Lecture 5

Electrolyte and Fluid Balance/

Exchange/ Transport in the Gut

Simon A. Lewis
23397
MRB 2.143C
[email protected]
 Electrolyte and Fluid Balance/
Exchange/ Transport in the Gut
• Introduction
• Daily Load
• Structure function
• Sites and Mechanisms of Electrolyte and
Non-electrolyte Transport in Intestine
• Vitamins
• Ca2+, Fe2+
We now have a mixture of particles that are
rich in monosaccharides, amino acids, di-
and tripeptides, free fatty acids,
monoglycerides, sterols, salts, vitamins,
trace elements, nucleic acids etc. that need
to be absorbed from the lumen of the
intestine into the blood.
 Daily Load
H2O Na+ Cl- K+
(liters) (moles) (moles) (moles)
Daily Load 5-8 1 1 0.06
Ingested 1-3 0.33 0.33 ~0.06
Secreted 4-5 0.67 0.67 ~0
Loss in Feces 0.1 0.003 0.002 0.013
Absorbed 4.9-7.9 0.997 0.998 0.047
Small Intestine 4-7 0.87 0.94 0.053
Large Intestine 0.9 0.127 0.058 -0.006

Fat 12-160 grams

Protein 60-120 grams
Carbohydrates 280-800 grams
 Ingest
2000 Saliva
ml/day 1500 ml/day
water

Gastric secretions
2000 ml/day

Bile
Small 500 ml/day
intestine
absorbs Pancreatic juices
8500 ml/day 1500 ml/day
Intestinal secretions
1500 ml/day
Colon
absorbs
400 ml/day

≅ 100 ml/day water excreted

 Relative Surface
Structure surface area area
increase (cm2)

Cylinder 1 3,300
 Relative Surface
Structure surface area area
increase (cm2)

Cylinder 1 3,300

Folds of 3 10,000
Kerckring
 Relative Surface
Structure surface area area
increase (cm2)

Cylinder 1 3,300

Folds of 3 10,000
Kerckring

30 100,000
Villi
 Relative Surface
Structure surface area area
increase (cm2)

Cylinder 1 3,300

Folds of 3 10,000
Kerckring

30 100,000
Villi

600 2,000,000
(2153 ft2)
Osmolality Along the Length of
the Small Intestine
 Hypotonic Meal
2000
Water Content in Lumen (mL)

1500

1000

500

0
Pylorus Ligament of Treitz Ileocecal Valve
 Hypertonic Meal
2000
Water Content in Lumen (mL)

1500

1000

500

Pylorus Ligament of Treitz Ileocecal Valve

 2500
Water Content in Lumen (mL)

2000

1500
Hypotomic
Hypertonic
1000

500

0
Pylorus Ligament of Treitz Ileocecal Valve
Ion Concentrations Along the Length of
the Small Intestine
 Duodenum
• Brings chyme into osmotic equilibrium
• Pancreatic bicarbonate increases pH of
chyme
• Hydrolysis of carbohydrate and proteins
• 100% carbohydrates absorbed
• 50-60% amino acids absorbed
• Na, Cl, K, and water absorption
• Calcium
• Iron
 Duodenum

• Glucose/galactose absorption is sodium

dependent
• Fructose is sodium independent
 Sugar Transport
Lumen Cell Blood
SGLT1 Glut2

2 Na+ Glucose
Glucose
Galactose/Glucose

. Na+/K+ pump
Na+ K+
K+
 Sugar Transport
Lumen Cell Blood
SGLT1 Glut2

2 Na+ Glucose
Glucose
Galactose/Glucose

. Na+/K+ pump
Na+ K+

Fructose K+
Fructose
Fructose

Glut5
Cl-

Glut2
 Duodenum

• Peptides are absorbed by cotransport with proton

• There are 6 amino acid transport systems
– 2 facilitated transport
– 2 Na dependent
– 1 Na and Cl dependent
– 1 Na and K dependent
• Biotin (Na dependent)
Protein Transport
Peptide Transport
Amino Acid Transport
 Brush Border Membrane Amino Acid
Transporters
Transporter Type Preferred Substrates
Na+ dependent
–B Neutral amino acids
–B0.+ Neutral amino acids, basic amino
acids, and cystine
–IMINO Imino acids (proline and
hydroxyproline)
–XAG Acidic amino acids

Independent of Na+
–b0.+ Neutral amino acids, basic amino
acids, and cystine
–y+ Basic amino acids
 Basolateral Membrane Amino Acid
Transporters
Transporter Type Preferred Substrates
Independent of Na+
–asc Small, neutral amino acids,
especially alanine, serine, and
cystine
–y+ Basic amino acids

–L Larger and hydrophobic neutral

amino acids
Na-glucose
...
…..
H2 O Water Transport
….
...

...
…..
….
...

H2 O
Na-glucose
...
…..
H2 O Water Transport
….
...

...
…..
….
...

H2 O
Duodenal Bicarbonate Secretion
Lumen Blood

H2 O
H+
+
CO2 Na+
↓ c.a. Na+
ATP
H+ ADP
+ K+
HCO3-

K+
Duodenal Bicarbonate Secretion
Lumen Blood

K+

H2 O
H+
Cl -
+
CO2 Na+
Cl-
↓ c.a. Na+
HCO3- ATP
H+ ADP
+ K+
HCO3-

Na+
K+
 Jejunum

• NaHCO3 absorption
• 20-30% of amino acids
• Na, Cl, K, and water absorption
• Calcium
• Iron
• Biotin, Thiamin, and Riboflavin (Na dependent)
• Nicotinic acid, Folic acid (facilitated diffusion)
 Jejunal Sodium Bicarbonate Absorption
Lumen Blood

H+ H+
H+
NaHCO3 Na+ + Na+
Na+ HCO3- ATP
ADP
K+
H2CO3 H 2O CO2 H2CO3 K+
+ HCO3-
CO2 H2O c.a.
 Ileum

• NaCl absorption
• 10-20% of amino acids
• Na, Cl, K, and water absorption
• Cobalamin
• Ascorbic acid (Na dependent)
• Bile salts (Na dependent)
 Ileal Sodium Chloride Absorption

Lumen Blood
Na+ Na+

H2CO3
H+ H+ H+ Na+
ATP
HCO3- HCO3- +
HCO3- ADP
H2O K+
Cl -
Cl
-
+ K+
CO2 CO2 H2CO3 Cl-

H2O c.a.
 Colon

• Proximal colon NaCl absorption similar to

ileum
• Distal colon Na absorption, modulated by
aldosterone
• Cl/HCO3 exchange
• K secretion
• Na, Cl, and water absorption
 Colonic Sodium Absorption
Lumen Blood

Na+ Na+

Na+
ATP
ADP
K+
K+
 Colonic Sodium Absorption
Lumen Blood
K+

Na+ Na+

Na+
ATP
ADP
K+
K+

Cl-
 Colonic Potassium Secretion
Lumen Blood

K+

Na+
ATP
ADP
K+
K+
 Colonic Potassium Secretion
Lumen Blood

K+

Na+
ATP
ADP
K+
K+
 Small and Large Intestine

• Chloride secretion in crypts

• Function to wash the surface of villi to
reduce bacterial colonization
 Intestinal Chloride Secretion
Lumen Blood

2 Cl-
Na+
K+

Na+
ATP
ADP
K+
K+
 Intestinal Chloride Secretion
Lumen K+ Blood

Cl- Cl- 2 Cl-

Na+
K+

Na+
ATP
ADP
K+
K+

Na+
 Intestinal Absorption of Vitamins
Vitamin Site of Absorption Mechanism

A, D, E, K Small intestine Micelle at brush border

Chylomicron at basolateral
B6 (Pyridoxin) Small intestine Passive diffusion

Ascorbic Acid (C) Ileum Na+ dependent

Biotin Duodenum and Jejunum Na+ dependent

B1 (Thiamin) Jejunum Na+ dependent

B2 (Riboflavin) Jejunum Na+ dependent
Folic Acid Jejunum Facilitated diffusion
Nicotinic Acid Jejunum Facilitated diffusion
 pepsin R binder trypsin IF

Protein-Cb Cb Cb-R Cb Cb-IF

Ca2+ : pH>5.6

bile ileum

redistribution
liver
Cb
storage plasma
plasma
Cb

••• T.C.II
•••

excreted by kidney
 U.V. Diet

7 dehydrocholesterol Vitamin D3 Calcium

Liver
Absorption
25 hydroxyvitamin D3

Kidney
+
Parathyroid Hormone

1,25 dihydroxyvitamin D3

Ca2+
RNA
Diffusion
Ca2•Calbindin Ca2+ ATPase
Ca2+ Ca2+
Ca2+ Na+

Ca2+
IMCal
Ca2+ Vesicles . Ca2+
 Iron Absorption
Lumen Fe3+ Fe3+ Fe3+
Plasma
Fe Ferritin
Fe Fe
3+ 3+ 3+

Heme Heme Fe3+ Fe3+ Fe3+

xanthine
oxidase
mucin Fe2+
Fe 2+

Fe3+
Fe2+ Fe2+ Fe2+ Fe2+ Fe2+

Fe3+
integrin mobilferrin
Fe2+ transferrin

H+ DCT1
WRAP UP
Smell, taste, chewing, and swallowing
food elicits 3 responses:

• Stimulate salivary action

• Stimulate gastric acid and pepsin secretion
• Stimulate pancreatic enzyme and NaHCO3,
secretion
 Salivary secretion
• Parasympathetic and sympathetic stimulation of
salivary secretion
• Moisten and lubricate food (mucus and serous
secretions)
• Control of dental caries, alkalinizing, buffering
and cleansing
• Carbohydrate digestion by alpha amylase
• Lipid digestion by lipases
 Swallow the Food
Food entering the stomach results in distension
• Release of Ach on parietal cells
• Ach stimulates the release of histamine, gastrin, GRP
• GRP stimulates Gastrin release
• Ach inhibits somatostatin release
• Inhibition of somatostatin release increases gastrin release
• Gastrin release stimulates histamine release

Acid secretion (Ach, histamine, and gastrin)

Pepsin secretion (Ach and gastrin)
Intrinsic factor secretion
 Presence of Peptides in the
stomach
• Directly stimulates gastrin release
• Gastrin stimulates histamine release

Acid secretion
 Increase in gastric pH

• Stimulates Gastrin and GRP release

• GRP release stimulates gastrin release
• Inhibits somatostatin release, increases
gastrin release
• Gastrin release stimulates histamine release

Acid secretion
 Food enters the intestine
• Distension, response is similar to distension
of the stomach
• Peptides stimulate gastrin release
• Gastrin stimulates histamine release

Acid secretion
After stomach is emptied, all pathways return
to control levels.
 Proton Barrier

• A mucous layer is secreted by the surface

cells
• The surface epithelium continuously
secretes HCO3 into the mucus
• This maintains a cell surface pH close to
neutral
Acid chyme enters the duodenum

• Brunners glands secrete NaHCO3

• Low pH releases secretin
• Secretin and Ach (from vagovagal)
stimulates NaHCO3 secretion by the
pancreas

• The pH in the duodenum increases

Peptides and fat stimulate the release
of CCK into the blood and Ach
release in the pancreas

• Stimulates the release of pancreatic

enzymes
• Enzymes aid in the digestion of proteins,
fats, and carbohydrates.
 CCK also has the following
functions

• Causes contraction of the gallbladder

• Relaxation of the sphincter of Oddi
• Release bile to aid in fat digestion
• Slow gastric emptying
• Potentiates the secretin stimulation of bicarbonate
secretion
• Satiety signal
 The small and large intestines

• Absorb 4.9-7.9 liters of water, 1 mole of Na

and Cl and 0.06 Moles of K
• All nutrients absorbed by the small intestine
• Most of the water and electrolytes absorbed
by the small intestine
• Fecal water and electrolyte loss is small
 Duodenum
• Pancreatic bicarbonate increases pH of
chyme
• Hydrolysis of carbohydrate and proteins
• 100% carbohydrates absorbed
• 50-60% amino acids absorbed
• Na, Cl, K, and water absorption
• Calcium
• Iron
• Brings chyme into osmotic equilibrium
 Duodenum
• Glucose/galactose absorption is sodium
dependent
• Fructose is sodium independent
• Peptides are absorbed by cotransport with proton
• There are 6 amino acid transport systems
– 2 facilitated transport
– 2 Na dependent
– 1 Na and Cl dependent
– 1 Na and K dependent
• Biotin (Na dependent)
 Jejunum

• NaHCO3 absorption
• 20-30% of amino acids
• Na, Cl, K, and water absorption
• Calcium
• Iron
• Biotin, Thiamin, and Riboflavin (Na dependent)
• Nicotinic acid, Folic acid (facilitated diffusion)
 Ileum

• NaCl absorption
• 10-20% of amino acids
• Na, Cl, K, and water absorption
• Cobalamin
• Ascorbic acid (Na dependent)
• Bile salts (Na dependent)
 Colon

• Na absorption, modulated by aldosterone

• Cl/HCO3 exchange
• K secretion
• Na, Cl, and water absorption
 Small and Large Intestine

• Chloride secretion in crypts

• Function to wash the surface of villi to
reduce bacterial colonization