Fluid Therapy

By:

ANESTHESIOLOGY AND INTENSIVE THERAPY DEPARTMENT

DR. MOHAMMAD HOESIN GENERAL HOSPITAL PALEMBANG
SRIWIJAYA UNIVERSITY
2018
Body water
compartment
 Water: major component of all fluid compartments within the body

Total body water represents approximately 60% of body weight in an average adult
(varies significantly with age, gender, and adiposity)

Table 1. Body fluid compartments (based on average 70-kg male)

Intracerllular
Total body water
component
Extracellular
 Table 2. The composition of fluid compartments.

Compartment
fluid volume
• Solute compositon
• Solute concentration

Differences in solute concentrations -- barriers that separate compartments.

The osmotic forces govern the distribution of water between compartments

Intracellular fluid
The outer membrane of cells – regulation of intracellular volume and composition

A membrane-bound ATP–dependent pump exchanges Na+ for K+ in 3:2 ratio

Cell membranes are relatively impermeable to Na+ and K+

Potassium is concentrated intracellularly

Sodium is concentrated extracellularly

The impermeability of cell membranes to most proteins  ↑ intracellular protein

concentration.
Extracellular fluid
Principal function of ECF
• Medium
• Cell nutrients and electrolytes delivery
• Cellular waste products removal

Sodium: most important extracellular cation and the major

determinant of extracellular osmotic pressure and volume.

Changes in ECF ~ changes in total body sodium content

Interstitial fluid
Most interstitial water is in chemical association with extracellular proteoglycans,
forming a gel

Interstitial fluid pressure is negative (about −5 mmHg)

As interstitial fluid volume increases, interstitial pressure also rises  positive.

Free fluid in the gel increases rapidly (edema).

Only small quantities of plasma proteins can normally cross capillary clefts  protein
content of interstitial fluid is relatively low (2 g/dL).

Protein is returned to the vascular system via the lymphatic system

Intravascular fluid
Intravascular fluid (plasma) is restricted to the intravascular space (endothelium)

Most electrolytes freely pass between plasma and the interstitium nearly identical
electrolyte composition.

Tight intercellular junctions (endothelial cells) impede the passage of plasma proteins

Plasma proteins (mainly albumin) are the only osmotically active solutes in fluid not
normally exchanged
Increases in extracellular volume are normally proportionately reflected in
intravascular and interstitial volume.
However, when interstitial pressure becomes positive, continued increases in ECF result
in expansion of only the interstitial fluid compartment.
In this way, the interstitial compartment acts as an overflow reservoir for the intravascular
compartment (edema)
Body water
movement
 Diffusion Through Cell Membranes
directly through the lipid bilayer of the cell membrane.
• Oxygen, CO2, water, and lipid-soluble molecules penetrate the cell membrane directly.

through protein channels within the membrane

• Cations penetrate the membrane poorly because of the cell transmembrane voltage
potential created by the Na+–K+ pump

reversible binding to a carrier protein that can traverse

the membrane (facilitated diffusion).
• Glucose and amino acids diffuse with the help of membrane-bound carrier proteins.

Fluid exchange between the intracellular and interstitial spaces is governed by the osmotic
forces created by differences in nondiffusible solute concentrations.

Relative changes in osmolality between the intracellular and interstitial compartments result
in a net water movement from the hypoosmolar to the hyperosmolar compartment
Diffusion Through Capillary Endothelium
Capillary walls (single layer of endothelial cells and basement membrane)

Oxygen, CO2, water, and lipid-soluble substances can penetrate directly through both
sides of the endothelial cell membrane.

Only low-molecular-weight watersoluble substances readily cross intercellular clefts.

High-molecular-weight substances penetrate the endothelial cleft s poorly

Fluid exchange across capillaries differs from that across cell membranes in that it is
governed by significant differences in hydrostatic pressures in addition to osmotic forces
Terima Kasih