BODY FLUID COMPARTEMENTS

(KOMPARTEMEN CAIRAN TUBUH)

Oleh: dr. HUSNIL KADRI, M.Kes
PSPDG Departement Medical Faculty Of Andalas University Padang

Water Intake and Output

Intake = Output

Fluid Compartments
Water occupies 2 main fluid compartments Intracellular fluid (ICF) about two thirds by volume, contained in cells Extracellular fluid (ECF) :
Plasma the fluid portion of the blood Interstitial fluid (IF) fluid in spaces between cells

Other ECF lymph, cerebrospinal fluid, eye humors, synovial fluid, serous fluid, and gastrointestinal secretions
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Fluid Compartments
Total Body Water: varies with fat

ICF high in K and Mg; ECF high in Na, Cl

Plasma high in protein, but interstitial fluid low in protein Smallest compartment (plasma) most important (intravascular volume thats controlled by kidney)
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Composition of Body Fluids

Water is the universal solvent Solutes are broadly classified into:
Electrolytes inorganic salts, all acids and bases, and some proteins Nonelectrolytes glucose, lipids, creatinine, and urea

Electrolytes have greater osmotic power than nonelectrolytes Water moves according to osmotic gradients
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Functions of Body Water

Give structure to the body Medium / Participates in biological rxns Medium for transportation Lubricant Temp control (600 kcal / L perspiration)

The Volume and Distribution of Total Body Water (TBW)

TBW = ~60% total body mass
Extracellular Fluid (ECF)
~1/3 TBW or 20% body mass

Intracellular Fluid (ICF)

~2/3 TBW or 40% body mass

Interstitial Fluid (~3/4 ECF)

cell membrane

10.5 L H20
capillary endothelium

28 L H20

Intravascular Fluid (~1/4 ECF)

Plasma = ~3.5 L H20

Adapted from C.A. Burtis, ed., et. al. Tietz Textbook of Clinical Chemistry. 3rd ed. Philadelphia: WB Saunders Company, 1999, pg 1096.

Extracellular and Intracellular

Extracellular fluids are similar (except for the high protein content of plasma)
Sodium is the chief cation Chloride is the major anion

Intracellular fluids have low sodium and chloride

Potassium is the chief cation Phosphate is the chief anion
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Extracellular and Intracellular

Sodium and potassium concentrations in extra- and intracellular fluids are nearly opposites This reflects the activity of cellular ATPdependent sodium-potassium pumps Electrolytes determine the chemical and physical reactions of fluids
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Mechanisms Controlling Fluid and Electrolyte Movement

Diffusion
molecules move from high to low concentration

Facilitated diffusion
involves carrier molecules

Active transport
movement against concentration gradient requires energy E.g.: keeping Na out and K in the cells (requires 11 ATP)

Fluid Movement Among Compartments

Compartmental exchange is regulated by osmotic and hydrostatic pressures Net leakage of fluid from the blood is picked up by lymphatic vessels and returned to the bloodstream Exchanges between interstitial and intracellular fluids are complex due to the selective permeability of the cellular membranes
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Water Balance and ECF Osmolality

To remain properly hydrated, water intake must equal water output Water intake sources
Ingested fluid (60%) and solid food (30%) Metabolic water or water of oxidation (10%)

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Water Balance and ECF Osmolality

Water output
Urine (60%) and feces (4%) Insensible losses (28%), sweat (8%)

Increases in plasma osmolality trigger thirst and release of antidiuretic hormone (ADH)

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Regulation of Water Intake

The hypothalamic thirst center is stimulated:
By a decline in plasma volume of 10%15% By increases in plasma osmolality of 12% Via baroreceptor input, angiotensin II, and other stimuli

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Regulation of Water Intake

Thirst is quenched as soon as we begin to drink water Feedback signals that inhibit the thirst centers include:
Moistening of the mucosa of the mouth and throat Activation of stomach and intestinal stretch receptors
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Regulation of Water Output

Obligatory water losses include:
Insensible water losses from lungs and skin Water that accompanies undigested food residues in feces

Obligatory water loss reflects the fact that:

Kidneys excrete 900-1200 mOsm of solutes to maintain blood homeostasis Urine solutes must be flushed out of the body in water
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Influence and Regulation of ADH

Low ADH levels produce dilute urine and reduced volume of body fluids High ADH levels produce concentrated urine Hypothalamic osmoreceptors trigger or inhibit ADH release Factors that specifically trigger ADH release include prolonged fever; excessive sweating, vomiting, or diarrhea; severe blood loss; and traumatic burns
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Electrolyte Balance
Electrolytes are salts, acids, and bases, but electrolyte balance usually refers only to salt balance Salts are important for:
Neuromuscular excitability Secretory activity Membrane permeability Controlling fluid movements

Salts enter the body by ingestion and are lost via perspiration, feces, and urine
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Electrolytes The Ion Components Inside and Outside the Cells Are Not the Same.
Electrolyte Potassium Symbol K+ Mg2+ PO4Na+ ClHCO3Ca2+ Reference range (serum) 3.7-5.2 mEq/L 1.8-2.4 mg/dL 4.5-6.0 mg/dL ( 11 yrs) 3.0-4.5 mg/dL ( 12 yrs) 136-145 mEq/L 98-108 mEq/L 22-32 mEq/L 8.9-10.2 mg/L

ICF

Magnesium Phosphate Sodium

ECF

Chloride Bicarbonate Calcium

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Adapted from Sara Duesterhoefts lecture, 2002.

Sodium in Fluid and Electrolyte Balance

Sodium holds a central position in fluid and electrolyte balance Sodium salts:
Account for 90-95% of all solutes in the ECF Contribute 280 mOsm of the total 300 mOsm ECF solute concentration

Sodium is the single most abundant cation in the ECF Sodium is the only cation exerting significant osmotic pressure
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Disorders of Water Balance: Dehydration

Water loss exceeds water intake and the body is in negative fluid balance Causes include: hemorrhage, severe burns, prolonged vomiting or diarrhea, profuse sweating, and diuretic abuse Signs and symptoms:thirst, dry flushed skin, and oliguria Other consequences include hypovolemic shock and loss of electrolytes
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Disorders of Water Balance: Dehydration

1 Excessive loss of H2O from ECF 2 ECF osmotic pressure rises 3 Cells lose H2O to ECF by osmosis; cells shrink

(a) Mechanism of dehydration

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Disorders of Water Balance: Hypotonic Hydration

Amount of water ingested quickly can lead to cellular overhydration or water intoxication ECF is diluted sodium content is normal but excess water is present The resulting hyponatremia promotes net osmosis into tissue cells, causing swelling
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Disorders of Water Balance: Hypotonic Hydration

Excessive H2O enters the ECF

ECF osmotic pressure falls

3 H2O moves into cells by osmosis; cells swell

(b) Mechanism of hypotonic hydration

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Sources
1. Beaudoin, D. Electrolytes and ion sensitive electrodes. PPT. 2003. 2. Ivkovic, A ., Dave, R. Renal review. PPT 3. Kersten. Fluid and electrolytes. PPT. 4. Marieb, EN. Fluid, electrolyte, and acid-base balance. PPT. Pearson Education, Inc. 2004

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