Body Fluids

TBW, Fluid compartments, GI Fluids

Dr. Mahmoud W. Qandeel

Outlines
• Total body water
• Fluids compartments
• Composition of Fluid Compartments
• GI secretions
• Body losses

Dr. Mahmoud W. Qandeel

One is false about total body water and it’s distribution :
(6/2019)
A. It is more in males than females.
B. It increases with age.
C. It is mainly occupied in the intracellular component.
D. The extra cellular fluid (ECF) contains about one third of total
body water.
E. Total body fluid in 70 kg male adult is 42L , ECF is 14L and ICF is
28L
Dr. Mahmoud W. Qandeel
 Total Body Water

• Water constitutes approximately 50% to 60% of total body weight.

• The relationship between total body weight and total body water
(TBW) is relatively constant for an individual and is primarily a
reflection of body fat.

• Factors which determine the overall water weight of a human being

include sex, age, mass and body fat percentage.

Dr. Mahmoud W. Qandeel

• The average young man is around 60% water, while a healthy
young woman is about 50%.

– Adipose (fat) tissue is the least hydrated tissue in the body (20%
hydrated), even bone contains more water than fat.
– In contrast, skeletal muscle contains 75% water.
– So, the more muscles one has, the higher the total body water % will be.

Dr. Mahmoud W. Qandeel

• Infants, with their low bone mass and low body fat, are 70-
80% water!

• Total body water declines after infancy, and by the team one
reaches old age, total body water is only about 45%

Dr. Mahmoud W. Qandeel

Dr. Mahmoud W. Qandeel
• Estimates of percentage of TBW should be adjusted
– Downward approximately 10% to 20% for obese individuals and
– Upward by 10% for malnourished individuals.

Dr. Mahmoud W. Qandeel

• Higher
–Young
–Thin
–Man

• Lower
–Old
–Obese
–Woman
Dr. Mahmoud W. Qandeel
 Fluid Compartments

• TBW is divided into three functional fluid compartments:

plasma, extravascular interstitial fluid, and intracellular fluid.

Dr. Mahmoud W. Qandeel

Dr. Mahmoud W. Qandeel
• The extracellular fluids (ECF)( plasma and interstitial fluid), together
compose about one third of the TBW, and the intracellular
compartment composes the remaining two thirds.

Dr. Mahmoud W. Qandeel

Dr. Mahmoud W. Qandeel
• The extracellular water composes 20% of the total body weight and is
divided between plasma (5% of body weight) and interstitial fluid (15%
of body weight).

• Intracellular water makes up approximately 40% of an individual’s total

body weight, with the largest proportion in the skeletal muscle mass

Dr. Mahmoud W. Qandeel

Dr. Mahmoud W. Qandeel
Dr. Mahmoud W. Qandeel
Dr. Mahmoud W. Qandeel
Dr. Mahmoud W. Qandeel
 Composition of Fluid Compartments
• The ECF compartment is balanced between sodium, the principal
cation, and chloride and bicarbonate, the principal anions.

• The ICF compartment is composed primarily of the cations

potassium and magnesium, and the anions phosphate and sulfate,
and proteins.
– It has higher concentration of osmotic and oncotic (protein) particles
than the extracellular compartment, thus allowing water to flow into
the cell.

Dr. Mahmoud W. Qandeel

 What about Ions
• Extracellular cation is Na

• Extracellular anions are Cl & HCO3

In contrast

• Intracellular cations are K & Mg

• Intracellular anions are phosh. & - protiens

Dr. Mahmoud W. Qandeel
Dr. Mahmoud W. Qandeel
Dr. Mahmoud W. Qandeel
GI secretions

Dr. Mahmoud W. Qandeel

Composition of gastrointestinal secretions
Source Volume Na K Cl HCO3
ml / 24 hr mmol / l mmol / l mmol / l mmol /l
Salivary 1000 10 26 10 30

Stomach 2000 60 10 130 0

Duodenum 100-2000 140 5 80 0

Ileum 3000 140 5 104 30

Colon 100-9000 60 30 40 0

Pancreas 100-800 140 5 75 115

Bile 50-800 145 5 100 35

Dr. Mahmoud W. Qandeel

Fluid losses

Dr. Mahmoud W. Qandeel

 Insensible loss
• Insensible loss = respiration and sweating
• Electrolytes free
• Fluid loss is 600-900 ml/d

• Increased by:
– Fever….. Each 1 C increases loss by 200 ml
– Sweating
– Use of non-humidified Oxygen

Dr. Mahmoud W. Qandeel

 Third space losses
• Fluid losses into spaces that are not visible, such as the bowel lumen (in
bowel obstruction) or the retroperitoneum (as in pancreatitis).
• Sequestration of fluids in nonfunctional space beyond fluid equilibrium.

• Local tissue injury, inflammation and capillary leak all cause

sequestration of ECF at 3rd space !

• E.g. at the site of operation and produces local edema and persists for
48 h and can collect up to 4 L.

Dr. Mahmoud W. Qandeel

 Third space loss
• Definition: redistribution of fluid to a site where it is no longer considered
part of ECF.
• Causes:
✓ Burns, crush syndrome.
✓ Ascites , pleural effusion
✓ Severe soft tissue infections
✓ Intestinal obstruction
✓ Retroperitoneium
✓ Site of major operative dissection
Dr. Mahmoud W. Qandeel
 Treatment
• GIT , third space loss should be replaced volume by volume by
normal saline
• Add 10- 20 mmol Kcl to each liter
• In shock R L is better than N S as it contain less Cl.

Dr. Mahmoud W. Qandeel

 Classifications of Body Fluids Changes
Disturbance in fluid Balance
• Extracellular volume deficit is the most common fluid disorder
in surgical patient and can be either acute or chronic

• Acute deficit is associated with CNS & CVS signs

• Chronic deficit display tissue signs (skin turgeros &sunken eyes)

Dr. Mahmoud W. Qandeel

• Laboratory examination may reveal
- Elevated BUN
- Urine osmolality > serum osmolality
- Low urine Na < 20 mEq/L

• Na concentration doesn’t reflect volume status (can be high,

normal or low)
• The most common etiology of volume deficit in surgical patients is
loss from GIT fluids
- From N/G tube
- Vomiting, diarrhea or fistula

Dr. Mahmoud W. Qandeel

• Sequestration secondary to soft-tissue injuries, burn, and
intra-abdominal process as peritonitis, obstruction or
prolonged surgery can lead to volume deficits. (3rd space)

• Extracellular volume excess may iatrogenic or 2nd to renal

dysfunction, CHF, or cirrhosis.
• Symptoms are primarily pulmonary & CVS

Dr. Mahmoud W. Qandeel

 Signs of Hypovolemia:
• Diminished skin turgor
• Dry oral mucus membrane
• Oliguria
- <500ml/day
- normal: 0.5~1ml/kg/h
• Tachycardia
• Hypotension
• Hypoperfusion→cyanosis
• Altered mental status

Dr. Mahmoud W. Qandeel

 Clinical Diagnosis of Hypovolemia:

• Thorough history taking: poor intake, GI bleeding…etc

• BUN : Creatinine > 20 : 1
• Increased specific gravity
• Increased hematocrit
• Electrolytes imbalance
• Acid-base disorder

Dr. Mahmoud W. Qandeel

 Signs of Hypervolemia:
• Hypertension
• Polyuria
• Peripheral edema
• Jugular vein engorgement

Dr. Mahmoud W. Qandeel

 Management of Hypervolemia:
• Prevention is the best way
• Guide fluid therapy with CVP level or pulmonary wedge pressure
• Diuretics
• Increase oncotic pressure: FFP or albumin infusion (may followed by
diuretics)
• Dialysis

Dr. Mahmoud W. Qandeel

Dr. Mahmoud W. Qandeel
 About the body water all are true Except:

A. It comprises about 55% by weight of the average 70 kg female

B. It's chiefly in the intracellular fluid and decreases with age
C. It's proportionally larger in infants than in adults
D. It's proportionally smaller in female than in male
E. Obese needs more fluid than sportsmen

Dr. Mahmoud W. Qandeel

 About the body water all are true Except:

A. It comprises about 55% by weight of the average 70 kg female

B. It's chiefly in the intracellular fluid and decreases with age
C. It's proportionally larger in infants than in adults
D. It's proportionally smaller in female than in male
E. Obese needs more fluid than sportsmen

Dr. Mahmoud W. Qandeel

One is false about total body water and it’s distribution :
(6/2019)
A. It is more in males than females.
B. It increases with age.
C. It is mainly occupied in the intracellular component.
D. The extra cellular fluid (ECF) contains about one third of total
body water.
E. Total body fluid in 70 kg male adult is 42L , ECF is 14L and ICF is
28L
Dr. Mahmoud W. Qandeel
One is false about total body water and it’s distribution :
(6/2019)
A. It is more in males than females.
B. It increases with age.
C. It is mainly occupied in the intracellular component.
D. The extra cellular fluid (ECF) contains about one third of total
body water.
E. Total body fluid in 70 kg male adult is 42L , ECF is 14L and ICF is
28L
Dr. Mahmoud W. Qandeel
The daily insensible water loss from skin and
lungs in healthy adult is:
A. 500 ml
B.900 ml
C.1500 ml
D.2000 ml
E.2500 ml

Dr. Mahmoud W. Qandeel

The daily insensible water loss from skin and
lungs in healthy adult is:
A. 500 ml
B.900 ml
C.1500 ml
D.2000 ml
E.2500 ml

Dr. Mahmoud W. Qandeel