body fluids introduction and regulation med
TRANSCRIPT
![Page 1: Body Fluids Introduction and Regulation Med](https://reader031.vdocuments.us/reader031/viewer/2022020621/61e9a39a12ba470fad42a405/html5/thumbnails/1.jpg)
Body Fluids Ref: Textbook of Medical Physiology Guyton and Hall, 13th Edition 303-
321, 12th Edition
Pages: 285-297
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Fluid Compartments
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Fluid Compartments
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Water Distribution
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• Synovial
• Pericardial
• Pleural
• Peritoneal
• Ocular
• Cerebrospinal
Transcellular Fluids
Water Distribution
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Movement of Fluids between Compartments
Major factors that regulate
movements:
- Osmotic pressure
- Hydrostatic pressure
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Composition of Body Fluids
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Water Inputs
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Water Balance
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Water Output
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Water Balance
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Water and Electrolytes Homeostasis
Systems involved in the regulation of fluids and electrolytes
- Kidneys,
- Cardiovascular system,
- Endocrine (Pituitary, Parathyroids, Adrenal glands)
- Lungs
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Movement of Fluids between Compartments
Major factors that regulate
movements:
- Osmotic pressure
- Hydrostatic pressure
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Regulation of Na+ and Water
- Osmolality
- Volume of ECF
different regulations with many overlapping mechanisms.
Involves regulation
of:
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Importance of Na+ and Water regulation
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Fig. 27.05
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Measurements of Body Fluids
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Measuring Body Fluids
Dilution Principle
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Dilution method for calculating fluid volume
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Properties of tracers used for calculation of volumes
• Properties of an Ideal Tracer The tracer should:
• be nontoxic
• be rapidly and evenly distribute throughout the nominated compartment not enter any other compartment.
• not be metabolized.
• not be excreted (or excretion is able to be corrected for) during the equilibration period
• be easy to measure
• not interfere with body fluid distribution
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Measurement of Total Body Water
* Radioactive water (3H2O, T2O, Tritium) or heavy water (2H2O, D2O, Deuterium).
This will mix with the total body water in just a few hours and the dilution method for calculation can be used.
* Antipyrine
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Measurement of ECF volumes
• 22Na+, (Sodium Space)
• 125I-iothalamate,
• Thiosulfate,
• Inulin (Inulin Space) (Measured in 30-60 minutes)
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Calculation of ICF (Intra- Cellular Volume)
ICF= Total Body water - ECF
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Measurement of Plasma volumes
Measurement of Total Blood
Volume
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Fig.19.01
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Plasma Composition
• Water: > 90%
• Small molecule: 2%, it is electrolytes,
nutriment, metabolic products,
hormone, enzymes, etc.
• Protein: 60-80 g/L, plasma protein
include albumin (40-50 g/L)(54%),
globulins (20-30 g/L,α1-, α2, β-, γ- )
(38%)and fibrinogen (7%). Most of
albumin and globulin made from liver.
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* 125I-Albumin
(RISA),
* Evans Blue (Dye (T1824))
* 51Cr-labeled Red Blood Cells *Calculated As = Plasma Volume 1-Hematocrit
Measurement of Plasma volumes
Measurement of Total Blood
Volume
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Body Fluids Ref: Textbook of Medical Physiology
Guyton and Hall, 13th Ed: pp: 305-321 12th Ed.: pp: 285-297
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Regulation of Fluid volumes and
osmolality
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Regulation of Na+ and Water
Involves regulation of:
- Osmolality
- Volume of ECF different regulations with many overlapping
mechanisms.
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Regulation of Na+ and Water
Involves regulation of:
- Osmolality:
- Increased osmolality thirst (Increase water intake).
- Increased osmolality stimulates release of ADH --> acts on renal collecting ducts increased water reabsorption (Decrease water output)
- Volume of ECF
Osmoregulation
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27 Oct. 2008 Fluid-balance.ppt 33
Body Water • Regulation of intake
–Regulated by hypothalamic “thirst center”
– “Thirst center” responds to osmoreceptor impulses, angiotensin II
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27 Oct. 2008 Fluid-balance.ppt 34
Body Water
• Regulation of output –Regulated by
hypothalamus
• ADH release from posterior pituitary
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Regulation of Na+ and Water
Involves regulation of:
- Osmolality:
- Volume of ECF:
- Depends on Na+ excretion in urine.
- Controlled by renin-angiotensin aldosterone system
Juxtaglomerular Cells (Kidney) release Renin Angiotensinogen Angiotensin I Angiotensin II (Lung) Aldosterone
Reduced Volume
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27 Oct. 2008 Fluid-balance.ppt 37
Body Water
• Regulation of output
–Regulated by renin-angiotensin mechanism
• Angiotensin II stimulates aldosterone secretion
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27 Oct. 2008 Fluid-balance.ppt 38
Body Water
• Regulation of output
–Regulated by atrial natriuretic peptide (ANP)
Effects: reduces BP, Salts and water by effects over vessels, decrease Angiotensin II, and Aldosterone secretions
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27 Oct. 2008
Disorders of Volumes
–Hypovolemia Results by excessive loss of fluids
–Hypervolemia Results by excessive intake or administration
of fluids
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27 Oct. 2008
Disorders of Osmolality
–Hyponatremia Results by excessive loss of Na+ or
administration of hypotonic fluids.
–Hypernatremia Results by excessive intake of Na+ or
administration of hypertonic fluids
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27 Oct. 2008
Disorders of Volumes
–Hypovolemia Results by excessive loss of fluids
–Hypervolemia Results by excessive intake or administration of
fluids
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27 Oct. 2008
Disorders of Volumes
–Hypovolemia
Results by excessive loss of fluids
–Hypervolemia Results by excessive intake or administration
of fluids
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27 Oct. 2008
Disorders of Volumes and Osmolality
–Hyponatremia with dehydration
–Hyponatremia with overhydration
–Hypernatremia with dehydration
–Hypernatremia with overhydration
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Oedema
• Caused by increasing capillary filtration:
- Increased capillary hydrostatic pressure:
- Decreased oncotic pressure
- Increase capillary permeability
- Decreased lymph drainage
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Oedema
• Caused by increasing capillary filtration:
Increased capillary hydrostatic pressure:
- Kidney causes: more retention of water and salts (Renal failure)
- Excess of Mineralocorticoids (aldosterone)
High venous pressure:
Heart failure, decrease of Venous return (obstruction, decreased venous pump activity)
Decreased arteriolar resistance
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Oedema
• Caused by increasing capillary filtration:
Increased capillary hydrostatic pressure:
High venous pressure:
Decreased arteriolar resistance
(Excessive body heat, Insufficiency of sympathetic nervous system, Vasodilators)
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• Decreased Oncotic pressure
Increased loss of proteins
- From Kidney in nephrotic syndrome
- from skin in burns and severe wounds
Decreased production of proteins:
- Liver diseases
- Decreased intake of proteins in malnutrition
Oedema
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• Increase capillary permeability
- During immune reactions by release of histamine
- Toxins,
- Infections
- Vitamin C deficiency
- Ischemia
- Burns
Oedema
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• Decreased lymph drainage:
-Cancer
- Infections
-Surgery
-Absence or abnormality of lymphatic vessels
Oedema
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Safety factors for preventing oedema
• Low tissue compliance
• Increased lymph flow
• Increased protein wash-down from interstitial fluids
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In negative pressure ranges
LOW compliance by presence of gel fluids results in relative increase in hydrostatic
pressure to small changes in volume prevents capillary filtration
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In positive pressure ranges
HIGH compliance
by accumulation of free fluids results in smaller increase in hydrostatic pressure
to high changes in volume Pitting oedema
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Safety factors for preventing oedema
• Low tissue compliance
• Increased lymph flow
• Increased protein wash-down from interstitial fluids
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Increased lymph flow
as safety factor
• Lymph flow can increase up to 10-50 folds
Carry away large amounts of fluids prevents interstitial pressure from rising into POSITIVE ranges
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Safety factors for preventing oedema
• Low tissue compliance
• Increased lymph flow
• Increased protein wash-down from interstitial fluids
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Increased lymph flow increased
Protein washout from
interstitial fluids
• Increased Lymph flow
Carry away large amounts of proteins (Protein washed out from
interstitial fluids) decrease Colloid osmotic pressure in interstitial fluid Lowering net filtration forces Prevents accumulation of fluids
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