Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Bagian Fisiologi
FK Unswagati
Body Fluid Compartments
Fluid in the :
- Synovial
interstitial blood - Peritoneal
fluid plasma - Pericardial
- Intraocular
spaces
- Cerebrospinal
fluid
Body Fluid Compartments
In lean adults, body fluids constitute 55% of
female and 60% of male total body mass
Intracellular fluid (ICF) inside cells
○ About 2/3 of body fluid
Extracellular fluid (ECF) outside cells
○ Interstitial fluid between cell is 80% of ECF
○ Plasma in blood is 20% of ECF
○ Also includes lymph, cerebrospinal fluid, synovial
fluid, aqueous humor, vitreous body, endolymph,
perilymph, and pleural, pericardial, and peritoneal
fluids
Guyton, 2006
Ionic Composition of Plasma and
Interstitial Fluid Is Similar
Hanya dipisahkan oleh membran kapiler yang
sangat permeabel, dengan komposisi ioniknya
sama
Perbedaan paling penting adalah konsentrasi
protein yang lebih tinggi dalam plasma; karena
kapiler memiliki permeabilitas rendah terhadap
protein plasma, hanya sejumlah kecil protein yang
bocor ke ruang interstitial di sebagian besar jaringan
the Donnan effect konsentrasi ion bermuatan
positif (kation) sedikit lebih besar (sekitar 2 persen)
dalam plasma daripada dalam cairan interstitial
Guyton, 2006
Important Constituents of the
Intracellular Fluid
The intracellular fluid is separated from the
extracellular fluid by a cell membrane that
is highly permeable to water but not to
most of the electrolytes in the body.
Guyton, 2006
Electrolyte and protein anion
concentrations
Guyton, 2006
Osmolality and Osmolarity
Osmolality konsentrasi dinyatakan
sebagai osmol per kilogram air
Osmolarity konsentrasi dinyatakan
sebagai osmol per liter larutan
Guyton, 2006
Tekanan Osmotik.
Osmosis molekul air melintasi membran
permeabel selektif akan dihambat dengan
memberikan tekanan ke arah yang berlawanan
dengan osmosis.
Jumlah tekanan yang diperlukan untuk
mencegah osmosis disebut tekanan osmotik
Semakin tinggi tekanan osmotik suatu
larutan, semakin rendah konsentrasi air dan
semakin tinggi konsentrasi larutan terlarut.
Guyton, 2006
Hubungan Antara Tekanan Osmotik dan
Osmolaritas.
Tekanan osmotik suatu larutan berbanding
lurus dengan konsentrasi partikel yang aktif
secara osmotik dalam larutan tersebut.
Guyton, 2006
Dinyatakan secara matematis, menurut hukum van
Ht Hoff, tekanan osmotik (π) dapat dihitung sebagai π
π = CRT
○ C adalah konsentrasi zat terlarut dalam osmol per liter,
○ R adalah konstanta gas ideal,
○ T adalah suhu absolut dalam derajat kelvin (273 ° +
celcius °).
○ π dinyatakan dalam milimeter merkuri (mm Hg).
○ Satuan tekanan yang biasa digunakan untuk cairan
biologis dengan T adalah suhu tubuh normal (273 ° + 37
° = 310 ° kelvin), nilai π dihitung sekitar 19.300 mm Hg
untuk larutan yang memiliki konsentrasi 1 osm / L .
untuk setiap milliosmole tekanan osmotik 19,3 mm
Hg
Guyton, 2006
Osmolaritas cairan tubuh Osmolarity
of the Body Fluids
Sekitar 80% dari total osmolaritas ECF
adalah ion natrium dan klorida
Sekitar 50% dari total osmolaritas ICF
adalah ion kalium
Guyton, 2006
Kesetimbangan Osmotik Dipertahankan
Antara Cairan Intraseluler dan
Ekstraseluler
1 miliosmol 19,3 mm Hg tekanan
osmotik
Jika membran sel terkena air murni dan
osmolaritas cairan intraseluler adalah
282 mOsm / L, potensi tekanan osmotik
> 5400 mm Hg
Guyton, 2006
isotonic
Jika sebuah sel ditempatkan dalam
larutan zat terlarut yang memiliki
osmolaritas 282 mOsm / L, sel tidak
akan menyusut atau membengkak
karena konsentrasi air dalam cairan
intraseluler dan ekstraseluler sama.
Zat terlarut tidak bisa masuk atau
meninggalkan sel.
Examples : NaCl 0,9% dan glucose 5%
Guyton, 2006
hypotonic
Jika sebuah sel ditempatkan ke dalam
larutan yang memiliki konsentrasi zat
terlarut yang lebih rendah (<282 mOsm /
L), air akan berdifusi ke dalam sel
membengkak air akan terus berdifusi
ke dalam sel melarutkan ICF sambil
juga memusatkan ECF sampai kedua
solusi memiliki osmolaritas yang sama.
Example : NaCl <0,9%
Guyton, 2006
Hypertonic
Jika sel ditempatkan dalam larutan yang
memiliki konsentrasi zat terlarut yang
lebih tinggi air akan mengalir keluar
dari sel ke dalam cairan ekstraseluler,
memusatkan ICF dan mengencerkan
ECF sel akan menyusut sampai dua
konsentrasi menjadi sama.
Example : NaCl > 0.9 %
Guyton, 2006
Guyton, 2006
Isosmotik jika larutan dengan
osmolaritas sama dengan sel
terlepas dari apakah zat terlarut dapat
menembus membran sel.
Hyperosmotic dan hypo-osmotic
jika masing-masing larutan yang
memiliki osmolaritas lebih tinggi atau
lebih rendah, dibandingkan dengan ECF
normal, tanpa memperhatikan apakah
zat terlarut meresap ke membran sel.
Guyton, 2006
Volume and Osmolality of
Extracellular and Intracellular
Fluids in Abnormal States
Factors can cause EC and IC volumes to
change markedly are :
Ingestion of water, dehydration, intravenous
infusion of different types of solutions, loss of
large amounts of fluid from the gastrointestinal
tract, and loss of abnormal amounts of fluid by
sweating or through the kidneys.
Guyton, 2006
Basic principles to calculate both
the changes in ICF and ECF
volumes and the types of therapy
1. Water moves rapidly across cell membranes;
the osmolarities of ICF and ECF remain
almost exactly equal to each other except for a
few minutes after a change in one of the
compartments.
2. Cell membranes are almost completely
impermeable to many solutes
the number of osmoles in the ECF or ICF
generally remains constant unless solutes are
added to or lost from the EC compartment.
Guyton, 2006
Effect of Adding Saline Solution
to the Extracellular Fluid
Guyton, 2006
2 liters of a hypertonic NaCl 3% solution
are infused into the ECF compartment of
a 70 kg patient, initial plasma osmolarity
is 280 mOsm/L. What would be the ICF
and ECF volumes and osmolarities after
osmotic equilibrium?
Guyton, 2006
The first step
To calculate the initial conditions,
including the volume, concentration, and
total mOsm in each compartment.
Assuming ECF volume is 20 % of
body weight and ICF volume is 40 % of
bodyweight,
Guyton, 2006
Total milliosmoles added to the ECF in 2
liters of NaCl 3% 3 g/100 ml, or 30
grams/liter.
Molecular weight of NaCl 58.5 g/mol
0.513 mole/liter of solution
2 liters of solution 1.026 mole of NaCl
1 mole of NaCl = 2 osmoles effect of
adding 2 liters of this solution is to add 2051
mOsm of NaCl to the ECF
Step 2
Calculate the instantaneous effect of
adding 2051 milliosmoles of NaClto the
ECF along with 2 liters of volume.
Third step
Calculate the volumes and
concentrations that would occur within a
few minutes after osmotic equilibrium
develops
Clinical Abnormalities of Fluid Volume
Regulation: Hyponatremia and
Hypernatremia
When plasma sodium concentration is
reduced more than a few milliequivalents
below normal (about 142 mEq/L)
hyponatremia
When plasma sodium concentration is
elevated above normal hypernatremia
Edema: Excess Fluid
in the Tissues
Intracellular Edema
Two conditions are especially prone to
cause intracellular swelling:
(1) depression of the metabolic systems of the
tissues
(2) lack of adequate nutrition to the cells.
Extracellular Edema
When there is excess fluid accumulation in
the extracellular spaces.
Two general causes :
(1) abnormal leakage of fluid from the plasma
to the interstitial spaces across the
capillaries
(2) failure of the lymphatics to return fluid from
the interstitium back into the blood
The most common clinical cause
excessive capillary fluid filtration
Factors That Can Increase Capillary
Filtration
Lymphatic Blockage Causes
Edema
When lymphatic blockage occurs,
edema can become especially severe
because plasma proteins that leak into
the interstitium have no other way to be
removed.
The rise in protein concentration raises
the colloid osmotic pressure of the
interstitial fluid, which draws even more
fluid out of the capillaries.
Condition can cause EC edema
Safety Factors That
Prevent Edema
1. The safety factor caused by low tissue
compliance in the negative pressure range
is about 3 mm Hg.
2. The safety factor caused by increased
lymph flow is about 7 mm Hg
3. The safety factor caused by washdown of
proteins from the interstitial spaces is
about 7 mm Hg
the total safety factor against edema : 17
mmHg
Terima kasih
SELAMAT BELAJAR