BODY FLUID

PRESENTED
BY
DR(MRS) OKORIE P.
 The body is formed by solids and fluids.

 The fluids part is more than 2/3 of the whole body.

 Water is an important component of the human body.

 About 60% of total body weight is water, this forms

the total body water but this varies with age, sex and
degree of obesity.
 It is less than 60% in obese people i.e. the fatter the
subject, the less the functional water content.

 This is because fat cells displace water.

 Infact, water may account for more than 70% of the

total body weight.

 The loss of 10-20 % of total body water leads to death.

In terms of volume, total body water in adult man(70kg)
is about 42 litres.

The water content is related to lean body mass(the total

body weight - the total fat i.e. fat free mass of the body)
and it measures about 70 % of lean body mass.

Lean Body Mass(LBM)= Total body water(TBW)

0.7
The Regulation of Water Content
 The water content of each individual is maintained
constant primarily by mechanisms which regulate the
osmolality (i.e. no of solute particles per kg of water )
of the body fluids.

 The hormone at the centre of the regulation of the

water content of the body is antidiuretic
hormones(ADH).
 Excess water intake provokes prompt water
diuresis(due to supposed ADH secretion), while water
deprivation provokes thirst, ADH and renal retention of
water.

 The regulation of Na+ content or ECF volume

indirectly regulated water content, since loss or gain of
Na+ is accompanied by changes in osmotically
equivalent amount of water (I.e. loss or gain of water).
 For a person in proper water balance, the water intake
equals the water output daily.

 The average daily water intake and output in

individuals in temperate and tropical climates are given
below.
Daily intake source Temperate climate(ml) Tropical climate(ml)

Drinks 1500 2500

Food 750 800
Cellular metabolism 350 350
Total Per day 2600 3650

Daily intake source Temperate climate Tropical climate (ml)

(ml)
Urine 1600 1350
Sweat 100 1500
Skin 400 400
Lungs 400 300
Faeces 100 100
Total daily output 2600 3650
 In general, most people normally drink more water
than the minimum 400ml required to excrete urinary
solutes(mainly urea and Na+).

 Tropical heat provokes much sweating, causing thirst

and some reduction in urine output.

 This is the main difference between residences in

temperate(cold) and tropics.

 This must be replenished with salt.

 Apart from sweat, water is constantly being lost from
evaporation of water diffusing through the skin as well
as from the alveoli of the lungs during expiration.

 Since, the individual is not aware of these losses, it is

referred to as insensible loss.
BODY FLUID COMPARTMENTS
 Fluids consists of water and contain solutes.

 Body fluid can be divided into 2 main compartments.

 a) Intracellular fluid (ICF)- 40% body wt. i.e.

28 litres
b) Extracellular fluid(ECF)-20% body wt. i.e.
14 litres
Both make up TBW –42 litres.
INTRACELLULAR FLUID (ICF)
 Intracellular fluid is the fluid inside the body cells. It volume is about 28L (2/3
of TBW).

 The fluid is contained within boundaries of cell membrane and each cell
regulates its own content.

 It provides body cells their tugor as well as a medium within which

biochemical reactions can take place.

 The major cations of ICF are K+ and Mg2+ while the major anions are proteins
and organic phosphate (ATP, ADP, and AMP).

 The pH of ICF is 7.0

EXTRACELLULLAR FLUID (ECF)
 This
is the fluid outside the cells. Its total volume is about 14L (1/3 of
TBW).

TheECF supports the cells and allows transport of nutrients and waste
products.

Themajor cation is Na+ and major anions are Cl- and HCO3-. The pH of
ECF is 7.4.

The ECF is subdivided into

 14L

fluid (ISF)  10.5L

Interstitial
Plasma ( 3L)
Transcellular Fluid (1 – 2L)

 
INTERSTITIAL FLUID (ISF)-TISSUE
FLUID
 It is found in the spaces between the cells. It surrounds all cells except
blood cells.

 It is about ¾ of the ECF volume (10.5L).

 The composition of ISF is the same as that of plasma except that it has
little protein.

 The relationship between plasma and ISF is a delicate one and any
imbalance in the two, causes the accumulation of fluid in the
extracellular space leading to edema (edema)
 
 PLASMA

 This is the fluid portion of the blood and measures

about 3L (i.e. ¼ of ECF).
 The plasma and interstitial fluid (ISF) are the 2 largest

components of the ECF and are in dynamic equilibrium

with each other through the pores of capillary
membranes.

 The major plasma proteins are albumin and globulins.

TRANSCELLULAR FLUID

 The term transcelluar fluid refers to fluid collections

secreted by epithelial cells such as cerebrospinal fluid,
intraocular, pericardial, synovial fluid, cochlea fluid etc.
 Although these fluid collections lie outside the cell
membranes and therefore are “extracellular”, they have little
in common with the rest of the ECF.
 The electrolyte composition is unique to each fluid and
different from that of the ECF. Its total volume is about 1 – 2
liter.
  
MEASUREMENT OF BODY FLUID
VOLUMES/COMPARTMENTS
 This is usually done using indicator dilution technique.

 This technique is based on the relationship between

the amount of a substance injected intravenously (A),
the volume in which that substance is distributed (V)
and the final concentration attained (C)

 The equation for this relationship is

 C=A or V = A
V C
  Where V is the volume (ml or L), in which the quantity
A (g, kg or mEq), is distributed to yield the
concentration C (in g/ml or L or in mEq/ml or L)

 E.g.: If 25mg of glucose is added to an unknown

volume of distilled water and the final concentration of
glucose after mixing is 0.05mg/ml, then the volume of
solvent is
 
 V= 25mg
0.05mg/ml = 500ml
 
 Procedure:
 a. Inject known amount of substance A (marker either dye or
radioactive isotope etc.)

 b. Allow adequate time for mixing uniformly through the compartment.

 c. Take a sample and measure the new concentration (c)

 E.g. II: Sample calculation:

 A patient is injected with the 500mg or mannitol. After a 2 hours
equilibration period, the concentration of mannitol in plasma is 3.2mg
/100ml. (During equilibration period 10% i.e. 50mg of the injected
mannitol is excreted in urine).

 What is the ECF volume?

 
 Volume = Amount (A)

Concentration (C)
  = 500
3.2mg/100L

= 500-50
3.2mg/100L

= 14.1 L
 Correction factor: Some amount of marker substance is lost
through the urine, during distribution so the formula is
corrected as follows.

 Volume = Amount of sub. injected – Amount excreted

Concentration of substance in sample of
fluid
 
 The Plasma volume, ECF volume, and total body water can
be measured using this dilution technique while ISF and
ICF volumes cannot be measured using this technique ISF
and ICF volumes can be derived as follows
 ICF = TBW – ECF
 ISF = ECF – Plasma
Criteria/Properties of Marker Substances

 Regardless of compartment, desirable markers share, the following

qualities
 i. It must not be toxic
 ii. It must remain in the compartment being measured
 iii. It must mix evenly throughout the compartment being measured
 iv. It must not be excreted rapidly
 v. It must not be metabolized or transformed during the period of the

experiment
 vi. It must not influence the distribution of water
 vii.It should be fairly easy to measure.

 
  Compartments / volume / suitable indicators
 a. TBW - Radioactive water – tritium oxide (3H20), Heavy water
(2H20), antipyrine
 b. ECF - Radioactive Sodium (22Na), Inulin, Mannitol
 c. Plasma - Radioactive iodine albumin (125 1-albumine), Evans blue
dye (T – 1824).
 
 Compositions of body fluid compartments
 The electrolyte composition of the main divisions of the body fluid
is given below.

 Na and Chloride constitute the bulk of the ions in ECF, while

potassium and phosphate form the bulk of ions inside the cells.

 There are variations from textbooks to textbooks.

 
Electrolytes ECF (Plasma) - ICF (Skeletal)
mEq
CATIONS
Na+ 142 10
K+ 4 160
Ca+ 5 2
Mg2+ 3 26
Total 154 198
ANIONS
Cl- 103 3
Hco3- 27 10
Hpo42- 2 100
So42- 1 20
Organic 5 65
acid
Protein 16 65
Total 154 198
 The reason for the unique distribution of major cations is the
presence of specific transport systems in the all membrane,
for instance, the ATPase – mediated Na-K pump which
actively transport K+ from ECF into the cell and Na+ out of
the cell.

 There are other forces which affect the distribution of

electrolytes across cell membranes, and this include the
passive forces of diffusion, osmosis and Gibbs – Donnan
equilibrium (caused by the presence of non diffusible protein
anions,
  inorganic phosphates i.e. product of ions inside =
product of ions (cations and anions) outside and
sulphates inside the cell and to lesser extent in the
plasma.
 
 Question 1: Discuss the body’s various fluid
compartments. Describe briefly how the various fluid
compartments may be measured. Discuss the
composition of body fluid compartment.  
TONICITY

 All fluid compartments of the body are in or nearly in Osmotic

equilibrium.

 The term tonicity is used to describe the osmolality of a

solution relative to plasma.

 Osmolality refers to the numbers of solute particles

(osmole) per kilogram of water.

 Osmolarity refers to the number of solute particles per liter of

solution
 Solutions that have the same osmolality as plasma
are said to be isotonic e.g. 0.9% NaCl (normal
saline): 5.2g glucose/100ml (5% glucose
solution).

 Those with greater osmolality are hypertonic e.g.

2% NaCl solution while those with lesser
osmolality are described as hypotonic e.g. 0.3%
NaCl.

 Normal Osmolality of plasma is approximately

300m Osm/L.
 When a cell e.g. RBC is placed into an isotonic
solution, there will be no change in volume of the cell
but if it is placed in hypotonic solution, the cell will
swell due to movement of water into the cell and if the
solution is sufficiently diluted, the cell will burst (lyse).

 Whereas if the cell is placed in hypertonic solution,

solution, the cell shrinks due to movement of water
molecules from the cell into the solution through the
process of osmosis.
SHIFTS/MOVEMENT OF WATER
BETWEEN COMPARTMENTS
 Water shifts between ECF and ICF so that the osmolality of the two
compartments become equal.

 The osmolarity of ICF and ECF are assumed to be equal after a brief
period of equilibration.

 The general clinical terms for volume abnormalities are dehydration and
overhydration.

 Dehydration is defined as a significant decrease in water content of the

body while overhydration is a significant increase in water content of
the body (both condition are associate with a change in ECF volume)
FORMS OF DEHYDRATION
 
1. Iso-osmotic Dehydration: (loss of isotonic fluid).
This is water deficit caused by loss of isotonic fluid e.g.
Diarrhea, hemorrhage, vomiting.

 It is also called Iso-osmotic volume contraction.

 Each of the above examples causes the following

effects.
a) ECF volume decrease but there will be no changes in
osmolality of ECF and ICF.
Because osmolality is unchanged, there will be no shift of
water between ECF and ICF.
b) Plasma protein concentration and hematocrit (Packed
Cell Volume) increase because, the loss of ECF
concentrate and RBC (only when the cause is vomiting or
diarrhea). But because ECF volume osmolality is
unchanged, the RBC will not swell or shrink
c) Arterial blood pressure decreases because of the
decreases ECF volume . 
 2. HYPER OSMOTIC DEHYDRATION:
 This is water deficit caused by decrease water
intake, excessive sweating (exercise heavy), and fever.

 It is also called hyper osmotic volume contraction

.Effects;
 Osmolality of ECF increases because sweat is hypo
osmotic i.e. relatively more water than salt is lost
during sweating.

 ECF volume decreases because of the loss of volume

in the sweat.
  Because ECF osmolality increases, water shifts out of ICF
into the ECF.
 As a result, ICF osmolality increases until it is equal ECF

osmolality.
 As a result of the shift of water out of the cells, ICF

volume decreases.
 Protein concentration increases because of the loss ECF

volume
 
 
3.HYPO-OSMOTIC DEHYDRATION (loss of
NaCl)
 Causes include renal loss of NaCl because of adrenal

insufficiency (e.g. as occurs in primary hypo

adrenocorticalism - Addison’s disease).
 Adrenal cortex fails to secrete the corticosteroid –

aldosterone (Aldosterone aid in renal reabsorption of

NaCl).
 It is also called hypo osmotic volume contraction. As a

result of this;
 Osmolality of ECF decreases because the kidneys loss more NaCl
than water as a result of the lack of aldosterone in adrenocortical
insufficiency.

 Aldosterone is important in renal reabsorption of NaCl.

 ECF volume decreases. Water shifts into the cells because of

decrease in ECF osmolality and as result of this shift, ICF osmolality
decreases until it equals ECF osmolality and ICF volume increases.

 Protein concentration increases because of the decrease in ECF

volume.

 Hematocrit increases because of the decreased ECF volume and the

swelling of the RBCs caused by water entry.
 FORMS OF OVER HYDRATION
 Isosmotic overhydration e.g. Infusion of Isotonic fluid e.g.
0.9% NaCl (normal saline), infusion of 3L of 0.9% NaCl will
cause iso-osmotic overhydration.

 It is also called isosmotic volume expansion. The following

effects will be observed.

 ECF volume increases but there will be no changes in

osmolality of ECF or ICF.

 Because osmolality is unchanged, there will be no shift of water

between ECF and ICF.
 Plasma protein concentration and hematocrit decreases
because the addition of fluid to ECF dilutes the protein
and RBCs.

 Because ECF Osmolality is not changed, the RBCs will

not shrink or swell

 Arterial blood pressure increases because ECF volume

increases.
  Hyper osmotic over hydration- (Excessive NaCl intake, oral
or parenteral intake e.g. drinking sea water) of large amounts of
hypertonic fluid. It is also called hyper osmotic volume
expansion.
 Effects ;
 Osmolality of ECF increases because there has been addition of

osmoles to the ECF.

 Water shifts from ICF to ECF. As a result of this shift, ICF

osmolality increases until it is equal to ECF osmolarity.

 As a result of the shift of water out of the cells, the volume of

the ECF increases (volume expansion) and the volume of the
ICF decreases.
 
 HYPOSMOTIC OVERHYDRATION: Causes: ingestion of
a large volume of water and during renal retention of water
due to the syndrome of inappropriate antidiuretic hormone
secretion (SIADH) water retention.

 Osmolality of ECF decreases because of the retention of

excess water.

 ECF volume increases because of the water retention and

water shifts into the cells (because of higher ICF osmolarity).

 As a result of this shift, ICF osmolarity decreases until it is

equal to ECF osmolality, and ICF volume increases.
Proteinconcentration decreases because of the increase in ECF volume.
Although hematocrit might also be expected to decrease, in fact it will

be unchanged because water shifts into the RBCs, increasing their

volume and offsetting the diluting effect of ECF volume expansion.

Question 2
Discuss the changes in ECF volume, ECF osmolarity, ICF volume, ICF

osmolarity caused by
a. Infusion of 3L of 0.9% NaCl
b. Ingestion of a large volume of water
c. Diarrhea
d. Heavy exercise
e. Excessive NaCl intake
f. Addition’s disease.

 
 
 
EDEMA

 Edema is an abnormal expansion of ISF volume.

 The forces that govern capillary fluid exchange acts

in both directions within the capillary and the

interstitial space.
 These forces are called starling forces (interstitial

pressures). They are related by the following

equation.
 
  Fluid movement = k [(Pc + i) – (Pi + c)]
 Outward forces inward forces

 Where Pc = Capillary hydrostatic pressure

 Pi = Interstitial hydrostatic pressure

c =Capillary oncotic pressure

i = Interstitial oncotic pressure
 K = capillary filtration coefficient.
Arteriole Interstitial space venule

37mmHg capillary 17mmHg

Oncotic pressure
=25mmHg

Interstital pressure=1mmHg

A typically muscle capillary hydrostatic
pressure (Pc) at arterial end is 37 mmHg
and at venous end, it is 17mmHg.
 The hydrostatic pressure is acting

outwards, tending to push fluid out the

capillary.
 The plasma oncotic pressure is 25mmHg

and for practical purposes, this can be

taken as equal at both the arterial and
venous end of the capillary
 Thus, at the arterial end of the capillary, there
is a net outward force of 11mmHg [(37-1) –
25].
 At the venous end there is a net inward force

of 9mmHg [25- (17-1)] which causes most of

the fluid filtered at the arterial end to be
absorbed back into the capillary lumen
 From these calculations, net filtration force
(outward) is 11mmHg while net reabsorption
force is 9mmHg (inward).
 Therefore more fluid is filtered than

reabsorbed.
 Approx. 24L of fluid is filtered per day. 85%

of this is reabsorbed.
 The remainder forms the lymph which is

drained by the lymphatics and return to the

circulation via the thoracic duct in the neck.
  Causes of edema
 There are 3 major causes of edema.

 a.
Factors that increase capillary hydrostatic
pressure.

 b.Factors that decrease osmotic gradient (colloid

osmotic pressure of plasma – colloid osmotic
pressure of ISF) across the capillaries.

 c. Inadequate tissue drainage.

 
 a. Factors that increase capillary hydrostatic pressure.

 i. Increase in venous pressure – This can be localized e.g.

obstruction by clot * travelling*. Generalized, e.g.
peripheral edema as in right heart failure.

 ii. Arteriolar dilation e.g. during heat and if standing, may

increase both (i) and (ii) leading to edema in the legs.

 iii. Salt and water retention lead to increase ECF Volume

which will increase accumulation of tissue fluid.
 
 b. Factors that decrease osmotic gradient across capillaries.
 i. Nutrition – (malnutrition e.g. lack of protein) – as seen in

the terminal stage of kwashiorkor.

 ii. Kidney diseases e.g. nephrosis – condition where large

amount of protein (mainly albumin) leak into the urine (lost).

 iii. Increase capillary permeability – causes proteins to leak into

the interstitial space thus decreasing osmotic gradient as occur
in burns, insect bites etc.

 iv. Liver disease – causes inadequate protein production.

 
  c. Inadequate tissue drainage.
 i. Obstruction of lymphatics (lymphoedema) e.g. infection

of the lymphatics by parasites e.g. filariasis leading to

elephantiasis of the leg.

 ii. Surgical removal of lymph nodes e.g. in radical

mastectomy- for breast cancer treatment.

 During the treatment some lymph nodes may need to be

removed leading to problems with lymphatic drainage of the
arm.
 
 Edema can be intracellular or extracellular
 1) Intracellular edema. Caused by depression of the

metabolic system of the tissue and lack of adequate nutrition

to the cells e.g. decrease blood flow delivery.

 This hampers the function of the cell membrane ionic pump

(Na + - K+ ATPase) that pumps out Na+ which normally
diffuses into the cell.

 Thus the accumulation of Na+ will lead to water moving into

the cell (by osmosis) causing intracellular edema.
  2) Extracellular edema: This type occurs from any
condition which causes the interstitial fluid pressure to
become substantially positive i.e. the above mentioned
causes of edema will lead to these substantial positive
interstitial pressures.
 
 Edema can also be described as pitting and non
pitting.
 Putting – This is noticed, when pressure is applied

by the finger and this leaves a depression after

removal and takes about 30 sees to disappear.

 The depression is due to disappearance of free fluid

to other area which later flows back after removal of
the pressure.

 Non Pitting – In this form of edema, no depression

occurs after applying pressure with the fingers. This
is because the fluid has coagulated (clotted).
THANK YOU.