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51 Cards in this Set
- Front
- Back
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Body fluid shifts
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Constant changes in the environment
Constant changes in concentrations in different body compartments Ingested as food and water – about 2100 ml/day Synthesized by the oxidation of carbs – about 200 ml/day |
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body weight
ECF= ICF= |
ECF=20%
ICF=40% |
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interstitial fluid?
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extracellular and plasma – it also can include synovial, intraocular, peritoneal, pericardial and CSF
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Gammaglobulins are _________
Protiens are _________.this gives osmotic pressure |
antibodies
negatively charges. |
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plasma protiens:
albumins globulins fibrinogen |
albumins-60
globulins-35 fibrinogen-4 |
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plasma composition?
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plasma protiens 7%
other solutes 1% water 92% |
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blood composition
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plasma 46-63%
formed elements 37-54% |
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formed element composition of blood
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RBC 99.9%
plts/WBC .01% |
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WBC composition
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neutrophis 50-70
lymphopcytes 20-30 eosinophils 2-4 monocytes 2-8 |
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nucleus in RBC?
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NO
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Water loss – “insensitive”
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Through respiration – as water vapor in exhaled air – and dependant on humidity
Through skin as evaporation – not sweating – through the cholesterol intense cornified outer layers of skin. |
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Fluid Intake: regulated by ?
Electrolyte intake: governed by? |
thirst mechanism, habits
dietary habits |
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Fluid Output: regulated mainly by ?Electrolyte output: regulated mainly by ?
overall fluid balance mainly by? |
kidneys
kidneys kidneys |
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Effect of increasing _________ intake 10-fold on urinary sodium excretion and extracellular fluid volume
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sodium
lasts for 7-12 days |
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normal insensible loss per day?
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350 lungs
350 skin 100 sweat 100 feces urine 1400 |
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total body water in obesity
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lower (more fat)
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increaseing age effect on total bosy water?
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less
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total body water?
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infant>man>women
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nonelectrolyte % 's in plasma
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phospholipids 280mg/dl
cholesterol 150 neutral fat 125 glucose 100 urea 15 LA 10 Cr 1.5 Bili 0.5 bile salts trace |
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Indicator Dilution Principle
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All you need to know is the volume and conc of the indicator and the concentration of the indicator in the compartment after it disperses.
Valid if: Indicator disperses only in compartment measured Indicator disperses evenly in compartment Indicator not metabolized or excreted |
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Measuring Body Fluid Compartments
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Total Body water can be determined by injecting:
deuterium (D2O), tritium (3H2O), antipyrine (C11H12N2O) - which is lipid sol. |
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Control of Body Fluid Distribution hydrostatic vs colloidal press
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Distribution across cell membranes:
determined by osmotic forces (mainly from electrolytes) Distribution across capillaries: determined by hydrostatic and colloid osmotic forces |
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Osmoles
Avagadro’s # |
Concentration (numbers of) osmotically active solute particles regardless of composition in a solution
1 osmole = 1 mole of solute particles 6.02x1023 1 mole of glucose has 6.02x1023 molecules of glucose per liter One mole of salt has twice as many particles because it dissociates |
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Effects of solutions on Cell Volume
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isotonic= no chane
hypotonic=cell swells hypertonic=cell Know avagadro’s #…6.023 |
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Osmotic Pressure (Π)
Π = CRT |
C = concentration (osm/L)
R = gas constant (62.3 if Π = mmHg) T = Kelvino = 273o + Co = 310o (normal body temp.) Π = 19,300 mmHg / Osm If C = mOsm/L, Π= C x 19.3 mmHg So, for 1 milliosmole, the pressure pushing water toward the solute, is 19.3mmHg |
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Hydrostatic pressure differences have a ____ effect on fluid movement across cell membrane
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small
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H2O moves across cell membranes ______
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easily
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Normal plasma [Na+] =
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140-145 mmol / L
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Consequences of Hyponatremia and Hypernatremia
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Water moves in and out of cells
→ cells swell or shrink Rapid swelling can cause herniation Because the skull is rigid, the brain cannot increase its volume by more than 10% without being forced down the neck (herniation). Rapid shrinking can tear vessels and cause hemorrhage |
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Defense of Cell Volume
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Extracellular hypertonicity increases expression of genes encoding proteins that increase intracellular osmoles.
Membrane transporters (Na+-H+- exchanger) Enzymes (e.g. aldose reductase that synthesize intracellular solutes (e.g. sorbital) Clinical significance: Rapid changes in extracellular fluid tonicity alter cell volume and cause neurologic complications, while slow changes have much less effect on cell volume and much less clinical effect. |
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Hypernatremia
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With Decreased Extracellular Fluid Volume
(water loss: hyperosmotic cellular dehydration – diab insipidus, excessive sweating) With Increased Extracellular Fluid Volume ( NaCl excess: hyperosmotic overhydration – Cushing’s, aldosteronism) lab values: Hematocrit, plasma proteins Urine volume |
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Hypernatremia
With Decreased Extracellular Fluid Volume (water loss: hyperosmotic dehydration) |
Increased hematocrit, plasma proteins
Small volume of concentrated urine - dehydration, excess sweating Large volume of dilute urine - diabetes insipidus - lack of ADH (“central” diabetes insipidus) - “nephrogenic” diabetes insipidus |
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Hypernatremia
With Increased Extracellular Fluid Volume ( NaCl excess: hyperosmotic overhydration) |
Primary aldosteronism
Cushing’s syndrome Decreased hematocrit, plasma proteins Usually the Hypernatremia is mild in these examples, but the person may have very low plasma K + (hypokalemia). |
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Hyponatremia
With Decreased Extracellular Fluid Volume ( NaCl Loss: hypo-osmotic dehydration) |
diarrhea, vomiting
Addison’s disease (decreased aldosterone) overuse of diuretics sodium wasting renal diseases Increased hematocrit, plasma proteins |
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Hyponatremia
With Increased Extracellular Fluid Volume (water excess: hypo-osmotic overhydration) |
Inappropriate ADH syndrome
Bronchogenic tumors Fibrosing tuberculosis lung lesions Circulatory failure (e.g., congestive heart failure) Decreased hematocrit, plasma proteins |
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Intracellular Edema
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Inflammation of tissues (increased cell
membrane permeability) Inadequate tissue nutrition (e.g. ischemia) Depression of tissue metabolic systems (e.g. hypothyroidism) Hyponatremia |
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Causes of Extracellular Edema (increased interstitial fluid volume)
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Increased Capillary Filtration
Failure of lymphatics to Return Interstitial Fluid to Circulation |
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Causes of Increased Capillary Filtration
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Increased cap permeability:
toxins, ischemic damage, infections, etc. Increased cap pressure increased arterial pressure, excess fluid retention, decreased arteriolar resistance increased venous resistance, increased venous pressure – rt. hrt. failure Decreased plasma proteins: nephrotic syndrome cirrhosis malnutrition |
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Safety Factors Against Edema
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Low compliance of interstitium when = 3 mmHg
interstitial fluid pressure is negative Increased lymph flow = 7 mmHg “ Washdown” of interstitial protein = 7 mmHg at high lymph flow rates Total Safety factor = 17 mmHg The interstitial ‘gel matrix’ helps as well----gel ha low compliance, free fluid has high compliance |
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Edema
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Pitting – when the fluid in tissue is free and able to be squeezed out of a thumb print. It takes a short while to refill
Non-pitting – the fluid is in the cells themselves, or the fluid in the interstitium is full of fibrin |
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Conditions Causing Edema
High capillary hydrostatic pressureExcess fluid retention by kidneys |
acute or chronic kidney failure
glomerulonephritis mineralocorticoid excess |
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Conditions Causing Edema
High capillary hydrostatic pressure Decreased arteriolar resistance |
- vasodilator drugs
- autonomic insufficiency Increased venous pressure - congestive heart failure - high output heart failure (e.g. anemia) - venous obstruction - venous valve failure - cirrhosis |
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Conditions Causing Edema
Decreased plasma proteins (low oncotic pressure) |
2. Decreased plasma proteins
(low oncotic pressure) Loss of proteins - burns, wounds - nephrosis - gastroenteropathy Failure to produce proteins - malnutrition (“kwashiorkor”) - cirrhosis - analbuminemia |
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Conditions Causing Edema
increased capillary permeability |
Immune reactions (histamine)
Toxins Burns Prolonged ischemia Vitamin deficiency (e.g. vitamin C) Pre-eclampsia and eclampsia in pregnancy |
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Conditions Causing Edema
Blockage of lymphatics |
Cancer
Surgery Infections (e.g. filaria nematodes) |
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Conditions Causing Edema
High capillary hydrostatic pressureExcess fluid retention by kidneys |
acute or chronic kidney failure
glomerulonephritis mineralocorticoid excess |
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Conditions Causing Edema
High capillary hydrostatic pressure Decreased arteriolar resistance |
- vasodilator drugs
- autonomic insufficiency Increased venous pressure - congestive heart failure - high output heart failure (e.g. anemia) - venous obstruction - venous valve failure - cirrhosis |
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Conditions Causing Edema
Decreased plasma proteins (low oncotic pressure) |
2. Decreased plasma proteins
(low oncotic pressure) Loss of proteins - burns, wounds - nephrosis - gastroenteropathy Failure to produce proteins - malnutrition (“kwashiorkor”) - cirrhosis - analbuminemia |
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Conditions Causing Edema
increased capillary permeability |
Immune reactions (histamine)
Toxins Burns Prolonged ischemia Vitamin deficiency (e.g. vitamin C) Pre-eclampsia and eclampsia in pregnancy |
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Conditions Causing Edema
Blockage of lymphatics |
Cancer
Surgery Infections (e.g. filaria nematodes) |
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Effusion is
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Is edema in potential spaces – pericardium, pleura, peritonium (ascites), synovium
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