Class 5- Alterations in Fluid and Electrolytes Acid-Base Flashcards
Fluid % of…
- Intracellular
- Interstitial
- Intravascular
- Transcellular
- 66%
- 24%
- 7%
- 2%
Isotonic Loss
- water and sodium are lost in proportion
- from vomiting, diarrhea, bleeding, diuretic therapy, hyperaldosterone
Isotonic Loss causes…
- increased thirst
- decreased urine
- flat neck veins
- decreased weight
- decreased BP
- lethargy
- tenting skin (poor turgor)
- increased HR
- increased antidiuretic
- less responsive
- increased aldosterone
- sunken eyes in elderly and babies
Treatment for Isotonic Loss
- replace isotonic fluid
- eg. saline IV
Intravascular Fluid Volume Excess: Fluid Overload
- isotonic gained
- water and sodium gained in proportion
- not usually an issue in people with normal heart, liver, and kidneys
What is Intravascular Fluid Volume Excess (Fluid Overload) caused by?
- heart failure
- too much isotonic solution uptake
- kidney failure
Signs and Symptoms of Intravascular Fluid Volume Excess
- increased weight
- increased neck vein distention
- increased BP (depending on organ function)
- decreased HR (depending on organ function)
Treatment for Intravascular Fluid Volume Excess
- medication
- dialysis
Edema: Interstitial Space
- swelling
- fluid always remains in interstitial space to be drained by lymph
Edema is caused by…
- increased capillary hydrostatic pressure
- decreased capillary oncotic pressure d
- increased capillary permeability
- increased interstitial oncotic pressure
- lymphatic obstruction
Manifestations of Edema
- localized edema
- dependent areas
- pulmonary edema
- pitting edema
- generalized edema
Describe Pulmonary Edema Symptoms
- difficulty breathing
- abnormal breath sounds
- increased resp rate
- increased fluid in lungs
- abnormal breath sounds
Edema Treatment
- elevating swollen limb
- elastic support stockings
- diuretic drug
- intravenous albumin
What changes fluid in intracellular space?
Na imbalances which regulates osmotic forces
Hypertonic Imbalances
- increased concentration of extracellular fluid
- water shifts out of cells
- serum sodium is greater than 145mEq/L
What is Hypertonicity caused by?
- sodium excess
- water deficit
- decreased ADH
What are the clinical manifestations of hypertonicity?
- cell dehydration
- dry skin
- thirst
- agitation
- restlessness
- headache
- seizures
- coma
- increased reflexes
What is most dangerously effected by hypertonicity?
- dehydrated neurons
- cause dangerous neurological symptoms
Hypotonic Imbalances
- concentration of extracellular fluid is decreased
- water moves into cells
- cellular edema
- serum sodium is less than 135mEq/L
What is hypotonicity caused by?
- sodium deficit
- water excess
What are the clinical manifestations of hypotonicity?
- primarily related to cell swelling
- neurological (headache, seizures, lethargy, coma)
- decreased reflexes
- muscle cramps
- weakness
Electrolyte Imbalances
- potassium is mostly intracellular (THE most dominant intracellular cation)
- sodium is mostly extracellular
- concentrations maintained by sodium potassium pump and ion channels
Sodium
- Two Imbalance Conditions
- Systems Affected
- Hypernatremia (hypertonic)
- Hyponatremia (hypotonic)
- neuromuscular
- CNS- consciousness level
- MSK- muscle cramps and weakness
Potassium: Hyperkalemia
- renal disease
- cell injury (crush injury)
- too much intake
- acidosis
- hypoaldosteronism
- medications: ACE inhibitors
Potassium: Hypokalemia
- diarrhea
- NG suction
- too little intake
- starvation not replacing K
- alkalosis
- hyperaldosteronism
- medications: some diuretics
Major systems affected by potassium imbalances
- cardiac
- neurological
- cardiac show dysrhythmias and cardiac arrest
- CNS reflexes and LOC affected
Calcium
- parathyroid disease
- Vitamin D imbalance
- malignancies
- musculoskeletal and cardiac show manifestations
- BP
- muscle tone
H+ Imblanaces
- required to maintain membrane potential integrity
- regulates speed of nerve impulse conduction and muscle fibre contraction
- maintains speed of enzyme reactions
Normal pH in arterial blood
- 7.35-7.45
Volatile Secretion of Acids
- carbonic acid
- eliminated by the lungs as CO2
- resp system excretes CO2 by increasing or decreasing ventilation rate
Nonvolatile Secretion of Acids
- sulfuric, phosphoric, and other organic acids
- eliminated by renal tubules
How does the renal system control pH?
excreting or conserving H+ or HCO3-
What compensates for Respiratory Alkalosis or Acidocis?
kidneys
What compensates for metabolic alkalosis or acidosis?
lungs
Respiratory Acidosis
- too much CO2
- CO2 converted to carbonic acid (pH<7.35)
What is Respiratory Acidosis caused by?
- slow/shallow breathing
- head injury
- spinal cord injury
- drug overdose
- poor gas exchange due to lung disease
Respiratory Alkalosis
- too little CO2 (PCO2 <35mmHg)
- less carbonic acid
- pH> than 7.45
What is Respiratory Alkalosis caused by?
- rapid deep breathing
- respiratory failure
- anxiety
- some neuro disorders
Metabolic Acidosis
- not enough bicarbonate ion (HCO3-) to counteract acid
Metabolic Alkalosis
- too much bicarbonate ion (HCO3-) or not enough acid
- pH>7.45
- HCO3>26mEq/L
What is Metabolic Alkalosis caused by?
- excess acid loss (kidney, vomiting, gastric suction)
- excessive base intake (antacid OD)
Partial Compensation
pH will move towards normal but not within normal range
Full Compensation
pH will become fully within normal range
