BODY FLUIDS BALANCE

Atan Baas Sinuhaji

Department of ChildHealth
School of Medicine,University Of Sumatera Utara
Medan

FLUIDS AND ELECTROLYTES BALANCE

BODY FLUIDS BALANCE

(PEDIATRICS)

SOLVENTS

WATER

BODY
FLUIDS
DISSOLVED SUBSTANCES:

ELECTROLYTES
GLUCOSE
PROTEIN
FAT
GASES (O2, CO2)

BARRIER/PROTECTIVE
CSF
CUSHION
BODY
FLUIDS

SOLVENTS
TRANSPORT
TEMPERATURE

DEHYDRATION FEVER

REACTANT
LUBRICANT

HYDROLYSIS
SYNOVIAL
FLUIDS

REGULATION

EQUILIBRIUM
1. VOLUME
2. DISTRIBUTION
3. COMPOSITION OF ELECTROLYTES
4. TONICITY
5. pH

ICF : 40 - 45%
TBW
(60-70%)

ECF : 20 - 25%

ISF
15%

PLASMA Trancelluler
5%

1-3%

THE DIFFERENCES BETWEEN

PEDIATRICS AND ADULT BODY FLUIDS
1. TBW PEDIATRICS
(60 - 70%)
2. ECF : ICF
NEONATES
CHILDHOOD
ADULT

>

ADULT
(50 - 55%)

= 1:1
= 2:3
= 1:2

3. DAILY TURNOVER OF WATER

INFANT
= 25% TBW
ADULT
= 6% TBW

INFANTS ARE SUSCEPTIBLE TO

THESE DISORDERS
1. DAILY TURNOVER OF WATER >>
2. INFANT IS MORE SUSCEPTIBLE
THAN ADULT DIARRHOEA,
VOMITING
3. HOMEOSTASIS MAY NOT BE AS
WELL DEVELOPED

INFANT 7 kg
ECF
INTAKE
OUTGO

= 1400 mL
= 700 mL/day
= 700 mL/day

ADULT 70 kg
ECF
INTAKE
OUTGO

= 14 L
= 2 L /day
= 2 L/day

VOLUME
VOLUME
RECEPTORS

Renal Blood Flow

THIRST
CENTRE

RENIN
ADH
(Antidiuretic Hormone) ALDOSTERON
WATER
RETENTION

H2O & Na+

RETENTION

VOLUME

WATER
INTAKE

TONICITY
THIRST
CENTER

OSMORECEPTORS

WATER
INTAKE

ADH
DILUTION
OF ECF

TONICITY

OSMOTIC PRESSURE
(290 mOsm/L)

Na+ = 135 mEQ/L

BUN (Blood Urea Nitrogen)

GLUCOSE

OSM

VOL
THIRST CENTRE

INTAKE
ABSORPTION
OUTPUT

SKIN & LUNGS

30 mL / kgBW /
day

STOOL
10 mL / kgBW /
day

REGULATION
ALDOSTERON
ADH

KIDNEYS

60 mL / kgBW / day

HOLLIDAY - SEGAR

10 kg
10 - 20 kg
> 20 kg

100 mL / kg
1000 mL + 50 mL/ kg
for each > 10 kg
1500 mL + 20 mL/ kg
for each > 20 kg

NB : 100 mL 2,5 mEq Na+

2 mEq K+
100 calori

OSMOLALITY

VOLUME

ADH

REABSORPTION OF
WATER IN THE DISTAL
TUBULES &
COLLECTING DUCTS

OSMOLALITY

VOLUME

ADH

VOLUME IS THE 1ST

DISTRIBUTION OF WATER
I VF
STARLING
FORCES

CAPILLARY
WALLS
ECF

ISF
TONICITY

Na+

CELL
WALLS
ICF

STARLING FORCES: BALANCE OF

HYDROSTATIC PRESSURE & ONCOTIC
PRESSURE

ONCOTIC PRESSURE
PLASMA PROTEIN
ALBUMIN

STARLING

FORCES DISTRIBUTION OF
WATER BETWEEN
INTERSTISIAL &
INTRAVASKULAR
S LAW OF THE HEART
RELATION OF TENSION
TO LENGTH IN CARDIAC
MUSCLE

COMPOSITION OF
ELECTROLYTES
Na+
K+
ClHCO3P- & Pr-

ECF
>
<
>
>
<

ICF
<
>
<
<
>

NATRIUM
INTAKE
ABSORPTION
OUTPUT
SWEAT

REGULATION

STOOL

HORMONES
ALDOSTERON
Atrial Natriuretic Factor

URINE

NEPHRONS
LOSING
RETAINING

Cortical Nephron
Juxtamedullary
nephron

KALIUM
INTAKE

SWEAT

ACID-BASE

K+ PLASMA

CELL

OUTPUT

ALDOSTERON

STOOL

URINE

HCO3H2CO3

BUFFERS
pH

pCO2

LUNGS

ACIDIFICATION=MAKE
NEW BICARBONATE

KIDNEYS

ALKALINIZATION
pH = - Log ( H+)

HCO3-

pH = pK + log

H2C03
HCO3

pCO2

pH
ACIDOSIS METABOLIC
pCO2
KUSSMAUL BREATHING
ACIDIFICATION OF THE URINE

DISORDERS
1. VOLUME
DE / OVERHYDRATION
HYPO / HYPERVOLEMIA
2. ELECTROLYTES
Na - HYPER / HYPO
K+ - HYPER / HYPO
3. pH

ACIDOSIS

ALKALOSIS :

- METABOLIC
- RESPIRATORY
- METABOLIC
- RESPIRATORY

SIGNS OF DEHYDRATION
1.
2.
3.
4.
5.
6.

LETHARGIC TO
7. WEAKNESS OF
COMATOSE
RADIAL PULSE
SUNKEN ANTERIOR
8. HYPOTENSION
FONTANELLA
SUNKEN EYES
9. THIRSTY
ABSENT OF TEARS
DRY OF MOUTH & TONGUE 10. TURGOR
HR
11. OLIGURIA/ANURIA
12.

BW

HYPONATREMIA
PROFOUND
CIRCULATORY
DISTURBANCE

CEREBRAL
EDEMA
Intra Cranial Pressure

ISCHEMIA CONVULSION

HERNIATION

MYELINOLYSIS

DEATH
TH/

SYMPTOMATIC HYPONATREMIA
NaCl 3%

HYPERNATREMIA
LESS
CIRCULATORY
DISTURBANCE

SHRINKAGE
INTRACRANIAL
HEMORRHAGE

PERMANENT
RESIDUAL

K+
DIARRHOEA

RENAL FAILURE

HYPOKALEMIA

HYPERKALEMIA

ICF
ECF
Resting Membrane Potential
(RMP = - log K+ ICF ) = - mV
ECF

NEUROMUSCULAR
ECG (T , ST , QT

, QRS , U wave )

Th/ : K+ up to 3mEq/kgBW/day

LOSS OF HC03

METABOLIC
ACIDOSIS

DIARRHOEA
Renal Tubular Acidosis

EXCRETION
DEHYDRATION

H+
PRODUCTION
1. STARVATION KETOSIS
2. SALICYLATE POISONING
3. TISSUE HYPOXIA LACTATE
4. INBORN ERROR

METABOLIC ACIDOSIS
1.NAUSEA, VOMITING & ANOREXIA
2.DEPRESSION OF CNS (COMA,
CONVULSION)
3.ARTERIAL DILATATION HYPOTENSION
4.CARDIAC CONTRACTILITY
5.HEART FAILURE
6.VENTRICULAR FIBRILLATION
7.O2 AFFINITY OF Hb ANOXIA
8.KUSSMAUL BREATHING HYPOCARBIA vasoconstriction Cerebral
Blood Flow drowsiness

pH ,

pCO2 , HCO3

METABOLIC ACIDOSIS
pH < 7, 2
HCO3- = 1 - 2 mEq/kgBW
(EMERGENCY)
DEHYDRATION (-)
LUNG DYSFUNCTION (-)
HYPOKALEMIA (-)

NORMAL VALUES
Na+
K+
Cl
Ca++
HCO3Osm
Oncotic Pressure
Anion Gap
pH
pCO2

= 135 - 150 mEq/L

= 3 - 5 mEq/L
= 100 mEq/L
= 10 mgr %
= 20 - 25 mEq/L
= 290 mOsm/kg water
= 7 - 19 mmHg
= Na+ - (Cl- + HCO3-)
= 8 - 16 mEq/L
= 7,35 - 7,45
= 27 - 40 mmHg

H2CO3 (mEq) = pCO2 (mmHg)x 0,03