FLUIDS

Isaac Nuako
Content:

- Fluids compartment
- Fluid balance
- Movement of body fluids
- Regulation of body fluids.
- Solutions – tonicity
- Oedema – intracellular & extracellular
BODY FLUID COMPARTMENTS

•Males - 60% body weight - 42L

•Females -55% body weight
•Infant – 73% body weight
•Older adult – 45% body
weight
Selectively permeable membranes separate
body fluids in distinct compartments.

A compartment may be as small as a single cell

and as large as interior of the heart or blood
vessels.

Fluid moves freely within ECF compartment.

General organisation of the circulatory system
 DISTRIBUTION OF BODY FLUIDS
• 2/3 Intracellular = inside the cell; 40 – 42% of body
wt
• 1/3 Extracellular = outside the cell, 17% of body wt
– Interstitial (80%) = found in microscopic spaces btn
tissue cells and outside blood vessels
– Intravascular (20%) = blood plasma found inside blood
vessels
• Transcellular ( constitute 1 – 2 litres) = fluid that is
separated by cellular barrier - CSF, pleural, synovial,
peritoneal, intraocular and GI.
 FUNCTIONS OF BODY FLUID
• Major component of blood plasma
• Solvent for nutrients and waste products
• Necessary for hydrolysis of nutrients
• Essential for metabolism
• Lubricant in joints and GI tract
• Cools the body through perspiration
• Provides some mineral elements
Composition of Body Fluids

• Water is the universal solvent

• Solutes are broadly classified into:
• Electrolytes – inorganic salts, all acids and bases,
and some proteins
• Nonelectrolytes – examples include glucose, lipids,
creatinine, and urea
• Electrolytes have greater osmotic power than
nonelectrolytes
• Water moves according to osmotic gradients
ELECTROLYTES
Non-Electrolytes
FLUID BALANCE

Fluid is in a balance when the amount of water gained

(e.g. through the digestive system) each day equals
the amount of fluid lost (e.g. through urinary system,
sweat glands) each day.

Fluid balance also means – the required amount of

H2O is present and proportioned normally among the
various compartments.
 SOLUTIONS
• Isotonic Solution - The same conc’n as blood plasma;
expand fluid volume without causing fluid shift.
• Hypotonic Solution - Lower conc’n than blood plasma (less
than 290 mOsm/L); moves fluid into the cells causing them
to enlarge - E.g. kidneys produce dilute urine- has more
H2O than electrolytes.
• Hypertonic solution - Higher conc’n than blood plasma;
pulls fluid from cells causing them to shrink. E.g. kidneys
produce conc’d urine- has more electrolytes than H2O.
•These are explained with regard to whether the
the solute is permeating and its osmolarity.

•Iso-osmotic
•Hyper-osmotic
•Hypo-osmotic
 Fluid shifts
• Water movement between ECF and ICF
– If ECF becomes hypertonic relative to ICF, water
moves from ICF to ECF

– If ECF becomes hypotonic relative to ICF, Water

moves from ECF into cells
 MOVEMENT OF BODY FLUIDS
• Osmosis = movement across a semi-permeable
membrane from area of lesser concentration to
area of higher concentration; high solute
concentration has a high osmotic pressure and
draws water toward itself.
– Osmotic pressure = drawing power of water
(Osmolality)
– Osmolarity = concentration of solution
 Osmotic Pressure & Osmolarity
Osmotic pressure of a solution is directly proportional to the
conc. of osmotically active particles in that solution regardless
of whether the solute is a large molecule or a small molecule.

Osmotic pressure α osmolarity

𝜋 = CRT (van’t Hoff’s law)

𝜋 − Osmotic pressure
C – concentration of solutes in osmoles per litre
R – ideal gas constant
T – absolute temperature in degrees kelvin
 OSMOLALITY Vs. OSMOLARITY
1. If osmolality is the number of osmoles of solute in
a kilogramme of solvent, then osmolarity is the
number of osmoles of solute in a litre of solution.

2. Osmolarity deals with the concentration of an

osmotic solution, while osmolality deals with the
concentration of particles in a fluid.

3. It is easier to determine the osmolality than the

osmolarity.
OSMOLALITY Vs. OSMOLARITY…

4. Osmolarity is expressed as Osom/L (mmol/L), and

osmolality is expressed as Osom/kg (mmol/kg).

5. Osmolality is used to determine medical conditions

like diabetes, shock and dehydration, while osmolarity
is used for the detection of the concentration of
dissolved particles in urine.

6. When the concentration of solutes is very low, the

osmolality and osmolarity are similar.
Movement of Body Fluids…

•Colloid osmotic pressure or Oncotic

pressure - keeps fluid in the intravascular
compartment by pulling water from the
interstitial space back into the capillaries.
Movement of Body Fluids…

• Diffusion = Molecules move from higher

concentration to lower
• Concentration gradient
• Filtration = water and diffusible substances move
together across a membrane; moving from higher
pressure to lower pressure
• Oedema results from accumulation of excess fluid in
the interstitial space
• Hydrostatic pressure causes the movement of fluids
from an area of higher pressure to area of lower
pressure
 ACTIVE TRANSPORT

• Requires metabolic activity and uses energy

to move substances across cell membranes
– Enables larger substances to move into cells
– Molecules can also move to an area of higher
concentration (Uphill)
– Sodium-Potassium Pump
• Potassium pumped in – higher concentration in ICF
• Sodium pumped out – higher concentration in ECF
 Blood Volume
- Blood is extracellular fluid contained in a chamber in
the circulatory system = intravascular fluid.
- However, blood contains both extracellular fluid (the
fluid in plasma) and intracellular fluid (the fluid in the
red blood cells).
- The average blood volume of adults is about 7% of
body wt (5 – 7L).
- About 60% of blood is plasma & 40% is red blood
cells (other formed elements form a smaller
percentage).
Haematocrit (Packed Red Cell Volume)
- The haematocrit is the fraction of the blood
composed of red blood cells.

- It is impossible to completely pack the red cells

together therefore true haematocrit is only about
96% of the measured haematocrit.

- The measured haematocrit Men = 0.40, and

women = 0.36. Severe anaemia = 0.10, a value that is
barely sufficient to sustain life.
 Blood volume measurement

𝒑𝒍𝒂𝒔𝒎𝒂 𝒗𝒐𝒍𝒖𝒎𝒆
𝒕𝒐𝒕𝒂𝒍 𝒃𝒍𝒐𝒐𝒅 𝒗𝒐𝒍𝒖𝒎𝒆 =
𝟏 − 𝒉𝒂𝒆𝒎𝒂𝒕𝒐𝒄𝒓𝒊𝒕
 REGULATION OF BODY FLUIDS

• Homeostasis is maintained through

–Fluid intake
–Fluid output regulation
–Hormonal regulation
 Fluid Intake
• Average adult intake
– 2200 – 2700 mL per day
• Oral intake accounts for 1100 – 1400 mL per day
• Solid foods about 800 – 1000 mL per day
• Oxidative metabolism – 200 - 300 mL per day
• Those unable to respond to the thirst mechanism
are at risk for dehydration
– Infants, patients with neurological or psychological
problems, and older adults

NB: Regulation of fluid gain is by regulation of thirst

 Fluid Intake

• Thirst control center located in the hypothalamus

– Osmoreceptors monitor the serum osmotic
pressure
– When osmolality increases (blood becomes more
concentrated), the hypothalamus is stimulated
resulting in thirst sensation
• Salt increases serum osmolarity
• Hypovolaemia occurs when excess fluid is lost
Dehydration - when water
loss is greater than water
gain.

Dehydration may be mild

or severe.
 Fluid Output Regulation

• Organs of water loss

– Kidneys- Urine

– Lungs - Respiratory losses

– Skin - Perspiration

– GI tract- Faecal Loss

 Fluid Output Regulation….

• Kidneys are major regulatory organ of fluid balance

– Receive about 180 liters of plasma to filter daily
– 1200 – 1500 mL of urine produced daily
– Urine volume changes related to variation in the amount
and type of fluid ingested
• Skin
– Insensible Water Loss
• Continuous and occurs through the skin and lungs
• Can significantly increase with fever or burns
– Sensible Water Loss occurs through excess perspiration
• Can be sensible or insensible via diffusion or perspiration
– About 300 to 400mL of insensible and sensible fluid lost
through skin each day
Fluid Output Regulation….

• Lungs
– Expire approx 300 to 400 mL of water daily
– Insensible water loss increases in response to changes in
resp rate and depth and oxygen administration

• GI Tract
– 3 – 6 liters of isotonic fluid moves into the GI tract and
then returns to the ECF
– 100 mL of fluid is lost in the feces each day
• Diarrhoea can increase this loss significantly
 PRIMARY REGULATORY HORMONES

• Fluid balance & electrolyte balance are

mediated by three hormones:

– Natriuretic peptides (ANP and BNP)

– Antidiuretic hormone (ADH)
– Aldosterone
Regulatory Hormones…
ATRIAL NATRIURETIC PEPTIDE (ANP)
– ANP is a hormone secreted from atrial cells of the
heart in response to atrial stretching and an
increase in circulating blood volume.

– ANP acts like a diuretic that causes sodium loss and

inhibits the thirst mechanism

– Monitored in CHF
Hormonal Regulation…

• ADH (Antidiuretic hormone)

– Stored in the posterior pituitary and released in
response to serum osmolality
– Pain, stress, circulating blood volume affect the release
of ADH
• Increase in ADH = Decrease in urine output

– Makes renal tubules & ducts more permeable to water

–In Summary, ADH Stimulates water

conservation and the thirst center
 Hormonal Regulation…
• Renin-angiotensin-aldosterone Mechanism.
– Changes in renal perfusion initiates this
mechanism

– Renin responds to decrease in renal perfusion

secondary to decrease in extracellular fluid volume

– Renin acts to produce angiotensin I which converts

to angiotensin II which causes vasoconstriction,
increasing renal perfusion

– Angiotensin II stimulates the release of

aldosterone when sodium concentration is low
• Renin-Angiotensin-Aldosterone System

(or low NaCl

flow in JGA)
 Hormonal Regulation…

• Aldosterone
– Released in response to increased plasma potassium
levels or as part of the renin-angiotensin-aldosterone
mechanism to counteract hypovolaemia
– Acts on the distal portion of the renal tubules to
increase the reabsorption of Na+ and the secretion and
excretion of K+ and H+
– Water is retained because sodium is retained
– Volume regulator resulting in restoration of blood
volume

In summary - Controls Na+ absorption and K+ loss along

the DCT
Series of Events in
Water Intoxication
Oedema
• Oedema refers to the presence of excess
fluid in the body tissues.

• Oedema occurs mainly in the extracellular

fluid compartment, but it can occur in the
intracellular fluid.
Intracellular Oedema

Two conditions are especially prone to cause

intracellular swelling:
(1)depression of the metabolic systems of the
tissues

(2) lack of adequate nutrition to the cells

Intracellular oedema can also occur in inflamed
tissues.

Inflammation usually has a direct effect on the cell

membranes to increase their permeability, allowing
Na+ & other ions to diffuse into the interior of the
cell, with subsequent osmosis of water into the cells.
Extracellular Oedema
Extracellular fluid oedema occurs when there is
excess fluid accumulation in the extracellular spaces.
There are general causes:
(1) abnormal leakage of fluid from the plasma to the
interstitial spaces across the capillaries,
(2) failure of the lymphatics to return fluid from the
interstitium back into the blood.

 The most common clinical cause of interstitial fluid

accumulation is excessive capillary fluid filtration.
Factors that increase Capillary Filtration
• The product of the permeability and surface
area of the capillaries (Increased capillary
filtration coefficient).

• Increased capillary hydrostatic pressure.

• Decreased plasma colloid osmotic pressure.

Lymphatic blockage
• Oedema can become especially severe because
plasma proteins that leak into the interstitium have
no other way to be removed.
• The rise in protein concentration raises the colloid
osmotic pressure of the interstitial fluid.
• Blockage of lymph flow can be especially severe with
infections of the lymph nodes. E.g. by filaria
nematodes.
• In certain types of cancer or after surgery in which
lymph vessels are removed or obstructed. e.g.
radical mastectomy.
 Other causes of Extracellular Oedema
I. Increased capillary pressure
A. Excessive kidney retention of salt and water
B. High venous pressure and venous constriction
e.g. heart failure
C. Decreased arteriolar resistance

II. Decreased plasma proteins

A. Loss of proteins in urine (nephrotic syndrome→
anasarca)
B. Loss of protein from denuded skin areas
III. Increased capillary permeability
A. Immune reactions that cause release of histamine
and other immune products
B. Toxins
C. Bacterial infections
D. Vitamin deficiency, especially vitamin C
E. Prolonged ischaemia
F. Burns
IV. Blockage of lymph return
A. Cancer
B. Infections (e.g., filaria nematodes)
C. Surgery
D. Congenital absence or abnormality of lymphatic
vessels
Oedema caused by Heart Failure
• ↑ venous pressure and capillary pressure
→increased capillary filtration.
• Arterial pressure tends to fall → ↓excretion of Na+
and H2O by the kidneys → ↑blood volume and
further raises capillary hydrostatic pressure to cause
still more oedema.
• ↓blood flow to the kidneys stimulates secretion of
renin, → ↑ formation of angiotensin II & ↑
secretion of aldosterone, both of which cause
additional Na+ and H2O retention by the kidneys.
• Pulmonary oedema
Oedema Caused by Decreased Plasma Proteins.
A reduction in plasma concentration of proteins
because of either
- failure to produce normal amounts of proteins or
- leakage of proteins from the plasma causes the
plasma colloid osmotic pressure to fall.
- A serious generalised oedema occurs when
plasma protein concentration falls below
2.5g/100ml

- Cirrhosis of the liver - ↓ protein production

-compresses abdominal portal venous drainage→
ascites