WEEK 4 Dr Zain, Body fluids2014,2.ppt
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Transcript of WEEK 4 Dr Zain, Body fluids2014,2.ppt
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Total body weight
100%
Interstitial F
15%
Plasma
5%
Transcelluar
1%
Water
60%
Other
40%
ECF
20%
ICF
40%
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Body Fluids
Man: water constitutes 60% of body weight
Women: water constitutes 50% of bodyweight
Functional compartments of body fluids:
Intracellular space – 40% of body weight
Extracellular space –
20% of body weightInterstital – 15%
Plasma – 5%
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Factors affecting body fluids
1. Water intake & output
2. Age:
- Infant: 73%Fetus- high content of water initially butdecreases progressively during late gestation and by 3-
5yrs age.- adults: 60%
3. Sex:
Adult male: 60%
Adult female: 40-50%
4. Obesity
5. Climate
6. Level of physical activity
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Comparison in male and female
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In average young adult male: Body composition
% of body weightBody composition
18%Protein, & related
substances
15%Fat
7%Mineral
60%Water
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Adult 75kg
ICF- 400-450ml/kg or 0.4x75Kg= 30 L.
ECF- 150-200ml/kg (or 0.17x75Kg = 12 liters).
Blood volume – 60-65ml/kg (5 L)
Major components of ECF:
• plasma volume- 30-35ml/kg (3L)
• interstitial fluid 120-165ml/kg (8)
• Trans cellular fluids
-Also includes lymph, cerebrospinal fluid,synovial fluid, aqueous humor, vitreous body,
endolymph, perilymph, pleural, pericardial, and
peritoneal fluids
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Normal Exchange of Fluid & Electrolytes
In steady state, water intake = water loss
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Water intake regulation
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Osm or mOsm unit for number of particles
1 mol of NaCl - 2 osm
Osmolarity - mOsm/L
Osmolality - mOsm/Kg water
Osmolality defines concentration of
solution
Tonicity defines effect of fluid on cell
volume
Osmotic Activity of Fluids
V l C l
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Volume ControlOsmoreceptors - Day to day control
Baroreceptors - Respond to pressure change
The body sense any change of the osmotic pressure
by
Osmoreceptor cells in paraventricular/ supraopticnuclei
The body then respond to the change by
•Neural output
• Hormonal mediators
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Osmoregulation
Excess free water (Posm 280)
Thirst inhibited
ADH declines
Urine dilutes to Uosm 100Osmoregulation
Decreased free water (Posm 295)
Thirst increased
ADH increases
Urine concentrates to Uosm 1200
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The role of ADH:
•ADH = secreted in response to osmo;
= secreted in response to vol;
ADH = urinary concentration
• ADH acts on DCT / CD to reabsorb water
• Acts via V2 receptors & aquaporin 2
• Acts only on WATER
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Fluid shifts in disease
• Fluid loss:
– GI: diarrhoea, vomiting, etc.
– Renal: diuresis, Absence of ADH or its receptors
causes diuresis called diabetes insipidus
–
Vascular: haemorrhage – Skin: burns
• Fluid gain:
–
Heart / liver / kidney failure:
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ELECTROLYTE Composition
Electrolyte Conc Plasma (mEq/L) ISF ICF
Sodium, Na+ 142 141 10
Potassium, K+ 5 4.1 150
Calcium, Ca++ 5 4.1 -
Magnesium, Mg++ 3 3 40
(155)
Chloride, Cl- 103 115 15Bicarbonate, HCO3- 27 29 10
Biphosphate, HPO4- 2 2 100
Sulfate, SO4-2 1 1 20
Protein 16 1 60
Organic foods 6 3.4 -(155)
I t i t
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Importanceimportance
• Maintaining ECF volume is critical to maintaining
blood pressure
• ECF osmolarity is of primary importance in long-term
regulation of ECF volume
• ECF osmolarity maintained mainly by NaCl balance:
• intake: 10.5g/d output: 10g/d in urine
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FLUIDS and ELECTROLYTES
IV FLUID REPLACEMENT THERAPYTypes of Solutions
Isotonic
0.9% sodium chloride (NSS) Lactated Ringer’s sol’n Hypotonic 5% dextrose and water (D5W) 0.45% sodium chloride
0.33% sodium chloride Hypertonic 3% NaCl Protein sol’ns
Colloids Salt our albumin Plasmanate, Dextran
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Factors affecting ADH
release
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REGULATION OF FLUID INTAKE (THIRST)
decreased salivation decreased blood volume increased blood osmotic pressure
dry mouth and throat decreased blood pressure stimulation of hypothalamic
osmoreceptors
conscious awareness of thirst increased water intake
stimulation of tactile
receptors
increased
angiotensin II
stimulation of hypothalamic thirstcenter
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REGULATION OF FLUID OUTPUT
dehydration
ANTIDIURETIC HORMONE
increased blood
osmolarity
stimulation of
hypothalamicosmoreceptors
rehydration
secretion of ADH
from posterior
pituitary gland
increased water
reabsorption
increased thirst
ALDOSTERONE
dehydration
rehydration
increased water
reabsorption
increased Na+
reabsorption
increased
aldosterone
increased
angiotensin II
ATRIAL NATRIURETIC PEPTIDE
increased blood volume
decreased Na+
reabsorption
decreased water
reabsorption
decreased blood volume
stretch of right atrium
secretion of ANP
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REGULATION OF BODY
FLUIDSFluid intake
Fluid outputHormonal influence
Lymphatic influences
Neurologic influencesRenal influences
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FLIUD IMBALANCES
The five types of fluid imbalances that mayoccur are:
Extracellular fluid imbalances(ECFVD)
Extracellular fluid volume excess(ECFVE)Extracellular fluid volume shift
Intracellular fluid vloume excess(ICFVE)
Intrcellular fluid volume deficit (ICFVD)
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EXTRACELULLAR FLUID VOLUME DEFICIT
An ECFVD,: commonly called as dehydration , is a
decrease in intravascular and interstitial fluids
An ECFVD can result in cellular fluid loss if it issudden or severe
* The goal of treatment is to restore fluid
volume, replace electrolytes as needed, andeliminate the cause of fluid volume deficit.
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THREE TYPES OF ECFVD
Hyperosmolar fluid volume deficit- water loss is greater than the
electrolyte loss
- the clinical problems that occur result from alterations in the
concentrations of specific plasma electrolytes.
- fluid moves the intracellular compartment into the plasma and
interstitial fluid spaces, causing cellular dehydration and
shrinkage.
Isosmolar fluid volume deficit (hypovolemia) –
equal proportionof fluid and electrolyte loss .
- most common type of dehydration.
- results in decreased circulating blood volume and inadequate
tissue perfusion.Hypotonic fluid volume deficit – electrolyte loss is greater than
fluid loss.
- fluid moves from the plasma and interstitial fluid spaces into
the cells, causing a plasma volume deficit and causing cells to
swell
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1. ISOTONIC DEHYDRATION
a. Inadequate intake of fluids and solutes.
b. Fluid shifts between compartments
c. Excessive losses of isotonic body fluids2. Hypertonic dehydration – conditions that increase fluid
loss, such as:
excessive perspiration, hyperventilation, ketoacidosis,
prolonged fevers, diarrhea, early stage renal failure and
diabetes insipidus.
3. Hypotonic dehydration
a. Chronic illnessb. Excessive fluid replacement (hypotonic)
c. Renal failure
d. Chronic malnutritio
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Extracellular fluid volume excess
ECFVE is increased fluid retention in theintravasular and interstitial spaces
Fluid intake or fluid retention exceeds
the fluid needs of the body.
Fluid volume excess is also called
OVERHYDRATION or fluid overload
TYPES
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TYPES:
1. I sotonic Overhydration
a. known as hypervolemia, isotonic overhydrationresults
from excessive fluid in the ECF compartment.
b. Only the ECF compartment is expanded, and fluid does
not shift between the extracellular and intracellular
compartment.
c. Isotonic hydration causes circulatory overload and
interstitial edema; when severe or when it occurs in a clientwith poor carediac function, CHF and pulmonary edema can
result.
2. Hypertonic overhydration
a. Occurence of hypertonic overhydration is rare and is
caused by an excessive sodioum intake
b. Fluid is drawn from the intracellular fluid compartment;
the extracellular fluid
volume expands; and the intracellular fluid volume decrease
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Oedema Definition
An increased volume of interstitial fluid in a tissue or
organ
May be localised or generalised (systemic)
Causes of Oedema
Raised capillary pressure
Reduced oncotic pressure
Endothelial damage (inflammation)
Impaired lymphatic drainage
O d
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Oedema
O d
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Oedema
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Raised Capillary Pressure
Cardiac failure
right ventricular failure - systemic oedema
left ventricular failure - pulmonary oedema
congestive cardiac failure - both
Local venous obstruction
deep vein thrombosis
external compression
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Reduced Oncotic Pressure Renal disease
loss of albumin across glomerulus Hepatic disease
inadequate albumin synthesis
Malnutrition
inadequate albumin synthesis
Lymphatic Obstruction
Tumours
Fibrosis Inflammation
Surgery
Congenital abnormality
Generalised Oedema
Congestive cardiac failure
Right ventricular failure
Renal disease
Li di