Body Fluid and Compartments | DR RAI M. AMMAR | ALL MEDICAL DATA by DR RAI M. AMMAR www.facebook.com/drraiammar www.twitter.com/drraiammar www.instagram.com/drraiammar www.linkedin.com/in/drraiammar www.medicall.com.pk/blog/auther/drraiammar/ For Any Book or Notes Visit Our Website: www.allmedicaldata.wordpress.com www.drraiammar.blogspot.com YOUTUBE CHANNEL : https://www.youtube.com/channel/UCu-oR9V3OdFNTJW5yqXWXxA ANY QUESTION ?? Get in touch with us at Any of the Above Social Media or Email at drraiammar@gmail.com allmedicaldata@gmail.com

1. Body Fluid And
Compartments
DR RAI M. AMMAR

2. HUMAN Body Composition
 Human Body Composition:
 Water ---- 60%
 Protein --- 18%
 Fat -------- 15%
 Mineral --- 07 %
Total body water (TBW) constitutes 55-60% of the body weight in men
and 45-50% of the body weight in young women.

3. Relationship between the volumes of major
fluid compartments

4. TBW variation with age

5. Barriers separate ICF, interstitial fluid and
plasma

6. Mass and water distribution

7.  Adult ICF- 400-450ml/kg ( about 30 liters).
 ECF- 150-200ml/kg (about 14 liters).
 Blood volume– 60-65ml/kg and is distributed as 15% arterial and 85%
venous.
 Major components of ECF:
- plasma volume- 30-35ml/kg
- interstitial fluid 120-165ml/kg
-Also includes lymph, cerebrospinal fluid, synovial fluid, aqueous humor, vitreous body,
endolymph, perilymph, pleural, pericardial, and peritoneal fluids.
In health, the total volume of transcellular fluids is < 1 L.

8. Measurements of body fluid
compartments
 Dilution principle
 A known amount of tracer is introduced into the space to be measured,
and its concentration measured after mixing.
Con1 X Vol1 = Con2 X (Vol1 + Vol2)
Con1 = initial concentration of indicator, Con2 = final concentration of
indicator
Vol1 = volume of indicator, Vol2 = volume to be measured.

9. Agents used for measurement of fluid
compartments
 TBW is measured using deuterium oxide (heavy water).
 ECF volume is measured using inulin, which is proportionally distributed
between plasma volume and interstitial volume.
 Plasma volume can be measured either by radioactive albumin or by
Evans blue. These substances neither leave the vascular system nor
penetrate the erythrocytes.
ISF volume = ECF volume – plasma volume
ICF volume = Total body water – ECF volume

10. Relationship between blood volume
and plasma volume
 Blood = plasma + cells in blood
 Volume of cells: packed cell volume (PCV)
 PCV is also called hematocrit (Hct)
 Blood volume
= plasma volume × 100 / (100 – Hct)
Blood volume = plasma volume × (100/100-Hct)

11. Measuring red cell volume
 Technique & principle:
 Use Chromium 51 labeled RBC as the indicator;
 Inject a known amount of Cr 51 labeled RBC intravenously;
 Allow them to mix with RBC in blood;
 Measure the fraction of RBC tagged with Cr 51;
 Principle: same – indicator dilution principle.
Lean body mass (LBM)
Definition: LBM is fat free mass
Total body mass = fat mass + fat free mass
Note: fat is relatively anhydrous
Note: the water content of LBM is constant
Water content of LBM is constant - 70 ml /100 g tissue

12. Body composition
Lean body mass = fat free mass
Total body weight = fat-free mass + fat mass

13. Composition of body fluid compartments
Ion Plasma(mmol/L) ICF(mmol/L)
Na+ 143 9
K+ 5 135
Ca2+ 1.3 <0.8
Mg2+ 0.9 25
Cl- 103 9
HCO3
- 24 9
HPO4
2- 0.4 74
Sulphate- 0.4 19
Proteinate- 1.14 64
Body fluid composition in neonates
ECF exceeds 30% and ICF is <40%. These differences are greatest in
premature babies, when ECF exceeds ICF.

14. Electrolytes
 Na+: most abundant electrolyte in the body
 K+: essential for normal membrane excitability for nerve impulse
 Cl-: regulates osmotic pressure and assists in regulating acid-base balance
 Ca2+: usually combined with phosphorus to form the mineral salts of bones
and teeth, promotes nerve impulse and muscle contraction/relaxation
 Mg2+: plays role in carbohydrate and protein metabolism, storage and use
of intracellular energy and neural transmission. Important in the functioning
of the heart, nerves, and muscles

16. ICF differs considerably from ECF
 ECF most abundant cation is Na+, anion is Cl-
 Sodium
 Impulse transmission, muscle contraction, fluid and electrolyte balance
 Chloride
 Regulating osmotic pressure, forming HCl in gastric acid
 Controlled indirectly by ADH and processes that affect renal reabsorption of sodium
 ICF most abundant cation is K+, anion are proteins and phosphates (HPO4
2-)
 Potassium
 Resting membrane potential , action potentials of nerves and muscles
 Maintain intracellular volume
 Regulation of pH
 Controlled by aldosterone
 Na+ /K+ pumps play major role in keeping K+ high inside cells and Na+ high outside cell

17. Major Electrolyte
imbalances(Pathophysiology)
 Dehydration
 Overhydration
 Hyponatremia (sodium deficit < 130mEq/L)
 Hypernatremia (sodium excess >145mEq/L)
 Hypokalemia (potassium deficit <3.5mEq/L)
 Hyperkalemia (potassium excess >5.1mEq/L)
 Chloride imbalance (<98mEq/L or >107mEq/L)
 Magnesium imbalance (<1.5mEq/L or >2.5mEq/L)

20. Hyponatremia
 The first step is the salt loss in excess of the water loss.
 2. Since the ECF-[Na+] is low, the ADH secretion is suppressed, and the
water excretion is increased. Hereby, both the ISF and the vascular spaces
are reduced often by more than 10%.
 3. This is an adequate stimulus for the volume-pressure receptors, which
override the osmoreceptors, whenever the effective circulatory volume is
threatened.

22. Hyponatremia
 Excessive sodium loss or H2O gain
 CAUSES
 Prolonged diuretic therapy
 Excessive diaphoresis
 Insufficient Na intake
 GI losses – suctioning, laxatives, vomiting
 Administration of hypotonic fluids
 Compulsive water drinking
 Labor induction with oxytocin
 Cystic fibrosis
 alcoholism

24. Treatment
 Restrict fluids
 Monitor VS
 Monitor serum Na levels
 IV normal saline or Lactated Ringers
 If Na is below 115, mEq/L hypertonic saline is ordered
 May give a diuretic for increasing H2O loss
 Encourage a balanced diet
 I/O
 Safety for weakness or confusion
 Assist with ambulation if low B/P

25. Hypernatremia
 The normal plasma-[Na+] is 135-145 mM, and values above 170 mM are
rare. Excessive infusion of saline (0.9% NaCl or 154 mM) can lead to
hypernatraemia. Such alarmingly high levels create an emergency
situation, where glucose infusion is indicated initially in order to reduce the
high level slowly. The increased plasma osmolality elicits a strong desire to
drink.

26. Sign and symptoms

27. Treatment of Hypernatremia
Low Na diet
May use salt substitutes if K+ OK
Encourage H2O consumption
Monitor fluid intake on patients with heart or renal disease
Observe changes in B/P, and heart rate if hypovolemic
Monitor serum Na levels
Assess respiratory for crackles
Weigh daily
Assess skin and mucus membranes
Assist with oral hygiene
Check neurological status
Teach patient to monitor I/O and watch for edema
Teach patient and family signs and symptoms and when to report them
Safety precautions

28. Potassium Imbalances
 Potassium is the most abundant cation in the body cells
 97% is found in the intracellular fluid
 Also plentiful in the GI tract
 Normal extracellular K+ is 3.5-5.3
 A serum K+ level below 2.5 or above 7.0 can cause cardiac arrest
 80-90% is excreted through the kidneys
 Functions
 Promotes conduction and transmission of nerve impulses
 Contraction of muscle
 Promotes enzyme action
 Assist in the maintenance of acid-base
 Food sources – veggies, fruits, nuts, meat
 Daily intake of K is necessary because it is poorly conserved by the
body

29. Hypokalemia
 Causes
 Prolonged diuretic therapy
 Inadequate intake
 Severe diaphoresis
 Gastric suctioning, laxative use, vomiting
 Excess insulin
 Excess stress
 Hepatic disease
 Acute alcoholism

31. Treatment
 IV or PO replacement
 PO with 8 oz of fluid
 Give K+ IV diluted in a large vein
 * Never push K+ as a bolus *
 Monitor site for infiltration
 Monitor patients at risk
 Monitor I/O
 Monitor EKG
 Monitor Serum K+
 Watch UOP
 Watch patients who take Digitalis for toxicity
 Teach family and patient dietary changes

32. Hyperkalemia
 Greater then 5.0, EKG changes, decreased pH
 Results form impaired renal function
 Metabolic acidosis
 Acts as myocardial depressant; decreased heart rate, cardiac output
 Muscle weakness
 GI hyperactivity

33. Etiology
 Increased dietary intake
 Excessive administration of K+
 Excessive use of salt substitutes
 Widespread cell damage, burns, trauma
 Administration of larger quantities of blood that is old
 Hyponatremia
 Renal failure

36. Hypokalemia and hyperkalemia

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 For Any Book or Notes Visit Our Website:
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 BY: DR RAI M. AMMAR MADNI

38.  THANK YOU