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Intracellular

(ICF) Extracellular (ECF)


o Interstitial o Plasma

Figure 5-13: Body fluid compartments

2/3
1/3

(65%) of TBW is intracellular (ICF)


extracellular water

o 25 % interstitial fluid (ISF)


o 5- 8 % in plasma (IVF intravascular fluid) o 1- 2 % in transcellular fluids CSF, intraocular

fluids, serous membranes, and in GI, respiratory and urinary tracts


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Fluid and electrolyte homeostasis is maintained in the body Neutral balance: input = output Positive balance: input > output Negative balance: input < output

Electrolytes charged particles


o Cations positively charged ions

Na+, K+ , Ca++, H+ o Anions negatively charged ions Cl-, HCO3- , PO43

Non-electrolytes - Uncharged
Proteins, urea, glucose, O2, CO2
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Ion transport Water movement Kidney function

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Cell in a hypertonic solution

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Cell in a hypotonic solution

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400 300 200 100 0

Protein Organic Phos. Inorganic Phos. Bicarbonate Chloride Magnesium Calcium Potassium Sodium

H2O Plasma

H2O Interstitial

H2O Cell

The Body as an Open System

Open System. The body exchanges material and energy with its surroundings.

Amount Ingested = Amount Eliminated

Pathological losses vascular bleeding (H20, Na+) vomiting (H20, H+)

diarrhea (H20, HCO3-).

Body
o o

control systems regulate ingestion and excretion:


constant total body water constant total body osmolarity

Osmolarity

is identical in all body fluid compartments (steady state conditions)


o Body water will redistribute itself as

necessary to accomplish this

Body Fluid and Electrolyte Balance

Water input and output


The role of the kidneys in maintaining balance of water and electrolytes

The regulation of body water balance


thirst sensation
control of renal water excretion by ADH

Laboratory testing can be performed on many types of fluids from the body other than blood. Some body fluid analyses include: Urinalysis Synovial Fluid Analysis Semen Analysis Pleural Fluid Analysis Sweat Analysis Pericardial Fluid Analysis Fetal Fibronectin (fFN) Peritoneal Fluid CSF Analysis Analysis

Samples

are usually obtained through collection of the fluid in a container (urine, semen) or by inserting a needle into the body cavity and aspirating with a syringe a portion of the fluid (CSF, pericardial fluid, etc.). For certain body fluids including pleural, pericardial, and peritoneal fluids, it is important to determine through testing whether the fluid is a transudate or an exudate because it can help diagnose the disease or condition present.

Caused

by an imbalance between the pressure within blood vessels (which drives fluid out) and the amount of protein in blood (which keeps fluid in) is a clear fluid with a low protein concentration and a limited number of white blood cells.

It

Seen

in conditions such as congestive heart failure and cirrhosis

Caused It

by injury and/or inflammation.

has a higher than normal protein content and may be cloudy due to increased numbers of cells. in conditions such as infections, malignancies (metastatic cancer, lymphoma, mesothelioma) or autoimune diseases

Seen

Gross Total

exam
exam

cell count

Microscopic Any

other special test (Chemistry, Microbiology, cytology, etc.)

Test

are performed in various areas of lab based on what the physician orders.
fluids sterile vs. non-sterile

Body

Fluid surrounding brain and spinal cord Sterile Production by the plexus

Specimen: Lumbar puncture


Collect 3-5 vials, each tube has a designated department.

Gross exam: Turbidity, Color,


microscopic exam, cell count

Numerate and differentiate cells seen Lymphocytes: usually see few #, increase # associated with viral, fungal, aseptic, bacterial meningitis, or nervous system disease (MS)

Monocytes: Less than 2% of normal CSF, increase # associated with TB meningitis, syphilis, viral encephalitis, subarachnoid hemorrhage.
Macrophages: few in number associated with malignancy, hemorrhage, inflammation PMN: very few, represent rapid disintegration, associated with Viral and acute diseases.

Eosinophils/Basophils: not normally seen in CSF Plasma cells: not normally present associated with viral disorders, Hodgkin's, and bleeds. Red Blood Cells: Few to none present Mesothelial cells: not present Malignant cells will see with malignant disease and infiltrate. Cells unique to CSF:Ependymal: resemble lymphocytes and Choroidal: resemble lymphocytes, usually occur in clumps.

Pleural Fluid: Lung fluid Effusion Transudate Exudates Lab analysis: Gross exam, cell count, etc. Cells unique to the lungs: Mesothelial cells RBC and WBC # is limited, if increase is seen in WBC and RBC without traumatic tap- indicates disease or infarct Cytology exam: useful in identifying malignancy or abnormal morphological cells.

Lab analysis: Gross exam, cell count, etc.


Differential: PMN, Lymph, Mono, etc. Cells unique to the lungs: Mesothelial cells RBC and WBC # is limited, if increase is seen in WBC and RBC without traumatic tapindicates disease or infarct Cytology exam: useful in identifying malignancy or abnormal morphological cells.

Abnormal

accumulation of fluid (effusion) in peritoneal cavity.


A.K.A.

ascites

Removal

procedureparacentesis

Lab

analysis: distinguish between transudate and exudates, gross exam, cell count, sedimentation, chemical analysis
and clarity of Peritoneal Fluid can indicate certain infections and diseases.

Color

Total Cell Count: Assist in diagnosis of certain diseases by determining total RBC and WBC number. A total WBC >0.3 X 109/L is considered abnormal. Differential: Assist in diagnosis of infection and disease patterns Use Wrights stain: Differentiate: PMN:>25% in abnormal Eosin:>50% (ruptured hydatid cyst, lymphoma, or vasculitis. Chronic peritoneal dialysis will see eosinophils.

Lymphocytes: CHF, cirrhosis, nephrotic syndrome


Mesothelial Cells: Associated with tuberculosis peritoneal effusions Malignant cells: seen with malignancy Ascites: a condition which fluid accumulates within the peritoneal space. Must have an accumulation of at > 100ml (several 100) before effusion can be detected on physical exam.

Pericardial

Fluid: accumulation of fluid of the lining of the heart (effusion) Cause: neoplasm, infections, collagen disease, renal disease, Cardiovascular disease.

Gross

Exam: Report appearance (bloody, clear, cloudy) Measure pH: pH less than 7.0 associated with infection or rheumatoid disorder. Cell count: see limited # of RB and WBC Evaluate sedimentation

Examine physical, chemical and microscopic detail Quantitate number of sperm present , report morphology and motility Specimen must be a fresh collection-clean, sterile container. Gross Exam: Color, pH, Volume, and viscosity. Agglutination study

Synovial

Fluid:Joint Fluid normally clear, viscous


as a lubricate and transports nutrient

Functions

Arthrocentesis:

aspirate of the joint fluid, aseptic technique

Lab Assay: Gross exam, microscopic exam, Gram stain, cultures, etc. Appearance: clear, transparent, viscous Viscosity test: String Test Mucin Clot test Note crystals (intracellular vs. extra cellular) Slide exam usually performed on concentration of the fluid using Wright-Giemsa or Papnicolaou

Plasma

Serum

Blood + clotting factor Formed elements. Contain fibrinogen & pr-othrombin. No thrombin is formed.

Blood clotting factor. Formed elements. No fibrinogen& prothrombin. Thrombin formed during clotting process.

Serum:

Blood is taken in clean tube. Put at 370 c for clotting. Centrifuge the sample. Use the supernatant that is serum.

Plasma:
Blood is taken on anticoagulant. Mix well blood with anticoagulant. Use the sample that is plasma.

Take blood sample from patient in suitable tube.

Centrifuge the sample for 10 min. to obtain clear serum

Never draw blood through a hematoma . Remove the tourniquet as early as possible to decrease flow velocity and turbulence. Do not remove the collection tube until full. When mixing is required, gentle inversion is adequate.

LFT used to detect, evaluated and monitor liver diseases or damage.


These include:

Total protein (albumin & globulins) Albumin (main protein made by liver) ALT or SGPT alanine aminotranferase AST or SGOT aspartate aminotranferase ALP alkaline phosphatase Bilirubin (total & direct) GGT, LDH, PT (pro-thrombin time)

KFT used to evaluate and monitor kidney diseases or damage & the effectiveness of the treatment.
These include: Urea & BUN blood urea nitrogen Creatinine and creatinine clearance. Uric acid.

Lipid profile includes:


1)Total lipids 3) Cholesterol 5) LDL
These

2)Triglycerides 4) HDL

tests must be carried out after 12-14 fasting due the high molecular weight of lipid molecules and the prolonged digestion and metabolism.

Blood glucose level is one of the most important test in the lab. Glucose is very essential for all body activities. This includes: 1) RBS random blood sugar 2) FBS fasting blood sugar 3) PPS post-prandial blood sugar

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