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The volume of distribution (Vd) is influenced by several physiological determinants, including tissue perfusion, membrane permeability, and the binding affinity of a drug for plasma proteins and tissues. Factors such as body fat percentage, age, and disease states can also affect Vd by altering the distribution of drugs in various compartments of the body. Additionally, the pH and ionization of the drug, along with the patient's hydration status, play crucial roles in determining how extensively a drug distributes into tissues. Overall, these physiological factors collectively influence how a drug disperses throughout the body's compartments.

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