FLUID & ELECTROLYTES
Fluid compartments
Total body water is distributed into 2 main compartments
1. Intracellular fluid [ ICF] = fluid inside the cells
2. Extracellular fluid [ ECF] = fluid outside the cells .further divided to
1. Intravascular fluid: plasma
2. Interstitial fluid: fluid outside the vessels
3. Transcellular fluid: special fluids. Include the:
Digestive fluids
CSF
Pericardial - pleural – peritoneal /fluid
Joint – intraocular – cochlear / fluid
Size of fluid compartments
1. ICF = 2/3 of TBW = 40% body wt.
2. ECF = 1/3 of TBW = 20 % of body wt. of this the :
1. Plasma = 25 % of ECF = 5 % of body wt
2. ISF = 75 % of ECF = 15 % of body wt
3. Transcellular fluid = < 1 % of ECF
Body fluid compartments as % of body wt
TBW ICF ECF ISF Transcellula
Plasma r
Neonat 80 % 40 % 40 % 5% 35 % <1%
e
Child 70 % 40 % 30 % 5% 25 % < 1%
Adult 60 % 40 % 20 % 5% 15 % <1%
Measurement of the body fluid compartments
By the indicator dilution method →
1. A substance is injected and allowed to equilibrate [ about 2 hrs]
2. Its volume of distribution is measured :
V= Q
C
V= volume of distribution [volume of the fluid compartment]
Q = amount of marker injected – amount metabolized or excreted
C = concentration of the marker in the sample
1. The plasma volume
Marker used :
1. dyes that bind to plasma proteins: Evans Blue [T 1824]
2. Radio nucleated serum albumen RISA]: leaks → results > actual
Volume: neonate = 150 ml – adult = 3. 5 L
2. Total blood volume :
Calculated if the plasma volume and the hematocrit are known .
= plasma volume X 100
100 - Ht
Volume = 8 % of body wt =
1. Preterm = 90 – 105 ml /kg
2. Term = 85 % ml /kg
3. > 1 mo = 75 ml / kg
4. > 1 yr = 67 – 75 ml /kg
5. Adult = 55 – 75 ml /kg
i.e.
1. Neonate = 300 ml
2. 1 yr = 600 ml
3. 5 yr = 1.5 L
4. Adults = 5.5 L
3. Red cell volume
Volume occupied by al the RBCs of the body
Measured using RBCs tagged with :
1. isotope of chromium – phosphorus - iron
2. Antigens
also calculated = total blood volume – plasma volume
volume = neonate 150 ml – adults 2 L
4. The extracellular fluid ECF
Markers used include :
1. Sugars: inulin – sucrose – mannitol – rafinose [large molecules .stay in plasma]
2. Ions: thiosulfate – thiocynite [tend to get into the intracellular space]
3. Radioisotopes of NA+ - CL‾ - Phosphorus – bromide
Volume : neonate = 1.2 L - adult = 14 L
5. The interstitial fluid ISF
Cannot be measured as it is difficult to sample
Calculated = ECF – Plasma
Volume : neonates = 1 L - adult = 10.5 L
6. The intracellular fluid ICF
Cannot be measured. Calculated : TBW – ECF
TBW measured using
1. deuterium oxide [ heavy water ]
2. Tritium oxide
3. Aminopyrine
Volume : neonate = 1.2 L - adult = 28 L
Notes
1. TBW as % of body wt
Varies with age – sex – and the amount of fat present .it is
1. Highest in the neonate. Decreases with age
2. higher in males than females [ 60 % to 50 %}
3. Inversely proportionate to the amount of fat present in the body , i.e. more fat means
less water
Water content of lean body tissue = 71 -72 ml /100 gr .fat is relatively free of water
Obesity lowers TBW, because the person has a smaller lean mass
2. The Ratio of ECF volume to ICF volume
This is larger in infants than in adults
1. in infants : ECF = 40 – 50 % of body wt - ICF = 40 %
2. in adults : ECF = 20 % of body wt - ICF = 40 %
The absolute volume of the ECF is smaller in children than adults hence dehydration
occurs more quickly and is often more sever in children.
3. Preterm babies
Have high TBW and ECF
Must complete their water unloading task in 1 wk [ takes 8 wks IU in full term]
Show marked dieresis resulting in decrease of ECF by 12- 15 %
4. Wt reduction in post natal period
Term = 3 – 5 %
Preterm = 12 – 15 %
Regained gradually in 10 – 20 days
Compartment Fraction of volume Markers used Cations Anions
TBW
TBW Neonate : 80 2.5 L deuterium oxide
% tritium oxide
Child : 70 42 L Aminopyrine
%
Adult : 60
%
ICF 2/3 of TBW N 1.2 L Calculated k+ Protein ‾
40 % of body A 28 L TBW - ECF Mg++ HPO₄‾ ‾
wt
1/3 of TBW Inulin –rafinose
ECF Neonate 40 % 1.2 L Sucrose – Na + CL‾
Child 30 % mannitol HCO3‾
Adult 20 % 14 L Thiosulfate
Thiocynite
¼ of ECF N 0,3 L Evans blue CL‾
Plasma 1/12 of TBW A 3.5 L RISA Na+ HCO3‾
5 % of ECF Protein ‾
ISF ¾ of ECF N 1L Calculated CL‾
¼ of TBW A 10.5 ECF – plasma Na+ HCO3‾
15 % of ECF L
Composition of body fluids
The distributing of body fluid is determined by the composition of electrolytes and
proteins in the different compartments of body fluids
Electrolyte is a substance capable of conducting an electrical current in solution.
Electrolytes exist as ions .there are 2 types of ions
1. Cations : positively charged : Na + - k+ - Mg++ - Ca ++
2. Anions: negatively charged: CL‾ - HCO3‾ - Protein ‾ - HPO₄‾ ‾ - SO₄‾ ‾
Composition of fluid compartments :
All concentrations in meq /L
plasma ISF ICF
Na+ 142 143 14
k+ 5 4 154
Ca ++ 3 5 -
Mg++ 3 3 26
CL‾ 113 117 3
HCO3‾ 27 27 10
Protein ‾ 16 2 72
Organic acid ‾ 6 6 4
HPO₄‾ ‾ 2 2 113
[phosphate]
SO₄‾ ‾ [sulfate] 1 1 17
Differences between fluid compartments
1. The extracellular fluid
The fluid outside the ells
Distributed in the blood , the interstitial , and the Transcellular compartments
Major cation the sodium. Major anions the chloride and bicarbonate
Contains large amounts of sodium and chloride , moderate amounts of bicarbonate and
small amounts of potassium ions
2. The plasma
Is the fluid component of blood. The blood cells are suspended in it
Consists of water 93 % + plasma proteins 7%
On volume base it forms 55 % of the blood volume
The blood cells form the remaining 45 %
3. The interstitial fluid
The ultrafiltrate of the plasma
Formed by plasma filtration across the capillary membrane
Has the same composition as the plasma :
1. Mai n cation : sodium
2. Main anions : chloride and bicarbonate
3. Has less protein ions [ Protein ‾] compared to the plasma
4. The intracellular fluid [ICF]
Major cations : potassium - magnesium
Major anions : Protein ‾ - organic phosphate [ATP – ADP – AMP ]
It is more acidic than ECF [ i.e. it has lower PH]
5. Osmolarity
Different solutes are present in the ICF and ECF
But total solute concentration [osmolarity ] is the same
This is because water moves freely across the cell membrane
6. Total ion concentration : in
1. Plasma = 292
2. ISF = 302
3. ICF = 368
The higher value in the ICF is due to the presence of high concentration of non diffusible
anions [proteins - PO₄‾ ‾ ] in the ICF
Definitions
1. The mole [ mol]
Is the molecular wt of a substance in grams
1 mol Na+ = 23 gr
1 mol CL‾ = 35.5 gr
1 mol Ca++ = 40 gr
1 mol = 1000 mmol [ millimole]
1 mmol = 1000 nmol [nanomole]
1 nmol = 1000 μmol [micromole]
1 μmol = 1000 pmol [picomole]
1pmol = 1000 fmol [fimtomol]
1 fmol = 1000 amol [ atomol ]
Molarity is the concentration of a substance in mol or mmol /L
A molar solution 1 M contains 1 mol of substance /L
Molality is the concentration of a substance in mol or mmol /kg water
A molal solution contains 1 mol of substance / kg water
2. The equivalent [eq]
Is the mole of a substance divided by its valence
1. 1 eq Na+ = 23/1 = 23 gr thus 1 mol Na+ = 1 eq Na+
2. 1 eq CL‾ = 35.5/1 = 35.5 gr thus 1 mol CL‾ = 1 eq CL‾
3. 1 eq Ca++ = 40 /2 = 20 gr thus 1 mol Ca++ = 1 eq Ca++
1 eq = 1000 meq [milliequivalent]
Normality is the concentration of a substance in eq or meq /L
A normal solution 1 N contains 1 eq /L or 1000 meq /L
3. The osmole [osm]
Is the mole of a substance divided by the number of osmotically active particles of the
substance in solution
1. 1 osm glucose = 180 /1 = 180 gr glucose
2. 1 osm NaCL = 23 + 35.5 = 29.5 gr
2
3. 1 osm CaCL = 40 + 71 = 37 gr
1 osm = 1000 mosm [milliosmoles]
Osmolarity is the number of osmoles of a substance per liter of solution osm/L
It is affected by the volume of solutes in solution and by temperature.
Osmolality is the number of osmoles /kg solvent.
It is not affected by the volume of solute in solution nor by temperature
In the body the osmotically active particles are dissolved in water. The density of water is 1
thus :
1. Osmolal concentration of a substance can be expressed in osm/ L
2. Osmolality can be expressed in osm/L of water
