COMPOSITION OF FLUID &

ELECTROLYTES
Editor:
dr. Husnil Kadri, M.Kes

Biochemistry Departement
Medical Faculty Of Andalas University
Padang
Electrolyte Composition of Body Fluids
 Electrolyte Composition of Body Fluid
Electolyte Plasma(mEq/L Interstetiel Intracelluler
(mEq/KgH2o) (mEq/KgH2o)
Cation:
Na+ 142 145 10
K+ 4 4 159
Ca2+ 5 3 1
Mg2+ 2 2 40
Total 153 154 210
Anion:
Cl- 103 117 3

HCO3- 25 28 7
Protein 17 - 45
Others 8 9 155
Total 153 154 210
 Electrolyte Balance
• Electrolytes are salts, acids, and bases,
but electrolyte balance usually refers only
to salt balance
• Salts are important for:
– Neuromuscular excitability
– Secretory activity
– Membrane permeability
– Controlling fluid movements
• Salts enter the body by ingestion and are
lost via perspiration, feces, and urine
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 THE MAJOR COMPOSITION
OF ECF & ICF
ICF (mEq/L) ECF (mEq/L)
Sodium 20 135 - 145
Potassium 150 3- 5
Chloride --- 98 - 110
Bicarbonate 10 20 - 25
Phosphate 110-115 5
Protein 75 10

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 Sodium in Fluid and Electrolyte
Balance
• Sodium holds a central position in fluid and
electrolyte balance
• Sodium salts:
– Account for 90-95% of all solutes in the ECF
– Contribute 280 mOsm of the total 300 mOsm
ECF solute concentration
• Sodium is the single most abundant cation in
the ECF
• Sodium is the only cation exerting significant
osmotic pressure
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Sodium in Fluid and Electrolyte Balance

• Changes in plasma sodium levels affect:

– Plasma volume, blood pressure
– ICF and interstitial fluid volumes
• Renal acid-base control mechanisms are
coupled to sodium ion transport

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 Regulation of Sodium Balance:
Aldosterone
• Adrenal cortical cells are directly
stimulated to release aldosterone by
elevated K+ levels in the ECF
• Aldosterone brings about its effects
(diminished urine output and increased
blood volume) slowly
 Sodium (Na+)

Key role (s): plasma osmolality and water balance

Regulation: Thirst
Kidney
Na+/K+ ATPase pumps
Na+/H+ pumps
Blood volume status
 ADH (saves water) when  blood volume
 aldosterone (saves salt) when  Na+ ( renin)

Clinical: Na disorders = water disorders

Hyponatremia
Hypernatremia
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 Hyponatremia

Sodium and/or Water

Symptoms Possible causes

nausea/vomiting excessive renal loss of salt
weakness (aldosterone deficiency)
mental confusion excessive ADH secretion
headache water overload
possible coma if too (congestive heart failure)
low

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 Hypernatremia

Sodium and/or Water

Symptoms Possible causes

dehydration extrarenal loss (diarrhea)
thirst renal losses ( water intake)
fever impaired secretion or ability to
tremors respond to ADH (diabetes insipidus)
lethargy excessive water loss
seizures hyperaldosteronism
coma

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 Potassium (K+)

Key role (s): Regulate cardiac contraction and rhythm,

muscle contraction

Regulation: Kidneys
Na+/K+ -ATPase pump
Acid/Base balance (i.e., K+/H+ pumps)
 Aldosterone results in  K+ excretion and
shift extracellular to intracellular.

Clinical: Hypokalemia
Hyperkalemia

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 Hypokalemia

Potassium and/or Water

Symptom Possible Causes

weakness extra -> intracellular shifts
fatigue (alkalosis, diuretics)
anorexia extrarenal losses
nausea (excessive diarrhea)
arrhythmia renal losses
cardiac arrest (renal disease)
hyperaldosteronism

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 Hyperkalemia

Potassium and/or Water

Symptoms Possible Causes

muscular weakness intra -> extracellular shifts
tingling (acidosis)
numbness renal disfunction
confusion (K+ secretion deficiency)
cardiac arrhythmias adrenal disfunction
cardiac arrest (hypoaldosteronism)
leukemia
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 Calcium (Ca2+)

Key role (s): primarily resides in bone, muscular contraction,

neurotransmission, membrane transport,
enzymes, and blood coagulation

Regulation: Kidney (reabsorbed in the proximal tubules)

Parathyroid hormone (PTH)
Vitamin D – active form controls homeostasis
Calcitonin – exact mechanism not known
Clinical: Hypocalcemia – hypoparathyroidism
Hypercalcemia – hyperparathyroidism

Serum Calcium = Ca2+ionized (45%) + Caprotein-bound (45%)

+ Cacomplexed to anions (10%)
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 Magnesium (Mg2+)

Key role (s): enzyme cofactor; calcium and bone homeostasis

Regulation: Kidney
 PTH,  serum Mg2+
aldosterone

Clinical: hypomagnesemia – decreased intake

- increased loss

hypermagnesemia – usually increased intake of

magnesium or renal disease

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 Chloride (Cl-)

Key role (s): Maintains osmolality, blood volume, electric

neutrality

Regulation: kidneys (reabsorbed in the proximal tubules)

aldosterone

Clinical: Hypochloremia – similar causes as hyponatremia,

prolonged vomiting, high [bicarbonate] associated
metabolic alkalosis

Hyperchloremia – similar causes as hypernatremia,

dehydration, low [bicarbonate] associated with
prolonged diarrhea or metabolic acidosis
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 Bicarbonate (HCO3-)

Key role (s): determines pH (along with H+); buffering

the blood and maintaining acid/base equilibrium

Regulation: kidneys (reabsorption in the tubules)

lungs

Clinical: Acid/Base disorders

CO2 + H2O  H2CO3  HCO3- + H+

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Calcium, phosphate, and magnesium metabolism
 Protein Imbalances
• Plasma proteins(especially albumin) are
important determinants of plasma volume

• Hyperproteinemia is rare
– Occurs with dehydration-induced
hemoconcentration

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 Hypoproteinemia
• Caused by
– Anorexia
– Malnutrition
– Starvation
– Fat dieting
– Poorly balanced vegetarian diets

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 Hypoproteinemia:
Clinical Manifestations
• Edema (b/c insufficient oncotic pressure to “hold” water in
vascular space)

• Slow healing
• Anorexia
• Fatigue
• Anemia
• Muscle loss
• Ascites (same reason as edema)
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 Components of Whole Blood

Plasma
(55% of whole blood)

Buffy coat:
leukocyctes and
platelets
(<1% of whole blood) Formed
elements
Erythrocytes
1 Withdraw blood 2 Centrifuge (45% of whole blood)
and place in tube

• Hematocrit
• Males: 47% ± 5%
• Females: 42% ± 5%
 Blood Plasma
• Blood plasma components:
– Water = 90-92%
– Proteins = 6-8%
– Organic nutrients – glucose, carbohydrates,
amino acids
– Electrolytes – sodium, potassium, calcium,
chloride, bicarbonate
– Nonprotein nitrogenous substances – lactic acid,
urea, creatinine
– Respiratory gases – oxygen and carbon dioxide
 Formed Elements
• Formed elements comprise 45% of
blood
• Erythrocytes, leukocytes, and platelets
make up the formed elements
– Only WBCs are complete cells
– RBCs have no nuclei or organelles, and
platelets are just cell fragments
• Most blood cells do not divide but are
renewed by cells in bone marrow
 NON-ELECTROLYTES
Ureum
• Kadar ureum serum mencerminkan
keseimbangan antara produksi dan
ekskresi.
• Peningkatan kadar ureum disebut uremia.
• Uremia prerenal perombakan protein
meningkat .
• Uremia renal  gagal ginjal.
• Uremia postrenal  obstruksi saluran urin
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 NON-ELECTROLYTES

• Di Amerika Serikat, kadar nitrogen ditetap-

kan sebagai Blood Urea Nitrogen (BUN).
• Nilai BUN serum normal = 8 – 25 mg/dl.
• Nitrogen menyusun 28/60 dari berat ureum.
• Kadar ureum dapat dihitung dari BUN dgn
menggunakan perkalian 2,14.

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 NON-ELECTROLYTES

Kreatinin
• Adalah produk akhir dari metabolisme
kreatin.
• Kreatin terdapat hampir di semua otot
rangka berupa fosfokreatin.
• Sebagian kecil kreatin berubah menjadi
kreatinin.

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 NON-ELECTROLYTES

• Kreatinin ini akan dibawa ke ginjal.

• Kadar kreatinin sebanding dengan massa
otot rangka.
• Kegiatan otot tidak banyak berpengaruh.
• Kadar pada pria = 0,6 – 1,3 mg/dl sedang-
kan pada wanita = 0,5 – 1 mg/dl
• Kreatinin serum meningkat pada gagal
ginjal
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 NON-ELECTROLYTES

• Kadar BUN yang meningkat, tetapi kadar

kreatinin serum normal berarti uremia non-
renal.
• Kalau kreatinin serum sangat meningkat,
maka akan diekskresi melalui saluran
cerna.

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 Reference

1. Beaudoin, D. Electrolytes and ion sensitive

electrodes. PPT. 2003.
2. Kersten. Fluid and electrolytes. PPT.
3. Marieb, EN. Fluid, electrolyte, and acid-base
balance. PPT. Pearson Education, Inc. 2004
4. Widmann, FK. Clinical Interpretation of
Laboratory Tests. 9th Ed. terjemahan

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