Fluid and Electrolytes Flashcards
1
Q
Alterations
A
- edema
- isotonic
- hypotonic
- hypertonic
- electrolytes
2
Q
edema
A
excessive accumulation of fluid within the interstitial spaces
3
Q
isotonic
A
- concentration equivalent to 0.9% NaCl
- normal saline solution
4
Q
hypotonic
A
- low solute (concentration >0.9% NaCl ECF)
- cells shrink
5
Q
hypertonic
A
- high solute (concentration <0.9% NaCl ECF)
- cells expand
6
Q
Normal total body water (TBW) volume
A
60%
42L
7
Q
normal Intracellular fluid volume
A
- 2/3
- 28L
8
Q
normal extracellular fluid volume
A
- 1/3
- 14L
9
Q
total body water
A
sum of all fluids
10
Q
what are the 3 components of extracellular fluid
A
- plasma fluid
- interstitial fluid
- transcellular
11
Q
normal plasma fluid volume
A
- 7%
- 3L
12
Q
normal interstitial fluid volume
A
- 28%
- 11L
13
Q
normal extracellular fluid volume
A
- 35%
- 14L
14
Q
intracellular fluid is located
A
within cells
15
Q
extracellular fluid is located
A
outside of cells
16
Q
interstitial fluid is located
A
between the cells in the body
17
Q
transcellular fluid is located
A
synovial, intestinal, intraocular
18
Q
intravascular fluid is located
A
in the blood vessels
19
Q
TBW in infants
A
75%
20
Q
TBW in 1 year olds
A
67%
21
Q
TBW in children
A
65%
22
Q
TBW in elderly
A
55%
23
Q
TBW ______ with age
A
decreases
24
Q
in obese individuals total body water is ______. Why?
A
- less
- adipose tissue is hydrophobic
25
obese individuals are more likely to be
dehydrated
26
the ECF has a higher concentration of _______ and _____ and a smaller amount of ______
1. sodium
2. chloride
3. potassium
27
the ICF has a higher concentration of ______ and a smaller concentration of ________ and _________
1. potassium
2. chloride
3. sodium
28
Hydrostatic pressure
- pressure exerted by a fluid in a confined space
- pressure exerted existing within a liquid at rest with respect to its surroundings
29
the more volume in the vessel; the _____ hydrostatic pressure
more
30
Oncotic pressure
- pressure excreted by proteins either in the blood plasma or interstitial fluid
- pulling force
- looks at colloids
31
what is the main protein
albumin
32
and increase in albunin in the blood will increase the _________________
oncotic pressure
33
osmotic pressure
- pressure needed to stop movement of water across a semi permeable membrane
34
capillary oncotic pressure pulls fluid into
the capillary
35
interstitial oncotic pressure pulls fluid into the
interstitial space
36
starling force
- net forces of the 4 forces acting together
37
starling forces =
net filtration
38
capillary hydrostatic pressure (blood pressure)
- facilitates the outward movement of water from capillary to interstitial space
39
capillary oncotic pressure (plasma)
- osmotically attracts water from the interstitial space back to the capillary
40
Interstitial hydrostatic pressure
- facilitates the inward movement of water from the interstitial space into the capillary
41
interstitial oncotic pressure
- osmotically attracts water from the capillary into the interstitial space
42
where _______ flows, ______ follows
sodium
water
43
At the arterial end ________ pressure is higher than _______ pressure so water flows out of the capillary
capillary hydrostatic pressure
capillary oncotic pressure
44
at the venous end _______ pressure is lower than ______ pressure, causing cluid to move back into the capillary
capillary hydrostatic pressure
capillary oncotic pressure
45
edema can cen be caused by
- increased capillary hydrostatic pressure
- decreased plasma ontonic pressure
46
Sodium
- 90% of the ECF
- regulates extracellular osmotic forces; therefore regulates water balance
47
Kidneys
- maintain the concentration through renal tubular reabsorption to maintain sodium 136-145mmol/L
48
what is normal sodium range
136-145mmol/L
49
what controls sodium balance
aldosterone
RAAS system
50
aldosterone function
- stimualtes water/NaCl reabsorption in response to a decrease in blood pressure/fluid volume
51
natriuretic peptide are made in the
heart
52
naturiueric peptides
- released when their is an increase in volume
- cause diuresis
- causes kidneys to excrete sodium (and water)
53
isotonic alteration
- hypovolemia
- hypervolemia
54
hypovolemia causes
hemmorage, severe wound drainage, diaphoresis, inadequate fluid intake
55
Hypovolemia signs
flat neck veins, weight loss, dry skin and mucosal membranes, normal or low BP
56
hypovolemia treatment
Isotonic IV solution
- 0.9% NS or D55, lactated ringers
57
hypervolemia casues
- isotonic fluid excess (excess IV's), hypersecretion of aldosterone
58
hypervolemia signs
- increased neck veins, edema, increased BP
59
hypervolemia treatment
diuretics
60
what is the major system that shows signs and symptoms of sodium imbalance
neuromuscular
61
how does sodium imbalance effect the neuromuscular system
- level of consciousness
- muscle cramps
- weakness
62
Chloride
- major anion in the ECF
-follows sodium
63
chloride transport is
passive
64
chloride is ________ proportional to
HCO3-
65
water balance is regulated by the secretion of
ADH
66
what triggers the release of ADH from the posterior pituitary gland
- increased plasma osmolarity
- decreased circulating blood volume
67
increased plasma osmolarity occurs when
water deficit or sodium excess in relation to TBW
68
decreased circulating blood volume can be caused by
vomitiing, diarrhea, or excessive sweating
69
hypernatremia
- occurs when serum Na level is over 145mmol/L
70
Isovolemic hypernatremia
- loss of free water with normal sodium level
- concentration of sodium is increased
71
Isovolemic hypernatremia can be caused by
dehydration, excessive diaphoresis, fever, burns, diarrhea, diabetes insipidus
72
dehydration results from
a loss f water and sodium
73
Hypovolemic hypernatremia
- loss of sodium is greater than the loss of water
74
Hypovolemic hypernatremia is caused by
loop diuretics
- failure of the kidneys to concentrate urine
75
hypervolemic hypernatremia
- increased TBW and greater increase of sodium
76
hypervolemic hypernatremia can be caused by
- infusion of hypertonic saline
- over secretion of ACTH or aldosterone
77
symptoms of hypernatremia
- thirst, weight gain, bounding pulse, increased BP
- CNS: muscle twitching, hyper-reflexes, confusiom, coma, convulsion
78
hypernatremia treatment
- salt free solutions D5W (must be given slowly to prevent edema)
79
hyponatremia
- serum sodium is less than 135mmol/L
80
hyponatremia is casued by
sodium deficit or water excess
81
isovolemic hyponatremia
- loss of sodium
82
isovolemic hyponatremia cause
- SIADH (syndrome of inappropriate antidiuretic hormone) --> most common cause
- inadequate sodium intake
83
SIADH casues
increased water retention, hypothyroidism, pneumonia
84
hypervolemic hyponatremia
- sodium levels rises, leads to an increase in water and TBW
- dilution of sodium in the ECF
85
hypervolemic hyponatremia causes
heart failure, cirrhosis of the liver, edema
86
hypovolemic hyponatremia
- loss of TBW
- greater loss of sodium
87
hypovolemic hyponatremia causes
prolonged vomiting and diarrhea, inadequate aldosterone, diuretics
88
Dilutional hyponatremia is also known as
water intoxication
89
Dilutional hyponatremia occurs when
there is an intake of large amounts of free water or replacement of fluid loss with IV (D5W); creating a hypotonic solution
90
Dilutional hyponatremia can occur in
marathon runners
- excessive sweating, large intake of water for thirst; dilutes sodium
91
Dilutional hyponatremia is manifested as
- cells swelling (cerebral edema or increased ICP)
- muscle twitching, decreased reflexes, weakness
92
hyponatremia treatment
Hypertonic IV solution (3% or 5% saline)
93
what is the major intracellular electrolyte
potassium
94
hypokalemia
- serum potassium below 3.5mmol/L
95
hyperkalemia
- serum K higher than 5.0mmol/L
96
causes of hyperkalemia
- increased intake of potassium
- shift of potassium from cells to the ECF
- decreased renal excretion
- meds that decrease K excretion
97
hypokalemia
serum potassium falls less than 3.5mmol/L
98
factors contributing to hypokalemia
- poor diet in elderly, alcoholism, anorexia
99
diabetic ketoacidosis treatment
- treated with fluids and insulin
*** insulin cannot be administered without providing a K supplement
100
diabetic ketoacidosis
low blood glucose
- no promotion of cellular entery of K
- hyperkalemia occurs
101
acidosis
ECF and ICF exchange hydrogen ions and K and NA occurs simultaneously
102
mild hyperkalemia manifestations
- neuromuscular irritability: restlessness, intestinal cramping, diarrhea
103
severe hyperkalemia manifestations
- decreased membrane resting potential (muscle weakness, loss of tone, paralysis)
- rapid repolarization of cardiac (changes in ECG
104
Clinical investigations should include hyperkalemia when there is a history of
renal disease, trauma, insulin deficency, addisons disease or metabolic acidosis
105
Treatment of hyperkalemia
- calcium gluconate (restores normal neuromuscular irritability and stabilizes resting potential)
- glucose administration
- sodium bicarbonate (metabolic acidosis)
- dialysis (removes K in renal failure patients)
106
the two major systems that show signs and symptoms for changes in patasium are
- cardiac (dysrhymias, cardiac arrest)
- neurological (reflexes, level of consciousness)
107
hypercalcemia causes
- hyperparathyroidism
- cancer
- metastases to bone
- overtaking vitamin D
108
hyoercalcemia effects
- fatigue, weakness, lethargy, impaired renal funciton, kidney stones, dysrhymias, cardiac arrest, osteoprosis
109
hypocalcemia causes
- decreased absorption of calcium in GI tract, blood administration, inadequate dietary intake, love vitamin D
110
hypocalcemia effects
neuromuscular excitability, hyperactive bowel, onvulsions, prolonged QT interval, cardiac arrest
111
normal calcium levels
2.1-2.6 mmol/L
112
normal phosphate levels
0.8-1.5 mmol/L
113
normal magnesium levels
0.75-0.95mmol/L
114
hyperphosphatemia causes
- chronic renal failure, chemotherapy, long term use of laxitives
115
hyperphosphatemia effects
- symptoms similar to hypocalcemia
- severe: calcification of soft tissues in the lungs, kidneys, and joints
116
hypophosphetmia causes
- intestine malabsorption releated to vitamin D deficency, use of antacids, alcohol abuse, respitory alkalosis
117
hypophosphatemia effects
- decreased capacity for oxygen transportation
- irritability, confusion, coma , bone reabsoption (rickets)
118
hypermagnesemia causes
- renal insufficency or failure
119
hypermagnesia effects
- smooth muscle contraction, excess nerve function, decreased tendon reflexes, muscle weakness, hypotension, decreased heart rate, respiratory distress
120
hypomagnesemia causes
- malnutrition, alcoholism, urinary losses (disfunction or diuretics)
121
hypomagnesemia effects
- irritability, muscle cramps, convulsions, increase heart rate, hypotension
122
edema
- excessive accumulation of fluid within the interstitial space
123
alterations in water movement (edema) is caused by what 4 things
- increased capillary hydrostatic pressure
- decreased plasma oncotic pressure
- increased capillary membrane permeability
- lymphatic channel obstruction
124
lymphatic channel obstruction examples
- tumor, trauma, radiation
125
localized edema
- fluid accumulation at a specific area
- localized to an organ
126
dependent edema
due to gravity
127
generalized edema
fluid accumulation that affest the whole body
128
lymphedema
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
treatment of edema
- support stockings, elevation, avoid prolonged standing, restrict sodium intake, diuretics,
- severe: IV administration of Albumin
130
pulmonary edema is caused by
heart failure or congestive heart failure
