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Anatomy & Physiology II___Name ANATOMY & PHYSIOLOGY II Lecture #16: Fluid and Electrolyte Balance I. INTRODUCTION The human body is about 60 % water by weight. All the body's cells are continuously bathed in fluid, which brings them nutrients and carries away waste materials. The fluid in the tissues, called interstitial fluid, is continually exchanged with fluid from blood plasma and with the fluid located inside cells. The distribution of the body's fluids is controlled in part by the electrolyte concentration in each compartment. In addition, electrolytes are vitally important to many key processes in the body. II. FLUID BALANCE A. DEFINITION - Fluid balance is the state in which the total amount of water in the body is normal and remains relatively constant. However, not only must the total volume remain relatively constant, but the distribution of the fluid in the fluid compartments must also be correct. B. DISTRIBUTION OF BODY FLUIDS The body contains about 40 L of water, which makes up roughly 60% of our total body weight. This is distributed as follows: 1. Intracellular fluid (ICF) - The water located within the cells of the body makes up about 2/3 of the total fluid (about 25 L). Its function is to facilitate the chemical reactions in the cells that maintain life. 2. Extracellular fluid (ECF) - The water located outside of the cells makes up about 1/3 of the total fluid (about 15 L). It is distributed in the following compartments: a. Blood plasma (about 3 L) – the fluid portion of the blood. b. Interstitial fluid (about 12 L) – the fluid in the tissue spaces around cells. c. Lymph (less than 1 L) – the fluid in lymph vessels. * Extracellular fluid serves two important functions: (1) it provides a constant environment for the cells, and (2) it transports substances to and from the cells. 2 C. GENERAL PRINCIPLES 1. Balance can be maintained only if intake equals output. Obviously, if more water is entering the body than leaving, fluid volume will increase and an imbalance will occur. Conversely, if more water is being excreted than is entering the body, the fluid volume will decrease and, again, we have an imbalance. 2. When more water enters the body than leaves we have a positive water balance. On the other hand, when more water is excreted than is taken in we have a negative water balance. 3. Mechanisms for controlling fluid output so that it matches fluid intake are very crucial and we will study these in some detail. Mechanisms to control intake also operate but are less elaborate. 4. The amount of fluid in a given individual is directly proportional to his or her total body surface area. D. ROUTES OF FLUID INTAKE AND OUTPUT 1. Obligatory water loss - even under ideal conditions the body will lose about 700 mL per day through the lungs and skin. An additional 500 mL per day is lost as urine in order to rid the body of waste products. These are minimum values that occur even if we do not sweat or defecate. 2. Average daily body exchange of water in a temperate climate: Intake Output Water & other beverages 1500 ml Lungs 550 ml Water in solid foods 750 ml Skin 150 ml Water of oxidation 250 ml Sweat 200 ml (from cellular metabolism) 2500 ml Feces 100 ml Urine 1500 ml 2500 ml To Do: Tell if each of these is part of or refers to the intracellular (I) or the extracellular fluid compartment E). Lymph Cytoplasm Plasma Interstitial fluid Contains most of the body’s water Fluid located between tissue cells Transports substances in body Provides medium for chemical reactions to occur Answer the following: If you urinate more than you drink, you are in: a) positive water balance; b) negative water balance Obligatory water loss is: a) the amount of water we lose after vigorous exercise as sweat; b) loss that results in a negative water balance; c) the minimum amount of water lost each day. Other than urine, most water is lost through the: a) skin; b) lungs; c) sweat; d) feces. 3 E. MECHANISMS FOR MAINTAINING NORMAL FLUID DISTRIBUTION 1. Control of Water Movement Between Plasma and Interstitial Fluids a. To move between the plasma and the interstitial fluid compartment, fluid must pass across the wall of the capillaries. This movement is controlled by: 1) Hydrostatic pressure (blood pressure) – tends to force fluid out of the capillary 2) Osmotic pressure due to plasma proteins – tends to draw fluid into the capillary. b. This creates a "tug of war" – If the hydrostatic pressure is greater than the osmotic pressure, fluid will move into the interstitial fluid. If the osmotic pressure is greater, then fluids will move into the plasma. c. Any factor that causes a change in either the hydrostatic or osmotic pressure will affect the movement of fluid between these compartments. Examples: 1) Liver damage can cause fewer plasma proteins to be made, so the osmotic pressure in the capillary will decrease, causing more fluid to enter the interstitial fluid. 2) A drop in blood pressure allows more fluid to flow into the plasma from the interstitial space, which helps to restore the blood pressure. 2. Control of Water Movement Between Interstitial and Intracellular Fluids a. To move between the interstitial fluid and the intracellular fluid compartments, fluid must cross the cell membrane. b. Movement is mainly controlled by the osmotic pressure in the two compartments. This will be determined by the electrolyte concentration in each compartment. c. Cells normally pump sodium out of the cell and potassium in, which causes excess sodium to accumulate in the interstitial fluid. d. A higher than normal sodium concentration in the interstitial fluid will draw water out of the cells, and a lower than normal sodium concentration will cause more water to flow into the cells. To Do: For each of the following statements, decide which direction fluid would tend to move. Use these choices: B = into the blood I = into the interstitial fluid C = into the cells Lower than normal sodium levels. Low blood pressure. Higher than normal sodium levels. Lower than normal levels of plasma proteins. High blood pressure. Higher than normal levels of plasma proteins. 4 F. MECHANISMS FOR MAINTAINING TOTAL FLUID BALANCE 1. Two Problems – The body must deal with two separate problems when maintaining fluid balance: a. It must keep the concentration of body fluids in the correct range. b. It must keep the total volume of fluid in the correct range. These are controlled by two different but interrelated systems. 2. Maintaining the Proper Concentration of Body Fluids a. The total concentration of dissolved material in the blood plasma must be maintained in a fairly narrow range to assure proper functioning. Thus when the body senses that the plasma is becoming either too dilute or too concentrated it makes adjustments to correct the imbalance. b. Nervous control – when the plasma becomes too concentrated, the vagus nerve stimulates feelings of dryness in the mouth and throat, causing us to drink fluids. c. Antidiuretic hormone (ADH) is the main hormone involved in this process. ADH causes the kidneys to reabsorb more water from the filtrate, thus increasing the amount of water in the plasma and diluting the solutes. plasma concentration stimulates (too little water, too much sodium) osmoreceptors negative in hypothalamus water balance thirst ADH release water intake water output water intake water output thirst ADH release positive osmoreceptors water balance in hypothalamus inhibits plasma concentration (more water, less sodium) To Do: Mark whether each of these occurs when the plasma is too dilute (D) or too concentrated (C). Osmoreceptors in hypothalamus are stimulated. Vagus nerve causes feelings of thirst. Osmoreceptors in hypothalamus are inhibited. Feelings of thirst decrease. ADH secretion decreases. Water output decreases (more reabsorption) ADH secretion increases. Water output increases (less reabsorption) 5 3. Maintaining the Proper Total Volume of Body Fluid a. The total volume in each of the fluid compartments must remain fairly constant. b. The plasma volume is especially important because it directly affects blood pressure. c. Too little fluid in the plasma compartment would result in hypovolemic shock and possibly death. d. Too much fluid in the plasma results in high blood pressure and extra stress on the heart and vessels of the brain. e. Aldosterone is the primary hormone involved in the process of maintaining the correct fluid volume. f. The renin-angiotensin-aldosterone pathway regulates the release of aldosterone: Plasma volume Plasma volume + Blood pressure Tubular Na reabsorption & H2O reabsorption (with ADH) Renin secretion by juxtaglomerular apparatus Plasma aldosterone Plasma renin levels Aldosterone release catalyzes by adrenal cortex conversion of Angiotensinogen Angiotensin I Plasma angiotensin II g. Aldosterone directly stimulates reabsorption of sodium by the kidney tubules. h. If some ADH is also present, which will be the case as long as the plasma concentration is normal or somewhat concentrated, then water will follow sodium by osmosis. i. As a result, the fluid reabsorbed will contain both sodium and water and will be isotonic with plasma, so it does not change the overall plasma concentration but it does increase the volume of the blood plasma. j. An isotonic solution is one that has the same electrolyte concentration as body fluids. To Do: Indicate whether each of the following would occur when fluid volume is too high (H) or too low (L). Hypovolemic shock Decreased angiotensin II levels High blood pressure Increased aldosterone secretion Decreased renin secretion Decreased aldosterone secretion Increased renin secretion Increased reabsorption of sodium Increased angiotensin II levels Decreased reabsorption of sodium If ADH is present, what effect will the absorbed fluid have on plasma concentration? a) it will make it more dilute b) it will make it more concentrated c) it will not change it 6 4.
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