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Ch. 2 Regulation of Fluids- Shift of water among the body fluids.

These examples examine shift of water among the body fluid and their consequences in the Htc and [Pr].
by

Legier Rojas

on 11 January 2013

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Transcript of Ch. 2 Regulation of Fluids- Shift of water among the body fluids.

Shift of water among the body fluids Shift of Water among the body fluid compartments The following videos examine the shift of water among body fluid compartments and the consequences in the plasmatic concentrations of the proteins concentration [Pr] and the hematocrit (Hct).
Examples of non-physiological and some pathological conditions are used. Click over the image to active the video Introduction The Darrow Yannet Diagram Isotonic Expansion Isotonic Contraction Hypertonic Expansion Hypertonic Contraction Changes produced in the extracellular fluids will have consequences in the intracellular fluid. The water distribution among the body fluid compartments has consequences in both volumes and concentrations in the compartments. The rule 60, 40, 20 in a person having 60 Kg of weight indicates, volumes of: 36 Lts as the total body water, 24 Lts in the intracellular fluid and 12 Lts in the extracellular fluid. From this 12 Lts in the extracellular fluid 9 Lts belong to the interstitial fluid and 3 Lts to the plasmatic or vascular fluid. Changes produced in the extracellular fluids will have consequences in the intracellular fluid. Changes in the volume of the extracellular fluid will make changes in both the plasmatic protein concentration and the hematocrit value. Also, changes in the concentration of the extracellular fluid will affect the hematocrit value. These situations can be better understood using the following examples. The following explanations of water movement among body compartments are based in the diagram of Darrow Yannet. In this diagram colored in gray, abscise is the water content in the intra and extracellular compartments. In the diagram, the bar size represents approximately the volume proportion in each compartment. The ordinate represent the osmotic concentration in these compartments. The osmotic concentration always should be equal in all compartments, mainly because the water movement. In other words, any change in the osmotic concentration in the extracellular fluid, will produce water movements until the osmotic concentration in the intracellular compartments reaches the equivalent value to the extracellular compartment.
In the boxes is showed in right hand of the figure, in blue, the relative plasmatic concentration of proteins is represented and, in red, the proportion of blood cells to the plasma is presented. Remember the hematocrit concept. In the upper part of the figure and labeled 1 to 6, are examples of alterations in the body fluids that we will discuss in following figures. During an isotonic expansion, such is the case of shown in the figure. The extracellular volume increases without change the osmolarity. This occurs for example when an isotonic sodium chloride is infused into the plasmatic fluid. The plasma protein concentration is reduced because the amount of proteins amount stays equal but the plasmatic volume is increased. Similarly the hematocrit is reduced for the same reason. In addition, the infusion of isotonic sodium chloride does not produce any change in the blood cell volume because the infused solution is isosmotic. Let see the isotonic contraction. During an isotonic contraction, such is the case of shown in the figure. The extracellular volume decreases without change the osmolarity. This occurs for example when losing fluid by diarrhea or during vomiting. The plasma protein concentration is increased because, the amount of plasma’s proteins stays equal but the plasmatic volume is decreased. Similarly the hematocrit is increased for the same reason. In addition, the loss of isotonic fluid does not produce any change in the blood cell volume because the loosed fluid is isosmotic. It is important to distinguish that during hemorrhage the protein concentration in the plasma does not change, but the amount of proteins is reduced by the blood loosening. Let see the hypertonic expansion. During hypertonic expansion, such is the case shown in the figure. The extracellular volume increases and the extracellular osmolarity is elevated. This occurs for example with an infusion of hypertonic saline or mannitol.
The plasma protein concentration is decreased because, the amount of proteins in the plasma stays equal but the plasmatic volume is increased. The hematocrit is decreased for two reasons, first because the extracellular volume is increased and second, because the hyperosmotic fluid added produces the reduction in the blood cells volume. In this case, the water moves from the intracellular fluid to the extracellular fluid. This later process partially reduces the elevated osmolarity in the extracellular fluid. The water movement outside the cells stops when the intracellular osmolarity reaches the extracellular fluid osmotic concentration of the extracellular fluid. Hypotonic Contraction Hypotonic Expansion Let see the hypertonic contraction. During hypertonic contraction, such is the case shown in the figure. The extracellular volume decreases and the extracellular osmolarity is elevated. This occurs for example during dehydration, diabetes insipidus, water deprivation, or in alcoholism. The plasma protein concentration is increased because, the amount of proteins in the plasma stays equal but the plasmatic volume is decreased. The hematocrit does not change for two opposites interactions; first the extracellular volume is decreased, this situation tends to increase the hematocrit and second, the hyperosmotic fluid added produces the reduction in the blood cell volume. The final consequence in the hematocrit is to stay approximately like the normal value. In this case, the water moves from the intracellular fluid to the extracellular fluid. This later process partially reduces the elevated osmolarity in the extracellular fluid. The water movement outside the cells stops when the intracellular osmolarity reaches the osmotic concentration of the extracellular fluid. Let see the hypotonic contraction. During hypotonic contraction, such is the case shown in the figure. The extracellular volume decreases and the extracellular osmolarity is reduced. This occurs for example during primary adrenal insufficiency. The plasma protein concentration is increased because, the amount of proteins in the plasma stays equal but the plasmatic volume is decreased. The hematocrit increases because the extracellular volume is decreased, and because plasmatic hypotonic situation. The final consequence in the hematocrit is to be largely elevated. In this case, the water moves from the extracellular fluid to the intracellular fluid. This later process partially elevates the osmolarity in the extracellular fluid. The water movement inside the cells stops when the intracellular osmolarity reaches the osmotic concentration of the extracellular fluid. Let see the hypotonic expansion. During hypotonic expansion, such is the case shown in the figure. The extracellular volume increases and the extracellular osmolarity is reduced. This occurs for example during the syndrome on inappropriate antidiuretic hormone, during the consumption of hypotonic saline or during water intoxication. The plasma protein concentration is decreased because, the amount of proteins in the plasma stays equal but the plasmatic volume is increased. The hematocrit stay similar to the normal value because two contrary forces are acting, first the extracellular volume is increased and this tends to reduce the hematocric, and second the plasmatic hypotonic situation tends to increase the volume of the blood cells, as a consequence to increases the hematocrit. The final consequence in the hematocrit is to be approximately similar to the normal value. In this case, the water moves from the extracellular fluid to the intracellular fluid. This later process partially elevates the osmolarity in the extracellular fluid. The water movement inside the cells stops when the intracellular osmolarity reaches the osmotic concentration of the extracellular fluid.
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