The sizes of the body fluid compartments can be altered under a variety of normal and pathophysiologic circumstances. In attempting to analyze how this happens, several principles must be kept in mind. The first is that most cell membranes are highly permeable to water, so that at all times the body fluid compartments are isotonic with the plasma; the only exception is the renal medulla, which is discussed in Chapters 27 and 28. The second is that the driving force for water movement across biologic barriers is a difference in the effective osmolarity across those barriers. As will be discussed in Chapter 3, the effective osmolarity is determined only by those solutes that exert an osmotic force across the membrane.
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