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Fluid Balance An Introduction to Fluid Balance • It is defined as the amount of water gained, and amount of water lost to the environment. • This process involves regulating content and distribution of body water in ECF, extracellular fluid, and ICF, intracellular fluid. • Its importance is that it supports the digestive and urinary system, it is the primary route of water gains and loss. • This is done via osmosis, diffusion, and carrier-mediated transport. Body Fluid Compartments • Total body water can be subdivided into two major compartments, intracellular fluid which is fluid inside cells, and extracellular fluid which is fluid outside of cell like in the blood and in the interstitial tissue between cells. • Major subdivisions of ECF split into interstitial fluid of peripheral tissues and plasma of circulating blood. • Minor subdivisions of ECF split into lymph, perilymph, endolymph, cerebrospinal fluid, synovial fluid, serous fluids, and aqueous humour. • ECF contains electrolytes, proteins, nutrients, and waste products. • Plasma is found within the blood vessels, whereas interstitial fluid is present outside the blood vessels. The interstitial fluid forms when plasma fluid is filtered through the capillary membrane. Interstitial fluid is present on the outside of the blood vessels in the tissue. Regulation Mechanisms • The kidneys regulate the fluid and electrolyte balance of the body by continually filtering the blood. This is vital to maintain a constant extracellular fluid volume and composition. • There are 3 main hormones, ADH, aldosterone, natriuretic peptides. • ADH stimulates water conservation at kidneys, reducing urinary water loss and concentrating urine, stimulates the thirst centre. • ADH is released from neurons in the anterior hypothalamus, near fenestrated capillaries. Rate of release varies with osmotic concentration; higher osmotic concentration increases ADH release. • Aldosterone is secreted by the adrenal cortex in response to rising potassium or falling sodium levels. Determines the rate of sodium absorption and potassium loss. “Water follows salt”, high aldosterone levels cause the kidneys to conserve salt, which also stimulates water retention. • Natriuretic peptides are released by cardiac muscle cells in response to abnormal stretching of heart walls. This reduces thirst and lower bloods pressure and plasma volume. • When the body loses water, plasma volume decreases, and electrolyte concentrations rise. Disruptions and Disorders Dehydration and its consequences: Develops when water loss is greater than gain. If water is lost, but electrolytes retained: ECF osmotic concentration rises, Water moves from ICF to ECF and Net change in ECF is small. Severe Water Loss may result from: Excessive perspiration, Inadequate water consumption, Repeated vomiting, Diarrhoea, Homeostatic responses, Physiologic mechanisms (ADH and renin secretion) and Behavioural changes (increasing fluid intake). Dehydration occurs when the body loses more fluids than it takes in, leading to an insufficient amount of water to carry out normal bodily functions. The consequences of dehydration can range from mild to severe, depending on the extent of fluid loss. Here are some potential consequences of dehydration: • Thirst and Dry Mouth: The initial signs of dehydration include increased thirst and a dry or sticky feeling in the mouth. • Dark Yellow Urine: Dehydrated individuals may produce urine that is dark yellow and concentrated. • Fatigue and Lethargy: Dehydration can lead to feelings of tiredness, lethargy, and a decrease in physical and mental performance. • Dizziness and Lightheadedness: Insufficient fluid levels can cause a drop in blood pressure, leading to dizziness and lightheadedness. • Headache: Dehydration is a common cause of headaches, and the severity of headaches may increase with the level of dehydration. • Dry Skin and Eyes: Lack of water can result in dry skin and eyes. • Rapid Heartbeat and Breathing: The heart may need to work harder to pump blood if there is a decrease in blood volume due to dehydration. Breathing may also become more rapid. • Muscle Cramps: Dehydration can cause electrolyte imbalances, leading to muscle cramps. • Heat-related Illnesses: In hot and humid conditions, dehydration increases the risk of heat-related illnesses such as heat exhaustion and heat stroke. • Impaired Cognitive Function: Dehydration can affect cognitive function, including concentration and short-term memory. • Kidney Problems: Severe dehydration can lead to kidney problems, including kidney stones and, in extreme cases, kidney failure. Constipation: Insufficient water intake can result in harder stools and difficulty in passing bowel movements. Edema is the abnormal accumulation of fluid in the interstitial spaces, which are the spaces surrounding cells in the body's tissues. This condition can impact the body in various ways, depending on the cause, severity, and location of the edema. Here are some general impacts of edema on the body: • Swelling: The most noticeable effect of edema is swelling in the affected areas. Common areas of swelling include the ankles, feet, legs, hands, and sometimes the face. • Weight Gain: Edema can contribute to an increase in overall body weight due to the accumulation of excess fluid. • Impaired Circulation: Edema can interfere with normal blood circulation. The pressure from accumulated fluid can compress blood vessels, leading to reduced blood flow to the affected tissues. • Decreased Oxygen Delivery: In severe cases, edema can impede the delivery of oxygen and nutrients to cells, affecting cellular function and potentially causing damage. • Pitting Edema: When pressure is applied to the swollen area, it may leave a temporary indentation or "pit." This is known as pitting edema and is often seen in conditions like heart failure or kidney disease. • Reduced Range of Motion: Edema in joints can limit their range of motion, leading to stiffness and discomfort. • Skin Changes: The skin over the swollen area may appear stretched, shiny, or reddened. In severe cases, the skin may ulcerate. • Organ Dysfunction: Edema can affect various organs, leading to dysfunction. For example, pulmonary edema (fluid in the lungs) can result in breathing difficulties, while cerebral edema (fluid in the brain) can cause increased intracranial pressure and neurological symptoms. • Compromised Wound Healing: Edema can impede the healing of wounds and increase the risk of infection due to impaired circulation and reduced oxygen delivery to the affected tissues. • Systemic Effects: In cases where edema is a symptom of an underlying systemic condition (such as heart failure or kidney disease), it can contribute to a cascade of effects throughout the body, affecting multiple organs and systems.