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Physiology
Fluid intake and output are balanced during Steady State
Conditions
Body fluid – total body water is approximately 60% -
74% of body weight
Distribution of Water
Intracellular fluid
Fluid inside the cell
2/3 of total body weight
(about 40% of total body
weight)
Major cations: K and Mg
Major anions: proteins and
organic phosphate (ATP,
ADP, AMP)
Distribution of Water
Extracellular fluid
Fluid outside the cell
1/3 of total body weight (about 20% of total body weight)
Composed of:
Interstitial fluid (3/4 of ECF)
- Composition is the same as that of plasma except that
it has little protein; Has ultrafiltrate of plasma
- Major cation: Na
- Major anion: Cl
Plasma (1/4 of ECF)
- Major plasma: albumin and globulin
- Major cations: Na ions
- Major anions: Cl and HCO3
Distribution of Water
Transcellular fluid
Considered as specialized ECF
Small compartments include:
Synovial
Peritoneal
Pericardial
Interlobular
CSF
Water Content Regulation
Water content is regulated so that the total volume of
water in the body remains constant
Kidneys – primary regulators of water excretion
Regulation process:
Osmosis
Osmolality
Baroreceptors
Major sources of Water
a) Ingested in the form of liquid or water in the foods
b) Synthesized in the body as a result of oxidizing
carbohydrates (Cellular metabolism)
Daily Loss of Water
Insensible water loss
Fluid loss in sweat
Water loss in feces
Water loss to the kidney
Constituents of ECF and ICF
Concentration of positively charged ions is highly greater
(about 2%) in the plasma than in the interstitial fluid
(Donnan Effect)
Ionic composition of plasma and interstitial fluid are similar
Shifts of Water between
Compartments
Water shifts between ECF and ICF so that the
osmolarities of the two compartments become equal
Osmolarity of ICF and ECF are assumed to be equal
after a brief period of equilibration
Osmosis net diffusion of water across a selectively
permeable membrane from a region of high water
concentration to one that has lower water concentration
Osmoles total concentration of solute particles
regardless of their exact composition
Types of Solution
a) Solution that will cause a change in cell volume
(impermeant solutes)
Isotonic solution – solution that will not cause a
cell to shrink or swell; water concentration in the ICF
and ECF are equal and solutes cannot enter or leave
the cell
Hypotonic solution – lower concentration of
impermeant solutes; cause swelling of cell
Hypertonic solution – higher concentration of
impermeant solutes; cause shrinking of cell
Types of Solution
b) Concentration of solution based on osmolarity
Isosmotic solution – osmolarity the same as the cell
Hyperosmotic solution – osmolarity is higher
compared to the normal ECF
Hypo-osmotic solution – osmolarity is lower
compared to the normal ECF
Examples of Shift of Water
between Compartment
Infusion of isotonic NaCl
Diarrhea
Excessive NaCl intake
Sweating
Adrenocortical insufficiency
Infusion of Isotonic NaCl
Also called isosmotic volume expansion
Addition of isotonic fluid
1. ECF volume increases, but there will be no change in osmolarity
of ECF or ICF
Reason: osmolarity is unchanged, there will be no shift of water
between ECF and ICF
2. Plasma protein concentration and hematocrit decreases
Reason: loss of ECF concentrates the protein and RBC
Because ECF osmolarity is unchanged, the RBC will not shrink
or swell
Arterial blood pressure increases because ECF volume increases
Diarrhea
Also called isosmotic volume contraction
Loss of isotonic fluid
1. ECF volume decreases, but there will be no change in
osmolarity of ECF and ICF
Because osmolarity is unchanged, there will be no shift
of water between ECF and ICF
2. Plasma concentration and hematocrit increases because the
loss of ECF concentrates the protein and RBC (ECF
osmolarity is unchanged: RBC will not shrink or swell)
3. Arterial blood pressure decrease because ECF volume
decreases
Excessive NaCl Intake
Hyperosmotic volume expansion
Addition of NaCl
1. Osmolarity of ECF increases – addition of osmoles
to ECF
2. Water shift from ICF to ECF – ICF osmolarity
increases until it is equal to ECF osmolarity
3. Volume of the ECF increases and the volume of the
ICF decreases
Sweating
Hyperosmotic volume contraction
Loss of water
1. Osmolarity of ECF – increases because sweat is
hypo-osmotic
2. ECF volume decreases – loss of volume in the sweat
3. ICF osmolarity increases until it is equal to ECF
osmolarity – water shifts out of ICF
4. ICF volume decreases due to shifting of water out of
the ICF
Adrenocortical Insufficiency
Hypo-osmotic contraction
Loss of NaCl
1. Osmolarity of ECF – decreases because the kidney loss
more NaCl than water as a result of the lack of aldosterone
in adrenocortical insufficiency
2. ECF volume decreases because water shifts into cells
3. ICF osmolarity decreases until it equals ECF osmolarity,
and ICF volume increases – water shift into the cells
4. Protein concentration decreases – increase in ECF volume
5. Hematocrit is unchanged – water shifts into the RBC,
increasing their volume and offsetting the diluting effect of
the ICF volume expansion
Clinical Abnormalities of
Fluid Volume
HYPONATREMIA
- Plasma Na concentration is reduced below normal
- Causes:
a) Loss of Na
Hypo-osmotic dehydration
e.g. Diarrhea, Vomiting
b) Excess water
Hypo-osmotic overhydration
e.g. excessive secretion of ADH
Clinical Abnormalities of
Fluid Volume
HYPERNATREMIA
- Plasma Na concentration is elevated above normal
- Causes:
a) Water loss
Hyperosmotic dehydration
e.g. Lack of ADH, diabetes insipidus
b) Excess Na
Hyperosmotic overhydration
e.g. excessive secretion of aldosterone
Edema
Presence of excess fluid in the body tissue
Occurs mainly in the ECF (can also involve the ICF)
Conditions that cause intracellular swelling:
1. Depression of the metabolic system of the tissue
2. Lack of adequate nutrition to the cell (e.g. deterioration of Na-K
pump Na enter the cell)
Causes of ECF edema:
1. Abnormal leakage of fluid from the plasma to the interstitial
spaces across the capillaries
2. Failure of the lymphatic to return fluid from the interstitium
back into the blood
3. Lack of protein
Edema
Walrus Puppy/ Anasarca
Conditions that Cause
Extracellular Edema
1. Increased capillary pressure
2. Decreased plasma protein
3. Increased capillary permeability
4. Blockage of lymph
Increased Capillary Pressure
a) Excessive kidney retention of salt and water
1. Acute or chronic kidney failure
2. Mineralocorticoid excess
b) High venous pressure
1. Heart failure
2. Venous obstruction
3. Failure of venous pump
c) Decreased arteriolar resistance
1. Excessive body heat
2. Insufficiency of sympathetic nervous system
3. Vasodilator drugs
Decreased Plasma Protein
Reduction of plasma protein concentration
- Plasma colloid osmotic pressure falls
- Increase capillary filtration throughout the body as
well as ECF edema
a) Loss of protein in urine
b) Loss of protein from denuded skin areas (burns and
wounds)
c) Failure to produce proteins
Liver disease
Serious protein or caloric malnutrition
Increased Capillary
Permeability
1. Immune reactions that cause release of histamine and
other immune products
2. Toxins
3. Bacterial infections
4. Vitamin deficiency, esp. vitamin C
5. Prolonged ischemia
6. Burns
Blockage of Lymph
Plasma proteins that leak into the interstitium have no
other way to be removed
Increased protein concentration raises the colloid
osmotic pressure of the interstitial fluid
Draws more fluid out of the capillaries
1. Cancer
2. Infections
3. Surgery
Three major factors that cause
increased capillary filtration of fluid
and protein into the interstitium
1. Increased capillary hydrostatic pressure
2. Decreased plasma colloid osmotic pressure
3. Increased capillary permeability, which causes leakage
of proteins and fluid through the pores of the
capillaries
Functions of Kidney in Homeostasis
1. Excretion of metabolic waste products and foreign
chemicals, drugs and hormone metabolites
2. Regulation of water and electrolyte balance
3. Regulation of body fluid osmolality and electrolyte
concentration
4. Regulation of acid-base balance
5. Regulation of arterial blood pressure
6. Secretion, metabolism, and secretion of hormones
7. Gluconeogenesis
8. Regulation of erythrocyte production (erythropoeitin)
9. Regulation of 1,25 dihydroxy Vit. D3 production
(calciferol)
Anatomy of Mammalian Kidney
Renin
Angiotensin II