same
Equilibrium: balance
Fluid intake = fluid output
Homeostatic Mechanisms:
Responses to disruptive changes
Compensatory
Self-regulating
Work by negative feedback:
Stimulus (stressor):
Response (mechanism):
Compensates for original stimulus
Then turns self off
Negative Feedback:
Works Like a Thermostat
Negative Feedback System: Calcium and PTH
Body and Water
55-60% of adult body weight is water
Higher due to muscle (more H2O) or lower due to fat (less H2O)
Females lower
Fluctuations in the amount of water in the body can have harmful and even fatal consequences
Functions of Water in the Body
Water is vital to health and normal cellular function, serving as:
A medium for metabolic reactions within cells
A transporter for nutrients, gases, wastes
A lubricant
An insulator and shock absorber
Maintenance of body temperature

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Body Fluids: Water and Solutes
The term fluid' refers to water and the components it contains
Solution: liquid containing a dissolved substance (fluid)
Solvent: liquid part of a solution (water)
Solute: substance that can be dissolved in a solution (electrolyte)
Cell Membrane
Membrane
Permeability
Selective permeability
Impermeability
Controls differences in fluid and electrolyte composition in the different body compartments
Fluid Compartments
Water

Most common substance in body

55% - 60% total adult body weight
~42 kg for 70 kg man
Fluid Compartments
2 compartments:
Intracellular fluid (ICF)
60% TBW
Body (cell) metabolism
Extracellular fluid (ECF)
40% TBW
Nutrients, gas, and wastes exchanged
ECF Subcompartments
Interstitial (ISF)
Tissue fluid, lymph
75% ECF
Surrounds, bathes cells
Intravascular (Plasma)
25% ECF
Entrance and exit site for F & E
Transcellular
Fluid in transit and special spaces
Transcellular Fluid is Found Where?
Intravascular Fluid: Plasma
Fluid in the intravascular space minus the formed elements of blood
Consists of water, protein, nutrients, electrolytes, and waste products
Electrolytes: narrow range
Solutes: Two Types
Electrolytes (crystalloids)
Solutes with an electrical charge

Break apart into ions

Nonelectrolytes
Solutes without an electrical charge
Remain intact in solution
Glucose, urea, lipids, C02, 02
Proteins (colloids)
Albumin, globulin, fibrinogen
Electrolytes
Chemical substances that break apart into electrically charged particles (ions) with positive (+) or negative (-)
charges when placed in a solution
Cation: positive charge
Anion: negative charge
Ions
Dissociated particles of electrolytes
Carry either a positive or negative charge
Cations (+): sodium (Na+), potassium (K+), calcium (Ca++), magnesium (Mg++), hydrogen (H+)
Anions (-): chloride (Cl-), phosphorus (HPO4 2 -), and bicarbonate (HCO3-)
Electrolytes: Measurement
Milliequivalent (mEq): chemical combining power of the ion
Measured per liter (mEq/L)
1 mEq of any cation equals 1 mEq of any anion
Sodium and chloride are equivalent since they combine equally
Most common measurement
Milligram or grams (mg %, g%): weight of ions in a solution
Concentration
mg/dL (100 ml) or g/dL
Calcium, phosphate, magnesium, 0.9% NaCl
Combining Power vs Weight
Functions of Electrolytes
Essential minerals
Fluid balance
Acid-base balance
Transmit neuromuscular impulses
Distribution of Electrolytes
Extracellular fluid
Na+
Sodium
Chloride
Cl Bicarbonate HCO3 Intracellular fluid
Potassium
K+
2+
Magnesium Mg
Phosphate
HPO42

Electroneutrality: total sum of cations must equal total sum of anions (pluses and minuses must equal)

Movement
Exchange: Water and Solutes
Constant movement of water and solutes between different fluid spaces
Goal: maintain homeostasis
Selective permeability: controls solute movement
Small particles (ions, 02, C02, H20) pass easily
Larger molecules (glucose, proteins) have more difficulty passing between fluid compartments
Sodium controls water distribution (water follows sodium)
Passive vs Active Transport
Gradient: difference in concentration, pressure, or electrical charge between two compartments
Passive transport: no energy expended
Flows down the concentration gradient
Only from high concentration to low
Passive Transport
Types of Passive Transport

Diffusion
Facilitated diffusion
Osmosis
Filtration
Simple Diffusion
Random movement of solutes across a permeable membrane down a concentration gradient
High conc. low conc.
Result: equal solute distribution (equilibrium)
No ATP energy
Example: smaller, fat-soluble molecules (02, C02)

Diffusion in Action
Facilitated Diffusion
Diffusion of large, lipid-insoluble solutes across a membrane, with the help of transport proteins
High conc. low conc.
Integral membrane protein acts as carrier
No ATP energy
Faster than simple diffusion
Example: glucose

Osmosis
Diffusion of water across a selectively permeable membrane (permeable to water, not to solute)
High water conc. low water conc.
Low solute conc. high solute conc.
No ATP energy
Examples: water movement from interstitium to cells, from interstitium to plasma

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Osmotic Pressure
Fluid-pulling power
Exerted by all particles in a solution
Driving force for movement of water across a cell membrane
Solute = Osmotic pressure
Osmotic pressure = water in
Osmotic pressure = water out

Osmolarity
Number of solute particles per 1L of body fluid
Measures osmotic pressure (fluid-pulling power)
Expressed as milliosmoles per liter (mmol/L)
Normal osmolarity = 270-300 mmol/L
Electrolyte molecules exert greater effect on osmosis than nonelectrolytes
Sodium is greatest determinant of ECF osmolarity
Water follows sodium
Tonicity
Effect of osmotic pressure on cellular volume
Concentration of solutes determines direction of water flow
Isotonic: 270 300 mmol/L
Equal solute and waterexact same number of particles in both solutionsno net movement (same)
Hypertonic: > 300 mmol/L
Greater solute, less waterwater pulled out of cells (shrinks)
Hypotonic: < 270 mmol/L
Less solute, more waterwater moves into cells (swells)
Tonicity of IV Fluids
Isotonic: same osmolarity (270 300 mmol/L)
Normal saline (NS or 0.9% NaCl), Lactated Ringers (LR)
Hypotonic: fewer solutes (< 270 mmol/L)
Water, NS (0.45% NaCl), and D5W (5% dextrose in water, after the dextrose is used up)
Filtration
Fluid-pushing power
LARGE AMOUNTS (bulk flow) of water & solutes together are forced through capillary membranes by
pressure in the blood
High hydrostatic pressure low hydrostatic pressure
Filtration
Filters out formed elements of blood and colloid proteins (no protein in interstitial fluid)
Opposes osmosis (fluid-pulling power)
No ATP energy
Examples: capillary bed, glomerulus (kidneys)
Colloids: Plasma Proteins
Large molecules unable to pass through membrane because of their size
Albumin, globulin, fibrinogen
Exert osmotic pull: colloid osmotic pressure, oncotic pressure
Pull water back into the vascular system

Colloid IV solutions:
Albumin, Dextran, Hetastarch
Remain in vascular compartment
Starlings Forces
Pressure differences in venous and arterial ends of capillaries influence direction of fluid movement
Filtration (arterial end): fluid out (due to higher hydrostatic pressure)
Reabsorption (venous end): fluid back in (due to higher colloid osmotic pressure)

Capillary Dynamics
Interplay of 4 forces:
Capillary hydrostatic pressure (CHP): MAJOR
ISF hydrostatic pressure (IFHP): MINOR
Capillary oncotic pressure (COP): MAJOR
ISF oncotic pressure (IFOP): MINOR
Capillary Dynamics
Arterial end: fluid out
Plasma ISF
Filtration prevails
(CHP + IFOP) (COP + IFOP) ~ 16 mm Hg
Venous end: fluid in
ISF Plasma
Osmosis prevails
(COP + IFHP) (CHP + IFOP) ~ 9 mm Hg
More fluid out than back in
Excess tissue fluid returned to vascular space by lymphatic vessels
Lymphatic System: Returns Excess ISF to Vascular System
Active Transport
Movement of solutes across a cell membrane against a concentration gradient, with the help of carrier
molecules (pumps)
Low conc. high conc.
Requires ATP energy
Example: sodium-potassium pump
Sodium-Potassium Pump
Transport protein pumps in cell membrane
Powered by ATP
3 Na+ ions transported to ECF against gradient
2 K+ ions transported to ICF against gradient
Maintains ECF, ICF homeostasis
Can You Name the Process?

Diffusion, osmosis, filtration, or active transport?

Fluid Movement Between Compartments