Chapter 25: The Body Compartments: Extracellular and Intracellular Fluids; Edema

Guyton and Hall, Textbook of Medical Physiology, 12th edition

Balance of Fluid Intake and Output

Steady-State Balance a. b. c. d. e. Daily intake of water Daily loss of water-insensible water loss Fluid loss in sweat Water loss in feces Water loss by the kidneys

Table 25.1 Daily Intake and Output of Water (ml/day)

Normal Intake Fluids ingested From metabolism Total Intake 2100 200 2300

Prolonged Heavy Exercise ? 200 ?

Output Insensible-skin
Insensible-lungs Sweat Feces Urine Total Output

350
350 100 100 1400 2300

350
650 5000 100 500 6600

Body Fluid Compartments

Fig. 25.1 Summary of body fluid regulation, including the major body fluid compartments

Compartments (cont.) Body Fluid Compartments a. Intracellular b. Extracellular-interstitial fluid and blood plasma c. Transcellular-fluids in the synovial, peritoneal, pericardial, intraocular spaces, and the CSF d. Total body water for men is about 60% and 50% for women e. Varies with age, gender, and degree of obesity

Compartments (cont.) Intracellular Fluid Compartment a. Constitutes about 40% of the fluid in the average person b. Concentration of substances is similar from cell to cell

Compartments (cont.) Extracellular Fluid Compartment a. Interstitial fluid-makes up about 75% of the fluid b. Blood plasma-makes up 25% of the fluid c. Only real difference between the two types is the protein composition of the plasma

Blood Volume Blood Volume a. Makes up about 7% of the body weight (5 L) b. 60% plasma and 40% cells c. Percentages vary according to gender, weight, etc. Hematocrit a. Red blood cell fraction of the blood b. 96% accurate because you cannot pack the cells completely c. Males (o.40) and females (o.30)

Constituents of Extra- and Intracellular Fluids

Fig. 25.2 Major cations and anions of intracellular and extracellular fluids.

Fig. 25.2 Nonelectrolytes of the plasma

Constituents of Extra- and Intracellular Fluids

Table 25.2 Osmolar substances in extracellular and intracellular fluids Plasma (mOsm/L of Water Interstitial (mOsm/L of Water Intracellular (mOsm/L of Water

Sodium Potassium Calcium Magnesium Chlorine Bicarbonate Phosphate Sulfate Phosphocreatine Carnosine

142 4.2 1.3 0.8 108 24 2 0.5

139 4.0 1.2 0.7 108 28.3 2 0.5

14 140 0 20 4 10 11 1 45 14

Amino acids

Constituents of Extra- and Intracellular Fluids

Table 25.2 Osmolar substances in extracellular and intracellular fluids Plasma (mOsm/L of Water Interstitial (mOsm/L of Water Intracellular (mOsm/L of Water

Creatine Lactate ATP Hexose monophosphate Glucose Protein Urea

0.2 1.2

0.2 1.2

9 1.5 5 3.7

5.6 1.2 4

5.6 0.2 4 4 4

Others
Total mOsm/L Corrected osmolar activity Total Osmotic Pressure (37 C)

4.8
301.8 282 5443

3.9
300.8 281 5423

10
301.2 281 5423

Basic Principles of Osmosis and Osmotic Pressure

Osmosis is the net diffusion of water across a selectively permeable membrane from a region of high water concentration to one that has a lower water concentration.
Rate of diffusion of water is called the rate of osmosis.

Moles vs. Osmoles

Osmoles-the total number of particles in a solution

One osmole is equal to 1 mole of solute particles

Osmole refers to the number of osmotically active particles in a solution rather than to the molar concentration

Osmolality vs. Osmolarity

Osmolality = osmoles/kg of water

Osmolarity = osmoles/L of solution

Osmotic Equilibrium

Isotonic-occurs if the water concentration of both intracellular and extracellular fluid is the same; cells do shrink or swell Hypotonic-occurs if the water concentration is lower inside the cell (solutes are higher inside) and the cell will swell and possibly lyse Hypertonic-occurs if the water concentration is higher inside the cell (solutes are lower inside) and the cell shrivels (crenates); water flows out of the cell

Fig. 25.5 Effects of isotonic, hypotonic, and hypertonic solutions on cell volume

Equilibrium (cont.) Isosmotic-solutions with an osmolarity the same as the cell Hyperosmotic-solutions with a higher osmolarity Hyposmotic-solutions with a lower osmolarity

Volume and Osmolality in Abnormal States

Effect of adding saline to extracellular fluid

Hyponatremia

Hyperantremia

Edema Intracellular Edema a. Hyponatremia b. Depression of metabolic systems of tissues c. Lack of adequate nutrition to the cells Extracellular Edema a. Abnormal leakage of fluid from plasma b. Failure of the lymphatics to return the fluid (lymphedema)