BODY FLUIDS

Body fluids are so important to the basic physiology of bodily functions. Water and
its dissolved constituents make up the bulk of a human or an animal’s body, and
determine the nature of nearly every physiological process. In most humans,
approximately 60% of the total body weight is water. This percentage varies between
50% and 70%, with the exact value primarily dependent on a person's fat content.
Since fat has very low water, individuals with more fat will have a lower overall
percentage of body weight as water. The total amount of water in an adult man
weighing 70 kg is approximately 40 litres (i.e., 57% of total body weight). In newborn
baby it is about 75% of total body weight.

The amount of body water is affected by:

 Age: reduces with age. Drastic decrease in 10 years of life
 Obesity: reduces percentage of water to as low a 45%
 Disease conditions: anaemia, dehydration etc.
 Exercise: increased respiratory rate leads to increased ventilation. Increased
body heat leads to excessive sweating.

Water level in the body is regulated homeostatically to equilibrate the amounts of

water gained to amount lost. Water in the body is gained through:
i) Oral intake
ii) Metabolism- oxidation of hydrogen in nutrients (particularly carbohydrates) in the
body.

Water can be lost from the body via:

i) evaporation from- a) the skin as sweat during thermoregulation
b) the respiratory system via pulmonary ventilation
ii) urinary and digestive systems e.g., urinary and faecal water.

At around 200C, approximately 1400 of the 2300 ml of water intake is lost in urine,
100 ml in faeces and 700 ml via evaporation from respiratory tract or diffusion
through skin.

Functions of body fluids.

 As a dispersion medium of body solutes e.g., Na+, K+, HCO3- etc.

 Provides optimal medium for body’s biochemical reactions which occur in a
fluid medium.
 Maintenance of structural integrity of cells and cellular organelles
 Water from body fluids acts as a coolant in terrestrial animals i.e., in
thermoregulation.
 As the transportation medium for body nutrients from the digestive system to
respiring tissues and metabolic waste products (e.g urea) to excretory organs
(e.g kidneys).
Classification of body fluids.

Body fluids are classified according to:

a) Fluid functions
b) Fluid composition
c) Anatomical compartment occupied by the fluid

Body fluid compartments

The body's water is effectively compartmentalized into several major divisions.

A. Intracellular Fluid (ICF)

This is body fluid found inside of cells and comprises 2/3 of the body's water. In
humans 60% of body weight is water. ICF and is about 40% of body weight and is
primarily a solution of potassium and organic anions, proteins etc. The cell
membranes and cellular metabolism control the constituents of this ICF. The
constituents of ICF in various types of body cells are reasonably similar hence
considered as one large fluid compartment representing a conglomeration of fluids
from all the different cells.

B. Extracellular Fluid (ECF)

The fluid found within the body but outside body cells. It constitutes the remaining
30% of the body's water (about 20% of adult human body weight). It is usually
termed the ‘internal environment’. The ECF is primarily a NaCl and NaHCO3
solution. The ECF is further subdivided into three sub-compartments:
I. Interstitial Fluid (ISF) surrounds the cells, but does not circulate. It
comprises about 70% of the ECF. It is referred to as ‘true internal
environment’.
II. Intravascular fluid. It constitutes blood and lymph. It makes up about
25% of the ECF. Blood is the main intravascular fluid consisting of
blood cells and plasma. Plasma is about 5 % of body weight and
circulates as the extracellular component of blood.
III. Trans-cellular fluid is a set of fluids that are outside of the normal
compartments. It is the fluid found in special body compartments and
whose composition is determined by the fluid functions.
 Fluids of potential spaces:
i. synovial fluid- lubricates joints
ii. pericardial fluid – cushions around the
heart
iii. peritoneal fluid- cushions the
abdominal organs
 Gastrointestinal tract fluids
 Intra-ocular fluids- vitreous and aqueous humour
 Cerebrospinal fluids- cushions central nervous system.
Composition of body fluids.

Water is the main component of all body fluids and functions as a carrier of other
fluid constituents e.g., ions, organic and inorganic molecules, nutrients, gases,
metabolic intermediates and cellular waste products.

Ionic composition of body fluids.

a) Extracellular fluid

Sodium ion is the major cation of ECF followed by Ca2+. Chloride and HCO3- are the
main anions. Plasma contains a significant concentration of negatively charged
plasma proteins, which have a large diameter and do not, therefore, traverse the
capillary pores. They are found in very small quantities in ECF. Other ions found in
small quantities in ECF include: K+, Mg2+, PO4-2, SO4-2 and organic acids.

NB. The levels of these electrolytes are regulated by the kidneys to ensure proper
balance of electrolytes and nutrients for cell survival and function.

b) Intracellular fluid

Potassium ion is the principal intracellular cation followed by Mg2+. Major anions
include: PO4-2, SO4-2 and proteins. Large negatively charged organic macromolecules
are confined to the ICF compartment by a highly selective cell membrane e.g., large
proteins (enzymes or structural proteins), metabolic intermediates etc. The Na+ - K+
pump at the membrane confines Na+ extra-cellularly and K+ intra-cellularly against a
concentration gradient for both ionic species. The electrogenic pump propels 3 Na+ to
the outside and 2 K+ to the inside leaving a net deficit of positive ions to the inside.

The following table gives representative values for the primary ionic constituents of
the major fluid compartments.

NB. All the body's fluid compartments are in osmotic equilibrium (except for
transient changes). The ions and small solutes that constitute the ECF are in
equilibrium with similar concentrations in each sub-compartment. The ECF volume
is proportional to the total Na content.
Electrolyte Plasma, Plasma Interstitial Intracellular
(mEq/L) Water Fluid Fluid
[molarity] (mEq/L) (mEq/L) (mEq/L)
[molality]
Cations:
Sodium 142 153 145 10
Potassium 4 4.3 4 160
Calcium 5 5.4 5 2
Magnesium 2 2.2 2 26
Total cations 153 165 156 198

Anions:
Chloride 101 108.5 114 3
Bicarbonate 27 29 31 10
Phosphate 2 2.2 2 100
Sulphate 1 1 1 20
Organic Acid 6 6.5 7
Protein 16 17 1 65
Total 153 165 156 198
Anions:

The units in the table above are in equivalents (litre volume or litre water [plasma]).
Plasma has approximately 7% (by volume) proteins and lipids. However, the ionic
activity is limited to the aqueous portion of the solution. Laboratories report
concentrations as mEq/Litre Plasma. The 7% non-aqueous portion must be
corrected to obtain the actual concentrations (if needed). This is why the numbers
in the second plasma column are higher than the first. Not all of the reported
concentrations are FREE. Some ions are bound to proteins or other ions. Proteins
have many negative charges per molecule. The equivalents given above are therefore
much higher than the molarity of those same proteins.

Units of Measure in Solutions:

Concentrations of substances are often given in terms of weight/volume. For example,

mg/L, or mg/100 mL are used. For a substance with a known molecular structure, one
can define a "Mole" of that substance as the weight of 6.23 x 1023 molecules, and is
commonly calculated as the sum of the atomic weights of each atom in a molecule.

A Molar Solution is an aqueous solution consisting of one mole of a substance plus

enough water to make one litre of solution. A Molal Solution is an aqueous solution
consisting of one mole of a substance plus 1 kg of water (usually very close to 1 litre
of water). The total volume may thus be more than 1 L. The difference between molar
and molal is important when a solution contains a large amount of non-aqueous
substance. For example, cream has 20% fat (homogenized in very small droplets).
There would be a 20% difference between the molarity of salt and its molality. A
laboratory might report a Na concentration of 20 mMolar (moles/L cream), but really
all the Na would be in the 80% that was water. Its "real" concentration (molality)
would be 24 mMolal (moles/L water).

Concentrations of ions are often given in Equivalents (or milliequivalents) per litre.
The equivalents of an ion is equal to the molarity times the number of charges per
molecule. Thus Equivalents is the measure of CHARGE concentration. Osmoles
refers to the number of impermeable particles dissolved in a solution, regardless of
charge. This will be important for determining the diffusional movement of water. For
substances that maintain their molecular structure when they dissolve (e.g. glucose),
the osmolarity and the molarity are essentially the same. For substances that
dissociate when they dissolve, the osmolarity is the number of free particles times the
molarity. Thus for a pure NaCl solution, a 1 Molar solution would be 2 Osmolar (1 for
Na, and 1 for Cl). When measured as osmoles per litre, one obtains the osmolarity.
For osmoles per kg water, one obtains osmolality.

REGULATION OF BODY FLUID VOLUMES.

Body fluid volume and osmolarity are regulated within narrow limits by homeostatic
mechanisms. These mechanisms respond to changes in volume or osmolarity of the
extracellular fluid.

a) Hormonal regulation.

A normal plasma concentration is central in the maintenance of the body fluid volume
and osmolarity.

i) vasoconstrictor agents.

 Norepinephrine and epinephrine

Norepinephrine is a powerful vasoconstrictor while epinephrine is less so and in some

instances even causes mild vasodilatation e.g., in the heart. During stress or exercise
NE excites the heart and blood vessels. Adrenal medulla is also stimulated to secrete
NE and E, which then circulate in blood and cause almost same excitatory effects on
the circulation as direct stimulation, thus providing a dual system of control.

 Angiotensin.

It is one of the most powerful vasoconstrictor agents known. It normally acts

simultaneously on all the arterioles of the body to increase total peripheral resistance,
thereby increasing the arterial pressure. A fall in plasma sodium concentration (e.g.,
due to increased water intake or loss of sodium through the kidneys) triggers
conversion of circulating α2 globulin to angiotensin I by the enzyme rennin, which
further converts angiotensin I to angiotensin II. Circulating angiotensin II stimulates
production of the hormone aldosterone by adrenal cortex. Aldosterone enhances
sodium re-absorption from the renal filtrate back to the plasma. A higher than normal
plasma sodium concentration inhibits production of aldosterone resulting in increased
urinary loss of sodium.
  Vasopressin (ADH)

It is a more powerful vasoconstrictor than angiotensin. During severe hemorrhage, a

low blood pressure and high osmo-concentration stimulate receptors in supra-optic
nuclei of the hypothalamus resulting in release of ADH by posterior pituitary gland in
to blood. ADH reaches collecting ducts of the kidney nephron and increases the ducts’
permeability to water resulting in re-absorption of water from renal filtrate into
surrounding interstitium. Increased water re-absorption and oral water intake restores
the ECF volume. Intracellular volume and osmo-concentration closes responds to
changes of these parameters in the ECF. Therefore, control of volume and osmolarity
of ECF indirectly controls same parameters in the ICF.

ii) vasodilator agents

 Bradykinin

Kinins are frequently formed in the blood and body fluids. Kinins are small
polypeptides that are split by proteolytic enzymes from α2 globulins in plasma or
tissue fluids. Kallikrein is one such example, found in inactive form in blood and
tissue fluids. Following tissue inflammation, activated kallikrein acts on α2 globulin to
release kallidin that is converted to bradykinin. This causes powerful arteriolar
vasodilatation and also increased capillary permeability.

 Serotonin

It is present in large amounts in chromaffin tissue of intestines and other abdominal

structures. It is also present in platelets. It can have either vasoconstrictor or
vasodilator effect, depending on the condition, or area of the circulation. The
functions of serotonin in regulation of circulation are almost entirely unknown.
Carcinoid tumours have been shown to secret large amounts of serotonin but these
large amounts do not seem to disturb circulation.

 Histamine.

It is released in all damaged or inflamed body tissues, or following allergic reactions.

Histamine, like bradykinin, has the ability to increase capillary porosity, allowing
leakage of both fluid and plasma protein into the tissues. The local vasodilatory and
edema are prominent in allergic reactions.

 Prostaglandins.

They posses both vasoconstrictor and vasodilator properties.

b) Ions and other chemical factors

An increase in Ca2+ concentration causes vasoconstriction following

stimulation of smooth muscle cells of blood vessels.
 An increase in K+ concentration causes vasodilatation via inhibition of smooth
muscle contraction.
An increase in Mg2+ concentration causes vasodilatation via general inhibition
of smooth muscles.
An increase of Na+ concentration causes arteriolar vasodilatation. This is as a
result of an increase in osmolality of fluids. Increased osmolality of blood
caused by increased glucose or other non-vasoactive substances also leads to
vasodilatation. Decreased osmolality causes arteriolar constriction.
Acetate and citrate are the only anions that cause vasodilatation.
A decrease in body pH like extreme increase in pH causes arteriolar dilatation.
An increase in pH, on the other hand, causes arteriolar constriction.
An increase in carbon-dioxide concentration has moderate to marked
vasodilatation effects in the brain, but has indirect vasoconstrictor effects via
sympathetic nervous system.

Measurement of body fluid volumes

It is sometimes necessary to know more precisely how water is distributed between

the various compartments in a particular individual. The volumes of some of the
compartments can be measured by the tracer (dye) dilution technique.

I) A known amount (usually weight) of tracer/dye or other foreign

substance is injected into the body fluid compartment whose
volume is to be determined.
II) Time is allowed for the tracer to disperse uniformly in the
compartment (e.g., 30 min for inulin)
III) A sample of fluid containing dispersed tracer is taken.
IV) The concentration of tracer is analyzed chemically,
photoelectrically or by any other suitable means.
V) The volume of fluid compartment is determined:

Vol of compartment (ml) = quantity of test substance

instilled/concentration of
test substance per ml of
sampled fluid (mg/ml)

The tracer used should:

a) Confine itself to the compartment whose volume is to be determined.
b) Be very easy to administer and analyze by standard laboratory methods.
c) Not be altered or eliminated during the period of determination.
d) Non-toxic.

Some of the substances used as tracers include: radioactive water, radioactive sodium,
bromide, chloride, radio-iothalamate, thiosulfate ion, thiocyanate, inulin and sucrose-
used for measuring ECF.
Directly Measurable volumes:

Total Body Water volume:

Use radioactive water (deuterium or tritium oxide). It distributes throughout all body
fluid compartments. Initial radioactivity of total tracer is determined. The tracer is
allowed 3 – 6 hours to distribute in the compartments. Sample of any body fluid is
taken and its radioactivity determined.

Total body water volume= Initial radioactivity of tracer/radioactivity of 1 ml of

sampled fluid.

ECF Volume:

Use Inulin (a starch) or Sucrose. These distribute throughout body, but are excluded
from cells. Other tracers used include: radioactive sodium, chloride, bromide,
radiothalamate, thiosulfate ions and thiocyanate ions.

Blood volume:

Radioactively- labelled erythrocytes are used as markers. Total radioactivity of tracer

erythrocytes is determined followed by injection of the erythrocytes into the blood.
Chromium-51 (Cr) is used to label the erythrocytes. Alternatively, blood volume is
determined by employing the relationship:
Blood volume (ml) = plasma x 100/1 – 0.87 hematocrit.

 Hematocrit = volume of erythrocytes/volume of whole blood after

centrifugation.

Plasma Volume:

Use radioactive albumin or dye (Evans Blue) that stay in plasma only. Plasma
proteins are confined to intravascular compartment and tracers employed bind firmly
to plasma proteins. Alternatively, radioactively- labelled plasma proteins are used
e.g., 131I-protein.

Indirectly Measurable Volumes:

There is no practical way to measure only the intracellular or the interstitial volumes.
Rather, these are calculated by combining the measured volumes given above.

Interstitial fluid volume:

It is equal to the extracellular fluid volume minus the plasma volume.

Intracellular fluid volume:

It is equal to the total body water volume minus the extracellular fluid volume.