Body Water and Electrolytes

 Water is the most abundant constituent of the human

body accounting approximately 60 to 70% of the body
mass in a normal adult.

 Water content of the body changes with age.

 It is about 75% in the new-born and decreases to less

than 50% in older individuals.

 Water content is greatest in brain tissue and least in

adipose tissue.
 IMPORTANCE OF WATER

 Water is a medium in which body solutes, both

organic and inorganic, are dissolved and metabolic
reactions take place.

 It acts as a vehicle for transport of solutes.

 Water itself participates as a substrate and a product

in many chemical reactions, e.g. in glycolysis, citric
acid cycle and respiratory chain.
 The stability of subcellular structures and activities of
numerous enzymes are dependant on adequate cell
hydration.

 Water is involved in the regulation of body tempe- rature

because of its highest latent heat of evaporation.

 Water also acts as a lubricant in the body so as to prevent

friction in joints, pleura, peritoneum and conjunctiva.

 Both a relative deficiency and an excess of water impair

the function of tissues and organs.
 Water is involved in the regulation of body
temperature because of its highest latent heat of
evaporation.

 Water also acts as a lubricant in the body so as to

prevent friction in joints, pleura, peritoneum and
conjuctiva.

 Both a relative deficiency and an excess of water

impair the function of tissues and organs.
 Total body water (TBW) and its distribution

Total body water, includes water both inside and outside

of cells and water normally present in the gastrointestinal
and genitourinary systems.

Total body water divided into two main compartments:

1. Extracellular water (ECW)

2. Intracellular water (ICW).

 The ECW includes all water external to cell
memb- ranes.

 The ECW can be further subdivided into:

– Intravascular water, i.e. plasma

– Extravascular water, i.e. interstitial fluid.

 The ICW includes all water within cell membranes.

Body water compartments.
 Volume of Body Water Compartment

 In a 70 kg adult the total body water is about 42 L.

 About 28 L of intracellular water (ICW) and 14 L of

extracellular water (ECW).

 The ECW is distributed as 3.5 L plasma water

(intravascular water) and 10.5 L interstitial water
(extra- vascular).
 Factors Affecting Distribution of Water

 Two important factors influence the distribution of water

between intracellular and extracellular compartments are:

– Osmolality or Osmolarity

– Colloidal osmotic pressure.

 Osmolarity or osmolality is a measure of solute particles

present in fluid medium.

 Osmolarity is the number of moles per liter of solution

and osmolality is the number of moles per kg of solvent.
 The osmotic pressure of a solution is directly proportional
to the concentration of osmotically active particles in that
solution.

 In a normal person, the osmotic pressure of ECF (mainly

due to Na+ ions) is equal to the osmotic pressure of ICF
(which is mainly due to K+ ions).

 Due to this osmotic equilibrium there is no net movement

of water in or out of the cells.
 Colloidal Osmotic Pressure

 Osmotic pressure is the force that tends to move water

from dilute solutions to concentrated solutions.

 The effective osmotic pressure of a solution depends on

the total number of solute particles in solution and the
permeability characteristics of the particular membrane.
 A solution with an osmotic pressure greater than plasma
called hypertonic or hyperosmotic.

 Hypotonic or hypo-osmotic solutions are those with

osmotic pressures less than those of plasma.

 Within the extracellular fluid, the distribution of water

between intravascular and extravascular compartments
depends on colloidal osmotic pressure exerted by the
plasma proteins, also called as oncotic pressure.
 NORMAL WATER BALANCE

 The body water is maintained within the fairly constant limits

by a regulation between the intake and output of water.

 Average daily water turnover in the adult is approximately

2500 ml.

 However, the range of water turnover depends on intake,

environment and activity.

 ELECTROLYTES

 Electrolytes are the inorganic substances which are

readily dissociated into positively charged (cations) and

negatively charged (anions) ions.

 The concentration of electrolytes are expressed as

milli- equivalent per liter (mEq/L)rather than

milligrams.
 In physiology, the primary electrolytes are:

• sodium (Na+),

• potassium (K+),

• calcium (Ca2+),

• magnesium (Mg2+),

• chloride (Cl−),

• hydrogen phosphate (HPO42−), and

• hydrogen carbonate (HCO3−).

 Distribution of Electrolytes
 Total concentration of cations and anions in each
compartment (ECF and ICF) is equal to maintain
electrical neutrality.
 Sodium is the principal cation of the extracellular fluid
Potassium by contrast, is the principal cation of
intra- cellularfluid.
 Chloride (Cl–) and bicarbonate (HCO3–) principal
anion in the extra- cellularfluid
 phosphate is the principal anion within the cells.
 Sodium, Potassium and Chloride

Sodium, potassium and chloride have an important role

in maintaining:

• Electrical neutrality

• Osmotic pressure

• Water and acid-base balance.

Plasma concentrations of these ions are:

• Sodium 135 mEq/L to 145 mEq/L

• Chloride 95 mEq/L to 105 mEq/L

• Potassium 3.5 mEq/L to 5 mEq/L

Clinical Conditions Related to Plasma Sodium level

alterations
Hypernatremia

Hypernatremia is an increase in serum sodium concentration

above the normal range of 135 mEq/L to145 mEq/L.

The causes of hypernatremia are:

 Water depletion,

 Water and sodium depletion,

 Excessive sodium intake or retention in the ECF e.g.

Cohn’s syndrome and in Cushing’s syndrome,.
Hyponatremia

Hyponatremia is a significant fall in serum sodium

concentration below the normal range 135 mEq/L to145
mEq/L.

The causes of hyponatremia are:

 Retention of water

 Loss of sodium
 Clinical Conditions Related to Plasma Potassium level
alterations

Hyperkalemia

The causes of Hyperkalemia

• Renal failure

• Mineralocorticoid deficiency: For example, in

Addison’s disease
• Acidosis

• Cell damage: For example, in rhabdomyolysis

Hypokalemia

Causes of low plasma concentration of potassium are:

 Gastrointestinal losses
 Renal losses
 Alkalosis
 Clinical Conditions Related to Plasma Chloride Level
Alterations

 Abnormalities of sodium metabolism are generally

accompanied by abnormalities in chloride metabolism.

 In most cases the causes of hypochloremia and

hyperchloremia are the same as those of hyponatremia
and hypernatremia.
 Regulation of water and electrolyte balance

 Water and electrolyte balance are regulated together.

• Hypothalamic mechanisms controlling thirst

• Antidiuretic hormone or vasopressin

• The renin-angiotensin-aldosterone system (RAAS)

• Atrial natriuretic factor (ANF) and

• Kidney

Hypothalamic regulation of water balance.

Renin-angiotensin-aldosterone system (RAAS).
 Disorders Of Water And Electrolyte Balances

Dehydration and over-hydration are the disorders of

water balance, which are due to an imbalance of water
intake and output or sodium intake and output.
 Dehydration

Dehydration may be defined as a state in which loss of

water exceeds that of intake, as a result of which body’s
water content gets reduced and the body is in negative
water balance.
Dehydration may be of two types:

 Dehydration due to pure water deficiency, without loss

of electrolytes, called simple dehydration

 Dehydration due to combined deficiency of water and

electrolyte, sodium
Simple Dehydration (Deficit of Water)

 Simple dehydration, defined as decrease in total body

water with relatively normal total body sodium.

 It may result from: Failure to replace obligatory water

losses or failure of the regulatory mechanisms that
promotes conservation of the water by the kidney.
 Simple dehydration is associated with hypernatremia,
i.e. increased level of sodium and increase in ECW
osmolarity because water balance is negative and sodium
balance is normal.

 The increase in ECW osmolarity (as water is lost from

the body) results in movement of water out of the ICW
compartment and results in contraction of both the
ECW and ICW compartments due to loss of water from
the body.
 Dehydration due to Combined Water and Sodium

Deficiency

 Dehydration results from a net negative balance of water

and sodium.

 In this case, water balance may be more negative, equal

to, or less negative than sodium balance.

 If water balance is more negative than sodium balance,

the result is hypernatremia or hyperosmolar

dehydration.

 If it is equally negative normonatremic or isomolar

dehydration results.

 If it is less negative hyponatremic or hyposmolar

dehydration results.
Causes of Dehydration due to Water and Sodium Deficit

 Hypernatremic dehydration

 Excessive sweating if free water intake is inadequate

 Water and food deprivation

 Diuretic therapy if free water intake is inadequate

 Osmotic diuresis with glycosuria.

 Normonatremic dehydration
• Vomiting
• Diarrhea
 Hyponatremic dehydration
• Salt-wasting renal disease
• Adrenocortical insufficiency, Addison’s disease
• Diuretic therapy if free water intake is
excessive
• Excessive sweating.
Causes of dehydration

 Simple dehydration results from deprivation of water either

due to no or inadequate intake of water or due to excessive
loss of water from body, e.g. in diabetes insipidus.

 Dehydration due to combined deficiency of water and

electrolyte occur as a result of vomiting, diarrhea, excessive
sweating, salt wasting renal disease, and adrenocortical
insufficiency (Addison's disease).
 Symptoms of dehydration

 Symptoms of simple dehydration are intense thirst, mental

confusion, fever and oliguria (decreased urine output).

 Symptoms of dehydration due to combined deficiency of water

and electrolytes are wrinkled skin, dry mucous membranes,

muscle cramps, sunken eyeballs and increased blood urea

nitrogen. With increasing severity, weakness, hypotension and

shock may occur

Treatment

Treatment of simple dehydration : The patient is asked to drink

plenty of water. If oral adminis­tration is not possible, an
isotonic solution of 5% dextrose is given intravenously.

Treatment of dehydration due to combined deficiency of water

and electrolyte : An isotonic solution of sodium chloride
(normal saline) is given intravenously.
 Symptoms of Dehydration
• The signs and symptoms of dehydration include:
• Thirst,
• Wrinkled skin,
• Dry mucous membranes,
• Muscle cramps;
• Oliguria (decreased urine output),
• Sunken eyeballs,
• Increased blood urea nitrogen, and increased haematocrit.
• With increasing severity, weakness, hypotension and shock may
occur.
Treatment
• Treatment of simple dehydration: The patient is asked
to drink plenty of water. If oral administration is not
possible, an isotonic solution of 5% dextrose is given
intravenously.
• Treatment of dehydration due to combined
deficiency of water and electrolyte: An isotonic
solution of sodium chloride (normal saline) is given
intravenously.
Overhydration or Water Intoxication

 Overhydration or water intoxication is defined as increase in

total body water (TBW) with normal total body sodium.

 It rarely results from excessive water consumption (polydipsia).

 A normal healthy individual can consume a large volume of

water without producing any deleterious effects, as the normal
individual has the capacity to excrete large volume of dilute
urine, when excess of free water (without electrolyte) is given.
 More often water intoxication results due to the retention

of excess water in the body, which can occur due to:

• Renal failure

• Excessive administration of fluids parenteral

• Hypersecretion of ADH (syndrome of inappropriate

ADH secretion, SIADH).

Symptoms of Overhydration

Acute fall in serum sodium results in nausea, vomiting,

headache, muscular weakness, confusion, seizures and
in severe cases convulsions, coma and even death can
occur.