Fluid and Acid Base Homeostasis

Irene Yuniar
 Fluid Distribution
Body fluid all the water and dissolved
solutes in the bodys fluid
compartments
 Regulation of Water and Solute Loss
Loss of body water or excess solutes depends
mainly on regulating how much is lost in the
urine.
Under normal conditions, fluid output (loss) is
adjusted by
antidiuretic hormone (ADH)
atrial natriuretic peptide (ANP)
aldosterone
 Regulatory Mechanism
Depend on :
total volume
distribution
concentration of solutes and pH

Insure homeostasis of body fluids

malfunction

nervous system and

organ dysfunction
Age Related Changes in Compartment Fluid Volumes
 Maintenance fluid requirements for children

Fluid regime/adjustment
Baseline 1 day of age 50 ml kg-1day-1
2 days of age 75 ml kg-1day-1
3 days of age 100 ml kg-1day-1
< 10 kg 100 ml kg-1day-1
1000 ml day-1 + 50 ml kg-1day-1 for every
10-20 kg
kg over 10 kg
1500 ml day-1 + 20 ml kg-1day-1 for every
> 20 kg
kg over 20 kg
Factors that
decrease Humidified gases X 0.75
requirement
Paralyzed X 0.7
High ADH (e.g. IPPV or coma) X 0.7
Hypothermia -12% per 0C core temp is < 370C
High ambient humidity X 0.7
Renal failure X 0.3/free fluids
 Maintenance fluid requirements for children (contd)

Fluid regime/adjustment
Factors that
increase Full activity and oral feeds X 1.5/free fluids
requirement
Fever + 12% per 0C core temp is > 37
Room temp over 31 0C + 30% per 0C
Hyperventilation X 1.2
Preterm neonate (< 1.5 kg) X 1.2
Radiant heater X 1.5
Phototherapy X 1.5
+ 4% per 1% of body surface area
Burns day 1
affected
+ 2% per 1% of body surface area
Burns day 2 +
affected
 Developmental and Biological
Variances
In an infant a sunken fontanel may indicate
dehydration
Infants have limited ability to dilute and
concentrate urine
Infants have a larger proportional surface are
of the GI tract than adults
Infants have a greater body surface area and
higher metabolic rate than adults
 Dehydration

Dehydration Regulation of fluid

gain is by regulation of thirst
Hyper volume
Composition of loss body fluid (mEq/L)

Type Na K Cl HCO3
Gastric 60- 10 110 0
110
Colon 120 30 90 60
Skin 40 0 0 0
Urine 50 40 90 0
Acid Base Balance
 Reasons for obtaining blood gases
To assess the oxygenation capacity of the
lungs for diagnostic reasons
To assess the oxygen pressure in the blood for
therapeutic reasons
To assess respiratory adequacy
To assess acid base status

A A Wijaya, 1st NICU-PICU

 Acid Base Balance
The overall acid-base balance of the body is
maintained by controlling the H+ concentration
of body fluids, especially extracellular fluid
Proteins 3-D structure sensitive to pH changes
Diet high in proteins tends to acidify the blood
3 major mechanisms to regulate pH
buffer system
exhalation of CO2 (respiratory system)
kidney excretion of H+ (urinary system)
21
 Actions of Buffer Systems
Prevent rapid, drastic changes in pH
Change either strong acid or base into weaker
one
Found in fluids of the body
3 principal buffer systems
protein buffer system
carbonic acid-bicarbonate buffer system
phosphate buffer system
25
26
 [HCO -] HCO
Normal
GINJAL
BASA3
HCO 3
3

pH = 6.1 + log Compensation

Normal PARU
pCO2
ASAM CO
CO22
Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Metabolic Alkalosis
32
 Respiratory Disorder
Every acute pCO2 changes of 10 mmHg will
change pH 0.08
Respiratory acidosis : pCO2 by 10 mmHg
will follow by HCO3 1 (acute) or 4
(chronic)
Respiratory alkalosis : pCO2 by 10 mmHg
will follow by HCO3 2 (acute) or 5
(chronic)
 Case 1
pH 7.2
pO2 89 mmHg
pCO2 25 mmHg
SBE -4 Interpretation?
HCO3- 10 mEq/L
Na+ 160 mEq/L
Cl- 102 mEq/L
K+ 5 mEq/L
 Case 2
pH 7.48 7.35-7.45
pCO2 45 35-45
SBE +10
HCO3 34 22-26
Na 150 135-155
Cl 102 98-110
Alb 4 3.5-4.5
pCO2 = 25
pH?????

(40-25/10)x0.08 = 0.12
pH = 7.4 + 0.12 = 7.52