Biochemistry and Clinical Pathology Water Balance

WATER BALANCE
Distribution of water: Water constitutes about 73% of lean body mass. It is distributed in extracellular
and intracellular compartments. The extracellular fluid comprises a little more than one third of
total body water. It is made up of;
i) Blood plasma, (ii) interstitial fluid (iii) lymph and (iv) Trans cellular fluid

The blood plasma and interstitial fluids are fairly uniform in composition throughout the body.
The transcellular fluids are heterogeneous group of fluids that are the product of the secretion of
various epithelial membranes. Transcellular fluids are the cerebrospinal fluid (C.S.F.), the aqueous
humor of the eye, various secretions of gastrointestinal tract and the contents of the renal
tubules and urinary passages. Remainder of body water is the intracellular fluid which may vary
markedly in composition from tissue to tissue.
Functions of water in body:
Water is the most abundant constituent of the body. Its major functions are as below;
1. Water provides the medium in which all of the metabolic processes of body take place.
2. It acts as solvent for many biomolecules.
3. It provides specific H+ ion concentration and mineral ions like Na +, K+ and Cl- in biological fluids.
4. It also acts as a lubricant in the body so as to prevent friction in joints, pleura, peritoneum and
conjunctiva.

Water balance (Water metabolism):

The body's content of water is maintained constant on the average, by the maintenance of
balance between intake and output.
Intake of Water
Most of our daily intake of water enters by oral route, approximately two-third is in the form of
pure water or some other beverage and remainder is in the food that is eaten. A small amount of
water is also synthesized in the body as the result of oxidation of hydrogen in the food. This
quantity of metabolic water ranges between 150-200 ml per day, depending on the rate of
metabolism. The normal intake of fluid, including that synthesized in the body, averages about
2400 ml per day.
Output of Water
Water is normally lost from body through the lungs and skin and in the feces and urine.
Approximately 1400 ml of 2400 ml of water intake, is lost in the urine, 100 ml is lost in the sweat
and 200 ml in the feces. The remaining 700 ml is lost in the evaporation through the lungs or by
diffusion through the skin.
Insensible water loss: Loss of water by diffusion through the skin and by evaporation from the
lungs is known as insensible water loss because the person does not know that he is actually
losing water at the time that it is leaving the body. These losses are not ordinarily measurable.
When intake and output are measured experimentally or clinically, the measured intake exceeds
output, the difference representing most of the insensible losses.
All air that enters the lungs becomes totally saturated with moisture before being exhaled. Water
lost by this route varies directly with the alveolar ventilations and inversely with the absolute
humidity of the expired air. The atmospheric vapour pressure normally, decreases with decreasing
temperature so that loss is greatest in very cold and least in warm weather. This explains the dry
feeling in the respiratory passages in cold weather.

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Biochemistry and Clinical Pathology Water Balance
Regulation of water balance:
1. Hypothalamus (Thirst mechanism): A thirst centre is located in the hypothalamus. Dehydration
leads to osmoconcentration of plasma, which stimulates the thirst centre. This tends to draw
water from intracellular compartment and provokes to drink required amount of water.
2. Solutes in the body: Osmotic forces are the principal factors which control the amount of fluid in
various compartments. These osmotic forces are maintained by the solutes. Organic substances of
larger molecular size, mainly the proteins affect the transfer of fluid from one compartment to
another and do not effect the total body water. The inorganic electrolytes Na + and K+ are most
important, both in the distribution and in the retention of body water.
3. Vasopressin or antidiuretic hormone: Vasopressin exerts an antidiuretic effect. The hormone
affects the renal tubules and enhances facultative reabsorption of water.
4. Aldosterone: Aldosterone increases the reabsorption of sodium and chloride by the renal tubules.
Accompanying the retention of sodium, potassium excretion is increased as a result of exchange
of intracellular potassium with extracellular sodium.
5. Renin-angiotensin system: Renin results in the production of angiotensin-II, which acts directly on
the aldosterone producing cells of adrenal cortex, consequently increasing the extracellular
sodium and water.
6. Kinins: Action of kinins is opposite of antidiuretic hormone. Kinins (bradykinin and kallidin) are
produced in the kidney and increase salt and water excretion. Prostaglandins modulate the
activity of kinins in kidney.

Dehydration:
Dehydration is a state in which loss of water exceeds intake resulting into reduced water body
content. In the body, negative water balance

Types of dehydration:
Primary dehydration: In primary dehydration there is purely water depletion and no salt
depletion. It occurs due to deprivation of water as in; desert travelling, in mental patients who
refuse to drink water, in water/fluid restricted 'fast, during fever or in the high temperature
environment, excessive water loss due to vomiting, prolonged diarrhoea, gastroenteritis and
excretion of large quantities of urine or sweat.
When the blood becomes hypertonic, it lowers the urinary output and also makes the urine
concentrated which leads to acidosis and eventually coma. Death occurs in man due to renal
failure, acidosis, intracellular hyperosmolality, circulatory collapse or neural depression, when
body water falls by 20%.
Secondary dehydration: The decrease or increase in the total electrolytes is accompanied by a
corresponding increase or decrease in the volume of body water. Secondary dehydration is due to
decrease in total electrolyte content of body fluids.
Dehydration due to injection of hypertonic solution: When a highly concentrated solution of sugar
or salt is injected into the body of an individual, the osmotic pressure of blood will increase which
results in the flow of fluid from the tissues into the blood until equilibrium is reached.
Consequently, blood volume increases. This increased blood volume soon returns to normal by
the loss of excess material through excretion which finally causes a net loss of body water
producing dehydration.

Effects of dehydration:

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Biochemistry and Clinical Pathology Water Balance
The consequences of dehydration are disturbance in acid base balance, loss of body weight, rise
in nonprotein nitrogen of blood, dryness, wrinkling and looseness of skin, elevation of plasma
protein concentration and chloride, rise in the body temperature, increased pulse rate, reduced
cardiac output, exhaustion and collapse.

Management of dehydration:
1. Ordinarily, sodium chloride solution may be given parenterally to compensate the loss.
2. In several disorders like diarrhoea, gastroenteritis pancreatic or biliary fistulas etc., a mixture of
two-thirds isotonic saline solution and one-third sodium lactate solution (M/6) should be
administered intravenously.