ANATOMY

AND
PHYSIOLOGY
MODULE 2
(Homeostasis)

Prepared by:
MARICEL L. DATOY, RN, MAN, LPT
Instructor

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Introduction:

Homeostasis, any self-regulating process by which biological systems tend to maintain stability
while adjusting to conditions that is optimal for survival. If homeostasis is
successful, life continues; if unsuccessful, disaster or death ensues. The stability attained is
actually a dynamic equilibrium, in which continuous change occurs yet relatively uniform
conditions prevail.
Any system in dynamic equilibrium tends to reach a steady state, a balance that resists outside
forces of change. When such a system is disturbed, built-in regulatory devices respond to the
departures to establish a new balance; such a process is one of feedback control. All processes
of integration and coordination of function, whether mediated by electrical circuits or
by nervous and hormonal systems, are examples of homeostatic regulation.

Objectives:

At the end of this lesson, you should be able to:

1. Define Homeostasis
2. Be able to give the percentage value of Total Body Water (TBW).
3. Enumerate the factors of TBW
4. Give the 2 major fluid Compartments
5. Enumerate the sub compartments of Extracellular Fluid (ECF) and give a brief
description of each.
6. Discuss the ionic composition of the body and give the elements for Anions & Cations.
7. State the 2 process by which water moves from 1 compartment to another within the
body
8. Discuss the factors causing marked changes in Intracellular Fluid (ICF) and Extracellular
Fluid
9. State and define Electrolyte Imbalances.
10. Discuss the water balance
11. Discuss Insensible water loss.
12. Enumerate Volume abnormalities and the general signs of dehydration.

Definition of Terms:

Homeostasis: is the ability to maintain a relatively stable internal state, physical, and chemical
conditions maintained by living systems.
Intracellular Fluid: (ICF) compartment is the system that includes all fluid enclosed in cells
by their plasma membranes.
Extracellular Fluid: fluid pertains to all body fluid outside the cell(s)
Plasma: is the clear, straw-colored liquid portion of blood that remains after red blood cells,
white blood cells, platelets and other cellular components are removed. It is the single

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 largest component of human blood, comprising about 55 percent, and contains water,
salts, enzymes, antibodies and other proteins.
Blood volume: refers to the total amount of fluid circulating within the arteries, capillaries,
veins, venules, and chambers of the heart at any time.
Interstitial Fluid: is a thin layer of fluid which surrounds the body's cells.
Trancellular fluid: is the portion of total body water contained within epithelial-lined spaces.
Cations: are ions with a net positive charge.
Anions: are ions with a net negative charge
Filtration: is a unit operation used to separate insoluble solids from liquids.
Osmosis: a process by which molecules of a solvent to pass through a semipermeable
membrane from a less concentrated solution into a more concentrated one, equalizing
the concentrations on each side of the membrane
Electrolytes: are minerals in your blood and other body fluids that carry an electric charge

Discussion:

Homeostatic Mechanism
The term homeostasis is used by physiologists to mean maintenance of nearly constant
conditions in the internal environment. Essentially all organs and tissues of the body perform
functions that help maintain these constant conditions. (Guyton 2006)

The maintenance of a relatively constant volume and a stable composition of the body
fluids is essential for homeostasis, some of the most common and important problems in clinical
medicine arise because of abnormalities in the control systems that maintain this constancy of the
body fluids. In this module the overall regulation of body fluid volume, constituents of the
extracellular fluid, acid-base balance, and control is discussed.

Total Body Water

Total body water on lean adult, body fluids constitute between 55% and 60% of total
body mass in females and males, respectively (Figure 27.1). Body fluids are present in two main
―compartments‖—inside cells and outside cells. Water is by far the largest single component of
the body, making up 45–75% of total body mass, depending on age and gender.

Body Fluid Compartments

Intracellular Fluid (ICF) (intra- within) or cytosol, the fluid within cells, contains two-thirds
of body fluid
 intracellular fluid differs significantly from the extracellular fluid;
specifically, it contains large amounts of potassium, magnesium, and
phosphate ions

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  Special mechanisms for transporting ions through the cell membranes
maintain the ion concentration differences between the extracellular and
intracellular fluids.
Extracellular fluid (ECF) (extra- outside), is outside cells and includes all other body fluids,
about other third of body fluid.
 -extracellular fluid is in constant motion throughout the body.
 -it is transported rapidly in the circulating blood and then mixed between the
blood and the tissue
 contains large amounts of sodium, chloride, and bicarbonate ions plus
nutrients for the cells, such as oxygen, glucose, fatty acids, and amino acids.
 also contains carbon dioxide that is being transported from the cells to the
lungs to be excreted, plus other cellular waste products that are being
transported to the kidneys for excretion.
Interstitial Fluid (inter- between), which occupies the microscopic spaces between
tissue cells about 80% of the ECF
Plasma- the liquid portion of the blood about 20% of the ECF
Other extracellular fluids that are grouped with interstitial fluid include:
(a) lymph in lymphatic vessels
(b) cerebrospinal fluid in the nervous system;
(c) synovial fluid in joints
(d) aqueous humor and vitreous body in the eyes
(f) endolymph and perilymph in the ears
(g) pleural, pericardial, and peritoneal fluids between serous membranes.

Movement of Water between Body Fluid Compartments

Normally, cells neither shrink nor swell because intracellular and interstitial fluids have
the same osmolarity. Changes in the osmolarity of interstitial fluid, however, cause fluid
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imbalances. An increase in the osmolarity of interstitial fluid draws water out of cells, and they
shrink slightly. A decrease in the osmolarity of interstitial fluid, by contrast, causes cells to swell.

Isotonic, Hypotonic, and Hypertonic Fluids.

The effects of different concentrations of impermeant solutes in the extracellular fluid on
cell volume are shown in Figure 25–5. If a cell is placed in a solution of impermeate solutes
having an osmolarity of 282 mOsm/L, the cells will not shrink or swell because the water
concentration in the intracellular and extracellular fluids is equal and the solutes cannot enter or
leave the cell. Such a solution is said to be isotonic because it neither shrinks
nor swells the cells.

Examples of isotonic solutions include a 0.9 per cent solution of sodium chloride or a
5 per cent glucose solution. These solutions are important in clinical medicine because they can
be infused into the blood without the danger of upsetting osmotic equilibrium between the
intracellular and extracellular fluids.

If a cell is placed into a hypotonic solution that has a lower concentration of impermeant
solutes (less than 282 mOsm/L), water will diffuse into the cell, causing it to swell; water will
continue to diffuse into the cell, diluting the intracellular fluid while also concentrating
the extracellular fluid until both solutions have about the same osmolarity. Solutions of sodium
chloride with a concentration of less than 0.9 per cent are hypotonic and cause cells to swell.
higher concentration of impermeant solutes, water will flow out of the cell into the extracellular
fluid, concentrating the intracellular fluid and diluting the extracellular fluid. In this case, the cell
will shrink until the two concentrations become equal. Sodium chloride solutions of greater than
0.9 per cent are hypertonic.

Isosmotic, Hyperosmotic, and Hypo-osmotic Fluids.

The terms isotonic, hypotonic, and hypertonic refer to whether solutions will cause a
change in cell volume. The tonicity of solutions depends on the concentration of impermeant
solutes. Some solutes, however, can permeate the cell membrane. Solutions with an osmolarity
the same as the cell are called isosmotic, regardless of whether the solute can penetrate the cell
membrane.

The terms hyperosmotic and hypo-osmotic refer to solutions that have a higher or lower
osmolarity, respectively, compared with the normal extracellular fluid, without regard for
whether the solute permeates the cell membrane. Highly permeating substances, such as urea,
can cause transient shifts in fluid volume between the intracellular and extracellular fluids, but
given enough time, the concentrations of these substances eventually become equal in the two
compartments and have little effect on intracellular volume under steady-state conditions.

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Water Balance
On a typical day, the average adult will take in about 2500 mL (almost 3 quarts) of
aqueous fluids. Although most of the intake comes through the digestive tract, about 230 mL (8
ounces) per day is generated metabolically, in the last steps of aerobic respiration. Additionally,
each day about the same volume (2500 mL) of water leaves the body by different routes; most of
this lost water is removed as urine. The kidneys also can adjust blood volume though
mechanisms that draw water out of the filtrate and urine. The kidneys can regulate water levels
in the body; they conserve water if you are dehydrated, and they can make urine more dilute to
expel excess water if necessary. Water is lost through the skin through evaporation from the skin
surface without overt sweating and from air expelled from the lungs. This type of water loss is
called insensible water loss because a person is usually unaware of it.

Regulation of Water Intake

Osmolality is the ratio of
solutes in a solution to a volume of
solvent in a solution. Plasma
osmolality is thus the ratio of solutes
to water in blood plasma. A person’s
plasma osmolality value reflects his
or her state of hydration. A healthy
body maintains plasma osmolality
within a narrow range, by employing
several mechanisms that regulate both
water intake and output.

Drinking water is considered

voluntary. So how is water intake
regulated by the body? Consider
someone who is experiencing
dehydration, a net loss of water that
results in insufficient water in blood
and other tissues. The water that
leaves the body, as exhaled air, sweat,
or urine, is ultimately extracted from
blood plasma. As the blood becomes
more concentrated, the thirst
response—a sequence of
physiological processes—is triggered.

Osmoreceptors are sensory

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receptors in the thirst center in the hypothalamus that monitor the concentration of solutes
(osmolality) of the blood. If blood osmolality increases above its ideal value, the hypothalamus
transmits signals that result in a conscious awareness of thirst. The person should (and normally
does) respond by drinking water. The hypothalamus of a dehydrated person also releases
antidiuretic hormone (ADH) through the posterior pituitary gland. ADH signals the kidneys to
recover water from urine, effectively diluting the blood plasma. To conserve water, the
hypothalamus of a dehydrated person also sends signals via the sympathetic nervous system to
the salivary glands in the mouth. The signals result in a decrease in watery, serous output (and an
increase in stickier, thicker mucus output). These changes in secretions result in a ―dry mouth‖
and the sensation of thirst.

This figure is a top-to bottom flowchart

describing the thirst response. The topmost box of
the chart states that there is insufficient water in the
body, which has two effects. The left branch of the
chart leads to decreased blood volume, which leads
to decreased blood pressure. This triggers an
increase in angiotensin two. Angiotensin two
stimulates the thirst center in the hypothalamus. On
the right branch, insufficient water in the body
leads to increased blood osmolality, which causes
dry mouth. Increased blood osmolality and dry
mouth is sensed by osmoreceptors in the
hypothalamus. This stimulates the thirst center in
the hypothalamus to increase thirst, giving a person
the urge to drink. Drinking decreases blood
osmolality back to homeostatic levels.

Figure 1.. The thirst response begins

when osmoreceptors detect a decrease in
water levels in the blood.

Decreased blood volume resulting from

water loss has two additional effects. First,
baroreceptors, blood-pressure receptors in the arch
of the aorta and the carotid arteries in the neck,
detect a decrease in blood pressure that results
from decreased blood volume. The heart is
ultimately signaled to increase its rate and/or
strength of contractions to compensate for the

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lowered blood pressure.
Second, the kidneys have a renin-angiotensin hormonal system that increases the
production of the active form of the hormone angiotensin II, which helps stimulate thirst, but
also stimulates the release of the hormone aldosterone from the adrenal glands. Aldosterone
increases the reabsorption of sodium in the distal tubules of the nephrons in the kidneys, and
water follows this reabsorbed sodium back into the blood.

If adequate fluids are not consumed, dehydration results and a person’s body contains too
little water to function correctly. A person who repeatedly vomits or who has diarrhea may
become dehydrated, and infants, because their body mass is so low, can become dangerously
dehydrated very quickly. Endurance athletes such as distance runners often become dehydrated
during long races. Dehydration can be a medical emergency, and a dehydrated person may lose
consciousness, become comatose, or die, if his or her body is not rehydrated quickly.

Regulation of Water Output

Water loss from the body occurs predominantly through the renal system. A person
produces an average of 1.5 liters (1.6 quarts) of urine per day. Although the volume of urine
varies in response to hydration levels, there is a minimum volume of urine production required
for proper bodily functions. The kidney excretes 100 to 1200 milliosmoles of solutes per day to
rid the body of a variety of excess salts and other water-soluble chemical wastes, most notably
creatinine, urea, and uric acid.
Failure to produce the minimum volume of urine means that metabolic wastes cannot be
effectively removed from the body, a situation that can impair organ function. The minimum
level of urine production necessary to maintain normal function is about 0.47 liters (0.5 quarts)
per day.

The kidneys also must make adjustments in the event of ingestion of too much fluid.
Diuresis, which is the production of urine in excess of normal levels, begins about 30 minutes
after drinking a large quantity of fluid. Diuresis reaches a peak after about 1 hour, and normal
urine production is reestablished after about 3 hours.

Role of ADH
This set of diagrams shows the effects of ADH on various structures within the body. In
the brain, ADH affects the cerebrum by influencing social behavior in some mammals. ADH is
also produced in the brain by the hypothalamus and released in the posterior pituitary. ADH also
constricts arterioles in the body, which are the small arteries that enter into capillary beds.
Finally, a kidney is shown because ADH increases the reabsorption of water in the kidneys.
Figure 2. ADH is produced in the hypothalamus and released by the posterior pituitary
gland. It causes the kidneys to retain water, constricts arterioles in the peripheral circulation, and
affects some social behaviors in mammals.

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 Antidiuretic hormone (ADH), also known as vasopressin, controls the amount of water
reabsorbed from the collecting ducts and tubules in the kidney. This hormone is produced in the
hypothalamus and is delivered to the posterior pituitary for storage and release (Figure 2.). When
the osmoreceptors in the hypothalamus detect an increase in the concentration of blood plasma,
the hypothalamus signals the release of ADH from the posterior pituitary into the blood.
ADH has two major effects. It constricts the arterioles in the peripheral circulation, which
reduces the flow of blood to the extremities and thereby increases the blood supply to the core of
the body.
ADH also causes the epithelial cells that line the renal collecting tubules to move
water channel proteins, called aquaporins,.from the interior of the cells to the apical surface,
where these proteins are inserted into the cell membrane. The result is an increase in the water
permeability of these cells and, thus, a large increase in water passage from the urine through the
walls of the collecting tubules, leading to more reabsorption of water into the bloodstream. When
the blood plasma becomes less concentrated and the level of ADH decreases, aquaporins are
removed from collecting tubule cell membranes, and the passage of water out of urine and into
the blood decreases.

This diagram depicts a cross

section of the right wall of a kidney
collecting tubule. The wall is
composed of three block-shaped cells
arranged vertically one on top of each
other. The lumen of the collecting
tubule is to the left of the three cells.
Yellow-colored urine is flowing
through the lumen. There is a small
strip of blue interstitial fluid to the
right of the three cells. To the right of
the interstitial fluid is a cross section
of a blood vessel. Arrows show that
water in the urine is entering the left
side of the wall cells through
aquaporins. The water travels through
the cells and then leaves the kidney
tubule through additional aquaporins
in the right side of the wall cells. The Figure 2. ADH is produced in the hypothalamus and released by the
water travels through the interstitial posterior pituitary gland. It causes the kidneys to retain water, constricts
space and enters into the blood in the arterioles in the peripheral circulation, and affects some social behaviors
in mammals
blood vessel. The aquaporins in the
wall cells are being released from aquaporin storage vesicles within their cytoplasm.

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 Figure 3. The binding of ADH to receptors on the cells of the collecting tubule results in
aquaporins being inserted into the plasma membrane, shown in the lower cell. This dramatically
increases the flow of water out of the tubule and into the bloodstream.
A diuretic is a compound that increases urine output and therefore decreases water
conservation by the body. Diuretics are used to treat hypertension, congestive heart failure, and
fluid retention associated with menstruation. Alcohol acts as a diuretic by inhibiting the release
of ADH. Additionally, caffeine, when consumed in high concentrations, acts as a diuretic.

SAQ #1: 1. Describe the effect of ADH on renal collecting tubules. (5 points of class standing)
ASAQ#1________________________________________________________________
SAQ #2: 2.Why is it important for the amount of water intake to equal the amount of water output?
(5 points of class standing)
ASAQ#2________________________________________________________________

Electrolytes in Body Fluids

The ions formed when electrolytes dissolve and dissociate have four general functions in the
body.
(1) Ions particular fluid compartments control the osmosis of water between fluid
compartments are more numerous than nonelectrolytes.
(2) Ions help maintain the acid– base balance required for normal cellular activities.
(3) Ions carry electrical current, which allows production of action potentials and
graded potentials.
(4) Several ions serve as cofactors needed for optimal activity of enzymes.

The body contains a large variety of ions, or electrolytes, which perform a variety of
functions. Some ions assist in the transmission of electrical impulses along cell membranes in
neurons and muscles. Other ions help to stabilize protein structures in enzymes. Still others aid in
releasing hormones from endocrine glands. All of the ions in plasma contribute to the osmotic
balance that controls the movement of water between cells and their environment.
Electrolytes in living systems include sodium, potassium, chloride, bicarbonate, calcium,
phosphate, magnesium, copper, zinc, iron, manganese, molybdenum, copper, and chromium. In
terms of body functioning, six electrolytes are most important: sodium, potassium, chloride,
bicarbonate, calcium, and phosphate.

Roles of Electrolytes
These six ions aid in nerve excitability, endocrine secretion, membrane permeability, buffering
body fluids, and controlling the movement of fluids between compartments. These ions enter the
body through the digestive tract. More than 90 percent of the calcium and phosphate that enters

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the body is incorporated into bones and teeth, with bone serving as a mineral reserve for these
ions. In the event that calcium and phosphate are needed for other functions, bone tissue can be
broken down to supply the blood and other tissues with these minerals. Phosphate is a normal
constituent of nucleic acids; hence, blood levels of phosphate will increase whenever nucleic
acids are broken down.
Excretion of ions occurs mainly through the kidneys, with lesser amounts lost in sweat
and in feces. Excessive sweating may cause a significant loss, especially of sodium and chloride.
Severe vomiting or diarrhea will cause a loss of chloride and bicarbonate ions. Adjustments in
respiratory and renal functions allow the body to regulate the levels of these ions in the ECF.
The following table lists the reference values for blood plasma, cerebrospinal fluid (CSF),
and urine for the six ions addressed in this section. In a clinical setting, sodium, potassium, and
chloride are typically analyzed in a routine urine sample. In contrast, calcium and phosphate
analysis requires a collection of urine across a 24-hour period, because the output of these ions
can vary considerably over the course of a day. Urine values reflect the rates of excretion of
these ions. Bicarbonate is the one ion that is not normally excreted in urine; instead, it is
conserved by the kidneys for use in the body’s buffering systems.

Sodium
Sodium is the major cation of the extracellular fluid. It is responsible for one-half of the
osmotic pressure gradient that exists between the interior of cells and their surrounding
environment. People eating a typical Western diet, which is very high in NaCl, routinely take in
130 to 160 mmol/day of sodium, but humans require only 1 to 2 mmol/day. This excess sodium
appears to be a major factor in hypertension (high blood pressure) in some people. Excretion of
sodium is accomplished primarily by the kidneys. Sodium is freely filtered through the
glomerular capillaries of the kidneys, and although much of the filtered sodium is reabsorbed in
the proximal convoluted tubule, some remains in the filtrate and urine, and is normally excreted.
 Hyponatremia is a lower-than-normal concentration of sodium, usually associated with
excess water accumulation in the body, which dilutes the sodium. An absolute loss of
sodium may be due to a decreased intake of the ion coupled with its continual excretion
in the urine. An abnormal loss of sodium from the body can result from several
conditions, including excessive sweating, vomiting, or diarrhea; the use of diuretics;
excessive production of urine, which can occur in diabetes; and acidosis, either metabolic
acidosis or diabetic ketoacidosis.
A relative decrease in blood sodium can occur because of an imbalance of sodium in one
of the body’s other fluid compartments, like IF, or from a dilution of sodium due to water
retention related to edema or congestive heart failure. At the cellular level, hyponatremia results
in increased entry of water into cells by osmosis, because the concentration of solutes within the
cell exceeds the concentration of solutes in the now-diluted ECF. The excess water causes
swelling of the cells; the swelling of red blood cells—decreasing their oxygen-carrying

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efficiency and making them potentially too large to fit through capillaries—along with the
swelling of neurons in the brain can result in brain damage or even death.
 Hypernatremia is an abnormal increase of blood sodium. It can result from water loss
from the blood, resulting in the hemoconcentration of all blood constituents. Hormonal
imbalances involving ADH and aldosterone may also result in higher-than-normal
sodium values.

Potassium
Potassium is the major intracellular cation. It helps establish the resting membrane
potential in neurons and muscle fibers after membrane depolarization and action potentials. In
contrast to sodium, potassium has very little effect on osmotic pressure. The low levels of
potassium in blood and CSF are due to the sodium-potassium pumps in cell membranes, which
maintain the normal potassium concentration gradients between the ICF and ECF. The
recommendation for daily intake/consumption of potassium is 4700 mg. Potassium is excreted,
both actively and passively, through the renal tubules, especially the distal convoluted tubule and
collecting ducts. Potassium participates in the exchange with sodium in the renal tubules under
the influence of aldosterone, which also relies on basolateral sodium-potassium pumps.

 Hypokalemia is an abnormally low potassium blood level. Similar to the situation with
hyponatremia, hypokalemia can occur because of either an absolute reduction of
potassium in the body or a relative reduction of potassium in the blood due to the
redistribution of potassium. An absolute loss of potassium can arise from decreased
intake, frequently related to starvation. It can also come about from vomiting, diarrhea, or
alkalosis.
Some insulin-dependent diabetic patients experience a relative reduction of potassium in
the blood from the redistribution of potassium. When insulin is administered and glucose is taken
up by cells, potassium passes through the cell membrane along with glucose, decreasing the
amount of potassium in the blood and IF, which can cause hyperpolarization of the cell
membranes of neurons, reducing their responses to stimuli.

 Hyperkalemia, an elevated potassium blood level, also can impair the function of
skeletal muscles, the nervous system, and the heart. Hyperkalemia can result from
increased dietary intake of potassium. In such a situation, potassium from the blood ends
up in the ECF in abnormally high concentrations. This can result in a partial
depolarization (excitation) of the plasma membrane of skeletal muscle fibers, neurons,
and cardiac cells of the heart, and can also lead to an inability of cells to repolarize. For
the heart, this means that it won’t relax after a contraction, and will effectively ―seize‖
and stop pumping blood, which is fatal within minutes. Because of such effects on the
nervous system, a person with hyperkalemia may also exhibit mental confusion,
numbness, and weakened respiratory muscles.

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Chloride
Chloride is the predominant extracellular anion. Chloride is a major contributor to the
osmotic pressure gradient between the ICF and ECF, and plays an important role in maintaining
proper hydration. Chloride functions to balance cations in the ECF, maintaining the electrical
neutrality of this fluid. The paths of secretion and reabsorption of chloride ions in the renal
system follow the paths of sodium ions.
 Hypochloremia, or lower-than-normal blood chloride levels, can occur because of
defective renal tubular absorption. Vomiting, diarrhea, and metabolic acidosis can also
lead to hypochloremia.
 Hyperchloremia, or higher-than-normal blood chloride levels, can occur due to
dehydration, excessive intake of dietary salt (NaCl) or swallowing of sea water, aspirin
intoxication, congestive heart failure, and the hereditary, chronic lung disease, cystic
fibrosis. In people who have cystic fibrosis, chloride levels in sweat are two to five times
those of normal levels, and analysis of sweat is often used in the diagnosis of the disease.

Bicarbonate
Bicarbonate is the second most abundant anion in the blood. Its principal function is to
maintain your body’s acid-base balance by being part of buffer systems. This role will be
discussed in a different section.
Bicarbonate ions result from a chemical reaction that starts with carbon dioxide (CO 2)
and water, two molecules that are produced at the end of aerobic metabolism. Only a small
amount of CO2 can be dissolved in body fluids. Thus, over 90 percent of the CO 2 is converted
into bicarbonate ions, HCO3–, through the following reactions:
CO2+ H 2 ↔ H2 + CO3 ↔ H2 + CO3− + H +
The bidirectional arrows indicate that the reactions can go in either direction, depending
on the concentrations of the reactants and products. Carbon dioxide is produced in large amounts
in tissues that have a high metabolic rate. Carbon dioxide is converted into bicarbonate in the
cytoplasm of red blood cells through the action of an enzyme called carbonic anhydrase.
Bicarbonate is transported in the blood. Once in the lungs, the reactions reverse direction, and
CO2 is regenerated from bicarbonate to be exhaled as metabolic waste.

Calcium
About two pounds of calcium in your body are bound up in bone, which provides
hardness to the bone and serves as a mineral reserve for calcium and its salts for the rest of the
tissues. Teeth also have a high concentration of calcium within them. A little more than one-half
of blood calcium is bound to proteins, leaving the rest in its ionized form. Calcium ions, Ca 2+,
are necessary for muscle contraction, enzyme activity, and blood coagulation. In addition,
calcium helps to stabilize cell membranes and is essential for the release of neurotransmitters
from neurons and of hormones from endocrine glands.

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 Calcium is absorbed through the intestines under the influence of activated vitamin D. A
deficiency of vitamin D leads to a decrease in absorbed calcium and, eventually, a depletion of
calcium stores from the skeletal system, potentially leading to rickets in children and
osteomalacia in adults, contributing to osteoporosis.
 Hypocalcemia, or abnormally low calcium blood levels, is seen in hypoparathyroidism,
which may follow the removal of the thyroid gland, because the four nodules of the
parathyroid gland are embedded in it. Hypercalcemia, or abnormally high calcium blood
levels, is seen in primary hyperparathyroidism. Some malignancies may also result in
hypercalcemia.

Phosphate
Phosphate is present in the body in three ionic forms:
The most common form is (1) H2PO4- Dihydrogen phosphate (2) HPO42- Hydrogen Phosphate
(3) PO4 3- Phosphate ion
Bone and teeth bind up 85 percent of the body’s phosphate as part of calcium-phosphate
salts. Phosphate is found in phospholipids, such as those that make up the cell membrane, and in
ATP, nucleotides, and buffers.
 Hypophosphatemia, or abnormally low phosphate blood levels, occurs with heavy use of
antacids, during alcohol withdrawal, and during malnourishment. In the face of phosphate
depletion, the kidneys usually conserve phosphate, but during starvation, this
conservation is impaired greatly.
 Hyperphosphatemia, or abnormally increased levels of phosphates in the blood, occurs if
there is decreased renal function or in cases of acute lymphocytic leukemia. Additionally,
because phosphate is a major constituent of the ICF, any significant destruction of cells
can result in dumping of phosphate into the ECF.

Regulation of Sodium and Potassium

Sodium is reabsorbed from the renal filtrate, and

potassium is excreted into the filtrate in the renal collecting
tubule. The control of this exchange is governed
principally by two hormones—aldosterone and angiotensin
II.
Aldosterone
Figure 1. Aldosterone, which is released by the adrenal
gland, facilitates reabsorption of Na + and thus
the reabsorption of water.
Recall that aldosterone increases the excretion of
potassium and the reabsorption of sodium in the distal
tubule. Aldosterone is released if blood levels of potassium

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increase, if blood levels of sodium severely decrease, or if blood pressure decreases. Its net effect
is to conserve and increase water levels in the plasma by reducing the excretion of sodium, and
thus water, from the kidneys. In a negative feedback loop, increased osmolality of the ECF
(which follows aldosterone-stimulated sodium absorption) inhibits the release of the hormone.
Angiotensin II
Angiotensin II causes vasoconstriction and an increase in systemic blood pressure. This
action increases the glomerular filtration rate, resulting in more material filtered out of the
glomerular capillaries and into Bowman’s capsule. Angiotensin II also signals an increase in the
release of aldosterone from the adrenal cortex.

In the distal convoluted tubules and collecting ducts of the kidneys, aldosterone
stimulates the synthesis and activation of the sodium-potassium pump. Sodium passes from the
filtrate, into and through the cells of the tubules and ducts, into the ECF and then into capillaries.
Water follows the sodium due to osmosis. Thus, aldosterone causes an increase in blood sodium
levels and blood volume. Aldosterone’s effect on potassium is the reverse of that of sodium;
under its influence, excess potassium is pumped into the renal filtrate for excretion from the
body.

Figure 2. Angiotensin II stimulates the release of aldosterone from the adrenal cortex.

Regulation of Calcium and Phosphate

Calcium and phosphate are both regulated through the actions of three hormones:
parathyroid hormone (PTH), dihydroxyvitamin D (calcitriol), and calcitonin. All three are
released or synthesized in response to the blood levels of calcium.
PTH is released from the parathyroid gland in response to a decrease in the concentration
of blood calcium. The hormone activates osteoclasts to break down bone matrix and release
inorganic calcium-phosphate salts. PTH also increases the gastrointestinal absorption of dietary
calcium by converting vitamin D into dihydroxyvitamin D (calcitriol), an active form of vitamin
D that intestinal epithelial cells require to absorb calcium.
MARICEL L. DATOY, RN, MAN, LPT
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 PTH raises blood calcium levels by inhibiting the loss of calcium through the kidneys.
PTH also increases the loss of phosphate through the kidneys.
Calcitonin is released from the thyroid gland in response to elevated blood levels of
calcium. The hormone increases the activity of osteoblasts, which remove calcium from the
blood and incorporate calcium into the bony matrix.

SAQ #3. Describe the effect of ADH on renal collecting tubules. (5 points of class standing)
ASAQ#3________________________________________________________________
SAQ #4.Why is it important for the amount of water intake to equal the amount of water output?
(5 points of class standing)
ASAQ#4________________________________________________________________

Summary:

 Homeostasis requires that water intake and output be balanced. Most water intake comes
through the digestive tract via liquids and food, but roughly 10 percent of water available
to the body is generated at the end of aerobic respiration during cellular metabolism.
Urine produced by the kidneys accounts for the largest amount of water leaving the body.
The kidneys can adjust the concentration of the urine to reflect the body’s water needs,
conserving water if the body is dehydrated or making urine more dilute to expel excess
water when necessary. ADH is a hormone that helps the body to retain water by
increasing water reabsorption by the kidneys.
 Electrolytes serve various purposes, such as helping to conduct electrical impulses along
cell membranes in neurons and muscles, stabilizing enzyme structures, and releasing
hormones from endocrine glands. The ions in plasma also contribute to the osmotic
balance that controls the movement of water between cells and their environment.
Imbalances of these ions can result in various problems in the body, and their
concentrations are tightly regulated. Aldosterone and angiotensin II control the exchange
of sodium and potassium between the renal filtrate and the renal collecting tubule.
Calcium and phosphate are regulated by PTH, calcitrol, and calcitonin.

References:
1. Kevin Patton, Essentials of Anatomy & Physiology 5 th Edition, McGraw-Hill Edition
2. Anatomy and Physiology, Open Stax, Rice University, 2013
3. Hole’s Human Anatomy & Physiology 11th Edition, McGraw-Hill Higher Edition
4. Elaine N. Marieb, Essentials of Human Anatomy and Physiology 10th Edition, Pearson
Education Inc., 2012

MARICEL L. DATOY, RN, MAN, LPT

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