BODY FLUID COMPARTMENT

JEROME J. PEPINGCO, MD, FPCP, FPSN

INTAKE OF BODY WATER
 Sources:
– Ingested water
– Water in food
• 2,100 ml / day
 Synthesized in the body
– Oxidation of CHO
• 200 ml / day
 Variable – climate, habits, physical activity
DAILY LOSS OF BODY WATER
Insensible water loss
o Respiratory & skin – 700 ml /day
– Skin loss – 300 to 400 ml / day
– Respiratory tract – same
o Sweating – depends on activity
– Averages 100 ml /day
– Heavy exercise : 1-2 liters / hour
o Feces – 100 ml / day
o Kidneys – urine
– Variable
– Dehydrated – 500 ml / day
– Polydipsic – 20 liters / day
DAILY INTAKE & OUTPUT OF WATER
– Synovial, peritoneal, pericardial, intra-
ocular fluid
– CSF
INTRACELLULAR FLUID COMPARTMENT
o 28 liters
o Inside 75 trillion cells
o 40 % of total body weight
o Same concentration of substances
o One large fluid compartment
EXTRACELLULAR FLUID COMPARTMENT
o Outside the cells
o 20 % of body weight
o 14 liters of 70 kg adult
o Interstitial fluid - ¾ of ECF
o Plasma - ¼ of ECF
EXTRACELLULAR FLUID
o Plasma – non-cellular part of blood
o Continuous exchange w/ IC
o Via capillary pores
o Permeable to solutes of ECF
o Impermeable to CHONs

SUMMARY OF BODY FLUID

Normal Heavy
exercise
Intake
Fluid ingested CATIONS & ANIONS OF ECF / ICF

2100
BODY FLUID COMPARTMENTS
???
o 70 kg adult – 60 % or 42 liters

Fr metabolism
o Depends on age, gender & fat content
o Extracellular fluid

200–– Interstitial
Blood plasma200
fluid

o Intracellular fluid
Total intake
o Transcellular fluid : 1 - 2 liters

2300 ???
BODY FLUID COMPARTMENT
JEROME J. PEPINGCO, MD, FPCP, FPSN
o Little K+, Ca++, Mg++, PO4-, acids
GIBBS-DONNAN EFFECT

NON-ELECTROLYTES OF PLASMA
FLUID VOLUME MEASUREMENT
• Indicator – dilution principle
• Placing an indicator substance
• Even dispersion in the compartment
• Analyzing the extend of dilution
• Principle of conservation or mass
• Total mass dispersed = total mass injected
INDICATOR DILUTION METHOD

BLOOD VOLUME
o Contains ECF (plasma) & ICF (fluid in RBC)
o Separate compartment
o Own chamber / circulatory system
o Controls CV dynamics
o 7 % of BW
o 5 liters
o 60 % plasma & 40 % RBC
HEMATOCRIT
o Packed RBC volume MEASUREMENT OF FLUID VOLUMES
o Centrifuging blood o Sample is analyzed chemically, photo-
o Male : 0.40 electrically or by other means
o Female : 0.36 o If none leaks out of the compartment
o Excessive RBC production : polycythemia Total mass in the compartment = Total mass of
substance injected
IONIC COMPOSTION: PLASMA & INTERSTITIAL FLUID Volume B x Concentration B equals
o Separated by permeable capillary Volume A x Concentration A
o Similar ionic composition
o Difference : CHONs in plasma
o Donnan effect : cations higher in plasma
o Anions higher in interstitial fluid
o Large amounts of Na+, HCO3- & Cl-
BODY FLUID COMPARTMENT
JEROME J. PEPINGCO, MD, FPCP, FPSN
o NaCl vs. water
Volume A x Concentration A o Rate of diffusion = rate of osmosis
Volume B =
Concentration B
MOLES & OSMOLES
Variables: o Water concentration depends on # of solute
Amount of substance injected
particles
Concentration of the fluid after the substance is injected
o Osmoles = total # of particles in a solution
Example:
o 1 osmole = 1 mole of solute particle
1 ml of a solution with 10 mg/ml of dye is o 1 mole = 6.02 X 1023
dispersed in chamber B and the final
o Osmole - # of osmotically active particles
concentration is 0.01 mg/ml
o Milliosmole (mOsm) = 1/1,000 osmole
? Volume of the chamber
o Solution
– 1 mole of glucose / li = 1 osm / li
Volume B = 1 ml x 10 mg/ml = 1000 ml
– NaCl – 2 ions – 2 osmol / liter
0.01 mg/ml
– Na2SO4 – dissociates to 3 osm / li
o Method can measure the volume of any
OSMOLALITY & OSMOLARITY
compartment in the body
o Osmolality – osmoles / kg H2O
o Conditions:
o Osmolarity – osm / liter sol’n
– Indicator dye disperses only in the
– Interchangeable
measured compartment
– Easier to use osmole/liter
– Indicator disperses evenly
OSMOTIC PRESSURE
– Indicator not metabolized or excreted
INDICATORS o Precise amount of pressure to prevent osmosis
VOLUME INDICATORS o Indirect measurement of H2O & solute
Total body water………………….. H2O, 2H2O, antipyrine
3
concentration of sol’n
ECF ……………………..22Na+, 125I-iothalamate, o High osmotic pressure = low H2O concentration
thiosulfate, inulin = high solute concentration
ICF …………………………………calculated as TBW – ECF
Blood volume……………………….51Cr-labeled RBC or OSMOTIC PRESSURE & OSMOLARITY
calculated Blood volume = o Osmotic pressure = concentration of
plasma volume / (1 – Hct.) osmotically active substances
Plasma volume…………………….125I-albumin, Evans blue o Without regard to molecular size
dye (T-1824)
o Example : same osmotic pressure
Interstitial fluid ……………………calculated ECFV – plasma
– 1 molecule of albumin = MW 70,000
volume
– 1 molecule of glucose = MW 180
OSMOSIS
o NaCl – 2X osmotic effect
o Net diffusion of water across a selectively
o Osmotic pressure = osmolarity
permeable membrane from high water
o Van’t Hoff’s law:
concentration to lower water concentration
– Л = CRT (mmHg)
o Water diffuses from an area of low solute
– C = concentration of solute
concentration (high water) to one with high
– R = ideal gas constant
solute (low water) concentration
– T = absolute temp in 0K
o Cell membrane impermeable to solutes
– 2730 + 0 centrigrade
o Highly water permeable
• normal body temp = 2730 + 370 = 3100K
o Water moves across membranes
BODY FLUID COMPARTMENT
JEROME J. PEPINGCO, MD, FPCP, FPSN
• Л = 19,300 mmHg for 1 osm / li sol’n – Not swell or shrink cells
• 1 mOsm conc. = 19.3 mmHg – Same extra & intracellular
• 1 mOsm conc. gradient – 19.3 mmHg osmotic concentrations
pressure exerted – Examples : 0.9 % NaCl or 5% glucose
solution
OSMOTIC PRESSURE OF A SOL’N – Important in clinical practice
o Example : 0.9% NaCl o Hypotonic solutions
– 0.9 gm NaCl / 100 ml sol’n – Lower impermeant solute concentation
– 9 gms / liter – Less than 282 mOsm / liter
– MW = 58.5 g/mole – Water will diffuse into the cell
– Molarity = 9/58.5 = 0.154 mol/li – Dilutes the intracellular fluid
– Osmolarity = 0.154 X 2 = 0.308 osm/li – Concentrate the extracellular fluid
o Osmolarity = 308 mOsm / liter – Cell swells
o Potential osm pressure = 308 X 19.3 mmHg = – 0.30 & 0.45 % NaCl solutions
5,944 mmHg
o Correction for inter-ionic attraction = osmotic
coefficient o Hypertonic
o NaCl osmotic coefficient = 0.93 – Higher solute concentration
o Actual Osmolarity = 0.93 X 308 = 286 – Water flows out of cells
mOsm/liter – Concentrates the ICF
– Dilutes the ECF
OSMOLARITY OF BODY FLUIDS – Cell shrinks
o Plasma / interstitial fluid – 80% due to Na+ & Cl- ABNORMAL STATES
o Intracellular substances - > 50 due to potassium o Factors that markedly change osmolality
o Osmolarity of all compartments = 300 mOsm / – Ingestion of water
liter – Dehydration
o Plasma – 1 mOsm / li higher – IVF infusion
o Due to plasma proteins – GIT losses
– Excessive sweating
EFFECTS OF SOLUTIONS ON CELLS – Renal losses
BASIC PRINCIPLES
1. Rapid movement of water across cell membranes
2. Cell membranes are almost completely impermeable
to many solutes

ABNORMAL STATES
o Fluid shifts / osmolarities after hypertonic saline
infusion
– 2 liters of 3% NaCl into ECF of a 70 kg
patient
– Calculate the initial conditions –
OSMOTIC EQUILIBRIUM volume, concentration, total mOsm in
o Isotonic fluids each compartment
– Osmolarity of 282 mOSm / liter
BODY FLUID COMPARTMENT
JEROME J. PEPINGCO, MD, FPCP, FPSN

Step 1 : Initial Step 2 : Effect

Conditions of adding 2
liters of 3%
Vol. NaCl after
o Calculate the total mOsm added to ECF o Final result:
o
o Conc.
3% = 30 gm / liter NaCl
MW of NaCl = 58.5 g / mol
osmotic – Adding 2 liters of 3 % NaCl
– 5 liters increase in ECF

equilibrium
o 0.513 mole NaCl / liter sol’n – 3 liters decrease in ICF
o
o Total
2 liters sol’n = 1.026 mole NaCl
1 mole NaCl = 2 osmoles
o Net effect = 2051 mOsm of NaCl added to ECF

(liters) Vol.
Conc.
o Calculate the effect of adding 2051 mOsm NaCl

(mOsm/li)
with 2 liters volume EFFECTS OF SOLUTIONS TO THE ECF
o ICF : no volume or concentration change but no

o
osmotic equilibrium

(mOsm)
ECF : increased solute and volume, increased Total
concentration
– Concentration : 5971 mOsm / 16 liters =
373 mOsm / liter (liters)
Step (mOsm/li)
ECF 2 14 : Effect
of280
adding3,920
2 (mOsm)
CLINICAL ABNORMALITIES OF FLUID VOLUME
REGULATION
liters of 3% 1. Plasma osmolality not routinely measured
2. Plasma Na+ - indicator of osmolality

NaCl ECF
HYPONATREMIA19.02
ICFo 28
Calculate volumes / concentrations after
o Excess water

Vol.
osmotic equilibrium
313.9
o Excess Na+ loss

280 7,840
o Total mOsm / total volume = 13,811 / 44 = o Primary Na+ loss – hypo-osmotic DHN

Conc.
o Diarrhea & vomiting
5,971
313.9 mOsm / liter
o ECF / ICF will have new concentration after o Diuretic over-use
equilibrium o Addison’s disease - aldosterone - Na+ re-

Total
o Calculate fluid volume in ECF / ICF absoprtion

TBF 42
(liters)
BODY FLUID COMPARTMENT
JEROME J. PEPINGCO, MD, FPCP, FPSN
HYPERNATREMIA
o Water loss
– Hyper-osmotic DHN
– Inability to secrete ADH
– Diabetes insipidus – central or
nephrogenic DI
– Dehydration – sweating / exercise
o Excess NaCl added to ECF
o Hyper-osmotic over hydration
o Excess aldosterone secretion
EDEMA: EXCESS TISSUE FLUID
o Intracellular edema
– Depression of metabolic system
– Lack of adequate cell nutrition
INTRACELLULAR EDEMA
Decreased tissue blood flow
Decreased tissue metabolism
Reduced cell membrane ionic pump
Na+ ions retained in ICF
Osmosis of water intracellularly
o May occur in inflamed tissues
o Increase cell membrane permeability
o Allows Na+ to enter cells
o Osmosis of water into cells
EXTRACELLULAR EDEMA
o Two causes:
– Leakage of fluid from plasma to the IC
across capillaries
– Lymphatic failure to return fluid from the IC
to blood
FACTORS THAT INCREASES CAPILLARY FILTRATION
Filtration = Kf X (Pc – Pif – πc + πif)
– Kf – capillary filtration coefficient
– Pc – capillary hydrostatic pressure
– Pif – IF hydrostatic pressure
– πc – capillary plasma colloid osmotic
pressure
– π if - IF colloid osmotic pressure
FACTORS THAT INCREASES CAPILLARY FILTRATION
o Increased capillary filtration coefficient
o Increased capillary hydrostatic pressure
o Decreased plasma colloid osmotic pressure
LYMPHATIC BLOCKAGE EDEMA
o Plasma CHONs leak into the IC
o IF colloid osmotic pressure rise
o Draws fluid out of capillaries
o Filaria nematode infection
o Cancers infiltrating LN
o Surgical removal – mastectomy
EDEMA CAUSED BY CHF
o Failure to pump blood from veins to arteries
o Raises venous & capillary pressures
o Increased capillary filtration
o Decreased water & salt excretion by the kidneys
o RAAS stimulation – fluid retention
o Left sided failure – pulmonary edema
EDEMA CAUSED BY DECREASED RENAL EXCRETION OF
SALT / WATER
o Kidney Disease – large amt. of salt & water in
the ECF leaking to the blood
o Effects:
– Increase in Interstitial fluid volume
– Hypertension – increased Blood volume
EDEMA DUE TO DECREASED PLASMA PROTEINS
o Reduction in plasma oncotic pressure
o Increased capillary filtration
o ECF edema
o Nephrotic syndrome / proteinuria
o Anasarca – serum protein < 2.5gms/dl
o Cirrhosis of the liver
– Failure of the liver to synthesize CHONs
– Compression of venous portal drainage
– High portal capillary pressure –
transudation of fluid - ascites
SAFETY FACTORS THAT PREVENT EDEMA
o 3 factors preventing fluid accumulation in the
interstitial spaces
BODY FLUID COMPARTMENT
JEROME J. PEPINGCO, MD, FPCP, FPSN
– Low compliance of the interstitium
when interstitial fluid pressure is
negative
– Lymph flow increase 10 to 50 fold
– Washdown of interstitial fluid protein
concentration – reduced colloid osmotic
pressure
LOW COMPLIANCE OF THE INTERSTITIUM
o Interstitial hydrostatic pressure < (-)3mmHg
atmospheric pressure
o Suction effect
o Low compliance of interstitium (I)
o A small rise in (I) fluid hydrostatic pressure
opposes capillary filtration
o Lymphatic system – return fluid / CHONs
filtered from capillaries to the interstitium
to the circulation
o Lymph flow can increase 10 – 50 fold
o Prevents interstitial pressure from rising to
positive pressure
o The safety factor is calculated to be about 7
mmHg
WASHDOWN OF THE (I) FLUID PROTEIN
Increased filtered interstitial fluid
Interstitial fluid pressure increases
Increased lymph flow

LOW COMPLIANCE OF THE INTERSTITIUM Proteins are carried with lymph flow
o In the (-) pressure, all fluid is in gel form
o Fluid is bound in a proteoglycan meshwork Less CHON in (I), less colloid osmotic pressure
o Prevents fluid from flowing easily
o Contrast: Decreased net filtration force
– Positive pressure
– Large accumulation of free fluid Prevents further fluid accumulation
– Tissues are compliant
– Pushes the brush pile of proteoglycans
apart
– Pitting edema
– Non-pitting – cell swelling or clotted fluid
with fibrinogen
INTERSTITIAL FLUID VOLUME & PRESSURE

INCREASED LYMPH FLOW