1. Homeostasis. Methods for clinical and laboratory evaluation.

- Overview - Human organism consists of trillions of cells all working together for
maintenance of entire organism.
o Maintaining constant internal environment with everything cells need to survive
e.g. oxygen, glucose etc. is necessary for individual cells and entire body.
o The varied processes by which body regulates its internal environment  referred
to as homeostasis.

- Homeostasis definition - any self-regulating process by which biological systems tend to

maintain stability while adjusting to conditions that are optimal for survival.
o Variables are regulated so internal environment remains stable even though
external environment varies.
o If homeostasis is successful, life continues; if unsuccessful, disaster or death
ensues.

- The homeostasis is artificially split into several parts for monitoring and management:
1) Isovolemic part– fluid balance
2) Isoionic part– ions or electrolyte balance
3) Isohydric part- acid-base balance
4) Isoosmotic part– osmotic balance
5) Isothermic part– temperature and energy balance

- Regulation of water intake - Hypothalamic thirst center stimulated:

o By a decline in plasma volume

o By increases in plasma osmolality
o Via baroreceptor input, angiotensin II, etc

- Regulation of water output - distal convoluted tubules and collecting ducts regulate water
output.
o ADH from posterior pituitary reduces water lost in urine -> When drinking
adequate water _-> ADH inhibited -> more water released in urine.
- Additional losses to be recognized in balance sheet:
o Increasing temp by 1°C - 100-300 ml
o Moderate sweating - 500 ml
o Excessive sweating with fever -1000-1500 ml
o Hyperventilation - 500 ml
o Open large compartments (operations over 5 hours) - 500 to 3000 ml
o Excess loss from GI tract (daily fluid secretion ~ 8200 ml -> reabsorption ~100-
200 ml) - all states increasing secretion or decreasing reabsorption lead to
significant water losses