Fluid, Electrolyte and Acid-Base Dynamics

Concentration of Solutions
Percent Salt
0.9% NaCl

Milliosmoles
300 milliosmoles/Liter

Milliequivalents
325 milliequivalents/Liter

Osmosis

Osmosis

Hypertonic Solution

0.9% NaCl
3% NaCl

Cells Crenate in a Hypertonic Solution

Hypotonic Solution

0.9% NaCl
0.5% NaCl

Cells in a Hypotonic Solution Swell and May Lyse

Isotonic Solution

0.9% NaCl
0.9% NaCl

Which Way Will Fluid Move? 300 mosm

310 mosm

Application Problem 1
Male 18 has recently started working outdoors in the hot weather to earn money for his tuition. 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
Gentleman has 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.

Application Problem 2
FARID has hypertension. His doctor has advised him to eat a low salt diet. He consumed a lot of salt the day before his last checkup. His blood pressure was up. Why?

Answer to Problem 2
The extra salt Farid ate made his blood hypertonic. Hypertonic blood will attract fluids from body cells by osmosis.

Electrolyte vrs. Nonelectrolyte

NaCl
Glucose

Na+ + ClGlucose

Aldosterone
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
Calcium

Estrogen
Calcium

Parathormone
Calcium

Blood pH = 7.4 (7.35-7.45)

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

Secreted HCO3 Rebsorbed

Blood Kidney Nephron
H+

+ H

HCO3-

Urine

Kidneys Regulate pH
Excreting excess hydrogen ions, retain bicarbonate
if pH is too low

Retaining hydrogen ions, excrete bicarbonate

if pH is too high

Lungs Regulate pH
Breath faster to get rid of excess carbon dioxide if pH is too low
Carbon dioxide forms carbonic acid in the blood

Breath slower to retain carbon dioxide if pH is too high

Carbon Dioxide and Acid

CO2 + H2O

H2CO3

+ H +

HCO3

Carbonic Acid

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?

Breath faster to get rid of carbon dioxide
eliminates acid

Blood pH Increases to 7.45 How does the body compensate?

Breath slower to retain more carbon dioxide
retains more acid

John 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 HCl

Weak Acid
Acid that releases only a few hydrogen ions Carbonic Acid

Buffers Change Strong Acids to Weak Acids

HCl + NaOH
Strong Acid Base

H2CO3 + NaCl
Weak Acid Salt

Bicarbonate: Carbonic Acid

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

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 Nerve impulse Muscle contractions

Hypernatremia
Excess sodium in the blood Hypertension Muscle twitching Mental confusion Coma

Hyponatremia
Deficiency of sodium in the blood Hypotension tachycardia Muscle weakness

Potassium
Attracts water into the ICF Nerve impulse Muscle contractions

Hyperkalemia
Excess potassium in the blood Cardiac arrhythmias and cardiac arrest Elevated T wave Muscle weakness

Hypokalemia
Deficiency of potassium in the blood Cardiac arrhythmias and cardiac arrest Flatened T wave Muscle weakness

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

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

Hypocalcemia
Deficiency of calcium in the blood Tetany 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

THE END