NoTeS Ltn FLUIDS IN THE BODY BODY FLUID COMPARTMENTS GENERAL CHARACTERISTICS + Fluid divsions in bedy + Includes intracellular fluid, extrace lular fluid 0-40-20 rule" * Total body water is 609 of body weight, lof which two thirds is intracellular ‘otal intracellular fluid is 40% of body weight, total extracellular fluid is 20% of body weight + Due to macroscopic electroneutrality principle, fluid compartments have sarme concentration of positive charges as, negative charges INTRACELLULAR & EXTRACELLULAR FLUID * Large difference between intracellular fluid and extracellular fluid (¢9, Na°K* ATPases establish high concentration of K" inside cel and high concentration ef Na* eutside cal) Intracellular fluid * Dissoives cations (esp. «° and Ma") and anions (esp. proteins and organic phosphates eg. ATP} Extracellular fluid + Includes interstitial fuid {around cell and plasma {aqueous part of blood, containing about 10% proteins eg. alburnin) * Both dissolve cations (esp. Na’) and anions (esp. Cl and HCO, } » Solutes and water travel between the interstitial fuid and plasma through pores in endothelial cells of capilaies * Negative plasma proteins are too big to travel through pores; electroneutralty is maintained by repelling smal anions into interstitial fluid and attracting small cations into plasma (Gibbs-Donnan effect} —+ interstitial fluid has 1 smal anion concentration (eg. Cl} and small cation concentration {e.g Na‘) VOLUMES OF BODY FLUID COMPARTMENTS + Determined by administering and ‘measuring concentration of substances that are known to settle in specific compartments (dilution method} * Radiolabeled albumin for plasma {cannot pass into interstitial luc) + Smaller molecules lice mannitel and inulin for interstitial Tuid feannot pass through cell membranes} + Heavy water 0,0} for total body water {knowing this and above, intracellular fluid ean be calculated too) * Measuring concentration of these substances in their respective body fluid compartments allows us to calculate volume (== AmountGiven Concentration ' Te account for loss of these substances in rine, subtract amount lst from ‘amount given and use this value in formula “Osieswossons: saDILUTION METHOD SAMPLE PROBLEM [ATO kg mani injected with 150MC! of D,0 and 650Mg of mannitol: During a two hour ‘equlibration period, he excretes 10% ofthe D,O and 1086 of the mannitl nis urine ter thot the concentration of 0 in the plasms f'0.32mC/100 mi andthe concentration of ‘mannitol is 46 ma/100mL Calculate the total body water (TEW),extracluar ful ECF), find intraceluer uc 1CF) volumes. 0.0 ' ' { WrecTeD _eWCACTED_cONCENTRATIN i i Do] Womcr Ix 03a rcy00 mt. t I MANNITOL | 650, 10% 46 9/100 rot afearou ~ ae EXTRACELLULAR FLUID (ECF) ‘STEP i: CALCULATE VOLUME,,, (0,0) & VOLUME,., (MANNITOL) ‘STEP 1a: Determine amount remaining in body ater excretion Amount remaining = ameunt injected » amount excreted ‘Amount, 150mCi- (10% x150mC) Amount... = 650mg - (10% x 650mg) 15omCi- 15mCi 650m3 65mg = 135mc: = 585mg ‘STEP 1b: Divide remaining amount by concentration Volume ny = Volume. Volume = VOR ns = 135196 x_100mL = 58596 x 100mL 03295 3698 a422 saa ‘STEP 2: CALCULATE VOLUME, Figure 594 A sample problem demonstrating how to solve for total body water, extracellular ‘luid, and intracellular fluid volumes using information gained from 0,0 and mannitol ss omossone OSMOSIS.orgChapter 59 Renal Physiology: Fluids in the Body WATER SHIFTS BETWEEN BODY FLUID COMPARTMENTS Key features + Movernent of water between body fluid compartments to maintain constant osmolarity + Shifts are characterized by change in ‘volume and concentration of extracellular fluid “ECF volume: t = expansion; | = contraction + ECF osmolarity: |= hyperosmatic; | = hyposmotic; no change = isosmotic + Six possible combinations VOLUME CONTRACTION Isosmotic volume contraction + Loss of isosmotic fluid frarn ECF += Volume | but osmolarity is constant —+ no water shift + {plasma volume and arterial pressure; } plasma protein concentration and hematocrt + Eg.darhes Hyperosmotic volume contraction + Loss of hyposmotic lui from ECF + Volume | and osmolarity t + water shifts from ICF {net effect is stil volume contraction) + [plasma volume and arterial pressure; 1 plasma protein concentration but hematocrit is unchanged (since red blood cell lose volume too} + Eq. heavy sweating (sweat is hyposmotic relative to ECF) Hyposmotic volume contraction + Loss of solutesihyperosmotic fluid from ECF = Volume | and osmolarity | + water shifts wolcr + {plasma volume and arterial pressure 4 plasma protein concentration and hematocrit + Eq. adrenal insufficiency (deficiency in several hormones, including aldasterane) Aldosterone important for sodium reabsorption from kidneys; | aldosterone = 1 sodium lass in urine VOLUME. EXPANSION Isosmotic volume expansion + Gain of isosrmotic uid in ECF + Volume 1 but osmolarity is constant —» no water shit + T plasma volume and arterial pressure | plasma protein concentration and hematocrit + Eg, receiving an intusion of isotonic NaC! solution Hyperosmotic volume expansion + Gain of solutes or hyperosmotic fuid in ECF + Volume f and osmolarity | + water shitts from ICF + T plasma volume and arterial pressure | plasma protein concentration and hematocrit + E49. eating salty chips Hyposmotic volume expansion + Gain of hyposmotic fluid in ECF + Volurne t and osmolarity | + water sitts AOICF {net effect is stil volume expansion} + T plasma volume and arterial pressure | plasma protein concentration but hematocrit is unchanged + Eq, too much antidiuretic hormone causing excessive water reabsorption MASORSORETYPES of VOLUME CONTRACTION ISOSMOTIC VOLUME CONTRACTION (Example: Dicrrhea) 1 ISOSMOTIC FLUID LOST FROM ECF + ECF VOLUME | PLASMA VOLUME) —> PLASMA PROTEIN (] T WeMaTOCRIT 2. ECF OSMOLARITY = CF OSMOLARITY —* NO ICF WATER MOVEMENT HYPEROSMOTIC VOLUME CONTRACTION (Example: Running a marathon) 1. NYPOOSMOTIC FLUID LOST FROM ECF —> ECF VOLUME | ECF OSMOLARITY ECF OSMOLARITY > ICF OSMOLARITY —» WATER MOVES FROM ICF TO ECE + ec 2 cF voUWME | PLASHA VOLUME | —» PLASMA PROTEIN () t ECF CF oswoLaRtTy t MemaTocRIT UNCHANGED HYPOOSMOTIC VOLUME CONTRACTION (Example: Adrenal insufficiency) 1. Jece SOLUTES —> ecr osmOLARITY ECF OSMOLARITY < IGF OSMOLARITY —+ WATER MOVES FROM ECF TO CF + €CF VOLUME. ICF VOLUME T PLASMA VOLUME | > PLASMA PROTEIN] ECF 2 ICF OSMOLARITY | wemaTocerT t Figure 59.2 Visualization of the types of volume contraction o 526 OSMOSIS.ORG (Chapter 59 Renal Physiology: Fluids in the Body TYPES of VOLUME EXPANSION ISOSMOTIC VOLUME EXPANSION (Example: listonic NeCl infusion) 1. 108NOTC FLUD ADDED To ECF — cor voLuNet PLASMA VOLUME T —> PLASMA PROTEIN J OSMOLARITY UNCHANGED wenaocerr | 2. ECF OSMOLARITY = ICF OSMOLARITY —» NO ICF WATER MOVEMENT HYPEROSMOTIC VOLUME EXPANSION (Example: Eating sally chips) 1 ecr sowTest + ec oswotaRrTY t 2 ECF OSMOLARITY > ICF OSMOLARITY —» WATER MOVES FROM ICF TO ECF > ECF VOLUME f.1CF VOLUME | PLASMA VOLUME f —» PLASMA PROTEIN} ECF £.eF OsMOLARITY wemarocert HYPOOSMOTIC. VOLUME EXPANSION (Example: SIADH) LTT WATER REABSORPTION, EXCESS WATER DISTRIBUTED THROUGHOUT TOTAL BODY WATER — cor 21cF voLUMe t PLASMA VOLUME f —> PLASMA PROTEIN) ECF & ICF OSMOLARITY | WEMATOCRIT UNCHANGED. Figure 59.3 Visualization ofthe types of volume expansion, o ( QOSMOSIS.ORG- 527RENAL CLEARANCE + Rate at which kidneys clear blood plasma _—_—* Free water clearance is renal clearance of of substance pure water * For substance "x renal clearance _ wpe CR = Ux urine concentration of x *U,,: urine osmolarity * (Pix plasma concentration of x +P plasma osmolarity = Ve urine flow rate + To measure reabsorptionisecretion of, substance in kidneys, inulin can be used as reference paint * Inulin is freely filtered Inulin s not reabsorbedlsecreted * Clearance ratio for substance xis += 1+ xis freely filtered, not secreted ©> 1 —>xis freely tered, secreted + <1 xis not freely fiteredis reabsorbed 528 OSMOSIS.ORGChapter 59 Renal Physiology: Fluids in the Body RENAL CLEARANCE SAMPLE PROBLEM PART 1 In 24 hour perio, a man has 2 liters f urns His plasms Na" concentration is 145mEqh. \hereas his rine N° concentration is 190m. What ithe man's ena 'aronce for sum? caluh step r-catcuvaTe ‘Y= URINE VOLUME = 2000mL, = 1.39mLInin TIME Ted0me ‘STEP 2: CALCULATE C,., Ce Bead = 190mEal 2139 mLnin = L43mLUnin Pe Taemeat (+ 145ml of plasma is cleared of Na" per minute PART 2 Returning tothe scenario Pat t's assume we gave that man an infusion of nun over hours. The wine concentration of inulin Omi, andthe plasma concentration of, inulin is imal The urine ow rates 1 39m (he value clelatd in Part 1). What isthe man's dearanceof nun? What i the clearance rato fr Na c= Wh ae STEP E: CALCULATE Cys, Cyan = Waa = Loman 2.39 mL = 1946mLnin Pe mgmt + 194.60 of plasmas cleared of inulin per minute ‘STEP 2: CALCULATE CLEARANCE RATIO FOR Ne" Cue =_Gu_= 143mLinin_ = 0007 Gun T946mLinin +0007 << 1, so very litle Na is excreted in the urine, Since ite frely tered, must be ‘extensively reabsorbed by the nephron to have such alow clearance rai, FREE WATER CLEARANCE SAMPLE PROBLEM ‘Awoman has 2 urine flow rate of 1SmLnin, arin oamlaty of 130mOsn¥L, and plea ‘oemolarty of 260Ouml. Whats her free water clearance? CH= V-Cae cHoev-n Plo = .SmLnin - 120mOenvL x 1.5mLnin 180m0=m. = 15min -0.7mLin = 08min + 0.8L of plasma is eared of solte-ree water every minute by the Kidneys Figure 59.4 Sample questions solving for ronal clearance of a solute and free water clearance. Os assosisons sxe