FLUID, ELECTROLITE,

ACID BASE BALANCE

Body Water Content
Infants have low body fat, low bone mass, and
are 73% or more water
Total water content declines throughout life
Healthy males are about 60% water; healthy
females are around 50%
In old age, only about 45% of body weight is
water

2
Fluid Compartments

Intracellular fluid (ICF) about 2/3 by volume,

contained in cells sitosol
Extracellular fluid (ECF) consists of two
major subdivisions
Plasma the fluid portion of the blood (IV fluid)
Interstitial fluid (IF) fluid in spaces between cells
Other ECF lymph, cerebrospinal fluid, eye
humors, synovial fluid, peritoneal fluid, and
gastrointestinal secretions
Chapter 26: Fluid, Electrolyte, and Acid-Base
Balance 3
Fluid Compartments

Chapter 26: Fluid, Electrolyte, and Acid-Base Figure 26.1

Balance 4
Balance Between Fluid Compartments
Volume of fluid in each is
kept constant. Since
water follows
electrolytes, they must be
in balance as well

Only 2 places for exchange between compartments:

Cell/plasma membranes separate intracellular from interstitial fluid.

only in capillaries are walls thin enough for exchange between plasma

and interstitial fluids Principles of Human Anatomy and

Physiology, 11e 5
FUNGSI CAIRAN TUBUH
Sarana untuk mengangkut zat-zat makanan ke
sel-sel
Mengeluarkan buangan-buangan sel
Mmbentu dalam metabolisme sel
Sebagai pelarut untuk elektrolit dan non
elektrolit
Membantu pencernaan
Mempemudah eliminasi
Mengangkut zat-zat seperti (hormon, enzim)
Composition of Body Fluids

Water is the universal solvent

Solutes are broadly classified into:
Electrolytes inorganic salts, all acids and bases,
and some proteins
Nonelectrolytes examples include glucose,
lipids, creatinine, and urea
Electrolytes have greater osmotic power than
nonelectrolytes
Water moves according to osmotic gradients
Chapter 26: Fluid, Electrolyte, and Acid-Base
Balance 7
Electrolyte Concentration

Expressed in milliequivalents per liter

(mEq/L), a measure of the number of
electrical charges in one liter of solution
mEq/L = (concentration of ion in
[mg/L]/the atomic weight of ion)
number of electrical charges on one ion

Chapter 26: Fluid, Electrolyte, and Acid-Base

Balance 8
Extracellular and
Intracellular Fluids
Sodium and potassium concentrations in
extra- and intracellular fluids are nearly
opposites
This reflects the activity of cellular ATP-
dependent sodium-potassium pumps
Electrolytes determine the chemical and
physical reactions of fluids

Chapter 26: Fluid, Electrolyte, and Acid-Base

Balance 9
Fluid Movement Among
Compartments
Compartmental exchange is regulated by
osmotic and hydrostatic pressures
Exchanges between interstitial and
intracellular fluids are complex due to the
selective permeability of the cellular
membranes

Chapter 26: Fluid, Electrolyte, and Acid-Base

Balance 10
Fluid Movement Among
Compartments
The process of filtration, reabsorbtion,
diffusion and osmosis allow continual
exchange of water and solutes among
body fluid compartements

Copyright 2009, John Wiley &

Sons, Inc.
Continuous Mixing of Body
Fluids

Chapter 26: Fluid, Electrolyte, and Acid-Base Figure 26.3

Balance 12
PERGERAKAN CAIRAN
TUBUH
DIFUSI
OSMOSIS
TRANSPORT AKTIF
FILTRASI
REABSORBSI

Copyright 2009, John Wiley &

Sons, Inc.
TIGA BENTUK TRANSPORT MELEWATI MEMBRAN

copyright cmassengale 14
 Transport Pasif
Difusi Sederhana
Tidak Membutuhkan energi
Perpindahan molekul dari
konsentrasi tinggi ke
konsentrasi rendah
Contoh: Oxygen dan air
berdifusi ke dalam sel dan
carbon dioxide berdifusi keluar
sel
copyright cmassengale 15
 DIFUSI

Difusi : Perpindahan partikel (molekul,

ion, atom) dari area dengan
konsentrasi tinggi ke area dengan
konsentrasi rendah

Menuruni Gradien Konsentrasi

Difusi

Tidak
membutuhkan
energi
Molekul
berpindah dari
konsentrasi
TINGGI KE
konsentrasi
RENDAH

copyright cmassengale 17
DIFUSI

Difusi adalah
proses PASIF
tidak
membutuhkan
energi untuk
membuat molekul
berpindah, karena
memiliki ENERGI
KINETIK alami
copyright cmassengale 18
Diffusion of Liquids

copyright cmassengale 19
Difusi Melewati Membran

Cell membrane

Solute moves DOWN concentration gradient (HIGH to LOW)

copyright cmassengale 20
Osmosis
Difusi
Diffusion across a
zat pelarut membrane
(misal : air) melewati
membran
semipermeabe
Perpindahan dari
Semipermea
area dengan ble
konsentrasi air membrane

TINGGI ke area
dengan konsentrasi
air (zat pelarut)
RENDAH
copyright cmassengale 21
OSMOSIS
TRANSPOR AKTIF
Membutuhkan
energi atau ATP
Memindahkan
material dari
konsentrasi
RENDAH ke
konsentrasi TINGGI
MELAWAN gradien
konsentrasi
copyright cmassengale 23
Transpor Aktif

Contoh: Pemompaan
Na+ (sodium ions) out
and K+ (potassium
ions) in against
strong concentration
gradients.
Called Na+-K+ Pump

copyright cmassengale 24
 Pompa Natrium Kalium

3 Na+ pumped in for every 2 K+

pumped out; creates a membrane
copyright cmassengale 25
 FILTRASI

Filtrasi adalah merembesnya suatu cairan

melalui selaput permeable.

Arah perembesan adalah dari daerah dengan

tekanan yang lebih tinggi ke daerah dengan
tekanan yang lebih rendah

Copyright 2009, John Wiley &

Sons, Inc.
Water Balance and ECF
Osmolality
To remain properly hydrated, water intake
must equal water output
Water intake sources
Ingested fluid (60%) and solid food (30%)
Metabolic water or water of oxidation (10%)

Chapter 26: Fluid, Electrolyte, and Acid-Base

Balance 27
Water Balance and ECF
Osmolality
Water output
Urine (60%) and feces (4%)
Insensible losses (28%), sweat (8%)
Increases in plasma osmolality trigger thirst
and release of antidiuretic hormone (ADH)

Chapter 26: Fluid, Electrolyte, and Acid-Base

Balance 28
Water Intake and Output

Chapter 26: Fluid, Electrolyte, and Acid-Base Figure 26.4

Balance 29
 Regulation of body
water gain
Metabolic water volume depends
mostly on the level of aerobic
cellular respiration, which reflects
the demand for ATP in body cells.
The main way to regulate body
water balance is by adjusting the
volume of water intake.
Dehydration when water loss is
greater than gain
Decrease in volume, increase
in osmolarity of body fluids
Stimulates thirst center in
hypothalamus
Regulation of fluid gain is by
regulation of thirst

Copyright 2009, John Wiley &

Sons, Inc.
Functions of the Kidneys

1) filter blood plasma,

separate wastes, return
useful materials to the
blood, and eliminate the
wastes.

2) regulate blood volume

and osmolarity.
The kidney produces urine through 4 steps.
Regulation of water and solute loss
Although increased amounts of water & solutes are lost through sweating &
exhalation during exercise, loss of body water or excess solutes depends
mainly on regulating how much is lost in the urine
The extent of urinary salt (NaCl) loss is the main factors that determines body
fluid volume. The reason for this is that water follows solutes in osmosis. Main
factor that determines body fluid osmolarity is extent of urinary water loss.
3 hormones regulate renal Na+ and Cl- reabsorption (or not)
Angiotensin II-Aldosterone promote urinary Na+ and Cl- reabsorption of
(and water by osmosis) when dehydrated
Atrial natriuretic peptide (ANP) promotes natriuresis, excretion of Na + and
Cl- followed by water excretion to decrease blood volume
Major hormone regulating water loss is antidiuretic hormone (ADH)
- stimulates thirst
- increases permeability of principal cells of collecting ducts to assist
in water reabsorption very concentrated urine is formed
- ADH secretion shuts off after the intake of water
- ADH secretion is increased when BP drops due to blood volume;
dehydration, vomiting, diarrhea, sweating .
Copyright 2009, John Wiley &
Sons, Inc.
Hormonal Regulation of Blood
Osmolality

27-34
Hormonal Regulation of Blood
Volume
Hormonal Regulation of Blood
Volume

27-36
RegulationofECFVolume
water follows salt
Fluid imbalance between the
intracellular and interstitial fluids
can be caused by a change in
their osmolarity.
Most often a change in
osmolarity is due to change in
Na+ concentration:
Increasing IF osmolarity draws
water out of cellscells shrink
Decreasing IF osmolarity causes
cells to swell
When water is consumed faster
than the kidneys can excrete it,
water intoxication may result.

Repeated use of enemas can

increase the risk of fluid and
electrolyte imbalances.
27_table_01
EDEMA

Fluid extravasations
and accumulation in
the interstitial spaces
EDEMA
Increased fluid in the interstitial tissue
spaces
Fluid may also accumulate in body cavities:
1. Hydrothorax
2. Hydropericardium
3. Hydroperitoneum is also called Ascites

Massive generalized edema is called

Anasarca
Fluid Homeostasis
Homeostasisismaintainedby
theopposingeffectsof: Lymphatics

1. VascularHydrostatic
Pressure

and

2. PlasmaColloidOsmotic
Pressure
Pathophysiologic Categories
of Edema
I. Increased Hydrostatic Pressure
II. Reduced Plasma Oncotic Pressure
III. Inflammation
IV. Others
ELECTROLYTES IN BODY FLUIDS

Electrolytes serve four general functions in the body.

Because they are more numerous than nonelectrolytes,

electrolytes control the osmosis of water between body

compartments.
Maintain the acid-base balance required for normal cellular

activities.
Carry electrical current, which allows production of action

potentials and graded potentials and controls secretion of

some hormones and neurotransmitters. Electrical currents are
also important during development.
Serve cofactors needed for optimal activity of enzymes.

Concentration expressed in mEq/liter or milliequivalents per liter

for plasma, interstitial fluid and intracellular fluid

Principles of Human Anatomy and

Physiology, 11e 44
 ICF differs considerably from ECF
ECF most abundant cation is Na+, anion is Cl-
Sodium

Impulse transmission, muscle contraction, fluid and electrolyte balance

Chloride

Regulating osmotic pressure, forming HCl in gastric acid

Controlled indirectly by ADH and processes that affect renal
reabsorption of sodium
ICF most abundant cation is K+, anion are proteins and phosphates (HPO42-)
Potassium

Resting membrane potential , action potentials of nerves and muscles

Maintain intracellular volume
Regulation of pH
Controlled by aldosterone
Na+ /K+ pumps play major role in keeping K+ high inside cells and Na+ high
outside cell

Copyright 2009, John Wiley &

Sons, Inc.
Electrolyte Composition of
Body Fluids

Chapter 26: Fluid, Electrolyte, and Acid-Base

Balance 46
Electrolyte and protein anion
concentrations

Copyright 2009, John Wiley &

Sons, Inc.
Komposisi elektrolit dalam
tubuh
Keseimbangan elektrolit intrasel dan ekstrasel sangat
penting dalam mempertahankan fungsi fisiologi tubuh
Selama keadaan homeostasis pertukarannya dilakukan
dengan sangat baik
Membran sel memiliki peran yang sangat penting
Perpindahan eletrolit antara intraseluler dan
ekstraseluler terjadi secara aktif sehingga membutuhkan
ATP.
Cntoh perpindahan ion Na+ dan K+ Pompa Na+K+
menyebabkan perbedaan muatan antara intrasel dan
ekstrasel potensial aksi
Copyright 2009, John Wiley &
Sons, Inc.
 Perpindahan air antara intrasel dan ekstrasel
terjadi secara pasif melalui proses osmosis
Air berpindah karena ada perbedaan tekanan
osmotik intrasel dan ekstrasel. Air berpindah
ke arah tekanan osmotik yang lebih tinggi
Tekanan osmotik ditentuka oleh konsentrasi
mineral terlarut (elektrolit), ion natrium
(ekstrasel), kalium (intrasel) dan ion lainnya
spt protein
Copyright 2009, John Wiley &
Sons, Inc.
27_table_02
 Acid-Base Balance
The overall acid-base balance of the body is maintained
by controlling the H+ concentration of body fluids,
especially extracellular fluid.

Homeostasis of H+ concentration is vital

Proteins 3-D structure sensitive to pH changes

normal plasma pH must be maintained between 7.35 -

7.45
diet high in proteins tends to acidify the blood

Principles of Human Anatomy and

Physiology, 11e 51
Prinsip Handerson
Hasselbalch
Persamaan dasar :

Dalam cairan tubuh terutama plasma darah :

Kompartemen penyangga basa adalah HCO3-

Komponen penentu keasaman adalah tekanan parsial karbondioksida

(pCO2)
Senyawa yang menjadi perantara adalah H2CO3

pH cairan tubuh (terutama plasma darah) adalah hasil

pembagian dari komponen basa utama (HCO3-) dan
komponen asam utama (pCO2) Semakin tinggi HCO3-
(semakin basa), semakin tinggi pCO2 (semakin asam)
Copyright 2009, John Wiley &
Sons, Inc.
MEKANISME KOMPENSASI

Mekanisme kompensasi untuk menjaga

keseimbangan asam basa :
Sistem Penyangga (buffer)

Sistem pernafasan

Ginjal

Mekanisme Intraseluler

Copyright 2009, John Wiley &

Sons, Inc.
Sistem Penyangga (Buffer)

Merupakan mekanisme kompensasi asam

basa yang berespon cepat agar pH berada
dalam keadaan normal.
Sistem penyangga : bikarbonat (HCO3-);
Protein, Hemoglobin, Fosfat

Copyright 2009, John Wiley &

Sons, Inc.
Sistem Penyangga :
Bikarbonat
Merupakan sistem penyangga yang paling
cepat
Terjadi melalui reaksi biokimiawi bolak bali
dengan persamaan :
H2O + CO2 > H2CO3 > H+ + HCO3-

Jika terjadi kelebihan CO2 yang menyebabkan asam, tubuh akan

mengkompensasi dengan pembentukan H2CO3 yang akan terurai
menjadi HCO3- + H+ demikian sebaliknya

Copyright 2009, John Wiley &

Sons, Inc.
Sistem Penyangga
Bikarbonat

Copyright 2009, John Wiley &

Sons, Inc.
Sistem Penyangga : Protein
Protein yang yang larut dalam plasma darah atau protein
intraseluler merupakan gugus asam dan basa sehingga
dapat berperan dalam menyerap ion hidorgen (H+)
pada ujung gugus basa ataupun melepaskan
hidrogen pada gugus asam

Sistem penyangga protein bekerja dengan baik pada

cairan intraseluler, pada cairan intravaskuler akan
memperkuat penyangga bikarbonat

Copyright 2009, John Wiley &

Sons, Inc.
Sistem Penyangga :
Hemoglobin
Hemoglobin (Hb) berperan dalam transport oksigen di
sirkulasi dan sistem penyangga asam basa
Hb berperan peting dalam sistem penyangga ketika ada
peningkatan CO2 (pCO2) atau suasana asam.
Hb akan mengikat H+ yang terbentuk dari sisa
metabolisme CO2 membentuk HHB atau HHB dapat
melepaskan H+ bila dibutuhkan untuk menjaga asam
basa
Hb yang belum berikatan dengan oksigen lebih berperan
daripada Hb yang sudah berikatan dengan oksigen
bikarbonat

Copyright 2009, John Wiley &

Sons, Inc.
Sistem penyangga fosfat

Sistem penyangga intraseluler, di

intravaskuler tidak begitu berperan karena
konsentrasinya kecil.
Fosfat juga menjadi penyangga pada sistem
pembentukan urine yang berasal dari
kelebihan fosfat yang tidak direabsorbsi oleh
tubulus nefron ginjal
Reaksi :
NaHPO4 + H+ NaH2PO4 + Na+
Copyright 2009, John Wiley &
Sons, Inc.
Buffer Systems
RESPON SISTEM
PERNAFASAN
Respon sistem pernafasan dalam
mempertahankan asam basa merupakan
keseimbangan lini kedua (terjadi beberapa
menit /beberapa jam)
Respon sistem pernafasan dalam mengatur pH
melalui : perubahan ventilasi paru, merubah
frekuensi dan dangkal atau dalamnya
pernafasan
Melalui perubahan ventilasi paru mengatur
kecepatan pembuangan CO2 (komponen asam)

Copyright 2009, John Wiley &

Sons, Inc.
RESPON SISITEM
PERNAFASAN
Mekanisme :
Peningkatan pCO2 H+ meningkat
merangsang pusat nafas di batang otak
(medula oblongata) untuk meningkatkan
ventilasi paru pengeluaran CO2 semakin
meningkat
Demikian sebaliknya

Copyright 2009, John Wiley &

Sons, Inc.
RESPON GINJAL
Pertahanan lini ketiga (terjadi setelah beberapa jam/hari)
Merupakan mekanisme pengaturan ekskresi bikarbonat
(HCO3-)
Pertahanan penting dan kuat ketika terjadi asidosis
dengan meningkatkan reabsorbsi bikarbonat di tubulus
ginjal serta pembentukan amonia melalui respon
penyangga amonium-fosfat
Pada kondisi alkalosis, ginjal merespon dengan
meningkatkan pengeluaran bikarbonat dengan
mengurangi sekresi H+ ke tubulus ginjal serta
mengurangi sekresi amonium

Copyright 2009, John Wiley &

Sons, Inc.
Regulation of Acid-Base Balance
Regulation of Acid-Base Balance

27-66
Regulation of blood pH by the
respiratory system
pH modified by changing rate &
depth of breathing:

faster breathing rate, blood pH

rises
slow breathing rate, blood pH
drops

H+ detected by chemoreceptors
in medulla oblongata, carotid &
aortic bodies

Respiratory centers inhibited or

stimulated by changes is pH

Copyright 2009, John Wiley &

Sons, Inc.
Respiratory Regulation of Acid-Base
Balance

27-68
Kidney Regulation of Acid-Base
Balance
PERANAN HEPAR
Berperan dala pengaturan metabolisme zat-zat yang berperan
dalam keseimbangan asam-basa
Peran hepar adalah dalam metabolisme ion organis seperti :
laktat, keton, asam amino, metabolisme amonium, produksi
albumin, produksi CO2 sebagai hasil akhir metabolisme
Pembentukan CO2 di hepar sebagai hasil akhir metabolisme
memiliki peran bermakna
CO2 yang terbentuk akan berdifusi keluar sel hepar larut
bereaksi dengan Hb melepaskan ion H+ dan HCO3-
Matabolisme zat2 di hepar membutuhkan H+ membantu
sistem penyangga bikarbonat
Bila terjadi kerusakan sel hepar oksidasi tidak sempurna di
mitokondria sel hepar menghasilkan benda-benda keton
Ketoasidosis (salah satu jenis asidosis metabolik)

Copyright 2009, John Wiley &

Sons, Inc.
27_table_03
Physiological responses to normalize
arterial blood pH
Changes in blood pH may be countered by compensation
Complete brought within normal range

Partial still too low or high

Respiratory compensation hyperventilation or

hypoventilation
Renal compensation secretion of H + and reabsorption of

HCO3-
Respiratory acidosis / alkalosis are primary disorders of
blood PCO2.
Metabolic acidosis/alkalosis are primary disorders of HCO3-
concentration

Copyright 2009, John Wiley &

Sons, Inc.
 Respiratory acidosis
Abnormally high PCO2 in systemic arterial blood
Inadequate exhalation of CO2
Any condition that decreases movement of CO2 out emphysema,
pulmonary edema, airway obstruction
Kidneys can help raise blood pH
Goal to increase exhalation of CO2 ventilation therapy

Respiratory Alkalosis
- Abnormally low PCO2 in systemic arterial blood
- Cause is hyperventilation due to O2 deficiency from high altitude or
pulmonary disease, stroke, severe anxiety, aspirin overdose
- Renal compensation involves decrease in excretion of H+ and increase
reabsorption of bicarbonate
- One simple treatment to breathe into paper bag for short time

Copyright 2009, John Wiley &

Sons, Inc.
 Metabolic Acidosis
Results from changes in HCO 3- concentration
Metabolic acidosis abnormally low HCO 3- in systemic arterial blood
Loss of HCO3- from severe diarrhea or renal dysfunction
Accumulation of acid (ketosis with dieting/diabetes)
Kidney failing to remove H+ from protein metabolism
Respiratory compensation by hyperventilation
Administer IV sodium bicarbonate and correct cause of acidosis
Metabolic Alkalosis
Abnormally high HCO3- in systemic arterial blood
Non-respiratory cause: vomiting acidic stomach contents, gastric suctioning
Excessive intake of alkaline drugs (antacids) & use of certain diuretics
Severe dehydration
Respiratory compensation is hypoventilation
Give fluid solutions to correct Cl-, K+ and other electrolyte deficiencies
and correct cause of alkalosis

Copyright 2009, John Wiley &

Sons, Inc.
27_table_04
TERIMAKASIH