BODY FLUIDS BALANCE

FLUIDS AND ELECTROLYTES BALANCE

BODY FLUIDS BALANCE (PEDIATRICS)

SOLVENTS

WATER

BODY FLUIDS
DISSOLVED SUBSTANCES:

ELECTROLYTES GLUCOSE PROTEIN FAT GASES (O2, CO2)

BARRIER/PROTECTIVE CSF CUSHION

BODY FLUIDS

SOLVENTS
TRANSPORT TEMPERATURE REACTANT LUBRICANT

DEHYDRATION FEVER HYDROLYSIS SYNOVIAL FLUIDS

REGULATION

EQUILIBRIUM 1. VOLUME

2. DISTRIBUTION
3. COMPOSITION OF ELECTROLYTES 4. TONICITY 5. pH

ICF : 40 - 45%
TBW
(60-70%)

ECF : 20 - 25%

ISF
15%

PLASMA Trancelluler
5% 1-3%

THE DIFFERENCES BETWEEN PEDIATRICS AND ADULT BODY FLUIDS

1. TBW PEDIATRICS (60 - 70%) > ADULT (50 - 55%)

2. ECF : ICF NEONATES CHILDHOOD ADULT

= 1:1 = 2:3 = 1:2

3. DAILY TURNOVER OF WATER INFANT = 25% TBW ADULT = 6% TBW

INFANTS ARE SUSCEPTIBLE TO THESE DISORDERS

1. DAILY TURNOVER OF WATER >>

2. INFANT IS MORE SUSCEPTIBLE THAN ADULT DIARRHOEA, VOMITING

3. HOMEOSTASIS MAY NOT BE AS WELL DEVELOPED

INFANT 7 kg
ECF INTAKE OUTGO = 1400 mL = 700 mL/day = 700 mL/day

ADULT 70 kg
ECF INTAKE OUTGO = 14 L = 2 L /day = 2 L/day

VOLUME VOLUME RECEPTORS Renal Blood Flow RENIN ADH (Antidiuretic Hormone) ALDOSTERON H2O & Na+ RETENTION WATER INTAKE THIRST CENTRE

WATER RETENTION

VOLUME

TONICITY

THIRST CENTER WATER INTAKE DILUTION OF ECF

OSMORECEPTORS

ADH

TONICITY

OSMOTIC PRESSURE
(290 mOsm/L)

Na+ = 135 mEQ/L

BUN (Blood Urea Nitrogen) GLUCOSE

OSM THIRST CENTRE

VOL

INTAKE
ABSORPTION OUTPUT
REGULATION ALDOSTERON ADH

SKIN & LUNGS

STOOL

KIDNEYS

30 mL / kgBW / day

10 mL / kgBW / day

60 mL / kgBW / day

 10 kg 10 - 20 kg > 20 kg

HOLLIDAY - SEGAR
100 mL / kg 1000 mL + 50 mL/ kg for each > 10 kg 1500 mL + 20 mL/ kg for each > 20 kg

NB : 100 mL 2,5 mEq Na+ 2 mEq K+ 100 calori

OSMOLALITY

VOLUME

ADH

REABSORPTION OF WATER IN THE DISTAL TUBULES & COLLECTING DUCTS

OSMOLALITY

VOLUME

ADH

VOLUME IS THE 1ST

DISTRIBUTION OF WATER
I VF

STARLING FORCES

CAPILLARY WALLS
ECF CELL WALLS ICF

ISF
TONICITY

Na+

STARLING FORCES: BALANCE OF HYDROSTATIC PRESSURE & ONCOTIC PRESSURE

ONCOTIC PRESSURE
PLASMA PROTEIN

ALBUMIN

STARLING

FORCES DISTRIBUTION OF WATER BETWEEN INTERSTISIAL & INTRAVASKULAR S LAW OF THE HEART RELATION OF TENSION TO LENGTH IN CARDIAC MUSCLE

COMPOSITION OF ELECTROLYTES
Na+ K+ ClHCO3P- & Pr-

ECF > < > > <

ICF < > < < >

NATRIUM
INTAKE
ABSORPTION OUTPUT REGULATION

SWEAT

STOOL

URINE

HORMONES ALDOSTERON Atrial Natriuretic Factor

NEPHRONS LOSING
RETAINING Cortical Nephron Juxtamedullary nephron

KALIUM
INTAKE
K+ PLASMA OUTPUT ACID-BASE

CELL ALDOSTERON URINE

SWEAT

STOOL

BUFFERS pH LUNGS
3

HCO3H2CO3

pCO2
ACIDIFICATION=MAKE NEW BICARBONATE

KIDNEYS

ALKALINIZATION
pH = - Log ( H+)

pH = pK + log
HCO3 pH
-

HCO3H2C03 pCO2

ACIDOSIS METABOLIC
pCO2 KUSSMAUL BREATHING ACIDIFICATION OF THE URINE

DISORDERS
1. VOLUME DE / OVERHYDRATION HYPO / HYPERVOLEMIA
2. ELECTROLYTES Na - HYPER / HYPO K+ - HYPER / HYPO 3. pH ACIDOSIS : - METABOLIC - RESPIRATORY - METABOLIC - RESPIRATORY

ALKALOSIS :

SIGNS OF DEHYDRATION
1. 2.

3. 4. 5.

6.

LETHARGIC TO COMATOSE SUNKEN ANTERIOR FONTANELLA SUNKEN EYES ABSENT OF TEARS DRY OF MOUTH & TONGUE HR

WEAKNESS OF RADIAL PULSE 8. HYPOTENSION 9. THIRSTY 10. TURGOR

7.
11. 12.

OLIGURIA/ANURIA BW

HYPONATREMIA
PROFOUND CIRCULATORY DISTURBANCE CEREBRAL EDEMA Intra Cranial Pressure
HERNIATION MYELINOLYSIS

ISCHEMIA CONVULSION

DEATH TH/ SYMPTOMATIC HYPONATREMIA NaCl 3%

HYPERNATREMIA
LESS CIRCULATORY DISTURBANCE SHRINKAGE INTRACRANIAL HEMORRHAGE

PERMANENT RESIDUAL

K+
DIARRHOEA
HYPOKALEMIA
ICF ECF Resting Membrane Potential (RMP = - log K+ ICF ) = - mV ECF

RENAL FAILURE
HYPERKALEMIA

NEUROMUSCULAR

ECG (T , ST , QT , QRS , U wave )

Th/ : K+ up to 3mEq/kgBW/day

LOSS OF HC03

METABOLIC ACIDOSIS
H+

DIARRHOEA Renal Tubular Acidosis

EXCRETION DEHYDRATION

PRODUCTION 1. STARVATION KETOSIS 2. SALICYLATE POISONING 3. TISSUE HYPOXIA LACTATE 4. INBORN ERROR

METABOLIC ACIDOSIS
1.NAUSEA, VOMITING & ANOREXIA 2.DEPRESSION OF CNS (COMA, CONVULSION) 3.ARTERIAL DILATATION HYPOTENSION 4.CARDIAC CONTRACTILITY 5.HEART FAILURE 6.VENTRICULAR FIBRILLATION 7.O2 AFFINITY OF Hb ANOXIA 8.KUSSMAUL BREATHING HYPOCARBIA vasoconstriction Cerebral Blood Flow drowsiness

pH , pCO2 , HCO3
METABOLIC ACIDOSIS pH < 7, 2 HCO3- = 1 - 2 mEq/kgBW (EMERGENCY) DEHYDRATION (-) LUNG DYSFUNCTION (-) HYPOKALEMIA (-)

NORMAL VALUES
Na+ K+ Cl Ca++ HCO3Osm Oncotic Pressure Anion Gap pH pCO2 = 135 - 150 mEq/L = 3 - 5 mEq/L = 100 mEq/L = 10 mgr % = 20 - 25 mEq/L = 290 mOsm/kg water = 7 - 19 mmHg = Na+ - (Cl- + HCO3-) = 8 - 16 mEq/L = 7,35 - 7,45 = 27 - 40 mmHg

H2CO3 (mEq) = pCO2 (mmHg)x 0,03