SCS 2472 - BIOCHEMISTRY WITH A

MEDICAL PERSPECTIVE

Clinical Insight: Water and pH

Balance
Dr. Robert Murray

Basic Points About Water

Water varies from 60-70% of body weight

It is questionable whether life can occur in
the absence of water
Humans cannot survive without water for
much longer than a week
Hunger strikers have gone without food for
over 50 days

Water Balance

A healthy adult takes in about 2.5L of water per

day
About the same amount is lost each day via urine,
feces, sweat and some other sources
The obligatory loss can be reduced to about 1.5L
per day, but not much less

Medical Conditions Involving

Water Balance
Inadequate Intake: When water is scarce or
not available
Excessive Loss: This may occur by
vomiting, diarrhea, urinary losses, excess
sweating and some other causes
A spectacular example of excessive loss is
cholera
I.V. replacement of water as saline, glucose
or other solutions is widely used

Structure of Aquaporins

Aquaporins are specialized water pores present in

the plasma membrane of certain cells
Abnormalities of aquaporin-2 in the kidney lead to
diminished reabsorption of water causing one type
of diabetes insipidus

Urinalysis
This is an important area of clinical medicine,
as it indicates whether kidney function is
normal or abnormal, but also gives important
information on non-kidney problems
Urine can be tested for volume, specific
gravity, protein, ketone bodies, various
metabolites, drugs, other compounds and pH

pH
DNA denaturation by the addition of base

Disorders affecting pH are quite frequent

Blood pH is normally held within the narrow limits
of 7.37-7.43
Variation of over 0.5 pH units on either side of pH
7.4 are often fatal
Changes of pH affect ionic bonds and H bonds; this
can affect the overall structures of DNA, proteins,
causing loss of function and even death

Assessment of Disorders of pH
Basic measurements: Blood pH, pCO2 and
bicarbonate
This helps to decide whether acidosis or
alkalosis is present and also assists in
diagnosis of the cause

Causes of Acidosis and Alkalosis

Many causes: usually classified as
metabolic, respiratory or mixed
Vomiting can cause a metabolic alkalosis
and uncontrolled diabetes mellitus can cause
a metabolic acidosis
Respiratory acidosis can be caused by
underventilation of the lungs, and
hyperventilation can cause respiratory
alkalosis

Summary
A sound knowledge of water balance and pH
and its regulation by buffers is important
Become familiar with the HendersonHasselbalch equation and various buffers
(bicarbonate, phosphate, haemoglobin and
ammonia production)
Appropriate treatment for problems of water
balance and pH is based on a thorough
understanding of water balance and pH

References
MedlinePlus (Medical Encyclopedia).
Acidosis
Nobelprize.org : Peter Agre (autobiography
and Nobel Lecture on Aquaporin Water
Channels).