BODY FLUIDS

(for MBBS Phase I)

Rosnah Ismail
Physiology Department, Faculty of Medicine
Universiti Malaya
January 2011

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 Cell (ICF)

Internal environment of
body (ECF)

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 Lecture Outcomes
At the end of the session, the student is able to:

 describe the compartments of body fluids

 describe how various volumes of body fluids can be
determined
 list the composition of body fluids
 explain the disturbances in water distribution under
various conditions

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 Body Fluid Compartment
Total Body Water;
60% (42L)

Intracelluar Fluid , ICF Extracellular Fluid, ECF

40% (28L) 20% (14L)

Plasma (3L) Transcellular

RBC (2L)
(1L)

Interstitial fluid (11L)

Total Blood
Volume (5L)
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8% body wt
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 Body Water
Total Body Water volume depends on

1. Gender:
♂ : 60% of body weight
♀ : 55% of body weight

2. Age:
infants > adults > old age
increase in fat content, decrease in in ECF and/ or ICF ?

3. Fat content:
more fat content , less water
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 Separation of ICF from ECF

• cell membrane
• semi permeable membrane
• ICF and ECF compositions are different
• free water movement between ICF and ECF
(aquaporins present in cell membrane)
• osmolarity ICF = ECF = 300 mOsm/L
• Changes in ECF osmolarity (osmotic pressure
difference) followed by water movement
(osmosis) until new equilibrium reached

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Separation of Interstitial Fluid from Plasma
• Capillary endothelium permeable to water and
electrolytes but not to proteins

• major difference in protein concentration

oncotic pressure difference

Major determinants of fluid movement from

interstitial space and capillary :
• hydrostatic pressure

• capillary oncotic pressure

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 Composition of ICF and ECF
E C F
Composition ICF Interstitial fluid Plasma
mmol/l mmol/l mmol/l
Na+ 12 145 142
K+ 150 4.4 4.3
Ca 2+ 4.0 2.4 2.5
Mg 2+ 34 1.1 1.1
Cl- 4.0 117 104
PO4 2- 40 2.0 2.0
Prot- 54 0 14
HCO3- 12 27 24
pH 7.1 7.4 7.4
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 Measurement of body Fluid
compartments
dye dilution technique

Principle
concentration = Mass of a substance
volume

Volume = Mass of a substance

Concentration
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 Principle: Concentration= Amount of substance
volume

X
1. Known amount of Dye X put
into container B with unknown
volume

2. Dye X mixes in the fluid B

contained in container B and reaches
equilibrium

Conc Xa = Amount of dye X

Volume B Xa

B
Volume container B = Amount of dye X
Conc Xa 14
 Properties of dye that can be used

1. For a certain compartment; dye has to remain in the

specific compartment
2. Non-toxic
3. Distributes evenly in the specific compartment
4. Can be measured
5. Neither synthesized nor metabolized by body
6. Does not influence the distribution of water or other
solutes within the compartment

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 Dye/indicator for various compartments

1. Total body water (TBW)

• Dye has to distribute evenly within all the

compartments; ECF and ICF
• Dye must cross cell membrane

e.g: deuterium oxide (2H2O), tritiated water (3H2O),

antipyrine

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2. Total ECF
• Dye has to distribute evenly within ECF, interstitium
and plasma
• Dye cannot cross the cell membrane
The crystalloids are larger and less diffusable
e.g: inulin throughout the ECF. They do not enter cells but the
lack of full ECF distribution results in
sucrose underestimation of ECF.

radioactive isotope (36 Cl, 85Br, 23Na)

The ionic tracers are small and distribute throughout the ECF
but there is some entry into cells. ECF will be over-estimated
with these tracers

Thus, what is measured is not the ‘true’ ECF so it is conventional to

refer to the compartment measured not as ECF but as a space
defined by the tracer used and the equilibration time (eg ‘20 hour
bromide space’).
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3. ICF

• Cannot be measured directly

There is no substance available so ICF is measured indirectly as the
difference between concurrently measured total body water and ECF.
The volume of ICF decrease with increasing age and this may account
for the age-related decline in total body water.

ICF = TBW - ECF

4. Interstitial fluid
• cannot be measured directly
There is no tracer which are distributed only throughout this
compartment. ISF is determined indirectly as the difference between
concurrently measured ECF & plasma volumes.

Interstitial fluid = ECF - plasma

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 4. Plasma
• Indicator should not leave blood vessel Indicator should be
confined to plasma
• Indicator should not cross into the RBC
in blood vessel

e.g: Evans Blue; binds to albumin

Or radioactive serum albumin (RISA)

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5. Total blood volume

Calculated from plasma volume

Total blood vol = plasma vol X 100

100-Hct

RBC Vol = Total blood vol – Plasma vol

Or can determine directly; using RBC tagged with

radioactive compound (radio-chromium; 51Cr-red cells)

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Summary of Indicators

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 Body Fluid disturbances
• Changes in water and solutes with external
environment occur through ECF
• Changes in ICF secondary to changes in ECF
• Fluid shifts from ICF to ECF and vice-versa when
osmolarity of ECF is perturbed

• ICF and ECF always in osmotic equilibrium

• plasma osmolarity gives a measure of ICF osmolarity

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 Fluid shifts between ICF & ECF and
ECF & plasma

• Knowledge of fluid shifts can be used to understand

the disturbances that can occur when fluid is lost from
body or added to body
• Fluid shifts depend on the type of fluid lost or added to
body
• It can be used as a basis for treatment of fluid
disturbances

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 Disturbances in Body Fluid

Initial disturbance occurs in ECF

Volume  : contraction
 : expansion

Osmolarity  : Isotonic
: Hypotonic
: Hypertonic

Changes in ECF osmolarity will shift the ICF

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 Body Fluid Disturbances

Expansion

Isotonic
Hypotonic
Hypertonic
Contraction

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Condition EXPANSION ECF ECF ICF ICF
vol Osm vol Osm
Add isotonic solution (isotonic expansion)    
Add hypertonic solution (hypertonic    
expansion) e.g.
Add hypotonic solution (hypotonic    
expansion) e.g. excessive drinking of water,
syndrome of inappropriate ADH secretion
(SIADH)

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Condition CONTRACTION ECF ECF ICF ICF
vol Osm vol Osm
Lose isotonic solution (isotonic contraction)    
e.g vomiting, diarrhoea, haemorrhage
Lose hypotonic solution (hypertonic    
contraction) e.g excessive sweating,
diabetes insipidus
Lose hypertonic solution (hypotonic    
contraction) e. Addison’s disease

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 Body responds to the body fluid disturbances

Normally:
• disturbance is temporary
• body responds to reduce disturbance

Mechanisms:
1. Water intake

2. Urine excretion
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 Examples for body fluid disturbance:

1. Excessive sweating: hypertonic contraction

Response: thirst sensation

decrease urine excretion

2. Drink large volumes of water: hypotonic expansion

Response: increase urine excretion

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Clinical setting:
Treatment regiment based on patient’s needs
Intravenous solutions are available in many formulations

To increase vascular volume:

use solution containing substances that do not
cross capillary membrane (e.g. 5% albumin)
To increase ECF volume:
use isotonic solutions (e.g. 0.9% NaCl)

To decrease the osmolality of body fluid:

use hypotonic solutions (hypotonic NaCl e.g
0.45% NaCl or 5% dextrose in water)

To increase osmolality of body fluid:

use hypertonic solutions (e.g. 3% NaCl)
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