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American Academy of Pediatrics
Article

Body Fluid Composition

Amrish Jain
Pediatrics in Review April 2015, 36 (4) 141-152; DOI: https://doi.org/10.1542/pir.36-4-141
Amrish Jain
Division of Nephrology and Hypertension, The Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children’s Hospital of Michigan, Detroit, MI.
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  1. Amrish Jain, MD
  1. Division of Nephrology and Hypertension, The Carman and Ann Adams Department of Pediatrics, Wayne State University School of Medicine, Children’s Hospital of Michigan, Detroit, MI.
  • AUTHOR DISCLOSURE

    Dr Jain has disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

  • Abbreviations:
    ADH:
    antidiuretic hormone
    AVP:
    arginine vasopressin
    BUN:
    blood urea nitrogen
    DI:
    diabetes insipidus
    ECF:
    extracellular fluid
    FWD:
    free water deficit
    GFR:
    glomerular filtration rate
    ICF:
    intracellular fluid
    SIADH:
    syndrome of inappropriate antidiuretic hormone
    Sosm:
    serum osmolality
    TBW:
    total body water
  • Educational Gap

    Body fluid composition is maintained in a normal physiologic range by regulatory mechanisms that control sodium and water metabolism. A detailed knowledge of the homeostatic mechanisms will help in understanding the pathogenesis and management of disorders of sodium and water balance.

    Objectives

    After completing this article, readers should be able to:

    1. Understand the distribution of fluid and solute in different body compartments.

    2. Demonstrate the homeostatic mechanisms involved in maintaining sodium and water metabolism.

    3. Calculate osmolality and recognize the clinical importance of maintaining osmotic equilibrium.

    4. Recognize common disorders of hypernatremia or hyperosmolality and evaluate and understand the role of calculating free water deficit in the treatment of these disorders.

    5. Recognize common disorders of hyponatremia or hypo-osmolality, appreciate the role of urine sodium and urine osmolality in evaluation, and understand the importance of slow correction of these disorders.

    Case Scenario

    A 6-month-old infant presents to the emergency department with vomiting for 3 days. He is lethargic and has a weak cry. His vital signs reveal an elevated heart rate (140 beats per minute), and physical examination findings are remarkable for dry mucous membranes. His capillary refill is more than 2 seconds. His initial laboratory values are as follows: serum sodium, 122 mEq/L (122 mmol/L); blood urea nitrogen (BUN), 28 mg/dL (10 mmol/L); serum creatinine, 0.4 mg/dL (35 μmol/L); serum glucose, 90 mg/dL (5.0 mmol/L); and serum osmolality (Sosm), 260 mOsm/kg (260 mmol/kg). Urinalysis reveals a specific gravity of 1.030, pH 6.5, and negative results for blood, protein, leukocyte esterase, or nitrite. Additional urine studies reveal a urine osmolality of 900 mOsm/kg (900 mmol/kg) and a urine sodium level of 6 mEq/L (6 mmol/L). A detailed history also …

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    In this issue

    Pediatrics in Review: 36 (4)
    Pediatrics in Review
    Vol. 36, Issue 4
    1 Apr 2015
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    Body Fluid Composition
    Amrish Jain
    Pediatrics in Review Apr 2015, 36 (4) 141-152; DOI: 10.1542/pir.36-4-141

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    Body Fluid Composition
    Amrish Jain
    Pediatrics in Review Apr 2015, 36 (4) 141-152; DOI: 10.1542/pir.36-4-141
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    • Article
      • Educational Gap
      • Objectives
      • Case Scenario
      • Introduction
      • Total Body Water
      • Solute Composition of Body Water
      • Water and Solute Movement: Osmotic Equilibrium
      • Osmolality
      • Water Metabolism
      • Sodium Metabolism
      • Hyperosmolality and Hypernatremia
      • Hypo-osmolality and Hyponatremia
      • Case Scenario Continued
      • References
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