Fluid Exchange Processes

Exchange Processes Between Fluid Compartments The movement of water and electrolytes between fluid compartments takes place by a variety of processes. Movement of water and electrolytes occurs through membranes and cell walls. The permeability of membranes is controlled by the size of the "pores" or "holes". The size of the pores can be changed in response to pressure and hormones. Some membranes selectively allow passage of certain ions or molecules and exclude all others. A semi-permeable membrane allows only water through it l. DIFFUSION (Df): Ions and molecules flow from an area of higher concentration to and area of lower concentration. Dialysis is the specific process of separating diffusible from nondiffusible ions and molecules. QUES. 15: Hemodialysis is the artificial cleansing of blood when kidneys are not working efficiently. The blood is diverted through a cellophane tube that serves as a dialyzing membrane. On the outside of the cellophane tube is an isotonic solution to all materials that are to be left in the blood. This solution, however, doe not contain waste products. Where do the waste products go by the process of diffusion or dialysis? 2. FILTRATION (FL): Pressure causes water, ions, and molecules to move from an area of higher pressure to an area of lower pressure. The pumping heart causes a blood pressure. The height of a column of water causes hydrostatic pressure.

Electrolyte Sodium Potassium Calcium Magnesium 142 5 5 2

ELECTROLYTE DISTRIBUTION Extracellular Intracellular meq/liter meq/liter 10 100 123

Function fluid balance, osmotic pressure Neuromuscular excitability acid-base balance bones, blood clotting enzymes

Total Positive ions

154

205 Electrolyte Distribution Extracellular Intracellular meq/liter meq/liter

Electrolyte Chloride Bicarbonate Proteins Phosphate Sulfate Total Negative ions 105 24 16 2 1 154

Function fluid balance, osmotic pressure acid-base balance osmotic pressure energy storage protein metabolism

2 8 55 149 205

3. ACTIVE TRANSPORT (AcT): Water and/or ions and molecules are carried by a larger molecule or a vacuole on a cell wall. This requires specific enzymes and energy. This transport is in the manner of a "pump" against a concentration difference. As you look at the table of Electrolyte Distributions, you may wonder how the potassium and phosphate ions get from the extracellular compartment into the cells. Active transport is needed to get potassium ions into the cells since diffusion will not work as the concentration of potassium is highest in the cells. Anytime there is a concentration differential where you need to go from a low concentration to a high concentration, then active transport mechanisms are needed. The cells have developed many types of these.

4. OSMOSIS (OS): Water only flows from a dilute solution to a more concentrated solution. Osmotic pressure is defined as the pressure required to be placed on a solution separated from water by a membrane to prevent osmosis from taking place. Osmosis occurs because there are more molecules of water bombarding the membrane on the pure water side than on the side containing a solution (water molecules plus dissolved molecules). OSMOTIC PRINCIPLE: Water only flows from a dilute solution to a more concentrated solution. Water flows from a solution of low osmotic pressure (Hypotonic) to a solution of higher osmotic pressure (hypertonic). If two solutions have identical osmotic pressures, they are isotonic. If one solution has a lower osmotic pressure (lower concentration

of salts), it is hypotonic with respect to the other. In the opposite situation a solution of higher osmotic pressure is hypertonic with respect to the other. In clinical situations the concentrations of solutions used for replacement of body fluids must be carefully controlled. A 0.9% NaCl (normal saline solution) or 5% glucose solutions are isotonic with body fluids. QUES. 13: If red blood cells are placed in a solution of low osmotic pressure (hypotonic), which direction will water flow in the red blood cells? (Called hemolysis) QUES. 14: If red blood cells are placed in a l.3% NaCl saline solution (hypertonic), which direction will the water flow in the red cells? (Called crenation)

QUES. 13: If red blood cells are placed in a solution of low osmotic pressure (hypotonic), which direction will water flow in the red

blood cells? (Called hemolysis) QUES. 14: If red blood cells are placed in a l.3% NaCl saline solution (hypertonic), which direction will the water flow in the red cells? (Called crenation)

Fluid /Electrolyte Balance

Fluid Exchange Processes Fluid Exchange in Tissues Fluid Exchange kidneys Fluid Excess Fluid Deficit

Elmhurst College Chemistry Department Virtual ChemBook

Fluid Excess - Edema

IMBALANCES OF FLUIDS AND ELECTROLYTES: Fluid and electrolyte disturbances are characteristically "multiple situations". Individual imbalances rarely exist alone. Imbalances may involve fluid, electrolytes, and pH simultaneously. Nonetheless this section will examine imbalances caused predominantly by a single factor since the "multiple situations" are quite difficult to understand. Exchange Process Effected 1. Increased blood pressure results in increased filtration from plasma. 2. Increased permeability of capillaries results in too large a loss of ions and protein from plasma. 3. Loss of plasma protein results in lower osmotic pressure in plasma. 4. Retention of salts especially total body sodium caused by decreased excretion in Clinical Condition

Hypertension

Click for larger image

Local inflammation caused by injury.

Kidney disease (cirrhosis); Malnutrition Kidney disease associated with low blood pressure; Congestive heart failure

urine from low blood pressure prevents effective filtration. Increased water is retained to maintain osmotic pressure. 5. High venular pressure Phlebitis, obesity, varicose prevents return of water by veins osmosis to plasma. 6. Blockage of lymphatic Local inflammation. drainage

Abnormal Conditions which Affect the Fluid Balance QUES. 18: Traumatic shock results from a leakage of protein from capillaries caused by sudden, severe injury, burns, or major surgery. Loss of protein means osmotic pressure relations are upset. If osmotic pressure drops to 11 mm, what happens at #2? What happens to the blood plasma volume? QUES. 19: In dehydration, loss of water from the plasma causes a relative increase in protein concentration, this causes an increase in osmotic pressure in the capillaries (for example OP = 20 at #2). What happens to the water balance in the interstitial compartment. QUES. 20: Water intoxication may result when large amounts of water are drunk on a hot day after loss of water and salts in perspiration. The electrolyte concentration in the interstitial compartment may drop to 150 meq/l. What happens in the cells at #4 as a result? How would the ingestion of salt along with water prevent this from occurring? Click for larger image QUES. 26: In cases of malnutrition, a decrease in plasma protein lowers the osmotic pressure in the capillary to 11. What happens as a result at #2? QUES. 27: Merely standing in one position causes the venular hydrostatic pressure to increase to 20 above the protein osmotic pressure at #2. What happens?

Lab Tests for ECF Fluid Excess or Deficit: An extracellular fluid (NaCl + water) excess causes the compartment to become expanded. This most commonly occurs when kidneys are not functioning properly as in renal disease or decreased renal blood flow. No electrolyte test will indicate this condition. The hematocrit value may be used to indicate extracellular fluid excess and will be somewhat low. (Hematocrit (HCT): Measures a volume percentage of red blood cells in the plasma. Normal value : Females = 37-47%; Males = 40=54%) Example: Why should the HCT value be low? If the normal HCT value is 40% and the normal plasma fluid content is 3 liters, what is the HCT % if the plasma fluid is now expanded to 3.3 liters? Solution: First find the volume of red cells (40% of total plasma). 3 L x 40 / 100 = 1.7 L of red blood cells. Find the new percentage of red blood cells at the increased volume. % HCT = 1.7 L / 3.3 L x 100 = 36.3% HCT

Therefore, a lower percent value for HCT means an INCREASE in the fluid volume. Low %HCT means ECF excess. A height %HCT means an ECF Deficit.

INTRACELLULAR FLUID EXCESS (WATER INTOXICATION) Cell volume is regulated by changes in the amount of total body water. All fluids taken into and excreted from the body pass through extracellular compartment. Osmosis and filtration distribute this in all compartments. For every liter taken in or excreted l/3 goes to or from the ECF compartment and 2/3 goes to or from the ICF compartment. See Question 20: above. Intracellular fluid excess is caused primarily by excessive water intake or an increase in vasopressin hormone. Interestingly, most cases occur in the hospital following trauma, surgery, or anesthesia. These conditions stimulate the release of vasopressin which in turn decreases urine volume and increases retention of water. Forced fluids without salt could aggravate the situation. Lab Test for ICF Fluid Excess - Measure the sodium concentration: Serum sodium electrolyte values are the best indicators of ICF excess or deficit even though sodium is found and measured in the ECF compartment. For a condition with excess water the value is less than normal for much the same reason as the hematocrit values. If the normal concentration of sodium is l40 meq/l or l40 mmoles/l

and 17 liters is the volume in the ECF compartment, what is the new concentration of Na if one Liter of excess water is ingested? The calculation gives a value of 132 mmoles/L Again a lower concentration of sodium means that it is present in a larger volume. Low sodium = ICF excess.