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a) Urine - 1000 ml
b) Sweat - 200 ml
c) Faeces - 200 ml
d) Breathing - 600 ml
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Total body water in an adult is about 40-45 litres
(70 kg man)
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Tissue composition of water (%)
TISSUE % Water
Kidney 83
Heart 79
Lungs 79
Skeletal muscle 76
Brain 75
Skin 72
Liver 68
Skeleton/bone 22
Adipose tissue 10
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Body fluid compartments in humans
Water homeostasis
The total excretion from both components is 2.4 - 2.8 L per day
b) Thirst
(a) Arginine Vasopressin (AVP/ADH)
NaCl, mannitol and sucrose e.g. are more potent than urea and
glucose
i) Hemodynamic changes
i) Nausea
It is a very potent stimulus for AVP release whether accompanied by
vomiting or not.
v) RAAS
Blood-borne angiotensin II stimulates AVP release.
Acetylcholine Fluphenazine
Nicotine Haloperidol
Apomorphine Promethazine
Isoproterenol Alcohol
Histamine Glucorticoids
Prostaglandin Phenytoin
Cyclophosphamide
Vincristine
Lithium
Naloxone
Cholecystokinin
Insulin
(b) Thirst
Plasma Hypovolaemia
osmolality
osmoreceptors Ang II
Thirst centre
Drinking
The body water content and composition is very finely maintained
GI absorption
Plasma osmolality
ADH suppression
Urine output
Dehydration Salt intake
Plasma osmolality
osmoreceptors
Increased ADH
release
Thirst centre
Increased tubular
reabsorption of water
Drinking
a) Carotid baroreceptors
decreased renal
Na+ reabsorption Renal Salt and water excretion
- Lithium induced
Hypotonic polyuria - Due to increase rapid metabolism of AVP by
of pregnancy increased circulating oxytocinase/
vasopressinase (cysteine aminopeptidase).
Can be treated with desmopressin
b) Psychogenic DI
P Na+ Aldosterone
Increase plasma osmolality
1. Hyponatraemia
a) Hyponatraemia with ECFV depletion
e.g. diuretic-induced
adrenal insufficiency
a) Hyponatraemia with excess ECFV
e.g. CCF
Hepatic failure, Nephrotic syndrome
a) Hyponatraemia with normal ECFV
e.g. Psychosis
glucocorticoid deficiency
a) Syndrome of inappropriate ADH secretion
Daily potassium balance
During periods of low dietary intake the kidney reabsorbs as much as 98-99%
of the filtered load of potassium.