hi and welcome to this video on fluid and electrolyte balance so let's go to the PowerPoint and that's not where I want it to be oh goodness sorry about that friends here we go all right and let's get rid of me okay so this is on chapter 25 on um loads and electrolytes so right in here all right so uh fluids of the body so you've probably heard that your 60 water and that's about right so you can see our human body is between 45 and 75 fluid and so we will actually put some numbers in for you here with probably match all right so it does depend on age and the amount of Adipose or muscle tissue that you happen to have adipose remembers hydrophobic so this is gonna this gonna this is going to lower oops Yeah lower fluid oh heavens and then muscle will raise fluid because it's proteins and and it's uh hydrophilic all right so infants have the highest percentage of fluid especially newborns right around that 75 number because they are so much protein and so little fat you know until they get a few months old and then it's going to shift but um uh initially when they're newborns they're just bags of water in protein that's basically what what newborns are elderly are going to have the um one of the lower right around the 45 percent children young and middle-aged adults in the middle range somewhere we're going to put about 60 percent um and then fluid decreases with age um and then it also decreases with adipose so we're going to be right around 40 with the person who has a fair amount of body fat okay so um notice so if we go back to this slide remember we're going to have less fluid and adipose and more fluid and muscle tissue so there we have 20 water in our adipose tissue skeletal muscle 75 water so oh and then we also have decreases with increased body fat and if you're at a higher percentage so let's say that you're up here around the 75 percent level you're going to have a lower risk and then those who are um in that 40 range with about 20 in their adipose tissue then they're going to have higher risk okay and since the elderly have less um body fluid than you know adults do then they are at a greater risk of fluid imbalance so that's what we're looking at there all right where do we find the fluid so fluid in our body is found either intracellularly or extracellularly so this is going to be two-thirds of our total body fluid and that's within our cells intracellular fluid and surrounded by the passage or surrounded by the plasma membrane which of course allows the passage of some but not all substances but water so it depends on what's in that water if it's going to be able to move or not just because the water moves doesn't mean that the material found within the water may move all right so then we have extracellular fluid so this is the one-third remaining and this is interstitial fluid and blood plasma so if we look at interstitial fluid this is going to compose about two-thirds of the ECF so if we put numbers together let's just go ahead and and so this will be one-third so we have about 62 percent ICF and so that means we have 38 percent um uh uh interstitial fluid I mean uh extracellular fluid so that's going to be about 30 percent um in the interstitial fluid and about eight percent in the plasma and so these two are the ECF okay so that's about how it's just distributed within your body so interstitial fluid remember is the extracellular fluid surrounds the cells and then blood plasma is the extracellular fluid within the blood vessels so um we have that capillary wall that's going to separate it from the interstitial fluid and the capillary wall is more permeable than the plasma membrane so you do have more things leaving a capillary leaving from the plasma going into the interstitial fluid or back the other way interstitial fluid and blood plasma similar in composition yet we're going to have an osmolarity of about 300 milliosmoles we talked about in the kidney video when we're looking at how do we get rid of extra water at the Loop of henle and and the nephron how do we produce a dilute urine with the um the loop henling so all right so there is that now in the fluids between the two compartments we're going to have um a definite difference in this in the ions that you're going to have intracellularly intracellularly versus versus extracellularly I'm gonna just get hung up on that the whole time I do this so I hope not all right intracellular you already know this okay potassium remember potassium is that intracellular eye cation and then we also have magnesium inside and phosphate and then of course those negatively charged proteins which contribute to membrane potential which we can never forget about them how long has it been since amp1 and now here we are at the end almost to the end of amp2 and we're still talking about membrane potential so remember friends that never leaves your life all right now why do you have a difference between what's inside and what's outside is because of the processes so transport processes that you have within the cell like active transport facilitated diffusion and those transport proteins so whether you have that sglt1 or you have some of the glute Transporters or um sodium potassium pump okay all of that is going to affect what's going to be where so if we go into interstitial fluid and plasma they're going to be the same that's why they have that same 300 milliosmol concentration or osmolality um but here is the important similar to each other except in one regard protein is present in blood plasma but very little in the interstitial fluid and we've gone over this again already multiple times but remember the main protein couldn't think how it's about for a minute is albumin and albumin creates colloid osmotic pressure and therefore you want the water to leave the interstitial fluid and go back into the plasma you do not want it to remain in the interstitial fluid or else you'll get edema and we don't want edema so if there's protein in the interstitial fluid you will get edema all right so what are the ions that we find in the fluid compartment sodium calcium I mean outside in the extracellular fluid chloride and bicarbonate bicarbonate we're going to find out when we do buffers that that is the major extracellular uh you guys major extracellular buffer in your body there you go because it's an anion and then again reflects the capillary permeability to the ions but not to the proteins because it's not going to be permeable to the proteins all right so this just shows a nice little picture so intracellular fluid is inside the cells extracellular fluid is going to be what's out here in the plasma and in the interstitial fluid so then intracellular two-thirds of the total fluid and then extracellular is one-third but of that one-third two-thirds of it is out in the interstitial fluid and one third of it is in the blood plasma so a lot of times people think wow you know there's a lot of fluid in the blood there really isn't remember you only have three liters of actual fluid Plasma in your blood three liters out of the 42 liters that you have in your body oh where do we get that 42 liters from well we get get it from if you take sixty percent of your body weight is due to water and you are a 70 kilogram male because that's our standard you take um uh this 60 percent of 70 is 42. so you have 42 liters of water excuse me so that's how we figure that out all right so now where do we find our fluids so intracellularly there's our intracellular cat ions and then here is our intracellular anions or proteins and then in our extracellular fluid here that cat ions that are extracellular look at this look at percent of cations outside of your cell 94 of all the cations outside your cell are sodium so there's so much sodium and it's very important because it's going to determine your fluid shifts which we'll look at here shortly all right and then your anions inside outside of the cell here they are so we have chloride with bicarbonate we have no proteins see no proteins right there and other okay because those are anions outside of the cell then in blood plasma again that same 94 why is because interstitial fluid has to be isotonic there we go so let's let's think about that for a minute isotonic okay why does interstitial fluid have to be isotonic to plasma because if it weren't one solution would be hypertonic one solution would be hypotonic and water would always be leaving the hypotonic solution and going into the hypertonic regardless of which one's which I mean it doesn't really matter the water is going to go from the hypo to the hyper I don't want that I do not want net osmosis happening into or out of myself so I must keep that interstitial fluid isotonic to the plasma and vice versa and believe me we'll still get to talk about that some more than just right now okay and then blood plasma anions again are going to be here but look at yep ten percent of the anions outside of the cell are proteins in the plasma okay all right so um like I just said fluid movement between compartments continuous in response to changes in osmolarity so the concentration so this is the sum of all solutes electric oops solutes we are not looking at a concentration gradient when we look at osmolarity what we're looking at with osmolarity is what is the tendency for osmosis to happen and so a a solution with a greater amount of solute has a higher osmolarity because you have more solute in there to draw water to you if you have a low solute concentration and it's not I'm not just saying sodium whatever it's all of the solutes together that will have less draw towards you and water will leave you if you have fewer solutes water will leave you and go to where there are more so we need to make sure and we'll see that in the next slide but I need you to understand that concept um Okay so just to then reiterate what I just said when a concentration between compartments vary so one is hypotonic one is hypertonic water will move by osmosis from hypotonic to hypertonic all right and then we'll continue until the water concentration is equal all right so what about if I drank some water so water will enter the blood from the digestive system it's absorbed so now as it's absorbed it's going to decrease the plasma osmolarity which is the same as diluting it so because because you can visualize dilute more than you can visualize decreased plasma osmolarity so now you have this dilute solution outside or in the plasma sorry so we're in in the blood vessels so now the water is going to leave the vessel and it's going to move into the interstitial fluid and then that's going to fill up that's going to become dilute and then it will move into the cells and so in that case the cells will swell and probably lice and then I'm going to put I'm just going to put ice but they may not but you'll probably get lysis happening okay and then reverse movement if water is lost from the body so in dehydration or hypovolemia so if you had just full-on blood loss well no not hypovolemia sorry just dehydration because well you'll see in a little bit there's a difference between dehydration hypovolemia so just if the water part is lost so when you're dehydrated you have lost just water you will lose some solute but not you will you will definitely lose water okay so if I drink lots of water like this woman is doing here so now blood and so water enters the capillaries dilutes the plasma so now it's hypotonic so the water will move to the more hypertonic in well first we want to have interstitial fluid like it says so we're going to go the interstitial fluid then we will go into the cell and the water will move by osmosis and we'll get as well or lice oops happening all right then if you're dehydrated sweat let's put this sweat is hypotonic it you don't think it is because you know when it runs in your eye because it kickboxing last night and dang it I was my eye was all sore and burning cause sweat excuse me sweat kept falling into my eye but it is hypotonic to your the rest of your body Solutions all right so now as I'm losing sweat it's coming from my plasma so let's see how do we want to put that um and is taken from plasma by the sweat glands so that's where the sweat glands are getting their water from they're getting it from the plasma and so now as that sweat is being excreted onto the surface of your skin your blood becomes hypertonic and then your intracellular fluid is now hypotonic so it'll go into your interstitial fluid first and then it will move into your um into your capillaries but in the meantime now what are your um these cells these hypotonic cells are now crenating because they're losing water they're shriveling up all right so we need to maintain a fluid balance so our fluid balance needs to be that our intake is equal to our output so what we take in whatever we eat and drink is going to be the same amount that we're going to be lost in a day and not only um lost um the water portion lost but the solutes so we need to make sure that we maintain a proper concentration of the solutes and so what we gain if we gain too much so this is my example that I used in um in my on-campus class this week was if you drank a bottle of soy sauce oh now I like soy sauce but I like it in small amounts so um I could never drink a bottle of soy sauce and nor should you ever drink a bottle of soy sauce because it is very very salty and so if you took in that large amount of solute from your food your kidneys are going to have to turn around and excrete an equal amount of solute or you're going to get dehydrated from the inside basically so we don't want that so the what the water is going to lose lose the water is going to leave um uh uh water is going to leave the cells and go into your plasma because that's where you just absorb the solute into the salt from the soy sauce and so your cells will cremate cremate yeah that's what my son does well crenate and shrivel okay so when we'll talk a lot more about that in a minute all right so how is our fluid intake or our fluid balance regulated multiple body systems so we're going to use digestive system we're going to use our um respiratory system we're going to use our urinary system you can use our integumentary system even okay so those are the four systems that are primarily involved with um a fluid balance so um they the four of them are gonna work to regulate the processes of fluid balance all right so how much fluid do we take in a day this is our magic number now you could take in more but on the average we're going to take in 2500 milliliters of um water a day so that 2500 milliliters we do a little thingy like this what you're going to take in right here so 2300 so this is fluid in 2300 milliliters is going to be in food and drink Okay and like it says your major way to increase body fluid so if you ever have a lack or deficit of fluid you're gonna get thirsty and you're gonna drink it that's the easiest way for it to get come into your body um okay then the second one so this is what ingested or pre-formed water water as water or you're going to make water okay so cellular cellular respiration and dehydration synthesis now I wouldn't count on a whole lot of water being made by dehydration synthesis as I am carrying out anabolic processes so like storing starch and triglycerides and all that making proteins and stuff although you will but that's I don't want to have to to um depend on that um instead I'm going to make much more water through this process okay there it is that is known as metabolic water and that will be my last 200 mls is this water right here okay all right so that's my fluid intake my fluid output oh look at that is also 2500 milliliters a day so let's draw this all right so [Music] um let's do this oh that's maybe a little far oh well I've already drawn it okay 1500 milliliters in urine this is how much urine we typically make so sixty percent of uh 2500 is around uh 1500 let's just find out exactly what it is um because I I want to make sure that I agree with that it is exactly 1500 milliliters all right so that's 60 1500 MLS all right now we then have sensible and insensible obligatory and facultative well obligatory is this right here this is obligatory some of this down here is going to be facultative some of it will be sensible some of it will be insensible so let's go ahead and divide it up into three more sections so we're going to put a section right here and a section right here okay so this is going to be in our skin and that's going to be about um 300 no 600 MLS we lose through our skin we call it transpiration just like plants transpire because our skin is water resistant but not waterproof some water leaves through our skin this is not sweat sweat you can put sweat in here but then when you start sweating you know this is like the insensible sweating you're not aware of but when it starts dripping down your face then that is beyond this this is so that sweat that's dripping down your face got sucked out of your interstitial fluid because it got sucked out of your plasma so it's getting sucked out of your interstitial fluid it's getting sucked out of your cells so that's why if we are sweating where it's running down our face or running down other parts of our body friends you've got to put it back you better drink after you've done a sweaty activity because you just sucked it out of your body cells and we can't keep doing that okay then this is in respiration through our lungs um if you are watching this sometime and you've spent some time in cold places where you can see your breath that's what you're seeing you're seeing the water vapor that's exhaled remember in respiratory system we said um what do we have to do to the inhaled air we need to warm it filter it and moisten it so that water that we moistened it with that we now exhale we will lose about 300 milliliters a day through respiration okay so exhaling and then the last hundred well it depends on what numbers you use up here somewhere between 100 and 200 mls we're going to lose in our feces um now if you have diarrhea okay you're not a water balance that is not a normal fluid output and what if you're constipated that too is not you're retaining more water than you are excreting or that you are eliminating so that's not good either but yeah if you have diarrhea that was water that should have been absorbed a long time ago or you have a secretory diarrhea like cholera or um shigella or salmonella or something like that where you're actually flooding the organism is binding to your um intestinal epithelium and causing you to to lose water extra secretion so you're losing water um uh so um that doesn't count either so excessive sweating and diarrhea that's not part of our normal water law output okay um so let's look at the difference between sensible and insensible obligatory and facultative all right so sensible water loss measurable feces and urine okay so here was my 1500 MLS I can absolutely measure that you know if you've had the urinate in a hat before because you're looking for kidney stones or or something else that were where we need to check your urine strain your urine for um we know that or you know you're just getting IV fluid here's this is a good example so you're getting IV fluids and we need to make sure that what how many bags we put in is how many bags of water are coming back out of you and so we have to measure your urine so if you're not catheterized then we need to we need to um you need to urinate into the hat so we can measure how much water or how much urine you produced keep that in your chart so that so that when your nurse comes on your new nurse comes on at shift change they know how much water we've put in you because of your IV fluid and we know how much water has come out of you and if all of it hasn't come out yet we need to pay close attention to does that come out before the end of the day before your 24 hour period um okay and then we can measure the amount of water in feces so remember I said between 100 and 200 mls okay but where's the rest so that's the insensible water loss not measurable lost in expired air and skin through sweat and cutaneous transpiration okay so remember this is sweat that's not pouring down your face or off your body or you're dripping it onto your yoga mat or something like that okay that doesn't count this sweat this is that's extra um it's just that sweat that you just do that just dries up in your clothes why you need to wash your clothes okay here's my little mom in your little mom note there all right so obligatory water loss loss of water always occurs always lost between breathing and skin we can't help it it's gonna happen water loss through feces and the minimal urine needed to eliminate waste so our nitrogenous wastes what amount do we need to get rid of that facultative on the other hand is depends on like it says how hydrated we are so we're gonna really control this hormonally okay so we're going to use things like aldosterone and ADH and ANP to regulate um the amount of fluid that is either retained or eliminated by the nephrons um and and two this will only control fluid output I can't regulate that fluid input because that's a voluntary thing so you will have stimuli you'll want to take a drink of water and we're going to try to get you to take a drink of water but we can regulate just how much comes out because we can get you to isotonic or whatever we need to get you to but we can't get you to put it in we don't have a hormone that says okay drink 800 milliliters of water no we're going to drink what we want and then let it absorb or we're going to throw it back up again if we drink too much you know if you're doing the gallon milk challenge or something like that um but the good thing about this even with the fluid output is it can decrease fluid loss if the body is dehydrated so we can effectively shut down your kidneys we can well okay so if we're doing it from your kidneys we can effectively shut down your kidneys and say you're done um we also if you're in sympathetic stimulation for example um you're gonna get so you're sweating you're hot and everything you're going to get to the point where you will not sweat anymore and that's when we know that you are severely overheated and you're like uh what do we want to call it heat stroke um Heat whatever um I can't think of the other one but with you're too hot and you've gone past the point of of sweating now because I've lost so much water I have shut down my sweat glands we never want to get that far because you are close to dying if you are not sweating and you're hot okay um so here is the intake and output so here food and water drink food metabolic water and um okay so here I'm just gonna say this I'm just putting this out there for those of you that drink a gallon of water a day why I mean it's good to be hydrated but you know what you're just gonna pee it all out it's you're only going to take in what you need the rest of it is just going to go right through you so if you don't want to be going to the bathroom every 10 minutes you don't need to drink a gallon of water but like I said it is good for you but yet don't don't drink too much much and then not go to the bathroom because then you can have hypotonic hydration which we'll look at in a minute and heaven's sakes you do not want to die of that we'll talk about an example of someone who did so um it's really not necessary your eight glasses of water was that 64 ounces 64 ounces is for let's see 64 ounces so a gallon is 128 so it's a half a gallon so even then that's a half a gallon is how many milliliters um oh it's so hard switching back and forth between metric and what you guys use why do I say what you guys use because I grew up in Canada I grew up in the metric system 1600 milliliters just go with that I'm not going to try to figure out how much of a gallon that is it is um so she's if she's drinking uh you know the little 500 milliliter water bottles it's uh three of those what yeah it's just three of those 500 milliliter water bottles so those you know those water bottles are Dasani the smallest water bottles of Dishonor or Arrowhead or whatever you can get that's you just need three of those that's all so there you go there's my oh God on a soapbox don't need to be on a soapbox but anyway there are problems if you drink too much water which we'll look at all right so there's our expired air 100 milliliters here is our cutaneous uh transpiration and sweat so coming through our integumentary system they put it at 500 millimeters because they gave that extra 100 milliliters to your feces and then um obligatory 500 mL of urine and then getting rid of that extra because look at I made 200 here I got 1600 here so I'm gonna absolutely lose 500 I have to lose 500 but then I'm gonna lose an additional thousand just to make sure that I'm in balance and here you can see facultative obligatory insensible and sensible so this is a great visual it's better than what I drew I like it all right so fluid and balance occurs if fluid output does not equal fluid intake we have five categories so volume depletion volume excess so this is isotonic stuff isotonic what if I get too much isotonic oops what if I lose isotonic fluid what if I gain isotonic fluid and then dehydration and this is um uh water loss so this is just water by itself water loss hypotonic hydration is water gain excess water intake water gain and then fluid sequestration so we're hiding it we stick it somewhere um okay so the first four of these are does the fluid and bounce so we're going to need depletion and excess dehydration hepatonic hydration okay does it change the osmolarity of the blood no no yes yes okay and then is the fluid imbalance caused by an excess or sorry deficiency of body fluid and so we already know this is a deficiency excess deficiency excess okay so deficiency depletion excess excess dehydration deficiency hypotonic hydration excess all right so if we're going to keep our osmolarity constant then we are gaining or losing isotonic fluid so volume depletion isotonic fluid loss is greater than isotonic fluid gain Hemorrhage Burns vomiting diarrhea not enough aldosterone so hyposecretion of aldosterone what you're doing is um not saving sodium okay so so you're losing the same amount as what you're in taking you're not um saving because that's what aldosterone is going to do and that's fine you may be in a situation where you are don't need to produce aldosterone and we'll talk more about that later all right so um all of these cases the stuff I'm losing so blood interstitial fluid um intestinal contents in these two those are all isotonic all right volume excess so um isoton um isotonic fluid gain is greater than isotonic fluid loss fluid intake normal but decreased fluid loss through kidneys or and I think I put this in the notes too much IV fluid okay so in um whatever so you'll get no change in osmolarity okay so um your concentration stays the same and so with both of them no net movement of water between the compartments okay so I'm isotonic here I'm ISO isotonic and volume depletion I'm oxytonic and volume excess okay all right then what if we have a change in osmolarity so dehydration is water loss greater than loss of solutes so what did I say profuse sweating yeah diabetes so what's happening with diabetes is that you have glucose in your urine so this is going to be osmotic diarrhea so not secretory diarrhea that I mentioned before this is osmotic diarrhea so what that means is that I am keeping glucose in my urine I'm not reabsorbing because I don't have any insulin or my insulin isn't effective so now glucose stays in my urine so now water will follow that remember we said water always follows salt well water always follows solute and so in this case normally it's salt it's sodium that it's following but in this case it's any solute so if you are diabetic and you have too much glucose in your bloodstream the water that you are supposed to absorb the water goes uh-uh I'm gonna stay here where it's really high osmolarity and so now your the water that should have been absorbed is now leaving in your urine and so that's why we see polyuria and polydipsy yeah so too much urine or a lot of urine and a lot of thirst that we see in diabetics those are often two of the um signs that we see I guess that would be a sign not a symptom no because you can well polyuria would be a sign High Dipsy would be a symptom but anyway um uh that's often how we diagnose someone for the first time with diabetes is by looking at that uh seeing that water loss okay intake of alcohol so intake of alcohol does a couple of things um but the main thing well it does a couple of things if you put it into this one example that I always use which I'm not going to use right now um but alcohol causes a hyposecretion of ADH okay so um you will alcohol goes to your brain and then it inhibits the production of ADH so if I don't make ADH remember ADH means antidiuretic hormone which means I am not going to the bathroom that's what antidiuretic hormone does it saves your water but if you're not making anti-diuretic hormone you are going to lose water and so this hyposecretion is also known as diabetes insipidus okay and we'll talk about that I think I have a clinical view of that in just a minute but alcohol causes that hypo secretion of ADH okay so that's why a lot of people when they're when they're drunk they go to the bathroom a lot because they have taken in so much alcohol that they're not making ADH plus they're already they're urinating out the water so oh so while we're on this track um uh hangovers so what are hangovers dehydration your brain's kind of shrinking and uh and so you get the headache and the miserable feeling so if you were going to drink and you don't want a hangover you need to drink equal parts of water and alcohol or maybe even more water than alcohol um what is it maybe it's eight ounces for every shot so eight ounces for every two ounces of alcohol but if you keep drinking water during that time that you're consuming alcohol then you will not dehydrate your brain so not that I know that from firsthand experience it's just a clinical thing that I know all right insufficient in water intake do we do that sometime yeah sometimes we do so um we uh just don't drink enough water and then we become dehydrated and then overexposure to cold weather um why does that dehydrate you um you know I don't know now I I'll think about that and then I'll let you know but um let's see so you're too cold you're not evaporating because that would be if you were hot no I'm gonna think about that having grown up in Canada I don't know I know that I breathed out there's a lot of steam so I'm gonna I'm gonna look at that one that's yeah I really hadn't thought about that before okay so what is happening with uh dehydration then your blood plasma becomes a hypertonic so water is going to shift from your cells to your interstitial fluid and then into your plasma and this is what we don't want possible dehydration of body cells the cells might crenate okay so there you go all right now hypotonic hydration this is the other so this is water gain or retention greater than solute gain so greater than solute gain or retention we also call hypotonic hydration water intoxication all right so maybe we have too much ADH and we're retaining too much water doubt that um what we're doing is drinking too much water okay drinking large amount of plain water um now sodium and water are lost during sweating as we know but drinking water only replaces the water not the solutes hence the formulation of Gatorade all right so Gatorade is a electrolyte glucose water solution that was formulated to help the boys that played football for the University of Florida Gainesville um Gator Squad okay University of Florida Gators that's one of my alma Waters and um yeah go Gators and um so the team doctor I don't know if he was the team doctor but he was a doctor that was associated with Florida with uh University of Florida and they're very proud of him too they have like a whole um uh whole uh not a program but a unit you know a whole section of the school that's in with dehydration and all that kind of stuff and and they are very proud of him I can't remember his name but anyway so here was what was happening all these boys they were they were practicing you know it's really humid and and so they were sweating a lot in Florida and um you know in August when they were at football practice and the boys were dropping like flies and he's like we gotta have something for these kids so that they're not going to um they're not going to keep passing out of football practice so he invented Gatorade and um and so that's why if you you are losing water from sweat or vomiting or something like that you need to replace the electrolytes oh diarrhea that was the other one so um you know sweating or diarrhea and you're losing more solutes you need to put those back and so you don't want to just drink plain water you might want to drink Gatorade now Gatorade does have a lot of sugar in it and so if you are you know maybe diarrhea and you don't want to keep it bad because you've got a lot of glucose you can just take Pedialyte and that will help you too all right so then if you're drinking too much water the water becomes the plasma becomes hypotonic and then fluid will move from the plasma interstitial fluids into the cells swelling of cells and lysis cerebral edema doing due to brain cell swelling which we absolutely do not want in convulsions coma and death okay so there was a radio contest I guess that's how they spelled it all right so about oh I don't know 15 years ago now 10 or 15 years ago there was a radio program or a radio contest in California called hold your weave for a week so they wanted the contestants to see how many um 500 milliliter water bottles they could drink without going to the bathroom so this woman I I don't know that she was the winner of the contest or anything but she drank and drank and drank and drank and did not go to the bathroom so now her her brain is becoming hypotonic her blood's hypotonic it's going out into her tissues um she's got cerebral edema convulsions coma and death so she died trying to win a Wii for I don't know her kids somebody's kids or maybe herself I don't know but that's uh that's pretty sad so you can drink too much water often though um uh if we have renal insufficiency and you are not getting rid of enough water that water can stay as well okay so there's that so the last one is fluid sequestration so our body fluids are normal but it's not in the right places so we have edema okay we could get edema puffiness fluid accumulation interstitial space we get that with um congestive heart failure we can get it with um a decreased plasma proteins hypoproteinemia not eating enough protein um I'm just trying to think of um oh yeah so left side failure right side failure I'm just thinking all congestive heart failures so you know the other pulmonary edema or um systemic tissue edema whatever okay then we have ascites which is accumulation of fluid within the peritoneal cavity this is almost always due to liver failure some kind of liver issue and they're not making proteins like they should and so you get a big swollen belly my son had said something about um he had oh he was telling me about a person that he was embalming and and he said oh Mom I just took off so much fluid out of his abdomen and I said did he die of liver failure and he says yep so that's what it was now if you have kwashiokor that's what the little malnourished children that have the big bellies okay you've probably seen pictures of that their arms are skin and bone but they have those big swollen tummies that's that swelling in their tummy is all fluid okay so that's protein malnutrition so their kidney or their liver doesn't have anything to make proteins out of the plasma proteins out of it care cardial fusion accumulation of fluid in the pericardial cavity we sure don't want that because then your heart can't beat like it should and um pleural effusion so this is fluid in your pleural cavity and like for pleurisy or something like that and again um this would be like pericarditis this would be pleurisy and now your lungs can't expand and you may get you may get lung collapse if you have too much fluid in there so there is um here's lymphedema probably because the um uh lymphatics can't carry the fluid back and it's remaining out in the out in the tissues so there's that and then here is cerebral edema um and so you can result excess fluid in your brain could be from intracranial pressure um so ICP um and then so here it is ischemic stroke brain hemorrhage traumatic brain injury and so that's what you're getting so if you've got a traumatic TBI in this case um that's going to give you a good cause for your intracranial pressure um but brain tumors hypotonic hydration there it is and then high altitude so high altitude cerebral edema is one of those things that people die of when they're on a Mount Everest for example you'll get high altitude cerebral edema or high altitude pulmonary edema and both of those are life-threatening and the minute we start to see it on you if you're on the mountain we got to get you down off the mountain and back into normal atmospheric pressure you're going to die and you're going to die pretty quick if we don't take care of it all right so we've been out at this for um almost in well 48 minutes by my clock 49 minutes so I'm going to stop right here and so this will be fluid and electrolytes one and then we will take a look in the next video at the regulation of fluid balance and we'll see in the next video