water and electrolyte balance with the different organs involved in the management of electrolyte Absorbtion and release

1. WATER AND
ELECTROLYTE
BALANCE
POST GRADUATE
DEPT OF BIOCHEMISTRY
SBMCH

2. FUNCTIONS OF WATER
1.PROVIDES AQUEOUS MEDIUM FOR ALL THE BIOCHEMICAL
REACTIONS IN THE BODY
2.REACTANT IN METABOLIC REACTIONS
3.VEHICLE FOR TRANSPORT OF SOLUTES
4.CLOSELY ASSOCIATED WITH REGULATION OF BODY
TEMPERATURE

3. WATER DISTRIBUTION IN THE BODY
 60% OF THE BODY WEIGHT IS WATER
1.INTRACELLULAR FLUID
2.EXTRACELLULAR FLUID
28L ----INTRACELLULAR FLUID
42L <
14L----EXTRACELLULAR FLUID
INTRAVASCULAR FLUID 2.8 L
EXTRAVASCULARFLUID 11.2 L

4. ADULT HUMAN : 60% WATER
 14 L ( ECF)
INTERSTITIAL FLUID 10.5 L
PLASMA 3.5 L

5. WATER INTAKE
 EXOGENOUS
1) INGESTED WATER AND BEVERAGES
2) SOLID FOODS
ENDOGENOUS
METABOLIC WATER FROM OXIDATION OF FOODSTUFFS
1g OF CARBOHYDRATE .PROTEIN AND FAT YIELD
0.6ml,0.4ml,1.1ml WATER RESPECTIVELY

6. WATER OUTPUT
 WATER LOSS OCCURS FROM
 URINE,SKIN,LUNGS AND FAECES
 URINE : 1-2 L/DAY
 WATER REGULATION IS CONTROLLED BY HARMONE
VASOPRESSIN

7.  SKIN – 450ML/DAY WATER LOSS
 LUNGS – 400 ML/DAY
 LOSS OF WATER BY PERSPIRATION AND RESPIRATION IS
CALLED INSENSIBLE WATER LOSS
 FAECES: 150 ML/DAY

8. WATER BALANCE IN THE
BODY
INTAKE PER DAY OUTPUT PER DAY
Water in food 1250ml Urine 1500ml
Oxidation of food 300ml S kin 500ml
Drinking water 1200ml Lungs 700ml
Feces 50ml
2750ml 2750ml

9. REGULATION OF WATER BALANCE
1) ADH- SECRETED FROM POST. PITUITARY GLAND
ADH PROMOTES WATER REABSORPTION FROM KIDNEYS AND THUS
REDUCES THE LOSS OF WATER FROM BODY
2) ALDOSTERONE
Hormone produced in adrenal cortex.It increases Na+
reabsoption by renal tubules.
3)THIRST CENTRE
located in hypothalamus of brain and regulates the intake of
water . Dehydration stimulates the thirst centre which causes us
to drink water
4) URINE FORMATION
if excess water is injected the kidney responds to it `and excess
water is excreted in urine and water balance is maintained

10. ELECTROLYTES
 THE MAJOR ELECTROLYTES IN THE PLASMA ARE
A) CATIONS (POSITIVELY CHARGED IONS)
sodium Na+,pottasium K+,calcium Ca+ magnesium Mg
+
B) ANIONS (NEGATIVELY CHARGED IONS)
chloride(cl-),Bicarbonate(HCo3-),sulfate(so4-

11. ELECTROLYTEBALANCE
• Electrolytes are the compounds which
readily dissociate in solution and exist as
ions ie., positively and negatively
charged particles.
• The electrolytes is expressed as
milliequivalents(mEq/L) rather
than milligrams.

12. ELECTROLYTES COMPOSITION OF BODY
FLUIDS
_ _
EXTRACELLULAR FLUID
(PLASMA)
INTRACELLULAR FLUID
(MUSCLE)
CATIONS _ ANIONS CATIONS ANIONS
Na+ 142 Cl 103 K 150 HPO2-
3
140
K+ 5 HCO3 27 Na 10 HCO3 10
Ca2+ 5 HPO2-
3
2 Mg 40
_
Cl 2
Mg2+ 3 SO2-
4
1 Ca 2 SO2-
4
5
PROTEI
NS
16 PROTEI
NS
40
ORGAN
IC
ACIDS
6 ORGAN
IC
ACIDS
5
155 155 202 202

13. REGULATION OF SODIUM AND WATER BALANCE
-MAJOR REGULATORY FACTORS
 Hormones ( Aldosterone, ADH)
 Renin-Angiotensin system.

 ALDOSTERONE ( mineralocorticoid Zona Glomerulosa of adrenal cortex )
( REGULATES)
 Na+ – K+ exchange and Na+ – H + exchange at the Renal Tubules.
 Net effect is SODIUM RETENTION.

14. Anti – Diuretic Hormone (ADH)
When Plasma Osmolality increases(due to
Na)
Osmorecepters of Hypothalamus are
stimulated
ADH secretion
Resulting in
Increases water reabsorption by the renal tubles

15. Renin-Angiotensin System
When ECF volume
falls
Renal plasma flow decreases
Leads to
Release of RENIN by juxtaglomerular

16.  FACTORS WHICH
STIMULATE THE RENIN RELEASE
• Decreased BP • Salt depletion • Prostaglandins
 INHIBITS THE RENIN RELEASE
• Increased BP • Salt intake • Prostaglandin inhibitors •
Angiotensin - II

18.  ATRIAL NATRIURETERIC FACTOR(ANF)
polypeptide hormone secreted by right atrium of the heart
ANF increases the urinary sodium excretion

19. CLINICAL CONDITIONS
1.DEHYDRATION

22. SIGNS OF SEVERE
DEHYDRATION

23. SHOCK

24. TREATMENT
• Intake of plenty of water
• Or IV isotonic solution(usually 5%
Glucose)
• Electrolytes either oral or IV
• Monitoring the water and electrolyte status
of body.

25. OVERHYDRATION
Overhydration can lead to water intoxication.
This occurs when the amount of salt and
other electrolytes in your body become too
diluted.
Hyponatremia is a condition in which
sodium (salt) levels become dangerously low.
This is the main concern of overhydration.

26. CAUSES OF overhydration
By making your body hold on to more
fluid. These includes:
congestive heart failure (CHF)
liver disease
kidney problems
Syndrome of inappropriate antidiuretic
hormone
nonsteroidal anti-inflammatory drugs

27. SYMPTOMS OF overhydration
common symptoms includes:
nausea and vomiting
Headache
changes in mental state such as confusion or disorientation
Untreated overhydration can lead to dangerously low levels of
sodium in your
blood. This can cause more severe symptoms, such as:
muscle weakness, spasms, or cramps
Seizures
Unconsciousness
coma

28. How is overhydration treated?
 Cutting back on your fluid intake
Taking diuretics to increase the
amount of urine you produce
Treating the condition that caused
the overhydration
 Stopping any medications causing the
problem
 Replacing sodium in severe cases

29. SODIUM
 Major cation of Extracellular fluid
 Total body sodium is 4000mEq,
 50% - Bones ,
 40% - ECF ,
 10% - soft tissues
 Normal Sr. Plasma level 136 – 145mEq/L

30.  Hyponatremia
 Hyponatremia is a low sodium level in the blood.
 It is generally defined as a sodium concentration of
less than 135 mEql/L
 Severe hyponatremia being below 120 mEql/L
Symptoms :
Mild symptoms 
decreased ability to think, headaches, nausea,
Severe symptoms 
confusion, seizures, and coma.

31. CAUSES
SEVERE VOMITING
DIARRHEA
BURNS
SWEATING
ADDISON’S DISEASE(ADRENOCORTICAL INSUFFICIENCY)
RENAL TUBULAR ACIDOSIDS

32.  Hypernatremia
 Hypernatremia  is a high sodium ion level in the
blood.
Serum sodium level of more than 145 mmol/L.
Severe symptoms occurs when levels are
above 160 mmol/L
SYMPTOMS :
•Early symptoms  a strong feeling of thirst,
weakness, nausea, and loss of appetite.
•Severe symptoms  confusion, muscle
twitching, and bleeding in or around the brain.

33. HYPERNATREMIA CAUSES
 CUSHING’S SYNDROME(Adreno cortical hyperactivity)
 PROLONGED CORTISONE THERAPY
 DECREASED INTAKE OF WATER
 PREGNANCY(where steroid hormones cause sodium
retention)
 DEHYDRATION
 EXCESS INTAKE OF SALT

34. OTHER CAUSES

35. • POTASSIUM
• Total body content of potasium 
3500mEq
• Major cation of INTRACELLULAR
FLUID.
• Maintains intracellular Osmotic Pressure.
• Normal serum potassium level
3.5-5.2mmol/L
• The cells contains 160mEq/L, so
precaution should be taken to
prevent hemolysis when estimating
for concentration of potassium

36. Hypokalemia is a low level of potassium
(K+) in the blood serum.
 Levels below 3.5 mmol/L defined as
hypokalemia.
Symptoms :
• Mildly low levels do not typically cause
symptoms.
• Feeling tired, leg cramps, weakness &
constipation
•It increases the risk of an abnormal heart
rhythm, which are often too slow, and can
cause cardiac arrest.

37. Causes of hypokalemia include
• Diarrhea,
• medications like furosemide and steroids,
• Dialysis, Diabetes Insipidus
• Hyperaldosteronism, Hypomagnesemia,
• not enough intake in the diet.
 It is classified as severe when levels are less
than
2.5 mmol/L.
 Low levels can also be detected on
an electrocardiogram (ECG)  T wave is

38. H YPERKALEMIA
Hyperkalemiais an elevated level of potassium
(K+) with levels above 5.5 mmol/L in the blood
serum
SYMPTOMS :
• Typically this results in no symptoms.
•when severe  palpitations, muscle pain,
muscle weakness, or numbness.
•An abnormal heart rate can occur which can
result in cardiac arrest and death.

39. Common causes includes :-
• kidney failure,hypoaldosteronism, and
rhabdomyolysis.
Medications which cause high blood
potassium includes spironolactone, NSAIDs,
and angiotensin converting enzyme
inhibitors.
The severity is divided into
Mild (5.5-5.9 mmol/L),
Moderate (6.0-6.4 mmol/L),
 severe (>6.5 mmol/L).
High levels can also be detected on
an electrocardiogram (ECG)  ELEVATED ‘T’ WAVE
 Pseudohyperkalemia, due to breakdown of cells during
or after taking the blood sample, should be ruled out.

40. • CHLORIDE
Intake , output and metabolism of sodium
and chloride run in parallel.
The normal serum range for chloride is
97 to 107 mEq/L.
 In CSF  125 mEq/L
 Renalthreshold for Chloride is about
110mEq/L.
 Daily excretion of chloride is 5-8mg/L

41.  HYPER CHLOREMIA
Hyperchloremi a is an electrolyte
disturbance in which there is an elevated level
of the chloride ions in the blood.
The normal serum range for chloride is
96 to 106 mEq/L ,
chloride levels at or above 110 mEq/L
usually indicate kidney dysfunction as it is a
regulator of chloride concentration.

42. Symptoms and causes includes :
 Dehydration  due to diarrhea, vomiting, sweating
Hypertension due to increased sodium chloride
intake
Cardiovascular dysfunction  due to increased
sodium chloride intake
Edema  due to influx in sodium in the body
Weakness  due to loss of fluids
Thirst  due to loss of fluids

43. Kussmaul breathing  due to high ion
concentrations, loss of fluids, or renal
failure
High blood sugar  due to diabetes
Hyperchloremic metabolic acidosis 
due to severe diarrhea and/or renal
failure
Respiratory alkadosis  due to
renal dysfunction

44.  Hypochloremia
Hypochloremia is an electrolyte disturbance in
which there is an abnormally low level of the
chloride ion in the blood.
It is associated with
hypoventilation,
chronic respiratory acidosis.
respiratory acidosis + metabolic alkalosis
(decreased blood acidity) it is often due to
vomiting.
It occurs in cystic fibrosis.