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Pathophysiology 2 > Fluid Balance > Flashcards

Fluid Balance Flashcards

(98 cards)

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1
Q

Intracellular fluid (ICF)

A

Collective volume of water inside all of the cells. Accounts for 2/3 of total body weight (TBW)

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2
Q

Extracellular fluid (ECF)

A

Fluid in the interstitial space and blood plasma outside of the cells (1/3 TBW)

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3
Q

Functions of the kidney

A
  1. Regulates body fluid volume and osmolality
  2. Regulates electrolytes
  3. Regulates acid-bases
  4. Excretes metabolic products
  5. Secretes hormones, vit D
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4
Q

Plasma (intravascular fluid)

A

Fluid portion of the blood and makes up 1/4 of ECF

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5
Q

Interstitial fluid

A

Fluid in the tissues, closely resembles ion concentration of plasma, but lacks proteins. Eventually returns to the venous system (makes up 3/4 of ECF)

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6
Q

What is a typical daily water output

A

2 to 3 liters through urine, feces and perspiration

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7
Q

What is a typical daily intake of water

A

~2.5L. 300-500 is metabolic water intake. Any water lost due to extreme sweating needs to be replaced on top of 2.5L

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8
Q

What is water balance regulated by

A

Thirst (increase in plasma osmolality) and ADH hormone

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9
Q

What does ADH do

A

stimulates water conservation at the nephron

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10
Q

Where is ADH released from

A

the hypothalamus (pituitary gland). Occurs when plasma osmolality exceeds a set-point or person is thirsty

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11
Q

Third spacing

A

When ECF moves into a space between the skin and fascia (outside the interstitial space) “third space”

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12
Q

What other way is the third space referred to

A

non-functional compartment because the fluid is unavailable for use with the intravascular system

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13
Q

What is an example of third spacing

A

Ascites

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14
Q

Interstitial edema

A

Different from 3rd spacing. Is caused from large volume of fluid in the circulatory system. Is functional because it can be used by circulatory system still

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15
Q

What is an example of interstitial edema

A

lymphedema

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16
Q

Osmosis

A

Net movement of solvent (water) through semipermeable membrane to area of higher solute concentration (NaCl) and lower water concentration

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17
Q

Osmolarity

A

The total amount of solute in a solution (per L)

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18
Q

Tonicity

A

The ability of a solute to cross a membrane. Based on pressure gradiant of two solutions (which way things will flow)

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19
Q

Isotonic

A

A solution that has the same concentration of solutes both inside and outside the cell

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20
Q

Hypertonic

A

Solute concentration is higher outside the cell, water flows out, cell shrinks

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21
Q

Hypotonic

A

Solute concentration is higher inside the cell, water flows in, cells bursts

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22
Q

Which ion is the most abundant EC solute

A

Na+

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23
Q

Which ion has the most effect on ECV

A

Na+, because water follows it and will increase ECV if there is a high Na+ outside the cell

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24
Q

What regulates Na+

A

The kidney, Na+ is reabsorbed along the nephron, depending on EC tonicity

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25
Which ion is found almost exclusively in IC fluid
Potassium
26
What is the role of K+
Helps maintain membrane resting potential, aids in cell membrane excitability. Heart conduction and nerve transmission
27
How is K+ regulated
Excreted mostly at distal tubule of nephron (with Na+). Aldosterone, acidosis/alkalosis,
28
Where is Ca+ predominantly located
IC in bone
29
What is the role of Ca+
Bone formation, membrane excitability, coagulation
30
How is Ca+ regulated
By parathyroid home stimulates calcitonin from bone. Reabsorbed at kidney
31
Where are the Ca+ regulation sites
Kidney, GI, Bone
32
What is the concentration level of H+ like in the body
Very low concentrations
33
High H+ means
Acidic
34
Low H+ means
Alkaline (basic)
35
Where is H+ regulated
By buffer systems in the kidney and lungs
36
How is H+ regulated
IC pH, aldosterone, and K+ concentrations. Also breath it off or it turns into HCO3 in kidney or is excreted
37
How is H+ removed
It is excreted or recycled as HC03
38
What is the function of Cl-
Help keeps things electrically neutral by working with Na
39
Where is Cl- controlled
At the nephron with Na+. If body needs more salt, it will reabsorb the Cl- with Na+. If body has too much, the cl- will be excreted. passive process.
40
Where is Cl- located
EC
41
Phosphate ions are located?
IC - mostly in the bone
42
Functions of phosphate
1. ATP, DNA, RNA | 2. skeletal mineralization
43
Where is phosphate regulated
Mostly absorbed in nephron
44
What other structure help regulate phosphate
1. PTH 2. Calcitriol 3. affected by Acid-base status
45
Where is the majority of HCO3 located
EC
46
What is the main function of HCO3
Buffering system for acids/bases
47
Where is HCO3 regulated
In the lungs and kidneys
48
How is HCO3 regulated
Indirect reabsorption at the kidney, if HCO3 high it is excreted in urine. If HCO3 is low, H+ are retained
49
What is most of the body weight made up of
H20
50
2/3 of osmotic content is located where
ICF (where solutes are, water will be also)
51
1/3 of osmotic content is located where
ECF (where solutes are water will be also)
52
What does water always follow
Na+
53
If you add just salt what happens to the ICF and ECF
expands the ECF, shrinks ICF
54
What do the kidneys do if there is an increase in Na+ in the blood
Kidneys will excrete sodium to avoid cell shrinkage throughout the body
55
What do the kidneys do if there is a decrease in Na+ in the blood
The kidneys will reabsorb Na+ (with cl-) at proximal, loop of henle, and distal tubule.
56
Where is most of the Na+ absorbed in the nephron
At the proximal tubule
57
What to look for in pt with fluid/electrolyte imbalance
1. Nonspecific symptoms 2. Draw labs, blood, urine 3. Good HPI 4. Determine if acute or chronic 5. repeating labs helps determine if treatment is working
58
Hyponatremia
Occurs when Na+ is abnormally low, due to drinking too much water or excess water in system (dilutes the Na+). Cells swell
59
Signs of hyponatremia
Fatigue, impaired concentration, anorexia, seizures, coma, death
60
Labs for hyponatremia
Urine sodium and assess for overall fluid status first
61
Treatment of hyponatremia
Depends of fluid state: 1. If hypervolemic - diuretics/fluid restriction 2. If Hypovolemic - saline 3. Euvolemic - Fluid restriction
62
Hypernatremia
Too much Na+ (concentration), due to not enough water. Cells will shrink and die
63
Signs of hypernatremia
Fatigue, thirst, impaired concentration, anorexia, seizures, coma, death
64
Labs for hypernatremia
Physical, urine/serum osm, urine Na+
65
Treatment of hypernatremia
Give free water, either drink it or give a bag of D5W
66
hypokalemia
Low K+ levels in the blood
67
Signs of hypokalemia
Paresthesias, muscle cramps, cardiac arrhythmias
68
Paresthesia
sensation of tingling, tickling, pricking
69
Labs for hypokalemia
HPI, FeK, chemistries
70
Treatment for hypokalemia
K+ supplementation oral or IV
71
Hyperkalemia
Too much K+ in blood, EMERGENT! Common cause of death in kidney failure pts
72
Signs of hyperkalemia
Paresthesias, muscle weakness, cardiac arrest | EKG: peaked T waves, PR prolonged, QRW widening
73
Labs for hyperkalemia
HPI, chemistries, urine potassium excretion
74
Treatment of hyperkalemia
CaGluconate - cardiac stabilization Insuline/glucose - shifts K+ into cells Bicarb Kayexelate - stool removal
75
Hypocalcemia
Not enough calcium
76
Signs of hypocalcemia
Tetany, muscle spasm, cramps, hypotension, bradycardia
77
Labs for hypocalcemia
complete metabolic panel
78
Treatment of hypocalcemia
Calcium replacement therapy
79
Hypercalcemia
Too much calcium
80
Signs of hypercalcemia
muscle weakness, GI symptom "stones, groans, and physciatric overtones"
81
Labs for hypercalcemia
Basic metabolic panel
82
Treatment for hypercalcemia
1. Increase urinary excretion | 2. If in renal failure, do dialysis
83
Hypophosphatemia
Abnormally low level of phosphate
84
Signs of hypophosphatemia
myalgias, weakness, rhabdomyolysis MS changes (associated with malnutrition)
85
Labs for hypophophatemia
Evaluate phosphate and calcium together, evaluate urine
86
Treatment for hypophosphatemia
Oral or IV replacement therapy
87
Hyperphosphatemia
Increased phosphate levels in blood
88
signs of hyperphosphatemia
Tetany, soft tissue calcifications, secondary hyperPTH
89
Labs for hyperphosphatemia
Measure amount of phosphate in blood
90
Treatment for hyperphosphatemia
Acute - saline infusion | Chronic - low phosphate diet and meds to block absorption in GI tract
91
Hypomagnesemia
Abnormally low levels of magnesium
92
Signs of hypomagnesemia
Neuromuscular weakness, muscle fasciculation, tetany, personality changes
93
Labs for hypomagnesemia
24hr urine test
94
Treatment for hypomagnesemia
Oral or IV replacement
95
Hypermagnesium
Too much magnesium in blood
96
Signs for hypermagnesium
Vague neuro symptoms, myoclonus
97
Labs for hypermagnesium
HPI and full chemistry panel
98
Treatment of hypermagnesium
Oral for moderate, IV for severe

Pathophysiology 2 (8 decks)

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