Body Fluid Compartments

Average Total Liters of Fluid-42(60%)

Interstitial Fluid; 11

Plasma; 3

Intracellular Fluid; 28

20%

Compartments and their

Relationship
Blood Plasma
3L

Interstitial
11 L

Intracellular
28 L

Transcellular
1L

most cases substances within the plasma must

pass through the interstitial fluid before entering
cells.
Therefore the interrelationships between these 4
compartments are crucial in underlying whole body

 Principle: In humans, the volumes of

the body fluid compartments are
measured by the dilution method.
The basic principle underlying this
method is that a marker substance
will be distributed in the body fluid
compartments according to its
physical characteristics.

The following steps are used to measure volumes of

body fluid compartments by the dilution method:

1. Identification of an appropriate marker

substance.
Required criteria of tracers to measure
the following compartments:
. Plasma: not permeable to capillary membranes,
e.g., albumin
. ECF: permeable to capillary membranes but not
cell membranes,e.g., inulin, mannitol, sodium,
sucrose
. Total body water: permeable to capillary and cell
membranes, e.g., tritiated water, urea

2. Injection of a known amount of

the marker substance. The
amount of marker
substance injected into the blood is
measured in milligrams (mg),
millimoles (mmol), or units of
radioactivity (e.g., millicuries [mCi]).

3. Equilibration and measurement

of plasma concentration. The
marker is allowed to
equilibrate in the body fluids,
correction is made for any urinary
losses during the equilibration
period, and the concentration of the
marker is then measured in plasma.

 4. Calculation of the volume of

the body fluid compartment

 V C = A, therefore V = A/C
V = Volume of the compartment to
be measured
C = Concentration of the tracer in
the compartment to be measured
A = Amount of the tracer

Calculation of blood volume

Example:

Hct = 50% (0.50)

Plasma volume = 3 L
Blood volume =

 If 300 mg of a dye was injected

intravenously and at equilibrium,and
the concentration in the blood was
0.05 mg/mL, the volume of the
compartment that contained the dye
would be:
Volume = 300 mg/ 0.05 mg/mL or
6000 mL

Q
If 1 milliliter of a solution containing
10 mg/ml of dye is dispersed into
chamber B and the final
concentration in the chamber is 0.01
milligram for each milliliter of fluid,
the unknown volume of the chamber
would be?

 A patient is injected with 500 mg of

mannitol. After a 2-hour equilibration
period, the concentration of mannitol
in plasma is 3.2 mg/100 mL. During
the equilibration period, 10% of the
injected mannitol is excreted in
urine. What is the patient's ECF
volume

A 65-kg man is participating in a research study for

which it is necessary to know the volumes of his
body fluid compartments.
To measure these volumes, the man is injected
with 100 mCi of D2O and 500 mg of mannitol .
During a 2-hour equilibration period, he excretes
10% of the D2O and 10% of the mannitol in his
urine.
Following equilibration, the concentration of D2O
in plasma is 0.213 mCi/100 mL and the
concentration of mannitol is 3.2 mg/100 mL.
What is his total body water, his ECF volume, and
his ICF volume? Is the man's total body water
appropriate for his weight?

The man's total body water is 42.3 L,

which is 65.1% of his body weight
(42.3 L is approximately 42.3 kg; 42.3
kg/65 kg = 65.1%). This percentage falls
within the normal range of 50% to 70%
of body weight.

Distribution of intravenously administered fluids

Vascular compartment: whole blood,

plasma, dextran in saline.
ECF: saline, mannitol. At least 2/3 of
the fluid would enter the ISF.
Total body water: D5W5% dextrose
in water. Once the glucose is
metabolized,the water would
distribute 2/3 ICF, 1/3 ECF.

SHIFTS OF WATER BETWEEN BODY

FLUID COMPARTMENTS Types

Examples

Iso-osmotic volume contraction

Diarrhea,Burns,haemorrhage,vomitti
ng

Hyperosmotic volume contraction

Severe dehydration (sweating, fever,

diabetes insipidus - ADH)

Hypo-osmotic volume contraction

Adrenal insufficiency ( aldosterone)

Iso-osmotic volume expansion

Infusion of isotonic saline

Hyperosmotic volume expansion

High NaCl intake

Hypo-osmotic volume expansion

Syndrome of inappropriate ADH

secretion (SIADH)

ISO-OSMOTIC VOLUME EXPANSION

1.ECF Fluid change ?

2.ECF Osmolarity ?
3.ICF Osmolarity ?
4.Hematocrit ?

ISO-OSMOTIC VOLUME CONTRACTION

1.ECF Fluid change ?

2.ECF Osmolarity ?
3.ICF Osmolarity ?
4.Hematocrit ?

HYPEROSMOTIC VOLUME EXPANSION

1.ECF Fluid change ?

2.ECF Osmolarity ?
3.ICF Osmolarity ?
4.Hematocrit ?

YPEROSMOTIC VOLUME CONTRACTION

1.ECF Fluid change ?

2.ECF Osmolarity ?
3.ICF Osmolarity ?
4.Hematocrit ?

YPO-OSMOTIC VOLUME EXPANSION

1.ECF Fluid change ?

2.ECF Osmolarity ?
3.ICF Osmolarity ?
4.Hematocrit ?

Hypo-osmotic volume contraction

1.ECF Fluid change ?

2.ECF Osmolarity ?
3.ICF Osmolarity ?
4.Hematocrit ?

 Loss of isotonic
fluid that might be
due to hemorrhage
(neglect loss of
intracellular fluid
as RBC volume),
isotonic urine, or
the immediate
consequences
of diarrhea or
vomiting:

 Loss of hypotonic
fluid that might be
due to sweating
(dehydration),
hypotonic urine, or
diabetes insipidus:

 Ingestion of salt
tablets:

 Person who drinks

1 liter of tap (or
distilled) water:
Infusion of
hypotonic saline
(half-normal
saline):

 Infusion of isotonic
saline:

 Infusion of
hypertonic saline
(or hypertonic
mannitol; mannitol
does not cross cell
membranes
easily):

 Primary adrenal
insufficiency

A 23-year-old man is brought to the

Emergency Department after collapsing
during basketball practice. On admission
he is lethargic and appears confused. His
coach reports that it was hot in the gym
and he was drinking a lot of water during
practice. An increase in which of the
following is the most likely cause of his
symptoms?
a. Intracellular tonicity
b. Extracellular tonicity
c. Intracellular volume
d. Extracellular volume
e. Plasma volume

A 70kg man is given a treatment intravenously. The

diagram shows the intracellular(ICF) volume And
extracellular fluid(ECF)volume before and after treatment.
Which of the following treatments was likely administered
to this man?
A. Hypertonic saline
B. Hypotonic saline.
C. Isotonic saline
D.Isotonic glucose.

7.A 14-year-old boy has a craniotomy performed under general endotracheal

anesthesia for removal of a craniopharyngioma. The anesthetic agent used is
halothane, and when he is fully awake in the recovery room, he is extubated and
sent to the floor. Five percent dextrose in one-third normal saline was dripping in his
intra-venous line at a rate of 125 mL/h. Four hours later, the nurses report that he
cannot be roused from a deep sleep. They also point out that his urinary output in
each of those 4 hours was 1059, 1100, 980, and 1250
mL, respectively. Laboratory studies show:
Sodium 156 mEq/L
Osmolarity 312 mOsm/L
pH 7.55

pco2

28 mm Hg

Bicarbonate

24 mEq/L

Which of the following best explains these findings?

(A) Brain edema

(B) Nephrogenic diabetes insipidus

(C) Respiratory depression induced by unmetabolized anesthetic
(D) Surgical trauma to the posterior pituitary
(E) Water retention

Oral Rehydration Therapy Is Driven

by Solute Transport
Oral administration of rehydration solutions has
dramatically reduced the mortality resulting from
cholera and other diseases that involve excessive
losses of water and solutes from the gastrointestinal
tract. The main ingredients of rehydration solutions
are glucose, NaCl, and water. The glucose and Na+
ions are reabsorbed by SGLT1 and other transporters in
the epithelial cells lining the lumen of the small
intestine .
Deposition of these solutes on the basolateral side of
the epithelial cells increases the osmolarity in that
region compared with the intestinal lumen and drives
the osmotic absorption of water. Absorption of glucose,
and the obligatory increases in absorption of NaCl and

THE MICROCIRCULATION
Starling forces

NFP = (Pc + IF) (PIF + C)

Qf = k [(Pc + IF) (PIF +
C)]
(Fluid mov
rate)

k = filtration coefficient;The Kf is a measure of the

capacity of the capillary membranes to filter water for a
given NFP and is usually expressed as ml/min per mm Hg
net filtration pressure

Qf = k [(Pc + IF) (PIF + C)]

Qf = fluid movement
k = filtration coefficient

Questions
1. Given the following values, calculate a
net pressure:
PC = 25 mm Hg
PIF = 2 mm Hg
C = 20 mm Hg
IF = 1 mm Hg
2. Calculate a net pressure if the
interstitial hydrostatic pressure is 2 mm
Hg.

EDEMA
The edematous state requires two
conditions for its development and
maintenance:
1. An increase in the Starling forces,
which promote the movement of fluid
from the vascular compartment to the
interstitium
2. Retention of sodium and water by the
kidney

I. Increased capillary pressure

A. Excessive kidney retention of
salt and water
Acute or chronic kidney
failure
Mineralocorticoid excess
B. High venous pressure and
venous constriction
Heart failure
Venous obstruction
Failure of venous pumps
Paralysis of muscles
Immobilization of parts of
the body
Failure of venous valves
C. Decreased arteriolar
resistance
Excessive body heat
Insufficiency of sympathetic

II. Decreased plasma

proteins
A. Loss of proteins in urine
(nephrotic syndrome)
B. Loss of protein from
denuded skin areas
Burns
Wounds
C. Failure to produce
proteins
Liver disease (e.g.,
cirrhosis)
Serious protein or
caloric malnutrition

III. Increased capillary

permeability
A. Immune reactions
that cause release of
histamine and other
immune products
B. Toxins
C. Bacterial infections
D. Vitamin deficiency,
especially vitamin C
E. Prolonged ischemia
F. Burns

IV. Blockage of lymph

return
A. Cancer
B. Infections (e.g.,
filaria nematodes)
C. Surgery
D. Congenital
absence or
abnormality of
lymphatic vessels

Peripheral edema expresses itself in

two different forms
1. Non-pitting edema: This is often referred to as a
lymphedema which is a disturbance of the
lymphatic system. This can develop after the
removal of systemic tissue such as after a
mastectomy. Non-pitting edema does not respond
to diuretics.
2. Pitting edema: This is the classical, most common
type observed clinically. Pitting edema generally
responds to diuretic therapy. Common causes
include nephrotic syndrome, congestive heart
failure, cirrhosis, pregnancy, idiopathic edema, and
nutritional edema

Packed Cell Volume

Percentage of the cellular elements (RBCs,WBCs
and platelets) in the whole blood.
PCV is considered equivalent to the volume of
packed red cells or the so called haematocrit
value, as the volume of WBCs and platelets is
very less.
In 100ml of blood PCV is 45ml.
Haematocrit is the volume of RBCs expressed as
percentage
Haematocrit value in males is about 45%
Haematocrit value in females about 42%

HEMATOCRIT (Htc)-Important Diagnostic

Measurement
Is the fraction of
the blood volume
made up of the
formed elements
(mainly RBC)
Is determined by the
centrifuging
heparinised/antico
agulated blood in
a standard
calibrated tube of a
smallblood
diameter
When
is allowed to clot or
coagulate, the suspending
medium is referred to as serum
56

(Htc)-Important Diagnostic Measurement

Plasma (55% of whole blood)

Buffy coat: Leucocytes and Platelets

<1% of whole blood
Formed
Elements
Erythrocytes (45% of whole blood)

57

HEMATOCRIT
Tube A

Tube B

Tube C

Normal

Anemi

Polycythemi

58

HEMATOCRIT
Determination of hematocrit values is a simple and important screening
diagnostic procedure in the evaluation of hematological disease

Values
Males: 40 54 vol% (mean 47%; 0.47)
Females: 38 46 vol% (mean 42%, 0.42)

in persons leaving at high altitudes, polycythemia,

etc.

in anemia, leukemia, bone marrow failure

Importance
Determines blood viscosity
Htc resistance to blood flow, load on the heart
& BP

The contribution of the WBC to hematocrit is only 0.08%. WBCs are lighter
than the RBCs, they form a thin whitish layer between the sedimented
RBCs and the plasma.
59