Interstitial fluid colloid osmotic

Plasma colloid osmotic pressure is generated by proteins in the plasma that cannot cross the capillary wall. These proteins exert an osmotic force, pulling fluid into the capillary. In fact, the plasma colloid osmotic pressure, which is about 28 mmHg, is the only force holding fluid within the capillaries. Interstitial fluid colloid osmotic pressure is generated by the small amount of plasma proteins that leaks into the interstitial space. Because these proteins... 

Figure 15.7 Starling principle a summary of forces determining the bulk flow of fluid across the wall of a capillary. Hydrostatic forces include capillary pressure (Pc) and interstitial fluid pressure (PJ. Capillary pressure pushes fluid out of the capillary. Interstitial fluid pressure is negative and acts as a suction pulling fluid out of the capillary. Osmotic forces include plasma colloid osmotic pressure (np) and interstitial fluid colloid osmotic pressure (n,). These forces are caused by proteins that pull fluid toward them. The sum of these four forces results in net filtration of fluid at the arteriolar end of the capillary (where Pc is high) and net reabsorption of fluid at the venular end of the capillary (where Pc is low).

Increased capillary permeability may allow plasma proteins to leak into the interstitial spaces of a tissue. The presence of excess protein in these spaces causes an increase in interstitial fluid colloid osmotic pressure and pulls more fluid out of the capillaries. Mediators of inflammation such as histamine and bradykinin, which are active following tissue injury and during allergic reactions, increase capillary permeability and cause swelling. 

Osmosis outward through the membrane is caused by interstitial fluid colloid osmotic pressure. 

Understanding the effects of colloid administration on circulating blood volume necessitates a review of those physiologic forces that determine fluid movement between capillaries and the interstitial space throughout the circulation (Fig. 10—5).4 Relative hydrostatic pressure between the capillary lumen and the interstitial space is one of the major determinants of net fluid flow into or out of the circulation. The other major determinant is the relative colloid osmotic pressure between the two spaces. Administration of exogenous colloids results in an increase in the intravascular colloid osmotic pressure. In the case of isosomotic colloids (5% albumin, 6% hetastarch, and dextran products), initial expansion of the intravascular space is essentially that of the volume of colloid administered. In the case of hyperoncotic solutions such as 25% albumin, fluid is pulled from the interstitial space into the vasculature... 

FIGURE 10-5. Operative forces at the capillary membrane tending to move fluid either outward or inward through the capillary membrane. In hypovolemic shock, one therapeutic strategy is the administration of colloids that can sustain and/or draw fluid from the interstitial space by increasing the plasma colloid osmotic pressure. (Reprinted from Guyton AC, Hall JE. Textbook of Medical Physiology. 8th ed. Philadelphia Saunders,... 

Although the interstitial fluid hydrostatic pressure is "negative," it causes fluid to be pulled out of the capillary, so this pressure is "added" to the other outward forces. The only force pulling fluid into the capillary is the plasma colloid osmotic pressure ... 

Oncotic pressure (or colloid osmotic pressure) is the osmotic pressure that results from the difference between the protein (mainly albumin) concentrations of plasma and the interstitial fluid. Water is lost from the body via feces, urine, salivation, insensible respiration, and through the skin, with sensible perspiration of sweat occurring in a few species. Although the movement of proteins between spaces is restricted, water and small ions can move across permeable membranes between the spaces. The volume of ECF is highly dependent on its sodium concentration and, under physiological conditions, the sodium ion concentrations of plasma and interstitial fluids are similar. 

Hydrostatic and colloid osmotic pressures within the blood and interstitial fluid primarily govern transcapillary fluid shifts (Figure 61.1). Although input arterial pressure averages about 100 mmHg at heart level, capillary blood pressure Pc is significantly reduced due to resistance R, according to the Poiseuille s equation ... 

In principle, osmosis can result either in an increase of concentration (by external expenditure of mechanical work) or in a decrease of concentration. The former—the increase of concentration by pressure—is found in the colloid-osmotic phenomena (see below). The second is far more common, since it corresponds to spontaneously occurring processes. In the organism, osmosis is primarily responsible for shifting fluids among the various fluid compartments for example, if much salt has penetrated into the interstitial space, then water is removed from the cells by osmosis, whereby the concentration inside the cells goes up. 

Protein colloids contain larger molecules and have a longer intravascular residence time than crystalloids, but eventual fluid loss to the extravascular space does occur. Protein colloids, such as albumin and PPF, are prepared from pooled human blood and, therefore, carry with them a risk of transmission of viral infection or induction of anaphylaxis. The PPF is a 5% mixture (5 g of protein in 100 ml of 0.9% NaCI solution) of proteins that is osmotically equivalent to human plasma. The composition of the protein mixture is 83 to 90% albumin. Albumin typically is administered as either a 5 or 25% solution. By definition, albumin preparations must be composed of a protein mixture that is more than 90% albumin. Generally, PPF is favored over albumin for fluid resuscitation, because albumin appears to cause more interstitial edema. 

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