INTEGROVANÉ MODELY FYZIOLOGICKÝCH SYSTÉMŮ

MUDr. Jiří Kofránek, CSc. INTEGROVANÉ MODELY FYZIOLOGICKÝCH SYSTÉMŮ Habilitační práce Praha 28. února 20

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výzkumný grant GAUK 242/995/C (995- - - - - - - - - - - iii

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Motto: Snili jsme po léta o instituci nezávis- v

Úvod 2 Virtuální pacient...2 vi

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wyer, Hara, Thompson, Chan, & Berg, 2009). Trenažéry Laerdal se osvědčily nejen ve výuce lékařů, ale i ve výuce sester (Cason, Kardong-Edgren, Cazzell, Behan, & Mancini, 2009). Druhým úspěšným výrobcem je americká firma METI, jejíž robotizované trenažéry jsou velmi efektivní (i když nákladnou) výukovou pomůcka pro výcvik anesteziologů a zdravotnických týmů zejména v oblasti medicíny akutních stavů (Sethi, Peine, Mohammadi, & Sundaram, 2009; Ellaway, Kneebone, Lachapelle, & Topps, 2009). Pořídit si drahý simulátor k efektivní výuce samo o sobě ale nestačí. Jak, zvláště v poslední době, upozorňuje řada autorů, výuka se simulátorem klade citelně vyšší nároky na vyučujícího, než klasická výuka. Při správném využití simulátoru, je však pedagogický efekt velmi výrazný, zvláště v takových oblastech, kde je rychlé a správné rozhodování velmi důležité, například v medicíně akutních stavů a v anesteziologii (Binstadt, Walls, White, Nadel, Takavesu & Barker; Lammers, 2006; Day, 2006; Wayne, Didwania, Feniglass, Fudala, Barsuk & McGaghie, 2008; Rosen, 2008; Kobayashi, Patterson, Overly, Shapiro, Williams & Jay, 2008; Jones & Lorraine, 2008; McGaghie, Siddall, Mazmanian & Myers, 2009). Vzhledem k technologickým i personálním nárokům proto vznikla na řadě předních univerzit i mimo ně specializovaná simulační centra pro lékařskou výuku na simulátorech, např. na Harwardu existuje Center for Medical Simulation - http://www.harvardmedsim.org/, v Oxfordu se problematikou lékařské výuky na simulátorech zabývá Oxford Simulation Centre - http://www.oxsim.ox.ac.uk/, a v Izraeli vzniklo štětře dotované Israel Center for Medical Simulation - http://www.msr.org.il/. Obr. 3 Guytonův grafický diagram regulace krevního oběhu z roku 972. 5

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- -. - - - t v = gt v = ds = gt dt gt s = 2 2 t = 2s g - - - - 8

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0 - - - -. - s

85 58A.4 84 83.3333 AHC AH + 85 58A.4 84 83.3333 AHC AH + + + RCD 332 0 33 RC + + RCD 332 0 33 RC - + HM 40 336 HMK 600 HM2 HKM VIE.5 337 HM 40 336 HMK 600 HM2 HKM VIE.5 337 - + 40 40 0 + QAO DVS QVO 5 6 0 VVS 3.257 5 + QAO DVS QVO 5 6 0 VVS 3.257 5 Chyba! Opraveno Opraveno Opraveno Opraveno Opraveno Chyba! Chyba! Chyba! Chyba!

269 268 52 267 u^3 P40^3 266 P4O 8.000 s xo AR s xo AR2 288 upper limit 8 PO 520 A3K 289 s x o AOM 287 02M 68 270 POT RDO OSV 26 POV 262 2688 263 DOB 264 MO2 265 2400 27 u^3 POT^3 x27 o s 272 POT QO2 0.00333 AK A2K 20 AR3 POC POB POA 286 283 260 s xo 0.7 40 POD POK 0.06 PON 0. 259 258 257 256 255 POV ARM 0.9457 POR ARM 40 290 AR 284 POJ 284b 0.33 0.3 if (POD<0) {POJ=PODx3.3} POZ 29 POT 292 POQ 8 8 upper limit 8 PA lower limit 4 00 294 POQ 8 3 293 P2O 296 8 295 298 297 EXE.24 EXC Z2 AUC CALCULATION PA when PA<40: AUC=.2 AUC PA AUC when 40>PA<80: AUC=0.03*(80-PA) when PA>=80: AUC=0 307 302 303 AUC calculation AU6 AB 30 DAU AUK AU2 u^3 AUB^3 304 AUB CALCULATION 0.0005 308 305 AUB when PA<40: AUB=.8578 PA AUB when 40>PA<70: AUB=0.04286*(70-PA) when PA>=70: AUB=0 s x o Z8 AUB calculation 309 0 6 AU8 AUZ AUN CALCULATION AUN 30 when PA<50: AUN=6 PA AUN when 20>PA<50: AUN=0.2*(50-PA) 3 AUJ when PA>=50: AUC=0 AU s xo AUN calculation AUJ^AUZ 37 36 0.2 AUM AU9.00 VV9 AUV 32 AUL 3.59 0.85 34 AU 0.3 33 VVR 0.5 AUD 2.95 0.7 VVR 35 2.949 AUH AUH AUY 39 320 38.00 0.5 AUM AVE AVE SVO 328 QLO 5 lower limit 50 0.07039 SVO HR 326 8 POT 7.999 57.4 lower limit 0.3 lower limit 0.2 lower limit 0.5 32 327 323 324 325 HMD 0.5 40 POV AAR-afferent arteriolar resistance [torr/l/min] AHM-antidiuretic hormone multiplier, ratio of normal effect AM-aldosterone multiplier, ratio of normal effect AMC-aldosterone concentration AMM-muscle vascular constriction caused by local tissue control, ratio to resting state AMP-effect of arterial pressure on rate of aldosterone secretion AMR-effect of sodium to potassium ratio on aldosterone secretion rate AMT-time constant of aldosterone accumulation and destruction ANC-angiotensin concentration ANM-angiotensin multiplier effect on vascular resistance, ratio to normal ANN-effect of sodium concentration on rate of angiotensin formation ANP-effect of renal blood flow on angiotensin formation ANT-time constant of angiotensin accumulation and destruction ANU-nonrenal effect of angiotensin AOM-autonomic effect on tissue oxygen utilization APD-afferent arteriolar pressure drop [torr] ARF-intensity of sympathetic effects on renal function ARM-vasoconstrictor effect of all types of autoregulation AR-vasoconstrictor effect of rapid autoregulation AR2-vasoconstrictor effects of intermediate autoregulation AR3-vasoconstrictor effect of long-term autoregulation AU-overall activity of autonomic system, ratio to normal AUB-effect of baroreceptors on autoregulation AUC-effect of chemoreceptors on autonomic stimulation AUH-autonomic stimulation of heart, ratio to normal 40 HM 2.8 40 5 32 5 BFN 322 2 PRA 40 AU 2.86 0 OVA 200 AR3 0.025 225 227 226 OVA 98.7 224 OSA 223 VPF 40 RMO BFM OVA 200 0.5 5 PLA 0 70 PPA 0.4667 36 28 5 PPC 0.55 37 0.000225 38 PCP PPC 39 POS PPI 40 BFM HM ARM.6 VIM CPF 0.0003 PFI 4 PLF 228 DFP 0.025 240 PM3 PK2 245 800 PMO AU 254 AMM 229 lower limit.00 239 237 02A PK PK3 0.5 PM^2 u^2 2500 253 246 230 5 236 238 QOM PM4 0.25-247 252 0.7 P2O AOM 23 2400 8 x o 235 Xo P2O POE upper limit 8 s 7.987 lower limit.005 DVS 248 25 24 RMO 8.000 232 57.4 60 234 242 P3O PVO 244 250 P3O^3 u^3 233 POM 0.08 PM5 243 PDO 22 PMO 249 8 52 EXC 40 PVO AOM AMM 0.9899 65 s 64 VV7 0 SRK 33 VV6 63 VV7 VV2 VV7 0.0095 6 VV 62 0.30 VVE 0.5 algebraic ANM 40 loop AVE breaking lower limit 0.95 42 4A 36 38 CN7 0 ANU.79 43 RV AMM 0.022 0.2 VIM RVS RSM 4 39 RAM RV CN2 96.3 AUM 7 7 35 ANU RAM 2.9 3 VIM 37 BFM PGS PC RAR 2.782 30.5 AUM 7 RAR PAM PAM.04 RVS.2 VVE AUM AUM 34 BFM 00 RBF 0.3229 VV7 0 4 PA BFN QAO PVS 99.96 5 6 VVR 2.86 3.78 0.495 0.00355 VBD DVS 2.95 3 7 8 2 9 33 RSN VVS VV8 32 BFN s PA PGS 3.25 x PVS VAS VAE o s VVE lower limit 0.000 QVO 0.3 0.0825 0.85 x o 2.8 VVS 3.7 00 QVO CV PVS VAS3 DAS 60 VAS VVS PA 59 VB 29 HSL.4 58 VLA 5 LVM 5 30 QAO QLN VPA VRA HMD LVM PA2 QLO HPL PVS PLA 5.085 45 QLO 46 QLO 0 0.02244 PR 260 0.6 PVS PLA LVM = f(pa2) QLN QRF 44 0 27 47 RVG 28 2.738 5 0. VLE CPA RVM 0.4 PLA 54 53 49 26 QLN 48 AUH HSR 25 VLA sqrt 0 RPA QVO 50 QLO -4 20 PP.4 HPR VLA QLN = f(pla) s 56 HMD 55 HMD x 2 o RPV RVM QRO lower limit 0 0.4 0.0357 6 DRA 20 52 5 0. DLA 24 57 PP2 3 PL 50 PLA x o RPT AUH 5 QRN PRA 0.026 PPA VRA s AUH PR 0 lower limit 4-4 20 QRN = f(pra) VRA PPA QPO 5.22 9 8 5 23 PLA 20 QRO 4 0.005 RPT PRA 22 2 QPO VPE VPA PRA 0. PGL PPA s x 0.09925 o 0.38 0 0.30625 5 0.0048 VPA PLF 45 AUK-time constant of baroreceptor adaptation AUL-sensitivity of sympathetic control of vascular capacitance AUM-sympathetic vasoconstrictor effect on arteries AUN-effect of CNS ischemic reflex on auto-regulation AUV-sensitivity control of autonomies on heart function AUY-sensitivity of sympathetic control of veins AUZ-overall sensitivity of autonomic control AVE-sympathetic vasoconstrictor effect on veins AlK-time constant of rapid autoregulation A2K-time constant of intermediate autoregulation A3K-time constant of long-term autoregulation A4K-time constant for muscle local vascular response to metabolic activity BFM-muscle blood flow [l/min] BFN-blood flow in non-muscle, non-renal tissues [l/min] CA-capacitance of systemic arteries [l/torr] CCD-concentration gradient across cell membrane [mmol/l] CHY-concentration of hyaluronic acid in tissue fluids [g/l] CKE-extracellular potassium concentration [mmol/l] CKI-intracellular potassium concentration [mmol/l] CNA-extracellular sodium concentration [mmol/l] CNE-sodium concentration abnormality causing third factor effect [mmo/l] CPG-concentration of protein in tissue gel [g/l] CPI-concentration of protein in free interstitial fluid [g/l] CPN-concentration of protein in pulmonary fluids [g/l] CPP-plasma protein concentration [g/l] CV-venous capacitance [l/torr] DAS-rate of volume increase of systemic arteries [l/min] DFP-rate of increase in pulmonary free fluid [l/min] DHM-rate of cardiac deterioration caused by hypoxia DLA-rate of volume increase in pulmonary veins and left atrium [l/min] 0 5 x s o CPP 46 42 VPF 47 PPN 44 50 CPN 49 PPR VPF 0.4 5 s x o 0.375 PPD 7.866e-008 48 PPD POS 0 PPI 43 2-(0.5/u) PPI = 2 - (0.5/VPF) 0.025 0.0003 DFP -4.842e-00 0.0252 VPF PLF 52 PPO DLP-rate of formation of plasma protein by liver [g/min] DOB-rate of oxygen delivery to non-muscle cells [ml O2/min] DPA-rate of increase in pulmonary volume [l/min] DPC-rate of loss of plasma proteins through systemic capillaries [g/min] DPI-rate of change of protein in free interstitial fluid [g/min] DPL-rate of systemic lymphatic return of protein [g/min] DPO -rate of loss of plasma protein [g/min] DRA-rate of increase in right atrial volume [l/min] DVS-rate of increase in venous vascular volume [l/min] EVR-postglomerular resistance [torr/l] EXC-exercise activity, ratio to activity at rest EXE-exercise effect on autonomic stimulation GFN-glomerular filtration rate of undamaged kidney [l/min] GFR-glomerular filtration rate [l/min] GLP-glomerular pressure [torr] GPD-rate of increase of protein in gel [l/min] GPR-total protein in gel [g] HM-hematocrit [%] HMD-cardiac depressant effect of hypoxia HPL-hypertrophy effect on left ventricle HPR-hypertrophy effect on heart, ratio to normal HR-heart rate [beats/min] HSL-basic left ventricular strength HSR-basic strength of right ventricle HYL-quantity of hyaluronic acid in tissues [g] IFP-interstitial fluid protein [g] KCD-rate of change of potassium concentration [mmol/min] KE-total extracellular fluid potassium [mmol] KED-rate of change of extracellular fluid potassium concentration [mmol/min] KI-total intracellular potassium concentration [mmol/l] 0.9897 8 POT VIM 329 339 VIM PO 8.25 PO2 338 0.333.5 lower limit 0.2375 VIE 337 POY 464e-7 330 0.00092 RC 40 HM2 336 33 336c RCD 2 332 336b 600 s HM 2 335 HM 40 VRC 40 0.0000058 333 RKC 334 00 VB VRC VRC RC2 2 0.3 5 00 HSL 5 PA 00 340 PPA4 34 u^0.625 PA4^0.625 HPL 342 343 RR GFN 205 200 0.25 208 0.0078 EVR PFL 99 AAR 98 AAR PPC 209 5.66 8 GLP 5 3.67 203 GF4 20 VIM algebraic GF3 loop breaking GF3 97 2 VIM 202 APD 96 GP3 upper limit 5.0 lower limit 0.4 AAR RFN.5.2 95 ARF 20 207.2 lower limit 0 RFN RBF lower limit 0.35 RBF.2 RFN AUM 00.2 REK 28 PPC HSR PPA 5 345 PP3 346 u^0.625 PP3^0. 347 348 HPR 344 349 x s x s o o HPR HPL KID-rate of potassium intake [mmol/min] KOD-rate of renal loss of potassium [mmol/min] LVM-effect of aortic pressure on left ventricular output MMO-rate of oxygen utilization by muscle cells [ml/min] M02--rate of oxygen utilization by non-muscle cells [ml/min] NAE-total extracellular sodium [mmol] NED-rate of change of sodium in intracellular fluids [mmol/min] NID-rate of sodium intake [mmol/min] NOD-rate of renal excretion of sodium [mmol/min] OMM-muscle oxygen utilization at rest [ml/min] OSA-aortic oxygen saturation OSV-non-muscle venous oxygen saturation OVA-oxygen volume in aortic blood [ml O2/l blood] OVS-muscle venous oxygen saturation O2M-basic oxygen utilization in non-muscle body tissues [ml/min] PA-aortic pressure [torr] PAM-effect of arterial pressure in distending arteries, ratio to normal PC-capillary pressure [torr] PCD-net pressure gradient across capillary membrane [torr] POP-pulmonary capillary pressure [torr] PDO-difference between muscle venous oxygen PO2 and normal venous oxygen PO2 [torr] PFI-rate of transfer of fluid across pulmonary capillaries [l/min] PFL-renal filtration pressure [torr] PGC-colloid osmotic pressure of tissue gel [torr] PGH-absorbency effect of gel caused by recoil of gel reticulum [torr] PGL-pressure gradient in lungs [torr] PGP-colloid osmotic pressure of tissue gel caused by entrapped protein [torr] PGR-colloid osmotic pressure of interstitial gel caused by Donnan equilibrium [torr] PIF-interstitial fluid pressure [torr] PLA-left atrial pressure [torr] 57600 57600 8 POT 350 6 0.0025 35 DHM 352 x o s upper limit HMD HMD 206 GFR 22 25 28 27 26 AM AHM 23 24 AM 220 29 22 NOD 6 CNY 222 2.9 RVS 66 DP0.6379 79 PPD 0.007 PVG BFN 67 0 DPL 2.8 77 78 3.7 PVS 85 DLP 0.04 PC LPK CPR DPP 7 0.00047 5 VB PC 5.004 6.8 80 70 VB 68 6 VRC 62 CPP PRP 2 s xo 20 VP 72 VP CFC 69 PPC PIF 0.007 28 0.4-6.3 CPP 6.8 69.77 VTC PTC 73 PPC 0.002 74 CPP 5 u^3 75 0.00902 VTC PC^3 CP 74.6283e-007 CPK CPI TVD 0.00 DPC 70 0.04 7 0.00 VUD VPD VP 0.0384 3 x s DFP o 3 20 DPC 0 3.004 VTL 0.002 VP 0.002 0.00899 VTL 5.038 0.002 PTC 5 PTC 05 0.25 0.04 0 VTC 83 VID VTD 2 84 x o s 2 VTS.99 VTS 85 PTT = (VTS/2)^2 (u/2)^2 PTT 0.4 VG 57 HYL 0.00 93 89 CHY -5.9 DPC VTL AHM AM 94 95 PGR PGC 90 DPL VIF PGP PLD-pressure gradient to cause lymphatic flow [torr] PLF-pulmonary lymphatic flow [torr] PMO-muscle cell PO2 [torr] POD-non-muscle venous PO2 minus normal value [torr] POK-sensitivity of rapid system of autoregulation PON-sensitivity of intermediate autoregulation POS-pulmonary interstitial fluid colloid osmotic pressure [torr] POT-non-muscle cell PO2 [torr] POV-non-muscle venous PO2 [torr] POY-sensitivity of red cell production POZ-sensitivity of long-term autoregulation PO2-oxygen deficit factor causing red cell production PPA-pulmonary arterial pressure [torr] PPC-plasma colloid osmotic pressure [torr] PPD-rate of change of protein in pulmonary fluids PPI-pulmonary interstitial fluid pressure [torr] PPN-rate of pulmonary capillary protein loss [g/min] PPO-pulmonary lymph protein flow [g/min] PPR-total protein in pulmonary fluids [g] PRA-right atrial pressure [torr] PRM-pressure caused by compression of interstitial fluid gel reticulum [torr] PRP-total plasma protein [g] PTC-interstitial fluid colloid osmotic pressure [torr] PTS-solid tissue pressure [torr] PTT-total tissue pressure [torr] PGV-pressure from veins to right atrium [torr] PVG-venous pressure gradient [torr] PVO-muscle venous PO2 [torr] PVS-average venous pressure [torr] QAO-blood flow in the systemic arterial system [l/min] 0.8 TRR 87 20 0.03826 DPL VTL lower limit 5 08 DPL 0.04 02 DPI 2 GPD 0 PTS = f(vif) 86 VG 0 s x o.4 VGD 00 V2D 0. VUD lower limit 0.0003 0.00 0.025 PTC 9 000 0 PG2 24.2 PIF CNE PTS 03 x s o 07 VUD 0.00008 20.5 CPI -6.328 PIF PIF -6.3 88 0. 2.5 CNX PTS PIF 92 PRM IFP PLD 06 0.004 PIF 7.8 97 96 u^2 CHY^2 CPI 20 04 VIF NOD 0.005 PTT 0.0005 VG 3 0.03332 98 99 0 09 GP GP2 GPD 7 2 x o s PGH GPR 0.25 92 93 94 8 POT STH STH 8.25 4 TVD lower limit 0.002 Z0 Z 0 90 9 AHM 0.0 TVD 0.00003 0.009 89 AHM AH4 6 AHM CNZ CNA CN8 CNR 39 77 PRA AHZ 2 AU 8 88 AH2 6 87 0 u 78 79 AH7 0.0007 AH8 lower_limit_0 62 ANM 63 AN5.004 lower limit 0.7 AN3 6 ANM 4.0 0 u REK 53b 53a.2 RFN (.2/u)^3 (.2/RFN)^3 0 CNE 0 42 CNA CNE ANM 52 0..002 AM ANM 64 4 PA 00 0.00352 CKE CNA 32 VIC 3 KI s x o 3550 KCD 2 KED 0.0028 KID 75 20 KOD REK NOD NED 230 0. 6 STH 0.025 QLN-basic left ventricular output [l/min] QLO-output of left ventricle [l/min] QOM-total volume of oxygen in muscle cells [ml] QO2-non-muscle total cellular oxygen [ml] QPO-rate of blood flow into pulmonary veins and left atrium [l/min] QRF-feedback effect of left ventricular function on right ventricular function QRN-basic right ventricular output [l/min] QRO-actual right ventricular output [l/min] QVO-rate of blood flow from veins into right atrium [l/min] RAM-basic vascular resistance of muscles [torr/l/min] RAR-basic resistance of non-muscular and non-renal arteries [torr/l/min] RBF-renal blood flow [l/min] RC-red cell production rate [l/min] RC2-red cell destruction rate [l/min] RCD-rate of change of red cell mass [l/min] REK-percent of normal renal function RFN-renal blood flow if kidney is not damaged [l/min] RKC-rate factor for red cell destruction RM0-rate of oxygen transport to muscle cells [ml/min] RPA-pulmonary arterial resistance [torr/l/min] RPT-pulmonary vascular resistance [torr/l/min] RPV-pulmonary venous resistance [torr/l/min] RR-renal resistance [torr/l/min] RSM-vascular resistance in muscles [torr/l] RSN-vascular resistance in non-muscle, n/minon-renal tissues [torr/l/min] RVG-resistance from veins to right atrium [torr/l/min] RVM-depressing effect on right ventricle of pulmonary arterial pressure RVS-venous resistance [torr/l/min] SR-intensity factor for stress relaxation SRK-time constant for stress relaxation 42 5 42 3 2 0 CKI 74 AM 20.039 73 AM5 AMP AMR 200 AMP = f(pa) 65 66 KN lower limit 6 9 33 CNA NID 0. VPF 4 5 VEC VP VTS CCD 0.0 9 AH 0.3333 AH lower limit 3 67 3.454e-006 VID 0 34 VID 25 86 80 s 3.3 60 AN2 AN AM3 AM AMT 60 69 35 x s o 83 68 5 ANT AHC 0.0785 85 s AHY ANC 30 29 28 2850 KE 27 0.03 CKE 5 40 AM 0.0004 22 23 5 KE CKE 24 x s o 25 26 0.00042 x s o NAE VIC VTW CNA 39.99 VTW CNA 42. 0.042 STH-effect of tissue hypoxia on salt and water intake SVO-stroke volume output [l] TRR-tubular reabsorption rate [l/min] TVD-rate of drinking [l/min] VAS-volume in systemic arteries [l] VB-blood volume [l] VEC-extracellular fluid volume [l] VG-volume of interstitial fluid gel [l] VGD-rate of change of tissue gel volumes [l/min] VIB-blood viscosity, ratio to that of water VIC-cell volume [l] VID-rate of fluid transfer between interstitial fluid and cells [l/min] VIE-portion of blood viscosity caused by red blood cells VIF-volume of free interstitial fluid [l] VIM-blood viscosity (ratio to normal blood) VLA-volume in left atrium [l] VP-plasma volume [l] VPA-volume in pulmonary arteries [l] VPD-rate of change of plasma volume [l] VPF-pulmonary free fluid volume [l] VRA-right atrial volume [l] VTC-rate of fluid transfer across systemic capillary membranes [l/min] VTD-rate of volume change in total interstitial fluid [l/min] VTL-rate of systemic lymph flow [l/min] VTW-total body water [l] VUD-rate of urinary output [l/min] VV7-increased vascular volume caused by stress relaxation [l] VVR-diminished vascular volume caused by sympathetic stimulation [l] VVS-venous vascular volume [l] Z8-time constant of autonomic response 42 9.8 VIC 58A 84 59 72 0 u 7-0.07 s AMC x70 o 0.4 AM2 NON-MUSCLE OXYGEN DELIVERY NON-MUSCLE LOCAL BLOOD FLOW CONTROL 278 277 276 275 274 273 285 282 28 280 279 AUTONOMIC CONTROL HEART RATE AND STROKE VOLUME u v MUSCLE BLOOD FLOW CONTROL AND PO2 s xo PULMONARY DYNAMICS AND FLUIDS 0 0 s xo RVM = f(pp2) 0 0 CIRCULATORY DYNAMICS VASCULAR STRESS RELAXATION s xo x o RED CELLS AND VISCOSITY HEART HYPERTROPHY OR DETERIORATION s xo s xo KIDNEY DYNAMICS AND EXCRETION CAPILLARY MEMBRANE DYNAMICS 0 0 TISSUE FLUIDS, PRESSURES AND GEL THIRST AND DRINKING 75 76 82 ANTIDIURECTIC HORMONE CONTROL 54 55 56 57 58 0 0 7 8 ANGIOTENSIN CONTROL ALDOSTERONE CONTROL KCD KIE KIR ELECTROLYTES AND CELL WATER s xo LIST OF VARIABLES - - - - - 2

2-2 2 - - - - - - 2 - - - - [HCO - ] - ] - - - - pco - 3 BE=0 meq/l BE=-5 meq/l - - - - - - - -

[H ] pco [H - - 2 - pco - - [HCO - - ] - ph-6, - 0,043 chb 0,0304 pco20-24,26 9,5,63 chbph - 7.4 3 2.5 a 996,35-0,35 chb a2 = 35,6875 + 0,258750 chb a3 = -82,4000 + 2.0 chb; a4 = -5,276250 2-5,025000 chb a5 =2 - chb a6 = 2,625 + 0,025 chb a7 = -2,556-0,09 chb 2 a8 =3,87634 + 0,86653 chb + 0,00534936 chb a9 = 0,0548-0,0274 chb a0 = 0,274-0,037 chb BE BEox a (- so2) Y ( a7 a8 a9 BE )/a0 ph (a a2*y (a3 a4 Y) log (pco2))/(a5 a6 Y) 0 rozdíl BE [m m ol/l] 2.5 0.5 0-0.5-25 -20-5 -0-5 0 5 0 5 20 25 BE (mmol/l) 4

pco pco - pco - - - - po pco.. - - 2 2 - - - 2 2 5

- - - - - [H ] [OH - - ], Tot ] A tot - TOT ] - ] [H [H ] [HCO - pco [H ] [CO [HCO - ] - - - SID- ] - [Cl - ] - TOT ]pco [H ] SID [H ] SID - ] [H ] - [H ] - - pco - TOT ] phpco,, TOT ] TOT ] - ph 2 [Alb TOT ] 6

ph pco,, [Alb TOT ], ph pco,, [Alb TOT ],, pco ph - - - - 2 TOT - SID [H - - 7

plazma H2O H2CO3 HCO3 - CO2 H + HBuf Buf - H2O HCO3 - H2CO3 CO2 H + HBuf Cl - Buf - erytrocyt plazma Cl - H2O HCO3 - H2CO3 CO2 H + HBuf Buf - e e e - 2 2 8

. - - - - pco - 2 pco - - - - - pco - - - - - - BB Na - 2- - 4 2 PO 4-2- 4 - Na - - Alb - 9

Alb - Alb- st- ] sa- ] st- - - ] sa- - - - [Alb][HAlb ] ] - st- sa- ] Korekce Siggaard-Andersenova nomogramu na 37 C 00 90 80 70 BB 38 C BE 38 C BB 37 C BE 37 C 60 50 40 BB PCO2 [torr] 30 20 BE 0 6.8 6.9 7 7. 7.2 7.3 7.4 7.5 7.6 7.7 7.8 ph 20

- pco [PO - ] -. - - - pco 2 0 00 90 80 70 60 50 40-5 0 5 0 5-0 20 30-5 20 BE [mmol/l] -20 0 6.8 6.9 7 7. 7.2 7.3 7.4 7.5 7.6 7.7 7.8-2 ph

- - - pco - 2 2-2 O 2 2 2 - - 22

- 2 - + cth - + cth - - - 23

- - - - - - - - - - 24

- - -. - -. - - - 2 2 2 - - - - 25

- - Vstup: (simulace alveolární hypoventilace) 26

Vstup: (simulace anémie) 27

- 28

a CO 29

- 30

- -. - 3

- - - - 32

- - - 2 2-33

- - 34

busconnector CD_NH4 so YNH4 CD_KA_Outflow CD_PO4_Outflow Artys_pH DT_AldosteroneEffect Y Y Y YTA Y Renal acidificat PHU CD_cTH so YTA kidney_bloodflow vein tissueflow arty 35

- 36

37

- 2-2 -. - 38

00 Renal artery pressure RAP GFR 227. 00 AffC Afferent artery conductance G L O M E R U L U S FF 0.34 6.25 Normal proximal tubule conductance [ml /min /torr] 89 Reanl blood flow rate 665.8 Renal plasma flow rate 0.07 TubC RBF RPF APr INPUTS : RAP - Renal artery pressure [torr] Affc - Afferent artery conductance [mll /min /torr] TubC - Proximal tubule conductaqnce [ml /min /torr] RBF - Renal blood flow [ml /min ] RPF - Renal plasma flow APr - Plasma protein concentration (in afferent artery ) [g/ml ] GKf - Glomerular filtration coeffitient [ml /min /torr] OUTPUTS : GFR - Glomerular filtration rate [ml /min ] FF - Filtration fraction [relative number ] GP - Glomerulal pressure [torr] PTP - Proximal tubule pressure [torr] AVeCOP - Average colloid osmotic pressure [torr] NETP - Net pressure gradient in glomerulus [torr] GP PTP AVeCCP 88. 36.33 37.58 Plasma protein cnoncentration [g/ml ] 6 GKf NetP 4.9 Normal glomerular filtration coeffitient [ml /min /torr] Glomerulus - - - - - - - 39

29.89 RAP G L O M E R U L U S GFR 25 6.25 Normal proximal tubule conductance [ml /min /torr] 89 665.8 AffC TubC RBF RPF INPUTS : RAP - Renal artery pressure [torr] Affc - Afferent artery conductance [mll /min /torr] TubC - Proximal tubule conductaqnce [ml /min /torr] RBF - Renal blood flow [ml /min ] RPF - Renal plasma flow APr - Plasma protein concentration (in afferent artery ) [g/ml ] GKf - Glomerular filtration coeffitient [ml /min /torr] OUTPUTS : GFR - Glomerular filtration rate [ml /min ] FF GP PTP 0.904 60.3 20.29 PNa GFR N A T R I U M - P R O X I M A L T U B U L E INPUTS : PNa - Plasma sodium concentration [mmol /ml ] GFR - GLomerulal filtration rate [ml /min ] LogA 2 - Logarithm of plasma angiotensin concentration [pg/ml ] PrxFNaNorm - Normal value of sodium proximal fractional reabsorbtion [relative number ] MDNaFlow PdxNaReab 3.643 4.37 0.07 Plasma protein cnoncentration [g/ml ] 6 Normal glomerular filtration coeffitient [ml /min /torr] 00. APr GKf FF - Filtration fraction [relative number ] GP - Glomerulal pressure [torr] PTP - Proximal tubule pressure [torr] AVeCOP - Average colloid osmotic pressure [torr] NETP - Net pressure gradient in glomerulus [torr] Glomerulus M Y O G E N I C R E S P O N S E AVeCCP NetP 32.2 0.8 Normal Na proximal fractional reabsorbtion 7.8 LogA2 PrxFNaNorm OUTPUTS : MDNaFlow - Sodium outflow [mmol /min ] PdxNaReab - Proximal sodium reabsorbrtion [mmol /l] PrxFNa - Proximal fractional sodium reabsorbtion [relative number ] Calculation of proximal tubule sodium reabsorbtion PrxFNa 0.7977 R E N A L P E R F U S I O N AffC INPUTS : EffC AffC - Afferent artery conductance [ml /min /torr] EffC Efferent artery conductance [ml /min /torr] 200 RenVenC RenVenC - Renal venous conductance [ml /min /torr] Venous conductance AP - Arterial pressure [torr] [ml /min /torr] VP - Vena renalis pressure [torr] AP Hct - Hematocrit [relative number ] Clamp - Renal artery pressure drop 7 VP caused by renal artery clamp [torr] Vena renalis pressure [torr] Hct OUTPUTS : 0.44 RAP - Renal artery pressure [torr] Hematocrit Clamp RBF - Renal blood flow rate [ml /min ] RPF - Renal plasma flow rate [ml /min ] Calculation of renal artery pressure and renal blood flow rate 0 Renal artery pressure clamp drop [torr] RAP RBF RPF 29.89 INPUT : RAP RAP - Renal artery pressure [torr] AffMyo OUTPUT : AffC - Myogenic effect [ x Normal ] Calculation of the myogenic response to changes in renal perfusion pressure (afferent conductance responds to changes in perfusion pressure, with pressure increases causing vasoconstriction ) 89 665.8 A F F E R E N T A R T E R Y AffMyo INPUTS : AffMyo - Myogenic effect [ x Nomal ] AffC MDSig - Macula densa feedback signal [ x Normal ] MDSig AffNorm - Normal conductance in afferent artery [ml /min /torr] OUTPUT : AffC - Vascular conductance [ml /min /torr] AffNorm 30 0.9997 Normal conductance Calculates conductance of afferent artery of Afferent artery [ml /min /torr] AP E F F E R E N T A R T E R Y loga2 EffC INPUTS : loga 2 - logarithm of angiotensin concentration EffC MDSig - Macula densa feedback signal [ x Normal ] MDSig EffNorm - Normal conductance in afferent artery [ml /min /torr] ZNAE A R T E R I A L P R E S S U R E 25. OUTPUT : EffC - Vascular conductance [ml /min /torr] EffNorm 25 Normal conductance LogA2 INPUTS : ZNAE - ECF sodium content [mmol ] loga 2 - Logarithm of plasma angiotensin concentration [pg /ml ] AP AP 00. Calculates conductance of efferent artery of Efferent artery [ml /min /torr].003 APNorm - Normal value of arterial pressurel [torr] 00 APNorm [torr] APNorm OUTPUT : AP Arterial pressure [torr] M A C U L A D E N S A MDNaFlow Control of arterial pressure by angiotensin and extracellular sodium content INPUTS : MDNaFlow - Macula densa sodium flow [mmol /min ] MDSig loga 2 - Logarithm of plasma angiotensin concentration [pg /ml ] LogA2 MDNorm - Normal macula densa feedback signal [ x Normal ] LogA2 OUTPUT : MDSig - Macula densa feedback signal [ x Normal ] MDNorm LogA2 8.9.276 Scope A2 loga2 Scope A N G I O T E N S I N PRA INPUTS : PRA - Plasma renin activity [ Units /ml ] CEAct - Converting enzyme activity [x Normal ] CEAct A2Inf Angiotensin 2 infusion rate [ng /min ] OUTPUTS : A2 - Plasma angiotensin 2 concentration [ pg/ml ] A2Inf LogA 2 - logarithm of plasma angiotensin concentration [ pg /ml ]) 0.945 PRA Converting Enzyme Activity 0 Angiotensin Infusion Rate R E N I N INPUTS : MDSig - Macula densa feedback signal [ x Normal ] VECml - Ectracellular fluid volume OUTPUT : PRA - Plasma renin activity [ Units/ml ] Calculation of plasma renin activity MDSig VECm l Macula densa feedback signal calculation based on macula densa sodium flow and angiotensin concentration Normal macula densa feedback signal Calculation of plasma angiotensin concentration and logarithm of plasma angiotensin concentration (most of the action of angiotensin are logarithmic in nature : concentration changes at higher concentrations produce less of an effect than changes of the same size at lower concentrations ) VECml A L D O S T E R O N E loga2 LogA2 INPUTS : loga 2 - Logarithm of plasma angiotensin concentration [pg /ml ] Aldo AldoInf - Aldosterone infusion rate [ng /min ] VTW - Total body water content [ml ] OUTPUT : Aldo - Plasma aldosterone concentration [ ng/dl ] Calculation of plasma aldosterone concentration AldoInf 0 Aldosteron Infusion Rate VTWm l -C- Totasl body water content [ml ] Aldo MDNaFlow Aldo N A T R I U M - D I S T A L T U B U L E DisNaFlow INPUTS : MDNaFlow - Sodium inflow [mmol /min ] Aldo - Plasma aldosterone level [pg /ml ] DisFNaNorm - Normal value of sodium distal fractional reabsorbtion [relative number ] DisNaReab DistNaFlow.854.789 OUTPUTS : DisNaFlow - Sodium outflow [mmol /min ] 6.867 0.5 DisFNaNorm DisNaReab - Distal sodium reabsorbrtion [mmol /min ] DisFNa - Distal fractional sodium reabsorbtion DisFNa 0.509 Normal distal [relative number ] fractional reabsorbtion for Na Calculation of distal tubule sodium reabsorbtion 262 S I M P L E S O D I U M B A L A N C E 0.44 NaDiet 0.25 ZNAE INPUTS : NaDiet [mmol /min ] NaDIet - Dietary sodium intake [mmol /min ] NaUrine - Sodium urine outflow [mmol /min ] NaUrine VECml - Extracellular fluid volume [ml ] PNa OUTPUT : ZNAE - ECF sodium content [mmol ] VECm l 5000 PNa - Plasma sodium concentration [mmol /ml ] Extracellular fluid volume [mmol /min ] Extracellular sodium quantity is the integral over time dietary sodium intake minus urinary sodium loss 0.243.664 0.9305 NaUrine CDNaReab CDFNa N A T R I U M - C O L L E C T I N G D U C T INPUTS : DisNaFlow DisNaFlow - Sodium inflow [mmol /min ] CDFNaNorm - Normal value of sodium distal fractional reabsorbtion [relative number ] OUTPUTS : NaUrine - Sodium urine outflow [mmol /min ] CDNaReab - Collecting duct sodium reabsorbrtion [mmol /min ] CDFNaNorm CDFNa - Collecting duct fractional sodium reabsorbtion [relative number ] 0.93 Normal collecting duct fractional reabsorbtion for Na Calculation of collecing duct sodium reabsorbtion - 40

4 PVS RVS BFN BFM PA PPA PRA PLA QLO VVE PC VV7 VB VVR RBF AVE HPR HMD HPL ANM AMM AUM ARM VIM AUH HSR HSL AMM AOM P2O OVA AU EXC BFM HM VPF AUM PPC AM CNE AHM VIM REK PA AHM POT TVD STH AU CNA PRA RFN REK CNA CNE ANM RVS VUD BFN PVS VRC PIF PTC DFP TVD VTL PPD CPI DPL VB DPC PC VP CPP PPC VTC ANM PA CKE CNA AM DPC VTC VID CPI PTC DPL VTL VTS PIF PA PPA POT HPR HPL HMD POT VB HM VIM VRC PPA PLA CPP PPC VPF PPD DFP QLO HMD AU PRA AUM AVE AUH VVR AU POT EXC P2O PA POV ARM VID NOD STH VPF VP VTS CNA CKE VTW AM REK VUD RBF RFN NOD AHM NON-MUSCLE OXYGEN DELIVERY MUSCLE BLOOD FLOW CONTROL AND PO2 VASCULAR STRESS RELAXATION KIDNEY DYNAMICS AND EXCRETION THIRST AND DRINKING ANTIDIURECTIC HORMONE CONTROL ALDOSTERONE CONTROL ANGIOTENSIN CONTROL ELECTROLYTES AND CELL WATER TISSUE FLUIDS, PRESSURES AND GEL HEART HYPERTROPHY OR DETERIORATION RED CELLS AND VISCOSITY PULMONARY DYNAMICS AND FLUIDS HEART RATE AND STROKE VOLUME AUTONOMIC CONTROL NON-MUSCLE LOCAL BLOOD FLOW CONTROL CIRCULATORY DYNAMICS CAPILLARY MEMBRANE DYNAMICS Vascular Stress Relaxation VVE VV7 VASCULAR STRESS RELAXATION INTPUT: VVE - VVE - excess blood (stressed ) volume in the veins [l] OUTPUT: VV7 - increased vascular volume caused by stress relaxation [l] Tissue Fluids, Pressures and Gel VTC DPC VID VTL DPL PTC CPI VTS PIF TISSUE FLUIDS, PRESSURES AND GEL INTPUTS: VTC - rate of fluid transfer across systemic intersticial fluid DPC -rate of influx protein into the interstitial fluid from plasma [g/min] VID - rate of fluid transfer between interstitial fluid and cells OUTPUTs: PTC - total colloid osmotic pressure of the tissue gel] VTL - lymph flow rate [l/min] DPL - rate of return of protein to the circulatin by way of the lymph [g/min] CPI - concentration pf protein in the interstitium [g/l] VTS - total interstitial fluid volume [l] Thirst And Drinking POT AHM STH TVD THIRST AND DRINKING INTPUT: POT - non muscle cells PO2 [torr] AHM - antidiurectical hormone effect to non renal vascular resistance, multiplifier (ratio to normal effect ) OUTPUT: STH - salt appetite multiplifier factor [ratio to normal] TVD - rate of intake of fluid by mouth or otherwise [l/min] Red Cells And Viscosity POT VB VIM VRC HM RED CELLS AND VISCOSITY INTPUT: POT - non-muscle cell PO2 [torr] VB - volume of blood [l] OUTPUT: VIM - blood viscosity [ratio to normal] HM - hematocrit [%] VRC - volume of red blood cells [] Pulmonary Dynamics and Fluids PPA PLA PPC CPP DFP VPF PPD PULMONARY DYNAMICS AND FLUIDS INTPUTS: PPA - pulmonary arterial pressure [torr] PLA - left atrial pressure [torr] PPC - plasma colloid osmotic pressure [torr] CPP - plasma protein concentration OUTPUTs: DFP - rate of change of free fluid in the lungs [l/min] VPF - volume of free fluid in the pulmonary interstitium [l/min] PPD - rate of loss of protein through the pulmonary capillary membrane [g/min] POV 40 POT 8 OVA 200 Non-Muscle Local Blood Flow Control POV ARM NON MUSCLE LOCAL BLOOD FLOW CONTROL INTPUT: POT - non-muscle cells PO2 [torr] OUTPUT: ARM - vasoconstrictor effect of local blood flow autoregulation in non-muscle tissues [ratio to normal] NON-MUSCLE OXYGEN DELIVERY HM OVA BFN AOM POT POV NON-MUSCLE OXYGEN DELIVERY INTPUTS: HM-hematocrit [% ] OVA-oxygen volume in aortic blood [ml O2/l blood] BFN-blood flow in non-muscle, non-renal tissues [l/min] AOM-autonomic effect on tissue oxygen utilization POT-non-muscle cell PO2 [torr] POV-non-muscle venous PO2 [torr] Muscle Blood Flow Control And po2 VPF HM BFM EXC AU OVA P2O AOM AMM MUSCLE BLOOD FLOW CONTROL AND PO 2 INTPUTS: VPF - volume of free fluid in the pulmonary interstitium HM - hematocrit [%] BFM - blood flow in muscles [l/min] EXC - Effect of excercise on the metabolic usage of oxygen by the muscles [ratio to resting state ] AU - overall activity of autonomic system OVA - oxygen content of arterial blood [ml O2 STPD/l blood] P2O - muscle cell PO2 [torr] AOM - autonomic effect on tissue oxygenation AMM - muscle vascular constriction caused by logical tissue control [multiplifier, ratio to normal] Kidney Dynamics and Excretion PA PPC VIM REK CNE AUM AHM AM VUD RBF RFN NOD KIDNEY DYNAMICS AND EXCRETION INTPUTS: PA - aortic pressure [torr] PPC - plasma colloid osmotic pressure [torr] VIM - blood viscosity (ratio to normal blood [torr min/ll] REK - percent of normal renal function [ratio to normal] CNE - sodium concentration abnormability causing third factor effect [mmol/l] AUM - sympathetic vasoconstrictor effect on arteries [ratio of normal effect ] AHM - antidiuretic hormone [ratio of normal effect ] AM - aldosterone multiplier [ratio of normal effect] VUD - rate of urinary output [l/min] RBF- renal blood flow [l/min] RFN - renal blood flow if kidney is not damaged [l/min] NOD - rate of renal excretion of sodium [mmol/min] AAR - afferent arteriolar resistance [torr min/l] EVR - postglomerular resistance [torr min/l] RR - renal resistance [torr min/l] GLP - glomerular pressure [torr] GFN - glomerular filtration rate of undamaged kidney [l/min] GFR - glomerular filtration rate [l/min] Heart Rate and Stroke Volume AU HMD PRA QLO SVO HR HEART RATE AND STROKE VOLUME INTPUTS: AUR - overall activity of autonomic system [ratio to normal] HMD - cardiac depresant effect of hypoxia, shock and other factors [ratio to normal] PRA - right atrial pressure [torr] QLO - output of left ventricle [l/min] SVO - stroke volume [l] HT - heart rate Heart Hypertrophy or Deterioration PA PPA HSL POT HSR HPR HPL HMD HEART HYPERTROPHY OR DETERIORATION INTPUTS: PA - systemic arterial pressure [torr] PPA - pulmonary arterial pressure [torr] HSL - basic strenght or left ventricle [ratio to normal] POT - Non muscle cells PO2 [troo] HSR - basic strenght or right ventricle [ratio to normal] HPR - hypertrophy effect of right heart [ratio to normal] HPL - hypertrophy effect of left heart [ratio to normal] HMD - cardiac depresant effect of hypoxia, shock HM 40 Electrolytes and Cell Water AM REK NOD STH VPF VP VTS VID CKE CNA VTW ELECTROLYTES AND CELL WATER INTPUTS: AM - aldosterone multiplier, ratio of normal effect REK - percent of normal renal function [ratio to normal] NOD - rate of excretion of sodium in the urine [mmol/min] STH - salt appetite multiplier factor [ratio to normal] VTS - systemic interstitial fluid volume [l] VP - plasma volume [l] VPF - pulmonary interstitial fluid volume [l] VID - rate of fluid transfer between interstitial fluid and cells [l/min] CKE - extracellular potassium concentration [mmol/l] CNA - extracellular sodium concentration [mmol/l] VTW - total body water [l] 0.9993 0.933 7.997 99.95 5.8-6.337.97 0.0087 0.03788 0.00667 5.063 0.03864 20.25 8.074e-006 0.0093 0.9943 39.95 5.00 42.2.97 5.8 2.999 0.025 8.074e-006.02 0.0965 0.9943 42.2 0.9996 5.00 99.95 2.862 0.0087 0.0009993.289e-008 5.063-6.337 40.0 98.8 2.862.00 2 99.95 2.789 3.772 2.862 0.0093 27.97 69.92 2.999 6.84 0.03864 4.999 5.072 0.03788 20.25-4.386e-006 0.00095 0.9996.2 9.843 42.2 0.0909 42.2 0.0909 0.9987.007.02 7.997.0 0.0009993 0.9987 0.00095 0.0965.2 0.323.006 99.95 0.9993 0.9987 9.843 0.9943.2 27.97 0.00 0.323 3.772 0.9834 0.025.00 98.8 7.973 72.48 5.072 0.0909.007.007 7.973 7.997 99.95 4.999.002.0 0.00 2.947 6.84.2.003 0.9834 0.9996.006 40 0.933 40.0.007.003.006.002 2.947 0.06998-4.386e-006 0.025 5.8.289e-008 7.997 69.92 27.97 0.00667 7.997 40.0 2 0.9993 4.999 40 2.789 5 0 5 00 2.8 0 0.3 2.9 3.7 28 5 7 0.002 0.04 70 3 2.95 0 0 0.025 40 0.3 2 20-6.3 0.04 0.002 5 2 42 5 0 0 0.2.2 0. 0.00 0 0.04 20 0 0.002 0.00 0 5-6.3 2 3.7 2.8 2.9 0.00 5 0 2.95 7.2.6 40 8 8 00 5 0 70 28 0 5 5 8 8 8 200 5 00 0.04 0 0.002 2 3 0.025 0. 42 5 00.2 42 8 42 0 0 28 00 0.3 40 0.025 Circulatory Dynamics ARM VIM AUM ANM AMM AVE RBF PC VVR VV7 AUH HMD HPL VB HSR HSL HPR BFM RVS PVS VVE PRA QLO PA BFN PPA PLA CIRCULATORY DYNAMICS INTPUTS: ARM - vasoconstrictor effect of all types of autoregulation VIM - blood viscosity (ratio to normal blood) AUM - sympathetic vasoconstrictor effect on arteries ANM - angiotensin multiplier effect on vascular resistance, ratio to normal AMM - muscle vascular constriction caused by local tissue control, ratio to resting state AVE - sympathetic vasoconstrictor effect on veins RBF - renal blood flow [l/min] PC - capillary pressure [torr] VVR - diminished vascular volume caused by sympathetic stimulation [l] VV7 - increased vascular volume caused by stress relaxation [l] AUH - autonomic stimulation of heart, ratio to normal HMD - cardiac depresant effect of hypoxia HPL - hypertrophy effect on left ventricle [ratio to normal] HPL - hypertrophy effect of left heart [ratio to normal] VB - blood volume [l] HSR - basic strenght or right ventricle [ratio to normal] HPR - hypertrophy effect of right heart [ratio to normal] BFM - muscle blood flow [l/min] RVS - venous resistance [torr/l/min] PVS - average venous pressure [torr] VVE - excess blood (stressed ) volume in the systemic veins [l] PRA - right atrial pressure [torr] QLO - output of left ventricle [l/min] PA - aortic pressure [torr] BFN - blood flow in non-muscle, non-renal tissues [l/min] PRA - right atrial pressure [torr] PLA - left atrial pressure [torr] Capillary Membrane Dynamics VUD RVS BFN PVS VRC PIF PTC DFP TVD VTL PPD CPI DPL PC VB VP DPC CPP PPC VTC CAPILLARY MEMBRANE DYNAMICS INTPUTS: PTC - colloid osmotic pressure of the tissue gel [torr] VTL - rate of return of fluid from the interstitium to the blood through the lymph [l/min] TVD - rate of intake of fluid by mounth or otherwise [l/min] RVS - venous resistance BFN - blood flow in non-muscle, non renal tissues PVS - average venous pressure VRC - volume of red blood cell VUD - rate of urinary output DFP - rate of increase in pulmonary free field PIF - intersticial fluid pressure PPD - rate od change of protein in pulmonary fluids CPI - concentration of protein in free intersticial fluid VP - plasma volume [l] DPL - rate of systemic lymphatic return of protela PC - systemic capillary pressure [torr] PPC - plasma colloid osmotic pressure [torr] VTC - toral rate of movement of fluid out of systemic capillaries [l/min] VB - blood volume CPP - plasma protein concentration DPC - rate of loss of plasma protein through systemic capillaries BFN 2.8 Autonomic Control PA POT P2O EXC AU VVR AUH AUM AVE AUTONOMIC CONTROL INTPUTS: PA - systemic arterial pressure torr POT - non-muscle cell PO2 [torr] P2O - muscle cell PO2 [torr] EXC - Effect of excercise on the metabolic usage of oxygen by the muscles [ratio to resting state ] AUZ - overall sensitivity of autonomic control [ratio to normal] OUTPUTs: AU - overall activity af autonomic system [ratio to normal] AUH - autonomic multilier effect on the heart output [ratio to normal] VVR - basic volume of venous tree(maximum volume at zero pressure ) [l] AUM - autonomic multipllier effect on arterial resistance [ratio to normal] AVE - autonomic multipllier effect on venous resistance [ratio to normal] Antidiurectic Hormone Control AU PRA CNA AHM ANTIDIURECTIC HORMONE CONTROL INTPUT: AU - overall activity of autonomic system, ratio to normal PRA - right artial pressure CNA - extracellural sodium contrentration OUTPUT: AHM - antidiurectic hormone multiplifier, ratio of normal effect Angiotensin Control REK RFN CNA ANM CNE ANGIOTENSIN CONTROL INTPUTS: REK - percent of normal renal function [ratio to normal] RFN - renal blood flow if kidney is not damaged [l/min] CNA - extracellural sodium concentration ANM - angiotensin multilier factor on vascular resistance [ratio to normal] CNE - sodium concentration abnormality causing third factor effect Aldosterone Control ANM PA CKE CNA AM ALDOSTERONE CONTROL INTPUT: ANM - angiotensin multiplier effect on vascular resistance, ratio to normal PA - aortic pressure [torr] CKE - extracellural potassium concentration CNA - extracellural sodium concentration OUTPUT: AM - aldosterone multiplier, ratio of normal effect AOM - HSR HPR HPL VTSN.98 VRA0 0. VPN 3 VPA0 0.30625 VP 3 VLA0 0.4 VID 0 VICnorm 25 VAS0 0.495 Urea and Water Excretion PLURC GFN NODN KODN AHM REK UROD VUDN VUD UREA AND WATER EXCRETION INTPUTS: PLURC - concentration of urea in body fluids [mmol/l] GFN - glomerular filtration rate if kidney is not damaged [l/min] NADT - the normalized delivery of sodium to the distal tubular system [ratio to normal] NODN - sodium excretion rate if kidney is not damaged [mmol/min] KODN - potassium excretion rate if kidney is not damaged [mmol/min] DTNAI - rate of sodium entry into the distal tubular system [mmol/min] AHM - antidiuretic hormone [ratio to normal] REK - percent of normal renal function [ratio to normal] UROD - urea excretion rate [mmol/min] VUDN - rate of urinary output if kidney id not damaged [l/min] VUDN - rate of urinary output [l/min] Urea URFORM UROD VTW PLURCNORM PLURC PLUR UREA INTPUTS: URFORM - rate of urea metabolic production [mmol/min] UROD -rate of urea excretion [mmol/min] VTW - total body water volume [l] PLURCNORM - normal value of urea concentration in body fluids [4 mmol/l] PLURC - concentration of urea in body fluids [mmol/l] PLUR - total body urea content[mmol/l] Unstressed volume in systemic venous tree VVR ANU ANY VV6 VV7 ATRVFB VVS0 UNSTRESSED SYSTEMIC VENOUS VOLUME INPUTS: VVR - normal maximum volume of blood in the venous system at zero pressure [l] ANU - nonrenal effect of angiotensin [ratio to normal] ANY - sensitivity of large veins to effect of angiotensin [normal value = -0.2 l/unit of angiotensin] VV6, VV7 - changes in basic volume of venous system cauused by stress relaxation [l] ATRVFB - change in basic volume of venous system caused by atrial volume receptor feedback OUTPUT: VVS0 - the maximum volume ov venous system at zero volume (so called unstressed venous volume) [l] URFORM 0.24 Thirst, Drinking and Salt Appetite POT AHC ANM DR STHENABLED TVDENABLED STH TVD THIRST,DRINKING AND SALT APPETITE INTPUTS: POT - non-muscle cell PO2 [torr] AHC - antidiuretic hormone concentration factor in the circulating body fluids [ratio to normal] ANM - angiotensin multilier effect to vascular resistance [ratio to normal] AMK - effect of aldosterone on potassium secretion [ratio to normal] DR - forced input of fluid over and above the natural drinking desire (it may be used for intravenous infusion as well) [l/min] STHENABLED - switching variable: if STHENABLED<=0, then STH is not calcultated and STH= TVDENABLED - switching variable: if TVDENABLED <=0 then TVD is not calculated and TVD=DR STH - salt appetite multiplier factor [ratio to normal] TVD - actual rate of fluid intake [l/min] The volume receptor feedback mechanism PRA ATRVFBM ATRRFBM AH7 ATRVFB ATRRFB THE VOLUME RECEPTOR FEEDBACK MECHANISM INPUTS: PRA - riight atrial pressure [torr] ATRVHBM - sensitivity controller of volumereceptor feedback effect on change of basic of venous system [ATRVFB=AH7*ATRRVBM, no effect = 0] ATRRFBM - sensitivity controller of volumereceptor feedback effect on nonmuscle arterial resistance [ATRRFB=AH7*ATRRFBM, no effect = 0] AH7 - effect of right atrial volume receptor reflex on ADH secretion [relative additive factor, normal value = 0] ATRVFB - change in basic volume of venous system caused by atrial volume receptor feedback ATRRFB - multiplier factor for the effect on muscle and non-renal vacular resistance of feedback from the atrial stretch receptors [multiplier, ratio to resting state ] The control Functions of Antitiuretic Hormone CNA AUP ANM PA AH7 ADH AHMRM AHC AHM AHMR THE CONTROL FUNCTIONS OF ANTIDIURETIC HORMONE INTPUTS: CNA - Concentration of sodium in extracelullar fluid [mmol/l] AUP - autonomic multipllier effect on ADH hormone excretion etc. [ratio to normal] ANM - angiotensin multiplier effect [ratio to normal] PA - systemic arterial pressure [torr] H7 - effect of right atrial volume receptor reflex on ADH secretion [relative additive factor, normal value = 0] AHMRM - sensitivity coefficient for the effect of ADH on systemic arterial resistance. AHC - antidiuretic hormone concentration in the circulating body fluids [ratio to normal] AHM - antidiuretic hormone multiplier [ratio to normal effect] AHMR - effect of antidiuretic on systemic arterial resistance [ratio to normal effect ] ANUBRM - sensitivity contoller for the effect of angiotensin of the baroreceptor system ANUVM - sensitivity controller for the multiplier factor of the systemic veins The control Functions of Angiotensin NAPT REK ANXM ANG ANUBRM ANUVM ANM ANU ANUBR ANUVN ANC THE CONTROL FUNCTIONS OF ANGIOTENSIN INTPUTS: NAPT - delivery of sodium to the macula densa area [ratio to normal value] REK - percent of normal renal function [ratio to normal] ANXM - controls of degree of hypertrophy of the juxtaglomerulal apparatus [0 = no hypertrophy] ANG - excess of angiotensin concentration caused by infusion [ratio to normal level of angiotensin] ANUBRM - sensitivity contoller for the effect of angiotensin of the baroreceptor system ANUVM - sensitivity controller for the multiplier factor of the systemic veins ANM - angiotensin multilier factor on vascular resistance [ratio to normal] ANU - angiotensin multilier factor on peripheral arteriolar resistance [ratio to normal] ANUBR - angiotensin multilier factor for the effect in controlling the sensitivity of the baroreceptor system[ratio to normal] ANUVM - angiotensin multilier factor for the constriction of systemic veins [ratio to normal] ANC - angiotensin concentration in blood [ratio to normal] The control Functions of Aldosterone ANM CKE ALD AMK AMNA AMC THE CONTROL FUNCTIONS OF ALDOSTERONE INTPUTS: ANM - angiotensin multiplier effect on vascular resistance [ratio to normal value] CKE - extracelullar fluid potassium concentrastion [mmol/l] ALD - rate of infusion of aldosterone [relative to normal rate of aldosterone secretion ] AMK - effect of aldosterone on potassium secretion [ratio to normal] AMNA - aldosterone for control of sodium reabsorbtion AMC - aldosterone concentration [ratio to normal]/n TVDENABLED TSP0 278.6 TENSGN TENSG Systemic Capillary Pressure PVS BFN RVS PC SYSTEMIC CAPILLARY PRESSURE INTPUTS: PVS - average of systemic venous pressure [torr] BFN - blood flow in non-renal and non-muscle tissues [l/min] RVS - resistance in small veins [torr min/l] OUTPUT: PC - systemic caplillary pressure [torr] Sodium Excretion NAPT RFAB VUDN AMNA AHM REK DIURET NADT DTNAI NODN NOD CNU SODIUM EXCRETION INTPUTS: NAPT - delivery of sodium to the macula densa area [ratio to normal] RFAB - the multiplier factor for the effect of renal hemodynamics on reabsorbtion of sodium and potassium in the distal tubule collecting duct [ratio to normal] VUDN - rate of urinary output if kidney is not damaged [l/min] AMNA - aldosterone for control of sodium reabsorbtion [ratio to normal effect ] AHM - antidiuretic hormone [ratio to normal effect ] REK - percent of normal renal function [ratio to normal] DIURET - effect of diuretic on the distal tubule collecting duct [ratio to normal - without diuretics] NADT - the normalized delivery of sodium to the distal tubular system [ratio to normal] DTNAI - rate of sodium entry into the distal tubular system [mmol/min] NODN - sodium excretion rate if kidney is not damaged [mmol/min] NOD - sodium excretion rate [mmol/min] CNU - concentration of sodium in urine [mmol/l] STHENABLED 0 Right Heart Pumping PRA PPA AUH OSA HSR HPR HMD QLO QLN QRO QRN RVM RIGHT HEART PUMPING INTPUTS: PRA - right atrial pressure [torr] PPA - pulmonary arterial pressure [torr] AUH - autonomic stimulation of heart [ratio to normal] OSA - oxygen hemoglobin saturation HSR - basic strenght or right ventricle [ratio to normal] HPR - hypertrophy effect of heart [ratio to normal] HMD - cardiac depressant effect of hypoxia. shock and other factors [ratio to normal] QLO - output of left ventricle [l/min] QLN - normalised output of the left heart [l/min] QRO - actual right ventricular output [l/min] QRN - normalised right ventricular output [l/min] RVM - depressing effect on right ventricle of pulmonary arterial pressure [ratio to normal] Resistances in the Systemic Circulation PA RAM RAR MYOGRS AUM VIM ANU AHMR ATRRFB AMM ARM RVSM AVE ANUVN PC RSN RSM RVS RESISTANCES IN THE SYSTEMIC CIRCULATION INTPUTS: PA - systemic arterial pressure [torr] RAM - basic vascular resistance of muscles [torr min/l] RAR - basic vascular resistance of non-muscle and non-renal tissues [torr min/l] MYOGRS - myogenic autoregulation effect on vascular resistance in muscle and in non-renal tissue (multiplier, ratio to normal) AUM - sympathetic vasoconstrictor effect on arteries in muscle and non-renal tissues [multiplier factor, ratio to normal] VIM - blood viscosity [ratio to normal] ANU - nonrenal effect of angiotensin [ratio to normal] AHM - antidiuretic hormone effect to non renal vascular resistance, multiplier (ratio to normal effect) ATRRFB - multiplier factor for the effect on muscle and non-renal vacular resistance of feedback from the atrial stretch receptors [multiplier, ratio to resting state ] AMM - muscle vascular constriction caused by local tissue control [multiplier, ratio to resting state ) ARM - the degree of vasoconstrictor effect of autoregulation in non-muscle and non-renal tissues [multilier, ratio to normal] RVSM - basal systemic venous multiplier causes basal vascular stretch in the venous system [ratio to normal] AVE - multiplier factor for the effect of the autonomic nervous system on venous resistance [ratio to basal effect ] ANUVN multiplier factor for the effect of angiotensin on venous resistance [ratio to normal] PC - systemic caplillary pressure [torr] RSN - vascular resistance in non-muscle and non-renal tissues [torr min/l] RSM - vascular resistrance in muscles [torr min/l] RVS - resistance in small veins [torr min/l] Resistances in the Pulmonary Circulation and Pulmonary Venous Pressure PPA PLA QPO RPA RPV RPT PVP RESISTANCES IN THE PULMONARY CIRCULATION AND PULMONARY VENOUS PRESSURE INTPUTS: PPA - pulmonary arterial pressure [torr] PLA - left atrial pressure [torr] QPO - rate of blood flow into pulmonary veins and left atrium [l/min] RPA - pulmonary arterial resistance [torr min/l] RPV - pulmonary venous resistance [torr min/l] RPT - total pulmonary vascular resistance [torr min/l] PVP - pulmonary venous pressure [torr] Renal Perfusion PA GBL PVS AAR EAR REK PAR RFN RR RBF RENAL PERFUSION INTPUTS: PA - systemic arterial pressure [torr] GBL - pressure drop in renal artery caused renal arterial constriction [torr] PVS - average systemic venous pressure [torr] AAR - resistance in afferent arteriole [torr min/ll] EAR - resistance in efferent arteriole [torr min/ll] REK - percent of normal renal function [ratio to normal] PAR - renal perfusion pressure [torr] RFN - renal blood flow if kidney is not damaged [l/min] RBF - renal blood flow [l/min] RR - renal resistance [torr min/l] Red cells production and destruction OSA VP VIM RFN REK VRC VB HM RC RC2 RED CELLS PRODUCTION AND DESTRUCTION INTPUTS: OSA - arterial oxygen saturation [ratio to full saturation] VP - plasma volume [l] VIM - blood viscosity [ratio to normal blood] RFN - renal blood flow (if kidney is not damaged) [l/min] REK - fraction of normal kidney mass [ratio to normal] VRC - volume of red blood cells [l] VB - volume of blood [l] HM - hematocrit [%] RC - red cells production rate [l/min] RC2 - red cells destruction rate [l/min] RVSM RFN.2 REK RAR 30.52 RAM 96.3 Pulmonary O2 Delivery VPF DOB RMO PO2DEF PO2AMB HM OSA OVA PULMONARY O2 DELIVERY INTPUTS: VPF - volume of free fluid in the pulmonary interstitium [l/min] DOB - non-muscle oxygen usage[ml/min] RMO - muscle oxygen usage [ml/min] PO2DEF - normalised difussion coecficient for oxygen through the pulmonary membrane [at norma PO2DEF=] PO2MAB - ambient oxygen pressure [torr] HM - hematocrit OUTPUTs: OSA - arterial oxygen saturation OVA - arterial blood oxygen content [ml O2/l blood] Pulmonary Fluid Dynamics PPA PLA PPC CPP CPF DFP VPF PCP POS PPI PFI PLF CPN PPN PPR PPD PULMONARY FLUID DYNAMICS INTPUTS: PPA - pulmonary arterial pressure [torr] PLA - left atrial pressure [torr] PPC - plasma colloid osmotic pressure [torr] CPF - pulmonary capillary filtration coeffitient [l/min/torr] OUTPUTs: DFP - rate of change of free fluid in the lungs [l/min] VPF - volume of free fluid in the pulmonary interstitium [l/min] PCP - pulmonary capillary pressure [torr] POS - osmotic pressure in pulmonary interstitial fluid pressure [torr] PPI - pulmonary interstitial fluid pressure [torr] PFI - rate of fluid filtration out of pulmonary capillary [l/min] PLF - pulmonary lymph flow rate [l/min] CPN - concentration of protein in pulmonary interstitial fluid [g/l] PPN - protein leakage rate through the pulmonary capillary membrane [g/min] PPR - total quantity of protein in pulmonary interstitial fluid [g] PPD - rate of loss of protein through the pulmonary capillary membrane [g/min] Potassium Excretion CKE CNA NADT DTNAI ANM AMK RFAB REK VUDN KODN KOD CKU POTASSIUM EXCRETION INTPUTS: CKE - extracellular potassium concentration [mmol/l] CNA - extracellular sodium concentration [mmol/l] NADT - the normalized delivery of sodium to the distal tubular system [ratio to normal] DTNAI - rate of sodium entry into the distal tubular system [mmol/min] ANM - angiotensin multilier effect to vascular resistance [ratio to normal] AMK - effect of aldosterone on potassium secretion [ratio to normal] RFAB - the multiplier factor for the effect of renal hemodynamics on reabsorbtion of sodium and potassium in the distal tubule collecting duct [ratio to normal] REK - percent of normal renal function [ratio to normal] VUDN - rate of urinary output if kidney is not damaged [l/min] KODN - potassium excretion rate if kidney is not damaged [mmol/min] KOD - potassium excretion rate [mmol/min] CKU - concentration of potassium in urine [mmol/l] Plasma Protein Dynamics VP VTCLP DPL CPI LPPR PPD DPR PPC DPC CPP DLP PLASMA PROTEINS DYNAMICS INTPUTS: VP - plasma volume [l] VTCLP - rate of leakage of whole plasma through the capillary membrane [l/min] DPL - rate of return of protein to the circulation through the lymph [g/min] CPI - concentration of protein in the interstitium [g/l] [torr] LPPR - rate of production of protein by the liver [g/min] PPD - rate of loss of protein through the pulmonary capillary membrane [g/min] DPR - rate of loos of protein through the kidney [g/min] OUTPUTs: PPC - plasma colloid osmotic pressure [torr] DPC - rate of influx of protein into interstitial fluid from plasma [g/min] CPP - plasma protein concentration [g/l] DPL - net rate of protein exchange between liver and plasma [g/min] Peritubular Capillaries RFN GLPC RFAB RCPRS PERITUBULAR CAPILLARIES INTPUTS: RFN - renal blood flow if kidney is not damaged [l/min] GLPC - average glomerular plasma colloid osmotic pressure [torr] RFAB - the multiplier factor for the effect of renal hemodynamics on reabsorbtion of sodium and potassium in the distal tubule collecting duct [ratio to normal] RCPRS - renal capillary pressure around the tubular systewm [torr] PXTP 8 PO2DFF PO2AMB 50 PLURCNORM 4 OMM 60 O2M 64.5 Non-muscle Local Blood Flow Control POT ARM NON MUSCLE LOCAL BLOOD FLOW CONTROL INTPUT: POT - non-muscle cells PO2 [torr] OUTPUT: ARM - vasoconstrictor effect of local blood flow autoregulation in non-muscle tissues [ratio to normal] NID 0. Myogenic Autoregulation of Afferent Arteriole PAR MYOGTAU TENSGN MYOGRSAA MYOGENIC AUTOREGULATION OF AFFERENT ARTERIOLE INTPUTS: PAR - renal perfusion pressure [torr] PC - capillary pressure [torr] MYOGTAU - time delay factor of myogenic response (in normal condition TENSTC= 240 min) TENSGN - factor of effectiveness of myogenic response OUTPUT: MYOGRSAA - myogenic autoregulation effect on vascular resistance in afferent arteriole [multiplier, ratio to normal effect ] Myogenic Autoregulation PA PC MYOGTAU TENSGN MYOGRS MYOGENIC AUTOREGULATION INTPUTS: PA - systemic arterial pressure [torr] PC - capillary pressure [torr] MYOGTAU - time delay factor of myogenic response (in normal condition TENSTC= 240 min) TENSGN - factor of effectiveness of myogenic response OUTPUT: MYOGRS - myogenic autoregulation effect on vascular resistance in muscle and in non-renal tissue [multiplier, ratio to normal] Muscle Local Blood Flow Control PMO AMM MUSCLE LOCAL BLOOD FLOW CONTROL INTPUT: PMO - muscle cells PO2 [torr] OUTPUT: AMM - vasoconstrictor effect of local blood flow autoregulation in muscles [ratio to normal] Macula densa CNA GFN NAPT RNAUG MACULA DENSA INTPUTS: CNA - Extracellular sodium concentration [mmol/l] GFN - glomerular filtration rate if kidney is not damaged [l/min] RNAUG - macula densa feedback signal [ratio to normal effect ] NAPT - delivery of sodium to the macula densa area [ratio to normal value] MYOGTAU 240 MYOGTAU 240 Left Heart Pumping PLA PA AUH OSA HSL HPL HMD QLO QLN LVM LEFT HEART PUMPING INTPUTS: PLA - left atrial pressure [torr] PA - systemic arterial pressure [torr] AUH - autonomic stimulation of heart [ratio to normal] OSA - oxygen hemoglobin saturation HSL - basic strenght or left ventricle (ratio to normal) HPL - hypertrophy effect of left heart [ratio to normal] HMD - cardiac depressant effect of hypoxia, shock and other factors [ratio to normal] QLO - actual left ventricular output [l/min] QLN - normalised lwft ventricular output [l/min] LVM - depressing effect on left ventricle of pulmonary arterial pressure [ratio to normal] LPPR 0.03 KID 0.06 Interstitial Tissue Fluids, Pressures and Gel Dznamics VTS DPC TSP0 PGH PTC VTL DPL CPI PTT PIF PTS VIF VG TSP INTERSTITIAL TISSUE FLUIDS, PRESSURES AND PROTEIN DYNAMICS INTPUTS: VTS - total interstitial fluid volume [l] DPC -rate of influx protein into the interstitial fluid from plasma [g/min] TSP0 - initial value of total interstitial tissue proteins [g] OUTPUTs: PGH - hydrostatic pressure in tissue gel [torr] PTC - total colloid osmotic pressure of the tissue gel] VTL - lymph flow rate [l/min] DPL - rate of return of protein to the circulatin by way of the lymph [g/min] CPI - concentration pf protein in the interstitium [g/l] PTT - total interstitial tissue pressure [torr] PIF - pressurte in the free interstitial fluid [torr] PTS - solid tissue pressure [torr] VIF - free interstitial fluid volume[l] VG - tissue gel volume[l] TSP - total interstitial tissue proteins [g] Heart hypertrophy or deterioration PA QAO PPA HSR HSL POT HPR HPL HMD HEART HYPERTROPHY OR DETERIORATION INTPUTS: PA - systemic arterial pressure [torr] QAO - blood flow in the systemic arteriel system [l/min] PPA - pulmonary arterial pressure [torr] HSR - basic strenght or right ventricle [ratio to normal] HSL - basic strenght or left ventricle [ratio to normal] POT - Non muscle cells PO2 [troo] HPR - hypertrophy effect of right heart [ratio to normal] HPL - hypertrophy effect of left heart [ratio to normal] HMD - cardiac depresant effect of hypoxia, shock Heart Rate and Stroke Volume AUR HMD PRA QLO HR SVO HEART RATE AND STROKE VOLUME INTPUTS: AUR - autonomic stimulation of heart rate [ratio to normal] HMD - cardiac depresant effect of hypoxia, shock and other factors [ratio to normal] PRA - right atrial pressure [torr] QLO - output of left ventricle [l/min] HR - heart rate [beats/min] SVO - stroke volume [l] HSR HSL Glomerulus PAR RFN AAR HM PPC PXTP GLFC REK GFR GFN GLP GLPC PFL GLOMERULUS INTPUTS: PAR - renal perfusion pressure[torr] RFN - renal blood flow if kidney is not damaged [l/min] AAR - resistance in afferent arteriole [torr min/ll] HM - hematocrit PPC - plasma colloid osmotic pressure [torr] PXTP - back pressurein proximal tubule [torr] GLFC - glomerular filtration coefficient [l/torr/min] REK - percent of normal renal function [ratio to normal] GFR - glomerular filtration rate [l/min] GFN - glomerular filtration rate if kidney is not damaged [l/min] GLP - glomerular pressure [torr] GLPC - average glomerular plasma colloid osmotic pressure [torr] PFL - net pressure gradient in glomerulus [torr] GLFC 0.0208 GBL 25 FIS 0 Extracellular and Intracellular Fluid Electrolytes and Volumes VP VTS VPF NID STH NOD KID KOD AMK ACLK VICNorm VEC VIC VTW VID NAE CNA CKE KI CKI KCD ECF AND ICF ELECTROLYTES AND VOLUMES INTPUTS: VP - plasma volume [l] VTS - systemic interstitial fluid volume [l] VPF - pulmonary interstitial fluid volume [l] NID - normal rate of sodium intake [mmol/min] STH - salt appetite multiplier factor [ratio to normal] NOD - rate of excretion of sodium in the urine [mmol/min] KID - rate of intake of potassium [mmol/min] KOD - rate of excretion of potassium in the urine [mmol/min] AMK - aldosterone multiplier factor for the effect of aldosterone on the transport of potassium through the cell membrane [ratio of normal effect ] ACLK - sensitivity control of the effect of the aldosterone on cellular membrane transport of potassium [ratio of normal effect] VICnorm - normal value of the intracellular fluid volume [l] VEC - volume of extracellular fluid [l] VIC - volume of intracellular fluid [l] VTW - total body water [l] VID - rate of fluid transfer between interstitial fluid and cells [l/min] NAE - total extracellular sodium content [mmol] CNA - extracellular sodium concentration [mmol/l] CKE - extracellular potassium concentration [mmol/l] KI - total intracellular potassium content [mmol] CKI - intracellular potassium concentration [mmol/l] KCD - rate of transferof potassium from the interstitial fluid into the intracellular fluid [mmol/min] Efferent Arteriole EARK RNAUG EFARF ANM VIM EAR EFFERENT ARTERIOLE INTPUTS: AARK - normal resistance in efferent arteriole [torr min/l RNAUG - macula densa feedback signal to efferent arteriole [ratio to normal] EAFRF - sensitivity contoller of macula densa feedback signal to efferent arteriole ANM - angiotensin multiplier effect on vascular resistance [ratio to normal] VIM - blood viscosity [ratio to normal blood] OUTPUT: AAR - afferent arteriolar resistance [torr l/min] Effect of stress relaxation on basic venous volume VVE VV6 VV7 VENOUS STRESS RELAXATION INTPUTS: VVE - excess blood volume in the veins [l] VV6 - increased venous vascular volume caused by long time stress realaxation [l] VV7 - - increased venous vascular volume caused by short time stress realaxation [l] EXC EFARF 0 EARK 43.333 279. 0.004025 23.22 0.0.42 0.606 0.004738 0.9764 5.682-4.676 0.00.003 0.0009.006 0.0003989 0.003467 0.02556 0 0.2582 2.97.52e-005.6e-005 40 2 5.05 2425 64.7-0 4.903 39.44 64.8 0.6903 50.84 0.00476.008 0.602-2.404e-005.002.0 0.8492.0 99.79 2.869 40 8.075 2402 2.754 60.09 60.09 0.688 8.43 39.32.026 6.87.003 0.06768 72.45-0.045.003.24.66.408 2.948 33.5 92.6 7.82 4.72 0.02556 0.02556 4.903 4.897 4.903.57 0.000705 0.9825.005 0.05073.38e-007 0.9982 0.0009 0.00435 0.5-2.682 7.82 2.754 2.869 0.2364 3.024 4.897 99.79 7.82-0.045 4.72 7.82.002.026.05 0.004.003.008 2.948 3.677 0.9673 0.9673 4.2 30.7 44.73 0.2582 4.885.5 0.05073 0.0528 0.238 4.02 0.000705 0.7392 4.903.57 0.9825 0.9673 0.5388.078 42.4 5.076.5 0.958 0.3769 0.238 0.000705.005.57 0.238 42.4 0.9673.008 0.9963 3.275 0.9673 4.2.024 0.7392 44.73 0.9963 74.79 30.66 40 74.79 0.7273 30.7 0.9963 30.7 8.075 8.075 99.79.0 42.4 99.79 4.273 5.076 0.908 8.43-0.034.034.5 0.908 0.9825 20.35 0.7036 0.9673 0.908 0.9963 96.47 9.88 0.9807 0.958 0.000705 0 0.000705 0.2364 7.95 72.73 0.05073 74.79 0.5388.078 0.0528 0.0528.0.024.005 0.05073 5.949 30.78 0.238 0.9963 95.5.038 2.869.00 4.903 0.3033 4.72 30.66 0.042 60.3 4.02 0.005006 4.96 24.92.00 42.4 3550 5.076 42.4 23-0.00048 39.88.038 0.082 40 4.903.00 60.09 64.8 40-0.04597 20.34-0.69 9.42e-005 9.409e-005 0.9775 3.024 95.5 73.8-0.0006 2.929 0.000736 2.02-2.682 0.5 0.00435 0.399 3.677 99.79 Delivery of Oxygen to the Non-muscleTtissues OVA BFN HM AOM O2M OSV POV POT DOB MO 2 QO 2 NON MUSCLE O2 DELIVERY INTPUTS: OVA - oxygen content of arterial blood [ml O2 STPD/l blood] BFN - blood flow in non-muscle and non-renal tissues [l/min] HM - hematocrit [%] AOM - autonomic effect on tissue oxygenation [ratio to normal] O2M - basic oxygen utilisation in non-muscle cells [ml O2 STPD/min] OSV - non-muscle venous oxygen saturation [%] POV - non muscle venous PO2 [torr] POT - non muscle cell PO2 [torr] DOB - rate of oxygen delivery to non-muscle cells [ml O2 STPD/min] MO2 - rate of oxygen utilisation by non-muscle tissues [ml O2 STPD/min] QO2 - non-muscle total cellular oxygen [ml O2 STPD] Delivery of Oxygen to the Muscles OVA BFM HM AOM OMM EXC OVS PVO PMO RMO MMO QOM MUSCLE O2 DELIVERY INTPUTS: OVA - oxygen content of arterial blood [ml O2 STPD/l blood] BFN - blood flow in muscles [l/min] HM - hematocrit [%] AOM - autonomic effect on tissue oxygenation [ratio to normal] OMM - basic oxygen utilisation in muscles [ml O2 STPD/min] EXC - Effect of excercise on the metabolic usage of oxygen by the muscles [ratio to resting state ] OVS - muscle venous oxygen saturation [%] PVO - muscle venous PO2 [torr] PMO - muscle cell PO2 [torr] RMO - rate of oxygen delivery to muscles [ml O2 STPD/min] MMO - rate of oxygen utilisation by muscles [ml O2 STPD/min] QOM - muscle total cellular oxygen [ml O2 STPPD] DR 0 DPR 0 DIURET Circulatory Dynamics - Flows And Pressures VB QRO QLO VVS0 VAS0 VRA0 VPA0 VLA0 CAS CV CRA CPA CLA RSN RSM RPT RR VIM FIS PA PVS PRA PPA PLA VAS VVS VVE VRA VPA VLA QAO QVO QPO BFN BFM RBF FISFLO RTP VT0 VE0 MCP CIRCULATORY DYNAMICS - FLOWS AND PRESSURES INPUTS: VB - blood volume [l] QRO - actual right ventricular output l/min] QLO - output of left ventricle [l/min] VVS0 - unstressed venous systemic vascular volume [l] VVE - excess volume (stressed volume) in systemic veins [l] VAS0 - unstressed volume in systemic arteries [l] VRA0 - unstressed right atrial volume [l] VPA0 - unstressed volume in pulmonary arteries [l] VLA0 - unstressed volume in left atrium and pulmonary veins [l] CAS - capacitance of systemic arteries [l/torr] CV - capacitance of venous systemic volume [l/torr] CRA - capacitance of right atrium [l/torr] CPA - capacitance of pulmonary arteries [l/torr] CLA - capacitance of left atrium and pulmonary veins [l/torr] RSN - vascular resistance in non-muscle and non renal tissues [torr min /l] RSM - vascular resistance in muscles [torr min /l] RPT -pulmonary vascular resistance [torr min /l] RR - total renal resistance [torr min /l] ( VIM - blood viscosity (ratio to normal blood) FIS - conductance fot the fistula [l/min/torr] PA - arterial (aortic) pressure [torr] PVS - average venous pressure [torr] PRA - right atrial pressure [torr] PPA - pulmonary arterial pressure [torr] PLA - left atrial mpressure [torr] VAS - volume in systemic arteries [l] VVS - systemic venous vascular volume [l] VVE - excess blood volume in the veins [l] VRA - right atrial volume [l] VPA - volume in pulmonary arteries [l] VLA - volume in left atrium [l] QAO - blood flow in the systemic arteriel system [l/min] QVO - rate of blood flow from veins into right atrium [l/min] QPO - rate of blood flow into pulmonary veins and left atrium [l/min] BFN - blood flow in non muscle and non renal tissues [l/min] BFM - blood flow in muscles [l/min] RBF - renal blood flow [l/min] FISFLO - blood flow through a fistula [l/min] RTP - total systemic peripheral resistance [torr min /l] VT0 - total unstressed blood volume [l] VE0 - total excess volume of blood in the vasculature [l] MCP - mean circulatory pressure [torr] Capillary Membrane Fluid Dynamics PC PPC PGH PTC VTL TVD VUD DFP VID CFC VPN VTSN VP VTCLP VTS CFILTR VTC VPREL VTSREL CAPILLARY MEMBRANE FLUID DYNAMICS INTPUTS: PC - systemic capillary pressure [torr] PGH - hydrostatic pressure in the tissue gel [torr] PPC - plasma colloid osmotic pressure [torr] PTC - colloid osmotic pressure of the tissue gel [torr] VTL - rate of return of fluid from the interstitium to the blood through the lymph [l/min] TVD - rate of intake of fluid by mounth or otherwise [l/min] VUD - loss of fluid into the urine [l/min] DFP - loss of fluid from the pulmonary capillaries [l/min] VID - rate of transfer of fluid into the cells [l/min] CFC - capillary filtration coefficient [l/min/torr] (normal value CFC=0.067) VPN - normal value of plasma volume [l] VTSN - normal value of interstitital fluid volume [l]/n VP - plasma volume [l] VTS - total interstitial fluid volume [l] VTCPL - rate of leakage of whole plasma through the capillary membrane [l/min] CFILTR - rate of filtration from the systemic capillaries [l/min] VTC - toral rate of movement of fluid out of systemic capillaries [l/min] VPR - plasma volume [ratio to normal] VTS - total interstitial fluid volume [ratio to normal] CV 0.0825 CRA 0.005 CPP 72 CPF 0.0003 CPA 0.0048 CLA 0.0 CFC 0.067 CAS 0.00355 Blood viscosity HM VIM BLOOD VISCOSITY INTPUT: HM - hematocrit [%] OUTPUT: VIM - blood viscosity [ratio to normal] Autonomic Contorl of the Circulation PA POT PMO EXC ANUBR AUZ AU AUH AUR VVR AUP AOM AUM AVE AUTONOMIC CONTROL OF THE CIRCULATION INTPUTS: PA - systemic arterial pressure torr POT - non-muscle cell PO2 [torr] PMO - muscle cells PO2 [torr] EXC - Effect of excercise on the metabolic usage of oxygen by the muscles [ratio to resting state ] ANUBR - direct effect of angiotensin on vasomotor center ["virtual" torr] AUZ - overall sensitivity of autonomic control [ratio to normal] OUTPUTs: AU - overall activity af autonomic system [ratio to normal] AUH - autonomic multilier effect on the heart output [ratio to normal] AUR - autonomic multilier effect on heart rate [ratio to normal] VVR - basic volume of venous tree(maximum volume at zero pressure ) [l] AUP - autonomic multipllier effect on ADH hormone excretion etc. [ratio to normal] AOM - autonomic multipllier effect on tissue oxygen utilisation [ratio to normal] AUM - autonomic multipllier effect on arterial resistance [ratio to normal] AVE - autonomic multipllier effect on venous resistance [ratio to normal] Afferent Arteriole AARK MYOGRSAA RNAUG ANM AUM VIM AAR AFFERENT ARTERIOLE INTPUTS: AARK - normal resistance in afferent arteriole [torr min/l] RNAUG - macula densa feedback signal [ratio to normal] AUM - sympathetic vasoconstrictor effect on arteries [ratio to normal] ANM - angiotensin multiplier effect on vascular resistance [ratio to normal] VIM - blood viscosity [ratio to normal blood] OUTPUT: AAR - afferent arteriolar resistance [torr l/min] AUZ ATRVFBM 0 ATRRFBM 0 ANY -0.2 ANXM ANUVM 0 ANUBRM 0 ANG 0 ALD 0 ALCLK AHMRM 0 ADH 0 AARK 40 2 PA PA PA PPA PPA HMD HMD HM HM HSL HSL BFN OSA RR ANM ANM ANM ANM ANU ANC AHC AHRM AHRM - -