Keseimbangan vol & eletrolit cairan tubuh.ppt

7/28/2019 Keseimbangan vol & eletrolit cairan tubuh.ppt

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Fluid and Electrolyte

Balance

M. Rasjad Indra

Laboratorium Ilmu FaalFK. UNIBRAW



Body Fluid Compartment



Body Fluid Volume

Intracellular 40 %

(42 liter in 70 kg

young adult)

Interstitial 15 %

(10.5 liter in 70 kg

young adult)

Plasma

5 %

(3.5 liter in 70 kg

young adult)

Transcellular 1-3 %

(Cerebrospinal) (Aqueous humor)

Extracellular 20 %

(14 liter in 70 kg

young adult)

Body fluid

60% (45-75) water



Electrolyte Composition of Body Fluid

Electrolytes Plasma(mEq/L)

Interstitial Fluid(mEq/Kg H2O)

IntracellularFluid (mEq/Kg

H2O)

Cation:

Na+ 142 145 10

K+ 4 4 159Ca2+ 5 3 1

Mg2+ 2 2 40

Total 153 154 210

Anion:

Cl- 103 117 3HCO3- 25 28 7

Protein 17 - 45

Others 8 9 155

Total 153 154 210



Daily Intake and Output of Water(in ml/day)

Normal Prolonged

Heavy Exercise

Intake

Fluid ingested 2100 ?

From metabolism 200 200Total intake 2300 ?

Output

Insensible-Skin 350 350

Insensible-Lungs 350 650

Sweat 100 5000

Feces 100 100

Urine 1400 500

Total output 2300 6600



• OsmosisThe net diffusion of water across the

membrane from a region of high water

concentration to one that has a lowerwater concentration

• Osmoles (Osm):The measurement of total number of

particles in a solution1 mole : 6.02 x 1023

1 mole/L NaCl ~ 2 osmoles/L (Na+ & Cl-)

• Osmotic pressure:The precise amount of pressure required to

prevent the osmosis1 osm/L ~ 19,300 mmHg; 1 mosm/L~19.3mmHG





Add pure water

• Normal • Add pure water

ICF ECFICF ECF



Add isotonic saline

• Normal • Add isotonic saline

ICF ECF ICF ECF



Add pure NaCl

• Normal • Add pure NaCl

ICF ECF ICF ECF



Ingestion of 1L

of water

Increased

extracellular

fluid volume

Cardiovascular

stretch receptor

Decreased ADH

release from

posterior

pituitary

Osmoreceptor

Decreased

plasma

osmolarity

Decreased

collecting duct

water

permiability

Decreased water

reabsorption

Increased water

excretion

Normal fluid

volume

Decreasedplasma ADH





Extracellularfluid volume

(effective

arterial blood

volume)

Kidneys,

cardiovascular

sensor

Kidneys

1. GFR

2. Aldosterone

3. Peritubular capillary Starlingforces

4. Sympathetic nerve activity

5. Intrarenal blood flow

distribution

6. Arterial natriuretic peptide

Renal

sodium

excretion

Sensor

Regulated

variabel

(-)



Decreased

effective

arterial blood

volume

Kidney

Angiotensinogen

Renin

Angiotensin I

Liver

Converting

enzyme

Lungs

Angiotensin II

Blood vessels Adrenal cortex Brain

Vasoconstrictor Aldosteron secre.

Sodium reabs.Blood pressure > H2O reabsorption

ADH secretion Thirst

Water intake

Normal effective arterial blood volume



Increased

Potasium intake

Increased plasma

[K+]Direct effect on adrenal

cortex

Increased [K+] in body cell

(including kidney cells)

Increased aldosterone

secretion

Increased plasmaaldosterone

Increase luminal membrane permiablility to

Na+ and K+ & Increase basolateral

membrane Na+/K+-ATPase activity in

collecting duct principal cells.

Increased potasium

secretion

Increased potasiumexcretion

Normal potasium

level



Definition of Edema:

An increase in the interstitial compartement of extracellularfluid volume (Harrison’s).

Starling Hypothesis

The balance of hydrostatic and oncotic pressures across thecapillary endothelium

Mean capillary hydrostatic pressure (Pc): 25 mmHg

Interstitial fluid hydrostatic pressure (PIF): 0 mmHg

Capillary oncotic pressure (Пc): 28 mmHg

Interstitial fluid oncotic pressure (ПIF): 3 mmHg

Arterial end of capillary:

Pc= 40 mmHg; PIF= 0 mmHg

Пc= 28 mmHg; ПIF= 3 mmHg

Net Filtration= 35-0-28+3= 10

Venous end of capillary:

Pc= 10 mmHg; PIF= 0 mmHg

Пc= 28 mmHg; ПIF= 3 mmHg

Net Absorption= 15-0-28+3= -10





Causes of Extracellular Edema

• 1. Increased capillary pressure

– Excessive kidney retention

– High venous pressure

– Decreased arteriole resistance

• 2. Decreased plasma proteins

– Loss of protein in urine

– Loss of protein from denuded skin

– Failure of produce protein



• 3. Increased capillary permiability

– Immune reaction

– Toxin

– Bacteria infection

– Vitamin deficiency (exp. Vit C)

• 4. Blockage of lymph return

– Cancer

– Paracyte infection (Filaria)

– Surgery

– Congenital absence or abnormal of Lymphatic vessels





Exercice

• The greatest fraction of the body’s water iscontained within:

a. Blood plasma

b. Cells

c. Extracellular fluid

d. Transcellular fluid

• Intravenous infusion of 1liter of isotonic saline will:

a. A 1-liter increase inintracellular fluid volume

b. A 1-liter increase inextracellular fluid volume

c. A 0.5-liter increase in intra-cellular fluid volume and a0.5-liter increase inextracellular fluid volume



• Intravenous infusion of 1liter of hypertonic saline willcause:

a. A decrease in intracellularfluid volume

b. An increase in extracellularfluid volume

c. An increase in plasmaosmolality

d. All of the above

• Antidiuretic hormoneincrease epithelial waterpermiability of:

a. Collecting ducts

b. Proximal tubules

c. Thick ascending limbs

d. All of the above



• ADH release from theposterior pituitary isstimulated by:

a. A fall in plasma osmolality

b. Severe hemorrhage

c. Stimulation of arterialbaroreceptors

d. Stretch of left arterialreceptor

• Which of the followingproduces a decrease inrenal sodium excretion?

a. Decrease plasmaaldosterone level

b. Increase plasma level of atrial natriuretic peptide

c. Increase GFR

d. Increase renal sympa-thetic nerve activity



• Which of the followingproduces an increase in renalsodium excretion?

a. Administration of glucocorticoids

b. Decrease peritbular capilaryhydrostatic pressure

c. Increase plasma estrgenlevels

d. Uncontroled diabetesmellitus

• Renin release is stimulatedby:

a. Increase blood pressure inafferent arterioles

b. Increase effective arterialblood volume

c. Increase NaCl transport bymacula densa cells

d. Stimulation of renalsympathetic nerves



• Which of the following arecommonly seen in patientswith severe congestive heart

failure?

a. Elevated plasma ADH levels

b. Generalized edema

c. Hyponatremia

d. Thirst

e. All of the above

• The most abundantintracellular cation is:

a. Calcium

b. Chloride

c. Potasium

d. Sodium



• Which of the followingpromotes a shift of potasium from cells to

extracellular fluid?

a. A fall in plasma pH

b. An overdose of digitalis

c. Inadequate blood flow

d. Lack of insulin

e. All of the above

• Which of the followingproduces excessive urinaryexcretion of potasium?

a. Acute renal failure

b. Inadequate aldosteronesecretion

c. Severe chronic renal failure(GFR=10 ml/min)

d. Uncontroled diabetesmellitus



• The following measurement were obtained in3.40 kg newborn infant:

Total body water 2600 ml

Extracellular water 1490 ml

Plasma water 155 ml

What are the volumes of (1) The intracellular water and

(2) the interstitial fluid-lymph water?

Keseimbangan vol & eletrolit cairan tubuh.ppt

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