Cairan tubuh dan

elektrolit
Dr.H.Hasrul Han

Bag: Patologi klinik FK Unsri
Body Fluids - distribution
Body fluids constitute 55-
60% of body mass
Higher in males due to
greater muscle mass and
lower fat
Total body water declines
throughout life with
changes in muscle mass
and fat
Water occupies 2 main
fluid compartments:
Intracellular (~2/3 of
total water)
Extracellular (~1/3 total
water)
plasma (20%)
interstitial fluid (80%)

Water balance
Normally body fluid volume
remains constant
water loss = water gain
Water gain:
~60% ingested liquids
~30% ingested in foods
~10% metabolic water
(from oxidation)
Water loss:
~4% faeces
~28% insensible water loss
(skin & lungs)
~8% perspiration
~60% urine
Additional fluid loss in
menstrual flow in females of
reproductive age
Regulation of body water gain and
loss
Regulation of body water gain
depends mainly on regulating
volume of water intake
Thirst centre in hypothalamus
governs urge to drink
Thirst centre stimulated by :
Nerve impulses from
osmoreceptors in hypothalamus
in PV or in plasma osmolality
Hypothalamic osmoreceptors lose water
to plasma
Increased transmission of nerve
impulses to thirst centre
dry mouth and pharynx - less
saliva from blood plasma
in PV = BP
increased angiotensin II (via JGA)
stimulates thirst centre
Regulation of body water (and
solute) loss depends mainly on
urinary excretion
Fluid Balance
Water loss
Ambient air temperature
Solar and thermal radiation
Water vapor pressure (humidity)
Solutes and wastes to be excreted
Amount and timing of activity
Amount of water intake
Physiological, behavioral, and
anatomical adaptations to reduce
water loss

Insensible water loss
(unaware of)
Not precisely regulated

Evaporation (respiration and skin)

Independent of sweating
(anhydrosis)

Minimized by cholesterol-filled
cornified layer of skin (barrier)

Increase loss in burn patients (10x)







Sweating
Highly variable
Dependent on physical activity and
environment temperature
water intake via thirst mechanism
Loss via feces
Normally small amount
Severe during diarrhea

Water loss via kidney
The most important regulator of water and
electrolyte balance
Several mechanisms controlling the rate of
excretion
water excretion (dehydration), excretion
with increased intake (same for electrolyte)
Kidneys adjust the excretion rate to match
intake and disease state

Body Fluid Compartments
Extracellular
Interstitial fluid and plasma (non-
cellular part of blood)

Transcellular (specialized type of
extracellular fluid)
Cerebrospinal fluid, intraocular fluid,
GI tract, potential fluid (peritoneal,
joint space)

Intracellular



Fluid and
electrolytes
come into the
plasma then
redistribute to
the other fluid
compartments
over time.
Note also the
lymphatics as
a recirculator
of plasma
proteins
Body Fluid Compartments
Total body water - 50-60 % of body weight
decrease with age, gender and obesity

Intracellular water - 40% of body weight
75 trillion cells
Similar composition in different species

Extracellular water - 20% of body weight
% is important in fluid therapy
Transcellular accounts for ~ 1-2 liters
Plasma
Plasma is the liquid portion of the blood that is
separated from the blood cells by centrifugation.
One of the characteristics of plasma is that it clots
easily.
Serum plus clotting factors is plasma, and clotted
plasma yields serum (as an interesting aside,
"serum" is Latin for whey, the liquid portion of
clotted milk removed in making cheese).
Plasma
Exchanges substances with
interstitial fluid via pores of the
capillary membrane

Pores permeable to all solutes in
extracellular fluid, except proteins

Plasma have higher protein
concentration
Composition of extracellular and
intracellular fluids
These
represent the
non-
electrolytes in
the plasma.
They also
contribute
osmolarity to
the plasma or
extracellular
fluid.
Intracellular volume
Can not be measured directly
Calculated as Total body water -
Extracellular volume
Plasma volume
Indicator can not permeate capillary
membrane
Most common
125
I-albumin, also
Evans blue dye (T-1824)
Interstitial volume
Can not be measured directly
Calculated as Extracellular volume -
Plasma volume

Forces impacting fluid distribution
Plasma vs Interstitial Space
Balance between Hydrostatic and
Colloid Osmotic forces across the
capillary membranes

Intracellular vs Extracellular
Osmotic effect (e.g. electrolytes)


Osmosis
Osmosis is the net movement of
water molecules over a partially
permeable membrane from an area
of less osmotic potential to an area
of more negative osmotic potential.
Excessive loss of H
2
O from
ECF
1
2
3 ECF osmotic
pressure rises
Cells lose H
2
O
to ECF by
osmosis; cells
shrink
(a) Mechanism of dehydration
Osmosis
Osmosis
Excessive H
2
O enters
the ECF
1
2 ECF osmotic
pressure falls
3 H
2
O moves into
cells by osmosis;
cells swell
(b) Mechanism of hypotonic hydration
Osmotic Pressure

Determined by number of particles per
unit volume, not by mass! (Molar
Concentration)

1 molecule of Albumin (mw 70000) and 1
molecule of Glucose (mw 180) has same
osmotic effect
What is the osmotic pressure of a 0.9%
NaCl solution?
0.9 % NaCl solution= 0.9g in 100 ml of
solution or 9g/1L
MW of NaCl =58.5
X mM=X mg/mw x 1000ml/ X ml
X mM=900mg/58.5 x 1000/100
154 mM = 154 mOsm
But wait, NaCl dissociates. So 154 x 2=308
mOsm/L
Potential osmotic pressure would be 308 x
19.3 mm Hg/mOsm/L or 5944 mm Hg
What is the osmotic pressure of a 5%
glucose solution?
Glucose mw=180
5g of glucose in 100mL of solution
X mM=5000 mg/180 x
1000ml/100mL
278 mM = 278 mOsm
Potential osmotic pressure would be
278 x 19.3 mm Hg/mOsm/L or 5366
mm Hg


Osmolarity of body fluids
Interstitial fluid and plasma (80% Na
+

and Cl
-
ions)

Intracellular fluid (50% K
+
ions)

Total osmolarity of each around 300
mOsm/L

Plasma 1 mOsm/L greater because of
osmotic affect of plasma proteins (20
mmHg greater pressure in the
capillaries)

Factors that impact intracellular and
extracellular volume
Ingestion of water
Dehydration
IV infusion of different
solutions
Loss of fluid via GI tract
Loss via sweat
Loss via kidneys

Important principles for fluid therapy
Water moves rapidly across cell
membranes
Osmolarity between compartments
will be almost exactly except for a
few minutes after one changes

Cell membranes are almost
completely impermeable to many
solutes
Osmoles remains constant, unless
solutes are added or lost from the
extracellular compartment



Edema Formation
Excess fluid in body tissue
Most cases in the extracellular fluid
compartment
Can also occur in the intracellular fluid
compartment as well
Extracellular - pitting edema


Decreased kidney excretion of salt and
water
Disease state (acute glomerulonephritis) with failure to filtrate
adequate amounts of fluid

Decreased plasma proteins
Failure of body to produce normal amounts of proteins
Leakage of proteins from plasma

Decreased plasma proteins (cont)
1. Nephrotic syndrome (damage to the
membranes of the renal glomeruli). Serious
edema when plasma protein falls below
2.5g/100ml.
2. Cirrhosis of the liver (hepatic tissue fibrosis).
protein synthesis leading to colloid osmotic
pressure.



Elektrolit
ion in the body fluid
1. Kation (Na,K,Ca,Mg)
2. Anion (Cl)
3. Penting pada perawatan penyakit
akut

Tujuan:
D/ dan Th/ gangguan elektrolit
Monitor hasil Th/
Mencegah komplikasi

C a r a :

Flame emission spectrophotometry
Ion selective electrode (ISE)
Spectrofotometer kinetik

Fungsi Kation
Na :tek. Osmotik CES, aktifitas neuro
muskuler,mempengaruhi asam basa, Cl
dan K serta membantu pengeluar-an air.
K: tek.Osmotik CIS, aktifitas enzym dan
neuromuskuler, mempengaruhi asam basa
dan fungsi ginjal
Ca: aktifitas neuromuskuler,perkem-
bangan rangka, pembekuan darah,
Mg: aktifitas intraseluler dan
mempengaruhi level Na,K,Ca dan fosfor
Fungsi Anion

Cl: mempengaruhi asam basa, menjaga tek.
Osmotik darah.
HCO3: sistem bufer yg mengatur pH
HPO4: mengatur level Ca, metabolisme
energi dan asam basa




Nilai Rujukan
Na: 135 145 mEq/L
K: 3,8 5,5 mEq/L
Ca: 8,9 10,1 mg/dL anak sp 10,6
Mg: 1,7 2,1 mg/dL
Cl: 100 108 mEq/L
PO4: 2,5 4,5 mg/dL anak 7mg/dL