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fluid and electrolyte disorders 1 Flashcards

1
Q

what percent is the adult human body made out of water?

A

50-60%

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2
Q

why do females have less water compared to males?

A

more adipose tissue

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3
Q

why do the blood, kidney, muscle, brain, and skin have more % water content compared to skeleton and adipose tissue

A

they are more vascular so they need more water

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4
Q

what is the fluid contained within the body’s cells

A

intracellular fluid (ICF)

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5
Q

ICF is ___ of body water in adults

A

2/3

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6
Q

what is the fluid outside of the body’s cells

A

extracellular fluid (ECF)

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7
Q

what are the 3 components of the ECF? Describe each and their %s

A
  1. plasma - 25% - in blood vessels
  2. interstitial fluid - 74-75% - fluid outside of body’s cells, but not in the blood vessels
  3. transcellular compartment - 1% - fluid in special compartments (CSF, joints, GI tract, GU tract, peritoneal cavity, pleural cavity, pericardial cavity)
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8
Q

total body water volume =

A

40L, 60%

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9
Q

ECF volume =

A

15L, 20% body weight
-interstitial fluid = 12L, 80% of ECF
-plasma = 3L, 20% of ECf

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10
Q

ICF volume =

A

25L, 40% body weight

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11
Q

what are the 3 that make up the composition of body fluids

A
  1. electrolytes - substances that dissociate in soln to make ions
  2. ions - charged particles from electrolytes
  3. nonelectrolytes - particles that don’t dissociate (glucose, urea, ethanol)
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12
Q

movement of particles along a concentration gradient is

A

diffusion

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13
Q

movement of water across semipermeable membrane is

A

osmosis

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14
Q

what allows movement of water but not most solutes

A

semipermeable membrane

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15
Q

amount of hydrostatic pressure needed to oppose movement of water across the membrane is

A

osmotic pressure

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16
Q

nondiffusable particles exert ____ or pull, drawing water from one side of the membrane to the other

A

osmotic activity/osmolality

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17
Q

higher # of nondiffusable particles = ? osmotic activity/osmolality

A

higher

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18
Q

ratio of plasma solutes and plasma water is

A

plasma osmolality (Posm)

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19
Q

what is the main plasma solute

A

Na+

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20
Q

what is the relationship between the plasma and ECF osmolality

A

they are the same as ICF due to most cell membranes being freely permeable to water

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21
Q

what measures number of dissolved particles per unit of water in the urine

A

urine osmolality (Uosm)

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22
Q

higher Uosm = ?
lower Uosm = ?

A

more concentrated urine
more diluted urine

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23
Q

what causes increased fluid retention in cases of dehydration/hypovolemia

A

antidiuretic hormone (ADH)
secreted by posterior pituitary

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24
Q

high serum osmolality = ? ADH = ? urine osmolality

A

high, high

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25
what compares weight of urine to weight of water
urine specific gravity
26
what is the effect that the effective osmotic pressure of a solution has on the size of cells
tonicity
27
tonicity is caused by water movement across the cell membrane due to ?
osmosis
28
tonicity is also called the ___
effective plasma osmolality
29
the effective plasma osmolality is sensed by ___ in the hypothalamus and carotid artery
osmoreceptors
30
increased plasma osmolality = release of ?
ADH
31
what tonicity has the same osmolality as ICF
isotonic
32
what tonicity has increased osmolality as compared to ICF
hypertonic
33
what tonicity has decreased osmolality as compared to ICF
hypotonic
34
ECF movement from blood vessel lumens to interstitial spaces at the ____ level
capillary
35
what are the 4 major forces influencing movement of water from plasma to interstitium
1. capillary filtration (hydrostatic) pressure 2. capillary colloidal osmotic pressure 3. interstitial hydrostatic pressure 4. tissue colloidal osmotic pressure
36
palpable tissue swelling due to expansion of interstitial fluid volume
edema
37
accumulation of fluid exceeds the absorptive capacity of the gel-based interstitial matrix proteins
pitting edema
38
other factors involved like excess plasma proteins in the interstitial tissue
nonpitting edema
39
where can nonpitting edema be seen in?
with infection, trauma, lymph system abnormalities, thyroid disease
40
what are the 4 pathophysiology contributing to development of edema
1. increased capillary hydrostatic pressure = increased intravascular volume, venous obstruction 2. decreased capillary colloidal osmotic pressure = increased loss/decreased protein production 3. increased capillary permeability 4. obstruction of lymph flow
41
total body water (TBW) varies with ?
age, sex, weight
42
avg person requires ___ mL of water per ___ calories metabolized
100, 100
43
why does fever cause increased demand for water
higher metabolic rate increased rsp rate
44
majority water gain is from
ingested liquids - 1600mL
45
majority water loss is from
kidneys - 1500mL
46
what is the most abundant cation in the body
sodium
47
majority of sodium is in the
ECF
48
how does sodium enter/leave the cell
Na/K/ATPase pump
49
what are the 3 regulations that sodium does
1. ECF volume 2. excites tissues 3. acid-base balance as part of sodium bicarbonate
50
major regulator of sodium and water balance
effective circulating volume
51
what is in the atria and in blood vessels (especially aortic arch, carotid sinuses, afferent arterioles in kidneys)
baroreceptors
52
what do baroreceptors sense
pressure-induced stretch of blood vessels to determine how much blood volume the body has
53
what helps regulate water intake
thirst
54
how is thirst stimulated
1. increased ECF osmolarity 2. decreased in blood volume
55
what is the earliest symptom of hemorrhage
thirst
56
hypodipsia is
deficiency of thirst
57
polydipsia is
excess of thirst
58
what does ADH do
1. causes vasoconstriction of smooth muscle 2. increases reabsorption of water by kidney at collecting duct 3. can see disorders of ADH secretion (SIADH, diabetes insipidus)
59
what adjustments would you see when theres a drop in osmotic pressure or blood volume
increased: SNS, RAAS, ADH, thirst decreased: ANP
60
what adjustments would you see when theres an increase in osmotic pressure or blood volume
increased: ANP decreased: SNS, RAAS, ADH, thirst
61
what are the 2 fluid imbalances
isotonic fluid volume deficit isotonic fluid volume excess
62
what are the 2 tonicity/sodium imbalances
hyponatremia hypernatremia
63
decrease in overall amount of ECF with proportionate loss of sodium and water is ?
isotonic fluid volume deficit
64
a deficit in the amount of circulating blood volume is ?
hypovolemia
65
what is the etiology of isotonic fluid volume deficit
loss of body fluids, accompanied by decrease in fluid intake - decreased fluid intake - inability to obtain or swallow - excessive fluid losses - GI, renal, skin - excessive third spacing - edema, ascites
66
what is the pathophysiology of isotonic fluid volume deficit
- decreased intravascular volume = decreased capillary hydrostatic pressure - less movement and delivery - plasma sodium concentration is normal
67
what is the compensatory mechanism of isotonic fluid volume deficit
increased thirst decreased urine output
68
lab abnormalities of isotonic fluid volume deficit
increased urine osmolality increased urine specific gravity increased hematocrit
69
neuro symptoms of isotonic fluid volume deficit
fatigue altered mental status
70
symptoms of isotonic fluid volume deficit
1. decreased vascular volume - hypotension - flattened neck veins - tachycardia -prolonged venous and capillary refill - shock 2. decreased ECF volume - sunken eyes and/or fontanels - decreased turgor - dry mucous membanes - weight loss
71
management of isotonic fluid volume deficit
symptomatic management replace fluids with isotonic electrolyte solutions
72
increase in overall amount of ECF is
Isotonic Fluid Volume Excess
73
proportionate gains of both sodium and water and tonicity of ECF is same as ICF is
Isotonic Fluid Volume Excess
74
etiology of Isotonic Fluid Volume Excess
decreased sodium and water elimination or increased intake - decreased elimination - HF, liver failure, renal failure, corticosteroids - increased intake - diet intake, excess fluid replacement, hypertonic fluids
75
pathophysiology of Isotonic Fluid Volume Excess
1. lowering secretion of aldosterone and ADH 2. increased intravascular volume = increased capillary hydrostatic pressure - more movement of fluid and substances from plasma to interstitium 3. plasma sodium concentration should be normal
76
compensatory mechanisms for Isotonic Fluid Volume Excess
decreased thirst increased urine output
77
lab abnormalities for Isotonic Fluid Volume Excess
decreased urine osmolality decreased urine specific gravity decreased hematocrit not always reliable
78
symptoms of Isotonic Fluid Volume Excess
1. increased vascular volume - pulmonary edem - distended neck veins - full, bounding pulse 2. increased ECF volume - ascites - edema
79
management of Isotonic Fluid Volume Excess
symptomatic management diuretic therapy reduce sodium and/or fluid intake
80
what can cause hyponatremia
body water content rises (overhydration) loss of sodium and water (dehydration)
81
what can cause hypernatremia
body water content declines (dehydration gain of sodium and water (overhydration)
82
sodium and its anions account for __% of ECF osmolality
90-95%
83
why can the TBW be low, normal, or high during hyponatremia
kidney independently regulates sodium and water homeostasis
84
what has a key role in the pathophys of many hyponatremia cases
ADH
85
what happens to the cells during hyponatremia
osmotic swelling of cells
86
what is the first step of hyponatremia
1. determine whether low sodium is due to: - excessive sodium loss - excessive water gain - sodium not really low at all
87
how do you tell the difference is determining the cause of the hyponatremia
1. check serum sodium - must correct glucose 2. check or calculate serum osmolality 3. check overall volume status - PE - neck veins, edema, capillary refill, BP, HR - labs - urine osmolality/urine specific gravity, BUN
88
majority of patients what type of hyponatremia
hypotonic hyponatremia
89
what is isotonic hyponatremia
extra molecules in blood interfere with lab calculations of sodium levels - extra proteins - high lipids - especially triglycerides
90
what is hypertonic hyponatremia
osmotic shift of water from ICF to ECF - sodium in bloodstream is diluted from all extra water - no loss of serum tonicity bc of - glucose, radiocontrast
91
hypotonic hyponatremia is due to
water retention in excess to sodium water is lost along with sodium, but more sodium is lost than water
92
what is hypervolemic hypotonic hyponatremia
excess fluid retention - sodium overall higher than baseline, but water is greater - seen in HF, liver disease, kidney disease
93
what is the most common type of hypotonic hyponatremia
- euvolemic hypotonic hyponatremia - due to ADH from trauma, stress, pain - SIADH - can tell body to hang onto water even if they are not hypervolemic - hypothyroidism = decreased CO = triggers ADH because the body thinks CO is down due to not enough blood - psychogenic polydipsia = drinking so much water at once that sodium drops - beer potomania - reduction in water excretion ability
94
what gives us an idea of whether the body is releasing ADH
urine osmolality
95
hyponatremia is largely dependent on ____ the change in Na conc happens
how quickly - rapid changes - clinical symptoms of hyponatremia, depending on severity - gradual changes - the body, especially cells in CNA, will adjust (homeostasis) and minimal clinical consequences occur WITHIN 48 HRS
96
How can rapid correcting sodium in a patient who has made homeostatic changes to a chronic hyponatremic state be dangerous
- body does not have time to adjust to rapid high levels of ECF sodium - excess movement of fluid out of the cells can cause cell death = osmotic demyelination syndrome / central pontine myelinolysis
97
lab abnormalities of hyponatremia
serum sodium <135 mEq/L osmolality and urine Na - can increase, decrease, or normal
98
musclar symptoms of hyponatremia
cramps - extremities, abdominal weakness
99
neuro symptoms of hyponatremia
HA anxiety, depression, altered behavior confusion/AMS lethargy decreased DTRs seizures coma rsp arrest death
100
symptoms of hyponatriema
GI - n/v/d, anorexia malaise pulmonary edema fingerprint edema
101
management of hyponatremia
- fluid restriction - <800 mL/day - diuresis for asymptomatic - boluses, loop diuretics, vasopressin for symptomatic
102
SE of vasopressin
thirst/polydipsia polyuria dry mouth fatigue black box warning - severe liver injury monitor - LFT, electrolytes, renal function interactions - graapefruit juice, digoxin, k-sparing
103
what is hypernatremia
ECF osmolality is always high when sodium is high loss of body water or increased intake of sodium
104
normal Uosm hypernatremia means
renal water-conserving ability is function nonrenal or renal loss of water
105
low Uosm hypernatremia means
characteristic of diabetes insipidus neurogenic - inadequate ADH release nephrogenic - kidneys are insensitive to ADH
106
euvolemia hypernatremia is
pure water loss TBW is down total body sodium has not changed but proportionately is higher
107
excess urine formation, no repsonse to ADH is indicative of
diabetes insipidus
108
what is hypervolemic hypernatremia
body has gained excess sodium and has retained water as a result, but not enough to dilute sodium
109
what is hypovolemic hypernatremia
1. hypotonic water loss; water and sodium lost, but water is lost faster 1. low urine sodium - body still trying to conserve sodium - GI loss - ESPECIALLY DIARRHEA - excess sweating 2. high urine sodium - body not hanging onto sodium DESPITE hypovolemia - diuretics - severe hyperglycemia
110
lab abnormalities of hypernatremia
serum sodium >145 mEq/L increased serum osmolality normal/decreased urine osmolality increased urine specific gravity increased hematocrit and BUN
111
symptoms of hypernatremia
increased ADH secretion - thirst, polydipsia, oliguria or anuria neuro symptoms - HA, delirium, seizures, restlessness dehydration - hypotension, weak pulses, decreased turgor, dry mucous membranes
112
management of hypernatremia
- calculate free water deficit - acute - more rapid correction - try to normalize within 24 hrs to avoid CNS damage - chronic - 6-12 mEq/L decrease in sodium per 24 hrs - overly rapid correction can cause CNS EDEMA

MOD 3 (5 decks)

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