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Fluid Balance

1. Body Compartments: Intracellular & Extracellular

a. Extracellular made up of intravascular, interstitial (between cells)
and smaller compartments outside of cells
b. Intracellular: Inside the cells
2. Functions of Body Fluid:
a. Transport nutrients, electrolytes, oxygen
b. Remove waste products
c. Regulate body temperature
d. Lubricate joints & membranes
e. Medium for food digestion
3. Fluid Losses:
a. Urine ~ 1000 1500 mL/day
b. Feces ~ 100 mL/day
c. Lungs ~ 400 500 mL/day
d. Skin
~ 300 500 mL/day
e. B,C, & D insensible losses not measurable
4. Solvent: a liquid in which a substance may be dissolved
5. Solute: a substance dissolved in a solution
6. Osmosis: movement of a solvent through a membrane, moving from an
area with less solute concentration to one of greater solute
concentration. The fluid moves to even out the number of particles per
mL or L. If compartment # 1 had 500 particles (solutes) in 1 L of fluid
and compartment # 2 had 1000 particles in 1 L of fluid, the fluid from
the first compartment would move over to the more concentrated
solution so the number of particles to fluid (ratio) would be equal.
7. Diffusion: solutes or particles move from areas of higher concentration
to ones of lower concentration
8. Osmol: unit of measurement of osmotic pressure
9. Osmolality: Osmotic pull exerted by all the particles per unit of water
Osmolarity: same as above
Ion: particle carrying a charge; negative or positive
Tonicity: the osmolality of IV fluids. We consider body fluids as
having osmolality and IV fluids as having tonicity.
Starlings Law: Hydrostatic intravascular pressure forces fluid out
of the capillary at the arterial end; the hydrostatic pressure
intravascularly is higher than interstitial (in the tissues) hydrostatic
pressure, so fluid goes out of the capillary into the interstial space.
Osmotic pressure is higher at the venous end of the capillary than that
in the tissues, so the fluid is pulled back into the vascular space. See
picture on next page:

Fluid Balance

Pressure Gradient: the difference in pressure between two
points. So fluid will flow from areas of higher hydrostatic pressure to
lower hydrostatic pressure at the arterial end of the capillary and the
colloid osmotic pressure is higher intravascularly than the tissue colloid
osmotic pressure, so the intravascular colloid osmotic pressure pulls
the fluid back into the vascular system at the venous end of the
Regulators of fluid balance:
a. Thirst
b. Sodium: water follows sodium. If FVD (fluid volume deficit)
kidneys hold unto more sodium and water follows (More
concentrated urine)
c. Protein, albumin: increases osmotic pressure thus pulling more
fluid into the vascular space. If low on albumin due to poor diet
= less osmotic pressure. If albumin or other proteins get out into
the tissues pull fluid out into the tissues ascites or edema
d. Antidiuretic hormone (ADH): produced in hypothalamus, stored
in back of pituitary gland, secreted if body senses low volume,
ECFVD (extracellular fluid volume deficit) or an increased
osmolality (increase in solutes - like high sodium levels). ADH
causes water reabsorption in kidneys.
e. Renin: comes from juxtaglomerular cells in kidney, released
when kidneys get less blood flow kidneys interpret low blood
flow to mean low blood volume or dehydration. Renin causes
angiotensinogen to convert to angiotensin I, which then is acted
on to convert to angiotensin II, a potent vasoconstriction and the
release of aldosterone sodium and water retention in kidneys
vasoconstriction of vascular system increase in vascular
volume and Bp and increased blood flow to the kidneys.
f. Aldosterone: comes from Adrenal cortex, promotes sodium,
chloride & water reabsorption in kidneys.

Fluid Balance



Tonicity of IV solutions:
Isotonic D5W, 0.9 NS, RL
Hypotonic 0.45 NS, 2.5% dextrose & water
Hypertonic 2 3% sodium chloride, D5W & .9 NS (D5W and
anything adding up the solutes in both mixtures make it
hypertonic) (something to think about in later years of practice
once D5W [5% dextrose in water] is metabolized, the sugar
dextrose is metabolized, it becomes a hypotonic solution)
Causes of fluid volume deficit (dehydration)
Vomiting/diarrhea (Influenza)
GI fistula (Crohns disease)
GI suctioning (Post gastric surgery)
Increased salt intake
Intestinal obstruction (Tumor)
Perforated ulcer
Profuse diaphoresis
Burns (especially full thickness burns)
Diabetic Ketoacidosis
Massive trauma (especially hip fractures or large bone fractures,
internal abd. Injuries)

Causes of fluid volume excess (overhydration)

Renal Failure
Renal disease
Heart failure
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Venous obstruction
Cortisone/steroid drugs
Filtration: both water and solutes move together across a
membrane from an area of high pressure to an area of lower pressure
hydrostatic pressure is a form of filtration. The larger particles do not
get filtered through unless something is wrong broken. This is why
plasma proteins remain in your blood stream and exert osmotic
pressure to pull the fluid back in from the tissues.
20. Active transport: movement of substances against the pressure
gradient, utilizes energy (ATP) to move.