Life Balances: Fluid Replacement (Electrolytes) And The Biochemical individual

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Fluid Replacement (Electrolytes) And The Biochemical individual

Old-time American ranchers used to drink batches of switchel -- a mixture of water, molasses, and vinegar -- during haying season. Workouts have changed since then, and, thankfully, so have the energy drinks. The water is still there, but the molasses and vinegar have been replaced with some form of sugar, minerals such as potassium and sodium, and ever-mysterious "natural flavors." The end result is basically the same: a double shot of water and high fructose corn syrup.

Most people believe a balance of 1 sodium and 2 potassium ratio can help the intake of water when in sports drinks but if you get enough of them in your diet they may not be any help for the first couple hours of a work out.

During prolonged exercise in the heat, people can become dehydrated at a rate of 1-2 L every hour (about 2-4 lbs of body weight loss per hour). Even a slight amount of dehydration causes physiological consequences. For example, every liter (2.2 lbs) of water lost will cause heart rate to be elevated by about eight beats per minute, cardiac output to decline by 1 L/min, and core temperature to rise by 0.3 degress C when an individual participates in prolonged exercise in the heat. Sweating is the way in which the body maintains its core temperature at 37 degrees centigrade. This results in the loss of body fluid and electrolytes and if unchecked will lead to dehydration and eventually circulatory collapse and heat stroke. To minimize disturbances in cardiovascular function and body temperature and to reduce the perceived difficulty of exercise, people should attempt to drink fluids at close to the same rate that they are losing body water by sweating.

The decision as to how much fluid to ingest should be based upon a risk-benefit analysis. Undoubtedly, the most serious consequence of inadequate fluid replacement, i.e., dehydration, hyperthermia, which when severe will cause heat exhaustion, heat stroke, and even death. The risks of too much fluid ingestion are gastrointestinal discomfort and physical difficulty of drinking large volumes of fluid.

There are three types of drinks all of which contain various levels of fluid and electrolytes: Isotonic, Hypotonic, and Hypertonic. Isotonic quickly replaces fluids lost by sweating and supplies a boost of carbohydrate. Glucose is the body's preferred source of energy.

Hypotonic quickly replaces fluids lost by sweating, suitable for those who need fluid without the boost of carbohydrates.

Hypertonic use is to supplement daily carbohydrate intake to top up muscle glycogen stores. If used during exercise Hypertonic drinks need to be used in conjunction with isotonic drinks to replace fluids.

Electrolytes serve three general functions in the body: many are essential minerals, they control osmosis or water between body compartments and they help maintain the acid-base balance required for normal cellular activities. The sweat the evaporates from the skin contains a variety of electrolytes. The electrolyte composition of sweat is variable but comprises of the following components: Sodium, Potassium, Calcium, Magnesium, Chloride, Bicarbonate, Phosphate and Sulphate.

Lactated Ringer's Solution (LRS) is a balanced (electrolyte concentration similar to serum) and isotonic (osmolality similar to serum) solution. Na+=131, k+=4, Ca++=3, Cl-=110, Lactate-=28mEq/L. LRS is non-acidifying; and provides small amounts of K+, and large amounts of Na+ and Cl-.

Lactate- combines with H+ to form lactic acid, which is metabolized to CO2 and H2O by the liver. Lactated Ringers, therefore, yields HCO3- (or more correctly, consumes H+) over a period of time as a function of liver metabolism of lactic acid. LRS is an excellent ECF replacement fluid, also of use in Metabolic Acidosis. It is the most commonly used fluid for a multitude of disease processes in all species.

Polyionic R-148 is also balanced and isotonic. Na+=140, K+=5, Mg++=3, Cl-=98, Acetate-=27, Gluconate-=23 mEq/L. Acetate- and gluconate- consume H+ similar to Lactate-. This solution is interchangeable with LRS. Since acetate is metabolized by more tissues than the liver, it is a better bicarbonate precursor and thus has theoretical advantage.

Polyionic R-148D5 and D5LR are solutions of polyionic R-148, or lactated Ringers, which also have 50 grams of Dextrose added per 1000 ml of solution. They are balanced and hypertonic (approximately 550 mOSm/L). The only real problem with these solutions is that they are about 2 x hypertonic. The possibility of phlebitis is increased. They should be given through a central vein and should not be used is there is already hyperosmolar or hyperglycemic. The addition of glucose as an energy source and to prevent hypoglycemia can be very useful.

The knowledge about the fluids of the body during health and illness is still relatively meager. The composition of these fluids is well established, but the factors that influence their rate of movement are practically unknown. The soda pop companies and the sports drinks know what to add as ingredients to get you to drink more, more, more. But they do not know what to add to make you balanced and well, well, well. The latter are especially important because the rates of exchange of the reactants in the multitude of chemical reactions that proceed simultaneously in the living must be somewhat dependent on the rate of exchange of the fluids of the body.

EQUILIBRIUM

The disturbances in fluid balance may be classified as: (1) disturbances in volume; (2) disturbances in electrolytic osmolar concentration; (3) disturbances in composition; (4) disturbances in distribution; (5) disturbances in the rate of internal exchange.

John L. Kitkoski took the mathematical development which dealt with the kinetics of conduction of electrons in biological solids and applied it to conduction of ions in cells because in some respects the cell resembles a solid rather than a liquid.

For conventional ion transport, the cell is regarded as a semi-permeable bag containing a solution of ions in liquid water. However, the state of intracellular water has been shown to be nonliquid, and major fractions of intracellular Na+ and K+ have been shown to exist in a complexed state. Therefore, it seems more appropriate to consider the cell as an organized, nonliquid phase, consisting of macromolecules embedded in a matrix of crystalline water. Intracellular Na+ and K+ ions may then be supposed to locate themselves mostly in complexed form on sites on the macromolecules (analogous to a valence band), but to be capable of mobility by hopping from site to site through the crystalline water in which the Na+ and K+ are only sparingly soluble (analogous to a conduction band). Such a picture leads to the concept that the conduction and potential of Na+ and K+ in the cell conform to mathematical laws analogous to those governing electrons in semiconductor solids.

Cell water is organized in layer of polarized water molecules, arranged in 10-20 concentric layers around each individual protein molecule. Symmetry of cell water is spherical (or ellipsoidal) around each protein molecule, but with the different spherical arrays randomly positioned relative to each other.

The driving potential for a current across the cell wall of a single species of ion what a single positive charge is the difference in chemical potentials of that type of ion between the inside and outside of the cell. Counter-ions are assumed able to move freely to maintain macroscopic charge neutrality. Interaction of potentials or of currents with other species of ions are assumed not to exist.

The essential chemical difference between the plasma and intercellular compartments relates solely to protein, with concentration of 16 mEq/L and 1 mEq/L per liter, respectively, (For body electrolyte purposes, proteins are considered to be anions.) Otherwise the ionic patterns of the two compartments are so close that they are generally considered to be one in most clinical situations elating to electrolyte balance. The chief extracellular cation is by far Na+ with an average of 142 mE/L. The concentration of K+ and Ca++ may each be taken as 5 mEq/L and that of Mg++ as 2 mEq/L. Hardly as a surprise, CL-, with a concentration of 103 mEq/L, is the chief anion. The average concentrations of HCO3- and HPO4= are 27 and 2 respectively. The total concentration of cation and total concentration of anion hover, in health, close to the value of 155 mEq/L.

Life Balances electrolytes are a melt-emulsion reaction, potentized ionic formula with a free floating orbital. Based on the Gustatory (taste) pathways an individual can determine how much electrolyte fluid replacement is needed at that time. If an individual is deficient, the electrolyte fluid replacement will taste thick and bad. If an individual has good fluid level, the electrolyte fluid replacement will have a thinner texture and a milder taste. If the individual has excesses, the electrolyte fluid replacement will be thin and bitter tasting.

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