from finch to fish to man: role of body fluid volume regulation robert w. schrier, md professor of...
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From Finch to Fish to Man:Role of Body Fluid Volume
Regulation
Robert W. Schrier, MDProfessor of MedicineUniversity of Colorado
School of Medicine
“The constancy of the Milieu Intérieur is the condition of free and
independent existence”
Claude Bernard19th Century French Physiologist
“The kidney presents in the highest degree the phenomenon of ‘sensibility’; the power of reacting to various stimuli in a direction which is appropriate for
the survival of the organism; a power of adaptation which gives one the idea
that its component parts must be endowed with intelligence.”
E.H. StarlingThe Fluids of the Body The Harter Lectures, 1909
BODY FLUID DISTRIBUTION
COMPARTMENT AMOUNT VOLUME IN 70 KG MAN
Total Body Fluid 60% of Body Weight 42.0 litersIntracellular Fluid 40% of Body Weight 28.0 litersExtracellular Fluid (ECF) 20% of Body Weight 14.0 litersInterstitial Fluid Two-thirds of ECF 9.4 litersPlasma Fluid One-third of ECF 4.6 litersVenous Fluid 85% of Plasma Fluid 3.9 litersArterial Fluid 15% of Plasma Fluid 0.7 liters
NEW YORK HEART ASSOCIATIONCLASSES OF CARDIAC FAILURE:
ASSOCIATED HEMODYNAMIC AND
HORMONAL CHANGES
Cardiac Index
Plasma Hormones
(AVP, Renin,
Aldosterone, NE)
Plasma Volume
CLASS II CLASS III CLASS IV
Normal
Plasma Renin
Activity
(ng/ml/hr)
r=0.68p<0.001logey=0l7x+24.32n=96SEE=0.94
Pretreatment Serum Na Concentration (mEq/L)
PRETREATMENT SERUM SODIUM CONCENTRATION CORRELATES WITH PLASMA RENIN ACTIVITY IN
PATIENTS WITH SEVERE HEART FAILURE
Evidence for Non-Osmotic Release of Vasopressin in Hyponatremic Patients with Congestive Heart Failure
Plasma Effective Osmolality and Minimum Urinary
Osmolality in Cardiac Failure Patients Before and During
After-Load Reduction
Selective V2 Receptor Antagonism Decreases Urinary
Osmolality in Patients with Chronic Heart Failure
Effect of Renal Denervation to Reverse Atrial
Natriuretic Peptide Resistance in Experimental
Congestive Heart Failure in Rats
Baseline Hemodynamic Data in Control Rats and Rats with High
Output Cardiac Failure Secondary to Aorto-Caval
Fistula
Hormonal Results in Control rats and Rats with High Output Cardiac Failure Secondary to
Aorto-Caval Fistula