composition of Body fluids in human.pptx

types and composition of body fluids in human beings

1. Body Fluids

2. SIGNIFICANCE OF BODY FLUIDS IN OUR BODY - IN HOMEOSTASIS - “MILIEU INTERIEUR” , - GROWTH, FUNCTIONS

3. IN TRANSPORT MECHANISMS -TRANSPORT MEDIUM - INTO & OUT, FOR ENZYMES, HORMONES, VITAMINS, ELECTROLYTES ETC., IN METABOLIC REACTIONS IN FORM & TEXTURE OF TISSUES IN TEMPERATURE REGULATION

4. 5 Total body water (TBW) 60% of body weight Infants & children – TBW more than adults – BUT absolute content significantly less Elder people – 10% less than adults

5. Body Fluid Regulation

6. Fluid Balance (ml/day) – 70 kg Adult Intake Fluids ingested 2100 From metabolism 200 2300 Normal Output Insensible - skin 350 Insensible - lungs 350 Sweat 100 Feces 100 Urine 1400 2300

7. Balance Concept Balance is necessary, in the long-term, to maintain life. Fluid Loss = Fluid Intake Electrolyte Loss = Electrolyte Intake Fluid Intake: regulated by thirst mechanism, habits Electrolyte intake: governed by dietary habits Fluid Output: regulated mainly by kidneys Electrolyte output: regulated mainly by kidneys

8. FACTORS AFFECTING BODY FLUIDS Water intake & output Age: - infant: 73% , elderly: 45% Sex: - adult male: 60%, adult female: 40-50% Obesity Climate Level of physical activity

9. Total Body Water in Relation to Body Weight: Effects of Gender, Body Build and Age Body Build TBW (%) TBW (%) TBW (%) Adult Male Adult Female Infant Normal 60 50 70 Lean 70 60 80 Obese 50 42 60 Increasing age decreases TBW % Increasing obesity decreases TBW %

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11. IONIC COMPOSITION OF BODY FLUIDS ECF Anions : Cl - (108Eql/L), HCO3- (24mEql/L) Cations : Na+ (142mEq/L ) K+ (4.2 mEq /L) Mg2+(0.8mEq/L) Nutrients : O 2 , glucose, fatty acids, & amino acids Wastes : CO 2 , Urea, uric acid pH 7.4 ICF Anions : Cl - (4 mEq /L) HCO 3 - (10 mEq /L) Phosphate ions Cations : Na + (14 mEq /L) K + (140 mEq /L) Mg 2+ (20 mEq /L) Nutrients : proteins pH 7.0

12. DISTRIBUTION OF TOTAL BODY WATER/FLUIDS - COMPARTMENTS (60% OF BODY WEIGHT IN 70 Kg ADULT) (40% ) ( 20%) (15%) (5%)

13. Distribution of ECF 15 Compartment % of BW Volume Plasma 4 – 5 3.5L Interstitial & transcellular fluid 10.5 10.5L

14. Plasma… 16 Fluid part of blood 25% of ECF Plasma volume = Blood Volume X 100 - Hematocrit 100 80ml/Kg of body weight Hematocrit – PCV – volume occupied by circulating RBCs

15. Interstitial fluid… 17 ECF present between the cells Surround all cells except blood cells Includes lymph Constant motion throughout body Cannot be measured directly Interstitial fluid = ECF volume – plasma volume

16. Transcellular fluid… 18 Fluid in the lumen of structures lined by epithelium Secretion of digestive glands CSF Pleural fluid Peritoneal fluid Synovial fluid 1.5% of body weight 1L

17. ICF.. 19 Within the cell 2/3 rd of total body water ICF = total fluid volume ECF

18. Control of Body Fluid Distribution Distribution across capillaries: determined by hydrostatic and colloid osmotic forces Distribution across cell membranes: determined by osmotic forces - (mainly from electrolytes)

19. Measurement of body fluid volumes… 21 Indicator dilution principle V = A / C A = amount of substance injected IV V = volume in which substance distributed C = final concentration attained

20. Indicator Mass A = Volume A x Concentration A Measuring Body Fluid Volumes: Indicator Dilution Principle A

21. Indicator Mass = Volume x Concentration A Measuring Body Fluid Volumes: Indicator Dilution Principle

22. Indicator Dilution Principle Valid if: Indicator disperses only in compartment measured Indicator disperses evenly in compartment Indicator not metabolized or excreted

23. Principle of measurement… 25 Injecting a substance Volume distribution - the volume of fluid in which the test substance is distributed Indicator leaves compartment by excretion or metabolism = Amount injected – amount removed final concentration of the substance

24. Characteristics of an indicator… 26 Relatively easy to measure Remain in the compartment being measured Not change the fluid distribution in the compartment being measured Non-toxic Mix evenly throughout the compartment being measured. Remain unchanged by the body during the mixing period or the amount changed must be known.

25. For example: I f 150mg of sucrose (A1) is injected into a 70 kg man, 10mg sucrose (A2) has been excreted and concentration of plasma sucrose(C) measured is 0.01mg then volume of distribution = 150mg-10mg/0.01mg = 14000ml

26. DIRECTLY MEASURABLE VOLUMES Total Body Water: Deuterium oxide, Tritium oxide, A minopyrine . ECF Volume: Radioactive substances like Sodium, Chloride (Cl-36,38), Bromide (Br82), S ulphate and T hiosulphate . Inulin (C14) , mannitol and sucrose.

27. Plasma volume : Radio-iodinated human serum albumin (RISA) serum albumin labelled with radioactive iodine – I 131 Evan’s B lue dye (T-1824) - becomes bound to plasma proteins Radio-iodinated gamma globulin and Fibrinogen

28. P32, FE55, 59 & Cr51 penetrate & bind to RBCs. RED CELL VOLUME MEASURED Plasma volume = B lood volume x 100 - PCV --------------- 100

29. MEASUREMENT OF BLOOD VOLUME Total blood volume = plasma volume x 100 100 - hematocrit

30. INDIRECTLY MEASURABLE VOLUMES Interstitial fluid volume: ISF volume = ECF volume – plasma volume Intracellular fluid: ICF volume = Total body water – ECF volume

31. VOLUMES MEASUREMENT TBW By dilution principle; used to measure other body spaces D 2 O (heavy water) is most frequently used Tritium oxide and amino pyrine are also used ECF Most accurate method is by using Inulin, Mannitol and sucrose have also been used ICF (cannot be measured directly) TBW – ECF Interstitial fluid volume (cannot be measured) ECF – Plasma volume Plasma Volume By dyes that become bound to plasma protein Ex: Evan blue (T-1824) Serum Albumin labeled with radioactive iodine, I 126 , Na 22 , Thio sulfate Total blood volume (TBV) Red cell volume TBV – Pl. V Measured by injecting tagged RBCs and measuring the fraction of red cells that is tagged. Commonly used tag is Ca 51 and Fe 59 , P 32 VOLUMES MEASUREMENT TBW By dilution principle; used to measure other body spaces D 2 O (heavy water) is most frequently used Tritium oxide and amino pyrine are also used ECF Most accurate method is by using Inulin, Mannitol and sucrose have also been used ICF (cannot be measured directly) TBW – ECF Interstitial fluid volume (cannot be measured) ECF – Plasma volume Plasma Volume By dyes that become bound to plasma protein Ex: Evan blue (T-1824) Serum Albumin labeled with radioactive iodine, I 126 , Na 22 , Thio sulfate Total blood volume (TBV) Red cell volume TBV – Pl. V Measured by injecting tagged RBCs and measuring the fraction of red cells that is tagged. Commonly used tag is Ca 51 and Fe 59 , P 32

32. FLUID BALANCE Balance of input and output of fluids for the metabolic processes to function Lymphatic system - Plays important role in body fluid regulation - Fluid moves from the interstitium through the lymphatics , across the nodes , and into the great veins Tissue fluid formation

33. Hydrostatic pressure Pressure difference between the plasma and the Interstitial fluid Net effect of the hydrostatic pressure is loss of water and solute from plasma to the ISF Arteriolar end - 35 mm Hg, venule end - 15 mm Hg

34. Oncotic pressure Capillary wall is permeable to water, but impermeable to plasma proteins These molecules will generate an osmotic pressure Osmotic gradient is created between the plasma and the interstitial fluid Movement of water from the interstitium and into the plasma Net Oncotic Pressure is about 25 mm Hg

35. British physiologist Ernest Henry Starling (1866-1927) first identified the interrelationship between the hydrostatic pressure and the oncotic forces within the capillary

36. Starling forces in disease The imbalances that can occur are Increased Pressure at the capillaries: Vasodilation net loss of fluid from the plasma this results in an expansion of the interstitial fluid

37. 2) Decreased Pressure at the Capillaries: Shock net gain of fluid to the plasma helps to compensate for plasma loss during hemorrhagic shock

38. 3) Increased Venous Pressure: Congestive Heart Failure - net loss of fluid from plasma to ISF - resulting edema is symptomatic

39. 4) Decreased Oncotic Pressure: Protein deficiency and tissue damage - net increase in hydrostatic pressure compared to oncotic, results in Edema

40. Body fluid disturbances

41. Dehydration Causes Inadequate fluid intake Excessive fluid loss Diarrhoea Vomiting Polyuria Haemorrhage Fever Burns Sweating

42. Symptoms Headache, fatigue, sunken eyes, dry skin, hypotension, weak thready pulse and reduced urine output Treatment Fluid replacement

43. Fluid overload Causes Retention of electrolytes Sodium retention – renal impairment, liver disorders Congestive cardiac failure

44. Symptoms Acute dyspnoea – pulmonary oedema Fatigue Dyspnoea Oedema Treatment Treating the underlying cause Diuretics

45. Clinical Abnormalities of Fluid Volume Regulation: Hyponatremia and Hypernatremia The primary measurement that is readily available to the clinician for evaluating a patient’s fluid status is the plasma sodium concentration. Plasma osmolarity is not routinely measured, but because Na+ and its associated anions (mainly Cl -) account for more than 90 % of the solute in the ECF P lasma Na+ concentration is a reasonable indicator of plasma osmolarity under many conditions.

46. When plasma sodium concentration is reduced more than a few milliequivalents below normal (135-145 mEq /L ), a person is said to have Hyponatremia . When plasma sodium concentration is elevated above normal, a person is said to have Hypernatremia .

47. Causes of Hyponatremia : Addition of excess w ater to ECF/retention of excess water - dilutes Na+ in ECF - Hypo-osmotic overhydration - excessive secretion of ADH - kidney tubules absorb more water - hyponatremia & overhydration or Loss of NaCl from ECF - results in Hypo-osmotic dehydration - decreased ECF volume - diarrhea , vomiting, overuse of diuretics-inhibit the kidneys to conserve Na+, Addison’s disease - decreased secretion of aldosterone

48. Causes of Hypernatremia: also causes increased osmolarity Water Loss from ECF - hyperosmotic dehydration - * Diabetes insipidus - causing dehydration and increased concentration of sodium chloride in the ECF * Nephrogenic diabetes insipidus - kidneys cannot respond to ADH * more common cause of hypernatremia associated with decreased ECF volume is dehydration - water intake less than water loss - sweating during prolonged, heavy exercise .

49. Excess Sodium in ECF - hyperosmotic overhydration - water retention by the kidneys * For ex. excessive secretion of the sodium-retaining hormone aldosterone can cause a mild degree of hypernatremia and overhydration . Thus , in analyzing abnormalities of plasma sodium concentration and deciding on proper therapy, one should first determine whether the abnormality is caused by a primary loss or gain of sodium or a primary loss or gain of water.

50. Edema : Excess Fluid in the Tissues Edema refers to the presence of excess fluid in the body tissues. ECF edema - more common Intracellular Edema D epression of the metabolic systems of the tissues - Blood flow to a tissue is decreased, the delivery of oxygen and nutrients is reduced. If the blood flow becomes too low , ionic pumps become depressed . S odium ions that normally leak into the interior of the cell can no longer be pumped out of the cells, and the excess sodium ions inside the cells cause osmosis of water into the cells

51. Ex. Ischemic leg, inflammation - direct effect on the cell membranes to increase their permeability, allowing sodium and other ions to diffuse into the interior of the cell, with subsequent osmosis of water into the cells. ( 2)Lack of adequate nutrition to the cells.

52. Extracellular Edema : Extracellular fluid edema occurs when there is excess fluid accumulation in the extracellular spaces. There are two general causes of extracellular edema : (1) abnormal leakage of fluid from the plasma to the interstitial spaces across the capillaries, and ( 2) failure of the lymphatics to return fluid from the interstitium back into the blood. The most common clinical cause of interstitial fluid accumulation is excessive capillary fluid filtration .

53. Lymphatic Blockage Causes Edema - When lymphatic blockage occurs, edema can become especially severe because plasma proteins that leak into the interstitium have no other way to be removed. The rise in protein concentration raises the colloid osmotic pressure of the interstitial fluid, which draws even more fluid out of the capillaries . Blockage of lymph flow can be especially severe with infections of the lymph nodes, such as occurs with infection by filaria nematodes . Blockage of the lymph vessels can occur in certain types of cancer or after surgery in which lymph vessels are removed or obstructed .

54. Summary of Causes of Extracellular Edema I. Increased capillary pressure A. Excessive kidney retention of salt and water 1. Acute or chronic kidney failure 2. Mineralocorticoid excess B. High venous pressure and venous constriction 1. Heart failure 2. Venous obstruction 3. Failure of venous pumps (a) Paralysis of muscles (b) Immobilization of parts of the body (c) Failure of venous valves C. Decreased arteriolar resistance 1. Excessive body heat 2. Insufficiency of sympathetic nervous system 3. Vasodilator drugs

55. II . Decreased plasma proteins Loss of proteins in urine ( nephrotic syndrome ) B. Loss of protein from denuded skin areas 1. Burns 2. Wounds C. Failure to produce proteins 1. Liver disease (e.g., cirrhosis) 2. Serious protein or caloric malnutrition III. Increased capillary permeability A. Immune reactions that cause release of histamine and other immune products B. Toxins C. Bacterial infections D. Vitamin deficiency , especially vitamin C E. Prolonged ischemia F. Burns

56. IV. Blockage of lymph return Cancer B. Infections (e.g., filaria nematodes ) C. Surgery D. Congenital absence or abnormality of lymphatic vessels

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