- First Spacing: fluid is normal (everything is where it's supposed to be) - Second spacing: increased fluid in interstitial spaces - Third spacing: fluid in areas that normally has little to no fluid in it (ex, ascites aka fluid in the abdomen, fluid in the lungs)

- Hormone that helps regulate homeostasis of fluid balance - Plasma osmolality increases, then ADH released, causing kidneys to reabsorb water, leading to plasma volume increasing and plasma osmolality decreasing - ADH inhibited by normal osmolality

- Hormone that helps regulate homeostasis of fluid balance - Important in the regulation of BP. - Made and secreted by the kidneys - Released into the bloodstream in response to decreased renal perfusion, decreased BP, decreased eCF, decreased serum Na+ concentration, and increased urinary Na+ concentration. - Elevated BP inhibits renin release

- Hormone that helps regulate homeostasis of fluid balance - maintains ECF volume by promoting renal reabsorption of Na+ and excreting of K+ and hydrogen ions. - stimulated by hyponatremia, hyperkalemia, and angiostensin II - inhibited by ANP and hypokalemia

- type of FVD - deficit of water in the ECF

Fluid and Electrolytes (A&P Review) Flashcards by Kaitlin Hobbs

What are electrolytes?

Molecules that split into ion when in water.

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What are the electrolytes that are cations (positively charged)?

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What are the electrolytes that are anions (negatively charged?)

HCO3 (bicarbonate)
CL (chloride)
PO4 (phosphate/phosphorus)

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What electrolytes are most present in ICF?

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What electrolytes are most prevalent in ECF?

- Cl

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Fluid Spacing

First Spacing: fluid is normal (everything is where it’s supposed to be)
Second spacing: increased fluid in interstitial spaces
Third spacing: fluid in areas that normally has little to no fluid in it (ex, ascites aka fluid in the abdomen, fluid in the lungs)

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Unit of Electrolytes

mEq = milliequivalents

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How is fluid intake regulated?

Thirst
Plasma osmolality
Decrease in blood volume

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How does fluid output occur?

Through skin, kidneys, lungs, and GI tract
- Fluid loss through skin and lungs is called insensible loss as you can’t measure how much water comes out of your skin and lungs like you can from your kidneys and GI tract

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ADH

Hormone that helps regulate homeostasis of fluid balance
Plasma osmolality increases, then ADH released, causing kidneys to reabsorb water, leading to plasma volume increasing and plasma osmolality decreasing
ADH inhibited by normal osmolality

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Renin

Hormone that helps regulate homeostasis of fluid balance
Important in the regulation of BP.
Made and secreted by the kidneys
Released into the bloodstream in response to decreased renal perfusion, decreased BP, decreased eCF, decreased serum Na+ concentration, and increased urinary Na+ concentration.
Elevated BP inhibits renin release

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Aldosterone

Hormone that helps regulate homeostasis of fluid balance
maintains ECF volume by promoting renal reabsorption of Na+ and excreting of K+ and hydrogen ions.
stimulated by hyponatremia, hyperkalemia, and angiostensin II
inhibited by ANP and hypokalemia

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Dehydration

type of FVD

- deficit of water in the ECF

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Isotonic Dehydration/ Hypovolemia

type of FVD
caused by decrease in plasma volume while the serum osmolality of the blood remains unchanged
most common type of FVD (80% of FVD cases)

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Hypertonic Dehydration

type of FVD
caused primarily by loss of water
water loss exceeds sodium loss making blood hypertonic to normal body fluids

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Hypotonic Dehydration

type of FVD
caused by loss of water and sodium
more sodium than water is lost, making blood hypotonic to normal body fluids

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Causes of Isotonic Dehydration

Hemorrhage
Diarrhea
Emesis
Suctioning
Profuse Sweating
Drainage
Diuretic Therapy
Severe Burns
CO poisoning

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Causes of Hypotonic Dehydration

Inadequate Na intake during rehydration
Salt-wasting renal conditions (ex. CKD - chronic kidney disease)
Adrenal insufficiency, adrenal failure, adrenalectomy
long term use of thiazide diuretic

Causes of Hypertonic Dehydration

Inadequate water intake by those who can’t get water for themselves (infants, elderly, disabled, immobile, those who can’t eat or swallow, those on prolonged NPO).
Severe isotonic fluid loss
increased solute intake without proportional water intake (ex. salt tablets, high sodium beverages, infant formula that hasn’t been properly diluted)
hyperglycemia and DKA
Diabetes insipidus

S/Sx of FVD

Vital Signs: Hypotension/orthostatic hypotension, tachycardia, thready pulse, tachypnea, temperature WNL or elevated, sudden weight loss (best indicator of fluid volume status)

CV: Weak, rapid pulse, heart palpations, dim peripheral veins

GI: Dry mouth, N/V

Integumentary: poor skin turgor, pale, cool, dry skin, sunken eyeballs, dry mucous membranes

MS: Muscle weakness, fatigue

Neuro: Thirst, lightheaded, confusion, altered mental status, decreased LOC

Renal: amber or dark colored urine, decreased urine output

Respiratory: increased respiratory rate

Overhydration

type of FVE

- excess water in the ECF

Isotonic Overhydration/Hypervolemia

type of FVE

- Plasma volume increases while plasma composition remains unchanged

Hypertonic Overhydration

type of FVE
Na+ and fluid excess caused by excessive sodium intake
sodium intake exceeds water intake, making blood hypertonic to normal body fluids

Hypotonic Overhydration

type of FVE
aka water intoxication
fluid excess caused by the overconsumption or excessive IV admin of salt-free solutions
water intake exceeds sodium intake, making the blood hypotonic to normal body fluids

Edema

- type of FVE - swell of soft tissues as a result of excess fluid accumulation - classified in extremities as either pitting or nonpitting

Causes of Isotonic Overhydration/Hypervolemia

- excessive administration of isotonic IV fluids - abnormal retention of water and sodium due to heart or renal failure or liver cirrhosis - long term corticosteroid therapy (prednisone)

Causes of Hypotonic Overhydration/Water Intoxication

- excessive intake of salt-free solutions, such as water - in infants, ingestion of diluted formula or excess water - irrigation of wounds and body cavities with hypotonic fluids (ex. enemas) - liver failure - syndrome of inappropriate antidiuretic hormone (SIADH) secretion

Causes of Hypertonic Overhydration

- excessive ingestion of NaCl - excessive admin of hypertonic IV solutions - primary hyperaldosteronism - cushing's syndrome

S/Sx of FVE

Vital Signs: Hypertension, tachycardia, tachypnea, temperature WNL, sudden weight gain (1kg gained = 1 L retained) CV: Bounding pulse, JVD, peripheral vein distension, S3 heart sound GI: Ascites, hepatomegaly, splenomegaly Integumentary: pale, cool, taut skin, edema MS: Muscle spasms Neuro: Headache, confusion, lethargy, seizure, coma (secondary to cerebral edema) Renal: polyuria, oliguria, anuria Respiratory: pulmonary edema, dyspnea, crackles, paroxysmal nocturnal dyspnea, cough

Anasarca

severe generalized edema

Ascities

accumulation of fluid in the peritoneal cavity

Cerebral Edema

accumulation of excess fluid in the brain

Generalized Edema

swelling throughout the body, involving multiple organs and extremities

Lymphedema

swelling caused by blockages of the lymph vessels that drain fluid from issues throughout the body

Periorbital Edema

edema around the eye

Peripheral Edema

swelling of the extremities, usually the legs

Pleural Effusion

Accumulation of fluid in the pleural cavity

Pulmonary Edema

Accumulation of fluid in the lungs

Albumin

Normal range = 3.5-5.0 g/dL - protein that is a contributor to osmotic pressure - plasma has large amounts of protein while interstitial space has very little - plasma protein molecules attract water, pulling fluid from tissue space to the vascular space

Prealbumin

Normal range = 15-36 mg/dL - protein made by liver - indicator of inflammatory state or malnutrition

BUN (blood urea nitrogen)

Normal range = 10-20 mg/dL - pt with FVD often has increase BUN with increased plasma and urine osmolality - pt with FVE often has decreased BUN with decreased plasma and urine osmolality

Creatinine

Normal range = Male: 0.6-1.2 mg/dL, Female = 0.5-1.1 mg/dL - indicator of kidney health, kidneys filter fluids

BNP (b-type natriuretic peptide)

Normal range = <100 pg/ML - hormones made by cardiomyocytes in response to increased atrial pressure (increase volume) and high serum sodium levels. - suppress secretion of aldosterone, renin, and ADH - promote excretion of Na+ and water, decreasing blood volume and BP

Urine Specific Gravity

Normal range = 1.010-1.025 - high readings indicate concentrated urine - low readings indicate dilute urine