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MD2 Foundation > Fluid Assessment and Balance > Flashcards

Fluid Assessment and Balance Flashcards

1
Q

What are the relative ion concentrations in intracellular fluid?

A

Rich in K

Low in Na

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2
Q

What determines the water content in a body compartment?

A

Electrolyte content

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3
Q

How is water and ions transported in the extracellular compartment?

A

Free movement of water

Active transport of Na and K

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4
Q

What are the relative ion concentrations in extracellular fluid?

A

Rich in Na

Low in K

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5
Q

What percentage of body weight is total body water?

A

60%

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6
Q

What are the factors that control sodium intake?

A

Largely voluntary

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7
Q

What are the factors that control sodium excretion?

A

Kidney

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8
Q

What is the relationship between sodium content and volume?

A

Low Na content = low volume

High Na content = high volume

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9
Q

What is the effect of water and sodium intake on intracellular volume?

A

Decreasing water and Na intake will eventually decrease intracellular volume
Increasing water intake doesn’t often affect intracellular volume, because excess water excreted

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10
Q

How is intracellular volume assessed?

A

Difficult to asses

Practically, assess osmolarity/as substitute, plasma Na

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11
Q

What is the relationship between plasma sodium and osmolarity?

A

Plasma Na increased = osmolarity increased

Plasma Na decreased = osmolarity decreased

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12
Q

Does osmolarity change between the extracellular and intracellular compartments?

A

No, it’s the same

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13
Q

How is saline solution distributed across the extracellular and intracellular compartments?

A

Because Na in extracellular compartment, water remains there, so extracellular volume increases, with no change in intracellular volume

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14
Q

What are the signs of increased extracellular volume?

A

Oedema
Possible raised JVP
Pulmonary oedema if CVD
Plasma Na and osmolarity unchanged

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15
Q

How is pure water distributed across the extracellular and intracellular compartments?

A

Distributes itself evenly across extracellular and intracellular compartments to maintain osmolarity

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16
Q

How do you detect the change in extracellular volume after giving just water?

A

Hard to detect change because of natural variation

17
Q

How do you detect the change in intracellular volume after giving just water?

A

Plasma Na and osmolarity decrease

18
Q

What happens when sodium rich fluid is lost from total body water?

A

Extracellular volume decreases because of loss of Na
Plasma Na concentration remains normal
No change in intracellular volume

19
Q

What are the signs of loss of extracellular volume?

A 
Low BP
Tachycardia
Low JVP
Peripheral vasoconstriction
Low urine Na, but concentrated urine
Decreased tissue turgor not particularly sensitive, especially in adults over 40-50
20
Q

What happens when just water is lost from total body water?

A

Loss of proportional water from both compartments

21
Q

What are the signs of just water loss from total body water?

A 
Extracellular compartment
- Hard to detect on examination of CVS unless CVS disease
Intracellular compartment
- Dry tongue
- Axilla
- Low tissue turgor in young
Plasma Na/osmolarity increased
Concentrated urine
22
Q

How do you adjust the volume in the extracellular compartment?

A

Modify Na and water intake/concentration

23
Q

How do you adjust the volume in the intracellular compartment?

A

Modify water intake

24
Q

What causes a high plasma osmolarity/sodium?

A

Water intake below

  • Obligatory water loss
  • Access to water
  • Increased loss
25
Q

What causes a low plasma osmolarity/sodium?

A

Water intake greater than ability to excrete

  • Increased ADH
  • Decreased distal tubule flow
  • Other tubular factors limiting free water excretion
  • Drugs, with variable contributions from above factors
    • Diuretics
    • Carbamazepine
    • Antidepressants
26
Q

What is the relationship between changes in extracellular volume and blood volume?

A

Correlate unless there’s hypoalbuminaemia/leaky capillaries

27
Q

Why do changes in extracellular fluid status occur without a change in plasma sodium concentration?

A

Osmotic control frequently overrides volume control

28
Q

What can an abnormal plasma potassium indicate?

A

Shift between intra- and extracellular space
Deficiency
Excess

29
Q

What things shift potassium into cells?

A

Insulin
Beta agonists
Aldosterone
Alkalosis

30
Q

What things shift potassium out of cells?

A 
Lack of
- Insulin
- Beta agonists
- Aldosterone
Acidosis
31
Q

What is the normal plasma potassium concentration?

A

3.5-5 mmol/L

32
Q

When are you concerned about plasma potassium concentration?

A

Less than 3.5 mmol/L

More than 5.5 mmol/L

MD2 Foundation (42 decks)

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