Tentir Keseimbangan Cairan dan

Elektrolit
by Erik Ahmad Hasyim

 Slide 1

Body is mostly water

• New planet  does it have water?

 Slide 2

Body is in osmotic equilibrium

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Water balance

 Slide 8
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Electrolytes in body fluids

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Two carefully regulated parameters

Effective Tonicity
circulating
volume (ECV)
Plasma volume Serum
osmolarity

Extracellular Serum Na+

fluid volume concentration

 Slide 12

Check point 2
• How kidney conserve water
– Vasopressin and aquaporins
• Plasma volume and osmolarity
– osmoreceptors, baroreceptors and atrial stretch
receptor
– AngII, Ald, ANP, thirst, ADH

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Graphical representation of volume vs

solute in ICF and ECF

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Check point 3 - IV fluid

• Crystalloid vs colloid
• NS 0,9%
• NS 0,45%, 3%
• RL
• D5%
• D40%
• D5% - NS0,9%
• D5% - NS0,45%

 Slide 18

Acid base balance

Precise regulation of free hydrogen

ion concentration in the body fluids
 Slide 19

Acids liberate free hydrogen ions,

whereas bases accept them

• Acid
– Special group of hydrogen-
containing substances that
dissociate when in solution to
liberate H+ and anions
• Strong acid
– Has greater tendency to dissociate
in solution than weak acid
– E.g: HCl in H2O and H2CO3

• So is base

 Slide 20

1. pH
• Because H+ is in the
denominator, a high H+
corresponds to a low
pH, and a low H+
corresponds to high pH
 Slide 21
• pH of arterial 7.35 – 7.45
• High protein diets tends to acidify blood

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2. Fluctuations in H+ alter
nerve, enzyme, and K+ activity
• Changes in excitability of nerve and muscle
cells are among the major clinical
manifestations of pH abnormalities
– Acidosis  depression of CNS
– Alkalosis  overexcitability
• H+ concentration exerts a marked influence on
enzyme activity (eg. ATPase)
• Changes in H+ influence K+ level in the body

 Slide 24

3. Sources of H+ in the body

• Carbonic acid formation
– From metabolically produced CO2
 Slide 25

Sources of H+ in the body (2)

• Inorganic acids produced during breakdown of
nutrients
– Protein from meat  contain sulfur and
phosphorus broken down to acid
• Organic acids resulting from intermediary
metabolism
– Fatty acids from fat metabolism, lactic acid from
muscle

 Slide 26

4. The removal of H+ from body

• Buffer system  temporarily bind H+,
removing the highly reactive H+ from solution
• Exhalation of CO2  reduces level of carbonic
acid in blood  reduces blood H+
• Kidney secretion of H+  through excretion in
urine

 Slide 27

Buffer system
• Weak acid and the salt of that acid (weak
base)
• Prevent rapid, drastic change of the pH
– By converting strong acid or base to weak acid or
base

• Protein buffer system

• Carbonic acid – bicarbonate buffer system
• Phosphate buffer system
 Slide 28

Exhalation of CO2
• Second line of defense
• May fail if there is pathology

 Slide 29

Kidneys in maintaining
acid-base balance
• Renal H+ excretion
– Eliminating H+ derived from sulfuric, phosphoric, lactic
and other (<< CO2  main by lungs)
• HCO3- excretion
– Controlled by increasing or decreasing reabsorption
• NH3 secretion
– Because urinary pH cannot go lower than 4.5
– Most secreted H+ must be buffered in the tubular fluid
so that it does not exist as free H+

 Slide 30

Control of the rate of tubular H+

secretion and HCO3 reabsorption
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