Clinical Information

Sodium (Na+) is the primary extracellular cation. Na+ is responsible for almost one half the osmolality of the plasma and, therefore, plays a central role in maintaining the normal distribution of water and the osmotic pressure in the extracellular fluid compartment. The amount of Na+ in the body is a reflection of the balance between Na+ intake and output. The normal daily diet contains 8 to 15 grams of sodium chloride (NaCl), which is nearly completely absorbed from the gastrointestinal tract. The body requires only 1 to 2 mmol/d, and the excess is excreted by the kidneys, which are the ultimate regulators of the amount of Na+ (and thus water) in the body. Na+ is freely filtered by the glomeruli. Approximately 70% to 80% of the filtered Na+ is actively reabsorbed in the proximal tubules with chloride and water passively following in an iso-osmotic and electrically neutral manner. Another 20% to 25% is reabsorbed in the loop of Henle along with chloride and more water. In the distal tubules, interaction of the adrenocortical hormone aldosterone with the coupled sodium-potassium and sodium-hydrogen exchange systems directly results in the reabsorption of Na+ and indirectly of chloride from the remaining 5% to 10% of the filtered load. It is the regulation of this latter fraction of filtered Na+ that determines the amount of Na+ excreted in the urine.