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14-September-2008 18:02:46 - Fluid balance Fluid balance is the concept of human homeostasis that the amount of fluid lost from the body is equal to the amount of fluid taken in. Euvolemia is the state of normal body fluid volume. Water is necessary for all life on Earth. Humans can survive for several weeks without food, but for only a few days without water. Contents 1 Routes of fluid loss and gain 1.1 Input 1.1.1 Regulation of input 1.2 Output 1.2.1 Regulation of output 1.2.1.1 Antidiuretic hormone 1.2.1.2 Aldosterone 2 Effects of drugs and illness 3 Fluid balance in an acute hospital setting 4 Trace elements 5 References Routes of fluid loss and gain Fluid can leave the body in many ways. Fluid can enter the body in ingested food and drink. Input A constant supply is needed to replenish the fluids lost through normal physiological activities, such as respiration, sweating and urination. Water generated from the biochemical metabolism of nutrients provides a significant proportion of the daily water requirements for some arthropods and desert animals, but provides only a small fraction of a human's necessary intake. In the normal resting state, input of water through ingested fluids is approximately 1200 ml/day, from ingested foods 1000 ml/day and from metabolism 300 ml/day, totaling 2500 ml/day 1. Regulation of input Main article: Thirst Input of water is regulated mainly through ingested fluids, which, in turn, depends on thirst. An insufficiency of water results in an increased osmolarity in the extracellular fluid. This is sensed by osmoreceptors in the organum vasculosum of the lamina terminalis, which trigger thirst. Output Some fluid is lost through perspiration and as water vapour in expired air. This is part of the body's temperature control mechanism and is termed insensible loss: it cannot be easily measured. Some sources say it accounts for a daily loss 500 to 650 milliliters of water,12 while other sources put the minimum value at 800 ml.3 In addition, fluid is lost through urine4 1500 ml/day in normal resting state1 and in faeces 100 ml/day 1.5 All in all, it balances the input of ~2500 ml/day1. Regulation of output The body's homeostatic control mechanisms, which maintain a constant internal environment, ensure that a balance between fluid gain and fluid loss is maintained. The hormones ADH Anti-diuretic Hormone, also known as vasopressin and Aldosterone play a major role in this. If the body is becoming fluid-deficient, there will be an increase in the secretion of these hormones, causing fluid to be retained by the kidneys and urine output to be reduced. Conversely, if fluid levels are excessive, secretion of these hormones is suppressed, resulting in less retention of fluid by the kidneys and a subsequent increase in the volume of urine produced. Antidiuretic hormone Main article: Antidiuretic hormone If the body is becoming fluid-deficient, this will be sensed by osmoreceptors in the organum vasculosum of lamina terminalis and subfornical organ6. These areas project to the supraoptic nucleus and paraventricular nucleus, which contain neurons that secrete the antidiuretic hormone, vasopressin, from their nerve endings in the posterior pituitary. Thus, there will be an increase in the secretion of antidiuretic hormone, causing fluid to be retained by the kidneys and urine output to be reduced. Aldosterone Main article: Renin-angiotensin system A fluid-insufficiency causes a decreased perfusion of the juxtaglomerular apparatus in the kidneys. This activates the renin-angiotensin system. Among other actions, it causes renal tubules i.e. the distal convoluted tubules and the cortical collecting ducts to reabsorb more sodium and water from the urine. Potassium is secreted into the tubule in exchange for the sodium, which is reabsorbed. Effects of drugs and illness When a person is ill, fluid may also be lost through vomiting, diarrhea, and haemorrhage. An individual is at an increased risk of dehydration in these instances, as the kidneys will find it more difficult to match fluid loss by reducing urine output the kidneys must produce at least some urine in order to excrete metabolic waste. Fluid balance in an acute hospital setting In an acute hospital setting, fluid balance is monitored carefully. This provides information on the patient's state of hydration, renal function and cardiovascular function. If fluid loss is greater than fluid gain for example if the patient vomits and has diarrhea, the patient is said to be in negative fluid balance. In this case, fluid is often given intravenously to compensate for the loss. On the other hand, a positive fluid balance where fluid gain is greater than fluid loss might suggest a problem with either the renal or cardiovascular system. If blood pressure is low hypotension, the filtration rate in the kidneys will lessen, causing less fluid reabsorption and thus less urine output. An accurate measure of fluid balance is therefore an important diagnostic tool, and allows for prompt intervention to correct the imbalance. Trace elements There are a variety of trace elements present in virtually all potable water, some of which play a role in metabolism; for example sodium, potassium and chloride are common chemicals found in very small amounts in most waters, and these elements play a role not necessarily major in body metabolism. Other elements such as fluoride, while beneficial in low concentrations, can cause dental problems and other issues when present at high levels. Water is essential for the growth and maintenance of our bodies, as it is involved in a number of biological processes. References ^ a b c d e Walter F., PhD. Boron. Medical Physiology: A Cellular And Molecular Approaoch. Elsevier/Saunders. ISBN 1-4160-2328-3. Page 829 ^ Physiology at MCG 7/7ch08/7ch08p28 ^ 3.2 Insensible Water Loss ^ Physiology at MCG 7/7ch08/7ch08p33 ^ Physiology at MCG 7/7ch08/7ch08p32 ^ M.J. McKinley and A.K. Johnson 2004. The Physiological Regulation of Thirst and Fluid Intake. News in Physiological Sciences 19 1: 1-6. doi:10.1152/nips.01470.2003. PMID 14739394. Retrieved on 2006-06-02. v d e Urinary system, physiology: renal physiology and acid base physiology Filtration Renal blood flow - Ultrafiltration - Countercurrent exchange Hormones affecting filtration Antidiuretic hormone ADH - Aldosterone - Atrial natriuretic peptide Secretion/clearance Pharmacokinetics - Clearance of medications Reabsorption Solvent drag - Na+ - Cl- - urea - glucose - oligopeptides - protein Endocrine Renin - Erythropoietin EPO - Calcitriol Active vitamin D - Prostaglandins Assessing Renal function/ Measures of dialysis Glomerular filtration rate - Creatinine clearance - Renal clearance ratio - Urea reduction ratio - Kt/V - Standardized Kt/V - Hemodialysis product - PAH clearance Effective renal plasma flow - Extraction ratio Acid base physiology Fluid balance - Darrow Yannet diagram - Body water - Interstitial fluid - Extracellular fluid - Intracellular fluid/Cytosol - Plasma - Transcellular fluid - Base excess - Davenport diagram - Anion gap - Arterial blood gas Buffering/compensation Bicarbonate buffering system - Respiratory compensation - Renal compensation Retrieved from http://en..org/wiki/Fluid_balance Categories: Electrolyte disturbances | Nutrition Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages עברית This page was last modified on 13 September 2008, at 11:25
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