Body Fluids

Fluids

● Fluid Intake and Output Are Balanced During

Steady-State Conditions
● The relative constancy of the body fluids is
remarkable because there is continuous
exchange of fluid and solutes with the
external environment as well as within the
different compartments of the body.
Daily Intake of Water

● Water is added to the body by two major sources:

– (1) it is ingested in the form of liquids or water in the food,
which together normally add about 2100 ml/day to the body
fluids, and
– (2) it is synthesized in the body as a result of oxidation of
carbohydrates, adding about 200 ml/day.
● Intake of water, however, is highly variable among
different people and even within the same person on
different days, depending on climate, habits, and
level of physical activity.
Daily Loss of Body Water

● Insensible Water Loss – skin & lungs

● Fluid Loss in Sweat
● Water Loss in Feces
● Water Loss by the Kidneys
– The most important means by which the body
maintains a balance between water intake and
output, as well as a balance between intake and
output of most electrolytes in the body, is by
controlling the rates at which the kidneys excrete
these substances.
Body Fluids
● Total amount of fluid in the human body is approximately
60 - 70% of body weight
– Age, gender, degree of obesity

● Body fluid has been divided into two compartments –

– Intracellular fluid (ICF)
● Inside the cells
● 40% of total body water (28 – 42 L)
– Extracellular fluid
● Outside the cells
● 20% of total body water
Body Fluid Compartments
Extracellular fluid includes
● Interstitial fluid
● Present between the cells
● Approximately 80% of ECF
● Plasma
● Present in blood
● Approximately 20% of ECF
● Also includes (transcellular fluid) – about 1-2L
● Lymph ● vitreous body,
● synovial fluid ● endolymph,
● aqueous humor ● perilymph,
● cerebrospinal fluid ● pleural, pericardial and
peritoneal fluids
Body Fluid Compartments
Barriers separate ICF, interstitial fluid
and plasma

● Plasma (Cell) membrane

● Separates ICF from surrounding interstitial
fluid
● Blood vessel wall
● Separate interstitial fluid from plasma
Blood Volume

● Blood contains both extracellular fluid and

intracellular fluid.
● a separate fluid compartment, the circulatory
system.
● average blood volume of adults is about 7
percent of body weight, or about 5 liters
● About 60 per cent of the blood is plasma and
40 per cent is red blood cells - variable
Hematocrit (Packed Red Cell
Volume)

● The hematocrit is the fraction of the blood

composed of red blood cells, as determined
by centrifuging blood in a “hematocrit tube”
until the cells become tightly packed in the
bottom of the tube.
● 0.36 - 0.40 – normal
● 0.10 – severe anemia
● 0.65 - polycythemia
Composition of body fluids

● Organic substances ● Inorganic substances

● Glucose ● Sodium
● Amino acids ● Potassium
● Fatty acids ● Calcium
● Hormones ● Magnesium
● Enzymes ● Chloride
● Phophate
● Sulphate
ECF (plasma vs. interstitial fluid)

● Almost the same ionic composition

● Separated by capillary wall
● Plasma – high amounts of protein
– Slightly greater concentration of cations
● Interstitial fluid – small amounts of protein
● Slightly greater concentration of anions
● Ion concentrations are considered to be
about equal
ECF vs. ICF
Difference
● ECF ● ICF
● Most abundant cation - Na+, ● Most abundant cation - K+
– muscle contraction – Resting membrane
– Impulse transmission potential
– fluid and electrolyte balance – Action potentials
– Maintains intracellular
volume
● Most abundant anion - Cl-
– Regulation of pH
– Regulates osmotic pressure
– Forms HCl in gastric acid ● Anion are proteins (4x as
much as plasma) and
phosphates (HPO42-)
● Moderate - Mg and SO4
ions
●Na+ /K+ pumps play major role in keeping K+ high inside cells and Na+
high outside cell
Measurement of Fluid Volumes in the
Different Body Fluid Compartments—The
Indicator-Dilution Principle
Regulation of Fluid Exchange and
Osmotic Equilibrium

● Osmosis
– is the net diffusion of water across a selectively
permeable membrane from a region of high water
concentration to one that has a lower water
concentration.
● Osmotic Pressure
● Osmotic Equilibrium Is Maintained Between
Intracellular and Extracellular Fluids
Isotonic, Hypotonic, and
Hypertonic Fluids
Isosmotic, Hyperosmotic, and
Hypo-osmotic Fluids.

● The tonicity refer to whether solutions will

cause a change in cell volume. Depends on
the concentration of impermeant solutes.
● Isosmotic – same osmolarity with cell
● The terms hyperosmotic and hypo-osmotic
refer to solutions that have a higher or lower
osmolarity, respectively, compared with the
normal extracellular fluid, without regard for
whether the solute permeates the cell
membrane.
Volume and Osmolality of
Extracellular and Intracellular
Fluids in Abnormal States

● Basic principles:
● 1. Water moves rapidly across cell
membranes
● 2. Cell membranes are almost completely
impermeable to many solutes
Sodium Na+

– Most abundant ion in ECF

– 90% of extracellular cations
– Plays pivotal role in fluid and electrolyte balance as it
accounts for half of the osmolarity of ECF
Clinical Abnormalities of Fluid
Volume Regulation: Hyponatremia
and Hypernatremia

● The primary measurement that is readily

available for evaluating a patient’s fluid status
is the plasma sodium concentration.
● When plasma sodium concentration is
reduced more than a few milliequivalents
below normal (about 142 mEq/L), a person is
said to have hyponatremia.
● When plasma sodium concentration is
elevated above normal, a person is said to
have hypernatremia.
Causes

● a primary loss or gain of sodium or a

primary loss or gain of water.
Edema

● Excess Fluid in the Tissues

● Intracellular Edema
● (1) depression of the metabolic systems of
the tissues, and (2) lack of adequate nutrition
to the cells.
● Low blood flow to a tissue → delivery of
oxygen and nutrients is reduced → disrupted
tissue metabolism → cell membrane ionic
pumps become depressed
Extracellular Edema

● Occurs when there is excess fluid

accumulation in the extracellular spaces.
● (1) abnormal leakage of fluid from the
plasma to the interstitial spaces across the
capillaries,
● and (2) failure of the lymphatics to return fluid
from the interstitium back into the blood.
CAUSES
Safety Factors That Normally
Prevent Edema

● (1) low compliance of the interstitium when

interstitial fluid pressure is in the negative
pressure range,
● (2) the ability of lymph flow to increase 10- to
50-fold, and
● (3) washdown of interstitial fluid protein
concentration, which reduces interstitial fluid
colloid osmotic pressure as capillary filtration
increases.
Chloride Cl-

– Most prevalent anion in ECF

– Moves easily between ECF and ICF because most
plasma membranes contain Cl- leakage channels and
transporters
– Can help balance levels of anions in different fluids
Bicarbonate HCO3-

– Second most prevalent extracellular anion

– Concentration increases in blood passing through systemic
capillaries picking up carbon dioxide
– Chloride shift helps maintain correct balance of anions in
ECF and ICF
Potassium K+

– Most abundant cation in ICF

– Establish resting membrane potential in neurons
and muscle fibers
– Maintains normal ICF fluid volume
– Helps regulate pH of body fluids when exchanged
for H+
Magnesium

– Mg2+ in ICF (45%) or ECF (1%)

– Second most common intracellular cation
– Cofactor for certain enzymes and sodium-potassium
pump
– Essential for synaptic transmission, normal
neuromuscular activity and myocardial function
Specialized Fluids of the Body

● Lymph
● Milk
● Cerebrospinal fluid
● Amniotic fluid
● Aqueous humor
● Sweat
● Tears
Lymph
● Clear and colorless fluid
● 96% water and 4% solids
● Solids –
– Proteins
● 2-6% of solids
● albumin, globulin, fibrinogen, prothrombin, clotting factors, antibodies,
enzymes
– Lipids
● 5-15%
● Chylomicrons
● Lipoproteins
– Carbohydrates
● Glucose mainly
– NPN
● Urea and creatinine
– Electrolytes
● Sodium, calcium, potassium, chloride, bicarbonates
Functions of Lymph

● Return protein from tissue spaces into blood

● Redistribution of fluid
● Removal of bacteria, toxins and other foreign
bodies from tissues
● Maintain structural and functional integrity of
tissue
● Route for intestinal fat absorption
● Transport lymphocytes
Milk
● Secreted by mammary glands
● Complete natural food
● 83-87% water and 13-17% solids
● Solids
– Carbohydrates
● Lactose
– Lipids
● Triacylglyerols
● Palmitic acid, myristic acid, stearic acid, lauric acid, butyric acid,oleic acid
– Proteins
● Caesin (80%), Lactalbumin
● Enzymes (proteases, xanthine oxidase,lysozyme), immunoglobulins
– Minerals
● Ca, Mg, P, Na, K, Cl
– Vitamins
● Fat and water soluble vitamins except Vit - C
Functions of Milk

● Milk sugar provides galactose, a structural

unit for growing infant.
● In intestine, it gets metabolized to lactic acid
which eliminates harmful bacteria.
● Source of protein, mineral and vitamins
Cerebrospinal fluid (CSF)

● Clear, colorless liquid formed within the

cavities of brain and around spinal cord
● %00ml CSF is formed everyday
● At any given time, there is 120-150ml CSF in
the system
● CSF is completely replaced about three
times a day.
Functions of CSF

● Hydrolic shock absorber

● Regulation of intracranial pressure
● Influences the hunger sensation and eating
behaviours
Amniotic Fluid

● Liquid produced by membranes and fetus

● Volume of fluid increases with gestational
age
● Clear with some desquamated fetal cell and
a little lipid.
Functions of AF

● Physical protection to the fetus

● Medium for exchange of various chemical
Aqueous Humor

● Fluid that fills the interior chamber of eye

● Secreted by ciliary body, enters anterior chamber
● Blockade in the flow of aqueous humor causes
glaucoma due to increased intraocular pressure.
● Posterior chamber of eye is filled with vitrous humor
which contains a gel (vitrous body of hyaluronic acid
secreted by retina)
Sweat

● Secretion of sweat gland

● Regulates body temperature by cooling and
evaporation
● Sweat glands controlled by ANS, Adrenal
cortical steroid - which affect the quantity of
electrolyte present
Sweat

● Insensible perspiration amounts to 800-1200ml/day

● Volume of sweat produced/day during muscular
exercise at elevated temperature may range from
10-14l, which may lead to water and electrolyte
imbalance
● Water content of sweat varies from 99.2-99.7%
● pH – 4.7 to 7.5
● Total non protein nitrogen (urea) varies from 0.07-
1% per hour during copius sweating
Sweat

● Electrolyte in sweat varies

– Na+ 12.6-127 meq/l
– K+ 5-32 meq/l
– Cl- 8.5-85 meq/l
Tears

● Produced by lachrymal glands

● Isotonic but becomes hypertonic due to
evaporation as fluid passes over the cornea
● When the tear flow is copius, fluid is isotonic
● Under stimulus with a slow rate of tear flow,
the fluid is about 25m osm hypertonic
Copius – Rapid tear flow induction
Tears

● pH – 7 to 7.6 due to loss of CO2

● Protein content is 0.6 to 0.18g/dl with an
albumin/globulin ratio of 1:5 or 2:1
● Small amount of mucin is also present
● Lysozyme – lyses the cells of a number of
micro-organisms by breaking down the
polysaccharides of their outer layer
Functions of Tears

● Lysozyme protects eye from infectious

agents
● Lubricate the surface of the cornea
● Fill the irregularities of the corneal surface to
improve optical properties
● Protects eyes from injury
Potential Space

● pleural cavity, pericardial cavity, peritoneal

cavity, and synovial cavities, including both
the joint cavities and the bursae.
● Virtually all these potential spaces have
surfaces that almost touch each other, with
only a thin layer of fluid (viscous
proteinaceous fluid) in between, and the
surfaces slide over each other.