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and osmolarity If the body regulates the total osmotic content of the ECF and regulates its osmolarity, it has accomplished the task of regulating its volume This is precisely what the kidneys do They regulate ECF osmolarity and total osmotic content Recall that more than 90% of the ECF osmotic content is accounted for by sodium and the equal number of anions that must accompany it To a first approximation, total ECF osmotic content 5 sodium content 3 2 The other 10% of the ECF solute is accounted for by substances such as potassium, glucose, urea, and so on The regulation of solutes other than sodium occurs for purposes unrelated to control of ECF osmolality, so that the regulation of osmotic content amounts to the regulation of sodium content Figure 7 8 shows how the ECF volume changes when the body takes on sodium loads and Figure 7 9 shows the excretory response to those loads In simple terms, long-term regulation of arterial blood pressure involves longterm control of body sodium content If the body controls sodium content and plasma osmolarity (the water content containing the sodium), it controls volume

he told them No team had ever won three in a row, he said; maybe none ever would (And as of this writing, no other team has) But this year, he said passionately, we have that chance! The championship ring that the Packers earned at the end of that season by beating the Oakland Raiders has three diamonds across its face, representing the three consecutive championships And on one side of the ring is the word CHALLENGE When creating your vision, you must look beyond current reality Don t make the mistake of limiting your vision by what seems possible today If you do, you will confine your vision to what appears to be realistic and where is the inspiration to be found in that

control of sodium and water excretion / 115

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Figure 7 8 Relation between sodium and extracellular fluid (ECF) Normal volume Each large rectangle repreICF ECF sents total-body water divided into an ICF (open areas) and ECF (shaded areas) The ECF is further subdivided into interstitial and plasma volumes Excess interstitial Excess sodium is almost always acsodium and water companied by water, so that excess ICF ECF sodium causes an expansion of the ECF volume If there is no change in osmolality, as shown in the middle Excess example, the expansion is entirely interstitial sodium in the ECF and there is no change in only ICF ECF ICF volume If there is excess sodium without excess water, as shown in the bottom example, water is drawn from the ICF to maintain equal osmolalities between compartments In both cases of excess sodium, the increase in ECF volume causes an increase in both plasma and interstitial volumes ICF, intracellular fluid; ECF, extracellular fluid

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