1 Explain the regulation of electrolyte balance in the human body

REGULATION OF FLUID & ELECTROLYTE

BALANCE

The kidney is the primary organ that maintains the total volume, pH, and osmolarity
of the extracellular fluid within narrow limits. The kidney accomplishes this by altering
urine volume and osmolarity. The kidney, in turn, is regulated by neural, hormonal, and
local factors. In
today’s lab we will study how the kidney responds to changes in the composition
of the extracellular fluid.

OBJECTIVES: After completing this activity, students will be able to:

1. define fluid and electrolyte balance and to discuss the kidney’s role in its regulation.

2. understand the role of antidiuretic hormone (ADH), aldosterone, renin, and atrial
natriuretic peptide (ANP) in regulating fluid and electrolyte balance and in maintaining
homeostasis.

3. predict how changes in blood volume and osmolarity will alter urine composition
(color, transparency, volume, specific gravity, and chloride concentration.)

4. analyze the results of case studies and explain the hormonal regulation occurring in
each condition.

5. prepare and interpret graphs

6. use flow charts to model physiological changes that occur in response to

disturbances in osmolarity or plasma volume.

7. use principles from chemistry (concentration and osmolarity), physics (specific

gravity, density, transparency), mathematics (graphs, means), and physiology to
explain the body’s responses to perturbations in fluid and electrolyte balance.

8. collaborate with team members to evaluate case studies.

9. communicate conclusions generated from the case studies during a class presentation

10. relate the changes in plasma osmolarity and volume that occur in these case studies to
real world situations that may occur.
REGULATION OF FLUID AND ELECTROLYTE BALANCE
Have you ever noticed the need for a drink after eating that large bucket of popcorn
at the movies? Or on television, patients entering the ER with substantial blood loss are
immediately given intravenous fluids (an IV)? Both scenarios relate to fluid and electrolyte
balance. What do these terms mean? Fluid refers to water. For water balance to occur,
water intake through
ingested liquids and foods and cellular metabolism must equal water output via sweating,
urine, feces, and breathing. Water balance is essential for the body to be properly hydrated,
avoiding both dehydration and over-hydration. Electrolytes are inorganic compounds that
dissociate in water to form ions. They get their name because they can conduct an electrical
current in solution. Sodium is the most abundant ion of the extracellular fluid and is the
main contributor to the osmolarity or solute concentration of blood.

One of the key tasks of the kidneys is to regulate fluid and electrolyte balance by
controlling the volume and composition of the urine. These adjustments are essential
because the osmolarity of body fluids must be around 300 milliosmols/liter. There are three
hormones that play key roles in regulating fluid and electrolyte balance: 1) antidiuretic
hormone, released from the posterior pituitary; 2) aldosterone, secreted from the adrenal
cortex; and 3) atrial natriuretic peptide, produced by the heart. We will consider the role of
each in turn.

Antidiuretic Hormone (ADH) is a hormone that prevents fluid loss and promotes
the conservation of body water. The term antidiuretic is derived from anti, meaning against,
and diuresis, which refers to fluid loss. The primary stimulus for ADH release from the
posterior pituitary gland is an increase in blood osmolarity (that is, increased solute
concentration and decreased water concentration). The elevation in blood osmolarity is
detected in the hypothalamus by specialized neurons called osmoreceptors. ADH acts by
increasing the reabsorption of water in the distal convoluted tubules and collecting ducts of
the nephrons in the kidney. The net result of this mechanism is that water is conserved.
Under these conditions a small volume of highly concentrated (hypertonic) urine is
excreted. Another action of ADH is to stimulate thirst. This results in an increase in water
intake, which lowers blood osmolarity and helps to restore homeostasis. If ADH is absent,
as occurs in the disorder called diabetes insipidus, water reabsorption in the kidney is
decreased dramatically and large volumes of dilute urine are excreted, up to 25 liters per
day!

Aldosterone is a hormone that regulates blood sodium levels. Aldosterone specifically

increases sodium reabsorption in the distal convoluted tubule and collecting duct of the
nephrons in the kidneys. The result of this mechanism is to conserve sodium. Because “water
follows salt,” this may also lead to water retention when ADH is present. Another action of
aldosterone is to increase the secretion of potassium by the kidney resulting in its decrease in
the blood and increase in the urine. Aldosterone release from the adrenal cortex is triggered
directly by an increase in potassium (primarily) or a decrease in sodium in the blood
reaching the adrenal cortex. Aldosterone release is also stimulated by the activation of the
renin-angiotensin system. In this mechanism, the juxtaglomerular cells of the kidneys
release renin in response to a decrease in blood volume, a reduction in blood pressure, or
 stimulation by the sympathetic nervous system. Renin is an enzyme that converts a plasma
protein called angiotensinogen to angiotensin I. Angiotensin I is in turn acted upon by
angiotensin converting enzyme (ACE) to form Angiotensin II. Angiotensin II has two
major actions: 1) it stimulates aldosterone release from the adrenal cortex, which increases
sodium reabsorption and results in sodium conservation; and 2) it causes vasoconstriction,
which elevates blood pressure. As a result of
these mechanisms, homeostasis is restored.

Atrial natriuretic peptide (ANP) is a hormone that promotes both fluid and sodium
loss by the kidneys. The name natriuretic actually means “salt excreting.” ANP release from
the atria is stimulated when blood volume and pressure are elevated. ANP has three major
effects: 1) it decreases aldosterone release, resulting in a decrease in sodium reabsorption
and increased sodium loss in the urine; 2) it decreases ADH release, which decreases water
reabsorption and increases water loss to lower blood volume and pressure; and 3) it
decreases thirst.

2 Describe the various mechanism employed by the body in

maintenance of blood ph

Buffer Systems
Proteins form a part of the buffer system to regulate the pH levels. These proteins can act as H+
acceptors or donors because of the presence of basic or acidic groups. Similarly phosphate
buffers also help in moderating the levels of pH. Buffers may help in regulating pH during minor
physiological changes, such as during breath holding (which increases the CO2 in the blood),
exercise (which increases lactic acid in the blood), or when gastric acid is secreted.

Respiratory Control

The pH of blood during normal conditions is 7.4. However, CO2 dissociates into carbonic acid in
the tissues. Thus, presence of more CO2 makes the blood more acidic. That is the reason when
we hold the breath for long durations, the CO2 levels increase in the blood lowering our pH
leading to fainting. On the other hand during alkalosis or increased pH, the breathing may get
slow in order to increase the CO2 levels and reduce the alkalinity. However, low breathing rate
could also lead to low oxygen levels which could be detrimental. Thus, respiration provides an
important control to regulate the pH levels.

Renal Control
The renal system regulates the pH of extracellular fluid. The changes in pH induced by the
respiratory system are in minutes, while the changes induced by the renal system are in the order
of days. If the acidity of the fluids is high, kidney secretes H+ ions, while if the carbonate ion
levels are high it retains H+ ions and secretes HCO3 ions. Although this process is slow but it
can prove an effective mode to regulate pH. One limitation of renal regulation is that the pH of
urine cannot be below 4.4. Thus, strong acids can be removed by reacting with basic salts of
phosphoric acid or by addition of base (NH3) to urine.

3 Describe the digestion and absorption of dietary lipids

Digestion and Absorption

Digestion is the mechanical and chemical break down of food into small organic fragments.
Mechanical digestion refers to the physical breakdown of large pieces of food into smaller pieces
which can subsequently be accessed by digestive enzymes. In chemical digestion, enzymes break
down food into the small molecules the body can use.

It is important to break down macromolecules into smaller fragments that are of suitable size for
absorption across cell membranes. Large, complex molecules of proteins, polysaccharides, and
lipids must be reduced to simpler particles before they can be absorbed by the digestive epithelial
cells. Different organs play specific roles in the digestive process. The animal diet needs
carbohydrates, protein, and fat, as well as vitamins and inorganic components for nutritional
balance.

Digestive enzymes are enzymes that break down polymeric macromolecules into their smaller
building blocks, in order to facilitate their absorption by the body. Digestive enzymes are found
in the digestive tracts of animals. Digestive enzymes are diverse and are found in the saliva
secreted by the salivary glands, in the stomach secreted by cells lining the stomach, in the
pancreatic juice secreted by pancreatic exocrine cells, and in the intestinal (small and large)
secretions, or as part of the lining of the gastrointestinal tract.

Intestinal microflora benefit the host by gleaning the energy from the fermentation of undigested
carbohydrates and the subsequent absorption of short-chain fatty acids. Intestinal bacteria also
play a role in synthesizing vitamin B and vitamin K as well as metabolizing bile acids, sterols
and xenobiotics.

Lipids
Lipid (fat) digestion begins in the stomach with the aid of lingual lipase and gastric lipase.
However, the bulk of lipid digestion occurs in the small intestine due to pancreatic lipase. When
chyme enters the duodenum, the hormonal responses trigger the release of bile, which is
produced in the liver and stored in the gallbladder. Bile aids in the digestion of lipids, primarily
triglycerides, through emulsification. Emulsification is a process in which large lipid globules are
broken down into several small lipid globules. These small globules are widely distributed in the
chyme rather than forming large aggregates. Lipids are hydrophobic substances. Bile contains
bile salts, which have hydrophobic and hydrophilic sides. The bile salts’ hydrophilic side can
interface with water, while the hydrophobic side interfaces with lipids, thereby emulsifying large
lipid globules into small lipid globules.

Emulsification is important for the digestion of lipids because lipases can only efficiently act on
the lipids when they are broken into small aggregates. Lipases break down the lipids into fatty
acids and glycerides. These molecules can pass through the plasma membrane of the cell,
entering the epithelial cells of the intestinal lining. The bile salts surround long-chain fatty acids
and monoglycerides, forming tiny spheres called micelles. The micelles move into the brush
border of the small intestine absorptive cells where the long-chain fatty acids and
monoglycerides diffuse out of the micelles into the absorptive cells, leaving the micelles behind
in the chyme. The long-chain fatty acids and monoglycerides recombine in the absorptive cells to
form triglycerides, which aggregate into globules, and are then coated with proteins. These large
spheres are called chylomicrons. Chylomicrons contain triglycerides, cholesterol, and other
lipids; they have proteins on their surface. The surface is also composed of the hydrophilic
phosphate “heads” of phospholipids. Together, they enable the chylomicron to move in an
aqueous environment without exposing the lipids to water. Chylomicrons leave the absorptive
cells via exocytosis, entering the lymphatic vessels. From there, they enter the blood in the
subclavian vein.

Digestion and Absorption of Lipids

Lipids are large molecules and generally are not water-soluble. Like carbohydrates and protein,
lipids are broken into small components for absorption. Since most of our digestive enzymes are
water-based, how does the body break down fat and make it available for the various functions it
must perform in the human body?

From the Mouth to the Stomach

The first step in the digestion of triglycerides and phospholipids begins in the mouth as lipids
encounter saliva. Next, the physical action of chewing coupled with the action of emulsifiers
enables the digestive enzymes to do their tasks. The enzyme lingual lipase, along with a small
amount of phospholipid as an emulsifier, initiates the process of digestion. These actions cause
the fats to become more accessible to the digestive enzymes. As a result, the fats become tiny
droplets and separate from the watery components.

In the stomach, gastric lipase starts to break down triglycerides into diglycerides and fatty acids.
Within two to four hours after eating a meal, roughly 30 percent of the triglycerides are
converted to diglycerides and fatty acids. The stomach’s churning and contractions help to
disperse the fat molecules, while the diglycerides derived in this process act as further
emulsifiers. However, even amid all of this activity, very little fat digestion occurs in the
stomach.

Going to the Bloodstream

As stomach contents enter the small intestine, the digestive system sets out to manage a small
hurdle, namely, to combine the separated fats with its own watery fluids. The solution to this
hurdle is bile. Bile contains bile salts, lecithin, and substances derived from cholesterol so it acts
as an emulsifier. It attracts and holds onto fat while it is simultaneously attracted to and held on
to by water. Emulsification increases the surface area of lipids over a thousand-fold, making
them more accessible to the digestive enzymes.

Once the stomach contents have been emulsified, fat-breaking enzymes work on the triglycerides
and diglycerides to sever fatty acids from their glycerol foundations. As pancreatic lipase enters
the small intestine, it breaks down the fats into free fatty acids and monoglycerides. Yet again,
another hurdle presents itself. How will the fats pass through the watery layer of mucus that
coats the absorptive lining of the digestive tract? As before, the answer is bile. Bile salts envelop
the fatty acids and monoglycerides to form micelles. Micelles have a fatty acid core with a
water-soluble exterior. This allows efficient transportation to the intestinal microvillus. Here, the
fat components are released and disseminated into the cells of the digestive tract lining.

Just as lipids require special handling in the digestive tract to move within a water-based
environment, they require similar handling to travel in the bloodstream. Inside the intestinal
cells, the monoglycerides and fatty acids reassemble themselves into triglycerides. Triglycerides,
cholesterol, and phospholipids form lipoproteins when joined with a protein carrier. Lipoproteins
have an inner core that is primarily made up of triglycerides and cholesterol esters (a cholesterol
ester is a cholesterol linked to a fatty acid). The outer envelope is made of phospholipids
interspersed with proteins and cholesterol. Together they form a chylomicron, which is a large
lipoprotein that now enters the lymphatic system and will soon be released into the bloodstream
via the jugular vein in the neck. Chylomicrons transport food fats perfectly through the body’s
water-based environment to specific destinations such as the liver and other body tissues.

Cholesterols are poorly absorbed when compared to phospholipids and triglycerides. Cholesterol
absorption is aided by an increase in dietary fat components and is hindered by high fiber
content. This is the reason that a high intake of fiber is recommended to decrease blood
cholesterol. Foods high in fiber such as fresh fruits, vegetables, and oats can bind bile salts and
cholesterol, preventing their absorption and carrying them out of the colon.

If fats are not absorbed properly as is seen in some medical conditions, a person’s stool will
contain high amounts of fat. If fat malabsorption persists the condition is known as steatorrhea.
Steatorrhea can result from diseases that affect absorption, such as Crohn’s disease and cystic
fibrosis.