Fluids and Electrolytes Nursing

PAUL E. MANAIG, MAEd. M.D

 To maintain good health, a balance of fluids and electrolytes, acids and bases must be normally regulated for metabolic processes to be in working state.

 A cell, together with its environment in any part of the body, is primarily composed of FLUID. Thus fluid and electrolyte balance must be maintained to promote normal function.

Fluids and Electrolytes Outline

3 concepts
Fluids Electrolytes Acids and Bases

THE BODY FLUIDS

A solution of solvent and solutes Our body is made up of fluids and solids About 50-60% of the body weight is WATER In a 70 Kg adult male: 60% X 70= 4042 Liters Note that 1 kg body weight= 1 liter of water

THE BODY FLUIDS

The body has two major compartments: 1 Intracellular 2. Extracellular

Intracellular

THE BODY FLUIDS

The Extracellular can be divided into:
Intravascular

- Interstitial Trans-cellular

THE BODY FLUIDS

The Proportion of Body Fluids

Interstitial 15%

Intracellular fluid 40%

Intravascular 5%
Transcellular 1-2%

The Intracellular Fluid

Found inside the cell surrounded by a membrane
This is compartment with the highest percentage of water in adults

The Extracellular Fluid

Fluid found outside the cells 1. INTERSTITIAL FLUID Found in between the cells 2. INTRAVASCULAR FLUID Found inside the blood vessels and lymphatic vessels 3. TRANSCELLULAR FLUID Found inside body cavities like pleura, peritoneum, CSF

Fluid Compartment in the Body

Volume Adult Male (L)
Male (%) Intracellular Fluid Extracellular Fluid Plasma Interstitial Fluid Other TOTAL Water 28 15 (4.5) (10.5) 43 40 20 (4) (15) (1) 60 Female (%) 33 17 (4) (9) (1) 50 Infant (%) 40 30 (4) (25) (1) 70

FLUID BALANCE
TOTAL BODY WATER (AS PERCENTAGE OF BODY WEIGHT) IN RELATION TO AGE AND SEX
AGE UNDER 18
18-40 40-60 OVER 60

MALE 65%
60% 50-60% 50%

FEMALE 55%
50% 40-50% 40%

Functions of Body Fluids

Transporter of nutrients, wastes, hormones, proteins and etc Medium or milieu for metabolic processes Body temperature regulation Lubricant of musculoskeletal joints Insulator and shock absorber

Composition of body fluids

Composed of solute, solvents, Electrolytes, proteins, etc Plasma and interstitial fluids contain essentially the same electrolytes and solutes, but plasma has a higher protein content The major ICF electrolytes are potassium, phosphates and magnesium The major ECF electrolytes are sodium, bicarbonates and chloride

Sources of Fluids: Fluid Input

1. Exogenous sources
Fluid intake- water from foodstuffs
IVF

Medications
Blood products

2. Endogenous sources
By products of metabolism secretions

Fluid Output: Fluid Losses

Routes of Fluid output Urine Fecal losses Sensible losses Sweat Insensible losses though the skin and lungs as water vapor

Sources and Losses of Water

Sources (mL)
Liquids Solid foods Cell metabolism 1200 1000 300

Losses (mL)
Urine Feces Insensible losses Lungs Skin 1400 200

400 500
2500

TOTAL

2500

Regulation of Extracellular Fluid Composition

Homeostasis requires that the intake of substances such as water and electrolytes equal their elimination. Over a long period, the total amount of water and electrolytes in the body does not change unless the individual is growing, gaining weight, or losing weight. The regulation of water and electrolytes involves the coordinated participation of several organ systems, especially the uroexcretory system.

Control of Fluid Balance is maintained By:

1. Thirst mechanism in the hypothalamus. 2. Antidiuretic Hormone (ADH) 3. Aldosterone

Fluid Dynamics
The movement of fluids (solutes and solvents) in the body compartment Diffusion Osmosis Filtration Active transport

The Concept of TONICITY

This is the concentration of solutes in a solution Reflected by the concentration of the Sodium

The Concept of TONICITY

A solution having the same tonicity as that of body fluid or plasma is considered ISOTONIC
0.9% NaCl

The Concept of TONICITY

A solution with high solute concentration is considered as HYPERTONIC
A solution with low solute concentration is considered as HYPOTONIC

Helpful Hints
In a HYPERTONIC solution, fluid will go out from the cell, the cell will shrink In a HYPOTONIC solution, fluid will enter the cell, the cell will swell In an ISOTONIC solution, there will be no movement of fluid.

Fluid Dynamics
The movement of fluids (solutes and solvents) in the body compartment Diffusion Osmosis Filtration Active transport

DIFFUSION
The movement of SOLUTES or particles in a solution from a higher concentration to a lower concentration If a sugar is placed in plain water, the glucose molecules will dissolve and diffuse distribute in the solution

OSMOSIS
The force that draws water or solvent from a less concentrated solution into a more concentrated solution through a semipermeable membrane The pressure that draws water inside the vessel which is more concentrated is called Osmotic pressure

OSMOSIS
A special type of osmotic pressure is exerted by the proteins in the plasma. It is called ONCOTIC PRESSSURE (COLLOID Pressure)

FILTRATION
The movement of both solute and solvent by hydrostatic pressure, ie, from an area of a higher pressure to an area of a lower pressure An example of this process is urine formation

Hydrostatic pressure
Hydrostatic pressure is the pressure exerted by the fluid against the container Increased hydrostatic pressure is one mechanism producing edema

Active transport
This is the movement of solutes across a membrane from a lower concentration to a higher concentration with utilization of energy Example is the Sodium-Potassium pump- a primarily active transport process

FLUID EXCESS: Edema

Occurs in the extracellular compartment and may be isotonic, hypotonic, or hypertonic Edema refers to an excessive amount of fluid in the interstitial compartment, which causes swelling or enlargement of the tissues.

CAUSES OF EDEMA: 1. Increased capillary hydrostatic pressure 2. Loss of plasma proteins (albumin). 3. Obstruction of the Lymphatic circulation 4. Increased capillary permeability

Effects of Edema: 1. Local area of swelling 2. Pitting edema 3. Significant increased in body weight 4. Functional impairment 5. Pain 6. Arterial circulation may be impaired

FLUID DEFICIT: Dehydration

Refers to insufficient body fluid resulting from inadequate intake or excessive loss or a combination of the two.

Causes of Dehydration: 1. Vomiting and diarrhea drainage or suction of any portion of Digestive system 2. Excessive sweating with loss of sodium and water 3. Diabetic ketoacidosis with loss of fluid, electrolytes and glucose in the urine 4. Insufficient water intake an elderly or unconscious person

Effects of Dehydrartion: 1. Dry mucous membranes in the mouth/decreased skin turgor 2. Lower blood pressure, weak pulse, and a feeling of fatigue, and 3. Increased hematocrit, indicating a higher proportion of red blood cells compared to water in the blood.

Compensatory Mechanisms: 1. Increasing thirst 2. Increasing the heart rate 3. Constricting the cutaneous blood vessels leading to pale and cool skin, 4. Decreasing urine output (water retention) leading to high specific gravity of urine (more concentrated) as a result of renal vasoconstriction and increased secretion of ADH and Aldosterone.

Comparison of Signs And Symptoms of Fluid Excess and Fluid Deficit

Fluid Excess (edema) Fluid Deficit (Dehydration)

Localized swelling (feet, hands, periorbital area, ascites)

Pale, gray, or red skin color Weight gain Slow, bounding pulse, high blood pressure Lethargy, possible seizures

Sunken, soft eyes

Decreased skin turgor, dry mucous membranes Thirst, weight loss Rapid, weak, thready pulse; low b lood pressure; orthostatic hypotension Fatigue, weakness, dizziness, possible stupor

Pulmonary congestion, cough, rales Laboratory values Decreased hematocrit Decreased serum sodium Urine: Low specific gravity, high volume

Increased body temperature Laboratory values Increased hematocrit Increased electrolyte or (variable) Urine: High specific gravity; low volume

Regulation of Body fluid balance

1. The Kidney Regulates primarily fluid output by urine formation Releases RENIN Regulates sodium and water balance

Regulation of Body fluid balance

2. Endocrine regulation Regulates primarily fluid intake by thirst mechanism ADH increase water reabsorption on collecting duct Aldosterone increases Sodium retention in the distal nephron ANF Promotes Sodium excretion and inhibits thirst mechanism

Regulation of Body fluid balance

3. Gastro-intestinal regulation

The GIT digests food and absorbs water Only about 200 ml of water is excreted in the fecal material per day

The ELECTROLYTES

Electrolytes are charged ions capable of conducting electricity and are solutes in all compartment

The ELECTROLYTES
Sources of electrolytes Foods and ingested fluids Medications IVF and TPN solutions

The ELECTROLYTES
Functions of Electrolytes Maintains fluid balance Regulates acid-base balance Needed for enzymatic secretion and activation Needed for proper metabolism and effective processes of muscular contraction, nerve transmission

The ELECTROLYTES

ECF and ICF vary in their electrolyte distribution and concentration

Cation and Anion

CATIONS- positively charged ions; examples are sodium, potassium, calcium ANIONS- negatively charged ions; examples are chloride and phosphates

Cation and Anion

The major ICF cation is potassium (K+); the major ICF anion is Phosphates The major ECF cation is Sodium (Na+); the major ECF anion is Chloride (Cl-)

Ions
Factors which influence the concentration of water and solutes inside the cells:
Transport mechanisms Permeability of the cell membrane

Concentration of water and solutes in the extracellular fluid

Ions
NORMAL VALUES AND MASS CONVERSION FACTORS
Normal Plasma Values Sodium (Na+) Potassium (K+) Chloride (Cl-) 135 145 meq/L 3.5 5.0 meq/L 98 107 meq/L Mass Conversion 23 mg = 1 meq 39 mg = 1 meq 35 mg = 1 meq

Bicarbonate (HCO3-)
Calcium (Ca2+) Phosphorus Magnesium (Mg2+) Osmolality

22 26 meq/L
8.5 10.5 mg/dL 2.5 4.5 mg/dL 1.8 3.0 mg/dL 285 295 mosm/kg

61 mg = 1 meq
40 mg = 1 mmol 31 mg = 1 mmol 24 mg = 1 mmol -

Sodium
Dominant extracellular ion. About 90 to 95% of the osmotic pressure of the extracellular fluid results from sodium ions and the negative ions associated with them. Recommended dietary intake is less than 2.5 grams per day. Kidneys provide the major route by which the excess sodium ions are excreted.

Sodium
In the presence of aldosterone, the reabsorption of sodium ions in the loop of Henle is very efficient. When aldosterone is absent, the reabsorption of sodium in the nephron is greatly reduced and the amount of sodium lost in the urine increases. Also excreted from the body through the sweat mechanism.

Sodium
Primary mechanisms that regulate the sodium ion concentration in the extracellular fluid:
Changes in the blood pressure Changes in the osmolality of the extracellular fluid

Sodium Regulation
INCREASED SODIUM Increased ADH secretion, Decreased urine volume and increased plasma volume DECREASED SODIUM

Decreased aldosterone secretion, decreased sodium reabsorption

NORMAL Na+

DECREASED SODIUM

Decreased ADH secretion, Increased urine volume and decreased plasma volume

INCREASED SODIUM

Increased aldosterone secretion, increased sodium reabsorption

Potassium
Electrically excitable tissue such as muscle and nerves are highly sensitive to slight changes in extracellular potassium concentration. The ECF concentration of potassium must be maintained within a narrow range for tissues to function normally.

Potassium
Aldosterone also plays a major role in regulating the concentration of potassium ions in the ECF. Circulatory system shock resulting from plasma loss, dehydration, and tissue damage causes extracellular potassium ions to become more concentrated than normal. In response, aldosterone secretion increases and causes potassium secretion to increase.

Potassium Regulation
INCREASED POTASSIUM Increased aldosterone secretion with increased potassium secretion by the kidneys and increased potassium in urine DECREASED POTASSIUM

NORMAL K+

DECREASED POTASSIUM

Decreased aldosterone secretion with decreased potassium secretion by the kidney and decreased potassium in the urine

INCREASED POTASSIUM

Calcium
Extracellular concentration of calcium ions is maintained within a narrow range. Increases and decreases in ECF concentration of calcium ions have dramatic effects on the electrical properties of excitable tissues. Parathyroid hormone (PTH) secreted by the parathyroid glands increases extracellular calcium levels.

Calcium
Calcitonin is secreted by the thyroid gland. It reduces blood levels of calcium when they are too high.

Calcium Regulation
Increased Calcitonin secretion with decreased bone resorption INCREASED CALCIUM DECREASED CALCIUM Decreased parathyroid hormone secretion with decreased bone resorption, decreased intestinal calcium absorption, and decreased kidney calcium reabsorption

NORMAL Ca++

DECREASED CALCIUM

Increased parathyroid hormone secretion with increased bone resorption, increased intestinal calcium absorption, and increased renal calcium reabsorption

INCREASED CALCIUM

Phosphate and Sulfate

Phosphate and sulfate are reabsorbed by active transport in the kidneys. Rate of reabsorption is slow, so that if the concentration of these ions in the filtrate exceeds the ability of the nephron to reabsorb them, the excess is excreted in the urine.

Helpful mnemonics
PI-SO Potassium is inside Phosphate is inside
Sodium is outside Chloride is outside

Regulation of Electrolyte Balance

1. Renal regulation Occurs by the process of glomerular filtration, tubular reabsorption and tubular secretion Urine formation
If there is little water in the body, it is conserved If there is water excess, it will be eliminated

Regulation of Electrolyte Balance

2. Endocrinal regulation Hormones play a role in electrolyte regulation Aldosterone promotes Sodium retention and Potassium excretion ANF promotes Sodium excretion Parathormone promotes Calcium retention and Phosphate excretion Calcitonin promotes Calcium excretion and Phosphate excretion

Regulation of Electrolyte Balance

3. GIT Regulation- electrolytes are absorbed and secreted and some are excreted thru the stool

THE CATIONS
SODIUM POTASSIUM CALCIUM MAGNESIUM

SODIUM
Normal range is 135-145 mEq/L Major contributor of plasma osmolarity FUNCTIONS 1. participates in the Na-K pump 2. assists in maintaining blood volume 3. assists in nerve transmission and muscle contraction

POTASSIUM
MOST ABUNDANT cation in the ICF Normal range is 3.5-5.0 mEq/L
FUNCTIONS 1. maintains ICF Osmolality 2. nerve conduction and muscle contraction 3. metabolism of carbohydrates, fats and proteins

CALCIUM
Majority of calcium is in the bones and teeth Normal serum range 8.5-10 mg/dL FUNCTIONS 1. formation and mineralization of bones/teeth 2. muscular contraction and relaxation 3. cardiac function 4. blood clotting 5. enzyme activation

CALCIUM
Regulation: GIT absorbs Ca+ in the intestine with the help of Vitamin D Kidney Ca+ is filtered in the glomerulus and reabsorbed in the tubules PTH increases Ca+ by bone resorption, Ca+ retention and activation of Vitamin D Calcitonin released when Ca+ is high, it decreases Ca+ by excretion in the kidney

MAGNESIUM
Second to K+ in the ICF Normal range is 1.3-2.1 mEq/L FUNCTIONS 1. intracellular production and utilization of ATP 2. protein and DNA synthesis 3. neuromuscular irritability

THE ANIONS
CHLORIDE PHOSPHATES BICARBONATES

CHLORIDE
The MAJOR Anion in the ECF Normal range is 95-108 mEq/L FUNCTIONS 1. major component of gastric juice aside from H+ 2. together with Na+, regulates plasma osmolality 3. participates in the chloride shift 4. acts as chemical buffer

PHOSPHATES
The MAJOR Anion in the ICF Normal range is 2.5-4.5 mg/L FUNCTIONS 1. component of bones 2. needed to generate ATP 3. components of DNA and RNA PTH decreases PO4 in blood by renal excretion Calcitonin increases renal excretion of PO4

BICARBONATES
Present both in ICF and ECF Normal range- 22-26 mEq/L FUNCTIONS 1. regulates acid-base balance 2. component of the bicarbonatecarbonic acid buffer system

IMBALANCE: EXCESS
1. HYPERNATREMIA More than 145 mEq/L Fluid moves out of cell crenation Etiology: sodium intake, IVF, water loss in excess of water, diarrhea S/SX: dry, sticky tongue, thirst

IMBALANCE: EXCESS
2. HYPERKALEMIA K+ more than 5.0 mEq/L Etiology: IVF with K+, acidosis, Hyper-alimentation and K+ replacement ECG: peaked T waves and wide QRS

IMBALANCE: EXCESS
3. HYPERCALCEMIA Serum calcium more than 10.5 mg/dL Etiology: Overuse of calcium supplements, excessive Vitamin D, malignancy, prolonged immobilization, thiazide diuretic ECG: Shortened QT interval

IMBALANCE: EXCESS
4. HYPERMAGNESEMIA Serum magnesium more than 2.1 mEq/L Etiology: use of Mg antacids, Renal failure, Mg medications S/SX: depressed tendon reflexes, oliguria, RR

IMBALANCE: EXCESS
5. HYPERCHLOREMIA Serum chloride more than 108 mEq/L Etiology: sodium chloride excess

IMBALANCE: EXCESS
6. HYPERPHOSPHATEMIA Serum PO4 more than 4.5 mg/dL Etiology: Tissue trauma, chemotherapy. PO4 containing medications, osteoporosis

IMBALANCE : DEFICIENCY
1. HYPONATREMIA Na level is less than 135 mEq/L Water is drawn into the cell cell swelling Etiology: prolonged diuretic therapy, excessive burns, excessive sweating, SIADH, plain water consumption S/SX: nausea, vomiting, seizures

IMBALANCE : DEFICIENCY
2. HYPOKALEMIA K+ level less than 3.5 mEq/L Etiology: use of diuretic, vomiting and diarrhea ECG: flattened , depressed T waves, presence of U waves

IMBALANCE : DEFICIENCY
3. HYPOCALCEMIA Calcium level of less than 8.5 mg/dL Etiology: removal of parathyroid gland during thyroid surgery, Vit. D deficiency, Furosemide, infusion of citrated blood S/SX- Tetany, (+) Chvosteks (+) Trousseauss ECG: prolonged QT interval

ACID-BASE CONCEPTS

Acid- substance that can donate or release hydrogen ions Carbonic acid, Hydrochloric acid

ACID-BASE CONCEPTS

Base- substance that can accept hydrogen ions Bicarbonate

ACID-BASE CONCEPTS

Buffer- substance that can accept or donate hydrogen Hemoglobin buffer Bicarbonate : carbonic acid buffer Phosphate buffer

ACID-BASE CONCEPTS
Bicarbonate : carbonic acid buffer
Most important buffer system Must maintain the balance of 20:1 Immediate but limited

ACID-BASE CONCEPTS
pH Measures the hydrogen concentration in a solution Measures the degree of acidity and alkalinity

Acid and Base

pH measures the degree of acidity and alkalinity. It is inversely related to Hydrogen. Normal ph 7.35-7.45 Decreased pH- ACIDIC-increased HydrogenpH below 7.35 Increased pH- ALKALOSIS-decreased hydrogenpH above 7.45

SUPPLY AND SOURCES OF ACIDS AND BASES

Sources of acids and bases are from: 1. ECF, ICF and body tissues 2. Foodstuff 3. Metabolic products of cells like CO2, lactic acids, ammonia

ABG analysis
This test helps to evaluate gas exchange in the lungs by measuring the gas pressures and pH of an arterial sample

ABG analysis
Pre-test: choose site carefully, perform the Allens test, secure equipmentssyringe, needle, container with ice Intra-test: Obtain a 5 mL specimen from the artery (brachial, femoral and radial) Post-test: Apply firm pressure for 5 minutes, label specimen correctly, place in the container with ice

Nursing care
Explain procedure to the client Obtain a heparinized syringe or vacuum container tube Perform Allens test before obtaining specimen (assessment of collateral circulation before radial artery puncture)

ABG analysis
ABG normal values PaO2 80-100 mmHg PaCO2 35-45 mmHg pH 7.35- 7.45 HCO3 22- 26 mEq/L O2 Sat 95-99%

Value pH

Normal 7.35-7.45

Acidosis Below 7.35

Alkalosis Above 7.45

paO2
SaO2 paCO2 HCO3

95-100 mmHg 95-98% 35-45 mmHg

Respirator Respirator y >45 y <35 <22 >26

22-26 mEq/L Metabolic Metabolic

remember
a high hydrogen acidic pH is low a low hydrogen alkalosis pH is high
a high CO2may mean acidic a low CO2 may mean alkalosis

Dynamics of Acid and bases

Acids and bases are constantly produced in the body They must be constantly regulated CO2 and HCO3 are crucial in the balance A ratio of 20:1 is maintained
(HCO3:H2CO3)

Respiratory and renal system are active in regulation

Ways to balance the acids and bases

Excretion Acid can be excreted Hydrogen can be excreted Bicarbonate can be excreted

Ways to balance the acids and bases

Production Bicarbonate can be produced Hydrogen can be produced Acid can be produced

Ways to balance the acids and bases

Neutralization Acids can be neutralized by bicarbonate Bicarbonate can be neutralized by acids

Regulation of acids and bases

Respiratory System Renal System Buffer System

Ways to balance the acids and bases

The respiratory system compensates for metabolic problems CO2 (acid) can be exhaled from the body to normalize the pH in ACIDOSIS CO2 (acid) can be retained in the body to normalize the pH in ALKALOSIS

The kidney can compensate for problems in the respiratory system The Kidney reabsorbs and generates Bicarbonate (alkaline) in ACIDOSIS The Kidney can excrete H+ excess (Acidosis) to normalize the pH in ACIDOSIS

Ways to balance the acids and bases

 The kidney can excrete bicarbonate (alkali) in conditions of ALKALOSIS The kidney can retain H+ (acid) in conditions of ALKALOSIS

Ways to balance the acids and bases

Ways to balance the acids and bases

Chemical buffers can also participate in the balance of acid-base 1. Carbonic acid- bicarbonate buffer 2. Phosphate buffer 3. protein buffer- ICF and hemoglobin
The action is immediate but very limited

FACTORS AFFECTING BODY FLUIDS, ELECTROLYTES AND ACIDBASE BALANCE AGE Infants have higher proportion of body water than adults Water content of the body decreases with age Infants have higher fluid turn-over due to immature kidney and rapid respiratory rate

FACTORS AFFECTING BODY FLUIDS, ELECTROLYTES AND ACIDBASE BALANCE GENDER AND BODY SIZE Women have higher body fat content but lesser water content Lean body has higher water content

FACTORS AFFECTING BODY FLUIDS, ELECTROLYTES AND ACIDBASE BALANCE ENVIRONMENT AND TEMPERATURE Climate and heat and humidity affect fluid balance

FACTORS AFFECTING BODY FLUIDS, ELECTROLYTES AND ACIDBASE BALANCE

DIET AND LIFESTYLE Anorexia nervosa will lead to nutritional depletion Stressful situations will increase metabolism, increase ADH causing water retention and increased blood volume Chronic Alcohol consumption causes malnutrition

FACTORS AFFECTING BODY FLUIDS, ELECTROLYTES AND ACIDBASE BALANCE ILLNESS Trauma and burns release K+ in the blood Cardiac dysfunction will lead to edema and congestion

FACTORS AFFECTING BODY FLUIDS, ELECTROLYTES AND ACIDBASE BALANCE MEDICAL TREATMENT, MEDICATIONS AND SURGERY Suctioning, diuretics and laxatives may cause imbalances

Fluid Imbalances
Fluid volume deficit
Occurs when the body lose BOTH

water and electrolytes HYPOVOLEMIA

Fluid Imbalances
Fluid Volume excess
Occurs when the body retains BOTH

water and electrolytes Called HYPERVOLEMIA

In Summary
A balance of Fluids, Electrolytes and Acids-Bases is necessary for health and homeostasis Fluid is a solution of solvent and solutes The body fluid is located in TWO compartments: Intracellular and Extracellular

In Summary
Most of body fluid is in the intracellular compartment The movement of fluids is governed by four mechanisms: Diffusion, Osmosis, Filtration and Active transport 50-60% of body weight is water

In Summary
Electrolytes are charged particles in a solution CATIONS are positive (Na, K, Mg, Ca) ANIONS are negative (Cl, HCO3, PO4) The concentration of these electrolytes varies in the compartments

In Summary
Potassium (+) and Phosphates (-) =ICF

Sodium (+) and Chloride (-) = ECF

In Summary
Acids are hydrogen donors. Examples are carbonic acid, lactic acid, ketoacid
Alkalis are hydorgen acceptors. Examples are bicarbonate, NaOH

In Summary
Our body fluid is regulated by many mechanisms and body systems: Kidney, Gastro-intestinal tract and Endocrine FLUID sources are INPUT coming from food, feeding and oral intake FLUID OUTPUT can occur through excretion of urine, sweat and feces. insensible losses are water vapor

In Summary
The HYPOTHALAMUS regulates intake via the thirst mechanism The KIDNEY regulates output via urine formation Other hormones include ADH, aldosterone and ANF

In Summary
Imbalances occur in the fluids and electrolytes:
Hyper if excess

Hypo if deficient

Imbalances occur in the Acids and bases:

Acidosis or Alkalosis Respiratory or Metabolic

Thank you!!!!