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Human Body Fluids, Electrolytes and Acid-Base Balance
1. COMPOSITION OF THE HUMAN
BODY:
FLUIDS, ELECTROLYTES AND ACID-
BASE BALANCE
Dr. Matwa Christopher
BSc[Hons]-physio; MBChB; MMed-PRAS (UoN)
2. OBJECTIVES
Students should understand the following at the
end of the presentation:
Chemical & fluid composition of the body
The normal concentrations of the body chemicals and
fluids
The major two body compartments and distribution of
chemicals & fluids therein
Factors affecting chemical and fluid distribution in body
compartments
Regulation of chemical and fluid distribution
3. INTRODUCTION :
CHEMICAL LEVEL OF ORGANISMS
Living material is composed of free elements, ions,
radicals, molecules and compounds.
Four elements compose of over 95% of the body.
Hydrogen (H) 10%,
Oxygen (0) 65%,
Carbon (c) 18 % and
Nitrogen (N) 3 %.
Additional elements common to the body include
calcium (Ca), Sodium (Na), Potassium (K)
Phosphorus (P), Sulfur (S) and Magnesium (Mn).
These elements combine to form macromolecules
that make up the cells
4. BODY COMPOSITION
In an average young adult male,
60-70% is water
15-20% is fat
15-18% of the body weight is protein and related
substances
5-7% is minerals, nucleic acids, radicals
% OF BODY WEIGHT
Material MALE FEMALE
Water
Protein
Lipids
Carbohydrates
Others (nucleic) acids, radicals
62
18
14
1
5
59
15
20
1
5
5. BODY FLUIDS AND COMPARTMENTS
Water.
The principal fluid medium of the cell
Present in most cells, except for fat cells, in a
concentration of 70 to 85 per cent.
Many cellular chemicals are dissolved in the water.
Others are suspended in the water as solid particulates.
Chemical reactions take place among the dissolved
chemicals or at the surfaces of the suspended particles
or membranes.
Directly related to muscle mass (70% water)
Inversely related to fat content (10% water)
6. TWO MAJOR COMPARTMENTS OF BODY WATER
Intracellular fluid
Cytosol
40% of total body weight or
2/3 of total body water
Extracellular fluid
Interstitial fluid, plasma, lymph, CSF, synovial fluid,
serous fluid, etc
20% of total body weight or
1/3 of total body water
7.
8. CONT’D
Comparment % total body water
Cytosol 62.5
Plasma 7
Connective tissue 5
Interstitial fluid and lymph 18
Bone 5
Transcellular 2.5
10. CONT’D
Stabilizing ECF and ICF involves:
1) Fluid Balance
Must have equal gain (food & metabolism) and loss (urine &
perspiration) of water
2) Electrolyte Balance
Electrolytes = ions from dissociated compounds that will conduct
an electrical charge in solution
Must have equal gain (absorption in GI) and loss (urine in kidney
and perspiration in skin)
3) Acid-Base Balance
The production of hydrogen ions by metabolism must be matched
by loss of these H+ ions at the kidney and lungs (carbonic acid)
How is stabilization achieved?
Homeostasis: the regulation of composition and volume of
both fluid divisions
11. FLUID FLOW
Diffusion
Movement of particles down a concentration gradient.
Osmosis
Movement of solvent molecules into a region of higher solute
concentration across a semipermeable membrane
impermeable to the solute
Active transport
Movement of particles up a concentration gradient ; requires
energy
Movement of fluids due to:
hydrostatic pressure
Capillary filtration
Interstitial hydrostatic pressure
osmotic pressure
Capillary colloidal osmotic pressure
Tissue colloid osmotic pressure
12. FLUID BALANCE
There is continuous flow between ICF and ECF and
the external environment:-
The flow between ICF and ECF:-
Hydrostatic pressure pushes water from the plasma into
the interstitial fluid
Colloid osmotic pressure draws water from the interstitial
fluid to the plasma
13. FLUID BALANCE
Fluid exchange between environment and ECF:-
Water losses (2500mL/day)
Insensible loss
Cannot be controlled or measured
Includes fecal, respiration, skin evaporations and perspiration
losses
40-600mL/day
Obligatory loss
Minimal amount of urine needed to excrete metabolic wastes
600mL/day
Facultative or sensible loss
Controlled and measured
Urine loss
1500mL/day
14. FLUID BALANCE
Water Gains
Must match water losses or dehydration will result
1000 mL from drink,1200 mL from food and 300 mL
metabolic “waste”
Systems of gain: GIT – intake
Systems of loss:
GIT – fecal (diarrhea)
Renal – urine
Integumentary, Respiratory – insensible
Applies to electrolytes and acid/bases
15. ELECTROLYTES
The electrolytes vary depending on the fluid division:
ECF
Principal cation = Na+
Principal anions = Cl- , HCO3-
ICF
Principal cation = K+, Mg2+
Principal anions = HPO4
2- and negatively charged proteins-
Although different ions dominate, both fluid divisions
have the same osmotic concentrations.
The ions cannot pass freely through cell membranes,
but the water can by osmosis, and will move to
equilibrium.
Thus, solute/electrolyte concentrations of the fluid
divisions will directly impact water distribution
16.
17. ELECTROLYTE BALANCE
Sodium
Major ECF ion
Where sodium goes, water follows
The total amount of Na+ in the ECF is due to a balance
between Na+ uptake in the digestive system and Na+
excretion in urine and perspiration.
The overall sodium concentration in body fluids rarely
changes because water always moves to compensate
Minor gains and losses of Na+ in the ECF are
compensated by water in the ICF and later adjusted by
hormonal activities:
ECF volume too low → renin-angiotensin system is activated
to conserve water and Na+
ECF volume too high → natriuretic peptides released: block
ADH and aldosterone resulting in water and Na+ loss
18. CONT’D
Potassium
Major ICF ion
Amount in concentration determined by GIT absorption
and renal excretion in exchange with Na+
The rate of tubular secretion of K+ in the kidney is
controlled by three factors:
Changes in the K+ concentration of the ECF
↑ K+ in ECF = ↑ K+ secretion
Changes in blood pH:- acidosis causes hyperkalemia
at low pH, H+ shifts K+ out of cells into ECF
In renal tubules, K+ at the exchange pump is ↓ as Na+ is
exchanged with H+ = ↓ K+ secretion (K+ accumulates)
Aldosterone levels
↑ aldosterone = ↑ Na+ reabsorption and ↑ K+ secretion
19. The most important factor in Acid –Bade balance is
the maintenance of hydrogen ion concentration of
ECF within the range that is optimal for survival of
the organism.
Function of cells are very sensitive to changes in H+
ion concentration.
Intracellular H+ ion concentration is dependent on
ECF H+ ion concentration
ACID – BASE BALANCE
20. CONT’D
H+ ion concentration in blood is very low compared to
other cations thus:
The normal plasma Na+ ion concentration is 145 meq/l,
K+ is 5 meq/l and
[H+] is 0.00004 meq/l.
The pH therefore is a more sensible way of denoting
[H+] as it’s the negative logarithm of [H+].
Negative logarithm of 0.00004 = pH = 7.4,
NB a decrease of pH of one unit means a 10 fold increase in
H+ concentration i.e. from 7 to 6.
pH of blood = True pH of plasma
Plasma pH is in equilibrium with that of RBC because RBCs
contain hemoglobin which is one of the most important blood
buffers
21. PH AND BUFFERING
Acid
A substance that dissociates to release H+ ions
Base
A substance that dissociates to release OH- ions or absorbs H+ ions.
The pH scale is used to measure the concentration of H+ ions in a
solution
pH = potential of Hydrogen
Water is neutral: H+ = OH-, pH 7
An acid solution
pH O - 7
has more H+ than OH-
A basic or alkaline solution
pH 7 – 14
has more OH- than H+
Strong acids or bases dissociate completely in solution
Weak acids or bases do not completely dissociate: many
molecules remain intact
22. CONT’D
Normal pH of the ECF = 7.35 – 7.45.
Above or below this range will disrupt cell
membranes and denature proteins
Acidosis = ECF pH below 7.35
Alkalosis = ECF pH above 7.45
Acidosis is the more common problem since
metabolism generates acid waste products
23. CONT’D
Types of Acids
Volatile Acids
Can leave solution and enter the atmosphere
CO2 + H2O ↔ H2CO3- ↔ H+ + HCO3-
lungs blood
Fixed Acids
Remain in solution until they are excreted e.g. sulfuric acid,
phosphoric acid
Organic Acids
The products of metabolism
These are usually metabolized into other wastes, but they can
build up under anaerobic conditions or starvation e.g. Lactic acid,
Ketone bodies
24. ACID/ ALKALINE SOURCES
Sources of Hydrogen ion.
Dietary – degradation of protein yield sulphates and phosphates
which hydrate them.
SO4 + H+ + OH – H2 SO4
PO4 + 3H – H3PO4
H+ load from this source is 150 meq/day
Other common sources of extra hydrogen ions include:
Strenuous exercise
lactic acid
Diabetic ketoacidosis
Acetoacetic and B-hydroxybutyric acid.
Ingestion of acidifying salts i.e.
NH4Cl
CaCl2
The net effect of these acids is to add HCl to blood
Failure of kidneys due to kidney disease to excrete H+
Has net effect of increasing H+ ion concentration in blood.
25. CONT’D
Sources of Alkali
Fruits are main source of Alkali because they contain K+
and Na+ salts of weak organic acids
the anion of these salts are metabolized to CO2 leaving
NaHCO3 and KHCO3 in body.
NaHCO3 and other alkalinizing salts are sometimes
ingested in large amounts e.g. baking soda.
Commonest cause of Alkaloses is vomiting due to loss
of gastric HCL
Increase in PCO2 result in respiratory acidosis and a
decrease mean respiratory alkalosis.
When acidosis and alkalosis occur changes are produced in
the kidneys which then tend to compensate for acidosis or
alkalosis hence adjusting the pH towards normal
26. MECHANISM OF PH CONTROL
Buffers
Dissolved compounds that can remove H+ ions to
stabilize pH
Usually buffers are a weak acid and its
corresponding salt
Three major buffering systems:
The Protein Buffer System
The carbonic acid – bicarbonate buffer system
Phosphate buffer system
27. PROTEIN BUFFER SYSTEM
Proteins are used to regulate pH in the ECF and ICF
(most effective in the ICF)
Amino acids can be used to accept or release H+ ions:
At typical body pH, most carboxyl groups exist as COO- and
can accept H+ ions if the pH begins to drop
Histidine and Cysteine remain as COOH at normal pH and
can donate H+ if the pH rises.
All proteins can provide some degree of buffering with
their carboxyl terminal.
Hemoglobin can have a great effect on blood pH
The Hemoglobin (Hb) Buffering System
Most effective in the ECF: blood
In RBCs the enzyme carbonic anhydrase converts CO2 into
H2CO3 which then dissociates
The H+ remains inside RBCs, but the HCO3- enters the
plasma where it can absorb excess H+
28.
29. CARBONIC ACID – BICARBONATE BUFFER
SYSTEM
The most important buffer for the ECF (free in plasma or
aided by Hb)
Carbon dioxide and water form carbonic acid which
dissociates into hydrogen ions and bicarbonate ions
The bicarbonate ions can be used to absorb excess H+ ions
in the ECF and then can be released as CO2 and H2O at the
lungs
This buffering only works if:
CO2 levels are normal
Respiration is functioning normally
Free bicarbonate ions are available
Bicarbonate ions can be generated from
CO2 + H2O or
NaHCO3-
but to have free HCO3-, H+ ions must be excreted at the kidney
30. PHOSPHATE BUFFER SYSTEM
Phosphate is used to
buffer ICF and urine
H2PO4 or Na2PO4 can
dissociate to generate
HPO4
2-, which can
absorb H+
As long as H+ is
excreted at the kidney
31. MAINTENANCE OF ACID – BASE
Buffering will only temporarily solve the H+ problem:
permanent removal as CO2 at the lungs or through
secretion at the kidney is necessary to maintain pH near
neutral
pH homeostasis:
Respiratory Compensation
Respiration rate is altered to control pH
↑ CO2 = ↓ pH
↓ CO2 = ↑ pH
Renal Compensation
The rate of H+ and HCO3- secretion or reabsorption can be
altered as necessary
↑ H+ = ↓ pH
↑ HCO3- = ↑ pH
32. RESPIRATORY ACIDOSIS AND ALKALOSIS
Changes in arterial pCO2 from any cause will affect
the [H2CO3]/HCO-
3} ratio and hence the pH
Rise in pCO2 means a rise in H2CO3 and resulting
in HCO-
3 and consequently a rise of [H+]. The
overall net effect is a fall in pH and vice versa
Resp. acidosis
Hypoventilation:
in CNS depression, drugs, illnesses like mysthenia gravis
Build up of CO2 hence reduced pH
Resp. alkalosis
Hyperventilation
CNS disorders, drugs, increased ammonia, pregnancy
Blow out of CO2 hence increase in pH
33. METABOLIC ACIDOSIS AND ALKALOSIS
Metabolic acidosis
When body is producing too much acid or renal failure
to excrete H+
Anion gap classification
Increased anion gap:
Ketoacidosis
Lactic acidosis
Chronic renal failure
Intoxication ie methanol
Normal anion gap
Intractable diarrhea
Renal tubular acidosis
intoxication
34. CONT’D
Metabolic alkalosis
Renal loss of H+
Excessive retaining of HCO3-
Hyperaldosteremia
Alkalotic agents eg ie excessive antiacids
35. UNCOMPENSATED METABOLIC ACIDOSIS OR
ALKALOSIS
Before renal mechanisms which are far much slower sets in,
the respiratory system has the very important duty of either
decreasing [H+] or adding up [H+] into the blood system.
In metabolic alkalosis, H+ ions are depleted from blood
evoking respiratory response of inhibiting ventilation thus
resulting in CO2 build up in blood.
In metabolic acidosis, the acid anions that replace HCO-
3 are
excreted in combination with a cation principally Na+
effectively maintaining electrical neutrality.
Note, for each H+ lost in urine one Na+ + one HCO-
3 are
reabsorbed.
The H+ in urine must be buffered to prevent decrease of pH to
below 4.5 which is injurious to cells.
Urine H+ is buffered by
HCO-
3 system which results H2O + CO2,
HPO4 + H+ results in - H2PO4 and
with NH3 to NH+
4
36. POTASSIUM METABOLISM AND ACID BASE
BALANCE
K+ ion and H+ ion produce parallel effect in plasma,
when there’s excess of H+ ion in plasma, K+ ion is
reabsorbed by renal tubule as H+ ion is lost.
In case of excess of K+ ion, K+ ion is lost by renal tubule
as H+ ion is reabsorbed ,
When H+ ion is low, K+ ion is lost as H+ ion is
reabsorbed and when H+ ion is in excess H+ ion is lost
as K+ ions is reabsorbed.