WHAT IS THIRD-SPACING?

Third spacing or Third-space fluid shift is a phenomenon in which too much fluid starts to leak out from the
intravascular space (blood vessels) into the interstitial space. The water in these spaces has no physiologic
function. Pericardial Effusion is an example of third-space fluid shift. The normal fluid around the pericardial
sac should be 50ml only, but in the case of Pericardial Effusion, the accumulation of fluid reaches to 750ml
which could cause reduced in cardiac output.

DIFFERENTIATE OSMOSIS AND DIFFUSION.

Osmosis is the diffusion of water from higher water concentration to lower concentration through a partially
permeable membrane. Cell membranes are semi-permeable, wherein water can move freely through them but
other particles, such as sugar molecules cannot pass through. The movement of water by osmosis is the main
reason why it is important to control the water balance of the body. Diffusion is the spreading out of particles
from an area of higher concentration to an area of lower concentration. Example of diffusion is the movement
of oxygen from the air into the blood and carbon dioxide out of the blood into the air in the lungs.

HOW DOES THE Na-K PUMP WORKS?

Sodium-Potassium pump is important in order to maintain the proper concentrations of both ions inside and
outside the cell. The Na-K pump is responsible for the movement of potassium into the cells at the same time
moving sodium outside the cells. This uses ATP/Adenosine Triphosphate to transport sodium and potassium
ions across the cell membrane.

WHY DOES CREATININE IS CONSIDERED THE BETTER INDICATOR OF RENAL FUNCTION THAN BUN?

BUN is the by-product of protein metabolism by the liver, while creatinine is the end product of muscle
metabolism. BUN is reabsorbed in the body 10x the number of the absorbed creatinine. The ratio between
BUN and creatinine is important in determining renal function. Therefore, creatinine is a more reliable indicator
of renal function than BUN because it is less influenced by other factors such as diet and hydration.

DISCUSS THE PHYSIOLOGY OF ADH.

ADH/Antidiuretic vasopressin is a hormone made by the hypothalamus in the brain which regulates and
balances the amount of water in the blood. ADH is released from the posterior pituitary gland, and it is
stimulated by decreased blood volume and increased serum osmolality. The osmoreceptors found in the
hypothalamus, will pick up the stimulus and prompt the posterior pituitary gland to release ADH into the
bloodstream. Once the ADH is in the bloodstream it will activate some proteins and channels that will serve as
the passageway for water reabsorption and from the distal tubules to be reabsorbed in the blood. The more
concentrated the plasma, the more ADH is released into the blood. When the ADH reaches the kidneys, it
causes them to reabsorbed more water. This keeps more water in the body and produces more concentrated
urine. When the plasma is more dilute, less ADH is released into the bloodstream. This allows more water to
leave the kidneys, producing more dilute urine. Once normal state is achieved, ADH production in the
hypothalamus is inhibited and the diuresis happens, not concentrated anymore.