Dec.

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 --

 Why you have to regulate both?

Fluids and Electrolytes: Body Water Content  How is it distributed?

 The “average” man contains about 60% water by weight. o 70 x .6= 42L TBW
 In many clinical situations, we will not be dealing with o 70 x .4 (intracellular) = 28L
“average” people. o 70 x .2 (extracellular) = 14L
o 70 x .15 (interstitial) = 10.5L
o Pag 0.5, 3.5L.

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PHYSIOLOGY Regulation of Body Fluid Volume and Fluid Osmolarity Renal 3

FACTORS WHICH AFFECT THE AMOUNT OF TOTAL BODY

WATER
 Obesity
 Gender
 Age
 In many clinical situations, we will not be dealing with
“average” people, they may be fatter or thinner, and this will
influence the size of their fluid compartments.
 With one exception, all body tissues contain far more water
than anyhing else. The exception is adipose tissue which
contains only about 20% water. Thus, a fat man contains
proportionately less water than does a thin man.
 Single Positive Important factor in dealing with factors that
affect Body fluid. Primarily, Fat content. The greater the fat
content of the body, the lesser the water. Inversely
proportional.
 There is a gender difference, too, because women have
proportionately more body fat than men. This means that
women contain less water in proportion to their weight than
do men.

REGULATION OF WATER
 Tama po ba ang water therapy? Iinom ka sa isang araw ng
sampung litro.In excess, mali po yun.

 Compare obese vs. lean:

o Obese:  fat content  lesser water volume
 Gender : Male vs. Female
o Female:  estrogen  promotes fat deposition  lesser
water volume than Male
o Male: testosterone promotes protein
 Age: The older you are the lesser percentage of water you
have.
 In Infant: The younger you are, the greater the percentage
whether you’re average or fat.
 Under normal circumstances, we all maintain a water
 Where can you observe the greatest percentage of TBW? “balance” so that our intake and our losses are equal.
Average infant, average male, average female, elderly?
 Normal condition, no diseases. Palagi kong naririnig 8 – 10
Average male because I’m talking with greatest water
glasses/day . Paano kung bata yun? Ang tama talaga,
volume.
30ml/KgBW daily. Kung per pound, 15ml.
 So pag volume, kunin mo percentage + Body Weight (BW)
 Kung ang infant 10kg? 10 kg x 30. Dapat ang iniinom niya
i.e. Infant 80%, 10 kgs lang siya. Hindi naman ako
lang ay 300 ml (kung normal ang environment). Pag mainit
nagtanong ng percentage, kung ang tanong ay
ang environment, tataasan mo. Pag may fever, tataasan mo.
percentage then ang highest infant.
 Saan galing ang 8 – 10 glasses? Yan ang average sa adult.
 Water Volume = Percentage x BW
Because we consider a 70 kg individual. Pag 70 x 30 = 2100
 There is an age difference, too, as shown in this table. An ml, i-round to 2000. Kadalasan ang iniinom natin, baso na
infant has proportionately more water, as much as 80% of its 200 ml, yung Malaki 250. Ilang baso ang 2000 kung 200?
body weight. A malnourished infant who is depleted of fat 10. Pag 250? 8.
may have even more than that.
 Depende sa weight (water intake). Huwag mong pilitin ang
 This is very important in clinical situations because a child is 8-10 glasses per day kung ang body weight mo ay 30 kgs.
much more vulnerable to the effects of water depletion than
and adult.

Body Fluid Volume

 Why do we have to regulate simultaneously fluid osmolarity?

Because they are affected by solutes.
 Fluid osmolarity, you have ECF and ICF osmolarity.
Normally they are both iso-. Normal fluid osmolarity =
280 – 300 mOsm/L.

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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.

GIBBS DONNAN EFFECT

 In man, the intracellular and extracellular fluids are of

comparable osmolality and normally, this is about 285
milliosmoles/kg.
 Water therefore will move equally in either direction across
the cell wall since the random movement of water molecules
will be the same in each direction.

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

 The body fluids can be divided into an intracellular

compartment (ICF) and an extracellular compartment
(ECF).
 In clinical situations, a more accurate estimate of
plasma osmolarity is obtained by the considering the
osmoles contributed by urea and glucose
 If you suspend RBC which is iso- to an isotonic solution. NO
NET MOVEMENT, NO CHANGE IN CELL VOLUME.
 Suspend in Hypertonic solution, cell shrink. Water will
always move from lower to higher concentration.
 Suspend inn hypotonic, mas marami solute. Water will move
into the cell  cell swells.
 The glucose and urea concentrations are expressed in
units of mg/dL(dividing by 18 for glucose and 2.8 for
urea* allows conversion from the units of mg/dL to
mmol/L and thus to mOsm/kg H2O). This estimation is
useful in patients with diabetes mellitus and chronic
renal failure.

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PHYSIOLOGY Regulation of Body Fluid Volume and Fluid Osmolarity Renal 3

 Thirst center and ADH

 How the kidney regulates water volume in the body? Pag
uminom ka ng madami, iihi ka ng madami. Pag uminom ka
ng onti, iihi ka ng onti.
 Pag onti ang ihi mo, concentrated yun. Pag madami, diluted
yun. Ang ginagawa lang talaga ng kidney either dilute or
concentrate urine.
 You drink a lot of water, what happens with ECF osmolarity?
Yan lang ang aalalahanin niyo, solute over solvent. Pag
uminom ka ng madami, tataas ang solvent. Anong
mangyayari sa osmolarity mo? Bababa. Which is why if you
drink a lot of water, that will favor a decrease in ECF
osmolarity or tonicity  Diluted urine (decrease vol.,
lesser urine osmolarity)
 Unlike if you drink less amount of water, pag less amount of
water  less solvent + inceased ECF osmolarity that will
favor concentrated urine (low volume, increased urine
IV Fluids osmolarity)
 Pag ikaw ay magbibigay ng IV fluid sa pasyente. Kailangan  Paano mo malalaman ang osmolarity ng urine?Sa urinalysis,
tamang IV fluid ang ibibigay mo. that’s equivalent to specific gravity. Mataas ang specific
 If you are not sure of the IV fluid, better not give that. gravity, mataas ang urine osmolarity. Normal = 1.010 –
 Let’s say I gave an IV fluid. Hindi naman parepareho ang IV 1.030.
fluid. May tinatawag kang .9NSS isotonic yun. Normal saline  Bakit naman po Dra pag uminom ng madami at bumaba ang
yun. ECF osmolarity. Bakit Diluted? Kasi po ang Decrease ECF
 .45 NaCl = hypotonic osmolarity  #1 Inhibitor to ADH secretion  No
 1% NaCl = hypertonic Reabsorption of Water  urine volume
 3% Dextrose = Hypo –  Pag madami kang iihi  Positive Water Clearance
 5% Dextrose = iso-  Pag onti  Negative Water Clearance
 Kaya ang D10W = Dextrose 10% in water, Hyper- na yun.
Kasi ang normal 5%.
 D5NSS = 5% Dextrose = NSS = hypertonic nay un,
pinagcombine sa isang litro.
 Let’s say I give an isotonic solution. Where do I administer?
Extracellular. Interstitial or Intravascular?Intravascular.
Intravenous or intraarterial? Intravenous.
 Let’s say you add an iso- fluid (greater than .9 NaCl/5%
Dextrose). If I will infuse that in the ECF what will happen
with ECF volume? It will increase or expand. ECF
Osmolarity? No Net Movement. Change in ICF volume?
None. What will happen to ICF osmolarity? The same.
SUMMARY: If you will give an isotonic fluid, only ECF
Volume changes (such that ECF osmolarity, ICF volume, ICF
osmolarity remains the same).
 If you give hypotonic fluid ( .9NaCl,  5% Dextrose)
o ECF volume  or it will expand
o Osmolarity 
o Hypo – ito, iso- yun? May papasok ba sa loob? Yes.
SUMMARY: If you give hypo- fluid, both volume will
increase/expand. But both osmolarity .
 Hypertonic solution given (ang fluid higher than .9NaCl or
greater than 5% dextrose)
o Volume expands/increases
o ECF osmolarity 
o Shift of fluid: fluid goes to ECF
o ICF volume: shrinks/decreases/contracts
o Pag binawasan mo ng tubig, anong mangyayari sa
osmolarity? Nagiging pa din hyper-. So hyper- siya.
o ICF osm will also 
SUMMARY: Pag nagbigay ka ng hypertonic solution, lahat yan
nag-iincrease except ICF volume which will contract or decrease.
Kaya kung hindi ka sigurado, mas better na ang ibibigay mo iso-.

Pero ang lesson dito, if your Patient is losing hypotonic solution,

then also give hypotonic fluid.. Patient losing isotonic, you also
give isotonic. How will you know, tignan mo ang ECF osmolarity.

CONTROL OF BODY FLUID AND

OSMOLARITY
 Achieved by regulating the excretion of water (osmolarity)
and NaCl (volume)
o Fluid volume regulation is almost entirely mediated by  Let’s say you drink, 1L of Pure Water misanang inom  ECF
changes in ECF osmolarity osmolarity  (to normalize:  urine volume)
o Osmoregulation is almost entirely mediated by changes
in water balance
o If you want to regulate body fluid volume, you have to
change osmolarity. If you want to regulate osmolarity,
you have to change water balance.
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PHYSIOLOGY Regulation of Body Fluid Volume and Fluid Osmolarity Renal 3

 What osmolarity of fluid enters TAL? ALWAYS HYPER-,

NEVER PERMEABLE TO H2O even with ADH. But
ACTIVE REABSORPTION OF SOLUTE WITHOUT H2O
 51:06 Fluid here, removing solute + retaining H2O  fluid
becomes hypo- and hypo-
 This is the diluting segment of the nephron, primarily
the Thick Ascending LOH with little contribution
from Early Distal.
 What is the osmolarity of the fluid that will leave
LOH and will enter Early Distal? Always Hypo-
 Hypo- dito, iso- doon. D’you have osmotic gradient? Yes
 We do not have ADH  Nephron not permeable to H2O
 remains hypo- H2O  fluid entering collecting duct is
also hypo-, outside hyper-  High Osmotic Gradient,
Membrane Not Permeable  Remains Iso- Isotonic
Fluid = Diluted Urine ( volume,  urine osmolarity)
 Less amount of H2O   osmolarity (#1 stimulus for
ADH secretion  ADH present  Reabsorption of H2O
 concentrated urine
 53:02 You filter plasma, plasma is iso-, cortex is iso-  no
osmotic gradient  no net reabsorption of H2O but active
reabsorption of solute (60-70%)  H2O follows, no change
in osmolarity  isoosmotic reabsorption in PCT  iso- to
LOH (with or without ADH)
 Juxtamedullary nephron = has some parts in the medulla,
some parts in the cortex.  Enters as hypo-, outside is hyper-  reabsorbs H2O
 Cortex is always iso- (line above) kaya mas lighter ang without solute (because no active reabsorption)  fluid
kulay. is hyper- (concentrating segment)
 Medulla always hyper-. As you go deeper, nagiging darker,  TAL = very powerful active reabsorption of solute
it goes hyper- & hyper-. If you compare outer and inner without water even with ADH
medulla. Inner medulla  tonicity than outer medulla.  Highest osmolarity of tubular fluid = Descending +
 We call that insterstitium, we call that mesangium. ascending – Thin LOH. Enters TAL as hyper-  you
have less solute with H2O hypo- fluid  diluting
PERMEABILITY OF TUBULAR MEMBRANE segment  Hypo- fluid entering Distal with or without
H2O NaCl ADH
Proximal    In Distal, fluid is hypo-, outside iso- with ADH already  fluid
Thin Descending   now go to interstitium  Fluid equilibrates with cortex 
Thick Ascending X  becomes iso-  go down as iso-, outside hyper-  more
LOH (Never permeable H2O reabsorption  equilibrate with medulla  hypertonic
to H2O even with fluid ( volume,  osmolarity)  concentrated urine
ADH, hanggang
Early Distal) From all aforementioned, Same sa PCT, Same sa Thin Desc.,
Late Distal They’re Both Excess Thin Asc., Thick Asc.. Nagkaiba lang sa fluid pag –
Collecting Duct ?  Walang ADH  hypo-
Only permeable Only permeable  May ADH  iso-
with ADH with Aldosterone  56:03 Pagdating sa Medulla, nagiging Hyper- with ADH

 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

REQUIREMENTS FOR EXCRETING  causes vasoconstriction (V1A) receptor - large quantities

 When ADH binds to B2 sa kidney  activate adenylate
CONCENTRATED URINE cyclase  cAmp , pKa activated (Pag G, cGmp; pag C, B-
 High ADH level
A-G yun)
 Hyperosmotic renal medulla
 What happens with pKa? pKa when activated, madami ka na
o Maximal concentrating capacity of human kidney =
talagang H2O channel na naka-float sa cytoplasm.
1200 mOsm/L – 1400 mOsm/L (sa Book)
 pKa   H2O channels moved to apical membrane para
o Maximal diluting capacity of human kidney =
iinsert para dumami --
50mOsm/L
o Maximal concentrating capacity of dessert animals = d. INSERTS H2O CHANNEL
10,000 mOsm/L
 REVIEW CELL SIGNALING IN CELL, IMPORTANT IN
ADH ENDOCRINOLOGY
 a.k.a. antidiuretic hormone or vasopressin (vasopressive
Osmotic Regulation – Water and Antidiuretic Hormone
effect/ vasoconstrictive effect)
 actually ang pangalan niya ay arginine vasopressin
 Dalawa kasi receptor niyan, B1(vasoconstrictive) and B2
(anti-diuretic effect)
 Biosynthesis : Hypothalamus (Supraoptic and
Paraventricular nuclei)
 Receptors : Osmoreceptors (responds to effective osmoles,
most effective = Na)
 Storage and Release : Posterior Pituitary Gland
 #1 Regulator : ECF osmolarity
o  ECF osmolarity 
o  ECF osmolarity  
  ECF osmolarity  Inhibitory to ADH  ADH  No
H2O Reabsorption H2O loss  Diuresis  Diluted
Urine  Positive H2O Clearance
 Conversely, when water intake is high and the osmolality of
the body fluids decreases, less ADH is secreted, the more
water is lost through the kidneys, the urine volume rises and
its concentration falls.
 Thus, varying ADH release results in a variation of water
loss that precisely matches the variations of osmolality in the
ECF.
 The osmolality of the body fluids can vary from about 50
milliosmoles /kg water to about 1200 milliosmolal (plasma
osmolality is 280 - 290 milliomolal).
 Urine volume can vary from about 500 ml/day to about 20
liters/day.

Biologic Effects

  ECF  ADH  permeable to H2O Retain H2O 

Anti-diuresis  Negative Water Clearance
 When osmolality increases due for example to dehydration,
the kidney excretes urine that is low in volume and more
concentrated than body fluids. This is accomplished through
the action of ADH which is produced by neurons in the
supraoptic and paraventricular nuclei of the hypothalamus.
 ADH increases the water permeability of the epithelial cells
of the late distal tubules and collecting ducts. This results in
the excretion of urine that is low in volume and high in
osmolality or concentration.

ADH INCREASES H2O REABSORPTION IN THE KIDNEY BY? COUNTERCURRENT MECHANISM

a.  H2O CHANNELS  Countercurrent  hypertonic medulla
b. OPEN H2O CHANNELS  produces hyperosmotic renal medullary interstitium.
c.  EXPRESSION OF GENES FOR H2O CHANNELS (1200-1400 mOsm/L)
d. INSERTS H2O CHANNEL o HOW? accumulation of solutes > water
 depends on the special anatomic arrangement of the ff:
 regulate volume and osmolarity of urine and ECF. (juxtamedullary nephrons)
o Pag madami ADH   urine vol, ECF volume  WHO ARE RESPONSIBLE?
o  ADH : Hindi mareabsorb ang H2O   urine volume, o loops of Henle – countercurrent multiplier
ECF volume  o vasa recta – countercurrent exchanger
o increases water permeability in the collecting duct and o collecting duct (little contribution)
medullary collecting duct to urea.  LOH: involved in concentrating and diluting urine
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PHYSIOLOGY Regulation of Body Fluid Volume and Fluid Osmolarity Renal 3

 medullary blood flow is low (1-5% of the total renal blood

FACTORS THAT INCRERASES SOLUTE flow)
 medullary blood flow is slow which minimizes solute loss
CONCENTRATION IN THE MEDULLARY
INTERSTITIUM
 active transport of solutes (Na+,Cl-, K+) out of the thick
ascending limb of the loop of Henle.
o most important
o NKCC Transporter sa plasma – Sodium Potassium
Chloride Transporter (Transporter Blocked by LOOP
DIURETICS)
 active transport of ions (Na+) from the collecting duct
 urea- waste product; urea reabsorbed  urea recycling +
very small amount of H2O reabsorbed in renal tubule 
contributes to madaming solute sa medulla
 passive diffusion of large amount of urea from the inner
medullary collecting duct.
 diffusion of small amount water from the medullary tubules.

OBLIGATORY URINE VOLUME

 Halimbawa, you are asked to excrete 600 mOsm of solute.

Ilan kaya ang urine volume ang dapat mong gawin para
Countercurrent Multiplier maitapon mo yan?You call that Obligatory Urine Volume
 produces hyperosmolar medullary insterstitium  In Seawater, 1L Seawater = 2400 mOsm/L
 ASCENDING LOOP OF HENLE
o impermeable to water
o Na+Cl- K+ co-transporter TOTAL CLEARANCE OF SOLUTES
(BLOOD)
 Expressed as osmolar clearance (Cosm )
 Osmolar Clearance
o Volume of plasma cleared of solutes per minute.
o Calculated as;

FREE WATER CLEARANCE

 Free Water Clearance, Paano mo malalaman? Alamin mo
Countercurrent Exchanger ilang solute ang i-excrete at ilang water i-excrete? Kung sino
mas madami, yun ang magdedetermine ng negative or
 Vasa Recta: preserves hyperosmolarity of the medullary
positive.
interstitium
 Una, osmolar clearance. Ilang solute ang dapat mong i-
 Charac feat: minimizes washout of solute from the medullary
remove?
interstitium, not normal Blood Volume, blood flow too low too
 Osmolar Clearance = Urine osmolarity times volume
slow  not capable of reabsorbing marami preserves
divided by plasma.
medullary interstitium
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PHYSIOLOGY Regulation of Body Fluid Volume and Fluid Osmolarity Renal 3

 Calculated as the difference between water excretion (urine

flow rate) and osmolar clearance.

 Positive Free Water Clearance VARIATION IN BODY FLUID OSMOLARITY

o Diluted Urine, NO ADH
o Excess water is excreted by the kidney Hyperosmolality Hypoosmolality
o Urine osmolarity is lesser than plasma osmolarity (Hypernatremia) (Hyponatremia)
o Water excretion
 water is lost from cells  shifts water into the
 Negative Free Water Clearance (shrinkage) cells (swelling)
o Maraming solute  mataas ang urine osmolarity   lethargy , weakness,  nausea, malaise,
concentrated seizure, coma and headache, confusion,
o Excess solutes are removed from the body death. lethargy, seizure and
o Urine osmlarity is greater than plasma osmolarity coma.
o Water conservation
 Hyper - = Diabetes Insipidus
 Hypo-= SIADH
CLINICAL IMPLICATIONS
Diabetes Insipidus Signs of ECF Volume Depletion
 Diabetes Insipidus (D.I.) : Onti ADH  No Water  What are 2 MAIN PROBLEMS if you have IMBALANCE OF
reabsorption  Polyuria  Positive Water Clearance INTAKE & OUTPUT?
 Either Mababa ADH secretion/Normal pero receptors may  Intake  Output = Overhydration
problema D.I. o Minsan naooverlook ang manifestations
 Central Diabetes Insipidus o MC: Cough + Dyspnea
o a.k.a. pituitary diabetes insipidus  Dehydration SxS:
o may problem sa secretion/synthesis  may problem sa o Dry cough
brain (hypothalamus, pituitary)  Central D.I. / o Poor skin turgor
Neurogenic / Pituitary D.I. o Sunken eyeball
o inadequate release of ADH (ADH deficiency) o Ang halos nawawala interstitial = INTERSTITIAL FLUID
o ADH level is low DEPLETION
o can be inherited and commonly caused by brain  Paano mo malalaman kung may kasamang intravascular?
neoplasms (30%), head trauma (30%), idiopathic (30%) Hypotensive, Tachycardic
infection, vascular lesions and others  Pag kasama na rin ICF  Severe Dehydration  excessive
o treatment is administration of exogenous ADH thirst, irritable = INTRACELLULAR FLUID DEPLETION
o polyuria and polydipsia
 Nephrogenic Diabetes Insipidus
o diabetes insipidus with primary defect in the kidney
o inability of the kidney to respond to ADH
o ADH level is normal or high / Intravascular
o congenital defect in V2 receptor (X-linked, 90%) or non
functional AQP2 (10%), drugs (lithium), ureteral
obstruction, low protein diet and hypercalcemia
o Polyuria and polydipsia

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)

VOLUME AND OSMOLARITY OF ECF AND

ICF IN ABNORMAL STATES
 Factors that will cause the change

Increased Decreased
 Ingestion of water  Dehydration
 Intravenous fluid infusion  Diarrhea
of different osmolarity  Excessive sweating
 Polyuria

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Manci  2 SEM, S.Y. 2015-2016 Page 8 of 8