Fluid And Electrolyte Balance Flashcards by joseph dizon

Percent of water in older adult

45-55%

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Percent of water in average adult?

60%

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Percent of water in newborn

78-80%

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Percent of water in early human embryo

97%

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What are the importance of water?

Universal biological solvent
Transport gases and substances
Dilute toxic substances and waste products and transports them to the kidney and liver
Medium for all chemical reaction
Minimize temperature changes throughout the body

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Importance of water.

Universal solvent due to:

Polar asymmetry

High affinity to polar molecule

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The total body fluids is distributed mainly between two compartments

Intracellular fluid (ICF)
Extracellular fluid (ECF)

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Intracellular fluid

40% of the body weight

Fluid found within the cell

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Extracellular fluid

20% of body weight

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Extracellular fluid further subdivided into

15% interstitial fluid ( between cells and blood vessels)

5% intravascular fluid ( inside blood vessels )

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Sources of wAter

Preformed water (2,100ml)
Metabolic water (200ml)

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Total body water =

Wt in kg x 0.60

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Total body water can change depending on the following factors

Age (mas matanda decrease water)
Fats ( obesity, mas mataba decrease ang water)
Gender ( mas madaming tubig ang lalake sa babae 65-55)

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Other extracellular fluids

Lymph

Transcellular fluids

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Water that are found in food and drinks ingested

Preformed water

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Water produced through the catabolic breakdown of nutrients during cellular respiration.

Metabolic water

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Net diffusion of water across a selectively permeable membrane from a region of high water concentration to one that has a lower water concentration.

Osmosis

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Water will diffuse into the cell, causing it to swell

If the cell is placed into a hypotonic solution

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Water will flow out of the cell into the extracellular fluid, causing cell shrinkage or crenation.

If a cell is placed in a hypertonic solution

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Factors affecting fluid movement

Starlings forces

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For filtration forces (pushing forces)

Capillary hydrostatic forces

Interstitial fluid colloid osmotic pressure

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For absorption forces (pulling forces)

Interstitial fluid hydrostatic pressure

Capillary plasma colloid pressure

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Capillary hydrostatic forces

Function

Outward the capillary membrane

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Capillary hydrostatic forces

Arterial end

30-40 mmHg (favors filtration)

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Capillary hydrostatic forces Venous end

10-15 mmHg (favors re absorption)

Interstitial fluid colloid osmotic pressure Function

Osmosis of water outside

Interstitial fluid colloid osmotic pressure Pressure

8mmHg

Interstitial fluid hydrostatic pressure If positive

Inward

Interstitial fluid hydrostatic pressure If negative

Outward

Interstitial fluid hydrostatic pressure Pressure

3mmHg

Capillary plasma colloid pressure Function

Osmosis of water inward

Capillary plasma colloid pressure Pressure

28mmHg 19mmHg from dissolved proteins 9 mmHg from donnan effect

Extra osmotic pressure caused by?

Cations

Summation of starling forces

If positive : filtration | If negative: absorption

For arterial end (filtration)

Outward force : 41 mmHg Inward force : 28 mmHg Net outward force : 13 mmHg

For venous end (reabsorption)

Outward force: 21mmHg Inward force: 28 mmZhg Net inward force : 7 mmHg Note: venous end is 10-15 mmHg it is contributing factor only

Normal values of plasma sodium concentration

140-145 mEq/L

Two primary systems are involved in regulating the concentration of sodium and osmolarity of extracellular fluid

The osmoreceptor- ADXh system | Thirst mechanism

Regulation of body fluid volume and osmolarity Center:

Hypothalamus

Regulation of body fluid volume and osmolarity Hormones

ADH and aldosterone

Regulation of body fluid volume and osmolarity Major determinant of osmolarity

Sodium

Regulation of body fluid volume and osmolarity Plasma sodium concentration

140-145

Regulation of body fluid volume and osmolarity Extracellular fluid osmolarity

300 mOsm/L

Osmoreceptors -ADH system Location

Hypothalamus

Osmoreceptors -ADH system Function

Signals for ADH production

Osmoreceptors -ADH system Signals for ADH production

Dehydration (with loss of water) Relative dehydration (without loss of water but elevated sodium ions) Increase plasma osmolarity

Thirst response system Location

Hypothalamus

Thirst response system Factors for stimulation

Increase plasma osmolarity Dryness of mucosal linings Stretch receptors of GIT

Osmoreceptors common denominator

Increased plasma osmolarity

When osmolarity (plasma sodium concentration) increase because of water deficit, this feedback system operates

Osmoreceptor -ADH feedback System

Osmoreceptor -ADH feedback system

Increase in extracellular fluid osmolarity Sending nerve signals to pituitary gland ti posterior pituitary Release ADH ADH acts on kidney tubules, Increased water reabsorption Correcting the initial excessively concentrated extracellular fluid.

Extracellular fluid becomes too dilute

Hypo osmotic Excess water Less ADH is formed

Baroreceptors location

Atria of the heart, | Pulmonary artery and vein

Barorecptors Message are relayed to the hypothalamus via the

Vagus nerve

Barorecptors ADZh secretion is stimulated by

Changes in circulating volume of body fluids

Barorecptors Reduction of around how many volume of water due to hemorrhage or excess perspiration will result in ADH secretion

8-10%

Connected to the response of the osmorecptors

Thirst response

Center of thirst?

Hypothalamus

Other factors involved in osmorecptors

Degree of dryness of mucosal linings of mouth and pharynx | Stretch receptors in the GIT

Loss of more solute specially sodium than water in ECF

Hypotonic dehydration

Hypotonic dehydration Fluid shift

Blood stream to cells

Hypotonic dehydration Results

Decrease vascular fluid volume Shock Cellular swelling Cerebral edema (headache, IICP and confusion)

Hypotonic dehydration Seen in

Heat stroke or exhaustion

Hypotonic dehydration Manifestation

``` Hypotension Tachycardia Low serum sodium Low urine specific gravity Increase urine volume ```

Uncommon

Hypotonic dehydration

Most common form of dehydration

Isotonic dehydration

Equal loss of solutes and water

Isotonic dehydration Fluid shift

No shift

Isotonic dehydration Cause

``` Diuretic therapy Vomiting Urine loss Hemorrhage Decrease fluid intake ```

Isotonic dehydration Manufestation increase

``` Hematocrit Protein BUN Urine specific gravity Dryness ```

Isotonic dehydration Manifestation decrease

``` Body weight Blood pressure( orthostatic hypotension) Pulse Urine volume and output (oliguria) Skin tugor ```

Isotonic dehydration If severe

With shock

2nd most common

Hypertonic dehydration

Loss of more water than solute in ECF

Hypertonic dehydration Fluid shift

Blood stream

Hypertonic dehydration Result

Cell shrinkage

Hypertonic dehydration Cause

``` Excess fluid loss Hyperventilation Watery diarrhea Diabetic ketoacidosis Diabetes insipidus Latrogenic (tube feeding without inadequate water) ```

Hypertonic dehydration Manifestation

Thirst Decrease skin tugor Increase urine specific gracity Sign of shock are usually not present

Isotonic expansion of the ECF

Isotonic overhydration

Isotonic over hydration

Interstitial fluid=intravascular fluid | Fluid overload or hyper volemia

Isotonic over hydration Rarely happen in persons with

Normal heart and kidneys

Isotonic over hydration Causes

IV isotonic fluids Saline enemas Increase sodium intake resulting in compensatory water retention

Isotonic over hydration Manifestation

``` Hypertension Crackles in lungs Distended neck veins Elevated respiration Polyuria Weight gain Increase respiration ```

Hypotonic expansion of ECF | Decrease serum osmolarity

Hypotonic overhydration

Hypotonic overhydration Fluid shift

Blood stream to cell

Hypotonic overhydration Result

Cell swelling Interstitial edema Electrolyte dilution

Hypotonic overhydration Cause

IV D5W (increase glucose metabolism) Patient in NPO with ice chips Tap water enemas Excess plain water

Hypotonic overhydration Manifestation

``` Photophobia Muscle twitching leading to convulsion Diorientation Polyuria Hyperiritability ```

Hypertonic expansion of the ECF | Increase serum osmolarity

Hypertonic overhydration

Hypertonic overhydration Fluid shift

Cell to blood stream

Hypertonic overhydration Result

Cell shrinkage Hypertension Increase cardiac work load leading to congestive heart failure

Hypertonic overhydration Causes

Administrations of hypertonic ( IV fluids, enemas, tube feedings) Sea water ingestion