Body Fluids: Dr. Deepthi de Silva Senior Lecturer Department of Physiology

Body fluids
Dr. Deepthi de Silva

Senior Lecturer
Department of physiology
At the end of these lectures you should be able to
• Describe the normal composition of the body
• Outline the distribution of water in the body
• Explain the terms osmotic pressure, osmolarity &
osmolality
• Outline the distribution of electrolytes in the
fluid compartments
• List fluids that are hypo, iso and hypertonic to
plasma
• Describe the outcome of expanding or reducing
the body fluid compartments
• Outline the reason for using colloid, 0.9% saline
and 5% dextrose as fluid replacement
What does the body contain?
Average male (70 kg)
Water 60%
Fat 15%
Protein 18%
Minerals 7%
Total body water
Intracellular Extracellular
(fluid inside cells)
Interstitial fluid
(fluid around cells)
Intra vascular
fluid
(fluid inside blood
vessels)
Transcellular fluid
Total body water
(60% of body weight)
• Intracellular Interstitial fluid

40% of body (15% of body
weight weight)
• Extracellular fluid
(20% of body
Plasma
weight)
(5% of body
weight)
• Trans cellular fluid
Distribution of body fluids
(70kg man)
Intracellular
(ICF) ~ 28L (2/3rd)
Plasma
Total body
Extracellular fluid ~3.5L
water
(TBW) (ECF) ~ 14L (1/3rd)
42L Interstitial
fluid
Transcellular fluid
~ 10.5L
0.7L
Physiological variations in TBW
• Age: TBW as % of body weight decreases
with age
• Sex: Male > female
(adult Male 55-60%; Female 45-50%)
Male Female
10-18 y 59% 57%
19-40 y 61% 51%
41-60 y 55% 47%
>60 y 52% 46%
• Fat content: greater the fat content less the
TBW as a % of body weight
Measuring body fluids
• Read up! (Ganong or Guyton textbook of
physiology)
• Remember that we use a specified
substance & see how it is diluted in a
fluid compartment [dilution principle]
– Albumin stays in plasma
– Inulin in ECF
– Heavy water in ALL compartments
Units for measuring solute
concentrations
• Mole (mol): molecular weight of a
substance in grams
e.g. NaCl = 23+35.5 = 58.5g
• Equivalent (eq) = 1 mol of ionised
substance/valence
e.g. Ca2+ = 40/2 = 20g
• Normality = gram equivalent in 1 Litre
e.g. 1N solution of HCl = 1 +35.5g =36.5g
Solutes diluted in body fluids
Plasma ISF ICF

Volume 3.5L 12.0L 26.5L
Na+ mmol/L 142 145 10
K+ mmol/L 4 4 150
Ca 2+
mmol/L 2 1 40
Mg2+ mmol/L 101 114 15
Cl- mmol/L 27 31 10
HCO3- mmol/L 1 1 100
PO4 mmol/L 0.5 0.5 20
Proteins 2 <0.1 60
Osmotic pressure
Membrane
permeable
to water
Solution Solution Solution Solution

A B A B
• Solution A has a lower concentration of solute

and higher concentration of water (solvent)
• Water moves from the high to low water
concentration area
• Called osmosis
• Osmotic pressure: pressure required to stop
this movement of water
Osmolarity
• Measured as Osmole =
Gram molecular weight of a substance
Number of free particles released in solution
• Osmolarity: number of osmoles/L of solvent
• Osmotic pressure
 number of particles
 temperature
P (osmotic pressure) =
n (no. of particles). R.T(temp)
V (volume)
Osmolality
• Osmolality: Number of osmoles per kg of
solvent
• In plasma, usually expressed as osmoles/L
Measuring of osmolal concentration:

- degree to which the freezing point is
depressed
- 1 mol ideal solution depresses it by 1.86oC
- Number of mosm/L = freezing point
/0.00186
Tonicity
• Osmolality of a solution with respect to plasma
• Osmolal concentration of plasma 290mosm/L -
plasma freezing point is -0.54oC
• Equal to 7.3 atmospheres pressure against water
• When an isotonic solution & plasma are separated by a
semi permeable membrane, there is no net flow of water
• Fluids isotonic to plasma

• 0.9% NaCl
• 5% dextrose
• King coconut water
Plasma osmolality
Plasma osmolality (mosm/L) =
2[Na+] + 0.055 [Glc] + 0.36 [urea]
(meq/L) (mg/dL) (mg/dL)
• Hypotonic fluids have a lower osmolality

than plasma <285mosm/L
• Hypertonic fluids have a higher
osmolality than plasma >300mosm/L
Changes in fluid balance
• Dehydration: loss of fluid from the body
• Isotonic contraction (dehydration)
– Loss of water and electrolytes in equal
proportions e.g. severe bleeding, burns
ECF ICF
Volume Decreased No net No change

movement
of water
Osmolality No change No change
Hypertonic dehydration
• Loss of water in excess of electrolytes
(especially sodium)
• Fluid lost has lower tonicity compared
to plasma e.g. severe sweating
ECF ICF
Volume Decreased Water Decreased
moves
from ICF
Osmolality Increased to ECF Increased
Hypotonic dehydration
• Loss of more electrolytes than water
e.g. Addison disease
ECF ICF
Volume Decreased Water Increased
moves
from ECF
Osmolality Decreased to ICF Decreased
Fluid replacement
• If the ECF compartment is reduced (i.e.
isotonic contraction) fluid replacement
has to remain in the ECF
• 0.9% saline is commonly used for this
purpose
• 1L of saline will be distributed
according to the ECF compartment
volume: 250mL to plasma
750 mL to interstitial fluid
The use of colloids
• Colloid contains proteins
• This solution will remain in the
circulation (i.e. plasma compartment)
and will not leave it to enter the ISF or
ICF compartments
• not always available
What about 5% dextrose?
• After infusion, the body's cells use the
glucose to generate energy
• Only the water is left behind!
• Water is distributed in all the fluid
compartments
• After 1L is infused
– ~ 660mL enters the ICF compartment
– ~ 340mL the ECF
~ 85mL to plasma, 255 to ISF
Tissue fluid formation and
reabsorption
• The capillaries are tiny blood vessels
• contain an arteriolar and venular end
• Tissue fluid is formed in the capillaries- fluid
comes out at the arterial end and goes back in
at the venous end
• Pressure of blood forces fluid out
“hydrostatic pressure”
• Osmotic pressure in the blood brings fluid in
to capillary “colloid osmotic pressure”
Starling’s forces
• Hydrostatic pressure
– Pressure exerted by blood in the capillary
– Increased when blood pressure is high
– High at arterial end and lower at venous
end
• Colloid osmotic pressure
– Pressure exerted by proteins in plasma
(do not cross the capillary membrane)
Arterial end Venous end
Capillary Capillary colloid

hydrostatic osmotic
pressure pressure
Interstitial
Interstitial
space
space
hydrostatic
colloid osmotic
pressure
pressure
Starling’s forces
Q = kf. S [(Pc+ i) – (Pi+ c)]
Q = rate of fluid formation

Kf = permeability coefficient
S = surface area
P = hydrostatic pressure
 = colloid osmotic pressure
c = capillary
i = interstitial fluid
Starling’s forces
Arteriolar Venular
end end
Pc c Pc c
37mmHg 25mmHg 17mmHg 25mmHg
i i
Pi Pi
0mmHg 0mmHg
1mmHg 1mmHg
Tissue fluid formation &
absorption
Arteriolar end
Q=kf.s[(37+0) – (25+1)]
Q= 11mmHg
Net outward pressure
Venular end
Q=kf.s[(17+0) – (25+1)]
15% tissue fluid Q= -9mmHg
Drained by Net inward movement
lymphatic system
Oedema formation
• Accumulation of excessive amounts of
fluid in the interstitial spaces
• Exceeds the capacity of the lymphatic
vessels to drain it
• Caused by altered Starling’s forces
Mechanisms of oedema formation
Factors that are Factors that are
increased reduced
• Increased capillary • Decreased capillary
hydrostatic pressure colloid osmotic
pressure
• Increased capillary • Decreased lymphatic

permeability drainage
Increased capillary hydrostatic
pressure
• Increase in hydrostatic pressure at the
venous end
• Causes include
– Venous thrombosis (blood clot obstructing
venous drainage)
- Right ventricular failure: systemic oedema
– Left ventricular failure: pulmonary oedema
Oedema due to reduced colloid
osmotic pressure
• Hypoalbuminaemia
reduced plasma albumin level
– Reduction in formation (in liver)
– Increase in loss (from kidney,
intestines, skin)
Increased capillary permeability
causing oedema
• Mainly causes localised oedema
– Following insect bites → histamine
release
– Allergic conditions
– Capillary damage
Lymphatic obstruction as a cause
of oedema
• Called lymphoedema
– Lymphatic vessels obstructed e.g. by
filarial parasite
– After removal of lymphatic vessels
e.g. after surgery for cancer
Clinical examination
• Oedema usually causes an increase in body
weight
• Pit formed in affected tissue
• Lymphoedema does NOT cause a pit

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Body fluids

Dr. Deepthi de Silva

• Intracellular Interstitial fluid

Plasma ISF ICF

Solution Solution Solution Solution

• Solution A has a lower concentration of solute

• Osmolarity: number of osmoles/L of solvent

Measuring of osmolal concentration:

• Fluids isotonic to plasma

• Hypotonic fluids have a lower osmolality

Volume Decreased No net No change

Capillary Capillary colloid

Q = kf. S [(Pc+ i) – (Pi+ c)]

Q = rate of fluid formation

• Increased capillary • Decreased lymphatic

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