HIS2 Body fluid compartments, osmolality- Learning Outcomes Describe the distribution and composition of body fluids

Male: 60% Water, 40% Solids (Fats, carbs, proteins, minerals) Water (60%) o 40% intracellular fluid o 20% extracellular fluid (5% plasma and 15% interstitial fluid) Also consist of electrolytes, small quantities of amino acids/glucose o ICF: Na+, Cl-, HCO3o ECF: K+, PO43-

Discuss how the composition of body fluids is maintained at a constant level

The composition is essential for cell function (ECF= homeostasis ICF= cell mechanisms) ECF = Glucose increases after a meal = increased secretion of insulin which decreases the amount of glucose in the plasma. Other examples: blood pressure, pH, temperature ICF has a selectively permeable cell membrane to water and small but not large ions/ small solutes. Na/K transporter pump where K is pumped back in the cell and kept constant

Explain how the osmotic pressure of body fluids is determined

Water moves down its concentration gradient, from area of low solute concentration to a high solute concentration, water will always move to dilute a solution. Typically ECF is similar to ICF in osmotic pressure, because there's no net movement of water into or out of the cells, it remains relatively constant.

Differentiate between osmolarity and osmolality

Osmolarity = A concentration of a solution is expressed in Osmol/L of solution o Body fluid is 283 mOsmol/L because of ECF: K+, PO43- ICF: Na+, ClOsmolality= A concentration of a solution expressed in Osmol/kg of solvent

Explain how the tonicity of solutions is determined

Tonicity is the measure of the osmotic pressure gradient of two solutions separated by a semi permeable membrane. Effected by solutes that cannot pass the membrane (Na, K, etc.) Hypertonic = Shrink and shrivel (Water escapes the cell, ECF < ICF ) Isotonic= No net effect (5% glucose or 0.9% saline ECF = ICF) Hypotonic= Swell and burst (Water enters the cell, ECF > ICF)

Describe the effects of water balance disturbances

Water balance disturbances associated with changes in body fluid osmolarity. o Osmotic movement of water into or out of the cell Water moves from low osmolarity to a high osmolarity.

Diabetes mellitus Type 1 and Type 2 Results from absolute or functional deficiency of circulating insulin (hyperglycemia) Glucose is osmotically active ( ECF osmolarity = water shift ECF to ICF = dehydration) Urinary glucose excretion (glycosuria) and kidney glucose excretion. Symptoms: polyuria, intra/extracellular dehydration, increased thirst.

Dehydration: Insufficient H2O intake (desert travel, difficulty swallowing. Symptoms mainly neurological as water lost from brain cells leads to shrinkage of cells. Non-neural Mild cases Moderate cases Severe cases symptoms Dry skin and Mental confusion Delerium, Circulatory tongue, sunken and irrationality convulsions, coma disturbances (vary eyeballs from slight lower BP, circ shock, and death Underhydration Excessive H2O loss (heavy sweating, vomiting, diarrhea, diseases such as cholera, diabetes insipidus) Overhydration Any surplus of water is excreted so it does not generally occur. Patients with renal failure (cannot excrete dilute urine and become hypotonic upon consuming more water than solutes) Low body mass infants Marathon runners who only drink water Over-heating (overexertion/MDMA-Ecstacy) Syndrome of inappropriate vasopressin/ADH secretion (SIADH) Excess water dilutes ECF ECF osmolarity decreases water moves by osmosis through cell membrane ICF osmolarity decreases disrupts cell function Symptoms: Related to water entering brain cells / swelling of brain cells leading to a decrease in cell fluid osmolarity. = confusion, lethargy, headache, dizziness, vomiting and severe cases coma/death. Also weakness (muscle cell swelling) and plasma volume increase

Diabetes Insipidus Deficiency in vasopressin (ADH/antidiuretic hormone) Normal for reduction in urine output, conserves water in the body. Patients can produce up to 20 L of urine (normal is 1.5L)

Relate the clinical use of IV solutions

Chemically prepared solutions for patients, by injection or infusion to blood. Used to replace lost fluid and aid in IV medication delivery Colloid solutions High molecular weight solutions Ex: albumin or other which do not readily cross the semi-permeable membrane. They stay longer than crystalloid (3-6h). Reduces abnormal accumulation of fluid in interstitial compartment (edema) because they draw fluid from interstitial/intracellular to vascular components. Clear solutions consisting of sterile water and electrolytes which cross a semi-permeable membrane into interstitial space and achieve equilibrium in 2-3 hours. The principle one for IV therapy and classified based on tonicity. Given to patients undergoing surgery (IV drip of saline), used to rehydrate or admin drugs. Isotonic saline can also be given to patients with low ECF volume (dehydrated). Hypertonic: 3% - 5% saline which may be given to patients with low plasma osmolarity and as a result water has moved into the cells Hypotonic: 0.45% saline which may be given to patients whose body fluids are hyperosmotic or with renal disease and cannot rehydrate but do not need additional sodium. Blood products

Crystalloid solutions