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Click to edit Master subtitle style dr. Dicky Kurniawan Tontowiputro, SH, SpPD
The body must maintain normal volume & composition of the extracellular fluid (ECF) & the intracellular fluid (ICF)
Fluid Balance
water gained ~ water lost Maintenance of normal fluid balance involves regulating content & distribution of body water in ECF & ICF
When the body loses water: plasma volume decreases electrolyte concentrations rise When the body gains or loses electrolytes: water is gained or lost by osmosis So fluid and electrolyte balance are intimately related, but the effects and the regulatory mechanisms are different
Water
60% of male BW 50% of female BW Mostly in the ICF Water exchange between ICF & ECF occurs across cell membranes by osmosis In old age, 45% of BW is water
Figure 271a
Water occupies two main fluid compartments ICF = fluid inside all cells throughout body 2/3 by volume Not an uniform body water content varies greatly from fat to muscle ECF = fluid outside cells Mostly made up of Interstitial fluid of peripheral tissues and plasma of circulating blood Also includes lymph, CSF, synovial fluid, serous fluids (pleural, pericardial, and peritoneal) 80% of ECF volume is in interstitial fluid and minor fluid compartments, 20% in plasma
ICF is relatively isolated inside cells all over the body, fluid does not mix ECF fluids exchange constituents all the time Occurs primarily across endothelial lining of capillaries from plasma to interstitial fluid Fluid moves from interstitial spaces to plasma through lymphatic vessels that drain into the venous system
Fluid Shifts
Rapid water movements between ECF and ICF in response to an osmotic gradient If ECF osmotic concentration increases:
ECF becomes hypertonic to ICF water moves from inside cells to ECF ECF becomes hypotonic to ICF water moves from ECF into cells
ICF volume is much greater than ECF volume (clinically they say about 2/3 to 1/3):
Figure 26.7a
Electrolyte Balance
Balances gains & losses of all electrolytes (ions) Primarily involves balancing rates of absorption across digestive tract with rates of loss at kidneys & sweat glands
Osmotic Concentrations
The osmotic concentration of ICF & ECF Is identical even though the composition of the ICF & ECF are different Osmosis eliminates minor differences in concentration because cell membranes are permeable to water Two-way water flow is substantial Compartmental exchange is regulated by osmotic & hydrostatic pressures
2.
3.
4.
All of the bodys homeostatic mechanisms that monitor & adjust body fluid composition respond to changes in the ECF, not in the ICF No receptors directly monitor fluid or electrolyte balance (only volume & osmolarity) Cells cannot move water molecules by active transport The bodys water or electrolyte content will rise if dietary gains exceed environmental losses, & will fall if losses exceed gains
Additional:
Erythropoetin ( EPO )
Figure 18.9
Osmoreceptors in hypothalamus monitor osmotic concentration of ECF (plasma, CSF) Change in osmotic concentration in plasma and CSF alters osmoreceptor activity Osmoreceptor neurons secrete ADH in proportion to osmotic concentration via the posterior pituitary
AD H Antidiuretic hormone made in hypothalamus released from posterior pituitary gland in response to 6 blood volume vasoconstriction (5bp) H2O recovery in kidney
2. Aldosterone
rising K+ (sensed at the adrenal cortex) or falling Na+ levels in blood activation of reninangiotensin system (usually due to changes in blood volume)
Determines rate of Na+ absorption and K+ loss along DCT and collecting system Water Follows Salt
High plasma aldosterone concentration causes kidneys to conserve salt Conservation of Na+ by aldosterone also stimulates water retention
angiotensin II fall in bp renin release from kidney angiotensinogen (from liver) angiotensin I reni n angiotensin II AC E
angiotensin II four functions: stimulates kidney to produce aldosterone stimulates secretion of ADH stimulates thirst stimulates CO and vasconstriction
(bp)
Aldosterone-cont`d
Figure 26.8
3. Natriuretic Peptides
ANP & BNP are released by cardiac muscle cells in response to abnormal stretching of heart walls due to elevated blood pressure or volume Reduce thirst Block release of Nor Epinephrine,Epinephrine,ADH & aldosterone Cause diuresis , by Na excretion at kidney stimulate peripheral vasodilation Lower blood pressure & plasma volume
natriuretic peptides natrium = sodium (Na) atrial natriuretic peptide (ANP) brain natriuretic peptide (BNP) released in response to stretching reduce blood volume reduce blood pressure
Erythropoetin ( EPO ) released from kidneys low bp low O2 levels stimulates bone marrow to make more RBCs
Water regulation
1)
Osmoreceptors are neurons in the CNS Baroreceptors in left atrium, left ventricle, and pulmonary veins sense blood volume (filling pressures), and baroreceptors in the carotid sinus and aorta monitor arterial blood pressure
2)
Volume changes
So changes in ECF/blood volume are corrected by both ADH & aldosterone Changes in sodium concentration or small changes in water balance are corrected by ADH only
Figure 273
Electrolyte Balance
Requires equal rates of gain and loss for each electrolyte in the body Electrolyte concentration directly affects water balance Concentrations of individual electrolytes affect cell functions
In ECF:
Cations: sodium ( Na ) Anions: chloride, bicarbonate Cations: potassium ( K ) Anions: phosphate ions, negatively charged proteins
In ICF:
Sodium and potassium concentrations in extraand intracellular fluids are nearly opposites Electrolytes determine the chemical and physical reactions of fluids
Na+, K+
Sodium holds a central position in fluid and electrolyte balance Sodium is the dominant cation in ECF Sodium salts provide 90-95% of ECF osmolarity (concentration):
Sodium concentration in the ECF normally remains stable Potassium Is the dominant cation in ICF
Na+ Regulation
If plasma volume is too large, venous return increases stimulating heart release natriuretic peptides (ANP and BNP)
Sympathetic nervous system impulses to the kidneys decline Afferent arterioles dilate
All of this causes sodium and water loss at kidneys increases ECF volume declines
Figure 275 (1 of 2)
Figure 275 (2 of 2)
Potassium Balance
98% of potassium in the human body is in ICF Cells expend energy to recover potassium ions diffused from cytoplasm into ECF Factors
KEY CONCEPT
Fluid balance and electrolyte balance are interrelated Effects are reduced by:
fluid shifts between ECF and ICF hormonal responses that adjust water intake and excretion (ADH) fluid shifts adjustments in rates of ion absorption and secretion (aldosterone) adjustments to rates of water gain and loss (ADH and aldosterone)
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