2._Komponen_kimia_cairan_tubuh

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Intracellular(ICF)

Extracellular(ECF)

o Interstitial

o Plasma

Figure 5-13: Body fluid compartments


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2/3 (65%) of TBW is intracellular (ICF)

1/3 extracellular water

o 25 % interstitial fluid (ISF)

o 5- 8 % in plasma (IVF intravascular fluid)

o 1- 2 % in transcellular fluids CSF, intraocularfluids, serous membranes, and in GI,respiratory and urinary tracts


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Fluid and electrolyte homeostasis ismaintained in the body

Neutral balance: input = output Positive balance: input > output

Negative balance: input < output


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Electrolytes charged particlesoCations positively charged ions

Na

+

, K

+

, Ca

++

, H

+

oAnions negatively charged ions Cl-, HCO3

- , PO43-

Non-electrolytes - Uncharged Proteins, urea, glucose, O2, CO2


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Ion transport

Water movement Kidney function


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Cell in a

hypertonicsolution


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Cell in a

hypotonicsolution


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0

100

200

300

400

Protein

Organic Phos.

Inorganic Phos.

BicarbonateChloride

Magnesium

Calcium

Potassium

Sodium

Interstitial

H2O

Plasma

H2O

Cell

H2O


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The Body as an Open SystemThe Body as an Open System

Open System. The body exchangesmaterial and energy with its

surroundings.


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Amount Ingested = Amount Eliminated

Pathological losses

vascular bleeding (H20,Na+)

vomiting (H20, H+)

diarrhea (H20, HCO3-).


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Body control systems regulate ingestionand excretion:

o

constant total body watero constant total body osmolarity

Osmolarity is identical in all body fluid

compartments (steady state conditions)o Body water will redistribute itself as

necessary to accomplish this


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Body Fluid and Electrolyte Balance

Water input and output

The role of the kidneys in maintaining

balance of water and electrolytes

The regulation of body water balance

thirst sensation

control of renal water excretion by ADH


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Laboratory testing can be performed on many typesof fluids from the body other than blood.

Some body fluid analyses include:

Urinalysis

Semen Analysis

Sweat Analysis

Fetal Fibronectin (fFN)

CSF Analysis

Synovial Fluid Analysis Pleural Fluid Analysis Pericardial Fluid

Analysis Peritoneal Fluid

Analysis


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Samples are usually obtained throughcollection of the fluid in a container (urine,semen) or by inserting a needle into the body

cavity and aspirating with a syringe a portionof the fluid (CSF, pericardial fluid, etc.).

For certain body fluids including pleural,pericardial, and peritoneal fluids, it isimportant to determine through testingwhether the fluid is a transudate or anexudate because it can help diagnose the

disease or condition present.


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Caused by an imbalance between the pressurewithin blood vessels (which drives fluid out) andthe amount of protein in blood (which keeps fluid

in)

It is a clear fluid with a low protein concentrationand a limited number of white blood cells.

Seen in conditions such as congestive heartfailure and cirrhosis


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Caused by injury and/or inflammation.

It has a higher than normal protein content and

may be cloudy due to increased numbers ofcells.

Seen in conditions such as infections,malignancies (metastatic cancer, lymphoma,mesothelioma) or autoimune diseases


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Gross exam

Total cell count

Microscopic examAny other special test (Chemistry,

Microbiology, cytology, etc.)

Test are performed in various areas of labbased on what the physician orders.

Body fluids sterile vs. non-sterile


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Fluid surrounding brain andspinal cord

Sterile

Production by the plexus Specimen: Lumbar puncture

Collect 3-5 vials, each tubehas a designated department.

Gross exam: Turbidity, Color,

microscopic exam, cell count


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Numerate and differentiate cells seen

Lymphocytes: usually see few #, increase # associated withviral, fungal, aseptic, bacterial meningitis, or nervous system

disease (MS) Monocytes: Less than 2% of normal CSF, increase #

associated with TB meningitis, syphilis, viral encephalitis,subarachnoid hemorrhage.

Macrophages: few in number associated with malignancy,hemorrhage, inflammation

PMN: very few, represent rapid disintegration, associatedwith Viral and acute diseases.


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Eosinophils/Basophils: not normally seen in CSF

Plasma cells: not normally present associated with viraldisorders, Hodgkin's, and bleeds.

Red Blood Cells: Few to none present

Mesothelial cells: not present

Malignant cells will see with malignant disease and infiltrate.

Cells unique to CSF:Ependymal: resemble lymphocytes andChoroidal: resemble lymphocytes, usually occur in clumps.


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Pleural Fluid: Lung fluid Effusion Transudate Exudates

Lab analysis: Gross exam, cell count,etc.

Cells unique to the lungs: Mesothelialcells

RBC and WBC # is limited, if increase

is seen in WBC and RBC withouttraumatic tap- indicates disease orinfarct

Cytology exam: useful in identifyingmalignancy or abnormalmorphological cells.


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Lab analysis: Gross exam, cell count, etc.

Differential: PMN, Lymph, Mono, etc.

Cells unique to the lungs: Mesothelial cells

RBC and WBC # is limited, if increase is seenin WBC and RBC without traumatic tap-indicates disease or infarct

Cytology exam: useful in identifyingmalignancy or abnormal morphological cells.


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Abnormalaccumulation of fluid(effusion) in

peritoneal cavity.

A.K.A. ascites

Removal procedure-

paracentesis


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Lab analysis: distinguishbetween transudate andexudates, gross exam,cell count,sedimentation, chemicalanalysis

Color and clarity ofPeritoneal Fluid canindicate certaininfections and diseases.


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Total Cell Count:

Assist in diagnosis of certain diseases by determining totalRBC and WBC number.

A total WBC >0.3 X 109/L is considered abnormal. Differential: Assist in diagnosis of infection and disease

patterns

Use Wrights stain: Differentiate:

PMN:>25% in abnormal

Eosin:>50% (ruptured hydatid cyst, lymphoma, or vasculitis.Chronic peritoneal dialysis will see eosinophils.


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Lymphocytes: CHF, cirrhosis, nephroticsyndrome

Mesothelial Cells: Associated with tuberculosisperitoneal effusions

Malignant cells: seen with malignancy

Ascites: a condition which fluid accumulates

within the peritoneal space. Must have anaccumulation of at > 100ml (several 100) beforeeffusion can be detected on physical exam.


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Pericardial Fluid:accumulation offluid of the lining of

the heart (effusion)Cause: neoplasm,

infections, collagendisease, renaldisease,Cardiovasculardisease.


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Gross Exam: Reportappearance (bloody,clear, cloudy)

Measure pH: pH lessthan 7.0 associatedwith infection orrheumatoid disorder.

Cell count: see limited #of RB and WBC

Evaluate sedimentation


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Examine physical, chemicaland microscopic detail

Quantitate number of sperm

present , report morphologyand motility

Specimen must be a freshcollection-clean, sterile

container. Gross Exam: Color, pH,

Volume, and viscosity.

Agglutination study


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Synovial Fluid:JointFluid normallyclear, viscous

Functions as alubricate andtransports nutrient

Arthrocentesis:

aspirate of the jointfluid, aseptictechnique


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Lab Assay: Gross exam, microscopic exam,Gram stain, cultures, etc.

Appearance: clear, transparent, viscous

Viscosity test: String Test Mucin Clot test

Note crystals (intracellular vs. extra cellular)

Slide exam usually performed on concentration of

the fluid using Wright-Giemsa or Papnicolaou


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Plasma Blood + clotting

factor

Formed elements.

Contain fibrinogen& pr-othrombin.

No thrombin isformed.

Serum Blood clotting

factor.

Formed elements.

No fibrinogen& pr-othrombin.

Thrombin formedduring clottingprocess.


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Serum: Blood is taken in clean tube.

Put at 370 c for clotting.

Centrifuge the sample.

Use the supernatant that is serum.

Plasma:Blood is taken on anticoagulant.

Mix well blood with anticoagulant.

Use the sample that is plasma.


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Take blood sample frompatient in suitable tube.

Centrifuge the

sample for 10

min. to obtain

clear serum


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Never draw blood through a

hematoma. Remove the tourniquet as early

as possible to decrease flow

velocity and turbulence. Do not remove the collection tube

until full. When mixing is required, gentle

inversion is adequate.


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LFT used to detect, evaluated and monitor liverdiseases or damage.These include:

Total protein (albumin & globulins) Albumin (main protein made by liver)

ALT or SGPT alanine aminotranferase

AST or SGOT aspartate

aminotranferase ALP alkaline phosphatase

Bilirubin (total & direct)

GGT, LDH, PT (pro-thrombin time)


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KFT used to evaluate and monitor kidneydiseases or damage & the effectiveness ofthe treatment.

These include:

Urea & BUN blood urea nitrogen

Creatinine and creatinine clearance.

Uric acid.


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Lipid profile includes:

1)Total lipids 2)Triglycerides

3) Cholesterol 4) HDL

5) LDL

These tests must be carried out after 12-14 fasting

due the high molecular weight of lipid moleculesand the prolonged digestion and metabolism.


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Blood glucose level is one of the mostimportant test in the lab.

Glucose is very essential for all bodyactivities.

This includes:

1) RBSrandom blood sugar2) FBS fasting blood sugar

3) PPSpost-prandial blood sugar


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