Body Fluids

The student will be able to: (MUST KNOW)

• Give the normal values of total body water (TBW) as % of

body weight in different age groups in males and females.
• Gives the % distribution of body water in different body fluid
compartments.
• Understand the concept of water gain and water loss and list
the factors that influence water balance.
• Explain the effective circulating volume and its application.
 The student will be able to: (MUST
KNOW)……
• Name different body fluid compartments, total fluid present in
the compartment and composition of ions in each
compartment.
• Give the characteristics of an ideal indicator used for
measuring body fluid volumes.
• Name the units of measurement, name the indicator used,
give the basic principle and method of measurement of body
fluid volume of different compartments.
• Explain why dehydration is common and often severe in
children
 Introduction:
• Stability in the volume and composition of body fluid in body
fluid compartments is essential for homeostasis.
• Functions of cells depend on fluids present both outside and
inside the cells.
• Therefore, maintenance of fluid volume of the body is an
important aspect of patient management in clinical medicine.
• Appropriate fluid replacement in dehydration and removal of
fluid in overhydration, hypervolemia and edema are mainstay
of treatment in fluid volume disorders.
 BODY COMPOSITION

Body Fluid Content:

• The body composition of a normal adult male on average
consists of 15% fat, 18% proteins, 7% minerals and 60% water.
• The total body water (TBW) as percentage of body weight on
average is about 60% in adult males, which is about 10% more
than adult females (Table 8.1).
• In infants and children, though TBW as percentage of body
weight is more than in adults, their absolute water content is
significantly less.
• In elderly people in both the sexes, TBW is about 10% less
than their adult counterparts.
• In females, TBW is less than males due to relatively greater
amount of adipose tissue (subcutaneous fat) in them

• Of total body water, about two-third is present in intracellular

compartment and one-third in extracellular compartment
 Normally, volume of different body compartments
can be calculated by following formula

• Total body water = 0.6 × Body weight

• Intracellular fluid volume = 0.4 ×Body weight
• Extracellular fluid volume = 0.2 × Body weight
• Interstitial fluid volume = 0.75 × ECF
• Plasma volume = 0.25 × ECF
BODY FLUID VOLUME DEPENDS ON WATER
BALANCE

• Control of volume of body fluids is directly linked with water

balance of the body.
• Therefore, before discussing regulation of body fluid
volumes, first let us understand the mechanism of water
balance.
• Normally, water balance is achieved by matching the water
gain with water loss.
Water Gain:
• Body gains water from two sources:
• Exogenous
• Endogenous

Exogenous Water Gain:

• Exogenous water gain occurs mainly by two processes:
a)drinking of water and b) water ingested with food.
• The exogenous water intake normally ranges from 2 to 10
liters per day.
Water Drinking:
• Drinking of water is the major form of water gain.
• It ranges from 0.5 to 8 liters /day depending mainly upon the
environmental conditions.
• Water intake is mainly controlled by the thirst centers in the
brain.

Ingestion of Water in Food:

• Water is present in all food preparations and fruits.
• On average, water ingested in food (in break fast, lunch, snacks
and dinner) varies from 1 to 5 liters per day
 Endogenous Water Gain:
• Water is one of the products of metabolism (other products
are ATP, CO2 and temperature).
• During the process of tissue oxidation, water is continuously
produced in the body.
• Endogenous production of water accounts for 300–500 ml of
water added per day to the body fluids.

Water Loss:
• Water loss from the body occurs mainly in four forms: urine,
feces, sweat and as insensible loss.
Loss in Urine:
• Urinary loss of water is a major form of water output from the
body.
• About one liter of water is excreted from the body in urine per
day.
• Kidney plays important role in water balance by altering water
excretion in urine, which primarily depends on the
concentration of ADH in plasma.

Fecal Loss:
• Normally, about 200 ml of water per day is excreted in feces.
Loss in Sweat:
• Sweating is greatly influenced by environmental
temperature and the level of physical activity
• The rate of sweat production per day is about 0.1 L at
ambient temperature of 23°C, 1.5 L at 38°C and 5 L at 45°C.

Insensible Water Loss:

• water is continuously evaporated from the skin surface.
• Water is also continuously evaporated from respiratory
passage in breathing.
Positive and Negative Water Balance

Positive water balance occurs when water gain is more than its loss.
• This causes hemodilution, therefore, decreases in osmolality of
plasma, decreases red cell count and produces hyponatremia.

Negative water balance occurs when water loss is more than its gain.
• This leads to dehydration and causes hemoconcentration.
• It increases plasma osmolality.
• Due to hemoconcentration, there is relative increase in red cell count.
 Factors Influencing Water Balance
Plasma Osmolality:
• Plasma osmolality is an important factor for water balance.
• Alteration in osmolality is detected by osmoreceptors in
hypothalamus that stimulates thirst.
• Increased plasma osmolality is also a primary stimulus for ADH
secretion.
Factors that Affect Plasma Osmolality:
• Plasma osmolality depends on the presence of osmotically active
molecules in plasma, especially NaCl, proteins and glucose.
Blood Volume:
• Alteration in blood volume is detected by volume receptors
in atria that send impulses to hypothalamus and pituitary to
secrete ADH.
• However, increased osmolality is a better stimulus than
hypovolemia for stimulation of thirst and ADH secretion

Factors that Affect Blood Volume:

• Blood volume depends on the plasma volume and the
hematocrit.
 Volume Sensors:
• Volume sensors or ECV sensors are volume receptors located in the
vascular tree that respond to stretch of the vessel wall.
• Generally classified into two categories: low pressure baroreceptors
and high-pressure baroreceptors.

• Low-Pressure Volume Receptors: are located in low pressure side of

circulation, especially in atria, and pulmonary vasculature.
• High-Pressure Volume Receptors: are present in high-pressure
compartment of circulation.
• These receptors include the baroreceptors present in carotid sinus,
aortic arch and left ventricle.
 BODY FLUID COMPARTMENTS

• There is about 42 liters of body fluid in an adult male, which is

about 60% of the body weight.
• The body fluid distributed mainly between the extracellular
compartment and intracellular compartment.

Extracellular Fluid Compartment:

• Fluid present in the spaces outside the cell constitutes
extracellular fluid (ECF).
• This includes plasma and interstitial fluid.
• ECF constitutes 20% of the body weight, which is about 14 liters
 Intracellular Fluid Compartment

• Intracellular fluid (ICF) is the fluid contained within the cells

of the body.
• It constitutes about two-thirds of total fluid of the body.
• It can not be measured directly.
• It is measured by subtracting ECF volume from total fluid
volume.
 Transcellular Fluid
Fluid is present in another compartment of the body called
transcellular fluid, which represents fluid present in the lumen
of structures lined by epithelium.
1. It includes fluid in the secretion of exocrine digestive glands,
cerebrospinal fluid (CSF), pleural, peritoneal, synovial and
pericardial fluids, intraocular (aqueous and vitreous humors)
fluids, bile, luminal fluids of the gut and fluid in the cochlea
and kidney tubules.
2. The total transcellular fluid volume is 1.5% of body weight,
which is about 1-2 L.
 MEASUREMENT OF BODY FLUID VOLUMES

General Principle:
• The volume of fluid compartment is usually measured by the
indicator dilution principle, which is based on the following
relationship:

• Where, A is the amount of a substance injected

intravenously, V is the volume in which the substance is
distributed and C is the final concentration attained.
Characteristics of an Indicator

• Should be relatively easy to measure.

• Should remain in the compartment being measured.
• Should not change the fluid distribution in the compartment
being measured.
• Should be non-toxic.
• Must mix evenly throughout the compartment being
measured.
• Should remain unchanged by the body during the mixing
period or the amount changed must be known
Principle of Measurement

• Size of fluid compartment is measured by injecting a substance and

then calculating the volume of fluid in which the test substance is
distributed.

• This is called the volume distribution of the injected substance, which

is equal to the amount injected divided by concentration of the
substance in the sample.
• If indicator leaves the compartment by excretion or
metabolism during the time allowed for mixing, then
calculation is done as follows:

Volume distribution = Amount injected – Amount removed

Final concentration of the substance
 Measurement of ECF Volume

Methods of Measurement
• ECF volume is measured by volume distribution principle using inulin, a
polysaccharide having molecular weight of 5200.
• Radioactive inulin is prepared by substituting 14C for one of the carbon
atoms of the molecule. Radioactive inulin levels are easily determined
by counting the samples with suitable radiation detectors.
• Also Cl– (36Cl– and 38Cl–), 82Br, mannitol and sucrose are used for
measurement of ECF volume.
• Cl– is largely extracellular. Therefore, radioactive isotopes of
Cl– (36Cl– and 38Cl–) are used for the purpose. However, ECF
volume determined by using Cl– is greater than actual
volume as some Cl– is also present in intracellular fluid.
• 82Br, sulphate, thiosulphate, thiocyanate and ferro-cyanide
are also used for measuring ECF volume. As these ions
interchange with Cl– in the body, they determine greater
values for ECF.
• Mannitol and sucrose have also been used to measure ECF
volume
Measurement of Plasma Volume

Plasma volume is measured by two dilution methods:

First Method: In the first method, the substance used neither
leaves the vascular system nor penetrates red cells.
• Examples are: Evans Blue Dye (T-1824), Radio-iodinated
human serum albumin (RISA), and Radio-iodinated gamma
globulin and fibrinogen.
Second Method: In the second method, radio-isotopes of
phosphorus (32P), iron (55,59Fe) and chromium (51Cr) are used
that penetrate and bind to red cells.
• Commonly used tag is 51Cr, which is attached to the red cells
by incubating in a suitable ‘Cr’ solution. Then, plasma volume
is calculated by using the formula:

Measurement of Interstitial Fluid Volume:

• The interstitial fluid volume is estimated as the difference

between ECF volume and plasma volume.
Measurement of ICF Volume
• Intracellular fluid volume (ICFV) cannot be measured directly by
dilution principle as no substance remains confined only to this
compartment.
• It is determined indirectly by subtracting ECF volume from total body
water (TBW). Thus, first TBW is measured.
Measurement of TBW is performed by indicator dilution principle:
• Deuterium oxide (D2O, heavy water) is usually used as it has
properties that are slightly different from H2O.
• Tritium oxide and aminopyrine can also be used for measuring TBW.
IONIC COMPOSITION OF BODY FLUIDS