Cairan dan Elektrolit

Oleh:
Reny Sulistyowati

Fluids and Electrolytes

Water constitutes 50% to 70% of the total body weight or about 40
liters
In males the ratio is ~ 65%
In females the ratio is less as they have more adipose tissue with lower
water content
Body water is distributed between two major compartments
Intracellular (ICF) that makes 40% of total body water
Extracellular (ECF) making 60% of total body water, divided between
Interstitial fluid (IF) (80% of ECF) that bathes the tissue cells
Plasma (20% of ECF) that circulates
The difference between IF and plasma is largely the high plasma
protein content

Total body water and its distribution between different

compartments

Marieb Human Anatomy and Physiology seventh edition Pearson Benjamin Cummings

Shift of body fluids through different compartments

Saladins Anatomy & Physiology fourth edition McGraw Hill

Water intake and output

Saladins Anatomy & Physiology fourth edition McGraw
Hill

Hydration and dehydration

Saladins Anatomy & Physiology fourth edition McGraw Hill

Fluids and Electrolytes

Body water acts as a solvent for two types of particles
Electrolytes: particles that can dissociate in solution from other
particles
and exist as electrically charged ions or compounds
Examples: Na+, K+, HCO3-,
Nonelectrolytes: particles that do not dissociate in solution, they
are
mostly organic
Examples: glucose, urea, amino acids, lipids

Fluids and Electrolytes

Definitions*
Units of measuring solute concentration
Mole = 6 x 106 molecules of a substance. This is a constant figure
Millimole = 1 / 1000 = 1 / 10-3 of a mole
Equivalent = amount of ionized solute = moles x valence of solute
Example: 1 mmol/L of CaCl2 concentration dissociates into 2 Cland one Ca++ therefore the Ca++ concentration is
1 mmol x 2 (Ca++ valency) = 2 meq/ L
Osmole: one osmole = number of particles in a solution in which a solute
dissociates
Osmolarity = concentration of particles in solution expressed as osmoles
Electrolyte as well as nonelectrolyte particles contribute to the
osmolarity of a solution

Modified from Costanzo Physiology second edition Saunders

Fluids and Electrolytes

Acid and Base
An acid is a chemical compound that releases H in a solution
The more the H+ released the stronger the acid and the lower
the pH
An example of a strong acid is HCl
An example of a weak acid is H2 CO3
A base is a compound that accepts H+
An example of a strong base is NaOH
An example of a weak base is HCO3-

Fluids and Electrolytes

pH
pH is a measure of H+ concentration in body fluids
It is expressed in a logarithmic term because of it is a very small
number
pH is the negative of H+ tenth logarithm
pH = - log10 (H+)

Fluids and Electrolytes

Compartment Volume Shifts
Normally there is a free interchange of water between the different
compartments e.g. exchange between intravascular and interstitial
compartments at the capillary level
Loss of blood results in a shift of water from the interstitial to the vascular
compartments
Excessive loss of interstitial fluid results in its shrinkage and a shift of
intracellular fluid to interstitial compartment
Burns, hemorrhage, vomiting, diarrhea, excessive sweating, lack of
water
intake are all examples
Excessive hydration of ECF leads to water shift into the cells

Fluids and Electrolytes

Water Balance
To a large extent, the amount of body water is constant
This is achieved my balancing water intake and loss from the body
About 2500 ml of water is taken (or produced) and the same amount
is lost
Intake: Drinking (60%)
Water in solid food (30%)
Internally produced water (10%)
Output: Urine (60%)
Loss through the lungs and skin (insensible loss) (30%)
Sweating (7%)
Feces (3%)

Fluids and Electrolytes

Composition of ICF and ECF
Na+ and Cl-, and HCO- make the bulk of ECF ions
K+ and Mg++ are the main intracellular ions balanced by proteins
and organic phosphates
Ca++ is overwhelmingly in the ECF
The IC pH is ~ 7.1, while the EC is ~7.4
The osmolarity of EC and IC is the same (290 mosm/L) since water
moves freely across the cell membrane
Plasma proteins do not pass into ECF because of their large size

Composition of extracellular and intracellular fluids,

notice that
the osmolarity is more or less the same
Vander Physiology eighth edition McGraw Hill

Fluids and Electrolytes

Electroneutrality
Each body fluid compartment must have an equal number of
anions
and cations
That is the same concentration in meq/L of the positively charged
as
the negatively charged molecules
The plasma membrane has a negative intracellular and
a positive extracellular surface

Fluids and Electrolytes

Creation of Concentration Differences
Across Cell Membrane
Maintaining a different concentration of the same ion across the
cell membrane is crucial to cell function
Without this difference neural transmission, muscle contraction,
and absorption of nutrient from the GI tract and renal tubular
function become impossible

The sodium potassium pump activated by ATP

It is responsible for the difference between the intracellular and
extracellular
concentrations of the two ions

Vander Physiology tenth edition McGraw Hill

Fluids and Electrolytes

Ion Channels and Mediated Transporters
Both are membrane integral proteins
Both are specific allowing one ion or a specific class of particles through
Ion channels are permanently open to the specific ions
Mediated transporters undergo conformational changes on either
side of the membrane, opening on one side and closing on the other
then reversing this movement to allow larger molecules to pass
The result is that ion channels are faster than mediated transporters
Mediated transport is of two types
Facilitated diffusion
Active transport

Types of transport across cell membrane

Facilitated diffusion uses a transporter to move particles from higher to lower
concentration. It stops when the concentration is equal on both sides of the
membrane
Active transport occurs against electrochemical gradient and consumes energy
(ATP)
Active transport is of two types: primary and secondary
Vander Physiology eighth edition McGraw Hill

Ions need open channels to diffuse

They can not diffuse through the bilayerd cell
membrane
They move ions several hundred times faster than
transporters

Vander Physiology eighth edition McGraw Hill

Fluids and Electrolytes

Creation of Concentration Differences
Across Cell Membrane
The Na+ K+ pump keeps Na+ concentration higher and K +
concentration lower outside the cell than inside it
This is an energy consuming process
Energy is derived from adenosine triphospahte (ATP)
The transporter acts as an enzyme that extracts energy from
ATP and converts it to ADP, the energy is used to move
particles
across a gradient
Na+ - K+ ATPase is responsible for creating the large concentration
gradient across the cell membrane
Typically for each 3 Na+ out 2 K+ get in resulting in an electrical
gradient with ECF positive and ICF negative

Primary active transport

Phosphorilation leads to affinity of transporter to the particle
Random oscillations of the transporter opens it to intracellular and
extracellular sides alternately
The transporter is an ATPase
Vander Physiology eighth edition McGraw Hill

Fluids and Electrolytes

Creation of Concentration Differences
Across Cell Membrane
Calcium has its Ca++ ATPase that keeps extracellular Ca ++
concentration higher than its intracellular concentration
Ca++ ATPase is present in cell wall, organelle membranes and
endoplasmic reticulum
In addition to the ATP consuming transporters, some molecules
establish concentration gradients utilizing the Na + gradient
established by
Na+ K+ ATPase
Amino acids, glucose, Ca++ and H+ are transported this way
This is referred to as secondary active transport

Fluids and Electrolytes

Creation of Concentration Differences
Across Cell Membrane
Secondary Active Transport*
The secondarily transported solute can move in the same direction
(into the cell) as the primary (Na +) ion as with glucose molecules
In this case the process is identified as cotransport
If the secondarily transported solute goes in the opposite direction
as
the primarily transported ion (Na +), that is outside the cell then
the process is termed countertransport

*Notice that the primary transport Na+ always moves from ECF to the cell inside

Secondary active transport Cotransport

Notice that the ion (Na+ in this case) is moving downhill while
the
co-transported solute is moving against a high gradient
If the solute moves in an opposite direction than the Na + the
process is
Vander Physiologycalled
tenth edition
McGraw Hill
countertransport

(not shown in this figure)

Movement of different solutes across cell membrane

Vander Physiology eighth edition McGraw Hill

Fluids and Electrolytes

Regulation of Water Intake
Low water intake will lead to plasma osmolality
Low blood volume or blood pressure activate angiotensin II
Both stimuli stimulate hypothalamic thirst center to secrete ADH
High plasma osmolality leads to salivary secretion thirst water
intake
Once wet, the buccal mucosa eliminates the feeling of thirst
Stretch receptors in the GI tract act on to inhibit thirst center and avoid
excessive water intake and plasma osmolality*

Fluids and Electrolytes

Water intake by the Cell
Water is a polar molecule
It passes through the cell membrane rapidly
Aquaporins are cell membrane proteins that facilitate the passing
of water
into the cell
The permeability of the cell membrane to water depends on the
number
of aquaporins
The number of aquaporins differ from cell type to the other and in
the same cell in response to different cignals

Fluids and Electrolytes

Water Output
The kidneys have to excrete metabolic by products dissolved in water
This mounts to about 500 cc*
Skin and lungs loose about 700 cc/day
Water is lost with the stools
The above represent obligatory water loss that needs to be replaced
The amount lost in the urine and sweat depend on the amount of
water ingested in drinks and food and the amount of sweat secreted
ADH resorbs water from renal collecting ducts only if the blood
volume is
low
ADH secretion is controlled by hypothalamic osmoreceptors and by
significant changes in blood pressure

Fluids and Electrolytes

Sodium
Sodium is the very valuable ion, it maintains total body water and
blood volume
Sodium is important in maintaining the resting cell membrane
potential
Sodium gradiants across cell membrane provides the energy for
cotransport
of glucose, amino acids, potassium and calcium
Sodium bicarbonate is a major ECF buffer
Sodium/potassium pump is important in generating body heat
The adult needs 0.5 Gm of sodium/day

Fluids and Electrolytes

Sodium Regulation
The adult needs 0.5 Gm of sodium/day
Sixty five percent of filtered Na is resorbed by renal PCT
Another 25% is resorbed by HL
High aldosterone levels resorb the rest in the DCT and CD, otherwise
no Na+ resorption occurs beyond DCT
Water may or may not follow aldosterone Na+ resorbed
Water resorption depends on ADH aquaporins inserted in CD principal
cells
Aldosterone is secreted in response to BP or Na+ in the JGA perfusate
Baroreceptors respond to BP vasoconstriction and activation of
renin/angiotensin/aldosterone mechanism

Fluids and Electrolytes

Sodium Regulation
Atrial Natriuretic Peptide (ANP): produces diuresis reducing blood
volume
Promotes Na+ renal CD resorption, inhibits ADH and renin
secretion
and causes vasodilatation

Saladins Anatomy & Physiology fourth edition McGraw Hill

Fluids and Electrolytes

Potassium
The most abundant ion in the ICF
Determines intracellular osmolarity
Part of the sodium potassium pump
Essential for protein synthesis

Fluids and Electrolytes

Potassium Regulation
The kidneys main function usually is to excrete potassium
Normally 60% - 80% of potassium is resorbed through renal PCT
Additional 10% resorbed through HL ascending limb
The rest is usually lost in the urine
If interstitial K+ is low, K+ will move from cells to interstitial space
CD principal cells reduce K+ loss to a minimum
Adrenal cortex cells are sensitive to K+ level, an increase will lead
to aldosterone secretion
High dietary K+ intake leads to K+ loss in the urine

The relation between potassium and hydrogen ions in the

plasma
Saladins Anatomy & Physiology fourth edition McGraw Hill

Potassium balance in the body

Costanzo Physiology second edition Saunders

Fluids and Electrolytes

Calcium
Component of the skeleton
Essential for the activation of muscle contraction, including the
heart
Intracellular secondary messenger for hormones and
neurotransmitters
Part of the coagulation mechanism
Must be kept outside the cells to avoid precipitation with phosphate

Fluids and Electrolytes

Phosphorus
Concentrated intracellularly as mon. di and triphosphates
Part of the nucleic acids, lipophosphates, ATP, GTP and cAMP
Activate many metabolic reactions
Help maintain body fluid pH

Fluids and Electrolytes

Acid-Base Balance
Cell function is possible only in a very tight range of H +
concentration (pH)
H+ changes the shape of proteins including the enzymes
The body produces two types of acid
Fixed: SO4, PO4 , lactic acid, fatty acids, ketone bodies, etc.
Volatile: H2CO3
Normal arterial pH is 7.40, venous pH is 7.35, ICF 7.00
Acidosis is a tendency towards pH
Acidemia is a drop in pH below 7.35
Alkalosis is a tendency towards a pH
Alkalemia is a rise of pH above 7.45

Fluids and Electrolytes

Hydrogen Ion Metabolism
H+ is produced from the metabolism of proteins and other organic molecules
Cell metabolism results in the formation CO2 which reacts with water
CO2 + H2 O= H+ + HCO3The loss of HCO3- in urine and stools constitutes a gain in H +
H+ is lost in vomitus and urine, and is incorporated in organic compounds
H+ is also lost in hyperventilation with the excessive loss of CO2

Fluids and Electrolytes

Acid-Base Balance
Blood pH is regulated by three mechanisms
Chemical buffers: act immediately
Respiratory rate and depth: intermediate speed
Renal correction: slow but most potent

Fluids and Electrolytes

Acid-Base Balance
Chemical buffers
A buffer is a mixture of a weak acid and its base or a weak base and its
acid
A buffered solution resists change in its pH when a strong acid
or a
strong base is added to it
Chemical buffers can hide change in pH temporarily until renal
control
takes effect
H2CO3 / HCO3- system
HCl + NaHCO3 NaCL + H2CO3 (weak acid)
NaOH + H2CO3 NaHCO3 (weak base) + H2O
Plasma HCO3- levels are referred to as alkaline reserve (25 mEq/L)

Fluids and Electrolytes

Acid-Base Balance
Chemical buffers
Carbonic acid Bicarbonate System:
H2CO3 / HCO3HCl + NaHCO3 NaCL + H2CO3 (weak acid)
NaOH + H2CO3 NaHCO3 (weak base) + H2O
Plasma HCO3- levels are referred to as alkaline reserve (25

mEq/L

Normally a 20:1 HCO3- to H2 CO3 maintains a plasma pH at the range of

7.35 7.45
Saladins Anatomy & Physiology fourth edition McGraw Hill

Fluids and Electrolytes

Acid-Base Balance
Chemical Buffers
Phosphate system:
Because of its ICF presence, it is more important as an IC than
plasma
buffer
Na2HPO4 (weak base) and NaH2PO4 (weak acid)
HCL + Na2HPO4 NaCl + NaH2PO4
NaOH + NaH2PO4 Na2HPO4 + H2O

Fluids and Electrolytes

Acid-Base Balance
Chemical Buffers
Ammonia/Ammonium System:
NH3 / NH4+
NH3 is generated in tubular cells absorbs H+
NH3 reacts with ClNH3 + H+ NH4+ + Cl- NH4 Cl

Fluids and Electrolytes

Acid-Base Balance
Chemical Buffers
Protein system:
Intracellular proteins can expose NH2 or COOH ends
(amphoteric)
In acidic medium absorbing H+ as in R-NH2 + H+ R-NH3+
In an alkaline medium releasing H+ as in R-COOH H+ + RCOOHemoglobin is an excellent intracellular buffer, reduced Hgb
binds H+

Fluids and Electrolytes

Acid-Base Balance
Respiratory Regulation
CO2 + H2O H2CO3 H+ + HCO3CO2 is easily expelled from the lungs
The addition of acid will cause the conversion of H 2CO3 to H2O and CO2
which is easily expelled from the lungs by RR
The addition of alkali depresses the respiratory center RR CO2
H2CO3 pH
Respiratory control has a large reserve capacity
It addresses volatile acid
Can affect change in pH within a very short time (minutes)

Fluids and Electrolytes

Acid-Base Balance
Renal Regulation
Addresses fixed acid, they actually eliminate H + from the body
Corrects the greatest quantity of excesses in acid or base
Correct imbalance slower than other two systems
Conserves some chemical buffers (HCO3- )
Generates some buffers (HCO3-, NH4+ from amino acid glutamine)
Secretes H+ in the urine in PCT and CD
H+ is obtained from dissociation of H2CO3 created by CO2 and H2O
For this, carbonic anhydrase is present in the renal cells

Fluids and Electrolytes

Acid-Base Balance
Renal Regulation
The renal tubules convert CO2 and H2O to H2CO3
H2CO3 dissociates into H+ and HCO3- in a reversible reaction
The enzyme carbonic anhydrase facilitates the two sides of the
reaction
In case of excess H+ the kidney excretes H+ in the urine and CO2 is
sent back to the PCT cell where it is converted to HCO 3- and
sent back to the ECF elevating the pH
In case of alkalosis HCO3- is secreted in the urine and more H + is
reabsorbed into the ECF

HCO3- reclaim from the filtrate

Bicarb left after Na+ resorption is converted to carbonic acid, carbonic anhydrase
(CA) splits carbonic acid to H2O and CO2, H2O is passed in the urine, CO2 enters the
cell where it is converted to H2CO3 then HCO3- . This exits to ECF through secondary
active transport with Na+

Marieb Human Anatomy and Physiology seventh edition Pearson Benjamin Cummings

Buffering of H+ by the kidney

Saladins Anatomy & Physiology fourth edition McGraw Hill