Exam 1 - Electrolyte And Fluid Balance Flashcards
1
Q
Normal ranges of Na+
A
135-145 mEq/L
135-145 mmol/L
2
Q
Normal ranges of K+
A
- 5-5 mEq/L
3. 5-5 mmol
3
Q
Normal ranges of Ca++
A
- 4-10.6 mg/dL
2. 1-2.65 mmol/L
4
Q
Normal ranges of Mg++
A
- 3-2.1 mg/dL
0. 65-1.05 mmol/L
5
Q
Normal ranges of Cl-
A
96-106 mEq/L
96-106 mmol/L
6
Q
Normal ranges of HCO3-
A
23-29 mEq/L
23-29 mmol/L
7
Q
Normal ranges of Phosphate
A
3-4.5 mg/L
1-1.5 mmol/L
8
Q
Definition of TBW
A
(Total body water)
Sum of all fluids within all body compartments
9
Q
What is ICF and where is it located?
A
Intracellular fluid
All fluid within cells
10
Q
How much of TBW is made up of intracellular fluid?
A
2/3 of it
11
Q
What is ECF and where is it located?
A
Extracellular fluid
All fluid outside the cells (literally anywhere outside of cells, could be in tissue, etc.)
12
Q
How much TBW makes up extracellular fluid?
A
1/3 of it
13
Q
What is ISF and where is it located?
A
Interstitial fluid
In space between cells and outside the blood vessels
14
Q
What is intravascular fluid and where is it located?
A
Fluid volume in intravascular space
Intravascular fluid is blood plasma
15
Q
What does intravascular fluid regulate?
A
Blood pressure
Pulse
Fluid balance in general
16
Q
Edema is fluid accumulation, where?
A
In interstitial space
17
Q
Ways we intake water
A
- drinking
- ingestion of water from food
- IVs
- water derived from metabolism
18
Q
Ways we output water
A
- renal excretion
- stool
- vaporization from skin (sweat) and lungs (breathing)
19
Q
Biggest way we output water?
A
Vaporization from lungs during breathing
20
Q
TBW range of infants
A
75-80%
21
Q
TBW range of children and adolescents:
A
60-65%
22
Q
What happens to our TBW as we age?
A
It decreases
23
Q
Why does TBW decrease as we age?
A
Decreased muscle mass & increse in fat cells
Decreased ability to regulate sodium and water balance
24
Q
Put the different age groups in order from least to most able to fight illness:
A
1- infants
2- children
3- Elderly
4- Adults
25
Why do geriatriac people have such a hard time regulating sodium?
B/c of failure in the sodium/potassium pump
26
What is a sensible loss?
An expected loss that can be quantified with a number
27
What is an insensible loss?
A loss of fluid that occurs without awareness and cannot be quantified with a number
28
Examples of a sensible loss
Urine
| Feces
29
Examples of an insensible loss
Vapors leaving lungs and skin
30
How does water move through our body?
Through the processes of filtration and diffusion
31
Two types of filtration
- Capillary hydrostatic pressure
| - Interstitial oncotic pressure
32
Other names for interstitial oncotic pressure:
Capillary oncotic pressure
| Plasma pressure
33
Which two things help determine blood pressure?
- capillary hydrostatic pressure
| - interstitial oncotic pressure
34
What does capillary hydrostatic pressure do?
Pushes water from capillaries into interstitial spaces
35
What if capillary hydrostatic pressure is too high?
Causes edema
36
What does interstitial oncotic pressure do?
Pulls water back into capillary space from tissues
37
How does capillary membrane play a part in water movement through the body?
Its integrity is key in the movement of water and solutes
| This is how everything moves back and forth
38
What is diffusion?
Movement of particles along a concentration gradient from an area of higher concentration to an area of lower concentration
39
Where does diffusion take place regarding water movement in the body?
Through the capillary membrane
| Diffusion is how everything moves in and out through the membrane
40
Why is the sodium/potassium pump a thing?
To balance intracellular and extracellular fluid
41
Regarding the sodium/potassium pump, which electrolyte is inside vs. outside the cell?
Potassium (K) is inside the cell
| Sodium (Na) is outside the cell
42
What is another balancing agent at work with the sodium/potassium pump?
Albumin
43
What happens if potassium leaves the cell?
Sodium goes in the cell
44
What is albumin?
| What is its function?
- Protein backbone for intravascular volume
- Albumin strands create a band that holds intravascular volume in place
- * maintains effective osmolarity by generating plasma oncotic pressure
45
What substances redily move across intact capillary membranes?
- sodium
- water
- glucose
46
What moves between intracellular and extracellular fluid?
Potassium
47
Major cation in ICF
Potassium
48
Daily dietary requirement of potassium
60-100 mEq
49
Foods that are high in potassium content
- Meats
- Dried fruits
- Fruit juices (orange)
- Bananas
- Avocados
- Potatoes
50
How does the body eliminate potassium?
Kidneys eliminate about 80% of ingested K
51
Which disease would cause patients to have high potassium?
Renal failure because the kidneys aren’t getting rid of the K
52
Major cation in ECF
Sodium
53
Excretion or absorption of Na usually involves what?
Proportionate excretion or absorption of water and Cl
54
Minimal daily requirement of sodium
2 grams/day
55
What type of protection does sodium provide?
ECF protection
56
Term for low sodium
Hyponatremia
57
Term for high sodium
Hypernatremia
58
Major extracellular cation involved in structure and function of teeth and bones
Calcium
59
What type of relationship do calcium and phosphorous have?
An inverse relationship. Increased serum Ca results in decreased serum P
60
Recommended daily dietary calcium intake?
800 mg/ day
61
How does Ca absorption occur?
Because of calcitriol, and calcitriol is activated by Vitamin D
62
What organ regulates calcium?
Parathyroid
63
Major cation in ICF, closely related to Ca and P
Magnesium
64
Major anion in ICF
Phosphorous
65
What causes edema?
Movement of water into interstitial space causes accumulation of water into tissue
66
What is localized edema?
Edema limited to site of trauma
| Occurs from injury
67
What is generalized edema?
Edema with a uniform distribution in area that hangs down (arms, legs, genitals)
Occurs due to disease
68
What is nonpitting edema?
Plasma proteins accumulated into tissue spaces and coagulated
69
Ways nonpitting edema occur?
Local infection or trauma
70
What is brawny edema?
A type of nonpitting edema characterized by thick/hardened & tight skin
71
What does pitting and nonpitting mean?
Pitting means if you push on the edema, an indention is left
| Nonpitting means no indention is left
72
What is pitting edema?
Accumulation of interstitial fluid exceeds the absorptive capacity of tissue; water is mobile and can be translocated with finger pressure
73
Which two types of edema only occur with generalized edema?
Brawny and pitting
74
What is third spacing?
Fluid gets pushed from interstitial spaces into other body cavities
75
Why does third spacing occur?
The body is trying to get rid of the extra fluid to restore balance so it pushes it to empty areas
76
Where does third space accumulation occur?
Transcellular spaces (serous cavities)
77
Examples of transcellular spaces where third spacing can occur:
- pericardial sac
- peritoneal cavity
- pleural cavity
78
Excessive fluid in the pleural cavity
Hydrothorax
79
Excessive fluid in the peritoneal cavity
Ascites
80
Fluid in the serous cavities
Effusion
81
What type of fluid goes into serous cavities with effusion?
Blood, plasma, proteins, inflammatory cells (pus)
82
Most common type of third spacing
Ascities
83
What can cause ascities?
Liver failure
84
Which hormone regulates water balance through out the body?
ADH (antidiuretic hormone)
85
No sense of thirst (spelling)
Adipsia
86
Decrease in thirst sensation (spelling)
Hypodipsia
87
Excessive thirst sensation (spelling)
Polydipsia
88
Process that stimulates thirst?
- ADH is released from pituitary gland and
- The hypothalamus sends a message to
- Antiotension II, which turns on thirst
89
Where is ADH released from?
The pituitary gland
90
What is another name for antidiuretic hormone?
Vasopressin
91
When is ADH secreted?
When plasma osmolality increases due to
- water deficit
- sodium excess
92
What happens to activate ADH?
Circulating blood volume decreases and blood pressure drops (due to dehydration)
93
What is natriuretic hormone (ANP)?
Hormone that provides intravascular balance: volume balance, and vascular tone
94
Where is NAP produced?
Atria of the heart
95
Functions of ANP
- Renal elimination of sodium (water follows)
| - Decreases plasma, lowering blood pressure
96
What is tonicity?
Change in water content resulting in cellular swelling/shrinking
97
Fluid that has the same concentration as blood:
Isotonic
98
Fluid that has the same concentration as ICF or ECF
Isotonic
99
Fluid that has lower concentration of particles (more dilute) than blood
Hypotonic
100
Fluid that has a higher concentration of particles than blood
Hypertonic
101
Measurement of an isotonic solution
0.9% NS per liter of fluid
102
Measurement of a hypotonic solution
<0.9% NS
103
Measurement of a hypertonic solution
>0.9% NS
104
What happens to cells when they are in a hypotonic solution?
Cells swell up
105
What happens to cells when they are in a hypertonic solution?
Cells shrink
106
What do hyoptonic solutions do to cells?
Invite more water into cell = increase in volume
107
What do hypertonic solutions do to cells?
Pulls water out of cell = decrease in volume
108
Give an example of when a hypertonic solution would be given to a patient
Increased intercranial pressure. Would want to quickly pull fluid out of head
109
0.9% NS is an example of which type of solution?
Isotonic
110
0.45% NS is an example of which type of solution?
Hypotonic
111
2.0% NS is an example of which type of solution?
Hypertonic
112
How is sodium regulated? Hormone that regulates this?
Mainly by the kidneys; primarily through aldosterone action
113
How do the kidneys regulate sodium?
Can hold sodium (therefore water too) back
| OR excrete more sodium (therefore water too = more urination)
114
Hormone that regulates sodium in conjunction with the kidneys
Aldosterone
115
How is the sodium in the ECF affected by aldosterone?
Aldosterone secretion stimulates the renal tubules to reasorb Na
116
Where is aldosterone secreted from?
The adrenal cortex
117
Low chloride
Hypochloremia
118
What causes hypochloremia?
Low sodium or a bicarbonate malfunction
119
Too much chloride
Hyperchloremia
120
*What causes hyperchloremia?
Too much sodium
| Too little bicarbonate
121
How would you treat hyperchloremia?
Lower sodium levels because if sodium lowers, so will chloride
122
Symptoms of hyperchloremia
No specific symptoms
123
3 ways potassium is regulated?
- K and Na have reciprocal relationship (sodium/potassium pump)
- When aldosterone secretion results in renal Na reabsorption, Kidneys excrete K
- *Serum K level rises in acidosis and falls in alkalosis (respiratory effort)
124
Explain why serum K levels may or may not reflect the total body potassium level
Serum potassium levels rise and fall with respiratory effort. So they are always fluctuating.
125
Why is it important to keep in mind that serum K levels rise and fall with respiratory effort?
This is why we don’t use lab values to treat patients. Its trend value may or may not reflect total body use and storage
126
Extremely high potassium
Hyperkalemia
127
When would we treat a patient with hyperkalemia?
If levels were extremely high (above 7)
128
Side effects of potassium levels above 7
Potassium directly affects cardiac muscle contraction and electrical conductivity. So high levels would result in heart rhythm abnormalities
129
Which is more dangerous, potassium or sodium, and why?
Potassium because it affects heart rhythm
130
What’s a “quick fix” to temorarly treat high potassium? Why?
Insulin and glucose, because insulin has a close relationship with potassium
131
What facilitates K+ movement into muscle cells?
Catecholamines (have to do with fight or flight response)
132
Where is calcium absorbed?
Small intestine (only in the presence of Vitamin D)
133
What does the parathyroid hormone (PTH) do?
Promotes Ca transfer from bone to plasma
| Aids intestinal and renal Ca absorption
134
What happens if there is decreased Ca in ECF?
- It directly stimulates PTH release from the parathyroid glands
- This releases calcium phosphate from bone and indirectly activates mechanisms to increase Ca reabsorption from P excretion from the renal tubules and the GI tract
135
What happens if someone has an issue with their parathyroid gland?
They will have an issue with calcium asorption
136
What is calcium usually bound to before it’s used?
Albumin
