Total body weight

100%
Other
40%

Water
60%
ICF
40%
Interstitial F
15%

ECF
20%
Plasma
5%

Transcelluar
1%

Body Fluids
Man: water constitutes 60% of body weight
Women: water constitutes 50% of body
weight

Functional compartments of body fluids:

Intracellular space 40% of body weight
Extracellular space 20% of body weight
Interstital 15%
Plasma 5%

Factors affecting body fluids

1. Water intake & output
2. Age:
- Infant: 73%Fetus- high content of water initially but
decreases progressively during late gestation and by 35yrs age.
- adults: 60%
3. Sex:
Adult male: 60%
Adult female: 40-50%
4. Obesity
5. Climate
6. Level of physical activity

Comparison in male and female

In average young adult male: Body composition

Body composition

Protein, & related

substances

% of body weight

18%

Fat

15%

Mineral

7%

Water

60%

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

Normal Exchange of Fluid & Electrolytes

In steady state, water intake = water loss

Water intake regulation

Osmotic Activity of Fluids

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

Volume Control
Osmoreceptors

- Day to day control

Baroreceptors

- Respond to pressure change

The body sense any change of the osmotic pressure

by
Osmoreceptor cells in paraventricular/ supraoptic
nuclei
The body then respond to the change by
Neural output
Hormonal mediators

Osmoregulation
Excess free water (Posm 280)
Thirst inhibited

ADH declines
Urine dilutes to Uosm 100

Osmoregulation
Decreased free water (Posm 295)
Thirst increased
ADH increases
Urine concentrates to Uosm 1200

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

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:

ELECTROLYTE Composition
Electrolyte Conc

Plasma (mEq/L)

Sodium, Na+
Potassium, K+
Calcium, Ca++
Magnesium, Mg++
Chloride, ClBicarbonate, HCO3Biphosphate, HPO4Sulfate, SO4-2
Protein
Organic foods

142
5
5
3
(155)
103
27
2
1
16
6
(155)

ISF

ICF

141
4.1
4.1
3

10
150
40

115
29
2
1
1
3.4

15
10
100
20
60
-

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

FLUIDS and ELECTROLYTES

IV FLUID REPLACEMENT THERAPY

Types of Solutions
Isotonic
0.9% sodium chloride (NSS)
Lactated Ringers soln
Hypotonic
5% dextrose and water (D5W)
0.45% sodium chloride
0.33% sodium chloride
Hypertonic
3% NaCl
Protein solns
Colloids

Salt pour albumin Plasmanate, Dextran

Factors affecting ADH

release

REGULATION OF FLUID INTAKE (THIRST)

decreased salivation

dry mouth and throat

decreased blood volume

increased blood osmotic pressure

decreased blood pressure

stimulation of tactile
receptors

stimulation of hypothalamic
osmoreceptors

increased
angiotensin II

stimulation of hypothalamic thirst

center

conscious awareness of thirst

increased water intake

REGULATION OF FLUID OUTPUT

ANTIDIURETIC HORMONE

ALDOSTERONE

ATRIAL NATRIURETIC PEPTIDE

dehydration

dehydration

increased blood volume

increased blood
osmolarity

increased
angiotensin II

stretch of right atrium

increased
aldosterone

secretion of ANP

stimulation of
hypothalamic
osmoreceptors

secretion of ADH
from posterior
pituitary gland

increased thirst

increased water
reabsorption

rehydration

increased Na+
reabsorption

decreased Na+
reabsorption

increased water
reabsorption

decreased water
reabsorption

rehydration

decreased blood volume

REGULATION OF BODY
FLUIDS
Fluid intake
Fluid output
Hormonal influence
Lymphatic influences
Neurologic influences
Renal influences

FLIUD IMBALANCES
The five types of fluid imbalances that may
occur are:
Extracellular fluid imbalances(ECFVD)
Extracellular fluid volume excess(ECFVE)
Extracellular fluid volume shift
Intracellular fluid vloume excess(ICFVE)

Intrcellular fluid volume deficit (ICFVD)

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 is
sudden or severe
* The goal of treatment is to restore fluid
volume, replace electrolytes as needed, and
eliminate the cause of fluid volume deficit.

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 proportion
of 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

1. ISOTONIC DEHYDRATION
a. Inadequate intake of fluids and solutes.
b. Fluid shifts between compartments
c. Excessive losses of isotonic body fluids
2. 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 illness
b. Excessive fluid replacement (hypotonic)
c. Renal failure
d. Chronic malnutritio

Extracellular fluid volume excess

ECFVE is increased fluid retention in the
intravasular 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:
1. Isotonic 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 client
with 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

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

Oedema

Oedema

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

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
Liver disease