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Felices Emerita Pascual - Perez RENAL PHYSIOLOGY Topic: THE BODY FLUIDS COMPARTMENTS : ECF & ICF Maintenance of a relatively constant volume and a stable composition of the body fluids is essential for homeostasis Water Balance – to maintain a steady – state, water intake must equal water excretion. Average INTAKE per day – 2300 mL
2100 mL from ingested food and beverages 200 mL from metabolism Average OUTPUT per day – 2300 mL 100 mL – feces (4%) 100 mL – sweat (8%) 700 mL – insensible losses via skin and lungs (25%) 1400 mL – urine (60%) BALANCE CONCEPTS Balance is necessary, in the long-term, to maintain life. Fluid Loss = Fluid Intake Electrolyte Loss = Electrolyte Intake Fluid Intake: regulated by thirst mechanism, habits Electrolyte intake: governed by dietary habits Fluid Output: regulated mainly by kidneys Electrolyte output: regulated mainly by kidneys BODY FLUIDS COMPARTMENTS TOTAL BODY WATER IN RELATION TO BODY WEIGHT: EFFECTS OF GENDER, BODY BUILD AND AGE
Transcellular fluid compartment – a specialized type of ECF 1-2 liter Synovial fuid Peritoneal fluid Pericardial fluid CSF (cerebrospinal fluid)
BODY FLUID COMPARTMENTS ECF 20% of body weight = 14 L (++) Na+, Cl- and Bicarbonate ions Has small amount of Potassium, Calcium, Magnesium phosphate and organic acids Proteins: Plasma > ISF ICF 40% of total body weight = 28 L Only small amount of Na+ and Clions and almost no Calcium Large amount of K+ and PO4- ions. Moderate quantities of Mg++ and Sulfate ions Proteins -4x greater than ECF
FLUID BALANCE (ml/day) – 70 kg Adult
ABCJJKKMP- Batch 2017
8 L Blood volume = 7% of body weight Hct in male = . NaCl and other electrolyte acting across the cell membrane Involves semi-permeable cell membrane Permeability: Water >>> NaCl Thus water moves very rapidly across the membrane so that the ICF remains isotonic with the ECF.40 Osmole . . Sp. BASIC PRINCIPLES OF OSMOSIS AND OSMOTIC PRESSURE BLOOD VOLUME Both ECF & ICF Average blood volume = 5 L (7 % of body weight) 60% plasma. CONTROL OF BODY FLUID DISTRIBUTION Distribution across cell membranes – determined by osmotic forces (mainly from electrolytes) Distribution across capillaries – determined by hydrostatic and colloid osmotic forces. Rate of osmosis – Rate of diffusion of water WHAT IS THE DIRECTION OF OSMOSIS? A.Batch 2017 Page 2 .5L C. 40% RBC Hematocrit Fraction of the blood composed of RBC Men – 0.36 Anemia – low levels Polycythemia – excessive production COMPUTATION OF BODY WATER (for a 70 kg man) Total Body Water (TBW) = 60% or 0.4 x BW 28L Pure water Osmosis – Net diffusion of water across a selectively permeable membrane from a region of high water concentration that has a lower water concentration.40 Females – 0.5 L / 1-0. * * * With solute * * * ABCJJKKMP.5L MEASUREMENT OF BLOOD VOLUME Total Volume = Plasma volume 1-Hematocrit An average 70 kg man: Total blood volume = 3.40 = 5.The higher the solute concentration the lower the water concentration. 42L ECF =20% or 0.6 x Body weight (BW) B.REGULATION OF FLUID EXCHANGE AND OSMOTIC EQUILIBRIUM b/w ICF & ECF The distribution of fluids between ECF and ICF is determined mainly by the osmotic effect of smaller solutes. ISF ¾ of ECF 10. 1 osmole is equal to 1 molecule of solute 1 mole of Glucose L = 1 osmole L 1 mole of NaCl L = 2 osmoles L 1 mole of Na2SO4 L = Osmoles L 1 milliosmole = 1 1000 osmole ICF =40% or 0.refers to the number of osmotically active particles in a solution.2 x BW 13L Plasma 1/3 of ECF 3.
Pressure at 37C *Slightly higher in plasma due to osmotic effects of plasma proteins **Correction factor (osmotic coefficient) for NaCl is 0.8 281 mosm/L 5423 Which has a higher osmotic pressure? Albumin.Batch 2017 Page 3 . hypotonic or hypertonic? Hyperosmotic – higher osmolarity than body fluids Hyposmotic – lower osmolarity than body fluids Osmolarity of solution refers to solution with higher or lower osmolarity compared with Normal ECF without regard for whether it can permeate the cell membrane.8* 282 mosm/L 5443 ISF 300.93 EFFECTS OF DIFFERENT CONCENTRATION OF IMPERMEANT SOLUTES IN ECF ON CELL VOLUME PRINCIPLES OF OSMOTIC EQUILIBRIUM Tonicity of solution.9% NaCl SOLUTION OSMOLARITY Plasma mosm/L 301. Glucose. refers to whether solution will cause a change in a cell volume. depends on concentration of impermeant solute . Isosmotic solution – has same osmolarity as body fluids CALCULATION OF THE OSMOLARITY AND OSMOTIC PRESSURE OF A SOLUTION What is the osmotic pressure of a -. ABCJJKKMP.9% NaCl solution? Is this isotonic.OSMOLARITY AND OSMOLALITY Osmolality Osmolal concentration of solution OSmoles per kg of water (osm/kg H2O) Osmolarity Osmoles per literof solution (osm/L) OSMOLARITY Fluid Osmolarity: ECF: Na and Cl ions ICF: 50% due to K+ Corrected osmolarity is 282 mosm/L RELATION BETWEEN OSMOTIC PRESSURE AND OSMOLARITY Osmotic pressure of a solution is directly proportional to the concentration of osmotically active substances regardless of the size of the solute/ OSMOLARITY OF A 0.8 281 mosm/L 5423 ICF 300. NaCl OSMOTIC PRESSURE : VAN HOFF’S LAW Total mosm/L Corrected** Total osm.
V.0 L OF WATER I.0 L ECF Osmolarity? Increase ICF Volume? Decrease ICF Osmolarity? Increase ABCJJKKMP.Batch 2017 Page 4 . hypo-osmotic or isosmotic? What is a hypo-osmotic solution? OSMOLARITY OF A 5% GLUCOSE SOLUTION REMEMBER!!! Water moves rapidly across cell membranes.V.REVIEW: WHAT’S THE EFFECT OF SOLUTIONS OF CARYING TONICITY ON RBC? WHAT ARE THE CHANGES IN THE FF VARIABLES AFTER GIVING 2.? ECF Volume? Increase ECF Osmolarity? Decrease ICF Volume? Increase ICF Osmolarity? Decrease 280 mOsm/L QUESTIONS: 200 mOsm/L 360 mOsm/L What is the osmolarity of a 5% glucose solution? (MW is 180 g/mol) Is the solution hyperosmotic. thus osmolarities between ECF & ICF remain almost equal. WHAT ARE THE CHANGES IN THE FF VARIABLES AFTER GIVING 2L OF 3% NaCl I. Cell membrane are almost impermeable to many solutes therefore the number of osmoles in ECF or ICF generally are constant unless solutes.? ECF Volume? Increase > 2.
adrenal insuff. Neurologic function is altered Rapid shrinking can tear vessels and cause hemorrhage Rapid swelling can cause herniation because the skull is rigid. CONSEQUENCES OF HYPONATREMIA AND HYPERNATREMIA • • Water moves in and out of cells cells swell or shrink This has profound effects on the brain. ABCJJKKMP.g. ischemia) Inflammation of tissues (increased cell membrane permeability) EXTRACELLULAR EDEMA ABNORMALITIES OF ECF FLUID Na+ CONCENTRATION Causes of increased interstitial fluid volume Increased Capillary Filtration Failure of lymphatics to return interstitial fluid to circulation 3 Factors that can increase capillary filtration 1. bronchogenic tumor Lack ADH.Batch 2017 Page 5 . hence an indicator of plasma osmolarity. vomiting.SUMMARY ABNORMALITIES OF BODY FLUID VOLUME REGULATION ABN Hyponatremic Dehydration Cause Diarrhea.g. the brain cannot increase its volume by more than 10% without being forced down the neck (herniation). Addisons Excess ADH. overuse of diuretics. Increased capillary filtration coefficient (permeability) (Kf) DETERMINANTS OF CAPILLARY FILTRATION ECF solute is 90% due to NaCl. INTRACELLULAR EDEMA Depression of tissue metabolic systems (e. hypothyroidism) Inadequate tissue nutrition (e. Diabetes insipidus. excessive sweating Cushingsm primary aldosteronism Plasma Na+ Conc ECF Vol ICF Vol Hyponatremic overhydration Hypernatremic dehydration Hypernatremic overhydration HYPO/HYPER OSMOTIC REFERS TO PLASMA Na+ CONCENTRATION EDEMA Presence of excess fluid in the body tissues. Increased capillary hydrostatic pressure (Pc) 2. Decreased plasma colloid osmotic pressure 3.
89 ml/min FILT = 2722 ml/day Where does all of this fluid (and protein in it) go? FUNCTION OF LYMPHATICS LOW TISSUE COMPLIANCE AND NEGATIVE INTERSTITIAL FLUID HYDROSTATIC PRESSURE NEGATIVE PRESSURE SUCKS. X Lymphatic Failure = Edema INCREASED LYMPH FLOW CAUSES OF ECF EDEMA Lymphatic blockage Infection Cancer Surgery Congenital absence of lymphatics SAFETY FACTORS AGAINST EDEMA • • • Low compliance of interstitium when = 3 mmHg interstitial fluid pressure is negative Increased lymph flow = 7 mmHg “ Washdown” of interstitial protein = 7 mmHg at high lymph flow rates TOTAL SAFETY FACTORY = 17 mmHg Lymph Flow EFFECT OF INTERSTITIAL FLUID PRESSURE ON LYMPH FLOW Increases lymph flow 10-50x ABCJJKKMP. because tissue became highly compliant.28 +8) = 6. IF volume does NOT change much if +3 fluid start to accumulate).6 x ( 17.(-3) .CAUSES OF INCREASED CAPILLARY FILTRATION NORMAL FILTRATION FILT = Kf x Net Filt Pressure = 6.Batch 2017 Page 6 .3) = 1. (If negative IFPr.3 .6 x ( + 0.
High capillary hydrostatic pressure • Excess fluid retention by kidneys acute or chronic kidney failure glomerulonephritis mineralocorticoid excess • Decreased arteriolar resistance vasodilator drugs autonomic insufficiency • Increased venous pressure congestive heart failure high output heart failure (e. Blockage of lymphatics • Cancer • Surgery • Infections (e.malnutrition (“kwashiorkor”) .cirrhosis . Increased capillary permeability • Immune reactions (histamine) • Toxins • Burns • Prolonged ischemia • Vitamin deficiency (e.PITTING VS NON PITTING EDEMA Thumbprint . When tissue cell swells instead of interstitium.Batch 2017 Page 7 . vitamin C) • Pre-eclampsia and eclampsia in Pregnancy 4. it pushes the fluid away from the area. peritoneal. WASHDOWN OF INTERSTITIAL PROTEINS CONDITIONS CAUSING EDEMA 1. Decreased plasma proteins (low oncotic pressure) • Loss of proteins burns.analbuminemia 3. fluid do not move away from the area.g.g.g. anemia) -venous obstruction venous valve failure cirrhosis 2. pericardial. filaria nematodes) FLUIDS IN THE “POTENTIAL SPACES” OF THE BODY Pleural. synovial cavities Fluid is exchanged between the capillaries and the potential spaces Lymphatic vessels drain protein from the potential spaces Effusion Edema fluid in the potential spaces Abdominal cavity – “ascites” Normal Interstitial hydrostatic pressure of Pleural cavity (-) 7 to (-) 8 mmHg Pericardial cavity (-) 5 to (-) 6 mmHg Joint spaces (-3) to (-) 5 mmHg ABCJJKKMP.When the thumb press against the tissue area. wounds nephrosis gastroenteropathy • Failure to produce proteins .
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