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Pathophysiology 2 > Fluid Balance > Flashcards

Fluid Balance Flashcards

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
Q

Which ion is found almost exclusively in IC fluid

A

Potassium

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26
Q

What is the role of K+

A

Helps maintain membrane resting potential, aids in cell membrane excitability. Heart conduction and nerve transmission

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27
Q

How is K+ regulated

A

Excreted mostly at distal tubule of nephron (with Na+). Aldosterone, acidosis/alkalosis,

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28
Q

Where is Ca+ predominantly located

A

IC in bone

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29
Q

What is the role of Ca+

A

Bone formation, membrane excitability, coagulation

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30
Q

How is Ca+ regulated

A

By parathyroid home stimulates calcitonin from bone. Reabsorbed at kidney

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31
Q

Where are the Ca+ regulation sites

A

Kidney, GI, Bone

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32
Q

What is the concentration level of H+ like in the body

A

Very low concentrations

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33
Q

High H+ means

A

Acidic

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34
Q

Low H+ means

A

Alkaline (basic)

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35
Q

Where is H+ regulated

A

By buffer systems in the kidney and lungs

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36
Q

How is H+ regulated

A

IC pH, aldosterone, and K+ concentrations. Also breath it off or it turns into HCO3 in kidney or is excreted

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37
Q

How is H+ removed

A

It is excreted or recycled as HC03

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38
Q

What is the function of Cl-

A

Help keeps things electrically neutral by working with Na

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39
Q

Where is Cl- controlled

A

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.

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40
Q

Where is Cl- located

41
Q

Phosphate ions are located?

A

IC - mostly in the bone

42
Q

Functions of phosphate

A
  1. ATP, DNA, RNA

2. skeletal mineralization

43
Q

Where is phosphate regulated

A

Mostly absorbed in nephron

44
Q

What other structure help regulate phosphate

A
  1. PTH
  2. Calcitriol
  3. affected by Acid-base status
45
Q

Where is the majority of HCO3 located

46
Q

What is the main function of HCO3

A

Buffering system for acids/bases

47
Q

Where is HCO3 regulated

A

In the lungs and kidneys

48
Q

How is HCO3 regulated

A

Indirect reabsorption at the kidney, if HCO3 high it is excreted in urine. If HCO3 is low, H+ are retained

49
Q

What is most of the body weight made up of

50
Q

2/3 of osmotic content is located where

A

ICF (where solutes are, water will be also)

51
Q

1/3 of osmotic content is located where

A

ECF (where solutes are water will be also)

52
Q

What does water always follow

53
Q

If you add just salt what happens to the ICF and ECF

A

expands the ECF, shrinks ICF

54
Q

What do the kidneys do if there is an increase in Na+ in the blood

A

Kidneys will excrete sodium to avoid cell shrinkage throughout the body

55
Q

What do the kidneys do if there is a decrease in Na+ in the blood

A

The kidneys will reabsorb Na+ (with cl-) at proximal, loop of henle, and distal tubule.

56
Q

Where is most of the Na+ absorbed in the nephron

A

At the proximal tubule

57
Q

What to look for in pt with fluid/electrolyte imbalance

A
  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
Q

Hyponatremia

A

Occurs when Na+ is abnormally low, due to drinking too much water or excess water in system (dilutes the Na+). Cells swell

59
Q

Signs of hyponatremia

A

Fatigue, impaired concentration, anorexia, seizures, coma, death

60
Q

Labs for hyponatremia

A

Urine sodium and assess for overall fluid status first

61
Q

Treatment of hyponatremia

A

Depends of fluid state:

  1. If hypervolemic - diuretics/fluid restriction
  2. If Hypovolemic - saline
  3. Euvolemic - Fluid restriction
62
Q

Hypernatremia

A

Too much Na+ (concentration), due to not enough water. Cells will shrink and die

63
Q

Signs of hypernatremia

A

Fatigue, thirst, impaired concentration, anorexia, seizures, coma, death

64
Q

Labs for hypernatremia

A

Physical, urine/serum osm, urine Na+

65
Q

Treatment of hypernatremia

A

Give free water, either drink it or give a bag of D5W

66
Q

hypokalemia

A

Low K+ levels in the blood

67
Q

Signs of hypokalemia

A

Paresthesias, muscle cramps, cardiac arrhythmias

68
Q

Paresthesia

A

sensation of tingling, tickling, pricking

69
Q

Labs for hypokalemia

A

HPI, FeK, chemistries

70
Q

Treatment for hypokalemia

A

K+ supplementation oral or IV

71
Q

Hyperkalemia

A

Too much K+ in blood, EMERGENT! Common cause of death in kidney failure pts

72
Q

Signs of hyperkalemia

A

Paresthesias, muscle weakness, cardiac arrest

EKG: peaked T waves, PR prolonged, QRW widening

73
Q

Labs for hyperkalemia

A

HPI, chemistries, urine potassium excretion

74
Q

Treatment of hyperkalemia

A

CaGluconate - cardiac stabilization
Insuline/glucose - shifts K+ into cells
Bicarb
Kayexelate - stool removal

75
Q

Hypocalcemia

A

Not enough calcium

76
Q

Signs of hypocalcemia

A

Tetany, muscle spasm, cramps, hypotension, bradycardia

77
Q

Labs for hypocalcemia

A

complete metabolic panel

78
Q

Treatment of hypocalcemia

A

Calcium replacement therapy

79
Q

Hypercalcemia

A

Too much calcium

80
Q

Signs of hypercalcemia

A

muscle weakness, GI symptom “stones, groans, and physciatric overtones”

81
Q

Labs for hypercalcemia

A

Basic metabolic panel

82
Q

Treatment for hypercalcemia

A
  1. Increase urinary excretion

2. If in renal failure, do dialysis

83
Q

Hypophosphatemia

A

Abnormally low level of phosphate

84
Q

Signs of hypophosphatemia

A

myalgias, weakness, rhabdomyolysis MS changes (associated with malnutrition)

85
Q

Labs for hypophophatemia

A

Evaluate phosphate and calcium together, evaluate urine

86
Q

Treatment for hypophosphatemia

A

Oral or IV replacement therapy

87
Q

Hyperphosphatemia

A

Increased phosphate levels in blood

88
Q

signs of hyperphosphatemia

A

Tetany, soft tissue calcifications, secondary hyperPTH

89
Q

Labs for hyperphosphatemia

A

Measure amount of phosphate in blood

90
Q

Treatment for hyperphosphatemia

A

Acute - saline infusion

Chronic - low phosphate diet and meds to block absorption in GI tract

91
Q

Hypomagnesemia

A

Abnormally low levels of magnesium

92
Q

Signs of hypomagnesemia

A

Neuromuscular weakness, muscle fasciculation, tetany, personality changes

93
Q

Labs for hypomagnesemia

A

24hr urine test

94
Q

Treatment for hypomagnesemia

A

Oral or IV replacement

95
Q

Hypermagnesium

A

Too much magnesium in blood

96
Q

Signs for hypermagnesium

A

Vague neuro symptoms, myoclonus

97
Q

Labs for hypermagnesium

A

HPI and full chemistry panel

98
Q

Treatment of hypermagnesium

A

Oral for moderate, IV for severe

Pathophysiology 2 (8 decks)

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