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Renal Exam 1 > Body Fluid Compartments > Flashcards

Body Fluid Compartments Flashcards

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1
Q

Total body water (TBW)

  • Equation?
  • Normal value?
A

.6 x body weight

normal is 42 L

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2
Q

Total body water is divided up into?

A

-Extracellular fluid (ECF)
-Intracellular fluid (ICF)
divided by the cell membrane

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3
Q

Extracellular fluid (ECF)

  • Equation?
  • Normal value?
A

.2 x body weight

normal is 14 L

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4
Q

Intracellular fluid (ICF)

  • Equation?
  • Normal value?
A

.4 x body weight

Normal is 28 L

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5
Q

Extracellular fluid can be divided into?

A
  • Interstitial fluid

- Plasma

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6
Q

Interstitial fluid

  • Equation?
  • Normal value?
A

.75 x ECF

normal is 10.5 L

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7
Q

Plasma

  • Equation?
  • Normal value?
A

.25 x ECF

Normal is 3.5 L

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8
Q

What separates the interstitial fluid from the plasma?

A

Capillary wall

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9
Q

The plasma can be divided into?

A
  • Venous (compliance)

- Arterial

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10
Q

Venous

  • Equation?
  • Normal value?
A

.8 x plasma

-normal is 2.8 L

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11
Q

If blood volume is low, what happens to the blood that you do have?

A

It is shunted toward the more important organs (brain and kidneys) to protect them

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12
Q

Arterial

  • Equation?
  • Normal value?
A

.2 x plasma

Normal is .7 L

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13
Q

Arterial is also known as?

-What does this mean?

A

Effective Circulating Volume (ECV)

-Volume of arterial blood EFFECTIVELY PERFUSING TISSUE

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14
Q

Transcellular fluid

A
  • Also included in the ECF
  • It normally contains only a small amount of water such as epithelial secretions, synovial fluid, CSF, etc
  • It is said to occupy a “third space” (i.e. 3 ECF compartments)
  • Overabundance of fluid in third space can be pathologic
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15
Q 
Hypovolemia due to vomiting
   -ECV?
   -ECF?
   -Plasma volume?
   -Cardiac output?
   -
A
  • ECV-decreased
  • ECF-decreased
  • Plasma volume-decreased
  • Cardiac output-decreased
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16
Q

Heart failure

  • ECV?
  • ECF?
  • Plasma volume?
  • Cardiac output?
A
  • ECV-decreased
  • ECF-increased
  • Plasma volume-increased
  • Cardiac output-decreased
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17
Q

Arteriovenous fistula

  • ECV?
  • ECF?
  • Plasma volume?
  • Cardiac output?
A
  • ECV-normal
  • ECF-increased
  • Plasma volume-increased
  • Cardiac output-increased
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18
Q

Severe Hepatic Cirrhosis

  • ECV?
  • ECF?
  • Plasma volume?
  • Cardiac output?
A
  • ECV-decreased
  • ECF-increased
  • Plasma volume-increased
  • Cardiac output-normal/increased
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19
Q

Clinical relevance of body fluid compartments

-Pharmacology-Volume of distribution (Vd) of a drug

A
  • Apparent volume of body fluid in which the total dose of the drug is distributed at the same concentration as in the plasma
  • Useful in calculating loading doses
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20
Q

If the Vd is less than or equal to 3L what compartment is the drug distributed in?

A

Drug is only in the plasma

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21
Q

If the Vd is 14L what compartment is the drug distributed in?

A

The drug is in the ECF (plasma and interstitial fluid)

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22
Q

If the Vd is 40-45L what compartment is the drug distributed in?

A

The drug occupies the total body water

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23
Q

If the Vd is is greater than 45L what compartment is the drug distributed in?

A

The drug is widely distributed and bound in body tissues

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24
Q

Normal daily urine output?

A

1400 mL

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25
Donnan effect
Albumin is very large and negative so it attracts positively charged Na and K ions
26
Non-electrolytes - Protein levels in ICF and intravascular compartments? - Protein levels in interstitial fluid
- Higher protein levels in ICF and intravascular compartments (primarily albumin) - Lower in interstitial fluid
27
Non-electrolytes | -Oncotic (osmotic?) pressure
Proteins normally do not move (membranes are impermeable to proteins), therefore they do not normally impact osmolarity but do exert oncotic pressure -Osmotic pressure generated by large molecules (proteins) in solution which are impermeable to membranes
28
Volumes- indicator/dilution methods-slide 13 | -Not sure if we need to know this
?
29
Balance of ions | -Normally, osmolarity is balanced between?
- Interstitial and intravascular fluids (ECF compartments) | - ECF and ICF
30
Balance of ions | -Na and K concentration is slightly higher than expected due to?
Donnan effect
31
Osmolarity of body fluid compartments | -ECF osmolarity is due to?
[Na + Cl]
32
Osmolarity of body fluid compartments - Concentration of Na in vasculature compared to interstitial fluid and ICF? - Due to?
- Concentration of Na in vasculature > interstitial fluid > ICF... - Due to Na-K ATPase pump on cell membranes working normally
33
Osmolarity of body fluid compartments - Concentration of Na in vasculature > interstitial fluid > ICF... - Due to Na-K ATPase pump on cell membranes working normally - Disruption of pump activity by? - results in?
Disruption of pump activity by hypoxia results in increased ICF Na -Water follows Na into cell and the cell swells
34
Osmolarity of body fluid compartments | -ICF osmolarity is due to?
[K+]
35
Osmolarity of body fluid compartments | -Plasma osmolality (osmolarity?) can be estimated by what two methods?
2 x [Na+] | 2 x [Na+] + glucose/18 + urea/2.8
36
Movement of water between compartments - Cell membrane between ECF and ICF - Permeable/impermeable to? - Fluid distribution between compartments is dependent on?
- Highly permeable to water - NOT permeable to most electrolytes - Fluid distribution between two compartments is dependent on osmolar gradient
37
Movement of water between compartments - Capillary membrane between ECF compartments is highly permeable to? - Fluid distribution is due to?
- small ions | - Fluid distribution is due to a balance of Starling forces
38
Movement of water between compartments - Fluid distribution is due to a balance of Starling forces - which ones and which way do they go?
- Capillary hydrostatic pressure (favoring filtration) | - Colloid oncotic pressure (primarily due to plasma proteins which opposes filtration)
39
Fluid shifts-osmotic equilibrium - ECF osmolarity controls? - Water enters or leaves ECF rapidly in order to?
- ECF osmolarity controls ICF volume | - Water enters or leaves ECF rapidly in order to balance osmolarity of ECF and ICF
40
Fluid shifts-osmotic equilibrium | -Osmotic equilibration?
-Movement of water across cell membranes from higher to lower concentration as a result of an osmotic pressure difference (difference in number of solute particles in sol'n) across the membrane
41
Fluid shifts-osmotic equilibrium | -Osmotic equilibration-osmotic pressure exerted across a membrane by a substance is also due to?
-osmotic pressure exerted across a membrane by a substance is also due to that membrane being impermeable to that solute
42
***Any fluid that enters your body goes through what fluid compartment FIRST?***
***Any fluid that enters your body goes through your ECF FIRST (acts as a reservoir)***
43
Darrow-Yannet Diagrams slide 20
?
44
Fluid shifts - ICF and ECF - When does water move between them? - Equilibration of ICF and ECF osmolality occurs primarily by?
- The ICF and ECF are in osmotic equilibrium - Water moves between these compartments only when an osmotic pressure gradient exists - Equilibration of ICF and ECF osmolality occurs primarily by shifts in water (not shifts in solute)
45
Factors affecting osmolarity and volume of ECF and ICF
- water ingestion/dehydration - intravenous infusions - diarrhea/vomiting - sweating - diuresis - disease
46
Examples - Excessive NaCl intake, hyperaldosteronism (Conn's disease) - ECF volume? - ICF volume? - ECF mOsm? - ICF mOsm?
- ECF volume-increased - ICF volume-decreased - ECF mOsm-increased - ICF mOsm-increased
47
Examples - Water gain (SIADH, psychogenic polydypsia) - ECF volume? - ICF volume? - ECF mOsm? - ICF mOsm?
- ECF volume-increased - ICF volume-increased - ECF mOsm-decreased - ICF mOsm-decreased
48
Examples - Water loss (dehydration) - ECF volume? - ICF volume? - ECF mOsm? - ICF mOsm?
- ECF volume-decreased - ICF volume-decreased - ECF mOsm-increased - ICF mOsm-increased
49
Examples - NaCl loss - ECF volume? - ICF volume? - ECF mOsm? - ICF mOsm?
- ECF volume-decreased - ICF volume-increased - ECF mOsm-decreased - ICF mOsm-decreased
50
Many diseases are accompanied by fluid shifts between compartments -Important for treatment?
Maintenance of adequate fluids in ICF, ECF or both is important in treatment of these patients
51
Fluid distribution between plasma and interstitial fluid (within ECF) is maintained by?
balance of hydrostatic and osmotic forces across capillaries
52
Fluid distribution between ECF and ICF is determined by?
osmotic effect of small solutes across cell membrane (highly water permeable, but impermeable to ions)
53
Clinical relevance of fluid balance-hydration therapy/replacement fluids -Intravenous replacement fluids used when oral rehydration not suitable-Targets compartment which is volume-depleted
K
54
Clinical relevance of fluid balance-hydration therapy/replacement fluids - Distribution in compartments depends on type of fluid - 2 types?
- Crystalloid fluids | - Colloid fluids
55
Crystalloid fluids
- Contain varying concentrations of electrolytes | - Can stay in ECF or be widely distributed depending on composition (e.g. normal saline, lactated Ringer's solution)
56
Colloid fluids
Contain large proteins and molecules which tend to stay within the vascular space (e.g. dextran, albumin)
57
Other important terms-isosmotic, hyperosmotic, hyposmotic solutions -What do these terms indicate?
Indicates osmolarity of solution compared to ECF (these terms do NOT indicate whether the cell membrane is permeable to the solute)
58
Isomotic
- Solutions which have the same osmolarity as the ECF | - When added to the ECF, does not change osmolarity, increases volume ONLY
59
Hyperosmotic
- Solution has an osmolarity greater than that of the ECF - When added to the ECF, osmolarity increases and causes water to flow out of the cells to the ECF compartment with a resulting increase in ECF volume and decrease in ICF volume
60
Hyposmotic
- Solution has an osmolarity less than that of the ECF - When added to the ECF, decreases osmolarity and water moves into the cells to equalize osmolarity - ECF and ICF volumes are both increased
61
Tonicity
-Changes in cell volume due to osmotic equilibrium with water movement across cell membranes
62
Tonicity | -Small changes in concentration of impermeant solutes in ECF can cause?
large changes in cell volume
63
Tonicity | -Movement of water?
Water always moves from an area in which it is in higher concentration to an area of lower concentration
64
Isotonic solution
No change is cell volume
65
Hypotonic solution
cell swells
66
Hypertonic solution
Cell shrinks
67
Fluid exchange/balance | -Distribution of fluid between the ECF and ICF compartments is determined primarily by?
- Ion distribution (Na) | - ATPase activity (keeps Na(inside) low and K(inside) high)
68
Fluid exchange/balance | -Distribution of ECF between the plasma and interstitial compartments is determined primarily by?
- Balance of hydrostatic vs. oncotic pressures | - intravascular pressure in capillaries vs. plasma protein and solute concentration
69
Edema | -Palpable swelling produced by expansion of?
Interstitial fluid volume
70
Edema | -Palpable swelling produced by expansion of interstitial fluid volume-Caused by?
- Alteration in capillary hemodynamics (altered Starling forces with increased net filtration pressure)-fluid moves from vascular space into the interstitium - Renal retention of dietary Na and water-expansion of ECF volume
71
Edema - Altered Starling forces-renal role - When does edema become apparent? Therefore?
- Edema does not become apparent until interstitial volume is increased by 2.5-3L (normal plasma volume is only 3L) - Therefore, edema fluid is not derived only from plasma - Compensatory renal retention of Na and water to maintain plasma volume in response to underfilling of the vasculature must occur in this situation to cause edema
72
Edema | -This renal compensation is?
This renal compensation is appropriate to restore tissue perfusion although it exacerbates edema -e.g. CHF
73
Edema | -Renal retention of Na and water-results in?
- Overfilling of the vascular tree - Inappropriate renal fluid retention - Usually results in elevated blood pressure, expanded plasma and interstitial volumes - E.g. primary renal disease (glomerulonephritis, nephrotic syndrome)
74
Non-pitting edema
Swollen cells due to increased ICF volume
75
Pitting edema
Increased interstitial fluid volume
76
Edema often treated with?
diurectics

Renal Exam 1 (6 decks)

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