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MOD 3 > fluid and electrolyte disorders 1 > Flashcards

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
Q

what compares weight of urine to weight of water

A

urine specific gravity

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26
Q

what is the effect that the effective osmotic pressure of a solution has on the size of cells

A

tonicity

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27
Q

tonicity is caused by water movement across the cell membrane due to ?

A

osmosis

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28
Q

tonicity is also called the ___

A

effective plasma osmolality

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29
Q

the effective plasma osmolality is sensed by ___ in the hypothalamus and carotid artery

A

osmoreceptors

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30
Q

increased plasma osmolality = release of ?

A

ADH

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31
Q

what tonicity has the same osmolality as ICF

A

isotonic

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32
Q

what tonicity has increased osmolality as compared to ICF

A

hypertonic

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33
Q

what tonicity has decreased osmolality as compared to ICF

A

hypotonic

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34
Q

ECF movement from blood vessel lumens to interstitial spaces at the ____ level

A

capillary

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35
Q

what are the 4 major forces influencing movement of water from plasma to interstitium

A
  1. capillary filtration (hydrostatic) pressure
  2. capillary colloidal osmotic pressure
  3. interstitial hydrostatic pressure
  4. tissue colloidal osmotic pressure
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36
Q

palpable tissue swelling due to expansion of interstitial fluid volume

A

edema

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37
Q

accumulation of fluid exceeds the absorptive capacity of the gel-based interstitial matrix proteins

A

pitting edema

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38
Q

other factors involved like excess plasma proteins in the interstitial tissue

A

nonpitting edema

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39
Q

where can nonpitting edema be seen in?

A

with infection, trauma, lymph system abnormalities, thyroid disease

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40
Q

what are the 4 pathophysiology contributing to development of edema

A
  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
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41
Q

total body water (TBW) varies with ?

A

age, sex, weight

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42
Q

avg person requires ___ mL of water per ___ calories metabolized

A

100, 100

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43
Q

why does fever cause increased demand for water

A

higher metabolic rate
increased rsp rate

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44
Q

majority water gain is from

A

ingested liquids - 1600mL

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45
Q

majority water loss is from

A

kidneys - 1500mL

46
Q

what is the most abundant cation in the body

A

sodium

47
Q

majority of sodium is in the

A

ECF

48
Q

how does sodium enter/leave the cell

A

Na/K/ATPase pump

49
Q

what are the 3 regulations that sodium does

A
  1. ECF volume
  2. excites tissues
  3. acid-base balance as part of sodium bicarbonate
50
Q

major regulator of sodium and water balance

A

effective circulating volume

51
Q

what is in the atria and in blood vessels (especially aortic arch, carotid sinuses, afferent arterioles in kidneys)

A

baroreceptors

52
Q

what do baroreceptors sense

A

pressure-induced stretch of blood vessels to determine how much blood volume the body has

53
Q

what helps regulate water intake

A

thirst

54
Q

how is thirst stimulated

A
  1. increased ECF osmolarity
  2. decreased in blood volume
55
Q

what is the earliest symptom of hemorrhage

A

thirst

56
Q

hypodipsia is

A

deficiency of thirst

57
Q

polydipsia is

A

excess of thirst

58
Q

what does ADH do

A
  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
Q

what adjustments would you see when theres a drop in osmotic pressure or blood volume

A

increased: SNS, RAAS, ADH, thirst
decreased: ANP

60
Q

what adjustments would you see when theres an increase in osmotic pressure or blood volume

A

increased: ANP
decreased: SNS, RAAS, ADH, thirst

61
Q

what are the 2 fluid imbalances

A

isotonic fluid volume deficit
isotonic fluid volume excess

62
Q

what are the 2 tonicity/sodium imbalances

A

hyponatremia
hypernatremia

63
Q

decrease in overall amount of ECF with proportionate loss of sodium and water is ?

A

isotonic fluid volume deficit

64
Q

a deficit in the amount of circulating blood volume is ?

A

hypovolemia

65
Q

what is the etiology of isotonic fluid volume deficit

A

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
Q

what is the pathophysiology of isotonic fluid volume deficit

A
  • decreased intravascular volume = decreased capillary hydrostatic pressure - less movement and delivery
  • plasma sodium concentration is normal
67
Q

what is the compensatory mechanism of isotonic fluid volume deficit

A

increased thirst
decreased urine output

68
Q

lab abnormalities of isotonic fluid volume deficit

A

increased urine osmolality
increased urine specific gravity
increased hematocrit

69
Q

neuro symptoms of isotonic fluid volume deficit

A

fatigue
altered mental status

70
Q

symptoms of isotonic fluid volume deficit

A
  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
Q

management of isotonic fluid volume deficit

A

symptomatic management
replace fluids with isotonic electrolyte solutions

72
Q

increase in overall amount of ECF is

A

Isotonic Fluid Volume Excess

73
Q

proportionate gains of both sodium and water and tonicity of ECF is same as ICF is

A

Isotonic Fluid Volume Excess

74
Q

etiology of Isotonic Fluid Volume Excess

A

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
Q

pathophysiology of Isotonic Fluid Volume Excess

A
  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
Q

compensatory mechanisms for Isotonic Fluid Volume Excess

A

decreased thirst
increased urine output

77
Q

lab abnormalities for Isotonic Fluid Volume Excess

A

decreased urine osmolality
decreased urine specific gravity
decreased hematocrit

not always reliable

78
Q

symptoms of Isotonic Fluid Volume Excess

A
  1. increased vascular volume
    - pulmonary edem
    - distended neck veins
    - full, bounding pulse
  2. increased ECF volume
    - ascites
    - edema
79
Q

management of Isotonic Fluid Volume Excess

A

symptomatic management
diuretic therapy
reduce sodium and/or fluid intake

80
Q

what can cause hyponatremia

A

body water content rises (overhydration)
loss of sodium and water (dehydration)

81
Q

what can cause hypernatremia

A

body water content declines (dehydration
gain of sodium and water (overhydration)

82
Q

sodium and its anions account for __% of ECF osmolality

A

90-95%

83
Q

why can the TBW be low, normal, or high during hyponatremia

A

kidney independently regulates sodium and water homeostasis

84
Q

what has a key role in the pathophys of many hyponatremia cases

A

ADH

85
Q

what happens to the cells during hyponatremia

A

osmotic swelling of cells

86
Q

what is the first step of hyponatremia

A
  1. determine whether low sodium is due to:
    - excessive sodium loss
    - excessive water gain
    - sodium not really low at all
87
Q

how do you tell the difference is determining the cause of the hyponatremia

A
  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
Q

majority of patients what type of hyponatremia

A

hypotonic hyponatremia

89
Q

what is isotonic hyponatremia

A

extra molecules in blood interfere with lab calculations of sodium levels
- extra proteins
- high lipids - especially triglycerides

90
Q

what is hypertonic hyponatremia

A

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
Q

hypotonic hyponatremia is due to

A

water retention in excess to sodium
water is lost along with sodium, but more sodium is lost than water

92
Q

what is hypervolemic hypotonic hyponatremia

A

excess fluid retention
- sodium overall higher than baseline, but water is greater
- seen in HF, liver disease, kidney disease

93
Q

what is the most common type of hypotonic hyponatremia

A
  • 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
Q

what gives us an idea of whether the body is releasing ADH

A

urine osmolality

95
Q

hyponatremia is largely dependent on ____ the change in Na conc happens

A

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
Q

How can rapid correcting sodium in a patient who has made homeostatic changes to a chronic hyponatremic state be dangerous

A
  • 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
Q

lab abnormalities of hyponatremia

A

serum sodium <135 mEq/L
osmolality and urine Na - can increase, decrease, or normal

98
Q

musclar symptoms of hyponatremia

A

cramps - extremities, abdominal
weakness

99
Q

neuro symptoms of hyponatremia

A

HA
anxiety, depression, altered behavior
confusion/AMS
lethargy
decreased DTRs
seizures
coma
rsp arrest
death

100
Q

symptoms of hyponatriema

A

GI - n/v/d, anorexia
malaise
pulmonary edema
fingerprint edema

101
Q

management of hyponatremia

A
  • fluid restriction - <800 mL/day
  • diuresis for asymptomatic
  • boluses, loop diuretics, vasopressin for symptomatic
102
Q

SE of vasopressin

A

thirst/polydipsia
polyuria
dry mouth
fatigue
black box warning - severe liver injury

monitor - LFT, electrolytes, renal function

interactions - graapefruit juice, digoxin, k-sparing

103
Q

what is hypernatremia

A

ECF osmolality is always high when sodium is high
loss of body water or increased intake of sodium

104
Q

normal Uosm hypernatremia means

A

renal water-conserving ability is function
nonrenal or renal loss of water

105
Q

low Uosm hypernatremia means

A

characteristic of diabetes insipidus
neurogenic - inadequate ADH release
nephrogenic - kidneys are insensitive to ADH

106
Q

euvolemia hypernatremia is

A

pure water loss

TBW is down
total body sodium has not changed but proportionately is higher

107
Q

excess urine formation, no repsonse to ADH is indicative of

A

diabetes insipidus

108
Q

what is hypervolemic hypernatremia

A

body has gained excess sodium and has retained water as a result, but not enough to dilute sodium

109
Q

what is hypovolemic hypernatremia

A
  1. hypotonic water loss; water and sodium lost, but water is lost faster
  2. low urine sodium - body still trying to conserve sodium
    - GI loss - ESPECIALLY DIARRHEA
    - excess sweating
  3. high urine sodium - body not hanging onto sodium DESPITE hypovolemia
    - diuretics
    - severe hyperglycemia
110
Q

lab abnormalities of hypernatremia

A

serum sodium >145 mEq/L
increased serum osmolality
normal/decreased urine osmolality
increased urine specific gravity
increased hematocrit and BUN

111
Q

symptoms of hypernatremia

A

increased ADH secretion - thirst, polydipsia, oliguria or anuria
neuro symptoms - HA, delirium, seizures, restlessness
dehydration - hypotension, weak pulses, decreased turgor, dry mucous membranes

112
Q

management of hypernatremia

A
  • 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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