- Isotonic solution - Hypertonic solution - Hypotonic solution

Finals_Fluid, Electrolyte, and Acid Base Balance Flashcards by Enrique Castro

delicate balance of fluids,
electrolytes, and acids and bases maintained in the
body

HOMEOSTASIS

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primary body fluid

Water

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Percentage of water in an average healthy adult’s, infant, and people older than 50 weight respectively

60% of average healthy adult’s
weight
70% to 80% in infants weight
50% to people
older than 50

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TWO COMPARTMENTS OF BODY’S FLUID

INTRACELLULAR FLUID (ICF)
EXTRACELLULAR FLUID (ECF)

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found within the cells of the body; 2/3 of the total body fluid in adults

INTRACELLULAR FLUID (ICF)

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found outside the cells; 1/3 of the total body fluid

EXTRACELLULAR FLUID (ECF)

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Two sub types of EXTRACELLULAR FLUID (ECF)

INTRAVASCULAR FLUID (PLASMA)
INTERSTITIAL FLUID

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COMPOSITION OF BODY FLUIDS

Ions
Cations
Anions
Electrolytes

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COMPOSITION OF BODY FLUIDS
- charged particles

Ions

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COMPOSITION OF BODY FLUIDS
- ions that carry a positive
charge

Cations

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COMPOSITION OF BODY FLUIDS
- ions that carry a negative
charge

Anions

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COMPOSITION OF BODY FLUIDS
- minerals in the body
that have electrical charge;
chemicals from which ions are
made

Electrolytes

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How are Electrolytes measured?

in milliequivalents per Liter of water
(mEq/L) or milligrams per 100 milliliters (mg/100mL)

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MOVEMENT OF BODY FLUIDS AND ELECTROLYTES

◎ Osmosis
◎ Diffusion
◎ Filtration
◎ Active Transport

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Movement of water across cell membranes, from the less concentrated solution to the more concentrated solution

OSMOSIS

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substances dissolved in a liquid

Solute

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component that can dissolve a solute

Solvent

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the concentration of solutes in body fluids; solute per kilogram of water

OSMOLALITY

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power of a solution to draw water
across a semipermeable membrane

OSMOTIC PRESSURE

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pulls water from the interstitial space into the vascular compartment

COLLOID OSMOTIC PRESSURE (ONCOTIC PRESSURE)

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Types of Solutions

Isotonic solution
Hypertonic solution
Hypotonic solution

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Identify the Types of Solutions
- solute and solvent are equal
- given to patients with no problem in their body fluids to administer medications

Isotonic solution

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Identify the Types of Solutions
- higher osmolality than body
fluids; cells shrink
- given to patients with water retention

Hypertonic solution

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Identify the Types of Solutions
- lower osmolality than body
fluids
- cells swell
- given to patients who experience dehydration

Hypotonic solution

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Movement of molecules through a semipermeable membrane from an area of higher concentration to an area of lower concentration

DIFFUSION

Fluid and solutes move together across a membranes from an area of higher pressure to one of lower pressure.

FILTRATION

2 types of pressure associated in Filtration

Filtration and Hydrostatic Pressure

pressure in the compartment that results in the movement.

Filtration pressure

Arterial end of net filtration pressure is?

BP is +10mm Hg

Venous end net filtration pressure

- 7 mm Hg

pressure exerted by a fluid within a closed system on the walls of the container in which it is contained.

Hydrostatic pressure

Normal Pressure of Blood

25 mm Hg

Substances can move across cell membranes from a less concentrated solution to a more concentrated one by expending energy

ACTIVE TRANSPORT

REGULATING BODY FLUIDS

◎ Fluid Intake ◎ Fluid Output ◎ Maintaining Homeostasis

average adult needs how many mL of fluid per day

2,500 mL per day.

Oral fluids = 1,200 to 1,500 mL Water in foods = 1,000 mL Water as by-product of food metabolism = 200 mL TOTAL = 2,400 to 2,700 mL

Familiarize

- primary regulator of fluid intake - located in the hypothalamus of the brain.

Thirst mechanism

How long does it take for fluid to be absorbed and distributed throughout the body

30 minutes to 1 hour

Fluid losses that counterbalance the adult’s 2,500-mL average fluid intake.

Fluid Output

Urine = 1,400 to 1,500 mL Insensible Losses - Lungs (water vapor in the expired air) and Skin = 350 mL to 400 mL Sweat = 100 mL Feces = 100 mL to 200 mL TOTAL = 2,300-2,600 mL

Familiarize

Homeostatic regulators/mechanisms

1. Kidneys 2. Antidiuretic Hormone 3. Renin-Angiotensin-Aldosterone System 4. Atrial Natriuretic Factor

Homeostatic regulators/mechanisms - Primary regulator of body fluids and electrolyte balance. - Regulates water and electrolyte secretion - Plays a significant role in acid-base regulation, excreting hydrogen ion (H+) and retaining bicarbonate

Kidneys

Homeostatic regulators/mechanisms - Regulates water excretion from the kidney - Synthesized in the anterior portion of the hypothalamus - Produced when serum osmolality rises - suppressed when serum osmolality decreases

Antidiuretic Hormone (ADH)

Homeostatic regulators/mechanisms - Restore blood volume (and renal perfusion) through sodium and water retention

Renin-Angiotensin-Aldosterone System

Renin-Angiotensin-Aldosterone System: in order

1. When blood flow or pressure to kidneys decreases, renin is released. 2. Renin causes the conversion of angiotensin to angiotensin I, which is converted to angiotensin II by angiotensin-converting enzyme. 3. Angiotensin II acts directly on the nephrons to promote Sodium and water retention. 4. Stimulates the release of Aldosterone from the adrenal cortex. It promotes sodium retention.

Homeostatic regulators/mechanisms - Released from cells in the atrium of the heart in response to excess blood volume and stretching the atrial walls. - Promotes sodium wasting and acts as a potent diuretic, thus reducing vascular volume - Reduces thirst, reducing fluid intake

Atrial Natriuretic Factor (ANF)

REGULATING ELECTROLYTES IMPORTANCE

1. Maintaining fluid balance 2. Contributing to acid-base regulation 3. Facilitating enzyme reactions 4. Transmitting neuromuscular reactions

Electrolytes Examples

◎ Sodium (Na+) ◎ Potassium (K+) ◎ Calcium (Ca++) ◎ Magnesium (Mg++) ◎ Chloride (Cl-) ◎ Phosphate (PO4-) ◎ Bicarbonate (HCO3-)

Identify the Electrolytes being described - Most abundant cation in the ECF and a major contribution to serum osmolality - Normal value: 135-145 mEq/L - Aids in transmitting nerve impulses and contracting muscles

Sodium (Na+)

Identify the Electrolytes being described - Major cation in ICF, with only small amount found in ECF. - Normal serum levels: 3.5 to 5.0 mEq/L - Vital electrolyte for skeletal, cardiac, and smooth muscle activity. - Must be consumed everyday because the body cannot conserve it. - Sources: avocado, raw carrot, spinach, dried fruits, banana, apricot, orange, beef, pork, milk

Potassium (K+)

Identify the Electrolytes being described - 99% of Calcium is found in the skeletal system, with a relatively small amount in the ECF. - Vital in regulating muscle contraction and relaxation, neuromuscular function, and cardiac function - Normal total serum levels: 8.5-10.5 mg/dL - Normal ionized serum levels: 4-5 mg/dL - Parathyroid hormone and calcitriol increase serum Ca++ levels; calcitonin decreases serum levels - Daily intake should be 1,000-1,500 mg of Calcium

Calcium (Ca++)

Identify the Electrolytes being described - Primarily found in the skeleton and in ICF - Second most abundant ICF cation - Normal serum levels: 1.5 to 2.5 mEq/L - Aids in relaxing muscle contractions, transmitting nerve impulses, regulating cardiac function, and intracellular metabolism. - Sources: cereal grains, nuts, dried fruits, legumes, green, leafy vegetables, dairy products, meat, fish

Magnesium (Mg++)

Identify the Electrolytes being described - Major anion of the ECF - Normal serum levels: 95 to 108 mg/dL - When sodium is reabsorbed in the kidney, chloride usually follows. - Major component of gastric juice (HCl), and is involved in regulating acid-base balance. - Found in the same foods as Sodium.

Chloride (Cl-)

Identify the Electrolytes being described - Major anion of ICF - Also found in the ECF, bone, skeletal muscle, and nerve tissue - Normal serum levels: 2.5 to 4.5 mg/dL - Aids in metabolizing Carbohydrate, Protein, and Fat; it is absorbed in the intestines - Sources: meat, fish, poultry, milk products, legumes

Phosphate (PO4-)

Identify the Electrolytes being described - Present in both ICF and ECF - Primary function is to regulate acid-base balance (major body buffer) - Regenerated by the kidneys - ECF bicarbonate levels are regulated by the kidney - Produced through metabolic processes

Bicarbonate (HCO3-)

substance that releases hydrogen ions (H+)

Acid

have a low hydrogen ion concentration and can accept hydrogen ions in solution.

Bases (Alkalis)

- the relative acidity or alkalinity of a solution - reflects the hydrogen ion concentration of the solution (inversely proportional)

normal pH

7.35-7.45

How does our body Regulate acid base balance

1. Buffers 2. Respiratory Regulation 3. Renal Regulation

Identify the type of regulation method of the body - prevent excessive changes in pH by removing or releasing hydrogen ions

BUFFERS

Major buffer systems in the ECF

- Bicarbonate (HCO3-) - Carbonic acid (H2CO3)

Major buffer systems in the ECF - acid buffer; opponent of acids

Bicarbonate (HCO3-)

Major buffer systems in the ECF - weak acid

Carbonic acid (H2CO3)

Ratio of carbonic acid and bicarbonic acid to achieve Normal pH

1 part Carbonic Acid (1.2 mEq/L) : 20 parts bicarbonate (24 mEq/L)

adding a strong acid in the ECF, depleting the bicarbonate and lowering the pH levels

ACIDOSIS

adding a strong base to the ECF, depleting carbonic acid as it combines with the base, increasing the pH levels.

ALKALOSIS

Identify the type of regulation method of the body - lungs help regulate acid-base balance by eliminating or retaining Carbon Dioxide (CO2), a potential acid.

RESPIRATORY REGULATION

Components of Carbonic acid

Carbon Dioxide (CO2) + Water (H2O)

High Carbonic acid and CO2 or High Bicarbonate levels? - respiration rate and depth increases, exhaling CO2 and decreasing carbonic acid levels

High Carbonic acid (H2CO3) and CO2 levels

High Carbonic acid and CO2 or High Bicarbonate levels? - the respiration rate and dept are reduced, retaining CO2 and increasing carbonic acid levels

High Bicarbonate (HCO3-) levels

Identify the type of regulation method of the body - Kidneys are the ultimate long-term regulator of acidbase balance, although slower to respond to changes. - reabsorbing and regenerating bicarbonate and hydrogen ions

RENAL REGULATION

Components of Carbonic Acid

Hydrogen ion (H+) + Bicarbonate (HCO3-)

what does kidney do when there is High H+ ions (acidic) in body?

- kidneys reabsorb and regenerate bicarbonate and excrete hydrogen ions - H2CO3 >> H+ (excreted) and HCO3- (retained)

what does the kidney do when there is Low H+ ions (alkalosis) in the body

- excess bicarbonate is excreted and H+ ion is retained - H2CO3 >> H+ (retained) and HCO3- (excreted)

FACTORS AFFECTING BODY FLUID, ELECTROLYTES, AND ACID-BASE BALANCE:

◎ Age ◎ Gender and Body Size ◎ Environmental Temperature ◎ Lifestyle

Two basic types of Fluid Imbalances

Isotonic and Osmolar

Identify which of the Two basic types of Fluid Imbalances - water and electrolytes are lost or gained in equal proportions

Isotonic

Identify which of the Two basic types of Fluid Imbalances - loss or gain of only water, so that the osmolality of the serum is altered (electrolytes are concentrated)

Osmolar

Four Categories of Fluid Imbalances

◎ Fluid Volume Deficit ◎ Fluid Volume Excess ◎ Dehydration (hyperosmolar imbalance) ◎ Overhydration (hypo-osmolar imbalance) 47

Identify the fluid imbalance being described - body loses both water and electrolytes from the ECF (intravascular compartment) in similar proportions

Fluid Volume Deficit (FVD) or Hypovolemia

Identify the fluid imbalance being described Causes: ○ Abnormal losses through the skin, GI tract, kidney ○ Movement of fluid in a third space (area that deems the fluid unavailable for us) 48

Fluid Volume Deficit (FVD) or Hypovolemia

Identify the fluid imbalance being described - body retains both water and sodium in similar proportions to normal ECF

Fluid Volume Excess (FVE) or hypervolemia

Identify the fluid imbalance being described Causes: - Increased intake of NaCl (sodium level is still normal, since both water and sodium are equally retained) - Infusion of sodium-containing fluids rapidly - Disease processes (heart failure, kidney failure, liver cirrhosis)

Fluid Volume Excess (FVE) or hypervolemia

excess interstitial fluid

EDEMA

leaves a small depression or pit after finger pressure is applied

Pitting Edema

Identify the fluid imbalance being described - Water is lost from the body, leaving the client with excess sodium - Cells are dehydrated/shrunk

Dehydration (Hyperosmolar imbalance)

Identify the fluid imbalance being described - Water is gained in excess of electrolytes, resulting in low serum osmolality and low serum Na+ levels - Cells are swollen

Overhydration (hypo-osmolar imbalance)

Identify the fluid imbalance being described - Can lead to cerebral edema and impaired neurologic function - causes Syndrome of Inappropriate Anti Diuretic Hormone (SIADH) and Head Injury

Overhydration (hypo-osmolar imbalance)

ELECTROLYTE IMBALANCES: Sodium

Hyponatremia and Hypernatremia

ELECTROLYTE IMBALANCES: Sodium - Less than 135 mEq/L - Severe cases: <110 mEq L - Can lead to neurological damage (cerebral edema) due to low serum osmolality - Causes: burns, GI losses, diuretics, head injury

Hyponatremia

ELECTROLYTE IMBALANCES: Sodium - Higher than 145 mEq/L - Cells are dehydrated - Primary manifestations are neurological in nature - Causes: water deprivation, diabetes insipidus, excessive use of NaCl

Hypernatremia

ELECTROLYTE IMBALANCES: Potassium - Less than 3.5 mEq/L - Causes: GI losses (vomiting, diarrhea) Potassium-wasting diuretics Poor intake of Potassium - S/Sx: muscle weakness, lethargy, cardiac dysrhythmias

Hypokalemia

ELECTROLYTE IMBALANCES: Potassium - More than 4.5 mEq/L - More dangerous than hypokalemia since it can lead to cardiac arrest - Causes: 1. Renal Failure 2. High Potassium Intake 3. Burns - S/Sx: confusion, muscle weakness, bradycardia, irregular pulse, numbness in extremities

Hyperkalemia

ELECTROLYTE IMBALANCES: Calcium - Total calcium: <8.5 mg/dL - Ionized calcium: <4 mg/dL - Causes: total thyroidectomy, hypomagnesemia, chronic alcoholism

Hypocalcemia

SEVERE HYPOCALCEMIA CAN CAUSE ____________ WITH MUSCLE SPASMS AND PARESTHESIAS AND CAN LEAD TO CONVULSIONS

Severe Hypocalcemia

Two signs of Hypocalcemia

- Chvostek’s sign - Trousseau’s sign

ELECTROLYTE IMBALANCES: Calcium - Total calcium: >10.5 mg/dL - Ionized calcium: >5 mg/dL - Calcium is mobilized from the skeleton due to malignancy or prolonged immobilization - S/Sx: depressed DTR, cardiac dysrhythmias, hypercalciuria, flank pain secondary to urinary calculi

Hypercalcemia

ELECTROLYTE IMBALANCES: Magnesium - Less than 1.5 mEq/L - Common cause: chronic alcoholism - Other causes: GI losses, burns, pancreatitis - S/Sx: Chvostek’s and Trousseau, increased reflexes, respiratory difficulties, cardiac dysrhythmias

Hypomagnesemia

ELECTROLYTE IMBALANCES: Magnesium - More than 2.5 mEq/L - Often iatrogenic (result of overzealous magnesium therapy) - S/Sx: depressed DTR, bradycardia, lethargy, respiratory depression, cardiac arrest

Hypermagnesemia

ELECTROLYTE IMBALANCES: Chloride - Below 95 mEq/L - Causes: GI/kidney losses, sweating - S/Sx: muscle twitching, tremors, tetany

Hypochloremia

ELECTROLYTE IMBALANCES: Chloride - Above 108 mEq/L - Causes: excess replacement of NaCl or KCl - S/Sx: acidosis, weakness, lethargy, dysrhythmias, coma

Hyperchloremia

ELECTROLYTE IMBALANCES: Phosphate - Below 2.5 mg/dL - Causes: GI losses, use of phosphate-binding antacids, alcohol withdrawal - S/Sx: paresthesias, muscle weakness and pain, metal changes, and possible seizures

Hypophosphatemia

ELECTROLYTE IMBALANCES: Phosphate - Above 4.5 mg/dL - Causes: tissue trauma, chemotherapy, renal failure, increased ingestion/administration of phosphate - S/Sx: numbness, tingling around the mouth and fingertips, muscle spasms, tetany

Hyperphosphatemia

Classification of Acid Base Imbalances

respiratory or metabolic

How does lungs normally regulate Carbonic acid levels?

retention/excretion of CO2 (respiratory acidosis or alkalosis)

How are Bicarbonate and Hydrogen ion levels regulated?

kidneys through (metabolic acidosis or alkalosis)

- Hypoventilation and CO2 retention cause carbonic acid to increase and the pH to fall below 7.35 - Causes: Asthma, COPD, CNS depression due to anesthesia/narcotic - causes the kidneys to retain bicarbonate to restore the normal carbonic acid to bicarbonate ratio - May require hours to days to restore the normal pH

RESPIRATORY ACIDOSIS

- When a person hyperventilates, exhaling more CO2 and decreasing carbonic acid levels = pH greater than 7.45 - Causes: psychogenic or anxiety-related hyperventilation - Kidneys will excrete bicarbonate

RESPIRATORY ALKALOSIS

- bicarbonate levels are low in relation to the amount of carbonic acid = decreased pH - Causes: renal failure, inability of the kidneys to excrete H+, diabetic ketoacidosis - Stimulates the respiratory center = increase depth and rate of respirations; CO2 is eliminated and carbonic acid falls

METABOLIC ACIDOSIS

- amount of bicarbonate in the body exceeds to the normal ratio - Causes: ingestion of NaHCO3 as an antacid, vomiting (loss of HCl) - Depresses the respiratory rate (slow and shallow) = CO2 is retained and carbonic levels increases

METABOLIC ALKALOSIS

CLINICAL MEASUREMENTS

◎ Daily Weights ◎ Vital Signs ◎ Fluid Intake and Output

LABORATORY TESTS

◎ Serum electrolytes ◎ Urine pH ◎ Urine specific gravity ◎ Urine Sodium and Chloride excretion ◎ Arterial Blood Gases (ABGs) - measures the acidity, or pH, and the levels of oxygen (O2) and carbon dioxide (CO2) from an artery.

LABORATORY TESTS - pH

Normal: 7.35 - 7.45 If above: Alkalosis If below: Acidosis

LABORATORY TESTS - pCO2

Normal: 35-45 If below: Alkalosis If above: Acidosis

LABORATORY TESTS - HCO3

Normal 22-26 If below: Acidosis If above: Alkalosis

LABORATORY TESTS - pO2

Normal: 80-100 If below: Hypoxemia If above: O2 Therapy

LABORATORY TESTS - SaO2

Normal: 95-100% If below: Hypoexemia If above: No info

GOALS of Fluid Therapy

◎ Maintain/restore normal fluid balance ◎ Maintain/restore normal balance of electrolytes in the IC and EC compartments ◎ Maintain/restore pulmonary ventilation and oxygenation ◎ Prevent associated risks

Types of Intravenous Fluids

- Hypertonic solution - Hypotonic solution - Isotonic solution

Identify the Types of Intravenous Fluids - concentrated with solute, expanding vascular volume

Hypertonic solution

Examples of Hypertonic Fluids

5% DEXTROSE IN NORMAL SALINE (D5NSS) - 5% DEXTROSE IN 0.45% NACL - 5% DEXTROSE IN LACTATED RINGERS (D5LR) - 5% DEXTROSE IN NORMOSOL-M (D5NM)

Identify the Types of Intravenous Fluids - less solutes, for treatment of cellular dehydration

Hypotonic solution

Examples of Hypotonic Fluids

- 0.45% NACL (HALF NORMAL SALINE) - 0.33% NACL (1/3 NORMAL SALINE)

Identify the Types of Intravenous Fluids - Isotonic solution

Isotonic solution

Examples of Isotonic Fluids

- 0.9% NACL (NORMAL SALINE, PLAIN NSS) - LACTATED RINGER’S (PLAIN LR) - 5% DEXTROSE IN WATER (D5W)

How to promote wellness in terms of fluid and electrolyte balance

adequate fluids and consumption of a balanced diet

3 ways to implement Enteral Fluid and Electrolyte Replacement

1. Fluid intake modifications 2. Dietary changes 3. Oral electrolyte supplements

Components of Normal Saline

Sodium Chloride

Components of Ringer’s solution

Sodium, chloride, potassium, calcium

Components of Lactated Ringer’s solution

Sodium, chloride, potassium, calcium, and lactate (metabolized in the liver to form bicarbonate)

Components of Volume expanders

dextran, plasma, albumin Note: used for severe blood/plasma loss

Formula for hourly rate of the fluid (cc/hr)

total infusion volume/total infusion time

Formula for Drops per minute

(total infusion volume x drop factor) divided by total time of infusion in minutes

Drop factors: Macroset

15 or 20 gtts/mL

Drop factors: Microset

60 gtts/mL

Common Venipuncture sites for for intermittent or continuous infusions

Metacarpal, basilic and cephalic veins

This Venipuncture site is inserted in the subclavian or jugular vein, with the distal tip resting in the SVC

Central Venous Catheters

This Venipuncture site is inserted in basilic or cephalic vein, for long-term intravenous access when the client will be maintaining IV therapy at home

Peripherally Inserted Central Venous Catheter (PICC)

This intervention Can be effective in restoring intravascular (blood) volume

BLOOD TRANSFUSIONS

Four main groups/types of human blood

A, AB, B, O

the only IV solution that is compatible with blood products

0.9% NaCl (Plain NSS)

Enumerate Blood Products

- Whole Blood - Packed Red Blood Cells (RBCs) - Platelets - Fresh Frozen Plasma (FFP) - Albumin and Plasma Protein Fraction

Identify Blood Products - not commonly used except for extreme cases of acute hemorrhage; RBCs, plasma, plasma proteins, fresh platelets, and other clotting factors

Whole Blood

Identify Blood Products - to increase the oxygen carrying capacity of blood in anemia, surgery and blood disorders

Packed Red Blood Cells (RBCs)

Identify Blood Products - given for patients with bleeding disorders or platelet deficiency

Platelets

Identify Blood Products - expands blood volume and provides clotting factors. No need to be typed and crossmatched

Fresh Frozen Plasma (FFP)

Identify Blood Products - blood volume expander

Albumin and Plasma Protein Fraction