1. Body Fluid

2. Body fluid The total body fluid is about 60% of the total body weight.
In the average 70 kg body weight it is about 42 liters.
Increase the percentage of fat in the body decreases the % of water.
Women contain less water than men because have more body fat.

4. Body fluid compartment
Extra cellular fluid :-
It is about 14 liters:
plasma 3 liters.
Interstial fluid in spaces between cells 10 L
Transcellular 1-2liters.
Intra ocular space
Synovial , peritoneal ,pericardial spaces.
Cerebrospinal fluid .

5. Body fluid Intra cellular fluid Equal 28 liters.
It is the fluid inside the cells.
It contains high Concentration of K &less concentration of Na.
Also it contains large amount of magnesium and phosphate.

6. Regulation of fluid transportation
The most common routes for transporting materials to and from intracellular compartments are (the fluid and materials transport across semipermiable membrane) :
1- osmosis
2- diffusion
3- active transport
4- filtration

7. 1- Osmosis
Through the process of osmosis , the solvent , the water passes from an area of lesser solute concentration and more water to an area of greater solute concentration and less water until equilibrium is established .

8. Osmosis

9. 2- Diffusion
Is the tendency of solute to move freely throughout a solvent .The solute (materials ) moves from an area of higher concentration to an area of lower concentration

10. 2- Diffusion

11. 3- Active Transport
Is a process that requires energy for the movement of substances through cell membrane from an area of lesser solute concentration to an area of higher solute concentration .
Adenosine triphosphate (ATP) stored in all cells , is released from a cell and supplies energy for solute movements in and out of the cell.

12. 4- Filtration
Is the passage of fluid through a permeable membrane .Passage is from an area of high pressure to an area of lower pressure

13. Body water Daily intake of water (by two main sources):
Ingested in the form of water or liquid which add about 2100ml/day to the body fluid
Synthesized as a result of metabolism and it is about 200ml/day.
Daily loss of body water:
Evaporation 700ml
Urine 1400 ml
Sweat 100 ml
Feces 100ml

15. Types of Solutions Isotonic solution Hypotonic solution
The water concentration in IC&ECF is equal and solutes can not enter or leave the cell.
Hypotonic solution
There are less solutes less osmotic pressure so water enter the cell and it swell.
Hypertonic solution
High solutes ,high osmotic pressure so water leave the cell and cell shrink.
Solution of NaCL 0.9%and glucose 5%are isotonic so it is important in clinical medicine because the cell neither swell nor shrink.

16. Water Balance
Is maintained in the body by adjusting water input and water output.
Control of water input:
Stimulated by thirst sensation.
Thirst sensation occurs as a result of:
Hypertonicity.
Hypovolemia.

18. Control of water loss
It is controlled by controlling the volume of urine.
Volume of urine is controlled by (ADH)
Anti- diuretic hormone (ADH):
Synthesized in the hypothalamus.
Stored in the posterior pituitary until it is secreted.
Secretion is stimulated by hypertonicity and hypovolemia.

21. Disturbances in body fluids
1- Fluid Volume Excess
Also it can be defined as hypervolemia , which occurs from an increase in total body sodium content and an increase in total body water

22. Causes of hypervolemia
1- excessive fluid intake
2- excessive sodium intake
3- Renal insufficiency or faluire
4- Steroid Therapy
5- Low protein intake or malnutrition
6- Decreased cardiac output (heart disease )
7- Head injury
8- Liver disease
9- Sever stress
10 – Hormonal disturbances

23. Manifestations of Hypervolemia
Weight gain
Edema
Bounding pulse
Jugular vein destination
Change in mental status
Abnormal breath sound (crackles )
Changes in breathing pattern
Oliguria
Specific gravity changes
Intake greater than output
Decrease hemoglobin or hematocrit
Azotemia
Changes in electrolytes
Restlessness & anxiety
Increase blood pressureShortness of breath (orthopnea)

24. Nursing Intervention of Hypervolemia
1- obtain patient history to ascertain the probable cause of fluids disturbance
2- weight monitoring & evaluate weight in relation to nutritional status
3-I &O chart 4- monitor v/s 5 – evaluate for edema 6- monitor serum electrolytes
Intervention
1- instruct the patient toward the restriction of fluid
2- restrict Na intake
3- Instruct pt to take prescribed diuretics
4- elevate the edematous leg
5- skin care
6- provide information regarding s&s of fluid volume excess

25. Fluid volume loss (hypovolemia)
Fluid volume deficit or hypovolemia . Occurs from a loss of body fluid or shift of fluids into 3rd space , or from reduced fluid intake
Causes :
Inadequate fluid intake
Fluid loss (diuresis, bleeding , severe diarrhea
Fever , infection which leads to increase metabolic rate .
Fluid shifts (edema or effusion )

26. Clinical manifestations of hypovelmia
Decrease urine output
Concentrated urine
Output greater than intake
Decrease venous filling
Hemoconcentration
Hypotension
Thirst
Dry m.m
Changes in mental status

27. Nursing care of hypovolemia
I- Assessment : the same as in hypervolemia
II- Nursing Intervention :
Encourage patient to drink prescribed amount
Administer IV fluid
Administer blood product as prescribed
Provide oral hygiene
Treat the underlying causes (diarrhea, vomiting)

29. Home work Define the following : Hyponatremia Hypernatermia
Hypocalcemia
Hypercalcemia
Hypokalemia
Hyperkalemia

30. Thank you