Some definitions are necessary

first to help us in our discussion of

fluid and electrolyte conditions

'Fluid Physiology' by Kerry Brandis http://www.anaesthesiaMCQ.com

 FISIOLOGI
CAIRAN TUBUH
S-1 PENDIDIKAN DOKTER
DEPARTEMEN ILMU FAAL
FAKULTAS KEDOKTERAN UNIVERSITAS AIRLANGGA
BODY COMPOSITION

?
Color Atlas of Physiology, 2003
Download for free at http://cnx.org/content/col11496/latest/
PROPERTIES OF WATER

'Fluid Physiology' by Kerry Brandis http://www.anaesthesiaMCQ.com

BODY FLUID COMPARTMENTS

Download for free at http://cnx.org/content/col11496/latest/

BODY FLUID DISTRIBUTION

Download for free at http://cnx.org/content/col11496/latest/

Electrolytes and proteins are unequally
distributed among the body fluids.
WATER MOVEMENT
CAPILLARY MEMBRANE
Water can cross capillary membranes via:
the intercellular gaps between the
endothelial cells (7nm vs 0.12nm)
pores in the endothelial cells special areas
where the cytoplasm is so thinned out
fenestrations (e.g. glomerular, intestinal villi)
diffusion across the lipid cell membranes
of the endothelial cells
Cell membrane
Guyton & Hall, 2006
MEMBRANE TRANSPORT
How Osmosis Works
TONICITY
The effective osmolality and is equal
to the sum of the concentrations of
the solutes which have the capacity
to exert an osmotic force across the
membrane.
1. Isotonic
2. Hypertonic
3. Hypotonic
 Image: Guyton & Hall, 2006
Animation: Pearson Education, Inc
WATER BALANCE
External balance:
input vs output
Internal balance:
movement of
water across the
capillaries and
movement of
water between
cell membranes
Guyton & Hall
External Balance
Insensible water loss

Guyton & Hall, 2006

Internal Balance
The net movement of water across
the capillary membrane depends on
the balance of hydrostatic and
oncotic pressures Starling's
hypothesis
The major factor governing net
movement of water between the
ICF and the ISF is the osmotic forces
WATER BALANCE CONTROL
Sensors: osmoreceptors & baroreceptors
Effectors: thirst & ADH

Central controller: hypothalamus

Color Atlas of Physiology, 2003
Color Atlas of Physiology, 2003
Rapid IV administration of 1,000
mls of isosmotic normal saline
Asumsi:
a. TBW 1/3 ECF & 2/3 ICF
b. ECF 1/4 plasma & 3/4 ISF
c. Osmolalitas plasma normal
d. [Na+] normal saline mirip ECF

1) Bagaimana distribusi cairan tersebut

dalam tubuh?
2) Bagaimana tonisitas dan pengaruhnya
terhadap IVF?
Normal Saline
[Na+] mirip ECF limits its distribution to
the ECF (ISF & plasma 3:1) ECF
Replacement Fluid
Volume ISF meningkat 750 mls.
Volume plasma meningkat 250 mls
blood loss of 1,000 mls requires about 3 to
4 times to restore normal IVF volume.
Osmolalitas plasma dan tonisitas tidak
berubah karena normal saline isosmotic.
Dextrose 5%?
Dextrose = d-glucose
Isosmotic saat awal pemberian, tetapi
glukosa dengan segera diambil oleh sel
net effect sama dengan pure water
distributed throughout the total body water.
Setiap kompartemen menerima cairan sesuai
proporsi kontribusi terhadap TBW (2/3 ICF, 1/3
ECF; ECF didistribusikan 1/4 plasma & ISF).
Dextrose 5%?
Distribusi 1.000 ml dextrose 5%:
1. ICF 670ml
2. ECF 330ml (ISF 250ml dan plasma 80 ml)

Osmolalitas plasma menurun.

Plasma Protein Solution?
Colloid distributed only to the
intravascular fluid.
IVF meningkat dari 5.000 ml menjadi 6.000
ml
ASSIGNMENT

READ:
CIRCULATION HUMAN FUNCTION
TERIMA
KASIH
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