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Pathophysiology > Fluid and Electrolytes > Flashcards

Fluid and Electrolytes Flashcards

1
Q

Alterations

A
  • edema
  • isotonic
  • hypotonic
  • hypertonic
  • electrolytes
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2
Q

edema

A

excessive accumulation of fluid within the interstitial spaces

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3
Q

isotonic

A
  • concentration equivalent to 0.9% NaCl
  • normal saline solution
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4
Q

hypotonic

A
  • low solute (concentration >0.9% NaCl ECF)
  • cells shrink
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5
Q

hypertonic

A
  • high solute (concentration <0.9% NaCl ECF)
  • cells expand
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6
Q

Normal total body water (TBW) volume

A

60%
42L

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7
Q

normal Intracellular fluid volume

A
  • 2/3
  • 28L
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8
Q

normal extracellular fluid volume

A
  • 1/3
  • 14L
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9
Q

total body water

A

sum of all fluids

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10
Q

what are the 3 components of extracellular fluid

A
  • plasma fluid
  • interstitial fluid
  • transcellular
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11
Q

normal plasma fluid volume

A
  • 7%
  • 3L
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12
Q

normal interstitial fluid volume

A
  • 28%
  • 11L
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13
Q

normal extracellular fluid volume

A
  • 35%
  • 14L
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14
Q

intracellular fluid is located

A

within cells

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15
Q

extracellular fluid is located

A

outside of cells

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16
Q

interstitial fluid is located

A

between the cells in the body

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17
Q

transcellular fluid is located

A

synovial, intestinal, intraocular

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18
Q

intravascular fluid is located

A

in the blood vessels

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19
Q

TBW in infants

A

75%

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20
Q

TBW in 1 year olds

A

67%

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21
Q

TBW in children

A

65%

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22
Q

TBW in elderly

A

55%

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23
Q

TBW ______ with age

A

decreases

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24
Q

in obese individuals total body water is ______. Why?

A
  • less
  • adipose tissue is hydrophobic
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25
Q

obese individuals are more likely to be

A

dehydrated

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26
Q

the ECF has a higher concentration of _______ and _____ and a smaller amount of ______

A
  1. sodium
  2. chloride
  3. potassium
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27
Q

the ICF has a higher concentration of ______ and a smaller concentration of ________ and _________

A
  1. potassium
  2. chloride
  3. sodium
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28
Q

Hydrostatic pressure

A
  • pressure exerted by a fluid in a confined space
  • pressure exerted existing within a liquid at rest with respect to its surroundings
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29
Q

the more volume in the vessel; the _____ hydrostatic pressure

A

more

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30
Q

Oncotic pressure

A
  • pressure excreted by proteins either in the blood plasma or interstitial fluid
  • pulling force
  • looks at colloids
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31
Q

what is the main protein

A

albumin

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32
Q

and increase in albunin in the blood will increase the _________________

A

oncotic pressure

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33
Q

osmotic pressure

A
  • pressure needed to stop movement of water across a semi permeable membrane
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34
Q

capillary oncotic pressure pulls fluid into

A

the capillary

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35
Q

interstitial oncotic pressure pulls fluid into the

A

interstitial space

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36
Q

starling force

A
  • net forces of the 4 forces acting together
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37
Q

starling forces =

A

net filtration

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38
Q

capillary hydrostatic pressure (blood pressure)

A
  • facilitates the outward movement of water from capillary to interstitial space
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39
Q

capillary oncotic pressure (plasma)

A
  • osmotically attracts water from the interstitial space back to the capillary
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40
Q

Interstitial hydrostatic pressure

A
  • facilitates the inward movement of water from the interstitial space into the capillary
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41
Q

interstitial oncotic pressure

A
  • osmotically attracts water from the capillary into the interstitial space
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42
Q

where _______ flows, ______ follows

A

sodium
water

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43
Q

At the arterial end ________ pressure is higher than _______ pressure so water flows out of the capillary

A

capillary hydrostatic pressure
capillary oncotic pressure

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44
Q

at the venous end _______ pressure is lower than ______ pressure, causing cluid to move back into the capillary

A

capillary hydrostatic pressure
capillary oncotic pressure

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45
Q

edema can cen be caused by

A
  • increased capillary hydrostatic pressure
  • decreased plasma ontonic pressure
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46
Q

Sodium

A
  • 90% of the ECF
  • regulates extracellular osmotic forces; therefore regulates water balance
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47
Q

Kidneys

A
  • maintain the concentration through renal tubular reabsorption to maintain sodium 136-145mmol/L
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48
Q

what is normal sodium range

A

136-145mmol/L

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49
Q

what controls sodium balance

A

aldosterone
RAAS system

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50
Q

aldosterone function

A
  • stimualtes water/NaCl reabsorption in response to a decrease in blood pressure/fluid volume
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51
Q

natriuretic peptide are made in the

A

heart

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52
Q

naturiueric peptides

A
  • released when their is an increase in volume
  • cause diuresis
  • causes kidneys to excrete sodium (and water)
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53
Q

isotonic alteration

A
  • hypovolemia
  • hypervolemia
54
Q

hypovolemia causes

A

hemmorage, severe wound drainage, diaphoresis, inadequate fluid intake

55
Q

Hypovolemia signs

A

flat neck veins, weight loss, dry skin and mucosal membranes, normal or low BP

56
Q

hypovolemia treatment

A

Isotonic IV solution
- 0.9% NS or D55, lactated ringers

57
Q

hypervolemia casues

A
  • isotonic fluid excess (excess IV’s), hypersecretion of aldosterone
58
Q

hypervolemia signs

A
  • increased neck veins, edema, increased BP
59
Q

hypervolemia treatment

A

diuretics

60
Q

what is the major system that shows signs and symptoms of sodium imbalance

A

neuromuscular

61
Q

how does sodium imbalance effect the neuromuscular system

A
  • level of consciousness
  • muscle cramps
  • weakness
62
Q

Chloride

A
  • major anion in the ECF
    -follows sodium
63
Q

chloride transport is

A

passive

64
Q

chloride is ________ proportional to

A

HCO3-

65
Q

water balance is regulated by the secretion of

A

ADH

66
Q

what triggers the release of ADH from the posterior pituitary gland

A
  • increased plasma osmolarity
  • decreased circulating blood volume
67
Q

increased plasma osmolarity occurs when

A

water deficit or sodium excess in relation to TBW

68
Q

decreased circulating blood volume can be caused by

A

vomitiing, diarrhea, or excessive sweating

69
Q

hypernatremia

A
  • occurs when serum Na level is over 145mmol/L
70
Q

Isovolemic hypernatremia

A
  • loss of free water with normal sodium level
  • concentration of sodium is increased
71
Q

Isovolemic hypernatremia can be caused by

A

dehydration, excessive diaphoresis, fever, burns, diarrhea, diabetes insipidus

72
Q

dehydration results from

A

a loss f water and sodium

73
Q

Hypovolemic hypernatremia

A
  • loss of sodium is greater than the loss of water
74
Q

Hypovolemic hypernatremia is caused by

A

loop diuretics
- failure of the kidneys to concentrate urine

75
Q

hypervolemic hypernatremia

A
  • increased TBW and greater increase of sodium
76
Q

hypervolemic hypernatremia can be caused by

A
  • infusion of hypertonic saline
  • over secretion of ACTH or aldosterone
77
Q

symptoms of hypernatremia

A
  • thirst, weight gain, bounding pulse, increased BP
  • CNS: muscle twitching, hyper-reflexes, confusiom, coma, convulsion
78
Q

hypernatremia treatment

A
  • salt free solutions D5W (must be given slowly to prevent edema)
79
Q

hyponatremia

A
  • serum sodium is less than 135mmol/L
80
Q

hyponatremia is casued by

A

sodium deficit or water excess

81
Q

isovolemic hyponatremia

A
  • loss of sodium
82
Q

isovolemic hyponatremia cause

A
  • SIADH (syndrome of inappropriate antidiuretic hormone) –> most common cause
  • inadequate sodium intake
83
Q

SIADH casues

A

increased water retention, hypothyroidism, pneumonia

84
Q

hypervolemic hyponatremia

A
  • sodium levels rises, leads to an increase in water and TBW
  • dilution of sodium in the ECF
85
Q

hypervolemic hyponatremia causes

A

heart failure, cirrhosis of the liver, edema

86
Q

hypovolemic hyponatremia

A
  • loss of TBW
  • greater loss of sodium
87
Q

hypovolemic hyponatremia causes

A

prolonged vomiting and diarrhea, inadequate aldosterone, diuretics

88
Q

Dilutional hyponatremia is also known as

A

water intoxication

89
Q

Dilutional hyponatremia occurs when

A

there is an intake of large amounts of free water or replacement of fluid loss with IV (D5W); creating a hypotonic solution

90
Q

Dilutional hyponatremia can occur in

A

marathon runners
- excessive sweating, large intake of water for thirst; dilutes sodium

91
Q

Dilutional hyponatremia is manifested as

A
  • cells swelling (cerebral edema or increased ICP)
  • muscle twitching, decreased reflexes, weakness
92
Q

hyponatremia treatment

A

Hypertonic IV solution (3% or 5% saline)

93
Q

what is the major intracellular electrolyte

A

potassium

94
Q

hypokalemia

A
  • serum potassium below 3.5mmol/L
95
Q

hyperkalemia

A
  • serum K higher than 5.0mmol/L
96
Q

causes of hyperkalemia

A
  • increased intake of potassium
  • shift of potassium from cells to the ECF
  • decreased renal excretion
  • meds that decrease K excretion
97
Q

hypokalemia

A

serum potassium falls less than 3.5mmol/L

98
Q

factors contributing to hypokalemia

A
  • poor diet in elderly, alcoholism, anorexia
99
Q

diabetic ketoacidosis treatment

A
  • treated with fluids and insulin
    *** insulin cannot be administered without providing a K supplement
100
Q

diabetic ketoacidosis

A

low blood glucose
- no promotion of cellular entery of K
- hyperkalemia occurs

101
Q

acidosis

A

ECF and ICF exchange hydrogen ions and K and NA occurs simultaneously

102
Q

mild hyperkalemia manifestations

A
  • neuromuscular irritability: restlessness, intestinal cramping, diarrhea
103
Q

severe hyperkalemia manifestations

A
  • decreased membrane resting potential (muscle weakness, loss of tone, paralysis)
  • rapid repolarization of cardiac (changes in ECG
104
Q

Clinical investigations should include hyperkalemia when there is a history of

A

renal disease, trauma, insulin deficency, addisons disease or metabolic acidosis

105
Q

Treatment of hyperkalemia

A
  • calcium gluconate (restores normal neuromuscular irritability and stabilizes resting potential)
  • glucose administration
  • sodium bicarbonate (metabolic acidosis)
  • dialysis (removes K in renal failure patients)
106
Q

the two major systems that show signs and symptoms for changes in patasium are

A
  • cardiac (dysrhymias, cardiac arrest)
  • neurological (reflexes, level of consciousness)
107
Q

hypercalcemia causes

A
  • hyperparathyroidism
  • cancer
  • metastases to bone
  • overtaking vitamin D
108
Q

hyoercalcemia effects

A
  • fatigue, weakness, lethargy, impaired renal funciton, kidney stones, dysrhymias, cardiac arrest, osteoprosis
109
Q

hypocalcemia causes

A
  • decreased absorption of calcium in GI tract, blood administration, inadequate dietary intake, love vitamin D
110
Q

hypocalcemia effects

A

neuromuscular excitability, hyperactive bowel, onvulsions, prolonged QT interval, cardiac arrest

111
Q

normal calcium levels

A

2.1-2.6 mmol/L

112
Q

normal phosphate levels

A

0.8-1.5 mmol/L

113
Q

normal magnesium levels

A

0.75-0.95mmol/L

114
Q

hyperphosphatemia causes

A
  • chronic renal failure, chemotherapy, long term use of laxitives
115
Q

hyperphosphatemia effects

A
  • symptoms similar to hypocalcemia
  • severe: calcification of soft tissues in the lungs, kidneys, and joints
116
Q

hypophosphetmia causes

A
  • intestine malabsorption releated to vitamin D deficency, use of antacids, alcohol abuse, respitory alkalosis
117
Q

hypophosphatemia effects

A
  • decreased capacity for oxygen transportation
  • irritability, confusion, coma , bone reabsoption (rickets)
118
Q

hypermagnesemia causes

A
  • renal insufficency or failure
119
Q

hypermagnesia effects

A
  • smooth muscle contraction, excess nerve function, decreased tendon reflexes, muscle weakness, hypotension, decreased heart rate, respiratory distress
120
Q

hypomagnesemia causes

A
  • malnutrition, alcoholism, urinary losses (disfunction or diuretics)
121
Q

hypomagnesemia effects

A
  • irritability, muscle cramps, convulsions, increase heart rate, hypotension
122
Q

edema

A
  • excessive accumulation of fluid within the interstitial space
123
Q

alterations in water movement (edema) is caused by what 4 things

A
  • increased capillary hydrostatic pressure
  • decreased plasma oncotic pressure
  • increased capillary membrane permeability
  • lymphatic channel obstruction
124
Q

lymphatic channel obstruction examples

A
  • tumor, trauma, radiation
125
Q

localized edema

A
  • fluid accumulation at a specific area
  • localized to an organ
126
Q

dependent edema

A

due to gravity

127
Q

generalized edema

A

fluid accumulation that affest the whole body

128
Q

lymphedema

A

swelling that generally occurs in one of your arms or legs
- caused by the remocal or damage to your lymph nodes in the limb

129
Q

treatment of edema

A
  • support stockings, elevation, avoid prolonged standing, restrict sodium intake, diuretics,
  • severe: IV administration of Albumin
130
Q

pulmonary edema is caused by

A

heart failure or congestive heart failure

Pathophysiology (9 decks)

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