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Renal 1 > Body Fluid Compartments & Homeostasis > Flashcards

Body Fluid Compartments & Homeostasis Flashcards

1
Q

Main Function of Kidney

A

Regulate volume and composition of body fluid within narrow limits

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2
Q

How to compartmentalize body fluid

A

1) Intracellular Fluid
2) Extracellular Fluid
3) Other- lymph, CSF, humors of eyes, serous fluid, GI secretion

60-40-20

  • 60% of BW is total Body water
  • 40% BW (or 2/3 TBW)= ICF
  • 20% BW ( or 1/3 TBW)= ECF

ECF

  • 1/4 of ECF= plasma
  • 3/4 of ECF= interstitial fluid
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3
Q

Significance of Plasma

A

-only fluid that can be acted on directly to control volume and composition of interstitial fluid and ECF

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4
Q

Extracellular Fluid Importance

A
  • intermediary btw cells and external environment

- H20 exchange btw ICF and external must go through ECF

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5
Q

Third Spacing

A
  • too much fluid shift from intravascular into interstitial area
  • fluid lost from intravascular space
  • due to pulmonary edema, trauma, burns

Normal: all fluid contained in intravascular, intracellular, interstitial space

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6
Q

ECF vs ICF (3)

A

1) Proteins in ICF can’t permeate enveloping membranes to leave cells
2) active Na-K pump in all cells
3) Na+ is primary ECF cation
k+ is primary ICF cation
- Cl- is next in ECF

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7
Q

Electrolytes ( vs. nonelectrolytes, significance)

A

Nonelectrolytes:

  • covalent bond
  • no electrical charge
  • glucose, lipids, urea

Electrolytes

  • dissociates into ions in water
  • Mg+, Na+, Cl-, k+
  • have ability to cause fluid shift
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8
Q

Na+ Osm

A

135-147 mEq/L

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9
Q

Cl- Osm

A

95-105 mEq/L

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10
Q

K+ Osm

A

3.5-5.0 mEq/L

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11
Q

HCO3- Osm

A

22-28 mEq/L

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12
Q

Ca2+ Osm

A

8.4-10 mg/dL

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13
Q

Pi osm

A

3.0-4.5 mg/dl

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14
Q

anion gap

A

8-16 mEq/L

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15
Q

Total Serum protein

A

6 -7.8 g/dl

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16
Q

albumin

A

3.5-5.5 g/dl

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17
Q

globulin

A

2.3-3.5 g/dl

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18
Q

Creatinine

A

0.6-1.2 mg/dl

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19
Q

Glucose

A

70-110 mg/dl

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20
Q

Urea Nitrogen (BUN)

A

7-18 mg/dl

21
Q

Serum Osm

A

285-295 mIsm/kg H2O

22
Q

Blood

  • content
  • average blood volume
  • Disturbances in plasma
A
  • ECF= plasma (60%)
  • ICF= RBC (40%)
  • average blood volume= 7% ( 5 liters)
  • ECF volume loss=> increased total plasma protein (concentration
  • ECF volume gain => decreased total plasma protein ( dilution)
23
Q

Hematocrit

  • definition
  • amount in women and men
  • Disturbances in hematocrit
A
  • fraction of blood in RBC
  • Men= 0.4
  • F= 0.36
  • anemia=0.10
  • ECF volume loss=> increased hematocrit (concentration)
  • ECF volume gain => decreased hematocrit ( dilution)
  • ICF volume loss=> decrease hematocrit (shrinkage of RBCs)
  • ICF volume gain=> increased hematocrit (swelling of RBCs)
24
Q

Gibbs- Donnan Effect

  • gradient
  • permeable to what
A

1) Protein particles create a oncotic gradient favoring water into cell
2) Negative charge of protein favor movement of charges into cell

  • generate both osmotic and electrochemical gradient across membrane
  • Permeable to ion
  • impermeable to large proteins
25
Q

How does our body counter Gibbs-Donnan? What happens when effects not countered?

A

If not countered-> IC protein would influx water into cell=. swell and death

Counter by:

  • Na/K Atpase pump
    • maintain high sodium concentration outside cell
    • protects cells from swelling and rupturing
    • prevent excessive inward movement of water
26
Q

Two factors that make free fluid movement possible

A

1) Water molecules diffuse through capillary walls faster than blood
2) Pressure difference inside and outside of vessels (capillary filtration pressure)

27
Q

Hydrostatic Pressure

A
  • blood pushing against walls of capillary

- forces fluids and solutes through the capillary walls into interstitial fluid

28
Q

Filtration

A

capillary blood pressure> plasma colloid osmotic pressure

- fluid leaves capillaries and enter interstitial fluid

29
Q

Absorption

A

Capillary blood pressure< plasma colloid osmotic pressure

-water returns to capillaries

30
Q

Plasma colloid osmotic pressure (in relation to albumin)

A
  • osmotic pulling of albumin in intravascular space brings water into blood vessels
31
Q

Edema

  • definition
  • causes (2)
  • types of edema
A
  • swelling bc of interstitial fluid volume

Causes
1) changes in capillary hemodynamics (starling forces) => increased filtration
(Normal= 3L)
- affected by plasma, Na+, water
2) Renal Retention of dietary Na+ and water expansion of ECF volume
- inappropriate renal fluid retention
- high BP

  • non-pitting edema: swollen cells due to ICF volume
  • pitting edema- increase interstitial fluid volume
32
Q

Starling forces (4)

A

1) Capillary Hydrostatic pressure (BP)- forces fluid out of capillary to interstitial space
2) Capillary (plasma) oncotic pressure- fluid from interstitial space into capillary
3) Interstitial hydrostatic pressure- fluid back into capillary
4) interstitial oncotic pressure- fluid out of capillary into interstitial space

33
Q

Types of Tonicity (3)

-Normal NaCl concentration

A

Normal NaCl concentration= 0.85%

  • think of it out of cell!

1) Isotonic= NaCl conc equals 85%
- equal movement of water in and out of cell
2) Hypertonic- NaCl conc greater than 85%
- net movement of water OUT of cell => cell shrink
3) Hypotonic ( sweating)= NaCl conc less 85%
- net movement of water INTO cell=> cell swell

34
Q

Replacement Therapy (2)

A

1) Crystalloids
- organic/inorganic salts dissolved in sterile water
- exm 0.9% NaCl, lactated Ringer’s , D5W ( dextrose in water)
- does not cross plasma membrane (stays in ECF)

2) Colloids
- large molecules that can’t pass through semipermeable membrane
- stay in INTRAvascular compartment

35
Q

Van’t Hoff’s Law

A
  • calculate osmotic pressure of a solution
36
Q

Serum Osmolarity equation

A

2Na + Glucose/18 + BUN/2.8

37
Q

Changes in volume depends on…

A

changes in Na+ balance

38
Q

Changes in Na+ concentration and osmolarity depends on…

A

changes in H20 balance

39
Q

Dehydration

  • causes (2)
  • types
A

1) decreased water intake
2) increased fluid loss

Hypernatremic
Hyponatremic

Normal osmolality 300 mOsm/kg
Normal Serum sodium 150 mEq/L

40
Q

Hypotonic (hyponatremic) dehydration (5) and clinical presentation

A

SWEATING

1) loss of sodium> loss of water in ECF
(serum sodium level below 130-135 mEq/L)
2) sodium conc in ICF greater than ECF
3) Fluid Shift ECF -> ICF 
4) Serum Na and Osmolality LESS than normal
5) Swelling, hypovolemia

symptoms: edema, depression, confusion, weakness, anorexia, diarrhea
- HTN, tachycardia, decreased urine output

41
Q

Hypertonic (Hypernatremic) dehydration

A 
1) loss of water> loss of sodium in ECF
(serum sodium above 147-150 mEq/L)
2) sodium conc in ECF greater than ICF
3) Fluid Shift ICF -> ECF 
4) Serum Na and Osmolality LESS than normal

symptoms: edema, HTN, weakness, thurst, decreased urine output, confusion, coma

42
Q

Fluid Shift disturbances (2,3)

A

1) Volume contraction- decrease ECF volume, blood volume, and BP
2) Volume expansion -
increase ECF volume, blood pressure, edema

1) Isosmotic= no change in body fluid osmolarity
2) hyperosmotic= body fluid osmolarity is increased
3) hyposmotic= body fluid osmolarity is decreased

43
Q

Darrow- Yannet Diagrams

A
  • effects of clinical conditions on osmolality and volume of ECF and ICF
44
Q

Darrow- Yannet Diagram: Iso-osmotic volume contraction

A
  • acute fluid loss conditions (hemorrhage, diarrhea, vomiting)
  • Decrease ECF volume
  • no changes in osmolality and ICF volume
45
Q

Darrow- Yannet Diagram: Hyper-osmotic volume contraction

A

-hypotonic fluid loss (dehydration, diabetes insipidus, alcoholism)

  • Decrease ECF and ICF volume
  • Increase Body Osmolality
46
Q

Darrow- Yannet Diagram: iso-osmotic volume expansion

A

-isotonic saline

  • Increase ECF volume
  • no change in osmolality and ICF volume
47
Q

Darrow- Yannet Diagram: Hypo-osmotic volume expansion

A

-Hypotonic fluid (excess water drinking)

  • Increase in ECF and ICF volume
  • Decrease in body osmolality
48
Q

EC and IC volume changes significantly due to (5)

A

1) excess ingestion/ renal retention of water
2) dehydration
3) IV infusion of different types of solution
4) loss of fluid in GI
5) sweating

Renal 1 (8 decks)

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