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51 Cards in this Set

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Body fluid shifts
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
body weight

ECF=
ICF=
ECF=20%
ICF=40%
interstitial fluid?
extracellular and plasma – it also can include synovial, intraocular, peritoneal, pericardial and CSF
Gammaglobulins are _________

Protiens are _________.this gives osmotic pressure
antibodies

negatively charges.
plasma protiens:
albumins
globulins
fibrinogen
albumins-60
globulins-35
fibrinogen-4
plasma composition?
plasma protiens 7%
other solutes 1%
water 92%
blood composition
plasma 46-63%
formed elements 37-54%
formed element composition of blood
RBC 99.9%
plts/WBC .01%
WBC composition
neutrophis 50-70
lymphopcytes 20-30
eosinophils 2-4
monocytes 2-8
nucleus in RBC?
NO
Water loss – “insensitive”
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.
Fluid Intake: regulated by ?
Electrolyte intake: governed by?
thirst mechanism, habits

dietary habits
Fluid Output: regulated mainly by ?Electrolyte output: regulated mainly by ?

overall fluid balance mainly by?
kidneys

kidneys

kidneys
Effect of increasing _________ intake 10-fold on urinary sodium excretion and extracellular fluid volume
sodium

lasts for 7-12 days
normal insensible loss per day?
350 lungs
350 skin
100 sweat
100 feces
urine 1400
total body water in obesity
lower (more fat)
increaseing age effect on total bosy water?
less
total body water?
infant>man>women
nonelectrolyte % 's in plasma
phospholipids 280mg/dl
cholesterol 150
neutral fat 125
glucose 100
urea 15
LA 10
Cr 1.5
Bili 0.5
bile salts trace
Indicator Dilution Principle
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
Measuring Body Fluid Compartments
Total Body water can be determined by injecting:
deuterium (D2O), tritium (3H2O), antipyrine (C11H12N2O)
- which is lipid sol.
Control of Body Fluid Distribution hydrostatic vs colloidal press
Distribution across cell membranes:
determined by osmotic forces
(mainly from electrolytes)

Distribution across capillaries:
determined by hydrostatic and
colloid osmotic forces
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
Effects of solutions on Cell Volume
isotonic= no chane
hypotonic=cell swells
hypertonic=cell

Know avagadro’s #…6.023
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
Hydrostatic pressure differences have a ____ effect on fluid movement across cell membrane
small
H2O moves across cell membranes ______
easily
Normal plasma [Na+] =
140-145 mmol / L
Consequences of Hyponatremia and Hypernatremia
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
Defense of Cell Volume
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.
Hypernatremia
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
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
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).
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
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
Intracellular Edema
Inflammation of tissues (increased cell
membrane permeability)

Inadequate tissue nutrition
(e.g. ischemia)

Depression of tissue metabolic systems
(e.g. hypothyroidism)

Hyponatremia
Causes of Extracellular Edema (increased interstitial fluid volume)
Increased Capillary Filtration

Failure of lymphatics to Return
Interstitial Fluid to Circulation
Causes of Increased Capillary Filtration
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
Safety Factors Against Edema
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
Edema
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
Conditions Causing Edema

High capillary hydrostatic pressureExcess fluid retention by kidneys
acute or chronic kidney failure
glomerulonephritis
mineralocorticoid excess
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
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
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
Conditions Causing Edema

Blockage of lymphatics
Cancer
Surgery
Infections (e.g. filaria nematodes)
Conditions Causing Edema

High capillary hydrostatic pressureExcess fluid retention by kidneys
acute or chronic kidney failure
glomerulonephritis
mineralocorticoid excess
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
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
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
Conditions Causing Edema

Blockage of lymphatics
Cancer
Surgery
Infections (e.g. filaria nematodes)
Effusion is
Is edema in potential spaces – pericardium, pleura, peritonium (ascites), synovium