Introduction to body fluid

composition and basic physiology of

fluid balance
DISTRIBUSI CAIRAN TUBUH

Best Practice & Research Clinical Anaesthesiology 23 (2009) 145–157

Kompartemen tubuh dan distribusi pada masing2
kompartemen
ECF endothel
I TBW =
Na N
Cell Membrane Na-K T 60% X BW (M)
ATP ase R 50% X BW (F)
K A
ICF
water water V
A ICF : 2/3 TBW
40% TBWwater
nucleus water S ECF: 1/3 TBW
C ISF:3/4 ECF
ICF ISF U
L IV:1/4 ECF
A
R THIRD SPACE
??
ICF ECF = ISF+IV
 JUMLAH CAIRAN
JUMLAH
UMUR JENIS KELAMIN
( % BB)
0 – 1 bulan 75,7
1 – 12 bulan 64,5
1 – 10 tahun 61,7
10 – 16 tahun Laki 58,9
Perempuan 57,3
17 – 19 tahun Laki 60,6
Perempuan 50,2
40 – 59 tahun Laki 54,7
Perempuan 46,7
> 60 tahun Laki 51,5
Perempuan 45,5
 Body Fluids/ Water
• Provide transportation of nutrients, oxygen to
cells

• Carry waste products away from cells

• Provide environtment for electrolyte chemical

reactions to occur
Solute Distribution in Fluid Compartments
(Cations and Anions in Body Fluids)

Figure 27.2
 Ionic Composition of Body Fluids
Electrolyte Plasma (mEq/L) Plasma water Interstitial Intracellular
(molarity) (mEq/kg)(molality) Fluid (mEq/L) Fluid (mEq/L)

Cations
Sodium 142 153 145 10
Potassium 4 4.3 4 160
Calcium 5 5.4 5 2
Magnesium 2 2.2 2 26
Total Cations 153 165 156 198
Anions
Chloride 101 108.5 114 3
Bicarbonate 27 29 31 10
Phospahate 2 2.2 2 100
Sulphate 1 1 1 20
Organic acid 6 6.5 7
Protein 16 17 1 65
Total Anions 153 165 156 198
 ZAT OSMOLAR PLASMA INTER’TIAL INTRA SEL
Na + 142 (mOsm/L) 139 (mOsm/L) 14 (mOsm/L)

K+ 4,2 4,0 140

Ca++ 1,3 1,2 0

Mg++ 0,8 0,7 20

Cl- 108 108 4

HCO3- 24 28,3 10

HPO4-, H2PO4- 2 2 11

SO4= 0,5 0,5 1

Phosphocreatin - - 45

Carnosine - - 14

Asam amino 2 2 8

Creatine 0,2 0,2 9

Lactate 1,2 1,2 1,5

Adenosine triphosphat - - 5

Hexose monophospahte - - 3,7

Glucose 5,6 5,6 T Book of-

Protein 1,2 0,2 Physiology
4

Urea 4 4 Guyton, 2006

4

Lain lain 4,8 3,9 10

OSMOLAR ACTIVITY (mOsm/ L ) 282,0 281,0 281,0

Keseimbangan
cairan Input = Output = 2500ml
Respiratory loss and Sensible
Insensible perspiration Perspiration
Fecal loss (variable)
(1150ml)
(150ml)

Metabolic Urine
Generation (1200ml)
(300ml)

Cell membrane Absorption across

GI epithelium(2200ml)
 Pergerakan cairan & Molekul
• Osmosis
• Difusi
• Filtrasi
• Transpor aktif
 ISOTONIC SOLUTIONS
• Same solute concentration as blood

• If injected into vein: no net movement of fluid

 Hypertonic solutions
• Higher solute concentration than blood
• If injected into vein:
- Fluid moves from interstitial space INTO vein
 Hypotonic Solutions
• Lower solute concentration than blood
• If injected into vein:
Fluid moves OUT of veins into tissues
Ruptured
Swelling
cell
cell
 Keseimbangan cairan intravaskular dan
interstisial

• Starling Hypothesis

• Endothelial Glycocalyx Layer

 HIPOTESA STARLING (1896)
• Recall Starling’s Law of the Capillaries which explains
fluid and solute movements from Ch. 19

Dalam keadaan normal terjadi “perembesan” cairan

dari intravaskuler ke ekstravaskuler.
 SISTEM LIMFE DI KAPILER

Sistem limfe mencegah

terjadinya penumpukan cairan di
interstitial sehingga tidak terjadi
edema.
“Double Barrier Concept”
 ENDOTHELIAL GLYCOCALYX LAYER
(EGL)
• Lapisan yang melapisi bagian dalam endothel.
• Ketebalan lapisan : 50 nm.
• Terdiri dari :
– Proteoglycan sulfat
– Hyaluronan
– Glycoprotein
– Protein plasma
 FUNGSI EGL
• Fungsi barier kapiler
• Mencegah adhesi leucocyte dan agregasi
thrombocyte.
• Mencegah terjadinya reaksi inflamasi.
• Mencegah terjadinya edema.
ENDOTHELIAL GLYCOCALYX LAYER
(EGL)

1).J Cereb Blood Flow Metab 2000; 20:1571–8

2).Annu. Rev. Biomed. Eng. 2007. 9:121–67
 PERBEDAAN STARLING dan EGL teori
PRINSIP STARLING
• Perbedaan tekanan onkotik
antara intra vaskuler dan
interstitial berperan
terjadinya “filtrasi” cairan ke
interstitial.
ENDOTHELIAL GYCOCALYX
LAYER
• Perbedaan tekanan onkotik
antara intra vaskuler dan
interstitial tidak berpenga-
ruh terjadinya “filtrasi”
cairan ke interstitial.
• Keutuhan EGL lebih
berperan terjadinya
“filtrasi” tersebut.
Fluid Shifts

Type • The physiologic shift (colloid-

free, shift of fluid & electrloytes)
• Vascular barrier is intact
1 • E/ Increased Hidrostatic pres.

Type • The Pathologic shift (fluid

containing protein

2 • Altered func.Vasc. Barrier

 PEREMBESAN CAIRAN
1. Tipe I:
– Disebut : “physiologic shift”.
– Terjadi pada keadaan normal (dinding kapiler
dalam keadaan utuh).
– Berisi air dan elektrolit (tidak mengandung
protein).
– Disebabkan karena tekanan hidrostatik ↑ (infus
cairan kristaloid yang berlebihan).
 PEREMBESAN…. (lanjutan)
2. Tipe II:
– Disebut “pathologic shift”
– Terjadi apabila EGL mengalami kerusakan.
– Berisi cairan yang mengandung protein.
– Penyebab kerusakan EGL:
• Pembedahan (lama dan “berat”nya tindakan).
• Stres mekanik .
• Endotoksin.
• Iskhemia-reperfusion injury.
• Hipervolemia akut sehingga keluar ANP.
• Mediator peradangan yang lain
 Konsep2 dasar pengaturan elektrolit dan cairan

• All the homeostatic mechanisms that monitor and

adjust the composition of body fluids respond to
changes in the ECF, not in the ICF.
(plasma and CSF detect significant changes in
composition or volume and trigger appropriate neural
and endocrine responses).

• No receptors directly monitor fluid or electrolyte

balance. But our receptors can monitor plasma volume
and osmotic concentration.
• Extracellular fluid balance is maintained
through closely regulated loss and retention
to ensure that the total level of fluid in the
body remain constant.
Relationship Between Fluid Volume &
Renal Perfusion
The Integration of Fluid Volume Regulation and [Na] in Body Fluid
 Blood volume and  Aldosteron release
 ANP release
 atrial distension
ADH release

HOMEOSTASIS  thirst
DISTURBED
 ECF volume
 Water loss
 (by fluid or HOMEOSTASIS
 Fluid and salt gain) RESTORED
 Na loss
HOMEOSTASIS
Normal ECF
volume HOMEOSTASIS  thirst
RESTORED
HOMEOSTASIS
DISTURBED
 Water loss
 ECF volume
(by fluid or fluid
 Na retention
and salt loss)
 Renin
secretion  Aldosterone
and release
 Blood volume
angiotensin II
and blood pressure  ADH release
activation
The Integration of Fluid Volume Regulation and [Na] in Body Fluid

Osmoreceptors  ADH release  Urinary water loss

stimulated  thirst  water gain

HOMEOSTASIS
DISTURBED
[Na] in ECF Additional water
Homeostasis dilutes ECF,
restored volume
HOMEOSTASIS
[Na] in ECF normal
Homeostasis
restored Water loss
Concentrates ECF
HOMEOSTASIS volume
DISTURBED
[Na] in ECF

Osmoreceptors  ADH release Urinary water loss

inhibited  thirst  Water gain

The Homeostatic Regulation of normal [Na] in Body Fluids

Atrial Natriuretic Peptide (ANP)
Peregangan Atrium berlebihan  Sekresi ANP
 Peningkatan GFR  Penurunan reabsorbsi
Na  Peningkatan eksresi garam dan air
 Kesimpulan
• Diatribusi air dalam tubuh: Intrasel (ICF), Ekstrasel
(ECF),Interstitial, Intravaskular dan Transelular
• Kandungan kristalloid dan kolloid memberikan peran
osmolalitas peran tekanan osmotik dan onkotik
• Perubahan osmolalitas dan volume ECF memicu reaksi
neurohormonal (ADH, ANP, Aldosteron) untuk
menjaga homeostasis cairan tubuh
• Perpindahan cairan anta Intravaskular dan interstitial
- fisiologis (Starling)
- patologis (Kerusakan glycocalyx)
Terima Kasih