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REnal > Fluid compartments > Flashcards

Fluid compartments Flashcards

1
Q

how much percent of our body is water

A

60%

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2
Q

how is water divided in ECF and ICF

A

ECF is 1/3

ICF is 2/3

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3
Q

the plasma is considered ECF or ICF

A

ECF

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4
Q

What is in the “third space” when there is excess fluid

A

water from epithelial secretions, synovial and CSF

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5
Q

what percent of ECF is plasma

A

1/4

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6
Q

how many liters are in the Arterial effective circulating volume

A

.7 liters

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7
Q

What is the effective circulating volume independent of

A

extracell volume, plasma volume and CO

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8
Q

What is Vd of a drug

A

the colume of body fluid in which the total dose is distributed at same concentration of plasma

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9
Q

if the Vd is 45

A

45 all body tissues, even bone and spinal fluid

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10
Q

how does daily total intake and output of fluid compare

A

in the end equal each other.

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11
Q

Compare Na, K, Ca, Mg and HCO3 and HPO4 in ICF vs ECF

A

ECF has higher Na and Cl and HCO3-

ICF has higher K, Mg and HPO4

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12
Q

How is the osmolarity in ECF vs ICF

A

the same osmolarity

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13
Q

where are there higher non-electrolyte protein levels

A

ICF, intravascular compartments

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14
Q

do the proteins change osmolarity? oncotic pressure?

A

changes oncotic pressure

does not change osmolarity because the large proteins are impermeable

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15
Q

majority of the non-electrolytes in the plasma are what 2 compounds

A

phospholipids and cholesterol

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16
Q

how do we measure total body water and plasma volume directly, clinically

A

dilution of injected radioactive substances or dyes

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17
Q

how is ICF fluid calculated

A

TBW-ECF

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18
Q

how is interstitial volume calculated

A

ECF- plasma volume

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19
Q

how can total blood volume be calculated

A

need to know plasma volume and Hct

TBV= plasma volume/1-Hct

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20
Q

how can you estimate plasma osmolality by [Na]

A

2X plasma [Na]

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21
Q

What is the donnan effect

A

Na K concentrations are higher in vascular spaces due to the negative charges of proteins

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22
Q

what besides [Na] is important in plasma osmolality

A

glucose/18 and urea/2.8

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23
Q

What keeps the Na concentration what it is

A

Na-K ATPase pump

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24
Q

what ion is the key regulater of intracellular osmolality

A

presence of K

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25
Q

fluid distribution between ECF and ICF depends on what

A

osmotic effects of Na and Cl

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26
Q

What is the capillary cell membrane between ECT and capillary permeable to

A

small ions

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27
Q

what is the fluid distribution dependent on between capillary and interstitial fluid

A

starling forces

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28
Q

What scenarios clinically result from fluid/solute loss

A

Bruns, Hemorrhage, vomiting/diarrhea, dehydration

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29
Q

what do you target during intravenous replacement fluids when oral rehydration is not suitable

A

target the volume-depleted comparment

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30
Q

what is in crystalloid fluids

A

contain varying concentrations of electrolytes and can stay in ECF or be widely distributed depending on composition

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31
Q

what are types of crystalloid fluids

A

normal saline, lactated Ringer’s solutions

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32
Q

what is in colloid fluids

A

large proteins and molecules that stay in vascular space

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33
Q

why do we give colloid fluids

A

to pull volume out of cells

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34
Q

a isosmotic solution means what

A

solutions that have the same osmolarity as the ECF

does not change osmolarity, increases volume only

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35
Q

a hyperosmotic solution means what

A

solutions have an osmolarity greater than that of the ECF

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36
Q

What will happen in the addition of a hyper osmotic solution

A

when added to the ECF, osmolarity increases and causes water to move from cells to ECF to increase volume

37
Q

a hyposmotic solution means what

A

solutions having an osmolarity less than that of ECF

38
Q

what happens in the addition of a hyposmotic solution

A

decreases the osmolarity and water moves into the cells

Increases both ECF and ICF

39
Q

What does tonicity of a solution depend on

A

the concentration of impermeant solutes in ECF vs ICF

40
Q

how does cell volume change when in an hypotonic solution? hypertonic? isotonic?

A

in hypotonic the cell V increases
in hypertonic the cell V decreases
isotonic- the cell V does not change

41
Q

What factors affect osmolarity and V of ECF and ICF

A

water ingestion, dehydration, intravenous infusions, diarrhea or vomiting, sweating, diuresis, disease

42
Q

what factor affects distribution of fluid between ECF and ICF compartments

A 
ion distribution Na
ATPase actvity(keeps Na low and K high intracell)
43
Q

what factos affect distribution of ECF between plasma and interstitial comparments

A

balance of hydrostatic vs oncotic pressure

intravascular pressure in capillaries vs plasma protein and solute concentration

44
Q

palpable swelling is from what

A

expansion of interstitial fluid volume

45
Q

renal retention of dietary Na and water how does ECF change

A

increases

46
Q

At what levels is edema apparent

A

2.5-3 L aboe normal plasma volume of 3L

47
Q

what usually causes edema

A

compensatory renal retention of Na and water to maintain plasma volume

48
Q

what clinical situations result in edema

A

primary renal disease like glomerulonephritis and nephrotic syndrome

49
Q

what causes non-pitting edema

A

swollen cells due to increased ICF volume

50
Q

how is edema usually treated

A

diuretics

51
Q

how is osmotic pressure determined

A

by the number of solutes in a solution, not size or mass or chemical nature

52
Q

what is the difference between osmolarity and osmolality

A

osmolarity is the number of solutes per L of solvent

osmolality is the number of solute per 1 kg of solvent

53
Q

What factor is osmolality independent of

A

temperature

54
Q

if you placed a RBC in a solution of urea what would happen

A

the RBC would burst because urea is hypotonic

55
Q

would urea be condisered and effective or ineffective osmole when talking about RBC membrane

A

ineeffective because it cannot exert an osmotic pressure since it can cross the membrane

56
Q

What is oncotic P

A

osmotic P generated by large molecules (proteins) in solution

57
Q

what is specific gravity

A

the total solute concentration in a solution

58
Q

What do we measure clinically to assess the concentrating ability or the urine

A

the specific gravity

59
Q

What makes of ECF

A

1/4 plasma

3/4 interstitial fluid from bone, dense CT and CSF

60
Q

Ascites is an example of what fluid utilization

A

“third space”

61
Q

how is urea measure in plasma

A

as the nitrogen in the urea molecule. BUN

62
Q

does hydrostatic pressure cause a gradeint across ECF and ICF? osmotic pressure?

A

hydrostatic pressure does not

osmotic pressure does

63
Q

what does the capillary filtration coefficient reflect of capillary wall? Kf

A

the movement of fluid and SA available for filtration

64
Q

Precapillary sphincters control what

A

hydrostatic P in an individual capillary and number of perfused capillaries in tissue

65
Q

What is used clinically to decrease a cerebral edema

A

mannitol because it does not cross blood brain barrier and sucks water out, effective osmole

66
Q

if you need to increase a patients vascular volume what do you infuse

A

5% albumin because albumin does not cross barrier

67
Q

how do you expans a patients ECF

A

isotonic NaCl solution

68
Q

what are the neural and hormonal effector mechanisms to changes in volume and osmolarity of blood

A

neural is sympathetic discharge

hormonal is ADH and aldosterone secretion

69
Q

where are the osmoreceptors of the body located

A

anterior hypothalamus near supraoptic nuclei

70
Q

what do osmoreceptors not respond to

A

hypertonic solutions of urea or glucose

71
Q

where are the volume receptors of the body located

A

right atrium

72
Q

an increase in blood volume has what effect

A

stimulate volume receptors that inhibit vasomotor area and suppress sympathetic discharge
also inhibit thirst and ADH secretion

73
Q

which type of receptor in the body is more sensitive. osmo or volume?
which has greater effects?

A

osmoreceptors more senstiive

volume receptors have stronger effects

74
Q

Where is ADH released and what is its role

A

posterior pituitary gland to promote water reabsorption from collecting duct to make isotonic or hypertonic

75
Q

What stimulates the release of aldosterone

A

circulating ANG II from SANS activity
rise in plasma [K]
fall in plasma [Na]

76
Q

What is the effect of aldosterone

A

reabsorption of Na from distal convoluted tubule

77
Q

What stimulates thirst? inhibits?

A

stimulated by osmoReceptor impulses and ANG II

inhibited by volume receptor stimulation

78
Q

What are the two major responses to hypovolemia

A

salt cravings and sympathetic discharge to retain Na and H2O

79
Q

What are the consequences to a lot of drinking plain water

A

increase ICF and ECF volumes with slightly lower osmolarity

80
Q

What is the response to drinking mass amounts of plain water

A

excretion of hypotonic urine. however Na always gets out so long term leads to Na depletion

81
Q

what is the consequence of drinking excess salt, hypertonic saline

A

plasma volume and osmolarity increase. the plasma colloid pressure decreases. so water moves out of capillaries increasing ECF volume and osmolarity. this extracts fluid from ICF (shrinking cells)

82
Q

what is the corrective response to intake of hypertonic saline

A

water retention because increase of plasma osmolarity. plasma volume overload overrides this osmolarity tonicity.
suppress thirst and ADH, excretion large volumes hypotonic urine..exacerbating osmolarity
Natriuretic hormone that promotes Na excretion

83
Q

sweating is creating what type of tonicity

A

loss of hypotonic fluids

84
Q

diarrhea, intestinal obstruction, ascites, burns, hemorrhage is creating what type of tonicity

A

loss of isotonic fluids

85
Q

what is the consequence of profuse sweating or diarrhea or hemorrhage

A

ECF V decreases(plasma is ok because proteins retain fluid)
ECF osmolarity increases(unless loss isotonic)
Rise in ECF osmolarity draws water from cells, Shrunk cells–> painful cramps

86
Q

what is the corrective response to losing hypotonic solution

A

stimulation of osmoR because plasma osmolarity increased, redicution of the plasma volume inhibits volume R.
need to re-correct with isotonic or hypotonic SALT solutions

87
Q

Na restricted diet or loss of hypertonic fluid from vomititng causes what

A

decrease in ECF osmolarity, water moves into cells
ECF V dec, ICF V increases- cell swell
thirst center swells and interprets as excess water so inhibits thirst

88
Q

what is the corrective response to loss of hypertonic solution

A

thirst is absent, which is good so cells don’t burst
intense Na craving to draw water out from ICF back into ECF
as cells lose water thirst is restored and fluid intake corrects the rest

REnal (7 decks)

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