Body

Fluids
By : Rudaina Hussain Alelyani
ID : 440802499
Leader : Dr.Isa
Members: Dr. Nahid, Dr. Jeelani, Dr. Sameer, Dr. Vijaya and Prof. Lukman

11-02-2021
 Learning objectives

Explain the principles of concentration Outline the functions of

gradient, water soluble and lipid

1 2
body electrolyte
soluble substances and exchange of
substances.

Explain the hydrostatic pressure – Outline the disturbances of volume

colloid and crystalloid osmotic pressures

3 4
and their importance in kidney, lung
and concentration of body fluids
and other tissues
 principles of concentration gradient:
PASSIVE TRANSPORT Movement of molecules across a membrane that requires
no energy and always occurs down a concentration gradient Types of passive
transport include: -Diffusion -Osmosis -Facilitated diffusion
Passive transport is diffusion across a membrane - Diffusion is the tendency for particles to
move from an area of high concentration to an area of low concentration.
Concentration gradient is the difference in concentration on two sides of a membrane · Passive
transport – no energy required by the cell for this to happen a 02, CO2 High Low Concentration
gradient
Passive transport uses a concentration gradient • The difference in concentration of a given
molecule between two points is called the concentration gradient. High The larger the gradient, the
greater the net movement of the molecules. • Molecules continue to move until equilibrium.
Equilibrium (gradient = 0) High to Low Low
DIFFUSION Concentration gradient- a difference between concentrations in a
space Molecules will always move down the concentration gradient toward areas of
lesser concentration
 Water and lipid soluble substances:

Lipids Water insoluble Substances Soluble in organic solvents (acetone, benzene) Important in
human nutrition Very concentrated form of energy, important biomolecules Types of Lipids
Simple Lipids: -Fatty Acids, -Triglycerides Compound Lipids: -Phospholipids -Cholesterol -
Eicosanoids -Lipoproteins (VLDL, LDL, HDL, Chylomicrons) -Fat Soluble Vitamins (A,D,E,K)

Water-Soluble Substances Water molecules Some substances that dissolve in water, such as
table salt (sodium chloride, NaCl) split into positively . and negatively charged ions. These
are called electrolytes.Positive = cation Negative = anion %3D Other molecules that
dissolve in water do not break up, but instead stick to a "shell" of water molecules.
 exchange of substances:
Exchange of Materials between Capillaries and Tissue Cells Colourless liquid between minute
spaces of tissue cells = tissue fluid • Cells are bathed by the tissue fluid which carries in solution
dissolved food substances and O, • These dissolved substances diffuse into the tissue cells •
Waste products diffuse from cells into the tissue fluid and then through the capillary walls into the
blood and to the excretory organs for removal
Exchange between blood and interstitial fluid Fluid pressure forces fluid out of the vessel and into
interstitial fluid a. when blood enters a capillary, then pulls it back into the blood at the venous end.
Osmotic pressure forces fluid out of the vessel and into interstitial fluid when blood enters a
capillary, then pulls it back at the venous b. end. Fluid pressure forces fluid out of the vessel and
into interstitial fluid when blood enters a capillary, and osmotic pressure pulls it back in at the
venous end of the capillary. d. Osmotic pressure forces fluid out of the vessel and into interstitial
fluid when blood enters a capillary, and fluid pressure pulls it back in at the venous end of the
capillary.
Pulmonary Ventilation •or breathing, is the exchange of air between the atmosphere
and the lungs. • As air moves into(Inspiration) and out of the lungs(Expiration), it
travels from regions of high air pressure to regions of low air pressure
Glomerular Filtration • As blood flows through the glomerulus protein-free plasma filters
through the glomerular capillaries into Bowman's capsule • Normally about 20% of the
plasma that enters the glomerulus is filtered This process is known as glomerular
filtration which is the first step in urine formation
 Hydrostatic pressure colloid and crystalloid osmotic pressures
and their importance in kidney, lung and other tissues

Hydrostatic Pressure • As the capillaries are narrower than the arterioles, a pressure builds up which
forces tissue fluid out of the blood plasma = hydrostatic pressure. Overall, pressure pushes tissue fluid
and small molecules out of the capillary, leaving cells and large proteins behind = This exchange occurs
by diffusion and facilitated diffusion
arterial end = 30−40 mm Hg, the venous end = 10−15 mm Hg and In the middle = 25 mm Hg

Osmotic ressure (OP) Total plasma osmotic pressure Sum of osmotic pressure produced by electrolytes
and non-electrolytes in the plasma Normal value: 280 – 310 mOsm/L
Colloid osmotic pressure (oncotic pressure) Produced by proteins (mostly albumin) Normal value: 1.5
mOsm/L (1/200 of total plasma OP) Plays important roles in regulating fluid exchange across blood vessels
Crystalloid osmotic pressure Produced by electrolytes (mostly from Na* (and Cl+)) The majority of
plasma OP Plays important roles in regulating fluid exchange across cell membrane
Osmotic pressure orderly by liver and kidney tissue :
the osmotic pressure is formed by electrolyte, kidney regulate value of
electrolyse, acid and base excretion, and then regulate the osmotic
pressure , the electrolyte equilibrium and adjust the balance of acid and
base in body fluids.
Liver and tissue maintains an osmotic pressure more than twice of the
blood. kidney tissue keep the osmotic pressure partially less than twice
of blood, the Fasting in all directions period of 7 days had
influence upon osmotic pressure keep by the liver or kidney “ it cells”,
decreases protein in our food that found to decreases the osmotic pressure
of liver cells after about 4 weeks. with It leads to a relapse changes in the
parenchyma, notably fatty infiltration. the pressure keep at a diminished
level during nearly 0 days.
 Cont..

The Increase of pressure in “common bile duct “ and the shift following biliary
obstruction are with by decreases of osmotic pressure, keep by liver tissue and
ligation of the ureter reduce the osmotic pressure keep it by kidney tissue, in all
instances osmotic pressure tends later to rise to its former. The osmotic pressure
keep by liver or by kidney tissue preserves an nearly uniform level under normal
conditions and possible little changed by conspicuous defect to the organ. When
this osmotic homeostasis is defected by severe injury the pressure preserves by the
tissue back it to its former level with recovery from the damage.
 Functions of electrolytes :

What are the main electrolytes?

1. Nat - most abundant ECF ions (cation)
2. impulse transmission
3. b. muscle contraction
4. C. water balance d. controlled by aldosterone in
kidney
5. 2. Chloride ions – major extracellular anions
6. a. regulate osmotic pressure
7. b. involved in pH as they will form HCI cC.
controlled by aldosterone
8. 3. Potassium ions – most abundant cations in ICF a.
maintaining fluid volume
9. b. impulse conduction
10.c. muscle contractions d. regulating pH e. controlled
by aldosterone
 Disturbances of volume and and concentration of body fluid:

Disturbances in Fluid Balance Volume deficit: • Extracellular volume deficit is

the most common fluid disorder in surgical patients Acute volume deficit: -
associated with cardiovascular and CNS signs - Chronic volume deficit: display
tissue signs (decreases skin turgor | sunken eyes) - cardiovascular and CNS
signs
Hyponatremia :
A low serum sodium level (due to sodium depletion or dilution) • There is an
excess of extracellular water relative to sodium. Extracellular volume can be
high, normal, or low. Dilutional hyponatremia: - From excess extracellular
water " Associated with a high extracellular volume status - Excessive oral
water intake - latrogenic IV excess free water administration " ADH secretion in
postoperative patients (1 reabsorption of free water from the kidneys) – self
limiting · Drugs (cause water retention): as antipsychotics, TCAS, and ACE
inhibitors
Acid-Base Homeostasis defect:
Compensation for acid-base derangements: - by respirators mechanisms (for
metabolic derangements): '- immediațe response - mediated by hydrogen-
sensitive chemoreceptors found in the carotid body and brain stem by metabolic
mechanisms (for respiratory derangements): delayed compensation - by eíther
increasing or decreasing bicarbonate reabsorption in kidneys Respiratory acid-
base derangements: · Acute: before renal compensation - Chronic: those
persisting after renal compensation • If the predicted change in pH is exceeded,
then a mixed acid-base abnormality may be present.
Metabolic Acidosis • Causes: - Increased intake of acids - Increased generation
of acids - Increased loss of bicarbonate Body response mechanisms: Producing
buffers (extracellular bicarbonate and intracellular buffers from bone and
muscle) - Increasing ventilation (Kussmaul's respirations) - Increasing renal
reabsorption and generation of bicarbonate - Increase renal secretion of
hydrogen (1 urinary excretion of NH4*)
 Potassium Abnormalities • Average dietary intake of potassium is = 50 to 100
mEq/d (excreted primarily in the urine) Extracellular potassium is maintained
within a narrow range (principally by renal excretion) • Only 2% of the total body
potassium is located within the extracellular compartment (critical to cardiac
and neuromuscular function) • Minor changes can have major effects on
cardiac activity
Hyperkalemia • Serum potassium concentration above the normal range of 3.5
to 5.o mEq/L • Causes: · Excessive potassium intake (oral or IV) - Increased
release of potassium from cells: Red cell lysis after transfusion HSA sis
Acidosis - Rapid rise in extracellular osmolality from hyperglycemia or IV
mannitol - Impaired potassium excretion by the kidnéys (acute and chronic
renal insufficiency) · Drugs: - Potassium-sparing diuretics (spironolactone)
ACE inhibitors - NSAIDS • Small shifts of intracellular potassium out of the
intracellular fluid compartment can lead to a significant rise in extracellular
potassium.
 EDEMA · Increased fluid in interstitial spaces • Hydrothorax,
hydropericardium, and hydroperitoneum (ascites) · Anasarca
= severe and generalized edema with profound
sub-q tissue swelling . NON-INFLAMMATORY
CATEGORIES OF EDEMA: Incr hydrostatic pressure
Reduced plasma osmotic pressure 1. 2. 3. Lymphatic
obstruction Sodium Retention
Pitting edema The accumulated fluid can be easily
moved on pressing the affected part, leaving a pit at site
of pressure (it pits on pressure). This is because the
edema fluid has low protein content → it is present free in
the tissue spaces. Occurs when edema fluid is
transutade: 1-All types of generalized edema (cardiac,
renal and nutritional edema). 2- Localized edema due to
venous obstruction
 References
1.Medical physiology for undergraduates by Indu Khurana.SECTION 6 :
pages 413-421
2-Guyton and Hall Textbook of Medical Physiology, Chapter 25 pages
305-313
3-Davidsons-Principles-and-Practice-of-Medicine,-22nd-
Edition111 Chapter 16 pages 310-312