Fluid and Electrolyte

Balance
M. Rasjad Indra
Laboratorium Ilmu Faal
FK. UNIBRAW

Body Fluid Compartment

Body Fluid Volume

Body fluid
60% (45-75)
water
Intracellular
40 %
(42 liter in 70 kg
young adult)

Extracellular
20 %
(14 liter in 70 kg
young adult)

Interstitial
15 %
(10.5 liter in 70 kg
young adult)

Plasma
5%
(3.5 liter in 70 kg
young adult)

Transcellular
1-3 %
(Cerebrospinal)
(Aqueous humor)

Electrolyte Composition of Body Fluid

Electrolytes
Cation:
Na+
K+
Ca2+
Mg2+
Total
Anion:
ClHCO3Protein
Others
Total

Plasma
(mEq/L)

142
4
5
2
153
103
25
17
8
153

Interstitial Fluid
(mEq/Kg H2O)

145
4
3
2
154
117
28
9
154

Intracellular
Fluid (mEq/Kg
H2O)
10
159
1
40
210
3
7
45
155
210

Daily Intake and Output of

Water (in ml/day)
Normal
Intake
Fluid ingested
From metabolism
Total intake
Output
Insensible-Skin
Insensible-Lungs
Sweat
Feces
Urine
Total output

Prolonged
Heavy Exercise

2100
200
2300

?
200
?

350
350
100
100
1400
2300

350
650
5000
100
500
6600

 Osmosis
The net diffusion of water across the
membrane from a region of high
water concentration to one that has a
lower water concentration

Osmoles (Osm):

The measurement of total number of

particles in a solution
1 mole : 6.02 x 1023
1 mole/L NaCl ~ 2 osmoles/L (Na+ & Cl-)

Osmotic pressure:

The precise amount of pressure

required to prevent the osmosis
1 osm/L ~ 19,300 mmHg; 1
mosm/L~19.3mmHG

Add pure water

Normal

ICF

Add pure water

ECF

ICF

ECF

Add isotonic saline

Normal

ICF

Add isotonic saline

ECF

ICF

ECF

Add pure NaCl

Normal

ICF

Add pure NaCl

ECF

ICF

ECF

Decreased ADH
release from
posterior
pituitary
Cardiovascular
stretch receptor

Decreased
plasma ADH

Osmoreceptor

Ingestion of 1L
of water

Decreased
collecting duct
water
permiability

Increased
extracellular
fluid volume
Decreased
plasma
osmolarity

Decreased water
reabsorption

Normal fluid
volume
Increased water
excretion

Increased ADH
release from
posterior
pituitary
Increased plasma
ADH
Cardiovascular
stretch receptor
Osmoreceptors

Dehydration

Decreased
extracellular
fluid volume

Thirst
Increased
plasma
osmolarity

Normal fluid
volume
Decreased water
excretion

Increased
water intake

Increased
collecting duct
water
permiability

Increased water
reabsorption

Angiotensinogen
Kidney

Liver

Renin
Angiotensin I

Decreased
effective
arterial blood
volume

Lungs
Converting
enzyme

Angiotensin II
Blood vessels

Adrenal cortex

Vasoconstrictor

Aldosteron secre.

Blood pressure >

Sodium reabs.

Brain
ADH secretion
H2O reabsorption

Normal effective arterial blood volume

Thirst
Water intake

Increased plasma
[K+]

Increased
Potasium intake
Normal potasium
level

Direct effect on adrenal

cortex
Increased aldosterone
secretion
Increased plasma
aldosterone

Increase luminal membrane permiablility to

Na+ and K+ & Increase basolateral
membrane Na+/K+-ATPase activity in
collecting duct principal cells.

Increased potasium
secretion

Increased potasium
excretion

Increased [K+] in body cell

(including kidney cells)

Definition of
Edema:
An increase in the interstitial compartement of
extracellular fluid volume (Harrisons).

Starling Hypothesis
The balance of hydrostatic and oncotic pressures
across the capillary endothelium
Mean capillary hydrostatic pressure (Pc): 25 mmHg
Interstitial fluid hydrostatic pressure (PIF): 0 mmHg
Capillary oncotic pressure (c): 28 mmHg
Interstitial fluid oncotic pressure (IF): 3 mmHg
Arterial end of capillary:

Venous end of capillary:

Pc= 40 mmHg; PIF= 0 mmHg

Pc= 10 mmHg; PIF= 0 mmHg

c= 28 mmHg; IF= 3 mmHg

c= 28 mmHg; IF= 3 mmHg

Net Filtration= 35-0-28+3=

10

Net Absorption= 15-0-28+3=

-10

Causes of Extracellular Edema

1. Increased capillary pressure

Excessive kidney retention

High venous pressure
Decreased arteriole resistance

2. Decreased plasma proteins

Loss of protein in urine

Loss of protein from denuded skin
Failure of produce protein

 3. Increased capillary permiability

Immune reaction
Toxin
Bacteria infection
Vitamin deficiency (exp. Vit C)

4. Blockage of lymph return

Cancer
Paracyte infection (Filaria)
Surgery
Congenital absence or abnormal of
Lymphatic vessels

Exercice
The greatest fraction

of the bodys water is

contained within:
a. Blood plasma
b. Cells
c. Extracellular fluid
d. Transcellular fluid

Intravenous infusion of 1

liter of isotonic saline will:

a. A 1-liter increase in
intracellular fluid volume
b. A 1-liter increase in
extracellular fluid volume
c. A 0.5-liter increase in
intra-cellular fluid volume
and a 0.5-liter increase in
extracellular fluid volume

 Intravenous infusion of 1 Antidiuretic hormone

liter of hypertonic saline
will cause:
a. A decrease in
intracellular fluid volume
b. An increase in
extracellular fluid volume
c. An increase in plasma
osmolality
d. All of the above

increase epithelial
water permiability of:
a. Collecting ducts
b. Proximal tubules
c. Thick ascending
limbs
d. All of the above

 ADH release from the

posterior pituitary is
stimulated by:
a. A fall in plasma
osmolality
b. Severe hemorrhage
c. Stimulation of arterial
baroreceptors
d. Stretch of left arterial
receptor

Which of the following

produces a decrease in
renal sodium excretion?
a. Decrease plasma
aldosterone level
b. Increase plasma level of
atrial natriuretic peptide
c. Increase GFR
d. Increase renal sympathetic nerve activity

 Which of the following

produces an increase in
renal sodium excretion?
a. Administration of
glucocorticoids
b. Decrease peritbular
capilary hydrostatic
pressure
c. Increase plasma estrgen
levels
d. Uncontroled diabetes
mellitus

Renin release is

stimulated by:
a. Increase blood pressure
in afferent arterioles
b. Increase effective arterial
blood volume
c. Increase NaCl transport
by macula densa cells
d. Stimulation of renal
sympathetic nerves

 Which of the following are

commonly seen in
patients with severe
congestive heart failure?
a. Elevated plasma ADH
levels
b. Generalized edema
c. Hyponatremia
d. Thirst
e. All of the above

The most abundant

intracellular cation
is:
a. Calcium
b. Chloride
c. Potasium
d. Sodium

 Which of the following

promotes a shift of
potasium from cells to
extracellular fluid?
a. A fall in plasma pH
b. An overdose of digitalis
c. Inadequate blood flow
d. Lack of insulin
e. All of the above

Which of the following

produces excessive urinary

excretion of potasium?
a. Acute renal failure
b. Inadequate aldosterone
secretion
c. Severe chronic renal failure
(GFR=10 ml/min)
d. Uncontroled diabetes
mellitus

 The following measurement were obtained

in 3.40 kg newborn infant:

Total body water

2600 ml
Extracellular water 1490 ml
Plasma water
155 ml
What are the volumes of (1) The intracellular
water and (2) the interstitial fluid-lymph water?