Fluid and Electrolyte imbalances Flashcards by Drew Hundertmark

causes of extracellular edema

increased capillary hydrostatic pressure
decreased plasma proteins
increased capillary permeability
blockage of lymph return

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factors that can increase capillary hydrostatic pressure

excess kidney retention of salt and water (acute/chronic KI, mineralocorticoid excess)
high venous pressure ( HF, venous obstruction, failure of venous pumps)
decreased arteriolar resistance (excessive body heat, insufficiency of SNS, vasodilator drugs)

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factors that can decrease plasma protein concentration

loss of protein in urine (nephrotic syndrome)
loss of proteins from denuded skin areas (burns/wounds)
failure to produce . proteins (such as in liver dz or severe protein or caloric malnutrition)

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factors that can increase capillary permeability

immune rxns that cause release of histamine
toxins
bacterial infections
vit deficiency (esp. c) 
prolonged ischemia
burns

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factors that can block lymph return

cancer
infections (filarial, nematodes )
surgery
congenital absence or abnormality of lymphatic vessels

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factors working to prevent extracellular edema from occurring

interstitium normally has a low compliance
lymph flow has a capacitance to increase 10-50 fold
increased amounts of protein-poor capillary fluid flow wash proteins out from the interstitial space, thereby decreasing net capillary filtration pressure

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causes of intracellular edema

depression of metabolic systems of tissue
lack of adequate nutrition to the cells
cells lack the resources to drive the NA/K ATPase so na accumulates in cells and they expand (water follows Na into cells)
too little extracellular Na
too much water

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increased RBF and GFR leads to

increased delivery of oslute to JG apparatus (senseed by macula densa )
increased resistance of afferent arterioles
decreased RBF, GFR

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ECV sensors

low pressure . - cardiac atria and pulmonary vasculature

high pressure - carotid sinus, aortic arch, JG apparatus of kidney

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regulatory hormones of the proximal tubule

angiotensin II, noreepinephrine and epinephrine

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regulatory hormones of hte late distal tubuel and collecting ducts

aldosterone, atrial natriuretic peptide

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increased Na intake leads to 
\_\_\_\_ ECF AND EABV
\_\_\_\_ sympathetics 
\_\_\_\_\_ ANP
\_\_\_\_\_\_ PIc 
\_\_\_\_\_\_ RAAS

increased ECF volume and increased effective arterial blood volume 
decreasing sympathetic (dilaiton of afferent arterioles, decreased na reabsorption in PT), increasing ANP (constricting efferent arterioles, decreased Na reabsorption) decreaseing PIc, decreased RAAS

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clinical signs of hypovolemia

decreased skin turgor 9tenting) 
thirst
dry mucous membranes
sunken eyes
oliguria
progressing to tachycardia, hypotension, tachypnea, confusion

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clinical signs of hypervolemia

weight gain
edema
bounding pulse

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causes of absolute hypovolemia

extra-renal - bleeding, GI fluid loss, skin fluid loss, respiratory fluid loss, extracorproreal ultrafiltration
renal - diuretics, na wasting tubulopathies, genetic or acquired tubulointerstitial disease, obstructive uropathy/postobstructive diuresis, hormone deficiency, hypoaldosteronism adrenal insufficiency

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causes of relative hypovolemia

extrarenal - edmatous states, HF, cirrhosis, anaphylaxis, drugs, spesis, pregnancy, third space loss
renal - severe nephrotic syndrome

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causes of volume excess

primary renal na retention (increased effective circulating volume) d/t - oliguric acute renal failure
acute glomerulonephritis
sevrere chronic renal failure
nephritic, nephrotic syndrome
primary hyperaldsoteronism
cushing syndrome
early stages of severe liver dz 
conn syndrome
gorndon syndrome
liddle syndrome 
secondary renal Na retention (decreased ECV) 
HF, later stages of severe liver dz, nephrotic syn drome, pregnancy

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hyper/hyponatremia is a problem with

WATER
hypo <135
hyper >145

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normal plasma osmolality value

285-295

quick estimate = 2x [Na]

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vasopressin is more responsive to changes in blood pressure or plasma osmolality

plasma osmolality

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factors that increase the secretion of ADH

increased plasma osmolality 
decreased blood volume 
decreased blood pressure
nausea/hypoxia
drugs: mrophine, nicotine, cyclophosphamide

factors that decrease the secretion of ADH

decreased plasma osmolarity
increased blood volume
increased blood pressure
drugs: alcohol clonidine haloperidol

factors that increase thirst

increased osmolarity 
decreased blood volume
decreased blood pressure
increased angiotensin II 
dryness of mouth

factors that decrease thirst

decreased osmolarity
increased blood volume
icnreased blood pressure
decreased angiotensin II
gastric distension

effect of diarrhea on body fluid compartments

loss of osmotic ECF only

effect of water deprivation on body fluid compartments

loss of h2o from icf and ecf | increased osmolarity in both compartments

effect of adrenal insufficiency on body fluid compartments

lost na increased volume icf decreased ecf both vbecome hypo-osmotic

plasma sodium concentration of less than 135 meq/l

hyponatremia

symptoms of hyponatremia and pneumonic

``` SALT LOSS stupor/coma anorexia, n/v lethargy tendon reflexes decreased ``` limp muscles orthostatic hypotensin seizures/HA stomach cramping

tx of hyponatremia

level 3 - severe - hypertonic NaCl followed by fluid restriction level 2 - moderate - vaptan or hypertonic nacl level 1 - fluid restriction

rapid overcorrection of hyponatremia can lead to

osmotic demyelination syndrome

things that can cause SIADH

``` tumors producing vasopressin ectopically drug induced brain tumors idiopathic subarachnoid hemorrhage stroke inflammatory brain lesions respiratoyr fialure HIV traumatic brain injury drug induced pneumonia neusea, pain, prolonged exercise post op ```

scenarios where hypernatremia is suspectedd

living alone who fall at home indicator of neglect in nursing homes in the desert without enough water

major causes of jhypernatremia

unreplaced water loss in scenarious such as sweat, gi losses, central/nephrogenic diabetes insipidus, osmotic diuresis or hypothalamic lesions water loss into cells - sever exercise or seizures sodium overload - ate too much salt

mneumonic of hypernatremia

``` TRIP twitching, tremors, hyperreflexia restlessness, irritability, oncfusion intestine thirst, dry mouth, decreased urine output pulmonary and peripheral edema ```

hyperkale is plasma concentration above

5.2

hypokalemia is plasma concentration below

3.7

hypokalemia does what to the plasma membrane of cells

HYPER-polarizes it - less likely to fire | but in cardiac tissue it causes tachycardia

hyperkalemia does what to plasma membrane threshold

``` decreases it hypopolarizes more likely to fire lethal kcl injection messes up membrane potential in cardiac tissue become HYPERPOLARIZED ```

effet of hyperkalemia on EKG

high t wave

effect of hypokalemia on ECG

low t wave, high u wave, low ST segment in severe hypokalemia

things that induce potassium uptake into cells

``` INSULIN ALKALEMIA (buffering mechanism) b2 agonist, aldsoterone deficiency, alpha blockers, alkalosis, hypoosmolarity ```

things that induce potassium eflux from cells

``` alpha agonist insulin deficiency aldosterone b2 blockers ACIDOSIS (buffering) hyperosmolarity exercise cell lysis ```

aldosterone effects what cells in the glomerulus

principal cells in the collecting ducts

high na intake increases/decreases/does not influence k excretion

``` does not influence decreased aldosterone (decreasing secretion) from na intake is offset by increased GFR and decreasd proximal tubular na reabosrption ```

hypokalemia causes mneumonic

``` graphic idea GI losses (vomitting, diarrhea) renal tubular acidosis (1 and 2 types) aldosterone paralysis hypothermia insulin excess cushing syndrome ``` insufficient intake diuretics elevated beta adrenergic activity alkalosis

signs and symptoms of hypokalemia

CNS - drowsiness, letahrgy neuromuscular *** - skeletal muscle weakness, smooth msucle weakness leading to ileus and constipation cardiovascular - ventricular arrhythmias, hypotension, cardiac arrest renal - impaired concentrating ability causes polyuria and nocturia metabolic - hyperglycemia

causes of hyperkalemia mneumonic

RED FETS renal disease - arf, ckd, type IV RTA . excessive intake - food, k iv fluids, blood transfusion drugs - k sparing diuretics, k salts of penicillin factitious: pro0longed use of tourniquet, hemolysis endocrineL addisons disease tissue release: rhabdomyolysis, burns, hemolysis, cytotoxic therapy shift out of cell - acidosis, beta antagonsit, insulin deficiency, tissue damage

signs and symptoms of hyperkalemia

cardiac - abnromal heat rhythm, bradycardia peaked t wave neuromuscular - numbness, weakness, flaccid paralysis

drug causes of hyperkalemia

drugs targeting RAAS