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Fluid, Electrolyte and Acid-Base Dynamics

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Definitions
Osmoles: The concentration of an osmotic solution. A milliequivalent is equal to 0.001 equivalent weight. An equivalent weight is equal to 1 mole divided by the valence of the substance. A MOLE is the molecular weight in grams per litre.

Concentration of Solutions
Percent Salt 0.9% NaCl (Normal Saline) Milliosmoles 300 milliosmoles/Liter Milliequivalents 325 milliequivalents/Liter

The passage of a liquid from a weak solution to a more concentrated solution across a semipermeable membrane that allows passage of the solvent (water) but not the dissolved solids.

Osmosis

Osmosis

Hypertonic Solution
Red Cell

0.9% NaCl
3% NaCl

Cells Crenate in a Hypertonic Solution

Isotonic Solution
No movement of liquid will occur as the concentration of Sodium Chloride in the Red Cell and surrounding fluid are of equal strength.

0.9% NaCl
0.9% NaCl
Normal Saline

Which Way Will Fluid Move? 300 mosm

310 mosm

Problem 1
A patient has recently started working outdoors in the hot weather.
After a few days he experienced headaches, low blood pressure and a rapid heart rate. His blood sodium was down to 125 meq/L.

The normal is 144 meq/L. How do you explain this?

Answer to Problem 1
The patient lost sodium by perspiration. The low sodium in his blood allowed fluid to move into cells by osmosis. Lack of fluid lowered his blood pressure to give him a headache. The increased heart rate was his bodies way of trying to increase blood pressure.

Problem 2
A patient has hypertension.
His doctor has advised her eat a low salt diet. She consumed a lot of salt the day before her last checkup. Her blood pressure was up. Why?

Answer to Problem 2
The extra salt she consumed made her blood hypertonic. Hypertonic blood will attract fluids from body cells by osmosis.

Electrolyte vs.. Non electrolyte


NaCl
Glucose

Na+ + ClGlucose

Aldosterone
Adrenal Gland

Kidney

Hormone secreted from the adrenal cortex Stimulates kidneys Retain sodium Retain water Secrete potassium

Estrogen
Female hormone from the ovaries Similar to aldosterone Stimulates the kidneys to retain sodium Increases fluid retention

Cortisol
Hormone from the adrenal cortex Converts lipids and protein to glucose Depress inflammation Stimulates the kidneys to retain sodium Increases fluid retention Elevated levels cause edema

Collecting Duct

Antidiuretic Hormone ADH


ADH

H2O Hypertonic
Interstitial Fluid
Urine

Calcitonin
BLOOD

Calcium

Estrogen
BLOOD

Calcium

Parathormone
BLOOD

Calcium

Blood pH = 7.4 (7.35-7.45)


Blood pH regulated by 1. Kidneys 2. Lungs 3. Buffers in blood

+ H

HCO3
Blood Kidney Nephron

Secreted Rebsorbed
H+

HCO3-

Urine

H+ = Hydrogen Ions HCO3- = Bicarbonate Ions

Kidneys Regulate pH by
Excreting excess hydrogen ions & retaining bicarbonate if pH is too low Retaining hydrogen ions & excreting bicarbonate if pH is too high

Lungs Regulate pH
Breathe faster to get rid of excess carbon dioxide if pH is too low. Carbon dioxide dissolves in blood to forms carbonic acid. Breathe slower to retain carbon dioxide if pH is too high.

Carbon Dioxide and Acid


LUNGS

CO2 + H2O

H2CO3
Carbonic Acid

H+ + HCO3Bicarbonate

The enzyme, Carbonic anhydrase accelerates the reaction

The reaction is reversable

More Carbon Dioxide = More Acid = Lower pH


Breathing slower will retain CO2

pH will decrease (more acid)


Breathing faster will eliminate more CO2

pH will increase (less acid)

Blood pH Drops to 7.3 How does the body compensate?


Breathe faster to get rid of carbon dioxide eliminates acid

Blood pH Increases to 7.45 How does the body compensate?


Breathe slower to retain more carbon dioxide retains more acid

A patient is taking Narcotics for Pain. The narcotics have depressed his breathing rate. What will happen to his blood pH?

pH will decrease because he will retain excess carbon dioxide which will increase the amount of acid in the blood

Buffers Regulate pH
Chemicals that resist changes in pH. Prevent large pH changes when an acid or base is added.

Strong Acid
Acid that releases many hydrogen ions
e.g. HCl

Weak Acid
Acid that releases only a few hydrogen ions e.g. Carbonic Acid

Buffers Change Strong Acids to Weak Acids


HCl + NaOH
Strong Acid Base

H2CO3+ NaCl
Weak Acid Salt

Bicarbonate : Carbonic Acid Ratio


20:1 = pH 7.4 21:1 = pH more than 7.4 19:1 = pH less than 7.4

Acidosis
pH below 7.35 Depresses the nervous system

coma

Alkalosis
pH above 7.45 Overexcites the nervous system convulsions - Tetany

Respiratory Acidosis. Respiratory Alkalosis. Metabolic Acidosis. Metabolic Alkalosis.

Respiratory Acidosis
Any condition that impairs breathing Carbon dioxide increases in blood Excess carbon dioxide lowers pH

Respiratory Alkalosis
Hyperventilation Carbon dioxide decreases in blood Low carbon dioxide raises pH

Metabolic Acidosis
Not caused by breathing or carbon dioxide imbalance. Excess acid in blood

Renal disease, Diabetes or Starvation.


Deficiency of bicarbonate in blood. Diarrhea

Metabolic Alkalosis
Not caused by breathing or carbon dioxide imbalance. Deficiency of acid in the blood.
Vomiting, Diuretics.

Excess bicarbonate in the blood.


Ingesting sodium bicarbonate.

Sodium
Attracts water into the ECF. (Extra Cellular Fluid) Nerve impulse. Muscle contractions.

Hypernatremia
Excess sodium in the blood.

Hypertension. Muscle twitching. Mental confusion. Coma.

Hyponatremia
Deficiency of sodium in the blood Hypotension (Low blood pressure) Tachycardia (Fast heart beat above 100BPM) Muscle weakness

Potassium
Attracts water into the ICF (Intracellular Fluid) Nerve impulse Muscle contractions

Hyperkalemia
Excess potassium in the blood

Cardiac arrhythmias and cardiac arrest Elevated T wave in ECG Muscle weakness

Hypokalemia
Deficiency of potassium in the blood

Cardiac arrhythmias and cardiac arrest Flattened T wave in ECG Muscle weakness

Calcium
Mostly in bones and teeth Blood clotting Nerve impulse Muscle contraction

Hypercalcemia
Excess calcium in the blood Kidney stones Bone pain Cardiac arrhythmias Cancer

Hypocalcemia
Deficiency of calcium in the blood

Tetany (uncontrolled muscle contraction) Weak heart muscle Increased clotting time

Aldosteronism
Excess production of aldosterone Elevated sodium levels Depressed potassium levels Hypertension

Addisons Disease
Hyposecretion of the Adrenal Cortex
Hyposecretion of Aldosterone Hyposecretion of Glucocorticoids
Hormones that convert protein sugar

Hypotension
Sodium deficiency

Low blood sugar


Not enough glucocorticoids

Cushings Syndrome
Excess glucocorticoids Tumor of adrenal gland Side effect of steroid drugs cortisone Hyperglycemia Fat accumulation Abdomen Back of neck (buffalo hump)

Insulin
Cell

Glucose

Blood

Diabetes Mellites
Hyposecretion or hypoactivity of insulin Hyperglycemia Glycosurea Polyurea Thirst Body burns more fat
Ketone bodies
Metabolic Acidosis

Fat deposits in arteries


Heart Attack, Stroke, Poor Circulation

Antidiuretic Hormone Collecting ADH


Duct

ADH

H2O Hypertonic
Interstitial Fluid
Urine

Diabetes Insipidus
Hyposecretion of ADH Increased urine volume Diabetes insipidus is caused by a problem with your pituitary gland or your kidneys.

The End