bahan kuliah water electrolyte and balance.ppt

8/11/2019 bahan kuliah Water electrolyte and balance.ppt

1/32

1

1

Ketut Suwitra

Division of Nephrology

Department of Medicine Faculty

of Medicine

Udayana University-Sanglah Hospital Denpasar


2/32

2

2

Composition of body fluids

Water

The major constituent of human body,

( 55 60%) of body weight

Solute

Dissolved substance


3/32

3

3

Factors that affect body fluid include :1. Fat cells

- little water, thus body water decreases

with increasing body fat

2. Age

- body water decreases with increasing age

3. Gender

- male : 60% of bw

- female : 55% 0f bw


4/32

4

4

Changes in total body water with age

Age Kilogram Weight (%)

Premature infant 80

3 months 70

6 months 60

1-2 years 59

11-16 years 58

Adult 58-60

Obese adult 40-50

Emaciated adult 70-75

Mosby, Fluid, electrolyte and Acud Base Balance, 2001


5/32

5

5

Solute

Electrolyte

kations (+ charge), K, Na,anion ( - charge), Cl, HCO3, PO4

Nonelectrolyte

glucose - urea

creatinin - bilirubin

coagulant factors

antibodies


6/32

6

6

Fluidcompartment

Extracellular

( 20% of bw)

Intracellular

( 40% of bw)

Transcellular

(

3% of bw)

Intravascular

(serum, lymph fluid)

( 8% of bw)

Extravascular

(interstitial fluid)

(12% 0fbw)

(cerebrospinal, sy

novial,

pericardial, etc)


7/32

77Comparison of ICEF to ECE

Solids

Intracellular

fluid

Ekstracellular

fluid

Mosby, Fluid, electrolyte and Acid Base Balance, 2001


8/32

88

Primary constituent of body fluid compartments

CompartmentNa+

(mEq/L)

K+

(mEq/L)

Cl-

(mEq/L)

HCO3-

(mEq/L)

PO43-

(mEq/L)

Intravascular (plasma) 142 4.5 104 24 2.0

Interstitial 145 4.4 117 27 2.3

Intracellular (skeletal muscle cell) 12 150.0 4 12 40.0

Transcellular

Gastric juice 60 7.0 100 0 --

Pancreatic juice 130 7.0 60 100 --

Sweat 45 5.0 58 0 --

Mosby, Fluid, electrolyte and Acid Base Balance, 2001


9/32

99

200

150

100

50

0

Na+ Na+

Na+

K

+

K+

K+

Cl

-

Cl-

Cl-PO4 PO4

PO4

HCO3-HCO3

-

HCO3-

Others

fosfat

Caviler

CellMem

brane

Plasma Interstitial fluid

Extracell fluid Intracell fluid

Electrolyte composition in human body fluid

FKUI, Gangguan keseimbangan air-elektrolit dan asam basa, 2007


10/32

1010

TOTAL BODY WEIGHT (70 KG)

TOTAL BODY WATER (42 L)

INTRACELLULAR

FLUID (28 L)EXTRACELLULAR

FLUID (14 L)

IF = ECF - PF

BLOODCELL

PLASMA(3L)

BLOOD VOLUME 5L

Body water compartment and distributionsSunatrio, Resusitasi carian, 2000


11/32

1111

BLOOD = Intravscular fluid + blood cells

(rbc, wbc, platelet)

SERUM = Blood (blood cells)

PL SM = Serum (non electrolyte solutions)


12/32

1212

Functions of the blood

1. Delivery of nutrients (e.g. glucose, oxygen) to the

tissues

2. Transport of waste product to the kidney and lungs

3. Delivery of antibodies and WBC to the site of

infection

4. Transport of hormones to their site of action5. Circulation of body heat


13/32

1313

BODY FLUIDS MUST BE IN EQUILIBRIUM STATE

Equilibrium in volume, composition, acid-base

KIDNEY


14/32

1414

Causes of water

and electrolyte

disequilibrium

Loss

- diarrhea

Excessive- lot of intake

Misdistribution

- acidosis hyperkalemIa


15/32

1515

Body fluid pH is tightly controlled

because most of enzyme reaction are

sensitive to pH changes

Normal pH range is 7.38 7.42

Normal H+ concentration 0.38 0.42


16/32

1616

0 40 50 100 150

7.40 7.30 7.0 6.82

[H+]

(nM)

[pH]

AcidemiaAlkalemia

pH = - log [H+]

Acidemia and alkalemia are defined by plasma pH or

hydrogen ion concentrations.

Vishnu Moorthy., Pathophysiology of Kidney Disease and Hypertension 2009

Acid-base balance


17/32

1717

Acid-base balance regulate by :

Buffer system in mild imbalanced and short time

Respiratory system / lung

Urinary system / kidney strong and most

important regulator


18/32

1818

Lung, buffers, and kidney in acid-base balance

Equilibrium

PCO2= 40 2 HCO3-= 24 2

pH = 7.40

0.02

[H+] = 40

2 nM

Metabolic acidosis : HCO3-

Metabolic alkalosis : HCO3-Respiratory acidosis : PCO2

Respiratory alkalosis : PCO2

Acidemia : pH, [H+]

Alkalemia : pH, [H+]

Vishnu Moorthy., Pathophysiology of Kidney Disease and Hypertension 2009

buffer buffer


19/32

1919

Buffer systems in different body compartment

Buffer systems Blood ECF and CSF ICF

HCO3- / CO2

Haemoglobin

Plasma proteins

Phosphate

Organic phosphate

Proteins

Note: CSF, cerebrospinal fluid ; ECF, extracellular fluid ;

ICF, intracellu lar fluid

Thomas, Stanley, Datta., Real and Urinary System, 2007


20/32

2020

When there is a disturbance either

in carbon dioxide (CO2) levels, which are primarily

regulation by the lungs, or in bicarbonate (HCO3) levels,

which are primarily regulation by the kidneys,

there is a compensatory change in other component

Davenport, 1973


21/32

2121

50

40

30

20

10

0

7.0 7.2 7.4 7.6 7.8

N

CC

C C

D

DD

D

pCO29.3 kPa pCO25.3 kPa

pCO22.7 kPa

H

CO3-(mmol/L

)

N = normal D = disease C= compensation

pH

Respiratory acidosis metabolic acidosis

Respiratory alkalosis metabolic alkalosis

Thomas R. Renal and Urinary Systems, 2007DAVENPORT DIAGRAM


22/32

2222

Kidney is the most important organ

in maintaining the acid-base balance

Kidney handling

of acid-base

Bicarbonate

reabsorbtion

Acid excretion

Titratable acid

formation

Formation ofurine ammonium


23/32

2323

Renal regulation of plasma HCO3-

5.0

2.5

0.0

0 20 40 60

filteredfiltered

reabsorbed

Tm

Plasma HCO3- (mmol/L)

HCO3-

(mmol/min)

Thomas R. Renal and Urinary Systems, 2007


24/32

2424

Kidney regulation of acid-base

Vishnu Moorthy, Pathophysiology of Kidney Disease and Hypertension 2009


25/32

2525

Kidney bicarbonate

reabsorption

Vishnu Moorthy, Pathophysiology of Kidney

Disease and Hypertension 2009


26/32

2626

Kidney titratable

acidity formation




27/32

2727

Kidney ammonium

excretion




28/32

2828

CASE ILLUSTRATION

Metabolic Acidosis

Three major mechanism :1. Bicarbonate loss

Kidney : Renal Tubular Acidosis

Gastrointestinal : Severe diarrhea

2. Excess metabolic production of H+

Diabetic Ketoacidosis

Excessive ingestion of H+ (methanol)

3. Renal Disease (AKI/CKD)

failure to excrete H+ and regenerate HCO3-


29/32

2929

New Equilibrium

PCO2 HCO3-< 22

pH = 7.40

Respiratory compensation:

Hyperventilation : PCO2

Dysequilibrium

HCO3-< 22

pH < 7.38

[H+] > 42 nM

Primary condition:

Metabolic acidosis : HCO3-

Metabolic

acidosis

Respiratory

compensation

Metabolic acidosis is

characteristic by a

decrease in serum

bicarbonate (HCO3-) levels

Vishnu Moorthy, Pathophysiology of KidneyDisease and Hypertension 2009


30/32

3030

Summary

Maintenance body fluid pH (acid-base) is an importantcondition for make an optimal enzymatic cell reaction

The kidney act together with buffer system and the

lungs to minimize any changes in plasma pH

Role of the kidney in acid-base regulation :

To reabsorb filtrated bicarbonate

To regenerate bicarbonate by excretion of

ammonium and titratable acids


31/32

3131

TRI HITA KARANA

Balance between

-God

-People

-Environment


32/32

3232

bahan kuliah water electrolyte and balance.ppt

Documents