Body Water And Electrolyte Metabolism

Body fluids are partitioned between the intracellular fluids (ICF), which constitute two-thirds of total body water, and extracellular fluids (ECF), which constitute one-third of total body water. The ECF consists of plasma and interstitial fluid plus lymph. The ionic composition differs substantially between ECF and ICF (Table 21.1). Sodium is the primary cation in ECF, whereas potassium is the principal intracellular cation.

The concentrations and distribution of electrolytes are not fixed, because cell membranes are permeant to ions and to water. Movement of ions and water in and out of cells is determined by the balance of thermody-namic forces, which are normally close to equilibrium. Selective changes of ion concentrations cause movement of water in or out of cells to compensate for these alterations. The kidneys are a major site where changes in salt or water are sensed. The loss of fluids due to illness or disease may alter intracellular and extracellular electrolyte concentrations, with attendant changes in fluid movement in or out of cells. Changes of extracellular or intracellular ion concentrations, particularly for potassium, sodium, and calcium, can have profound effects on neuronal excitability and contractility of the heart and other muscles.

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