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From Finch to Fish to Man: Role of Body Fluid Volume Regulation. Robert W. Schrier, MD Professor of Medicine University of Colorado School of Medicine. Darwin’s Origin of the Species. “The constancy of the Milieu Int é rieur is the condition of free and independent existence”.

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from finch to fish to man role of body fluid volume regulation
From Finch to Fish to Man:Role of Body Fluid Volume Regulation

Robert W. Schrier, MD

Professor of Medicine

University of Colorado

School of Medicine

the constancy of the milieu int rieur is the condition of free and independent existence
“The constancy of the Milieu Intérieur is the condition of free and independent existence”

Claude Bernard

19th Century French Physiologist

slide5

“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. Starling

The Fluids of the Body

The Harter Lectures, 1909

body fluid distribution
BODY FLUID DISTRIBUTION

COMPARTMENT AMOUNT VOLUME IN

70 KG MAN

Total Body Fluid 60% of Body Weight 42.0 liters

Intracellular Fluid 40% of Body Weight 28.0 liters

Extracellular Fluid

(ECF) 20% of Body Weight 14.0 liters

Interstitial Fluid Two-thirds of ECF 9.4 liters

Plasma Fluid One-third of ECF 4.6 liters

Venous Fluid 85% of Plasma Fluid 3.9 liters

Arterial Fluid 15% of Plasma Fluid 0.7 liters

new york heart association classes of cardiac failure associated hemodynamic and hormonal changes
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

slide14

PRETREATMENT SERUM SODIUM CONCENTRATION CORRELATES WITH PLASMA RENIN ACTIVITY IN PATIENTS WITH SEVERE HEART FAILURE

r=0.68

p<0.001

logey=0l7x+24.32

n=96

SEE=0.94

Plasma Renin Activity

(ng/ml/hr)

Pretreatment Serum Na Concentration (mEq/L)

slide16
Evidence for Non-Osmotic Release of Vasopressin in Hyponatremic Patients with Congestive Heart Failure
slide20
Plasma Effective Osmolality and Minimum Urinary Osmolality in Cardiac Failure Patients Before and During After-Load Reduction
slide24
Selective V2 Receptor Antagonism Decreases Urinary Osmolality in Patients with Chronic Heart Failure
the relationships between plasma avp levels and urinary excretion of aqp2 in normal subjects
The Relationships between Plasma AVP Levels and Urinary Excretion of AQP2 in Normal Subjects
slide35
Effect of Renal Denervation to Reverse Atrial Natriuretic Peptide Resistance in Experimental Congestive Heart Failure in Rats
slide37
Baseline Hemodynamic Data in Control Rats and Rats with High Output Cardiac Failure Secondary to Aorto-Caval Fistula
slide38
Hormonal Results in Control rats and Rats with High Output Cardiac Failure Secondary to Aorto-Caval Fistula