Department of Physiology

Lecture: Fluids and Electrolytes 2016

Sources: Boron and Boulpaep, Medical Physiology , Second Edition

Guyton and Hall, Text Book of Medical Physiology Thirteenth Edition
Harrisons Principles of Internal Medicine 19th Edition
Basic Concepts of Fluid and Electrolyte Therapy Lobo et al 2013

Water content : 60% in Males; 50% in Females

Source: Water from: 1. Ingested food and water Average 2.2 L per day
2. Oxidation of carbohydrates( Metabolic water) : 200-300ml/day

Loss of water: Renal via urine- (kidney :most important organ for regulating water and electrolyte
balance

Non Renal: Insensible water loss: via skin and respiratory tract: 700 ml to 900l/day
++ Sweating: variable and dependent on environmental temperature and
Physical activity
GIT: Feces: 100 ml/day
Fever: Increases insensible water loss by 10% per degree Celsius above 38C

Fluid Compartments Divided into: Extracellular Fluid 25-45%; Intracellular Fluid 55-75%

Intravascular and Extravascular Fluid

Blood (Plasma and it’s components) Interstitial fluid

++ Transcellular Fluid: specialized type of ECF 1-2 L found in synovial, pericardial and intraocular spaces

Distribution of extracellular fluid between plasma and interstitial space are determined by:
1. Hydrostatic pressure or force
2. Osmotic pressure

Terms to remember Regulatory Volume Increase

Osmosis Regulatory Volume Decrease
Osmotic Equilibrium
Osmolality Acute and Chronic long term response
Osmolarity to hyperosmolality
Isotonic Solution
Hypertonic Solution
Hypotonic Solution

Total osmolality(mOsm): 2* Sodium + Glucose (mg/dL)/ 18 + Blood urea Nitrogen (mg/dL)/ 2.8

Tonicity or Effective Osmolality: (mOsm): 2* Sodium + Glucose (mg/dL) / 18

Normal Osmolality: 280-295mOsm/Kg
Types of fluids:
Crystalloid: Describes all clear glucose and/or salt containing fluids used for Intravenous therapy
. Cornerstone of fluid resucitation
Example : .9% saline ; D5Water
Colloid: Fluid containing microscopic particles (protein or starch) suspended in crystalloid ----
--Particles remain intravascularly  create osmotic gradient result to intravascular volume
expansion . May cause anaphylaxis.
Example: Albumin, Dextran
Blood( Plasma and it’s components): Component Therapy

Indication for Intravenous Therapy:

1. Resuscitation : Restore intravascular volume; use to correct on going losses; to initially
stabilize and may overlap with replacement
2. Replacement: Provide maintenance fluid AND correct deficit
3. Maintenance: help provide physiological fluid and electrolyte requirements

Electrolyte Normal Values Function

Sodium 135-145mEq/L Main ECF Cation
Chloride 98-108 mEq/L Main ECF Anion
Calcium 4.5-5.3 mg/dL Almost equal
concentration in ECF
and ICF
HCO3 22-26 mEq/L Regulate acid Base
Balance

Electrolyte Normal Values Function

Potassium 3.5- 5.0 mEq/L Main ICF Cation
Magnesium 1.5-2.5 mg/dL Important ICF Cation
Phosphates 2.5-4.5mg/dL Main ICF Anion
Acts ass Hydrogen
Buffer

Fluids

Fluids Effect
ISOTONIC Effective osmolality is unaltered
D5 water( Isotonic- Hypotonic Glucose metabolized to CO2
and H2O
Hypertonic Solution ECF osmolarity increases
osmosis of water from cells to
ECF
Hypotonic Solution ECF osmolarity decreases
ECF water diffuses into cells
No effect on osmotic gradient
Expand ECF
No effect on ICF
Dilute ECF water enters ICF-
 dilutes solute in ICF water
goes out to ICF to maintain
balance
Increase in ECF volume ,
decrease ICF volume
Increase osmolarity in ICF and
ECF
ECF and ICF increases Volume
Although ICF> ECF
 Solutions Tonicity Osmolarity Uses
Normal Saline / Isotonic 308mOsm/L Hydration Risk of
.9% NS Fluid resuscitation Hyperchloremic
Most common Acidosis
and
Lactated Ringers Isotonic 273mOsm/L Fluid Lactate more
(LR) Replacement stable in IVF than
Bicarbonate
3% NaCL Hypertonic 1026mOsm/L Acts as plasma Use in
expander Hyponatremia
Increase
Circulatory Risk of
Volume Hypernatremia
D5LR Hypertonic 295 mOsm/L Replacement
.45% NS Hypotonic 143mOsm/L Replacement Use in
Hyperosmolar
conditions
D5W Isotonic 278mOSm/L Provide calories
Then hypotonic
inside

Example of electrolyte/ Fluid Imbalance: Hyponatremia/Hypernatremia

Abnormality Causes Cells Plasma ECF ICF Correction

Na ECF Volume Volume
Hyponatremia With Use of Cell Hypertonic
dehydration/Low Diuretics, Swelling Solution
volume Diarrhea
Vomiting
Hyponatremia Overhydration/ Excessive Cell Hypertonic
Increase Volume secretion of Swelling Solution
ADH , Tumors
Hypernatremia Dehydration Diabetes Cell Hypotonic
Insipidus Shrinkage Solution
Excessive D5
sweating
Hypernatremia Overhydration Excessive ECF Cell Hypoosmotic
Sodium Shrinkage NaCl
Primary D5
Aldosteronism