CHAPTER

8
Body Fluids
Learning Objectives
On completion of study of this chapter, the student MUST be able to:
1. Give the normal values of total body water (TBW) as % of body weight in different age groups in males and females.
2. Gives the % distribution of body water in different body fluid compartments.
3. Name different body fluid compartments, total fluid present in the compartment and composition of ions in each compartment.
4. Give the characteristics of an ideal indicator used for measuring body fluid volumes.
5. Name the units of measurement, name the indicator used, give the basic principle and method of measurement of body fluid volume
of different compartments.
6. Explain why dehydration is common and often severe in children.
The student MAY also be able to:
1. Describe details of methods of measurement of various body fluid compartments.

Functions of cells depend on fluids present both outside Of total body water, about two-third is present in intra-
and inside the cells. Unicellular organisms float in water cellular compartment and one-third in extracellular com-
or air and exchange their nutrients, waste products and partment (Table 8.2).
gasses through their body surface, i.e., the cell mem-
brane. However, multicellular organisms, especially orga­ BODY FLUID COMPARTMENTS
nisms with complex body systems have no direct access to
their immediate environment, and therefore, they contact Extracellular Fluid Compartment
outer environment through interstitial fluid and transport
systems of their body. Therefore, body fluid is compart- Fluid present in the spaces outside the cell constitutes
mentalized into intracellular and extracellular fluids in extracellular fluid (ECF) compartment. This includes
complex organisms. The body compositions and distribu- plasma, interstitial fluid and transcellular fluid.
tion of fluid in different compartment are as follows:
1. The body composition of a normal adult male on aver- Plasma
age consists of 15% fat, 18% proteins, 7% minerals and Plasma is the fluid part of the blood. It constitutes about
60% water. 25% of the ECF, which is about 5% of the total body weight
2. The total body water (TBW) as percentage of body (Table 8.3).
weight on average is about 60% in adult males, which
Volume of plasma can be calculated from blood vol-
is about 10% more than adult females (Table 8.1).
3. In infants and children, though TBW as percentage ume and PCV (packed cell volume) as:
of body weight is more than in adults, their absolute 100 − Hematocrit
Plasma volume = Blood volume ×
water content is significantly less. 100
4. In elderly people in both the sexes, TBW is about 10% Blood Volume and Red Cell Volume
less than their adult counterparts.
5. In females, TBW is less than males due to relatively Blood volume is the plasma volume and blood cell vol-
greater amount of adipose tissue (subcutaneous fat) ume. It is about 80 ml/kg of body weight or 8% of the total
in them. body weight.
64 Section 1: General Physiology

Table 8.1: TBW as % of body weight. Table 8.2: Distribution of total body water (TBW) in ECF
Age Males Females and ICF compartments in a 70 kg adult male.
Infants 65–70 65–70 Compartment % of BW % of b.w. Volume
Children (upto 9 years) 60–65 59–62 TBW 60 100 42 L
10–17 years 58–60 55–58 ECF 20 33 14 L
18–39 years 58–64 48–55
ICF 40 67 28 L
40–59 years 52–58 45–50
(BW: Body weight; b.w.: Body water).
60 years and above 50–55 42–48

2. The total transcellular fluid volume is 1.5% of body

Table 8.3: Distribution of ECF in a 70 kg adult male. weight, which is about 1L.
Compartment % of ECF % of BW Volume % of b.w.
Intracellular Fluid Compartment
Plasma 25 4–5 3.5 L 8
Interstitial and 10.5 15 10.5 L 25 Intracellular fluid (ICF) is the fluid contained within the cells
transcellular fluid of the body. It constitutes about two-thirds of total fluid of
(BW: Body weight; b.w.: Body water). the body. It can not be measured directly. It is measured
by subtracting ECF volume from total fluid volume.
Red cell volume is the volume occupied by the cir-
culating red cells. It is determined by subtracting plasma
MEASUREMENT OF BODY
volume from total blood volume. However, it is also cal- FLUID VOLUMES
culated by injecting red cells tagged with radioactive iso-
General Principle
topes such as 51Cr, 59Fe or 32P. Fraction of red cell tagged
is measured after proper mixing has occurred. Total blood The volume of fluid compartment is usually measured by
volume is less in children (Clinical Box 8.1). the indicator dilution principle, which is based on the fol-
lowing relationship:
Clinical Box 8.1
A A
Dehydration is common and rapid in children: Ratio of ECF volume C = i.e., V=
to ICF volume is larger in infants and children than in adults. However, V C
as the total volume of ECF is much smaller in children than in adults. Where, A is the amount of a substance injected intrave-
In addition, the regulatory mechanisms for maintaining ECF volume are
nously, V is the volume in which the substance is distri­
not well developed in infants and children. Therefore, dehydration is
more common and occurs rapidly in these age groups. buted and C is the final concentration attained.

Characteristics of an Indicator
Interstitial Fluid
1. Should be relatively easy to measure.
It is ECF volume present in the space between the cells
2. Should remain in the compartment being measured.
(ECF outside the vascular system). Interstitial fluid sur-
rounds all cells except blood cells and includes lymph 3. Should not change the fluid distribution in the com-
(lymph constitutes 2–3% of the total body weight). It is in partment being measured.
constant motion throughout the body and is exchanged 4. Should be non-toxic.
rapidly with the circulating blood. 5. Must mix evenly throughout the compartment being
1. Interstitial fluid volume is about 15% of body weight. measured.
2. It can not be measured directly as substances used for 6. Should remain unchanged by the body during the
it rapidly equilibrate with plasma. mixing period or the amount changed must be known.
3. It is calculated by subtracting plasma volume from ECF
volume. Principle of Measurement
Size of fluid compartment is measured by injecting a sub-
Transcellular Fluid stance and then calculating the volume of fluid in which
Transcellular fluid represents fluid in the lumen of struc- the test substance is distributed. This is called the volume
tures lined by epithelium. distribution of the injected substance, which is equal to
1. It includes fluid in the secretion of exocrine digestive the amount injected divided by concentration of the sub-
glands, cerebrospinal fluid (CSF), pleural, peritoneal, stance in the sample.
synovial and pericardial fluids, intraocular (aqueous If indicator leaves the compartment by excretion or
and vitreous humors) fluids, bile, luminal fluids of the metabolism during the time allowed for mixing, then cal-
gut and fluid in the cochlea and kidney tubules. culation is done as follows:
 Chapter 8: Body Fluids 65
Amount injected – Amount removed Commonly used tag is 51Cr, which is attached to the
Volume distribution = red cells by incubating in a suitable ‘Cr’ solution. Then,
Final concentration of the substance
plasma volume is calculated by using the formula:
Measurement of ECF Volume 100 − PCV
Plasma volume = × Blood volume
100
The ECF volume is difficult to measure, as the limit of this
(PCV is packed cell volume, which is practically the red
space is ill-defined, and few substances mix rapidly in all
cell volume).
parts of the space while remaining exclusively extracel­
lular. Measurement of Interstitial Fluid Volume
Interstitial fluid volume cannot be measured directly as it
Methods of Measurement
is difficult to sample and no substance penetrates exclu-
ECF volume is measured by volume distribution principle sively in this compartment. Substance that equilibrates
using inulin, a polysaccharide having molecular weight of in interstitial fluid also equilibrates in plasma. Therefore,
5200. the interstitial fluid volume is estimated as the difference
1. Radioactive inulin is prepared by substituting 14C for between ECF volume and plasma volume.
one of the carbon atoms of the molecule. Radioactive
inulin levels are easily determined by counting the Measurement of ICF Volume
samples with suitable radiation detectors.
Intracellular fluid volume (ICFV) cannot be measured
2. Also Cl– (36Cl– and 38Cl–), 82Br, mannitol and sucrose
directly by dilution principle as no substance remains con-
are used for measurement of ECF volume.
fined only to this compartment. It is determined indirectly
3. Cl– is largely extracellular. Therefore, radioactive iso-
by subtracting ECF volume from total body water (TBW).
topes of Cl– (36Cl– and 38Cl–) are used for the purpose.
Thus, first TBW is measured.
However, ECF volume determined by using Cl– is
greater than actual volume as some Cl– is also present
in intracellular fluid.
Measurement of TBW
4. 82Br, sulphate, thiosulphate, thiocyanate and ferro- Measurement of TBW is performed by indicator dilution
cyanide are also used for measuring ECF volume. As principle:
these ions interchange with Cl– in the body, they deter- 1. Deuterium oxide (D2O, heavy water) is usually used as
mine greater values for ECF. it has properties that are slightly different from H2O.
5. Mannitol and sucrose have also been used to measure However, in equilibration experiments for measuring
ECF volume. TBW, it gives accurate results.
2. Tritium oxide and aminopyrine can also be used for
Measurement of Plasma Volume measuring TBW.
Plasma volume is measured by two dilution methods. Measurement of red cell volume, plasma volume
First Method: In the first method, the substance used effective blood volume is described in next chapter.
neither leaves the vascular system nor penetrates red
cells. Examples are: IONIC COMPOSITION OF BODY FLUIDS
i. Evans Blue Dye (T-1824) that remains bound to plasma
proteins. Basic Features
ii. Radio-iodinated human serum albumin (RISA) i.e.
1. The distribution of electrolytes varies in body com-
serum albumin labeled with radioactive iodine. It
slowly escapes from circulation into the interstitial partments.
fluid. Suitable sample of injected solution and plasma 2. Sum of the concentrations of the cations equals the
samples obtained after injection are counted in a scintil­ sum of the concentrations of the anions in respective
lation counter. compartments. This makes the fluid in each compart-
iii. Radio-iodinated gamma globulin and fibrinogen. ment electrically neutral.
These substances generally do not leak out of the 3. Na+, Ca2+, Cl– and HCO3– are largely extracellular (Table
blood stream. 8.4) and K+, Mg++, organic phosphates (PO43–) and pro-
Second Method: In the second method, radio-iso- teins (prot–) are mainly intracellular.
topes of phosphorus (32P), iron (55,59Fe) and chromium 4. Essentially, almost all the K+ in the body is in the
(51Cr) are used that penetrate and bind to red cells. There- exchangeable pool, whereas only 65%–70% of the
fore, the red cells volume, i.e. volume occupied by all the body Na+ is exchangeable. Solutes that are exchange-
circulating RBCs in the body can be measured by injecting able are osmotically active.
tagged red cells intravenously. After thorough mixing has 5. Almost all of the body Ca++ (in bone) and most of the
occurred, fraction of the RBCs that is tagged is measured. body Mg++ (in bone and cells) are nonexchangeable.