63
S. Faubel and J. Topf4 Volume Regulation
4
4Volume Regulation
64
The Fluid, Electrolyte and Acid-Base Companion
The purpose of this chapter is to explain volume regulation. An under-standing of volume regulation is necessary to understand most of the disor-ders covered in this book, including hyponatremia, hypernatremia, meta-bolic alkalosis, congestive heart failure and edema formation.
Volume regulation
is the simultaneous adjustment of plasma volume
and
blood pressure in order to maintain the adequate perfusion of tissues. Although the term
volume regulation
implies only the regulation of plasmavolume, adequate tissue perfusion requires that plasma moves. The move-ment, or circulation, of plasma throughout the body requires the mainte-nance of blood pressure.
Effective circulating volume
is a term which implies that for adequatetissue perfusion, plasma volume, as well as blood pressure, must be main-tained. Therefore, volume regulation should be thought of as
effective circu-lating volume
regulation.
3L2L1L
plasma volume
Volume regulation is the concomitant adjustment of plasma_________ and blood _________.aaavolume; pressure
and
Introduction
The regulation of volume involves the regulationof plasma volume and blood pressure.
volume
(effective circulating volume)
blood pressure
In this book, the terms “effective volume depletion”, “volume depletion” and “low effectivevolume” all refer to the same concept:
low effective circulating volume from a decrease inplasma volume and/or blood pressure
. The term “hypovolemia” is only used to refer toeffective volume depletion from
fluid loss
, such as with vomiting or diarrhea.
65
S. Faubel and J. Topf4 Volume Regulation
Plasma volume is the extracellular component of the blood volume. Plasmavolume is approximately 3 liters in a 70 kg man.Plasma volume is regulated by signals which act at various sites of thenephron to affect the resorption of sodium and water.
Sodium resorption
by the kidney is the primary mechanism by whichplasma volume is increased. In the nephron, the important sites for volumeregulation are the proximal tubule and the collecting tubule. In the proxi-mal tubule, the resorption of sodium causes the resorption of water; in thecollecting tubule, the resorption of sodium occurs without water. Renal re-sorption of sodium is the first and best defense against volume depletion.
Water resorption
is an additional mechanism by which the kidney canincrease plasma volume. Resorption of water alone (without sodium or an-other solute) occurs in the collecting tubules of the distal nephron. The re-sorption of water is not as effective at increasing plasma volume as theresorption of sodium. This second-line defense is employed only when vol-ume is very low.
3L2L1L
plasma volume
The primary mechanism of increasing plasma volume is the resorp-tion of _________ by the kidney.aaasodium
Effective circulating volume
Plasma volume
Plasma volumeis increased through the resorption of sodium and water.
Water resorption
withorwithout
As reviewed in Chapter 1,
Moles and Water
, the plasma compartment is about 8% of totalbody water (TBW). In an adult man,TBW is 60% of weight.Therefore, in a 70 kg man,TBW
is 42 liters (60% of 70 liters); the plasma compartment is 3 liters (8% of 42).
H
2
OH
2
OH
2
O
Sodium resorption
Na
+
Na
+
Na
+
Na
+
Na
+
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