https://userupload.net/8mky0eijld91 An understanding of the physiology of body fluids is essential when considering appropriate fluid resuscitation and fluid replacement therapy in critically-ill patients. In healthy humans, the body is composed of approximately 60% water, distributed between intracellular and an extracellular compartments. The extracellular compartment is divided into intravascular, interstitial and transcellular compartments. The movement of fluids between the intravascular and interstitial compartments, is classically described as being governed by Starling forces, leading to a small net efflux of fluid from the intravascular to the interstitial compartment. More recent evidence suggests that a model incorporating the effect of the endothelial glycoclayx layer, a web of glycoproteins and proteoglycans that are bound on the luminal side of the vascular endothelium, better explains the observed distribution of fluids. The movement of fluid to and from the intracellular compartment and the interstitial fluid compartment, is governed by the relative osmolarities of the two compartments. Body fluid status is governed by the difference between fluid inputs and outputs; fluid input is regulated by the thirst mechanism, with fluid outputs consisting of gastrointestinal, renal, and insensible losses. The regulation of intracellular fluid status is largely governed by the regulation of the interstitial fluid osmolarity, which is regulated by the secretion of antidiuretic hormone from the posterior pituitary gland. The regulation of extracellular volume status is regulated by a complex neuro-endocrine mechanism, designed to regulate sodium in the extracellular fluid.

1. PHYSIOLOGY
OF
BODY FLUIDS
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2. CONTENTS
1. INTRODUCTION
2. EXTRA-CELLULAR FLUIDS, INTRA-CELLULAR FLUIDS
AND FLUID ELECTROLYTE BALANCE
3. SALIVA
4. URINE
5. LYMPH
6. CEREBROSPINAL FLUID
7. OTHER BODY FLUIDS – SYNOVIAL FLUID, SWEAT, TEARS
8. CONCLUSION
9. LIST OF REFERENCES

3. INTRODUCTION

4. A quote from Starling (1896)
"... there must be a balance between the hydrostatic pressure of
the blood in the capillaries and the osmotic attraction of the
blood for the surrounding fluids. "
" ... and whereas capillary pressure determines transudation,
the osmotic pressure of the proteids of the serum determines
absorption."

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6. EXTRA-CELLULAR FLUIDS,
INTRA-CELLULAR FLUIDS
AND
FLUID ELECTROLYTE
BALANCE

7. Total H2O Total Solids
Total extracellular H2O = 24% Bone and Conn. tiss. = 14%
Cell solids = 8%
Total intracellular H2O = 36% Body fat = 18%
60% 40%
BODY FLUID COMPARTMENTS
plasma
4.2%
Interstitial
& Lymph
11.5%
Transcellular H2O
1.5%
Bone & Connective
tissue H2O
EC = 7% IC = 4%
Muscle RBC Other
(24%) (3.4%)
(4.1%)
Intracellular H2O
32%
Capillary
Endothelium
Cell Membrane
(plasma, ISF, conn. tiss.,
transcellular)
(values below all given as % of total body weight, TBWt)

8. Interstitial Fluid,
ISF
Capillary Endothelium
Intracellular H2O,
ICW
Plasma Membrane
Extracellular H2O,
ECW
simplified view…...
24% of TBWt 36% of TBWt
4.2% 20%
PLASMA

9. CHANNELS OF WATER GAIN –
1. Drinking
2. Food water
3. Water produced during metabolism
4. Under unnatural conditions – I V and rectal
transfusions are also routes
CHANNELS OF WATER LOSS –
1. Urine
2. Skin – insensible perspiration and sweating
3. Water loss during expiration
4. Feaces

10. Components of Daily Obligatory Water Loss
Typical values
Insensible loss
800 mls
Minimal sweat loss
100 mls
Faecal loss
200 mls
Minimal urine volume to excrete solute load
500 mls
Total
1,600 mls.

12. Composition Of Body Fluids

13. CONSTITUENTS ECF
(mOsm/L of water)
ICF
(mOsm/L of water)
Na+
142 14
K+
4.2 140
Ca++
1.3 0
Mg++
0.8 20
Cl-
108 4
HCO3
-
24 10
HPO4
-
, H2
PO4
-
2 11
SO4
-
0.5 1
PROTEINS 1.2 4
UREA 4 4

14. CHANNELS OF ELECTROLYTE GAIN –
1. Food
2. Drinking water
CHANNELS OF ELECTROLYTE LOSS –
1. Kidney
2. Sweat

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16. The control of salt and water balance is performed
through two separate mechanisms—
• one that controls extracellular fluid Na+
content or
as we will see extracellular fluid volume
(reninangiotensin-aldosterone system and atrial
natriuretic peptide)
and
• another that controls extracellular fluid (or
plasma) osmolality (ADH and thirst).

17. ACID BASE BALANCE
H+
ion concentration. The concept of pH.
1909 - Sorensen introduced the concept of
pH.
pH = log 1
[H+
]
pH of blood = 7.4 (range 7.36 to 7.42)
Acidosis – pH < 7.36
Alkalosis – pH > 7.42

18. MECHANISM TO TACKLE pH THREATS
BLOOD BUFFERSLUNGS KIDNEY
PLASMA
BUFFERS
CELLULAR
BUFFERS
BICARBONATES PROTEINS PHOSPHATES
PROTEINS PHOSPHATES

19. The vascular compartment, its subdivisions, its relation to the interstitial
compartment and the location of receptors.

20. Role of the atria as volume receptors.

21. The signals that impinge upon the juxtaglomerular apparatus
in response to vascular volume changes and the effector mechanisms
controlled by the apparatus.

22. The role of efferent sympathetic nerve activity (ESNA)
in the response to volume changes.

23. ABNORMALITIES OF ELECTROLYTE BALANCE
SODIUM DEPLETION:
CAUSES –
1. Excessive loss – Addison`s disease, severe diarrhoea, burns.
2. Diminished intake of sodium
Sodium depletion as a rule, is associated with water depletion
so the clinical picture is a combined depletion of sodium and
water.
CLINICAL FEATURES
1. The fall in BP results in – pallor, tachycardia and cold
extremities.
2. Fall in GFR results in – oliguria, anuria and uremia.

24. PURE WATER DEPLETION
Children are more susceptible
This condition is rare in adults and is seen in adults in the
state of coma.
SIGNS AND SYMPTOMS
• Thirst
• Mental confusion
• Early phases – BP is normal
• Urine is highly concentrated

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26. DEPLETION OF POTASSIUM
Occurs in disease like Primary Aldosteronism and Cushing’s
disease
Diarrhoea
Diuretics
CLINICAL FEATURES -
Abnormal resting membrane potential and abnormalities of
excitability and conductivity is seen in the muscles and
nerves
Weakness of muscles

27. PURE WATER EXCESS (WATER INTOXICATION)
CAUSES –
1. It can occur in excess of ADH secretion
2. Stress (like after major surgical operation)
3. Drugs like indomethacin, phenylbutazone and
carbamazipine
FEATURES –
Early symptoms
1. Confusion
2. Headache
3. Dizziness
If not treated convulsions, coma and death can follow.

28. SODIUM EXCESS
CAUSES –
1. Diseases of kidney
2. Heart failure
3. Iatrogenic (excessive administration of cortisol and
contraceptives
4. Conn’s disease
FEATURES –
1. Hypertension
2. Edema
3. Cardiovascular embarrassment

29. POTASSIUM EXCESS
CAUSES –
1. In cases suffering from severe oliguria or anuria
FEATURES –
1. Heart block
2. Reduced contractility

30. ACIDOSIS
METABOLIC ACIDOSIS RESPIRATORY ACIDOSIS
CAUSES –
• Diabetic acidosis,
• Renal acidosis,
• Lactic acidosis,
• Severe diarrhoea
CAUSES –
• Cor pulmonale,
• Advanced emphysema,
• Acute bronchial asthma
ALKALOSIS
METABOLIC ALKALOSIS RESPIRATORY ALKALOSIS
1. Severe vomiting leading
to loss H+
from the
gastric juice
2. Excessive use of
diuretics leading to loss
of chlorides
•Hyperventilation

31. SALIVA

32. DEFINITION:
• According to Stedman’s medical dictionary, 26th
ed. – Saliva is a clear tasteless, odourless, slightly
acidic, viscous fluid consisting of secretions from
the parotid, submandibular and mucous glands of
oral cavity.
• According to Dorland’s medical dictionary, 26th
ed. – Saliva is a clear alkaline somewhat viscid
solution from the parotid, sublingual and
submaxillary and small mucous glands of mouth.

33. CLASSIFICATION
Based on the size and location of the glands;
1. Major
a. Parotid
b. Sub-mandibular
c. Sub-lingual
2. Minor
a. Labial and Buccal
b. Glossopalatine
c. Palatine
d. Lingual
Based on the histo-chemical nature of secretion;
• Serous – Parotid and von Ebner’s glands
• Mucous – Glossopalatine and Palatine glands
• Mixed – Submaxillary and Sublingual

34. DIAGRAM ILLUSTRATING SYMPATHETIC AND PARA-
SYMPATHETIC INNERVATION OF SALIVARY GLANDS

35. SALIVON: It is the secretory unit of the salivary gland

36. The secretory unit (salivary unit) consists of the
1. acinus,
2. myoepithelial cells,
3. the intercalated duct,
4. the striated duct, and
5. the excretory duct.
All salivary acinar cells contain secretory granules;
1. in serous glands, these granules contain amylase,
and
2. in mucous glands, these granules contain mucin.

37. Acini, responsible for producing the primary secretion,
are divided into 3 types:
1) Serous (protein-secreting)=spherical cells rich in
zymogen granules
2) Mucous (mucin-secreting)=more tubular shaped
cells; mucinogen granules are washed out on H&E
preparations giving an empty cell appearance
3) Mixed=serous demilunes, or predominantly mucous
acinar cells capped by a few serous acinar cells

38. MECHANISM OF
SECRETION
Two stage process;
1. Involves the Acini.
2. Involves the Salivary ducts.

39. The production of saliva is an
active process occurring in 2
phases:
1) Primary secretion – occurs in
the acinar cells. This results in a
product similar in composition
and osmolality to plasma.
2) Ductal secretion – results in a
hypotonic salivary fluid. It also
results in decreased sodium and
increased potassium in the end
product.
Production of Saliva

41. REGULATION OF SECRETION-
• CONTROLLED BY AUTONOMIC NERVOUS
SYSTEM
∀ β - ADRENERGIC RECEPTOR – PROTEIN
SYNTHESIS
∀ α - ADRENERGIC RECEPTOR – SECRETION OF
WATER AND ELECTROLYTES

42. COMPOSITION OF SALIVA
99% WATER 1% SOLIDS
ORGANIC INORGANIC
Na+
,K+
, Ca++
,Mg++
,
Cl-
,HCO3
-
, HPO4
--
,F-
,I-
αamylase (ptyalin),
Lipase,
glycoproteins,
lysozymes, peroxidase, lactoferrin, histatin
albumin,
urea,
amino acids,
immunoglobulins (secretory IgA, IgG and IgM),
cyclic AMP,
clotting factors.

43. PROPERTIES OF SALIVA
VOLUME: 1 –1.5 L of saliva is secreted by an average
healthy adult in 24 hours
60% - submandibular gland
30% - parotid gland
5% - sublingual gland
7% - minor salivary gland
pH = 6.7 – 7.4
Specific gravity = 1.002 – 1.008
•The basal salivary flow rate=0.001-0.2 ml/minute/gland.
•With stimulation, salivary flow rate=0.18-1.7 ml/min/gland.

44. Functions of Saliva
• Digestive
1. Amylase
2. Lipase
• Protective
1. Lysozymes
2. Immunoglobulins
3. Lactoferrin
4. Peroxidase
• Lubricative
1. Mucin
2. Moistening of the oral cavity
• Other functions
1. Taste perception
2. Excretion
3. Buffering action
4. Temperature regulation

45. Role of saliva in -
•Caries prevention
mechanical action
antibacterial action
prevents demineralization of the teeth
helps in remineralization of the teeth
•Retention of dentures
adhesion
cohesion
surface tension
capillary attraction
•Galvanism
polarization
cataphoresis

46. Disorders related to salivary secretion
•Hypersecretion (Ptyalism / Sialorrhea)
Causes
Problems associated – difficulty in impression making
Treatment – Parasymphatolytics (atropine)
Sympathetic depressants (Ergotamine)
•Hyposecretion
Causes
Problems associated – difficulty in denture retention, mucosal
ulceration
Treatment – Sympathomimetic drugs (Adrenaline, Ephedrine)
Parasympathomimetics (Pilocarpine)

47. XEROSTOMIA
• It is a subjective feeling of dryness of mouth
• Unstimulated salivary flow rate < 0.12 ml / min
• Stimulated salivary flow rate < 0.60 ml / min
• Etiology –
1. Developmental
2. Dehydration
3. Damage to the salivary glands
4. Vitamin deficiency
5. Drugs
6. Ageing

48. Clinical features –
• Atropic inflammed ulcerated mucosa
• Pain and swelling of salivary glands
• Dry cracked lips
• Atropy of the tongue
• Difficulty in swallowing and speech
• Rampant caries
• Discomfort to the patient
Associated problems –
• Difficulty in denture retention

49. Management of xerostomia–
• Physicians consultation
• Symptomatic relief
• Regular intake of water through out the day
• Frequent use of mouth washes
• Patients under medication should avoid taking drugs at
bed time
• Milk has been proposed as a salivary substitute
• Drugs like Pilocarpine(5mg) and Acetylcholine
• Artificial saliva
• Acupuncture
• Nicotinamide 250 – 400 mg tid for 2 weeks

50. URINE

51. DEFINITION
ACCORDING TO DORLAND’S DICTIONARY
26th
ed. –
Urine is the fluid excreted by the kidneys,
stored in the bladder and discharged
through the urethra.

52. GENERAL ORGANIZATION OF KIDNEYS AND
URINARY TRACTS

53. The NEPHRON:
the Functional Renal Unit
Afferent Arteriole
Efferent Arteriole

55. Two kinds
of
nephrons
Juxtamedullary
Nephron
Cortical
Nephron

56. macula
densa
How does the filter work?

58. How the Kidney Works

59. How the Kidney Works (cont’d)

63. FUNCTIONS OF LOOP OF HENLE
• Concentration of the urine
- Countercurrent multiplier mechanism
• Reabsorption of Na+
,Cl-
and water

65. Distal Convoluted Tubule

66. FACTORS AFFECTING GFR –
1. Balance between the hydrostatic and colloidal osmotic
forces acting across the capillary membrane
Kf - Capillary filtration coefficient
2. Change in the permeability of the filtering membrane
3. Sympathetic nervous system activation will reduce the
GFR
4. Hormones like adrenaline and noradrenaline also
decrease the GFR
5. Tubulo-glomerular feedback
GFR = Kf x NET FILTRATION PRESSURE
NET FILTRATION PRESSURE= HYDROSTATIC PRESSURE + COLLOIDAL OSMOTIC PRESSURE

67. AUTO-REGULATION OF GFR
GFR is the function of renal blood flow.GFR = 125 ml/min or
180 l/day
The relative constancy of GFR and renal bood flow independent
of the systemic influences is referred to as autoregulation.
The tubulo-glomerular feedback mechanism autoregulates the
renal blood flow.
The Juxtaglomerular Apparatus

68. Tubuloglomerular Feedback
(using the juxtaglomerular apparatus)

69. CONSTITUENTS AMOUNT
WATER 95%
INORGANIC CONSITUTENTS
CHLORIDE 9 gm/l
PHOSPHATE 2 gm/l
SULPHATE 1.5 gm/l
SODIUM 6 gm/l
POTASSIUM 2 gm/l
CALCIUM 0.2 gm/l
MAGNESIUM 0.2 gm/l
IRON 0.003 gm/l
ORGANIC CONSTITUENTS
UREA 15-25 gm/l
URIC ACID 0.4-0.6 gm/l
CREATININE 0.8-1.5 gm/l
AMMONIA 0.6 gm/l
OTHER SUBSTANCES TRACES
PROPERTIES:
Volume = 800 – 2500 ml/day (mean = 1500 ml/day)
Specific gravity = 1.001 – 1.025
Colour = pale yellow
pH = acidic

70. ABNORMAL CONSTITUENTS:
1. Glucose (glycosuria)
2. Proteins (proteinuria)
3. Ketone bodies (ketonuria)
4. Blood (hematuria)
5. Bile salts, bile pigments
6. Porphyrins

71. LYMPH

72. DEFINITION:
Lymph is transparent, slightly yellow, often opalescent liquid
found within the lymphatic vessels and collected from all parts
of the body and returned to the blood via the lymphatic system.
THE LYMPHATIC SYSTEM consists
(1) of complex capillary networks which collect the lymph in the
various organs and tissues;
(2) of an elaborate system of collecting vessels which conduct the
lymph from the capillaries to the large veins of the neck at the
junction of the internal jugular and subclavian veins, where the
lymph is poured into the blood stream; and
(3) lymph glands or nodes which are interspaced in the pathways of
the collecting vessels filtering the lymph as it passes through
them and contributing lymphocytes to it.

73. Scheme showing relative positions of primary lymph
sacs

75. TOTAL LYMPH FLOWING = 2 – 3 L/day
Rate of flow = 120 ml/hr
COMPOSITION:
•Electrolytes – Na+
, K+
, Cl-
, HCO3
-
slightly higher than plasma
•Urea, glucose – same as plasma
•Proteins – lesser than plasma
•Albumin:globulin ratio higher than plasma
•Immunoglobulin higher than plasma
•Chylomicrons
•Lymphocytes
•Clotting factors

76. FUNCTIONS:
1. The plasma proteins that escapes into the tissue
fluid is returned back to the blood via the lymph
2. Lymph carries hormones
3. Lymphocytes and antibodies enter the blood via
lymph
4. Lymph nodes destroy any bacteria coming from
the efferent vessels
5. Chylomicrons enter the blood from the intestine
via the lymphatic channels

77. CEREBROSPINAL
FLUID

78. CEREBROSPINAL FLUID is found in the ventricles of the
brain, cisterns around the outside of brain and
subarachanoid space.
FORMATION: It is formed by the choroid plexus and
secreted into the lateral ventricles from where it enters 3rd
and 4th
ventricle and finally into the subarachanoid space.
AMOUNT SECRETED = 100 – 150 ml/day
FUNCTION:
1. To cushion the brain within its solid vault.
2. Nutrition to the brain
3. Excretion of waste products

80. COMPOSITION:
It is an ultrafiltrate of plasma
The final composition is dependant on –
1. Secretion of ultrafiltrate by choroid plexus
2. Addition or removal of constituents by Meninges and nervous tissues
Proteins are in trace amount and lipids and bilirubin are absent.
CONSTITUENTS CSF SERUM
GLUCOSE mg/100ml 55-80 55-80
UREA mg/100ml 6-23 6-23
URIC ACID mg/100ml 0.6-0.7 3-5
PROTEINS mg/100ml 20-40 6500-8500
SODIUM meq/l 142-150 138-148
POTASSIUM meq/l 2.3-3.2 4.2-5.5
MAGNESIUM meq/l 2.5-3.0 1.6-2.1
CALCIUM meq/l 2.3-2.8 4.8-5.2
CHLORIDE meq/l 120-130 100-110
BICARBONATE meq/l 24-29 24-29
BILIRUBIN mg/100ml 0 0.2-1
pH 7.4 7.4

81. PRESSURE OF CSF –
The pressure can vary between 65 – 195 ml of water
Normal pressure = 130 ml of water (when lying down in
horizontal position
The CSF can be obtained by lumbar puncture and pressure
measured
Conditions in which CSF pressure increases –
1. Brain tumours
2. Hemorrhage
3. Infection
4. Hydrocephalus

82. TEARS

83. DEFINITION:
Tears is defined as the watery, slightly alkaline and saline
secretion of the lacrimal gland which moistens the conjunctiva.
The lacrimal apparatus.
Right side.
Lacrimal gland is situated between the socket
and the eyeball, at its upper and lateral portion
Alveoli of lacrimal gland
COMPOSITION:
1. Proteins = 0.6-0.8 gm/100ml
2. Electrolytes and other non-protein materials
3. Lysozyme
pH = 7.0 - 7.4

84. FUNCTIONS:
1. Keeps the cornea moistened and thus helps to
maintain the optical properties of the eye
2. Washes away any irritant that may fall into the eye
3. Lysozyme
4. Express the emotions of the individual as in grief

85. SWEAT

86. A diagrammatic sectional view of the
skin (magnified).
SWEAT:
Fluid secreted from the sweat glands.
Insensible perspiration = 600 – 700 ml/day and consists of
pure water
Visible perspiration (sweating) in hot and humid conditions
exercise
sympathetic stimulation
It contains water, sodium, chloride and lactic acid.
FUNCTION:
It maintains the body temperature.

87. SYNOVIAL
FLUID

88. DEFINITION:
It is transparent fluid material secreted by the synovial membrane
and found in the joint cavity, bursae and tendon sheath.
COMPOSITION:
1. Proteins = 1% (albumin,
globulin and proteoglycans;
fibrinogen is absent)
2. Hyaluronic acid
3. Water and electrolytes
FUNCTIONS:
Lubrication of bursae, tendons and joint spaces

89. AQUEOUS
HUMOR

90. AQUEOUS HUMOR: It is a thin watery fluid which occupies the
posterior and anterior chambers of the eye.
FORMATION: It is produced by capillaries of ciliary body by the
process of dialysis and active transport.
CILIARY BODY
POSTERIOR CHAMBER
THROUGH THE PUPIL
ANTERIOR CHAMBER
CANAL OF SCHLEMN
COMPOSITION:
It is an ultrafiltrate of plasma
Proteins absent, ascorbic acid is 20 times more than plasma
Volume = 0.25ml. Rate of formation is 2 –3 µl/min

92. FUNCTIONS:
1. Maintains the intra-ocular tension. Normal intra-occular
tension = 12 – 20 mm of Hg.
2. Supplies nutrients and removes waste products from lens
and cornea.
APPLIED PHYSIOLOGY:
GLAUCOMA:
It is a disease of the eye in which the intra-ocular pressure
becomes pathologically high, sometimes rising to 60 – 70 mm of
Hg.
It is the most common cause of blindness

93. CONCLUSION

94. LIST OF REFERENCES:
1. Textbook of Medical Physiology-Guyton&Hall,10th
ed
2. Concise Medical Physiology-Chaudhuri,4th
ed
3. Orban’s Histology&Embryology,11th
ed
4. Tencate’s Oral Histology,6th
ed
5. Essentials Of Oral Physiology-Robert Bradley,1st
ed
6. A Textbook of Biochemistry-A.V.S.S.RamaRao,9th
ed
7. Prosthodontic Treatment for Edentulous Patients-Zarb,Bolender,12th
ed
8. Complete Denture Prosthodontics-John J Sharry,3rd
ed
9. Essentials of Complete Denture Prosthodontics-Winkler,2nd
ed