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Drug Action I > Block 2 - Fluid Balance Physiology > Flashcards

Block 2 - Fluid Balance Physiology Flashcards

1
Q

What maintains homeostasis? Why is it important?

A

Consistent fluid and electrolyte adjustments

Imbalances can cause life-threatening complications

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2
Q

What are electrolytes?

A

Any substance that dissociates into ions in water

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3
Q

What can fluid fluctuations affect?

A
  1. Cellular function
  2. Blood volume
  3. Hemodynamics
  4. Overall workload of heart and vital signs
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4
Q

What are the outcomes of having excess fluid?

A
  1. Increase BP
  2. Fluid leakage leads to edemas
  3. Insufficient oxygenation
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5
Q

What are the outcomes of being fluid deficient?

A
  1. increase HR
  2. Decrease BP
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6
Q

What are the effects of electrolyte composition?

A
  1. Electrical potential of cells
  2. Cardiovascular function
  3. Fluid shifts
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7
Q

What are the compartments of total body water?

A

Intracellular and extracellular

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8
Q

What is ICF’s primary cation?TBW composition?

A

K+
63-70%
Water, protein, electrolytes

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9
Q

What is the ECF’s primary cation? TBW composition?

A

Na+
30-35%

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10
Q

What are components of ECF?

A
  1. Intracellular: Whole blood
  2. Interstitial: Surrounds cells in tissues
  3. Transcellular: Fluide in defined spaces (CSF, synovial, body cavity)
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11
Q

What is osmosis?

A

Water movement from less to more concentrated areas

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12
Q

How does Na+ and K+ affect osmosis?

A

Na+: responsible for osmotic balance of the ECF
K+: affects osmotic balance in the ICF

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13
Q

What is diffusion?

A

Molecules move from higher to lower concentrated areas

Solutes restricted to one primary compartment have more osmotic activity

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14
Q

What is active transport?

A

Requires ATP when solutes move against their electrochemical gradient

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15
Q

What is filtration?

A

Movement of the water or blood passing through a membrane by a force such as pressure

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16
Q

What drives blood from arterial to venous end of capillary?

A

Osmotic or hydrostatic pressure between capillaries and interstitial space

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17
Q

What is colloid osmotic pressure?

A
  1. Oncotic (water pulling) pressure
  2. Due to the concentration of proteins
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18
Q

What is hydrostatic pressure?

A

Pressure of fluids or their properties when in equilibrium

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19
Q

Describe the arteriolar end of capillary?

A

Net filtration occurs at the arterial end

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20
Q

Describe the venous end of capillary?

A

Net reabsorption occurs at the venous end of a capillary

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21
Q

What is an edema?

A

Accumulation of interstitial fluid volume

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22
Q

What are the causes of edemas?

A
  1. Increased capillary hydrostatic pressure
  2. Increased capillary permeability
  3. Decreased colloid osmotic pressure
  4. Obstruction in lymphatic system
  5. Excess body water and sodium
  6. Combination of mechanisms
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23
Q

What are edemas caused by increased capillary hydrostatic pressure? Results?

A
  1. Sodium and water retention
  2. Venous obstruction
  3. Increased systemic venous pressure due to heart failure
  4. Increased Blood volume due to renal failure
  5. Localized edema
  6. Leakage of fluid into the interstitial space
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24
Q

How can edemas be caused by increased capillary permeability? Results?

A
  1. Damage to the integrity of endothelium
  2. Trauma and burns
  3. Hyperemia and inflammation
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25
Q

How can edemas be caused by decreased colloid osmotic pressure?

A

Decreases in colloid osmotic pressure contribute to accumulation of fluid in tissues

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26
Q

What is the role of plasma proteins in edemas?

A
  1. Maintain fluid resorption
  2. Depletion ceases central blood volume, causing movement of fluid into interstitial space
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27
Q

How can the obstruction in lymphatic systems cause edema?

A

Fluid and plasma protein accumulation in interstitial space causing lymphedema

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28
Q

How can excess body water and sodium cause edemas?

A
  1. Decreased cardiac output from heart failure and increased volume shifts fluid into interstitial space
  2. Inadequate excretion of sodium in renal failure
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29
Q

What are the outcomes of sodium retention?

A
  1. Increased circulating plasma volume
  2. Increased capillary pressure
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30
Q

What are the classes of edemas?

A
  1. Localized
  2. Generalized
  3. Dependent
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31
Q

What are localized edemas?

A

Found in an area of tissue due to an injury, infection, or obstruction

32
Q

What are generalized edemas?

A

Uniformly distributed and may accumulate in gravity dependent positions

33
Q

What are dependent edemas?

A

Gravity-related swelling, typically found in disease processes that cause fluid volume excesses

34
Q

What are the types of fluid spacing and how is it distributed?

A
  1. First: normal ICF and ECF
  2. Second: edema
  3. Third: fluid accumulation in abnormal places
35
Q

What are the clinical manifestations of edemas?

A
  1. Swelling that may be palpable
  2. Compresses surrounding tissue and circulatory structures
  3. Pulmonary edema
36
Q

What are the results of pulmonary edemas?

A

Shortness of breath to inadequate oxygenation of blood

37
Q

How are edemas graded?

A
  1. Palpability rated 1-4
  2. 4 rating: more serious and enduring edema
  3. Pitted edema: pit remains after swollen area is pressed
38
Q

What is purpose of the thirst mechanism?

A
  1. Hypothalamic osmoreceptors facilitate water movement into or out of capillaries between plasma and interstitial fluid
  2. Posterior pituitary release vasopressin
  3. Kidneys retain water
39
Q

What is the importance of water intake?

A
  1. Decrease serum osmolarity
  2. Inhibits ADH secretion
  3. Causes kidneys to produce dilute urine
40
Q

How does you body regulate fluids?

A
41
Q

What are the signs of dehydration?

A
  1. Dry mouth and tongue
  2. Lack of tears
  3. No wet diaper for 3 hr
  4. Sunken eyes and cheeks
  5. Sunken fontanels
  6. Irritability
42
Q

What is a sign of dehydration in children?

A

Diarrhea and vomiting

43
Q

What are the signs of dehydration in older adults?

A
  1. Smaller fluid reserves
  2. Reduced ability to conserve water
  3. Lose sense of thirst
  4. Chronic disease, mobility issues
  5. Should increase fluid intake
44
Q

What are the electrolytes? Which are positive? Which are negative?

A

Cations: Na+, K+, Ca2+, Mg+
Anions: HCO3-, Cl-, Po43-

45
Q

What regulates sodium concentrations?

A
  1. Renal and hormonal mechanism
  2. Natriuretic peptides
  3. RAAS
46
Q

What regulates water?

A
  1. ADH
  2. Concentration of sodium
47
Q

What are the types of fluid imbalances?

A
  1. Volume (isotonic) imbalances
  2. Osmolar imbalances
48
Q

What is volume imbalance?

A
  1. Osmolality remains normal
  2. Hypervolemia or hypo
  3. Sodium level remains normal
49
Q

What is osmolar imbalances?

A

Alteration in concentration between water and sodium or other solutes in ECF

50
Q

What is the role of sodium to osmolality?

A
  1. Main cation in ECF
  2. Primary determinant of ECF osmolality
51
Q

What are classes of water balance and how does it relate to osmolality?

A
  1. Isotonic (osmolality same as body fluids)
  2. Hypertonic (osmolality higher than blood fluids)
  3. Hypotonic (osmolality lower than body fluids)
52
Q

What is the standard plasma osmolality?

A

0.9% sodium (isotonic)

53
Q

Describe how water and solutes increase at equivalent rates?

A
  1. Same osmolality in hypervolemic form
  2. Occurs with or after an increase in extracellular sodium levels
  3. Excess volume generally refers to increased ECF volume
54
Q

What causes renal sodium retention?

A
  1. Leads to increased body sodium content
  2. Subsequent increase in excess volume
55
Q

What is the underlying cause of renal sodium retention?

A

Increase in enteral or parenteral sodium ingestion

56
Q

What causes excess fluid?

A
  1. Excessive admin of IV
  2. Hypersecretion of adrenocorticoid hormones
57
Q

What is the function of aldosterone? Hypersecretion of it?

A

Acts directly on kidneys to increase sodium and water retention

Can lead to isotonic fluid volume excess

58
Q

Disease states that affect isotonic fluid volume excess?

A

Heart failure, liver failure, malnutrition

59
Q

Clinical manifestations of fluid excess?

A
  1. Weight gain
  2. Decreased hematocrit
  3. Decreased plasma protein
  4. DIstened neck veins
  5. Increased BP
  6. Increased capillary hydrostatic pressure
  7. Edema
60
Q

What is isotonic fluid volume deficiency?

A

Symmetric loss or depletion of water and electrolytes -> depleted at equivalent rates

Dehydration or hypovolemia

Fluid moves out of cells intro dehydrated ECF -> cells shrink from osmosis

61
Q

What causes fluid deficiencies?

A
  1. Hemorrhage
  2. Vomiting
  3. Diarrhea
  4. Fever
  5. Excess sweating
  6. Burns
  7. Uncontrolled diabetes mellitus
62
Q

What are the clinical symptoms of fluid deficiency?

A

Hypovolemia with a normal serum sodium level
1. Decrease urine output
2. Weight loss
3. Increased hematocrit

63
Q

What are the clinical manifestations of fluid deficiency?

A
  1. Tachycardia
  2. Decreased skin turgor
  3. Decreased BP
  4. Potential hypovolemic shock
64
Q

What is diabetes insidious?

A

Impaired secretion of ADH (vasopressin)

65
Q

What is desmopressin? What does it do?

A

Synthetic vasopressin that increase urine osmolality

66
Q

How is the urine affected in those with DI?

A

Urine osmolality is reduced after a water deprivation

67
Q

What happens when aldosterone is secreted?

A
  1. Mineralocorticoid syntehsized and secrete by adrenal cortex
  2. Decreased blood pressure stimulates renin secretion and subsequent activation of the renin-angiotensin-aldosterone system (RAAS).
  3. Causes sodium retention, increased fluid volume, and increased blood pressure.
68
Q

What are natriuretic peptides? Examples?

A

Released in response to elevated atrial pressure that stimulate the release of uradilantin from kidney to antagonize RAAS
1, Atrial natriuretic peptide
2. Brain natriuretic peptide

69
Q

What are atrial natriuretic peptides?

A

Produced by atrial cells

70
Q

What are brian natriuretic peptides?

A

Originates from ventricular cells

71
Q

What is hypernatremia? How is it caused?

A

Increased output or decreased intake of water
1. Increased sodium consumption
2. Thirst impairment or water deprivation
3. Diarrhea
4. Burns
5. Heat stroke
6. Fever and infection causing increased respiratory rate and dehydration
7. May be secondary to disease

72
Q

What are the clinical manifestations of hypernatremia?

A
  1. Hyperosmolality
  2. Fever, dry membranes, hypotension, TCHY
  3. Low jugular venous presure
  4. Restlessness
  5. Pulmonary edema
  6. CNS symptoms (Muscle twitching, hyperreflexia, confusion, coma, convulsions, cerebral hemorrhage)
73
Q

What are the causes of hyponatremia?

A
  1. Vomiting and diarrhea
  2. Diuretic
  3. GI depletion, disease
  4. Postoperative hypotonic fluid administration
  5. Oral water intoxication
74
Q

Describe the fluid shifts from ICF to ECF in hyponatremia?

A
  1. Fluid shifting from area of low solute concentration to area of high solute concentration.
  2. In hyperglycemia, fluid moves to the ECF, diluting the high amounts of blood sugar.
  3. Fluid shift ultimately dilutes the sodium in the intravascular space.
75
Q

What is hyponatremia?

A

Sodium deficits from loss of body fluids

76
Q

What are the clinical manifestations of hyponatremia?

A
  1. Neurological (lethargy, HA, confusion, seizures, coma)
  2. Hypotension
  3. Tachycardia
  4. Deceased urine output
77
Q

How can hyponaternia cause inadequate excretion of body fluids?

A
  1. Renal dysfunction
  2. Adrenal insufficiency
  3. SIADH
  4. Diabetic ketoacidosis

Drug Action I (32 decks)

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