Body Fluids and The

Kidneys
The Body Fluid Compartments:

Extracellular and Intracellular

Fluids:
Interstitial Fluid and Edema
 The maintenance of a relatively constant volume and
a stable composition of the body fluids is essential for
homeostasis
Fluid Intake and Output are Balanced During Steady-
State Conditions
Body Fluid Compartments
 1. Extracellular Fluid Compartment - 14.0 L
Interstitial - 11.0 L = 3/4
Plasma - 3.0 L = 1/4

2. Extracellular Fluid Compartment = 28.0 L

3. Transcellular Fluid Compartment 1to 2 liters - includes fluid in the
following Spaces:
° Synovial
° Peritoneal
° Pericardial
° Intraocular
° Cerebrospinal fluid
 Total Body Water is 60% of the body
weight = 42 liters
Extracellular Fluid 20% = 14.0L
Intracellular Fluid 40% = 28.0L
Blood Volume
Blood contains both extracellular fluid (the fluid in the plasma)
and intracellular fluid ( the fluid in the red blood cells)
Constituents of Extracellular Fluid and
Intracellular Fluid
 Regulation of Fluid Exchange and Osmotic
Equilibrium Between Intracellular and Extracellular
Fluid

Basic Principles of Osmosis and Osmotic Pressure

Osmotic Equilibrium is Maintain Between Intracellular Fluid

and Extracellular Fluid
Isotonic, Hypotonic and Hypertonic Fluids
Osmotic Equilibrium Between Intracellular and Extracellular Fluids is
Rapidly Attained

Volume and Osmolality of Extracellular Fluid in Abnormal States

Basic Principles to Calculate Changes in Intracellular and

Extracellular Fluid Volumes and Types of Therapy

1. Water moves rapidly across cell membrane; therefore the osmolarities of ICF
and ECF remain almost exactly equal to each other.

2. Cell membranes are most completely impermeable to many solutes; therefore

the number of osmoles in the ECF or ICF remain constant.
Effect of Adding Saline Solution to the Extracellular Fluid
Clinical Abnormalities of Fluid Volume Regulation: Hyponatremia
and Hypernatremia
Causes of Hyponatremia:

- Excess Water
- Loss of Sodium

Causes of Hypernatremia:

- Water loss
- Excess of Sodium
EDEMA: presence of excess fluid in the body tissues

A. Intracellular Edema
A. depression of the metabolic systems of the tissues
B. lack of adequate nutrition to the cells
C. Inflammation
B. Extracellular Edema
A. abnormal leakage of fluid from the plasma to the interstitial spaces
across the capillaries

B. 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

Factors That Can Increase Capillary Filtration

1. Increase Filtration Coefficient - product of

permeability and surface area of the capillaries ( kf )
2.Increase Capillary Hydrostatic Pressure ( Pc )
3. Decrease capillary Colloid Osmotic Pressure
( iic)

Filtration = Kf x ( Pc - Pif - iic +iiif )

Major Factors that cause Increased Capillary Filtration of Fluid
and Protein into the Interstitium:

1. Increased capillary Hydrostatic Pressure

2. Decreased Plasma Colloid Osmotic Pressure

3. Increased Capillary Permeability

 Summary of Causes of Extracellular Edema
1. Increased capillary pressure
A. Excessive kidney retention of salt and water
1. Acute and chronic kidney failure
2. Mineralocorticoid excess
B. High venous pressure
1. Heart failure
2. Venous obstruction
3. Failure of venous pump
A. paralysis of muscle
B. immobilized parts of body
C. Failure of venous valves
C. Decreased arteriolar resistance
1. Excessive body heat
2. Insufficiency of sympathetic
nervous system
3. Vasodilator drugs
II. Decreased plasma proteins
A. Loss of proteins in urine ( nephrotic syndrome )
B. Loss of proteins from denuded skin areas
1. Burns
2. Wounds
C. Failure to produce proteins
1. Liver disease
2. Serious protein or caloric malnutrition
III. Increased capillary permeability

A. Immune reactions that cause release of histamine

B. Toxins
C. Bacterial infections
D. Vitamin deficiency, especially vitamin C
E. Prolonged ischemia
F. Burns
IV. Blockage of lymph return
A. Cancer
B. Infections ( filarial nematodes)
C. Surgery
D. Congenital absence or abnormality of
lymphatic vessels
Safety Factors That Prevent Edema

1. The safety factors caused by low tissue compliance ( -3 mmHg )

2. The safety factor caused by increased lymph flow ( 7 mmHg )

3. The safety factor caused by washdown of proteins from the
interstitial spaces ( 7 mmHg )