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PHYSIOLOGY > FLUID DISTRIBUTION AND EDEMA > Flashcards

FLUID DISTRIBUTION AND EDEMA Flashcards

1
Q

intracellular fluids

A
  • 2/3 is water
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2
Q

whole vascular volume

A
  • 5L
  • 3L is plasma
  • 40% RBC
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3
Q

total body weight

A
  • 60% (60L) men

- 50% women more adipose tissue 5% breast

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4
Q

TBW

A
  • 60L
    40% intracellular fluid
    20% extracellular fluid 2/3 is interstitial (in bet.cells)
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5
Q

ICF vs ECF

A
  • fluid goes from ICF(6) to ECF(12) due to greater concentration
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6
Q

osmotic pressure/ osmolar pressure

A
  • lift draw of water to the area of higher concentration

- balancing out electrical forces

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7
Q

hydrostatic pressure

A
  • arteriolar
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8
Q

electrical pressure

A
  • K+ and Na+ cation ions repel each other
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9
Q

2x Na concentration

A
  • index for EXTRACELLULAR OSMOLARITY
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10
Q

ECF osmolarity INCREASES

A
  • cell SHRINK
  • sodium concentration with in the cell is INCREASING
  • HYPEROSMOLAR
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11
Q

ECF osmolarity DECREASES

A
  • cell SWELL

- cells becomes dehydrated

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12
Q

STEADY STATE SITUATION

A
  • intracellular=extracellular concentration of water
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13
Q

osmolar pressure

A
  • is the SODIUM
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14
Q

WATER PUT ON A BLOOD

A
  • cells swell and burst patient dies

- D5W is used to prevent this

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15
Q

ICF

A

2/3 TBW

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16
Q

ECF

A

1/3 interstitial

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17
Q

TBW men

A

60L

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18
Q

TBW women

A

50L

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19
Q

blood minus cell

A
  • plasma
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20
Q

serum

A
  • clotting factors removed(post clotted blood)
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21
Q

plasma

A
  • has the clotting factors

- physiologic

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22
Q

volume

A
  • widening convergence and expansion
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23
Q

concentration

A
  • vertical increase(hyperosmolar) and decrease(hypo osmolar)
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24
Q

loss of isotonic fluid (hemorrhage loss of intracellular fluid as RBC volume not changing concentration), isotonic urine, diarrhea or vomiting

A
  • losing only plasma
  • extracellular fluid loss
  • volume
  • no movement of fluids in either direction because ICF and ECF has the same 300 mosm concentration
  • DECREASE ECF VOLUME
  • NO CHANGE IN BODY OSMOLARITY AND ICF VOLUME
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25
Q

loss of hypotonic fluid sweating, hypotonic urine, diabetes insipidus, dehydration, ALCOHOLISM (nephrogenic DI) inhibit ADH loss of free water

A
  • salt retention increase osmolality ECF
  • increasing concentration decreasing volume
  • effect on ICF fluid move out of the cells to compensate hence ICF volume is decreasing
  • DECREASE IN ECF AND ICF VOLUME
  • INCREASE IN BODY OSMOLARITY
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26
Q

salt tablets

A
  • increase osmolality
  • dehydrate the cells
  • ECF concentration will increase
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27
Q

tap water or distilled water has the lowest sodium content, IVF

A
  • ECF osmolality decreases

- ICF concentration decrease

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28
Q

patient hypotensive, sepsis, GI bleeding, burns volume loss

A
  • you want the volume in the vascular space

- normal saline IVF is used

29
Q

major blood volume loss

A
  • IVF used normal saline .9 or lactated ringer isotonic solution it will expand ECF
30
Q

infusion of isotonic saline normal saline, 0.9%, ringers lactate

A
  • no osmotic draw
  • INCREASE ECF VOLUME
  • NO CHANGE IN BODY OSMOLARITY AND ECF VOLUME
31
Q

hypertonic saline in hge, mannitol

A
  • it will cause seizures because of the rises in osmolality
  • expand plasma volume increase
  • INCREASE ECF VOLUME AND BODY OSMOLARITY
  • DECREASE ICF VOLUME
32
Q

high sodium affects the

A
  • CNS seizures
33
Q

primary adrenal insufficiency

A
  • loss of aldosterone
  • function of aldosterone retain sodium excrete hydrogen ions and potassium
  • decrease osmolality due to loss of sodium, chloride and water cause decrease in volume(hypo osmolality)
  • decrease blood pressure
34
Q

HYPOTONIC SALINE, water intoxication

A
  • INCREASE ECF AND ICF VOLUME
  • DECREASE BODY OSMOLARITY
  • dehydrate the cells
35
Q

arteriolar constriction and dilation(has circular muscles) of the afferent and efferent

A
  • hydrostatic forces(water pressure)

- hydrostatic pressure constant in the the afferent and efferent is maintained by

36
Q

GFR

A
  • 20% is filtered
37
Q

efferent and afferent arteriole

A
  • pressure is the same hydrostatic pressure
38
Q

constrict and dilate

A
  • arterioles
39
Q

cannot constrict and dilate

A
  • venules
  • large arteries(AORTA, femoral artery, brachial artery)
  • capillaries
  • veins
40
Q

after load

A
  • arteriolar resistance
41
Q

capillaries(very thin)

A
  • highly permeable because they cannot constrict and dilate
  • can diffuse in and out
  • protein can leak out in the interstitial
42
Q

oncotic pressure

A
  • is protein
43
Q

hydrostatic pressure

A
  • capillary
  • push fluid out in the arteriolar capillary (FILTRATION)
  • if it is in the INTERSTITIAL FLUID(reabsorption), forces push IN
44
Q

oncotic pressure

A
  • interstitium
  • pull OUT the fluid into the interstitial fluid capillary (FILTRATION)
  • if it is in the capillaries (reabsorption), forces pulls IN
45
Q

Pc plus ^^if 25 + 1

A
  • 26
46
Q

Pif plus ^^c 20 + 2

A
  • 22
47
Q

rate fo flow is

A
  • 26 minus 22 = 4mm Hg
48
Q

decrease hydrostatic pressure in the interstitial FLUID/space

A
  • will INCREASE THE FORCE OF FILTRATION
49
Q

tracers

A
  • dye injected IV 300mg
  • trace divided by blood concentration 0.05mg/ml= volume of distribution
  • 300mg/0.05mg/ml=6000ml
50
Q

inulin

A
  • is filtered but not reabsorb nor secreted
51
Q

the lower the hct

A
  • the higher the plasma
52
Q

the higher the hct

A
  • the lower the plasma
53
Q

ECF

A
  • saline and mannitol pass the cellular membrane will go to interstitial space
54
Q

higher water concentration

A
  • low osmolality
55
Q

low water concentration

A
  • high osmolality
56
Q

urea changes the osmolality equally

A
  • no net movement of water
57
Q

mannitol can

A
  • increase osmolality
58
Q

EDEMA

A
  • INCREASE hydrostatic pressure with in the capillary it pushes fluid in the interstitial space
  • STARLING FORCE
  • retention of sodium and water in the kidney
  • CHF no intravascular volume, afferent constricts, JG constricts, start making renin, angiotensin, angiotensin II aldosterone causing hypotension
59
Q

non pitting edema (lymphedema)

A
  • lymphedema
  • does not respond to diuretics
  • develops after removal of systemic tissue (e.g. removal of axillary lymph node in breast cancer)/altered normal lymphatic drainage/configuration
60
Q

pitting edema (MOST COMMON)

A
  • RESPOND TO DIURETICS

- common causes include nephrotic syndrome,CHF, cirrhosis

61
Q

retention of sodium and water by the kidney causing decrease renal perfusion

A
  • cirrhosis
  • nephrotic
  • CHF
  • pericarditis
62
Q

pulmonary edema (CHF)

A
  • anything that blocks the return of fluid in the LEFT ATRIUM from pulmonary veins then drains into the left ventricle
  • back up of fluid due to left ventricular dysfunction at the pulmonary capillary system
  • increase capillary pressure causing pulmonary edema
  • LEFT VENTRICLE ==>LEFT ATRIUM=>PULMONARY VEIN=>PULMONARY CAPILLARIES==> INCREASE HYDROSTATIC PRESSURE==> puts fluid in the interstitial space and in the alveoli= causing pulmonary edema(FLUID BACK UP)
  • HYDROSTATIC PRESSURE> ONCOTIC PRESSURE
  • decrease in albumin
63
Q

normal person

A
  • no protein in the alveoli

- alveolus should be empty kept by tight junctions( in drowning alveolus has water)

64
Q

alveolar proteinosis

A
  • protein in the alveoli

- with oncotic pressure in the alveoli

65
Q

DIURETICS ARE GIVEN

A
  • to DECREASE hydrostatic pressure in the pulmonary capillaries
66
Q

most common form of pulmonary edema

A
  • CARDIOGENIC PULMONARY EDEMA
  • lower plasma proteins predispose to cardiogenic edema
  • increase left atrial pressure, venous return, capillary pressure and filtration
  • MOST COMMON SIGN DYSPNEA
  • caused by low plasma proteins
  • pulmonary wedge pressure (LEFT ATRIAL PRESSURE)confirms the diagnosis IS INCREASE
  • sitting upright relieves the pressure
  • treatment goal: reduce LEFT ATRIAL PRESSURE diuretics DECREASES HYDROSTATIC PRESSURE
67
Q

DIURETICS

A
  • empty the lungs
68
Q

non cardiogenic edema( FRIED LUNGS)

A
  • due to direct injury of the alveolar epithelium
  • severe lung injury (ARDS)
  • MOST COMMON CAUSE: GASTRIC ASPIRATION AND SEPSIS
  • presence of protein containing fluid the the alveoli inactivates the surfactant
  • NO HYDROSTATIC PRESSURE INVOLVED
  • ARDS direct damage the capillaries, BURNS, ATELECTASIS, amniotic fluid embolus, DIC
69
Q

lymphatics

A
  • cleans the lungs by taking all the proteins

PHYSIOLOGY (40 decks)

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