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semester 2 2019 > fluid balance and electrolytes > Flashcards

fluid balance and electrolytes Flashcards

1
Q

what percentage of the body weight of an adult is made up of water?

A

50-70%

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2
Q

what are the major fluid compartments of the body, and what percentage of fluid do they contain?

A

intracellular fluid (ICF) - two thirds

extracellular fluid (ECF) - one third

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3
Q

how is the ECF further compartmentalised?

what percentage of the ECF does each comprise?

A 
interstitial fluid - 80% of ESF
intravascular fluid (plasma)- 20% of ESF
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4
Q

what is the ICF mostly comprised of?

A 
cytoplasm
water
electrolytes (mostly K+ and Mg+)
proteins
waste products
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5
Q

what is interstitial fluid mostly comprised of?

A 
water
electrolytes (mostly Na+, Cl- and HCO3-)
amino acids 
hormones
neurotransmitters
lymph
waste products
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6
Q

what is interstitial fluid?

A

fluid which bathes or surrounds the cells

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7
Q

what is intravascular fluid mostly comprised of?

A 
water
electrolytes/ions
proteins
whole blood (Plasma, RBCs, WBCs)
glucose
clotting factors
hormones
CO2/O2
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8
Q

normal serum levels for sodium?

A

135-145 mEq/L

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9
Q

normal serum levels for potassium?

A

3.5-5 mEq/L

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10
Q

normal serum levels for magnesium?

A

1.5-2 mEq/L

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11
Q

normal serum levels for chloride?

A

98-110 mEq/L

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12
Q

normal serum levels for bicarbonate?

A

22-28 mEq/L

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13
Q

normal serum levels for calcium?

A

2-2.5 mmol/L

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14
Q

what is hydrostatic pressure?

A

the pressure exerted by fluids, such as blood and tissue fluid, against the walls of the capillaries/blood vessels

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15
Q

what is oncotic pressure?

A

the pressure exerted by proteins (mostly albumin) to pull fluid back into the vessels

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16
Q

what is the source of hydrostatic pressure?

A

the pumping action of the heart

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17
Q

what is another name for osmotic pressure?

A

colloid osmotic pressure

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18
Q

what else apart from hydrostatic pressure and oncotic pressure will affect fluid movement between compartments?

A

osmotic gradient

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19
Q

what provides an osmotic gradient, which drives the shift of water between compartments?

A

solutes – electrolytes (charged particles) and other molecules (proteins, glucose, lipids)

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20
Q

why does the osmotic gradient affect fluid movement between compartments?

A

water is the only substance which can easily cross the blood vessel endothelial wall (semi-permeable membrane) so osmosis will shift fluids acording to solute concentration

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21
Q

what is osmolarity?

what is it measured in?

A

the measure of solute concentration within a solution

mOsm/L

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22
Q

what does increased serum osmolarity mean?

A

an increase in concentrations in solutes in the blood - this means the patient is dehydrated and may need fluid replacement

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23
Q

what is tonicity?

A

the relative concentration of solutes in two fluids, aka the ability of an extracellular solution to make water move into or out of a cell by osmosis

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24
Q

what is an isotonic solution?

A

ICF and ECF have same number of ions - no net movement into or out of cells (normal saline 0.9%NaCl)

25
Q

what is a hypertonic solution?

A

more ions in the ECF - water is drawn out of cells, cells lyse (10% dextrose)

26
Q

what is a hypotonic solution?

A

ECF has fewer ions, so water is drawn into cells and they swell and burst (0.25% NaCl)

27
Q

when might you use a hypertonic solution?

A

in the case of cerebral oedema, it can reduce swelling in the brain by drawing water out of brain cells (you might use mannitol)

28
Q

what is osmolarity in the body fluid compartments?

A

osmolarity in the body fluid compartments is 300 mOsm/L

29
Q

examples of an isotonic solution?

A

0.9% sodium chloride

Hartmann’s

5% dextrose in water

30
Q

what are hypotonic solutions used for in IVT?

A

in the management of hyperosmolar diabetes and metabolic alkalosis

31
Q

example of a hypotonic solution?

A
  1. 45% sodium chloride (or .33% or .2%)

2. 5% dextrose in water

32
Q

examples of a hypertonic solution?

A

10% dextrose in water
20% dextrose in water
50% dextrose in water (mannitol)

33
Q

when are hypertonic solutions used in IVT?

A

usually only when glucose needs to be replaced, rather than to influence fluid volume

but can be used to promote diuresis, or to manage cerebral oedema

34
Q

what is the difference between pitting oedema and non-pitting oedema?

A

in pitting oedema, lymphatic system is overwhelmed and can’t drain fluid adequately

in non-pitting, lymphatic system is blocked and cannot drain fluid at all

OR the oedema is not due to fluid only, but rather tissue deposits. Pressing on this “oedema” will not disperse this tissue elsewhere → “non-pitting”

35
Q

underlyling causes of non-pitting oedema?

A

lymphoedema (lymphatic drainage blocked)

Grave’s disease (underlying tissue deposits)

36
Q

common causes of pitting oedema?

A

diseases that cause fluid and sodium retention

protein deficiency

venous congestion

increased capillary permeability

37
Q

clinical manifestations of pulmonary oedema?

A

dyspnoea, chest pain

cyanosis, hypoxaemia

frothy, pink cough

restlessness and anxiety

38
Q

common causes of hypernatraemia?

A

dehydration

hormonal imbalances of ADH and aldosterone

39
Q

clinical manifestations of hypernatraemia?

A 
thirst
nausea
weakness
muscle twitch 
seizures
confusion
coma
40
Q

electrolytes: role of sodium?

A

nerve transmission
muscle contraction
maintains normal concentration of ECF
regulates BP and BV

41
Q

common causes of hyponatraemia?

A

excess water accumulation in the body → dilutes Na+

loss of Na+ due to vomiting, diarrhoea, sweating, diuretics, excessive urine output

42
Q

clinical manifestations of hyponatraemia?

A

N+V

headache, confusion, lethargy

irritability, muscle weakness, cramps

seizures and coma

43
Q

electrolytes: role of potassium?

A

nerve transmission, muscle contraction, normal heart rhythms, concentration of ICF

44
Q

common causes of hyperkalaemia

A

increased dietary intake of potassium

45
Q

common causes of hypokalaemia?

A

starvation leading to reduced intake

vomiting/diarhoea

redistribution of K+ in insulin-dependant diabetic patients

46
Q

clinical manifestations of hypokalaemia?

A

arrhythmias

cramps, muscle weakness

47
Q

clinical manifestations of hyperkalaemia?

A

arrhythmias, cardiac arrest, death

confusion, numbness

48
Q

electrolytes: role of calcium?

A 
nerve transmission
muscle contraction
strong bones and teeth
blood clotting
enzyme reactions
49
Q

electrolytes: role of magnesium?

A

enzyme reactions; cardiac and respiratory function

50
Q

electrolytes: role of chloride?

A

acid/base balance, nerve transmission

51
Q

how much plasma volume does a textbook male have?

A

3 litres

52
Q

what is an appropriate level of fluid for most patients to meet fluid maintenance requirements?

A

about 30ml/kg/day (1 - 1.5 ml per kg per hour)

53
Q

what is ascites?

A

fluid collecting in the abdomen

54
Q

main ions inside cells?

A

potassium, magnesium, proteins

55
Q

main ions outside cells?

A

sodium, chloride, bicarbonate

56
Q

how is the water/sodium regulated in the body?

A

not enough water in blood - ADH, aldosterone cause water to be reabsorbed in kidneys, BP increases
too much water - ADH and aldosterone inhibited, urine becomes more dilute

57
Q

two signs of hypercalcemia?

A

trousseau’s sign, chvostek’s sign

58
Q

is 5% dextrose hypotonic or isotonic?

A

isotonic in the bag, hypotonic in the body (so it’s a good fluid for dehydration. also used for hypoglycaemia/ insulin shock)

59
Q

another name for Hartmann’s solution?

A

CSL (compound sodium lactate)

Ringer’s lactate solution

sodium lactate solution

semester 2 2019 (16 decks)

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