fluid and electrolytes Flashcards
homeostasis
Volume and composition of each space remains constant. ie - disruption, vomiting, diaerrhea, ace inhibitors, diuretics
water - how much is body weight? And needed for what? (water temp eliminates and transports)
Primary component of body
Accounts for approx 60% of body wt (varies by age)
Adequate balance is necessary for- maintenance of temp - elimination of waste products - all transportation within body.
solutes - electrolytes
Chemical compounds that develop an ionic charge when dissolved in water. either + or - charge.
All body fluids contain electrolytes.
Regulation of electrolyte levels is critical for (electra on acid with muscles and bad metabolism)
maintenance of body fluid osmolality (The concentration of particles dissolved in a fluid)
acid balance
neuromuscular function
cell metabolism
nonelectrolytes - measured by what? and ex (not electra, weigh and love sugar, urea, crete, proteins)
Do not dissociate in solution
measured by wt
Glucose - Urea - Creatinine - Bilirubin - Proteins
transcellular fluids and ex.
not subject to significant gains or losses) (aceities - a fluid collects in spaces within your abdomen)
fluid spacing - 1st spacing
Normal distribution of fluid (homeostasis)
movement of body fluids
Fluid constantly moves among intracellular, interstitial and vascular spaces to maintain body fluid balance
Moves through permeable membranes
- permits movement of water and some solutes
osmosis - when is it important to consider? (intravenous is simply osmosis)
Osmosis stops when equilibrium is reached
Major force in body fluid movement
Important to consider with IV therapy
osmotic pressure (Osmosis with pebbles)
holds the water. Protein in capillary draws water into it.
Refers to pulling power of a solution for water
The higher the osmolality of a solution, greater pulling power for water
oncotic pressure (onka with colloids)
colloids (larger molecules, like protein) pull back into capillaries and plasma.
filtration (filter the straw)
Movement of fluids and solutes from an area of high hydrostatic pressure to an area of low hydrostatic pressure into or out of the capillary
Dependent on forces favoring filtration & opposing it
Think of as a tug of war - pushing and pulling
forces that work with filtration (oppposites - cap and inter)
Capillary hydrostatic pressure (blood pressure)
Interstitial oncotic pressure (water-pulling)
forces favoring reabsorption (onca reabsorbs the plasma)
Plasma oncotic pressure (water-pulling)
Interstitial hydrostatic pressure
Interstitial fluid to plasma - ex. (socks push plasma)
Fluid drawn into plasma space whenever there is increase in plasma osmotic or oncotic pressure
Wearing of compression stockings or hose is a therapeutic action on this effect
active transport
Movement of solute from an area of lower solute concentration to an area of higher solute concentration
Depends on ATP
Example is Sodium- Potassium pump
ADH
Hormone synthesized by hypothalamus
Secreted by posterior pituitary. it’s stimulated by a change in osmolarity. ie eating a lot of potato chips. ADH acts on kidneys to retain water
regulation of body fluids - so basic it’s crazy…
Thirst Mechanism
Stimulated by thirst receptors in hypothalamus
Primary protection against hyperosmolality***
Normally occurs with even small fluid losses
Stimulates release of ADH and aldosterone
causes of fluid volume excess (FVE)
Renal Disease
Too rapid infusion of IV fluids
Steroid Therapy
Production of ADH
Cardiac Disease
causes of fluid volume deficit (FVD) and what type of spacing?
NPO
Drains
Surgery
Blood loss
Fluid loss from GI tract
Profuse sweating
polyuria
fever
third spacing
decreased intake
intracellular elecrolytes (Ps indoors)
potassium and phosphorus
extracellular (plasma) electrolytes - which ones are on the outside? (outdoor pool)
sodium and chloride
most of our water in cells or plasma?
cells
Second spacing - (the 2nd you walk, you have intertitial fluid) and ex.
Abnormal accumulation of interstitial fluid. ex. - increased bp and walking a long time, then have edema in lower extremities.
third spacing (3rd base is tight) and ex.
Abnormal accumulation in areas that have no or little amt of fluid
Fluid unavailable for use ex. ascities. body has the fluid but it’s trapped in other areas, not for circulation.
hypotonic (cell is opposite of vj)
cell is swollen - more solute to water inside cell than water surrounding it. at risk for cerebral edema
hypertonic - and at risk for what?
at risk for lysing. neuro risks.
to correct edema, use what type of med? (which one shrinks?)
hypertonic med
facilitated diffusion
need a carrier. ex glucose.
diffusion
movement of solutes across concentration gradient. ex electroyltes, gases like 02. this is just solutes.
if you don’t have protein in veins to pull fluid back in, the result will be
edema
renin angiotensin
glomerulus sense bp drop, secretes renin, to liver, then lung, then to adrenal for aldosterone.
aldosterone - and what med blocks it? (alden doesn’t lisin)
will stimulate kidneys to retain Na and water will follow. constricts blood vessels. lisinapro (ace inhibitor - blocks angio 2, and keeps blood vessels open, lowers bp, inteferes with aldosterone)
increased aldosterone - lower levels of what? (just K)
lowers levels of K+ and higher levels of Na
2 syndromes that impact ADH and the alchy
SIADH alcohol can turn off ADH and put out more dilute urine - just water, not Na+. Might cause hypernatremia. Diabetes insipidus. damage to hypothalamus or pituatry .our kidneys will excrete more dilute urine. patient will develop dehydration.
ANP - opposite effect of ADH
kicks in with fluid volume overload. see it with heart failure or overload. promotes vasodilation, lower bp, and diuresis. when chemo receptors are overstretched.
one liter of water weighs
2.2 lbs, or 1 kg
factors that affect electrolyte ratio (young/old fat/skinny percentage)
factors that affect ratio - age, neonates about 90%, older about 45% , adipose - more fat less proportion of body water. more muscle - higher
transcellular fluid occurs where in the body? (think of linings)
CSF
GI tract
Pleural
Synovial
Peritoneal
Normally ICF and ECF are
isotonic with each other.
osmolality (Ozmolalities are small)
how many particles are in the blood per kilogram
osmolarity
particles per liter
hyperosmolarity (hyper lars has too much sugar and salt in his blood)
It is a condition in which the blood has a high concentration of salt (sodium), glucose, and other substances
thirst reflex depressed in older people*** older ppl at risk for
hypernatremia, hypo-osmolarity, and dehydration. I/o important, water stations, talk about fluids they like, pay attention.
what causes 3rd spacing? (space the 3 hearts among my capillaries)
heart failure, capillary leakage syndrome (biotherapy).
symptoms of 3rd spacing (3 muskateers, 3 crackles)
may have increased in HR, decrease in BP, decreases pulses, crackles on lungs, edema, decreased urine output. need to find a way to pull fluid back into vascular.
low Oz is…
Low Oncotic is…
low Oz is edema in the cell. Intracellular.
Low Oncotic is edema outside of the cell. Extracellular.
hydrostatic (hydro straw)
drives fluid out of the capillaries
meds for 3rd spacing (loop around 3rd base)
might use lasix or blood transfusion.
reabsorb?
oncotic
causes of SIADH (shada in my lungs)
pulmonary conditions, lung cancer, pneumonia will release of ADH, could trigger SIADH. Running in marathon could trigger SIADH. our body will hold onto water and can create hyponatremia.
SIADH v. insipidous
SIADH results in the retention of water, remember “SI” for “soaked inside.” For DI, excess fluid leaves the body, therefore think “dry inside.”
LOC with dehydration
disoriented
dehydration - is specific gravity high or low?
higher specific gravity and solute because you don’t have fluids to lower solutes
the more particles in the urine (the more concentrated)
the higher the specific gravity
with deyhdration, hematocrit is
elevated. it’s dilusional.
alcohol - suppresses what?
ADH - pee more.
dehydration causes increased or decreased bowel sounds?
decreased in all 4
daily weights is the best measure of
fluid volume. I/O is an approximation.
risk with SIADH
hyponatremia - altered mental status
treatment for 3rd spacing
lasix or blood transfusion
osmotic
pulling power of solutes in plasma?
oncotic
colloid pulling into vascular
filtration has to do with
hydrostatic pressure - pushing or pulling
if you want to hydrate a cell, use a
hypotonic solution - makes cell swell
