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Page 1: Balance{ Water}
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WATER BALANCEWATER BALANCE

NORMAL WATER CONTENT OF NORMAL WATER CONTENT OF BODYBODY

75% AT BIRTH75% AT BIRTH 55-60% YOUNG ADULTS55-60% YOUNG ADULTS

MEN SLIGHTLY HIGHER THAN WOMENMEN SLIGHTLY HIGHER THAN WOMEN (MORE FAT, LESS WATER)(MORE FAT, LESS WATER)

45% IN ELDERLY, OBESE45% IN ELDERLY, OBESE

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WATER BALANCEWATER BALANCE

TOTAL BODY WATERTOTAL BODY WATER ~40 LITERS~40 LITERS SEVERAL FLUID COMPARTMENTSSEVERAL FLUID COMPARTMENTS

65% INTRACELLULAR FLUID (ICF)65% INTRACELLULAR FLUID (ICF) 35% EXTRACELLULAR FLUID (ECF)35% EXTRACELLULAR FLUID (ECF)

25% INTERSTITIAL FLUID (TISSUE FLUID)25% INTERSTITIAL FLUID (TISSUE FLUID) 8% BLOOD PLASMA AND LYMPH8% BLOOD PLASMA AND LYMPH 2% TRANSCELLULAR FLUID2% TRANSCELLULAR FLUID

SYNOVIAL, PLEURAL, PERICARDIAL, ETC.SYNOVIAL, PLEURAL, PERICARDIAL, ETC.

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WATER BALANCEWATER BALANCE

TOTAL BODY WATERTOTAL BODY WATER ENTERS BODYENTERS BODY

OSMOSIS FROM DIGESTIVE TRACTOSMOSIS FROM DIGESTIVE TRACT ALSO PRODUCED BY AEROBIC RESPIRATIONALSO PRODUCED BY AEROBIC RESPIRATION ALSO PRODUCED BY CONDENSATION ALSO PRODUCED BY CONDENSATION

REACTIONSREACTIONS

EXITS BODYEXITS BODY URINARY, DIGESTIVE, RESPIRATORY, & URINARY, DIGESTIVE, RESPIRATORY, &

INTEGUMENTARY SYSTEMSINTEGUMENTARY SYSTEMS

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WATER BALANCEWATER BALANCE

TOTAL BODY WATERTOTAL BODY WATER FLUID EXCHANGED BETWEEN FLUID EXCHANGED BETWEEN

COMPARTMENTSCOMPARTMENTS CAPILLARY WALLS, PLASMA MEMBRANES CAPILLARY WALLS, PLASMA MEMBRANES DRIVEN BY TRANSIENT OSMOTIC GRADIENTSDRIVEN BY TRANSIENT OSMOTIC GRADIENTS OSMOTIC GRADIENTS DEPENDENT ON SOLUTE OSMOTIC GRADIENTS DEPENDENT ON SOLUTE

MOLECULESMOLECULES MOST ABUNDANT SOLUTES ARE ELECTROLYTESMOST ABUNDANT SOLUTES ARE ELECTROLYTES WATER BALANCE AND ELECTROLYTE BALANCE WATER BALANCE AND ELECTROLYTE BALANCE

ARE CLOSELY RELATEDARE CLOSELY RELATED

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WATER BALANCEWATER BALANCE

WATER BALANCEWATER BALANCE FLUID GAIN = FLUID LOSSFLUID GAIN = FLUID LOSS BOTH TYPICALLY ~2500 ML / DAYBOTH TYPICALLY ~2500 ML / DAY

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WATER BALANCEWATER BALANCE

WATER GAINWATER GAIN TYPICALLY ~2500 ML / DAYTYPICALLY ~2500 ML / DAY 1600 ML FROM DRINK1600 ML FROM DRINK 700 ML FROM FOOD700 ML FROM FOOD 200 ML FROM METABOLISM200 ML FROM METABOLISM

AEROBIC RESPIRATIONAEROBIC RESPIRATION CONDENSATION REACTIONSCONDENSATION REACTIONS

A.K.A. DEHYDRATION REACTIONSA.K.A. DEHYDRATION REACTIONS

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WATER BALANCEWATER BALANCE

WATER LOSSWATER LOSS TYPICALLY ~2500 ML / DAYTYPICALLY ~2500 ML / DAY 1500 ML EXCRETED AS URINE1500 ML EXCRETED AS URINE 200 ML ELIMINATED IN FECES200 ML ELIMINATED IN FECES 300 ML EXPIRED IN BREATH300 ML EXPIRED IN BREATH 100 ML SECRETED AS SWEAT100 ML SECRETED AS SWEAT 400 ML LOST AS CUTANEOUS 400 ML LOST AS CUTANEOUS

TRANSPIRATIONTRANSPIRATION DIFFUSES THROUGH EPIDERMIS, EVAPORATESDIFFUSES THROUGH EPIDERMIS, EVAPORATES

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WATER BALANCEWATER BALANCE

WATER LOSSWATER LOSS CAN VARY GREATLYCAN VARY GREATLY

INCREASED RESPIRATORY LOSS IN COLD INCREASED RESPIRATORY LOSS IN COLD WEATHERWEATHER

INCREASED SWEAT LOSS IN WARM INCREASED SWEAT LOSS IN WARM WEATHERWEATHER

INCREASED RESPIRATORY AND SWEAT INCREASED RESPIRATORY AND SWEAT LOSS, DECREASED URINE OUTPUT LOSS, DECREASED URINE OUTPUT DURING PHYSICAL EXERTIONDURING PHYSICAL EXERTION

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WATER BALANCEWATER BALANCE

WATER LOSSWATER LOSS OBLIGATORY WATER LOSSOBLIGATORY WATER LOSS

RELATIVELY UNAVOIDABLERELATIVELY UNAVOIDABLE EXPIRED AIR, CUTANEOUS EXPIRED AIR, CUTANEOUS

TRANSPIRATION, SWEAT, FECAL TRANSPIRATION, SWEAT, FECAL MOISTURE, MINIMUM URINE OUTPUT MOISTURE, MINIMUM URINE OUTPUT (~400 ML/DAY)(~400 ML/DAY)

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WATER BALANCEWATER BALANCE

REGULATION OF WATER INTAKEREGULATION OF WATER INTAKE GOVERNED BY THIRSTGOVERNED BY THIRST

PROVOKED BY INCREASED PLASMA OSMOLARITYPROVOKED BY INCREASED PLASMA OSMOLARITY PROVOKED BY BLOOD LOSSPROVOKED BY BLOOD LOSS

THIRST CENTER IN HYPOTHALAMUSTHIRST CENTER IN HYPOTHALAMUS RESPONDS TO SIGNS OF DEHYDRATIONRESPONDS TO SIGNS OF DEHYDRATION

ANGIOTENSIN IIANGIOTENSIN II ANTIDIURETIC HORMONE (ADH)ANTIDIURETIC HORMONE (ADH) SIGNALS FROM OSMOCENTERSSIGNALS FROM OSMOCENTERS

INHIBITS SALIVATIONINHIBITS SALIVATION

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WATER BALANCEWATER BALANCE

REGULATION OF WATER INTAKEREGULATION OF WATER INTAKE INHIBITED SALIVATIONINHIBITED SALIVATION

DRY MOUTHDRY MOUTH SENSE OF THIRSTSENSE OF THIRST INGESTION OF WATERINGESTION OF WATER

COOLS AND MOISTENS MOUTHCOOLS AND MOISTENS MOUTH DISTENDS STOMACH AND INTESTINESDISTENDS STOMACH AND INTESTINES REHYDRATES BLOODREHYDRATES BLOOD

THIRST INHIBITEDTHIRST INHIBITED

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WATER BALANCEWATER BALANCE

REGULATION OF WATER OUTPUTREGULATION OF WATER OUTPUT CONTROLLED VIA ALTERATIONS IN URINE CONTROLLED VIA ALTERATIONS IN URINE

VOLUMEVOLUME URINE VOLUME AFFECTED BYURINE VOLUME AFFECTED BY

SODIUM REABSORPTIONSODIUM REABSORPTION WATER FOLLOWS SODIUM REABSORPTIONWATER FOLLOWS SODIUM REABSORPTION MORE LATERMORE LATER

ANTIDIURETIC HORMONE (ADH)ANTIDIURETIC HORMONE (ADH) BLOOD VOLUME BLOOD VOLUME , [Na+] , [Na+] , OSMORECEPTORS , OSMORECEPTORS

STIMULATED, PITUITARY RELEASES ADHSTIMULATED, PITUITARY RELEASES ADH AQUAPORINS PRODUCED IN KIDNEY’S COLLECTING AQUAPORINS PRODUCED IN KIDNEY’S COLLECTING

DUCTSDUCTS FACILITATE REABSORPTIONFACILITATE REABSORPTION ALSO WORKS IN REVERSEALSO WORKS IN REVERSE

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WATER BALANCEWATER BALANCE

WATER BALANCE DISORDERS WATER BALANCE DISORDERS FLUID DEFICIENCYFLUID DEFICIENCY

VOLUME DEPLETION (HYOVOLEMIA)VOLUME DEPLETION (HYOVOLEMIA) DEHYDRATIONDEHYDRATION

FLUID EXCESSFLUID EXCESS VOLUME EXCESSVOLUME EXCESS HYPOTONIC HYDRATIONHYPOTONIC HYDRATION

FLUID SEQUESTRATIONFLUID SEQUESTRATION

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WATER BALANCEWATER BALANCE

WATER BALANCE DISORDERS WATER BALANCE DISORDERS FLUID DEFICIENCY: HYPOVOLEMIAFLUID DEFICIENCY: HYPOVOLEMIA CAUSED BY PROPORTIONATE LOSS OF CAUSED BY PROPORTIONATE LOSS OF

WATER AND SODIUM WITHOUT WATER AND SODIUM WITHOUT REPLACEMENTREPLACEMENT

TOTAL BODY WATER DECREASEDTOTAL BODY WATER DECREASED OSMOLARITY UNCHANGEDOSMOLARITY UNCHANGED CAUSESCAUSES

HEMORRHAGEHEMORRHAGE SEVERE BURNSSEVERE BURNS CHRONIC VOMITING OR DIARRHEACHRONIC VOMITING OR DIARRHEA

MAJOR CAUSE OF INFANT MORTALITYMAJOR CAUSE OF INFANT MORTALITY

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WATER BALANCEWATER BALANCE

WATER BALANCE DISORDERS WATER BALANCE DISORDERS FLUID DEFICIENCY: DEHYDRATIONFLUID DEFICIENCY: DEHYDRATION CAUSED BY LOSS OF MORE WATER THAN CAUSED BY LOSS OF MORE WATER THAN

NaNa++

TOTAL BODY WATER DECREASEDTOTAL BODY WATER DECREASED ECF OSMOLARITY INCREASESECF OSMOLARITY INCREASES CAUSESCAUSES

LACK OF DRINKING WATERLACK OF DRINKING WATER DIABETES MELLITUSDIABETES MELLITUS ADH HYPOSECRETIONADH HYPOSECRETION PROFUSE SWEATINGPROFUSE SWEATING OVERUSE OF DIURETICSOVERUSE OF DIURETICS

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WATER BALANCEWATER BALANCE

WATER BALANCE DISORDERS WATER BALANCE DISORDERS

FLUID DEFICIENCY: DEHYDRATIONFLUID DEFICIENCY: DEHYDRATION AFFECTS ALL FLUID COMPARTMENTS AFFECTS ALL FLUID COMPARTMENTS INFANTS MORE VULNERABLE THAN ADULTSINFANTS MORE VULNERABLE THAN ADULTS

HIGHER METABOLISM HIGHER METABOLISM MORE WASTES MORE WASTES MORE WASTES MORE WASTES MORE URINE VOLUME MORE URINE VOLUME

IMMATURE KIDNEYSIMMATURE KIDNEYS URINE LESS CONCENTRATEDURINE LESS CONCENTRATED

GREATER SURFACE AREA-TO-VOLUME RATIOGREATER SURFACE AREA-TO-VOLUME RATIO GREATER WATER LOSS BY EVAPORATIONGREATER WATER LOSS BY EVAPORATION

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WATER BALANCEWATER BALANCE

WATER BALANCE DISORDERS WATER BALANCE DISORDERS

EFFECTS OF FLUID DEFICIENCYEFFECTS OF FLUID DEFICIENCY CIRCULATORY SHOCK CIRCULATORY SHOCK

DUE TO LOSS OF BLOOD VOLUMEDUE TO LOSS OF BLOOD VOLUME NEUROLOGICAL DYSFUNCTION NEUROLOGICAL DYSFUNCTION

DUE TO DEHYDRATION OF BRAIN CELLSDUE TO DEHYDRATION OF BRAIN CELLS

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WATER BALANCEWATER BALANCE

WATER BALANCE DISORDERS WATER BALANCE DISORDERS

FLUID EXCESSFLUID EXCESS LESS COMMON THAN FLUID LESS COMMON THAN FLUID

DEFICIENCY DEFICIENCY KIDNEYS ARE TYPICALLY ABLE TO KIDNEYS ARE TYPICALLY ABLE TO

EXCRETE MORE URINEEXCRETE MORE URINE

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WATER BALANCEWATER BALANCE

WATER BALANCE DISORDERS WATER BALANCE DISORDERS

FLUID EXCESS: VOLUME EXCESSFLUID EXCESS: VOLUME EXCESS CAUSED BY PROPORTIONATE RETENTION CAUSED BY PROPORTIONATE RETENTION

OF EXCESS WATER AND SODIUMOF EXCESS WATER AND SODIUM TOTAL BODY WATER INCREASEDTOTAL BODY WATER INCREASED OSMOLARITY UNCHANGEDOSMOLARITY UNCHANGED CAUSESCAUSES

ALDOSTERONE HYPERSECRETIONALDOSTERONE HYPERSECRETION RENAL FAILURERENAL FAILURE

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WATER BALANCEWATER BALANCE

WATER BALANCE DISORDERS WATER BALANCE DISORDERS FLUID EXCESS: HYPOTONIC HYDRATIONFLUID EXCESS: HYPOTONIC HYDRATION ““WATER INTOXICATION”, “POS HWATER INTOXICATION”, “POS H220 BALANCE”0 BALANCE” CAUSED BY RETENTION OF MORE WATER CAUSED BY RETENTION OF MORE WATER

THAN SODIUMTHAN SODIUM TOTAL BODY WATER INCREASED TOTAL BODY WATER INCREASED ECF OSMOLARITY DECREASESECF OSMOLARITY DECREASES CAUSESCAUSES

REPLACEMENT OF WATER AND SALT WITH WATERREPLACEMENT OF WATER AND SALT WITH WATER LACK OF PROPORTIONATE INTAKE OF ELECTROLYTESLACK OF PROPORTIONATE INTAKE OF ELECTROLYTES

ADH HYERSECRETIONADH HYERSECRETION

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WATER BALANCEWATER BALANCE

WATER BALANCE DISORDERS WATER BALANCE DISORDERS

EFFECTS OF FLUID EXCESSEFFECTS OF FLUID EXCESS PULMONARY EDEMA PULMONARY EDEMA CEREBRAL EDEMA CEREBRAL EDEMA

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WATER BALANCEWATER BALANCE

WATER BALANCE DISORDERS WATER BALANCE DISORDERS FLUID SEQUESTRATIONFLUID SEQUESTRATION EXCESS FLUID ACCUMULATES IN A EXCESS FLUID ACCUMULATES IN A

PARTICULAR LOCATIONPARTICULAR LOCATION TOTAL BODY WATER MAY BE NORMALTOTAL BODY WATER MAY BE NORMAL CIRCULATING VOLUME MAY DROPCIRCULATING VOLUME MAY DROP EXAMPLESEXAMPLES

EDEMA (IN INTERSTITIAL SPACES)EDEMA (IN INTERSTITIAL SPACES) HEMORRHAGE (LOST TO CIRCULATION)HEMORRHAGE (LOST TO CIRCULATION) PLEURAL EFFUSION (IN PLEURAL CAVITY)PLEURAL EFFUSION (IN PLEURAL CAVITY)

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ELECTROLYTE BALANCEELECTROLYTE BALANCE

IMPORTANCE OF ELECTROLYTESIMPORTANCE OF ELECTROLYTES SALTSSALTS

E.G. NaCl, CaE.G. NaCl, Ca33(PO(PO44))22, ETC., ETC. INCLUDE IONS IN DEFINITIONINCLUDE IONS IN DEFINITION

MANY ROLESMANY ROLES INVOLVED IN METABOLISMINVOLVED IN METABOLISM DETERMINE ELECTRICAL MEMBRANE DETERMINE ELECTRICAL MEMBRANE

POTENTIALSPOTENTIALS AFFECT OSMOLARITY OF BODY FLUIDSAFFECT OSMOLARITY OF BODY FLUIDS AFFECT WATER CONTENT AND DISTRIBUTIONAFFECT WATER CONTENT AND DISTRIBUTION ETC.ETC.

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ELECTROLYTE BALANCEELECTROLYTE BALANCE

SODIUMSODIUM PRINCIPAL EXTRACELLULAR CATIONPRINCIPAL EXTRACELLULAR CATION

90 – 95% OF OSMOLARITY FROM SODIUM SALTS90 – 95% OF OSMOLARITY FROM SODIUM SALTS ROLESROLES

DEPOLARIZATIONDEPOLARIZATION MUSCLES, NERVESMUSCLES, NERVES

AFFECT TOTAL BODY WATERAFFECT TOTAL BODY WATER AFFECT WATER DISTRIBUTIONAFFECT WATER DISTRIBUTION COTRANSPORTCOTRANSPORT

GLUCOSE, AMINO ACIDS, CALCIUM, ETC.GLUCOSE, AMINO ACIDS, CALCIUM, ETC. ETC.ETC.

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ELECTROLYTE BALANCEELECTROLYTE BALANCE

SODIUM HOMEOSTASISSODIUM HOMEOSTASIS 0.5 G / DAY DIETARY REQUIREMENT0.5 G / DAY DIETARY REQUIREMENT RECEIVE 3 – 7 G / DAY FROM OUR DIETRECEIVE 3 – 7 G / DAY FROM OUR DIET KIDNEYS EXCRETE EXCESS (~5 G / DAY)KIDNEYS EXCRETE EXCESS (~5 G / DAY) EXCRETION REGULATED BY 3 EXCRETION REGULATED BY 3

HORMONESHORMONES ALDOSTERONEALDOSTERONE ANTIDIURETIC HORMONE (ADH)ANTIDIURETIC HORMONE (ADH) ATRIAL NATRIURETIC FACTOR (ANF)ATRIAL NATRIURETIC FACTOR (ANF)

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ELECTROLYTE BALANCEELECTROLYTE BALANCE

SODIUM HOMEOSTASISSODIUM HOMEOSTASIS REGULATION BY ALDOSTERONEREGULATION BY ALDOSTERONE ““SALT-RETAINING HORMONE”SALT-RETAINING HORMONE” STEROID HORMONESTEROID HORMONE ALDOSTERONE SECRETION ALDOSTERONE SECRETION

STIMULATED BY:STIMULATED BY: HYPONATREMIAHYPONATREMIA HYPERKALEMIAHYPERKALEMIA HYPOTENSIONHYPOTENSION

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ELECTROLYTE BALANCEELECTROLYTE BALANCE

SODIUM HOMEOSTASISSODIUM HOMEOSTASIS REGULATION BY ALDOSTERONEREGULATION BY ALDOSTERONE TARGET CELLSTARGET CELLS

DISTAL CONVOLUTED TUBULEDISTAL CONVOLUTED TUBULE COLLECTING DUCTCOLLECTING DUCT

TRANSCRIBE GENE FOR NaTRANSCRIBE GENE FOR Na++-K-K++ PUMP PUMP SODIUM REABSORPTION INCREASESSODIUM REABSORPTION INCREASES HH++ AND K AND K ++ SECRETION INCREASES SECRETION INCREASES URINE pH DROPSURINE pH DROPS

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ELECTROLYTE BALANCEELECTROLYTE BALANCE

SODIUM HOMEOSTASISSODIUM HOMEOSTASIS REGULATION BY ALDOSTERONEREGULATION BY ALDOSTERONE AVERAGE NaAVERAGE Na++ EXCRETION 5 G / DAY EXCRETION 5 G / DAY ALDOSTERONE REDUCES TO ~0ALDOSTERONE REDUCES TO ~0 WATER REABSRBED WATER REABSRBED

PROPORTIONALLYPROPORTIONALLY SODIUM CONCENTRATION IN BODY SODIUM CONCENTRATION IN BODY

UNCHANGEDUNCHANGED

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ELECTROLYTE BALANCEELECTROLYTE BALANCE

SODIUM HOMEOSTASISSODIUM HOMEOSTASIS REGULATION BY ALDOSTERONEREGULATION BY ALDOSTERONE INHIBITED BY HYPERTENSIONINHIBITED BY HYPERTENSION KIDNEYS THEN REABSORB LITTLE KIDNEYS THEN REABSORB LITTLE

NaNa++

EXCRETION INCREASED TO ~30 G / EXCRETION INCREASED TO ~30 G / DAYDAY

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ELECTROLYTE BALANCEELECTROLYTE BALANCE

SODIUM HOMEOSTASISSODIUM HOMEOSTASIS REGULATION BY ADHREGULATION BY ADH INDEPENDENTLY MODIFIES SODIUM AND INDEPENDENTLY MODIFIES SODIUM AND

WATER EXCRETIONWATER EXCRETION CAN CHANGE SODIUM CONCENTRATIONCAN CHANGE SODIUM CONCENTRATION

HIGH BLOOD [NaHIGH BLOOD [Na++] ] ADH SECRETION ADH SECRETION INCREASES WATER REABSORPTIONINCREASES WATER REABSORPTION

SODIUM CONCENTRATION DECREASEDSODIUM CONCENTRATION DECREASED ADH ALSO STIMULATES THIRSTADH ALSO STIMULATES THIRST

ALSO HAPPENS IN REVERSEALSO HAPPENS IN REVERSE

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ELECTROLYTE BALANCEELECTROLYTE BALANCE

SODIUM HOMEOSTASISSODIUM HOMEOSTASIS REGULATION BY ANFREGULATION BY ANF HYPERTENSION HYPERTENSION ANF SECRETION ANF SECRETION

INHIBITS ADH AND RENIN SECRETIONINHIBITS ADH AND RENIN SECRETION INHIBITS SODIUM & WATER INHIBITS SODIUM & WATER

REABSORPTIONREABSORPTION MORE SODIUM AND WATER EXCRETEDMORE SODIUM AND WATER EXCRETED BLOOD PRESSURE DECREASEDBLOOD PRESSURE DECREASED

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ELECTROLYTE BALANCEELECTROLYTE BALANCE

SODIUM HOMEOSTASISSODIUM HOMEOSTASIS REGULATION BY OTHER HORMONESREGULATION BY OTHER HORMONES ESTROGENS MIMIC ALDOSTERONEESTROGENS MIMIC ALDOSTERONE

WATER RETENTION DURING PREGNANCYWATER RETENTION DURING PREGNANCY MENSTRUAL WATER RETENTIONMENSTRUAL WATER RETENTION

PROGESTERONEPROGESTERONE REDUCES SODIUM REABSORPTIONREDUCES SODIUM REABSORPTION DIURETIC AEFFECTDIURETIC AEFFECT

GLUCOCORTICOIDSGLUCOCORTICOIDS PROMOTE SODIUM REABSORPTION, EDEMAPROMOTE SODIUM REABSORPTION, EDEMA

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ELECTROLYTE BALANCEELECTROLYTE BALANCE

SODIUM HOMEOSTASIS: IMBALANCESSODIUM HOMEOSTASIS: IMBALANCES RELATIVELY RARERELATIVELY RARE HYPERNATREMIAHYPERNATREMIA

CAN RESULT FROM IV SALINECAN RESULT FROM IV SALINE CAUSES WATER RETENTION, HYPERTENSION, CAUSES WATER RETENTION, HYPERTENSION,

EDEMAEDEMA HYPONATREMIAHYPONATREMIA

GENERALLY FROM WATER EXCESSGENERALLY FROM WATER EXCESS HYPOTONIC HYDRATIONHYPOTONIC HYDRATION CORRECTED BY EXCRETION OF EXCESS WATERCORRECTED BY EXCRETION OF EXCESS WATER

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ELECTROLYTE BALANCEELECTROLYTE BALANCE

POTASSIUMPOTASSIUM PRINCIPAL INTRACELLULAR CATIONPRINCIPAL INTRACELLULAR CATION AFFECTS INTRACELLULAR OSMOLARITYAFFECTS INTRACELLULAR OSMOLARITY AFFECTS CELL VOLUMEAFFECTS CELL VOLUME ROLESROLES

PRODUCES RESTING & ACTION POTENTIALSPRODUCES RESTING & ACTION POTENTIALS COTRANSPORTCOTRANSPORT THERMOGENESISTHERMOGENESIS COFACTOR FOR PROTEIN SYNTHESISCOFACTOR FOR PROTEIN SYNTHESIS

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ELECTROLYTE BALANCEELECTROLYTE BALANCE

POTASSIUM HOMEOSTASISPOTASSIUM HOMEOSTASIS HOMEOSTASIS LINKED TO THAT OF NaHOMEOSTASIS LINKED TO THAT OF Na++

KK++ AND Na AND Na++ COREGULATED BY ALDOSTERONE COREGULATED BY ALDOSTERONE 90% OF K90% OF K++ REABSORBED IN PCT REABSORBED IN PCT

REMAINDER EXCRETED IN URINEREMAINDER EXCRETED IN URINE CONTROL IMPARTED IN DCT & CONTROL IMPARTED IN DCT &

COLLECTING DUCT (CD)COLLECTING DUCT (CD) HIGH [KHIGH [K++] ] SECRETE MORE INTO FILTRATE SECRETE MORE INTO FILTRATE LOW [KLOW [K++] ] SECRETE LESS INTO FILTRATE SECRETE LESS INTO FILTRATE EXCHANGED FOR NaEXCHANGED FOR Na++

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ELECTROLYTE BALANCEELECTROLYTE BALANCE

POTASSIUM HOMEOSTASISPOTASSIUM HOMEOSTASIS REGULATION BY ALDOSTERONEREGULATION BY ALDOSTERONE HIGH [KHIGH [K++] ] ALDOSTERONE ALDOSTERONE

PRODUCTIONPRODUCTION NaNa++-K-K++ PUMP PRODUCED PUMP PRODUCED NaNa++ AND K AND K++ COREGULATED COREGULATED INCREASE KINCREASE K++ SECRETION SECRETION DECREASE NaDECREASE Na++ SECRETION SECRETION

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ELECTROLYTE BALANCEELECTROLYTE BALANCE

POTASSIUM HOMEOSTASIS: IMBALANCESPOTASSIUM HOMEOSTASIS: IMBALANCES MOST DANGEROUS ELECTROLYTE IMBALANCESMOST DANGEROUS ELECTROLYTE IMBALANCES HYPERKALEMIAHYPERKALEMIA

EFFECTS DEPEND ON SPEED OF CONC RISEEFFECTS DEPEND ON SPEED OF CONC RISE QUICK RISE QUICK RISE NERVE/MUSCLE CELLS VERY EXCITABLE NERVE/MUSCLE CELLS VERY EXCITABLE CARDIAC ARRESTCARDIAC ARREST

E.G., K+ RELEASED FROM INJURED CELLSE.G., K+ RELEASED FROM INJURED CELLS E.G., TRANSFUSION WITH OLD BLOODE.G., TRANSFUSION WITH OLD BLOOD E.G., EUTHANASIA, CAPITAL PUNISHMENT LETHAL INJECTIONE.G., EUTHANASIA, CAPITAL PUNISHMENT LETHAL INJECTION

K+ HAS LEAKED FROM ERYTHROCYTESK+ HAS LEAKED FROM ERYTHROCYTES SLOW RISE SLOW RISE NERVE/MUSCLE CELLS LESS EXCITABLE NERVE/MUSCLE CELLS LESS EXCITABLE (Na+ CHANNELS INACTIVATED)(Na+ CHANNELS INACTIVATED)

E.G., ALDOSTERONE HYPOSECRETION, RENAL FAILURE, E.G., ALDOSTERONE HYPOSECRETION, RENAL FAILURE, ACIDOSISACIDOSIS

E.G., SUPPLEMENTAL K+ TO RELIEVE MUSCLE CRAMPSE.G., SUPPLEMENTAL K+ TO RELIEVE MUSCLE CRAMPS

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ELECTROLYTE BALANCEELECTROLYTE BALANCE

POTASSIUM HOMEOSTASIS: IMBALANCESPOTASSIUM HOMEOSTASIS: IMBALANCES HYPOKALEMIAHYPOKALEMIA

NERVE/MUSCLE CELLS LESS EXCITABLENERVE/MUSCLE CELLS LESS EXCITABLE MUSCLE WEAKNESS, LOSS OF MUSCLE TONE, MUSCLE WEAKNESS, LOSS OF MUSCLE TONE,

DEPRESSED REFLEXES, IRREGULAR HEART DEPRESSED REFLEXES, IRREGULAR HEART ACTIVITYACTIVITY

E.G., HEAVY SWEATING, CHRONIC VOMITING OR E.G., HEAVY SWEATING, CHRONIC VOMITING OR DIARRHEA, EXCESSIVE LAXATIVES, DIARRHEA, EXCESSIVE LAXATIVES, ALDOSTERONE HYPERSECRETION, ALKALOSISALDOSTERONE HYPERSECRETION, ALKALOSIS

E.G., DEPRESSED APPETITE, BUT RARELY FROM E.G., DEPRESSED APPETITE, BUT RARELY FROM DIETARY INSUFFICIENCYDIETARY INSUFFICIENCY

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ELECTROLYTE BALANCEELECTROLYTE BALANCE

CHLORIDECHLORIDE MOST ABUNDANT ANION IN ECFMOST ABUNDANT ANION IN ECF

MAJOR CONTRIBUTION TO OSMOLARITYMAJOR CONTRIBUTION TO OSMOLARITY ROLESROLES

FORMATION OF HClFORMATION OF HCl CHLORIDE SHIFTCHLORIDE SHIFT

COCO22 LOADING/UNLOADING LOADING/UNLOADING

REGULATION OF BODY pHREGULATION OF BODY pH

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ELECTROLYTE BALANCEELECTROLYTE BALANCE

CHLORIDE HOMEOSTASISCHLORIDE HOMEOSTASIS ClCl-- STRONGLY ATTRACTED TO SOME STRONGLY ATTRACTED TO SOME

CATIONS (E.G., NaCATIONS (E.G., Na++, K, K++, Ca, Ca2+2+)) CANNOT KEEP THEM APARTCANNOT KEEP THEM APART

HOMEOSTASIS ACHIEVED AS AN HOMEOSTASIS ACHIEVED AS AN EFFECT OF NaEFFECT OF Na++ HOMEOSTASIS HOMEOSTASIS ClCl-- PASSIVELY FOLLOWS Na PASSIVELY FOLLOWS Na++

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ELECTROLYTE BALANCEELECTROLYTE BALANCE

CHLORIDE IMBALANCESCHLORIDE IMBALANCES HYPERCHLOREMIAHYPERCHLOREMIA

RESULTS FROM DIETARY EXCESSRESULTS FROM DIETARY EXCESS RESULTS FROM INTERVENOUS SALINE RESULTS FROM INTERVENOUS SALINE

ADMINISTRATIONADMINISTRATION HYPOCHLOREMIAHYPOCHLOREMIA

SIDE EFFECT OF HYPONATREMIASIDE EFFECT OF HYPONATREMIA SIDE EFFECT OF HYPOKALEMIASIDE EFFECT OF HYPOKALEMIA

KIDNEYS RETAIN K+ BY SECRETING Na+, Cl- KIDNEYS RETAIN K+ BY SECRETING Na+, Cl- FOLLOWSFOLLOWS

EFFECTSEFFECTS ALTERED ACID-BASE BALANCEALTERED ACID-BASE BALANCE

Page 50: Balance{ Water}

ELECTROLYTE BALANCEELECTROLYTE BALANCE

CALCIUMCALCIUM ROLESROLES

STRENGTHENS BONESTRENGTHENS BONE MUSCLE CONTRACTIONMUSCLE CONTRACTION SECOND MESSENGER FOR HORMONESSECOND MESSENGER FOR HORMONES ACTIVATES EXOCYTOSISACTIVATES EXOCYTOSIS BLOOD CLOTTINGBLOOD CLOTTING

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ELECTROLYTE BALANCEELECTROLYTE BALANCE

CALCIUMCALCIUM BINDS TO PHOSPHATE IONBINDS TO PHOSPHATE ION

CAN FORM CaCAN FORM Ca33(PO(PO44))22

HIGH CONCENTRATIONS OF BOTH IONS HIGH CONCENTRATIONS OF BOTH IONS WILL FORM PRECIPITATE CRYSTALSWILL FORM PRECIPITATE CRYSTALS

INTRACELLULAR [CaINTRACELLULAR [Ca2+2+] MUST BE KEPT ] MUST BE KEPT LOWLOW

CaCa2+2+ PUMPED OUT & INTO E.R. PUMPED OUT & INTO E.R.

Page 52: Balance{ Water}

ELECTROLYTE BALANCEELECTROLYTE BALANCE

CALCIUM HOMEOSTASISCALCIUM HOMEOSTASIS REGULATED BY PTH & CALCITROLREGULATED BY PTH & CALCITROL

ALSO BY CALCITONIN IN CHILDRENALSO BY CALCITONIN IN CHILDREN BLOOD [CaBLOOD [Ca2+2+] REGULATED VIA] REGULATED VIA

BONE DEPOSITION & REABSORPTIONBONE DEPOSITION & REABSORPTION INTESTINAL ABSORPTIONINTESTINAL ABSORPTION URINARY EXCRETIONURINARY EXCRETION

Page 53: Balance{ Water}

ELECTROLYTE BALANCEELECTROLYTE BALANCE

CALCIUM IMBALANCESCALCIUM IMBALANCES HYPERCALCEMIAHYPERCALCEMIA

REDUCES EMBRANE PERMEABILITY TO Na+ REDUCES EMBRANE PERMEABILITY TO Na+ INHIBITS DEPOLARIZATION OF INHIBITS DEPOLARIZATION OF

NERVES/MUSCLESNERVES/MUSCLES MUSCULAR WEAKNESS, CARDIAC MUSCULAR WEAKNESS, CARDIAC

ARRHYTHMI, ETC.ARRHYTHMI, ETC. RESULTS FROMRESULTS FROM

ALKALOSISALKALOSIS HYPERPARATHYROIDISMHYPERPARATHYROIDISM HYPOTHYROIDISMHYPOTHYROIDISM

Page 54: Balance{ Water}

ELECTROLYTE BALANCEELECTROLYTE BALANCE

CALCIUM IMBALANCESCALCIUM IMBALANCES HYPOCALCEMIAHYPOCALCEMIA

INCREASES EMBRANE PERMEABILITY TO Na+INCREASES EMBRANE PERMEABILITY TO Na+ NERVES/MUSCLES OVERLY EXCITABLENERVES/MUSCLES OVERLY EXCITABLE TETANUS IF CONCENTRATION DROPS TO TETANUS IF CONCENTRATION DROPS TO

LOWLOW RESULTS FROMRESULTS FROM

ACIDOSISACIDOSIS VITAMIN D DEFICIECYVITAMIN D DEFICIECY DIARRHEADIARRHEA PREGNANCY OR LACTATIONPREGNANCY OR LACTATION HYPOPARATHYROIDISMHYPOPARATHYROIDISM HYPERTHYROIDISMHYPERTHYROIDISM

Page 55: Balance{ Water}

ELECTROLYTE BALANCEELECTROLYTE BALANCE

PHOSPHATESPHOSPHATES RELATIVELY CONCENTRATED IN ICFRELATIVELY CONCENTRATED IN ICF ROLESROLES

COMPONENTS OF BONESCOMPONENTS OF BONES COMPONENTS OF DNA & RNACOMPONENTS OF DNA & RNA COMPONENTS OF PHOSPHOLIPIDSCOMPONENTS OF PHOSPHOLIPIDS ACTIVATE / DEACTIVATE ENZYMESACTIVATE / DEACTIVATE ENZYMES BUFFER pH OF BODY FLUIDSBUFFER pH OF BODY FLUIDS

Page 56: Balance{ Water}

ELECTROLYTE BALANCEELECTROLYTE BALANCE

PHOSPHATESPHOSPHATES COMPONENTS OFCOMPONENTS OF

NUCLEIC ACIDS (DNA, RNA)NUCLEIC ACIDS (DNA, RNA) NTPs AND dNTPs (ATP, dATP, GTP, dGTP, etc)NTPs AND dNTPs (ATP, dATP, GTP, dGTP, etc) cAMPcAMP PHOSPHOLIPIDSPHOSPHOLIPIDS VARIOUS OTHER PHOSPHORYLATED MOLECULESVARIOUS OTHER PHOSPHORYLATED MOLECULES

GENERATED VIA ATP HYDROLYSIS, ETC.GENERATED VIA ATP HYDROLYSIS, ETC. EXIST AS MIXTURE OF THREE FORMSEXIST AS MIXTURE OF THREE FORMS

POPO443-3- (PHOSPHATE ION)(PHOSPHATE ION)

HPOHPO442-2- (MONOHYDROGEN PHOSPHATE ION)(MONOHYDROGEN PHOSPHATE ION)

HH22POPO44-- (DIHYDROGEN PHOSPHATE ION)(DIHYDROGEN PHOSPHATE ION)

Page 57: Balance{ Water}

ELECTROLYTE BALANCEELECTROLYTE BALANCE

PHOSPHATE HOMEOSTASISPHOSPHATE HOMEOSTASIS DIET PROVIDES AMPLE PHOSPHATEDIET PROVIDES AMPLE PHOSPHATE READILY ABSORBED BY SMALL READILY ABSORBED BY SMALL

INTESTINEINTESTINE REGULATIONREGULATION

RENAL TUBULES SITE OF REGULATIONRENAL TUBULES SITE OF REGULATION PTH INCREASES PHOSPHATE EXCRETIONPTH INCREASES PHOSPHATE EXCRETION EXCRETION RATE AFFECTED BY URINE pHEXCRETION RATE AFFECTED BY URINE pH

Page 58: Balance{ Water}

ELECTROLYTE BALANCEELECTROLYTE BALANCE

PHOSPHATE IMBALANCESPHOSPHATE IMBALANCES PHOSPHATE HOMEOSTASIS NOT PHOSPHATE HOMEOSTASIS NOT

VERY CRITICALVERY CRITICAL BODY CAN TOLERATE WIDE BODY CAN TOLERATE WIDE

VARIATIONS OF PHOSPHATEE VARIATIONS OF PHOSPHATEE CONCENTRATION WITH LITTLE CONCENTRATION WITH LITTLE EFFECTEFFECT

Page 59: Balance{ Water}

ACID-BASE BALANCEACID-BASE BALANCE

ACIDS, BASES, AND pHACIDS, BASES, AND pH ACIDACID

ANY SUBSTANCE RELEASING HANY SUBSTANCE RELEASING H++

[H+] INCREASES (pH DECREASES)[H+] INCREASES (pH DECREASES) BASEBASE

ANY SUBSTANCE ACCEPTING HANY SUBSTANCE ACCEPTING H++

[H+] DECREASES (pH INCREASES)[H+] DECREASES (pH INCREASES) pHpH

A MEASURE OF [HA MEASURE OF [H++]] -LOG [H-LOG [H++]] SCALE 0 – 14, 7 IS NEUTRALSCALE 0 – 14, 7 IS NEUTRAL

Page 60: Balance{ Water}

ACID-BASE BALANCEACID-BASE BALANCE

WHY IS ACID-BASE BALANCE WHY IS ACID-BASE BALANCE IMPORTANT?IMPORTANT?

METABOLISM REQUIRES NUMEROUS METABOLISM REQUIRES NUMEROUS ENZYMESENZYMES

ENZYMES ARE PROTEINSENZYMES ARE PROTEINS pH AFFECTS PROTEIN STRUCTUREpH AFFECTS PROTEIN STRUCTURE PROTEIN STRUCTURE AFFECTS FUNCTIONPROTEIN STRUCTURE AFFECTS FUNCTION DEVIATIONS FROM NORMAL pH CAN DEVIATIONS FROM NORMAL pH CAN

INACTIVATE ENZYMES AND SHUT DOWN INACTIVATE ENZYMES AND SHUT DOWN METABOLIC PATHWAYSMETABOLIC PATHWAYS

Page 61: Balance{ Water}
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ACID-BASE BALANCEACID-BASE BALANCE

BLOOD pHBLOOD pH BLOOD AND TISSUE pH 7.35 – 7.45BLOOD AND TISSUE pH 7.35 – 7.45

ENZYMES FUNCTION WELL WITHIN THIS ENZYMES FUNCTION WELL WITHIN THIS RANGERANGE

ENZYMES FUNCTION POORLY (OR NOT ENZYMES FUNCTION POORLY (OR NOT AT ALL) WHEN SIGNIFICANTLY OUTSIDE AT ALL) WHEN SIGNIFICANTLY OUTSIDE OF THIS RANGEOF THIS RANGE

THIS RANGE MUST BE MAINTAINEDTHIS RANGE MUST BE MAINTAINED ACID-BASE BALANCEACID-BASE BALANCE

Page 63: Balance{ Water}

ACID-BASE BALANCEACID-BASE BALANCE

BUFFERSBUFFERS ANY MECHANISM OF RESISTING ANY MECHANISM OF RESISTING

SIGNIFICANT CHANGES IN pH SIGNIFICANT CHANGES IN pH ACCOMPLISHED BY CONVERTING:ACCOMPLISHED BY CONVERTING:

STRONG ACID STRONG ACID WEAK ACID WEAK ACID STRONG BASE STRONG BASE WEAK BASE WEAK BASE

Page 64: Balance{ Water}

ACID-BASE BALANCEACID-BASE BALANCE

BUFFERSBUFFERS PHYSIOLOGICAL BUFFER PHYSIOLOGICAL BUFFER

SYSTEM STABILIZING pH BY CONTROLLING SYSTEM STABILIZING pH BY CONTROLLING BODY’S OUTPUT OF ACIDS, BASES, OR COBODY’S OUTPUT OF ACIDS, BASES, OR CO22

URINARY SYSTEMURINARY SYSTEM BUFFERS GREATEST QUANTITYBUFFERS GREATEST QUANTITY REQUIRES HOURS OR DAYS TO EXERT EFFECTREQUIRES HOURS OR DAYS TO EXERT EFFECT

RESPIRATORY SYSTEMRESPIRATORY SYSTEM SMALLER EFFECTSMALLER EFFECT EXERTS EFFECT WITHIN MINUTESEXERTS EFFECT WITHIN MINUTES

Page 65: Balance{ Water}

ACID-BASE BALANCEACID-BASE BALANCE

BUFFERSBUFFERS CHEMICAL BUFFER SYSTEMCHEMICAL BUFFER SYSTEM

COMBINATION OF WEAK ACID AND WEAK BASECOMBINATION OF WEAK ACID AND WEAK BASE BINDS TO HBINDS TO H++ AS [H AS [H++] RISES, AND] RISES, AND RELEASES HRELEASES H++ AS [H AS [H++] FALLS] FALLS CAN RESTORE NORMAL pH ALMOST CAN RESTORE NORMAL pH ALMOST

IMMEDIATELYIMMEDIATELY THREE MAJOR CHEMICAL BUFFER SYSTEMSTHREE MAJOR CHEMICAL BUFFER SYSTEMS

BICARBONATE SYSTEMBICARBONATE SYSTEM PHOSPHATE SYSTEMPHOSPHATE SYSTEM PROTEIN SYSTEMPROTEIN SYSTEM

Page 66: Balance{ Water}

ACID-BASE BALANCEACID-BASE BALANCE

BICARBONATE BUFFER SYSTEMBICARBONATE BUFFER SYSTEM CARBONIC ACID (HCARBONIC ACID (H22COCO33))

WEAK ACIDWEAK ACID BICARBONATE ION (HCOBICARBONATE ION (HCO33

--)) WEAK BASEWEAK BASE

COCO22 + H + H220 0 H H22COCO33 H H++ + HCO + HCO33--

WORKS IN CONCERT WITH WORKS IN CONCERT WITH RESPIRATORY AND URINARY SYSTEMRESPIRATORY AND URINARY SYSTEM THESE SYSTEMS REMOVE COTHESE SYSTEMS REMOVE CO22 OR HCO OR HCO33

--

Page 67: Balance{ Water}

ACID-BASE BALANCEACID-BASE BALANCE

PHOSPHATE BUFFER SYSTEMPHOSPHATE BUFFER SYSTEM DIHYDROGEN PHOSPHATE ION(HDIHYDROGEN PHOSPHATE ION(H22POPO44

--)) WEAK ACIDWEAK ACID

MONOHYDROGEN PHOSPHATE ION (HPOMONOHYDROGEN PHOSPHATE ION (HPO442-2-))

WEAK BASEWEAK BASE HH22POPO44

-- H H++ + HPO + HPO442-2-

STRONGER THAN BICARBONATE STRONGER THAN BICARBONATE BUFFERING SYSTEMBUFFERING SYSTEM

MORE IMPARTANT IN BUFFERING ICF AND MORE IMPARTANT IN BUFFERING ICF AND RENAL TUBULES THAN IN ECFRENAL TUBULES THAN IN ECF

Page 68: Balance{ Water}

ACID-BASE BALANCEACID-BASE BALANCE

PROTEIN BUFFER SYSTEMPROTEIN BUFFER SYSTEM PROTEINS ARE MORE CONCENTRATED THAN PROTEINS ARE MORE CONCENTRATED THAN

BICARBONATE AND PHOSPHATE BUFFERSBICARBONATE AND PHOSPHATE BUFFERS ACCOUNTS FOR ~75% OF ALL CHEMICAL ACCOUNTS FOR ~75% OF ALL CHEMICAL

BUFFERING OF BODY FLUIDSBUFFERING OF BODY FLUIDS BUFFERING ABILITY DUE TO CERTAIN BUFFERING ABILITY DUE TO CERTAIN

FUNCTIONAL GROUPS OF AMINO ACID FUNCTIONAL GROUPS OF AMINO ACID RESIDUESRESIDUES CARBOXYL GROUPSCARBOXYL GROUPS

--COOH --COOH -COO -COO-- + H + H++

AMINO GROUPSAMINO GROUPS --NH--NH33

++ -NH -NH22 + H + H++

Page 69: Balance{ Water}

ACID-BASE BALANCEACID-BASE BALANCE

RESPIRATORY CONTROL OF pHRESPIRATORY CONTROL OF pH COCO22 + H + H220 0 H H22COCO33 H H++ + HCO + HCO33

--

ADDITION OF COADDITION OF CO22 INCREASES [H INCREASES [H++]] REMOVAL OF COREMOVAL OF CO22 DECREASES [H DECREASES [H++]] CAN NEUTRALIZE 2-3 X MORE ACID CAN NEUTRALIZE 2-3 X MORE ACID

AS CHEMICAL BUFFERSAS CHEMICAL BUFFERS

Page 70: Balance{ Water}

ACID-BASE BALANCEACID-BASE BALANCE

RENAL CONTROL OF pHRENAL CONTROL OF pH CAN NEUTRALIZE MORE ACID OR CAN NEUTRALIZE MORE ACID OR

BASE THAN BOTH RESPIRATORY BASE THAN BOTH RESPIRATORY SYSTEM AND CHEMICAL BUFFERSSYSTEM AND CHEMICAL BUFFERS

RENAL TUBULES SECRETE HRENAL TUBULES SECRETE H++

HH++ EXCRETED IN URINE EXCRETED IN URINE EXCHANGED FOR SODIUM ION (NaEXCHANGED FOR SODIUM ION (Na++)) ONLY POSSIBLE WHEN [HONLY POSSIBLE WHEN [H++] INSIDE ] INSIDE

TUBULE CELLS IS > [HTUBULE CELLS IS > [H++] IN TUBULAR ] IN TUBULAR FLUIDFLUID

Page 71: Balance{ Water}
Page 72: Balance{ Water}

ACID-BASE BALANCEACID-BASE BALANCE

ACID-BASE BALANCE DISORDERSACID-BASE BALANCE DISORDERS AT pH 7.4, 20:1 HCOAT pH 7.4, 20:1 HCO33

--:H:H22COCO33 RATIO RATIO IF [HIF [H22COCO33] INCREASES, pH DROPS] INCREASES, pH DROPS

pH BELOW 7.35 = pH BELOW 7.35 = ACIDOSISACIDOSIS IF [HCOIF [HCO33

--] INCREASES, pH INCREASES] INCREASES, pH INCREASES pH ABOVE 7.45 = pH ABOVE 7.45 = ALKALOSISALKALOSIS

Page 73: Balance{ Water}

ACID-BASE BALANCEACID-BASE BALANCE

ACID-BASE BALANCE DISORDERSACID-BASE BALANCE DISORDERS RESPIRATORY ACIDOSISRESPIRATORY ACIDOSIS

COCO22 PRODUCTION EXCEEDS RESPIRATORY CO PRODUCTION EXCEEDS RESPIRATORY CO22 ELIMINATIONELIMINATION

COCO22 ACCUMULATES IN ECF ACCUMULATES IN ECF pH DROPSpH DROPS

RESPIRATORY ALKALOSISRESPIRATORY ALKALOSIS RESPIRATORY CORESPIRATORY CO2 2 ELIMINATION EXCEEDS COELIMINATION EXCEEDS CO22

PRODUCTIONPRODUCTION EXCESSIVE VENTILATION (HYPERVENTILATION)EXCESSIVE VENTILATION (HYPERVENTILATION) pH RISESpH RISES

Page 74: Balance{ Water}

ACID-BASE BALANCEACID-BASE BALANCE

ACID-BASE BALANCE DISORDERSACID-BASE BALANCE DISORDERS METABOLIC ACIDOSISMETABOLIC ACIDOSIS

INCREASED PRODUCTION OF ORGANIC ACIDSINCREASED PRODUCTION OF ORGANIC ACIDS E.G., FERMENTATION E.G., FERMENTATION LACTIC ACID LACTIC ACID E.G., ALCOHOLISM, DIABETES MELLITUS E.G., ALCOHOLISM, DIABETES MELLITUS KETONE BODIES KETONE BODIES

INGESTION OF ACIDIC DRUGSINGESTION OF ACIDIC DRUGS E.G., ASPIRINE.G., ASPIRIN

LOSS OF BASELOSS OF BASE E.G., CHRONIC DIARRHEA, OVERUSE OF LAXITIVESE.G., CHRONIC DIARRHEA, OVERUSE OF LAXITIVES

METABOLIC ALKALOSISMETABOLIC ALKALOSIS RARERARE OVERUSE OF BICARBONATESOVERUSE OF BICARBONATES

E.G., ANTACIDSE.G., ANTACIDS LOSS OF STOMACH ACID FROM CHRONIC VOMITINGLOSS OF STOMACH ACID FROM CHRONIC VOMITING

Page 75: Balance{ Water}
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ACID-BASE BALANCEACID-BASE BALANCE

ACID-BASE BALANCE DISORDERSACID-BASE BALANCE DISORDERS ACIDOSISACIDOSIS HH++ PASSIVELY DIFFUSES INTO CELLS PASSIVELY DIFFUSES INTO CELLS KK++ DIFFUSES OUT DIFFUSES OUT

ELECTRICAL BALANCE MAINTAINEDELECTRICAL BALANCE MAINTAINED HH++ BUFFERED BY INTRACELLULAR PROTEINS BUFFERED BY INTRACELLULAR PROTEINS NET LOSS OF CATIONS FROM CELLNET LOSS OF CATIONS FROM CELL MEMBRANE IS NOW HYPERPOLARIZEDMEMBRANE IS NOW HYPERPOLARIZED NERVE & MUSCLE CELLS DIFFICULT TO NERVE & MUSCLE CELLS DIFFICULT TO

STIMULATESTIMULATE CENTRAL NERVOUS SYSTEM DEPRESSEDCENTRAL NERVOUS SYSTEM DEPRESSED

CONFUSION, DISORIENTATION, COMACONFUSION, DISORIENTATION, COMA

Page 77: Balance{ Water}
Page 78: Balance{ Water}

ACID-BASE BALANCEACID-BASE BALANCE

ACID-BASE BALANCE DISORDERSACID-BASE BALANCE DISORDERS ALKALOSISALKALOSIS HH++ PASSIVELY DIFFUSES OUT OF CELLS PASSIVELY DIFFUSES OUT OF CELLS KK++ DIFFUSES INTO CELLS DIFFUSES INTO CELLS

GAIN IN POSITIVE INTRACELLULAR CHARGEGAIN IN POSITIVE INTRACELLULAR CHARGE MEMBRANE POTENTIAL SHIFTEDMEMBRANE POTENTIAL SHIFTED NERVOUS SYSTEM HYPEREXCITABLENERVOUS SYSTEM HYPEREXCITABLE

NEURONS FIRE SPONTANEOUSLYNEURONS FIRE SPONTANEOUSLY SKELETAL MUSCLES OVERSTIMULATEDSKELETAL MUSCLES OVERSTIMULATED

MUSCLE SPASMS, TETANY, CONVULSIONS, MUSCLE SPASMS, TETANY, CONVULSIONS, RESPIRATORY PARALYSISRESPIRATORY PARALYSIS

Page 79: Balance{ Water}

ACID-BASE BALANCEACID-BASE BALANCE

ACID-BASE IMBALANCE COMPENSATIONACID-BASE IMBALANCE COMPENSATION RESPIRATORY SYSTEM COMPENSATIONRESPIRATORY SYSTEM COMPENSATION ADJUSTS PADJUSTS PCOCO2 2 IN ECFIN ECF

COCO22 EXCESS EXCESS INCREASED VENTILATION INCREASED VENTILATION COCO22 DEFICIENCY DEFICIENCY DECREASED VENTILATION DECREASED VENTILATION

EFFECTIVE VS EFFECTIVE VS RESPIRATORYRESPIRATORY ACIDOSIS AND ACIDOSIS AND ALKALOSISALKALOSIS

NOTNOT VERY EFFECTIVE VS VERY EFFECTIVE VS METABOLICMETABOLIC ACIDOSIS ACIDOSIS AND ALKALOSISAND ALKALOSIS I.E., CANNOT RID BODY OF KETONE BODIESI.E., CANNOT RID BODY OF KETONE BODIES

CAN CORRECT pH 7.0 TO 7.2 OR 7.3CAN CORRECT pH 7.0 TO 7.2 OR 7.3 NOT ALL THE WAY TO 7.4NOT ALL THE WAY TO 7.4

Page 80: Balance{ Water}

ACID-BASE BALANCEACID-BASE BALANCE

ACID-BASE IMBALANCE COMPENSATIONACID-BASE IMBALANCE COMPENSATION RENAL SYSTEM COMPENSATIONRENAL SYSTEM COMPENSATION SLOWER TO RESPONDSLOWER TO RESPOND CAN FULLY RESTORE NORMAL pHCAN FULLY RESTORE NORMAL pH URINE pH NORMALLY 5 – 6URINE pH NORMALLY 5 – 6

MAY DROP TO 4.5 WITH EXCESS HMAY DROP TO 4.5 WITH EXCESS H++

RESPONSE TO ACIDOSISRESPONSE TO ACIDOSIS RENAL TUBULES INCREASE HRENAL TUBULES INCREASE H++ SECRETION SECRETION HH++ IN URINE IS BUFFERED IN URINE IS BUFFERED

MAY RISE TO 8.2 WITH EXCESS HCOMAY RISE TO 8.2 WITH EXCESS HCO33--

RESPONSE TO ALKALOSISRESPONSE TO ALKALOSIS HCOHCO33

-- CONCENTRATION IN URINE ELEVATED CONCENTRATION IN URINE ELEVATED