Absorption of Water and Electrolytes

The small intestine must absorb massive quantities of water. A normal person or animal of similar size takes in roughly 1 to 2 liters of dietary fluid every day. On top of that, another 6 to 7 liters of fluid is received by the small intestine daily as secretions from salivary glands, stomach, pancreas, liver and the small intestine itself.

By the time the ingesta enters the large intestine, approximately 80% of this fluid has been absorbed. Net movement of water across cell membranes always occurs by osmosis, and the fundamental concept needed to understand absorption in the small gut is that there is a tight coupling between water and solute absorption. Another way of saying this is that absorption of water is absolutely dependent on absorption of solutes, particularly sodium:

• Sodium is absorbed into the cell by several mechanisms, but chief among them is by cotransport with glucose and amino acids - this means that efficient sodium absorption is dependent on absorption of these organic solutes.
• Absorbed sodium is rapidly exported from the cell via sodium pumps - when a lot of sodium is entering the cell, a lot of sodium is pumped out of the cell, which establishes a high osmolarity in the small intercellular spaces between adjacent enterocytes.
• Water diffuses in response to the osmotic gradient established by sodium - in this case into the intercellular space. It seems that the bulk of the water absorption is transcellular, but some also diffuses through the tight junctions.
• Water, as well as sodium, then diffuses into capillary blood within the villus.

Examine the animation above and consider the osmotic gradient between the lumen and the intercellular space (inside the villus). As sodium (green balls) is rapidly pumped out of the cell, it achieves very high concentration in the narrow space between enterocytes. The osmotic gradient is thus formed across apical cell membranes and their connecting junctional complexes. The arrow that appears denotes movement of water across the epithelium.

Water is thus absorbed into the intercellular space by diffusion down an osmotic gradient. However, looking at the process as a whole, transport of water from lumen to blood is often against an osmotic gradient - this is important because it means that the intestine can absorb water into blood even when the osmolarity in the lumen is higher than osmolarity of blood.

This ability is best explained by the "three compartment model" for absorption of water and, like many aspects of gut permeability, varies along the length of the gut. The proximal small intestine functions as a highly permeable mixing segment, and absorption of water is basically isotonic. That is, water is not absorbed until the ingesta has been diluted out to just above the osmolarity of blood. The ileum and especially the colon are able to absorb water against an osmotic gradient of several hundred milliosmols.