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Renal 3 - Regulation of Body Fluid Vol and Fluid Osmolarity
Renal 3 - Regulation of Body Fluid Vol and Fluid Osmolarity
12, 2015
Renal
Regulation of Body Fluid and Volume
3 Carina C. Gomez, MD
OUTLINE
I. Introduction
A. Body Water Content
B. Distribution of Body Water
C. Fluids and Electrolytes
D. Body Fluid Volume
II. Regulation of Water
III. Gibbs Donnan Effect
IV. Fluid Osmolarity
V. Osmosis
VI. Control of Body Fluid and Osmolarity
VII. Requirements for Excreting Concentrated How much water do we have in our body?
Urine
When we talk about the “average” man, we are talking by
A. ADH
convention about a man who is about 175 meters tall and
B. Biologic Effects
weighs about 70 kilograms. Such a man contains about 60%
C. Osmotic Regulation
water by weight.
VIII. Countercurrent Mechanism
IX. Factors That Increrases Solute
Distribution of the Body Water
Concentration in the Medullary Interstitium
X. Obligatory Urine Volume
XI. Total Clearance of Solute
XII. Free Water Clearance
XIII. Clinical Implications
XIV. Volume And Osmolarity of ECF and ICF in
Abnormal States
LEGEND
From the Lecture/PowerPoint slides Fluids and Electrolytes
Notes from Lecture/PowerPoint slides Two Major Compartments:
From AUDIO RECORDING OF LECTURER o Inside the cell – Intracellular
o Outside the cell – Extracellular
OBJECTIVE: o “Rule of 2/3”
Determine Total Body Water (TBW) (Body Fluid There are fluids inside the Blood Vessels and fluids outside.
Compartment) The one inside, intravascular. Outside, Interstitial.
ECF Osmolarity Intravascular because ang fluid sa blood ay plasma.
Explain the effect of changes in Osmolarity with Body Fluid Iba ang total body volume sa plasma volume
Volume Blood Volume = 7 – 8 %, hindi lang 5% kasi hindi lang
Mechanism of Undiluted and Diluted Urine naman fluid ay blood.
Describe ADH (Synthesis, Release, Storage, Stimulus, Here is a useful mnemonic: the 60:40:20:15:5 rule.
Inhibitory Factor, Biologic Effect, etc.) Memorize it.
Counter Current Mechanism (Exchanger and Multiplier) Total Body Water 60% of body weight
Difference between Negative and Positive Water Clearance Intracellular fluid 40% of body weight
Some Disorders Extracellular fluid 20% of body weight
Interstitial Water 15% of body weight
INTRODUCTION Plasma 5% of body weight
When you regulate volume, it should be simultaneous with
osmolality.
Bakit kailangan i-regulate ang fluid volume --
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PHYSIOLOGY Regulation of Body Fluid Volume and Fluid Osmolarity Renal 3
REGULATION OF WATER
Tama po ba ang water therapy? Iinom ka sa isang araw ng
sampung litro.In excess, mali po yun.
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PHYSIOLOGY Regulation of Body Fluid Volume and Fluid Osmolarity Renal 3
Pag IV fluids, ang IV fluids kung tonicity ang pinag-uusapan. Osmolality of Body Fluid
Medyo wider ang range nun, mga 250 – 350 ang considered
na iso-
Kung ano ang osmolarity sa ECF, yun ang osmolarity sa
ICF. Mas madali i-determine ang ECF osmolarity, esp.
plasma osmolarity.
FLUID OSMOLARITY
How to determine ECF osmolarity? 90+% of osmolarity is
because of Na.
Na = very “effective osmole” But suppose that the osmolality of the ECF should become
Normal Na Concentration = 134 – 145, pag dinouble mo 300. There is now an osmotic gradient, and water moves
yun, 270 – 290. Malapit yan sa sa normal na 280- 300. Anw, predominantly from the cells into the ECF until there is
approximation lang yan. equalization of the osmotic pressure.
Why do we have to regulate that simultaneously? Differences in osmolality of the various fluid compartments
Halimbawa, regulated ICF + ECF, regulated osmolarity. Is can only exist transiently because water will flow to equalize
there any movement into and outside of the cell? Yes. osmolality among the compartments.
The amount entering and leaving the are just the same. Thus osmotic factors exert control over the distribution of
There is just NO NET MOVEMENT. Why it is very important volume between compartments.
to regulate BOTH.
OSMOSIS
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PHYSIOLOGY Regulation of Body Fluid Volume and Fluid Osmolarity Renal 3
Let’s say H2O intake ECF osmolarity No ADH 56:32 Halimbawa, Medulla mo hypo-, fluid iso- : membrane
(hindi permeable ang late distal to water) Diluted Urine permeable fluid secreted. Importante fluid mo sa medulla
Yung Nephrons start to filter plasma (plasma is iso-) hyper-.
iso- dito, iso- doon No Net Absorption of H2O
Do you have Net Absorption of H2O? None
But we said in Renal 1, in this case (PCT) you have a
very powerful active reabsorption of solute whether you
like it or not. These will reabsorb 60 – 70 % of sodium
Na reabsorbed osmotically active Na H2O follows
(because membrane is permeable) Major Major
Kung ilang percentage ang nireabsorb mong Na, yun din stimulus inhibitor
ang percentage na nireabsorb mong H2O. Will you change for ADH for ADH
osmolarity? No = ISOOSMOTIC REABSORPTION (which
we absorbed here in PCT)
Anong fluid ang mag-eenter ng LOH? Iso-, because you do
not change the osmolarity. The fluid that will enter LOH is
always iso-. Outside hyper-.
D’you have net movement of H2O? The movement of
H2O is goin’ up. You reabsorb H2O
Will Na follow? This is the area which is mostly fluid =
Thin Descending (Reabsorption of H2O without
solute)
ECF Positive Water
You reabsorb H2O because of osmotic gradient
Clearance
You can not reabsorb solute because there is no active Late Distal primarily Collecting
reabsorption fluid here becomes hyper- and hyper-
Highest Osmolarity in Tubular Fluid = THIN Negative Water Clearance
DESCENDING + THIN ASCENDING (Lahat INCREASE EXCEPT
URINE VOLUME)
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PHYSIOLOGY Regulation of Body Fluid Volume and Fluid Osmolarity Renal 3
Biologic Effects
SIADH
Syndrome of Inappropriate Hypersecretion of
Antidiuretic Hormone
Signs of ICF Volume Depletion
Malakas excretion of H2O due to polyuria + polydipsia (ADH
Intense thirst, but no water to correct it.
deficient/not working) ECF osmolarity (nareretain tubig)
Disturbance in the function in the cells of the brain mad
Hypoosm H2O channels ADH secretion
with thirst
H2O reabsorption Concentrated urine SIADH
Negative Water Clearance
high plasma level of ADH above what would be expected on
the basis of body fluid osmolality and blood volume and
pressure.
water is retained hence produce concentrated urine
result to body fluid hypoosmolality (dilutional hyponatremia)
can be due to brain neoplasm and infection, drugs, cerebral
disease (cerebral salt wasting) and pulmonary disease
(pulmonary salt wasting)
Increased Decreased
Ingestion of water Dehydration
Intravenous fluid infusion Diarrhea
of different osmolarity Excessive sweating
Polyuria
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