بسم اهلل الرحمن الرحيم

Size: px

Start display at page:

Download "بسم اهلل الرحمن الرحيم"

Sophia Hart
5 years ago
Views:

Ans: When you are not maintaining optimal amounts of ( Na+, Cl-, H2O, Glucose, minimal urea.

1 بسم اهلل الرحمن الرحيم o Always we try to maintain a Homeostasis mechanism. Homeostasis : maintenance of internal environment. How?! The environment,that cells live in it,must be in a constant natural concentration of different ions, molecules,..etc ( Na+, Cl-, H2O, Glucose ) o When you feel that you are cranky? sick? Ans: When you are not maintaining optimal amounts of ( Na+, Cl-, H2O, Glucose, minimal urea..) o As we know : Cells Tissues Organs Systems Body So>> If we maintain a homeostasis for cells every system will be healthy and can do his function properly. Examples : *Kidneys will : get rid of waste substance. *GI system will : absorb what we need from fructose. *Lungs will : give as the amount of oxygen that we need and get rid of CO2. Ultimately, homeostasis will be maintained for cells, they will be healthy and so on in a complete cycle. BUT, if this cycle is broken at any part > then illness will take place, that is, any illness is a result of disturbance of the internal environment. 1

2 Internal environment Water composition in the body : It differs by 3 factors : 1- Sex :- 60% usually applicable to males & 55% usually to females! Why? Because, during puberty ( 12 years in females & 14 in males ) sex hormones affect the body as : Female Male Hormones estrogen and progesterone Androgens like testosterone Typical physiological appearance shoulder + pelvis equal, waist narrower ( like the Shoulder very wide, Pelvis narrow hourglass ) fat accumulates in the breast and pelvis. building more muscles. Fat store less quantity of water. muscle cells have more water than fat. Notes : For children it is equal ( boys & girls ) When female becomes obese H2O = 40% The menstrual cycle in not a reason why the water percentage in females is less, Actually a cup of water can compensate for the amount the lost water. 2- Age :- Infants ( 73% ) > mid age > elderly people. 3- Fat composition :- Thin > Obese 2

3 Body fluid compartments : 1. Intracellular (2/3) Notice that : this compartment has the highest composition because we have billions of cells. 2. Extracellular (1/3) Is divided into : A. Interstitial fluid (80%) : - it is the fluid between cells (Intercellular) - it is the most important one to be maintained - it is our Internal Environment - it supplies the cells with oxygen and cholesterol and let them get of waste, and maintain the PH level. B. Plasma (20%) But! Blood is considered as?? Actually, it is both ( extra- & intra- ),, It is a tissue but in a liquid form, that has > platelets,plasma, WBC s, RBC s. So, there is a fluid within the cells ( RBC s & WBC S ) and between the cells (plasma ). * Notice that plasma is considered in general as extracellular, but as a blood component it is interstitial. Remember : As a Doctor you deal with blood ( IV fluid ) >> the injection occur in blood..then substances diffuse within the body to other fluid compartments. ****************** How to maintain a constant level of water in the body?? Ans: By balancing between inputs & outputs of water. Inputs : 1- ingested food ( fruits & vegetables with water component about % ) 2- drink 3- metabolic water ( 200 ml per 24 hours ) Outputs ( 2.5 L water lost per day ) : 1- kidneys ( 1.5 L ) 2- ( 1 L ) by : a- sweating b- lungs ( as a vapor ) c- GI tract 3

4 Things related : Renal Failure Kidney always feels guilt when patient loose fluids then it shuts down and kills it s cells, this cause renal failure. Note: Burn patients, we should give them high quantities of water in order to save him from kidney failure or even death by dehydration! death may be by toxins of burn also. *************** Sweating ( loosing of water across the skin ) There are two types of sweating : 1- Sensable sweating > it happens when exposure to high tempratures,in order to decrease body T, and causes wet cloths. 2- Insensible > we don t feel it and happens with low tempratures to Moisturizes the skin. Note : Some people don t have sweat glands, they loose water from Dermis, Epidermis, and blood vessels. How we measure body water?? Ans : There are two methods : ***** Note : 1- Old method : Burning or Dehydration, by water vaporization & solid precipitation. 2- New method : by using Radioactive water, we inject some of it in the blood then it will diffuse in the body ( con. 1 * V1 = con. 2 * V2 ) Joints (synovial) fluid, pericardial fluids, peritonial fluids, CSF (cerebrospinal fluid) >> all these fluids are nither extracellular nor intracellular, they re considered to be transcellular fluids ( about 1-2 L). 4

5 Regulation of fluid exchange between ICF & ECF 1) Between plasma and interstitial fluid. 2) Between intracellular and interstitial fluid. 1 2 Membrane Capillary membrane Cell membrane Factors that affect the movement across the membrane 1-Hydrostatic pressure (pumping power of the heart) 2-Colloid osmotic(oncotic) pressure : depending on protein component in the blood that try to withdraw & return fluid to the blood. * There is a balance between hydrostatic filtration & colloid returning. Ionic composition : it is the difference between extra- & intra- component of ions. * Lymphatic drains 10%(2-3L/day) of the fluid,like large proteins that had been filtrated from blood, and returns it to the blood. Notes about lymph : *Radical mastectomy because of tumor : removal of the whole breast with axillary lymph nodes in order to prevent cancer spread. A patient who has Radical mastectomy >> First symptom is swelling of the arm ; because there is no lymphatics liters for each arm is the amount of fluid that s not going to be resent to the vascular system no matter how the circulation is good. 5

6 **The only region that doesn t have lymph is the Brain. Types of Intravenous fluids commonly used in hospitals for replacing blood loss 1- Crystalloids : Normal saline, dextrose 5%, Hartmann s solution ( Na lactate ). - Normal saline a- the most common IV fluid that more than 90% of the patients take it in the hospitals b- For each 100ml,there is 0.9g NaCl. example : If we have 1000ml we use 9g of NaCl then we have 9g/L.. so we can prepare it easily - Na lactate Surgeons love it because it directly compensate plasma ions. 2- Colloids : Dextran, gelatin ** We use colloids with emergency cases when a patient lose a large quantities of blood.so it withdraw fluids and raise blood volume. BUT, it is very dangerous > so we use it only with very extreme cases. 3-Blood products : fresh frozen plasma, albumin, or even whole blood. 6

According to the diagram above : - A : isotonic solution : We give it to the patient that suffers from vomiting, severe dehydration, hormones of kidneys disease.

7 According to the diagram above : - A : isotonic solution : We give it to the patient that suffers from vomiting, severe dehydration, hormones of kidneys disease.so to prevent hypopolemia >we give normal saline ( isotonic) - C : Hypotonic : Fluid more than salt so osmolarity,, volume both intracellular & extracellular. *When you add a hypotonic solution you must expect > expanding in volume but decreasing in osmolarity. - B : Hypertonic : Salt more than fluid ( concentrated ).water moves from cells to interstitial fluid so ::: Blood volume,, blood osmolarity,,but intracellular volume,, osmolarity. *** Decreasing the volume of intracellular fluid causes Brain Edema. - It is a very dangerous situation because brain incloses the skull > so this cerebral edema may cause Clock & anticlock to the brain. 7

8 - When we see a patient losing his conscious level, cardiovascular control & Respiration >>>we must give him immediately. - Hypertonic solution is the best treatment with a patient who suffers from a cerebral edema because of a concernal trauma ( like : car or motorcycle accidents & falling from a height ). - And also, as the skull is rigid in adult ( can t expand to fit the swelling of the brain ) we may remove parts of it >> making a hole, in order to increase the volume. for example we make this surgery in the left side with right handed people ; because it the place of talking intelligence,.etc. if it is very sever we make it also in the second half - The most important danger that may occur here >> too much expanding of the brain causes >>pulling stem ( the most important part of the brain ) to the vertebral column which is very narrow causing to respiratory center dead.. so dead of the whole body! Hadeel Abudari 8

Sheet #10 Dr. Eman Al-khateeb 21/4/2014. Body fluid I. -what type of IV(Intravenous) fluid should be given to this patient

Sheet #10 Dr. Eman Al-khateeb 21/4/2014. Body fluid I. -what type of IV(Intravenous) fluid should be given to this patient Body fluid I Introduction : before we start talking about body fluid I want to mention a few point why we give you these lectures, as mentioned in the first lectures with doctor faisal we have a balanced