Water represents ∼65% of the weight of an adult human. Water is distributed in the intracellular (ICF) and an the extracellular (ECF) compartments. This last includes the intravascular space, and the interstitial fluid. Daily water ingestion is ∼2500 mL. A similar amount is eliminated per day through the urine, feces, skin, and lungs. The main ECF cation is Na+, while the major cation in the ICF is K+. Among the anions, Cl− predominates in the ECF; phosphates, sulfates, and proteins are found in the ICF. The presence of proteins (which behave as anions at the pH of biological fluids) in compartment spaces surrounded by semipermeable membranes determines an uneven distribution of diffusible ions. This phenomenon, called the Gibbs–Donnan equilibrium, plays an important role in cell volume and osmotic stability. The osmolarity of plasma is ∼300 mOsm/L. Regulation of ECF osmolarity and volume depends mainly on renal activity and the mechanism of thirst. Oncotic pressure is the osmotic pressure exerted by the proteins present in body fluids. The difference in oncotic pressure between blood and the interstitial space, and its balance with the capillary hydrostatic pressure (Starling equilibrium) helps maintain fluid exchange in the interstitial space. Dehydration and hyper hydration are alterations in the body water balance. They can present without changes in osmolarity (isotonic with respect to normal plasma), or can be accompanied by increased or reduced osmolarity (hypotonic or hypertonic, respectively). Acid–base balance is essential to cope with the continuous changes in pH due to intake and production of acids and bases in the body. Several buffer systems operate in the body. In the intracellular space proteins (Prot−/ProtH) and phosphates (HPO42−/H2PO4−) function as buffer systems. In the intravascular space, the main buffer is hemoglobin. In the ECF the bicarbonate/carbonic acid pair is the most important buffer system. CO2 produced by cellular activity, dissolves in body fluids and is hydrated in a reaction catalyzed by carbonic anhydrase to give carbonic acid, which rapidly ionizes into bicarbonate and H+. The H2CO3− concentration depends on the amount of CO2 dissolved and PCO2PCO2. At normal pH (7.4), the ratio [HCO3−]/[CO2] value is 20. Bicarbonate/carbonic acid regulation is achieved by close control of the HCO3−/CO2 system. This takes place at two main levels: (1) The respiratory system , which responds to blood pH and PCO2PCO2 changes acting on the respiratory center. A decrease in pH or increase in PCO2PCO2 stimulates the frequency and depth of breathing, augmenting CO2 removal. PCO2PCO2 reduction or pH increase depress pulmonary ventilation and promotes CO2 accumulation in blood. (2) Renal regulation controls body pH via three main mechanisms: bicarbonate reabsorption, urine acidification, and production of ammonium ions. Changes in pH in the renal tubular cells modify the activity and expression of the mechanisms involved in H+ and HCO3− transport. Increased H+ secretion enhances HCO3− reabsorption and acid excretion. Disorders of acid–base balance are characterized by modifications of the HCO3−/CO2 system. Depending on the alteration, four types of acid–base alterations can be distinguished: (1) Respiratory acidosis consists of a decrease in pH originated by alterations in pulmonary ventilation, which reduce CO2 removal and increase the partial pressure of PCO2PCO2; (2) Metabolic acidosis is the drop in pH caused by a primary reduction in plasma bicarbonate and it is produced by excessive loss of bicarbonate, retention or intake of acids. It can be caused by renal insufficiency; (3) Respiratory alkalosis is the condition characterized by the increase in pH in which the primary alteration is the decrease in PCO2PCO2, due to situations that produce pulmonary hyperventilation; (4) Metabolic alkalosis, is the state caused by a primary increase in bicarbonate, which elevates blood pH, due to excessive intake of alkali or the excessive removal of acids from the body. Respiratory and metabolic acidosis and alkalosis may be uncompensated or compensated if the systems of regulation function efficiently.