Fluid, Electrolyte 52 Flashcards
Intercellular fluid
Within body cells
2/3 of body fluid in adults
Extra cellular fluid
Outside of cells
1/3 of body fluid
Two main compartments of extra cellular fluid ECF
Intravascular and interstitial
Intravascular fluid
Plasma
20% of ECF
Interstitial fluid
75% ECF
Surrounds cells
Other compartments of ECF
Lymph and transcellular fluids
Transcellular fluid
Cerebrospinal, pericardial, pancreatic, intraocular, biliary, peritoneal, synovial fluids
Electrolytes
Capable of conducting electricity
Example: Na+ and Cl-
Cations
Positive charge
Anions
Negative charge
Milliequivalent
Refers to the chemical combining power of the ion
Or
Capacity of cations to combine with anions to form molecules
Laboratory tests usually use…
Plasma. This reflects what is happening in ECF, especially intravascular fluid
ICF cations and anions
Cations: potassium and magnesium
Anions: phosphate, sulfate
Selectively permeable
Water moves easily through, but other substances vary.
Solutes
Substances dissolved in a liquid
Crystalloids
Salts that dissolve readily into true solutions
Colloids
Substances like large proteins that do not readily dissolve into true solutions
Solvent
Component of a solution that can dissolve a solute
Body solvent
Water
Body solutes
Electrolytes, gases, urea, amino acids, proteins
Osmolality
Concentrations of solutes in body fluids
Water is vital for normal cellular function
Medium for metabolic reactions Transporter for nutrients and wastes Lubricant Insulates, shocks Body temperature
Isotonic
Same osmolality as ECF
Hypertonic
Higher osmolality than ECF
Hypotonic
Lower osmolality thanECF
Osmotic pressure
Power of a solution to pull water across a semipermeable membrane
Colloid osmotic pressure or inciting pressure
Plasma proteins exert osmotic pressure. Hold water in plasma and in their vascular compartment
Diffusion
Two solutes of different concentrations are separated by a semipermeable membrane
Osmosis
Water moves across cell membranes from area of less concentration to area of more concentration (of solutes)
Filtration
Fluid and solutes move across a membrane from an area of higher pressure to lower pressure
Example of filtration
Fluid and nutrients from capillaries to interstitial fluid
Filtration pressure
Pressure that results in movement of fluid and solutes out of a compartment
Hydrostatic pressure
Pressure exerted by a fluid within a closed system on the walls of the container in which it is contained
Blood on vessel walls
Active transport
Movement of solutes across cell membrane from a less concentrated area to a more concentrated one
Active transport important to
Sodium snd potassium ion concentration of ECF and ICF
Thirst center of brain
Hypothalamus
Angiostensin ( reduced blood flow to kidneys)
Normal urine output
1400 to 1500 mL daily
Feces
Amount of chyme enters intestine. 1500 mL daily
100 ml reabsorbed
Insensible losses
Through skin and lungs
300-400 mL daily
Obligatory losses
Fluid losses required to maintain body function
500 ml through kidneys
1300 ml total daily
Kidneys
Primary regular of body fluids and electrolyte balance
ADH
Regulates water excretion from kidneys
Renin- angiotensin - aldosterone system
Neuroendocrine system helps maintain fluid balance
Atrial natriuretic factor
Atrium of heart, responds to stretching and excess fluid volume
Atrial natriuretic factor on thirst
Inhibits thirst, reducing fluid intake
Electrolytes are important for
Maintaining fluid balance
Acid-base regulation
Enzyme reactions
Transmit neuromuscular reactions
Sodium
Most abundant cation in EFC. Controls serum osmolality
Normal sodium levels
135- 145 mEq/ L
Potassium
Major cation in ICF. Must ha e for neuromuscular response to stimuli
Calcium
99% in bones, other in ECF. Cardiac function, neuromuscular function
Calcitonin
Reduce calcium in blood
Parathyroid hormone
Release calcium from bones
Total serum calcium level
8.5 to 10.5 mg/dL
Bound and unbound calcium
Magnesium
Second most abundant cation in skeleton and ICF
** intracellular metabolism, ATP production***
Normal magnesium in ECF
1.5 to 2.5 mEq/ L
Magnesium in ECF
Neuromuscular and cardiac function
Ways to get magnesium
Cereal grains, nuts, dried fruit, green leafy veggies, dairy, meat, fish
Ways to get potassium
Body cannot preserve it
Fruits, veggies, meat, fish
Chloride
Major anion of ECF
Regulates serum osmolality and blood volume
Normal serum levels for chloride
95- 108 mEq/L
Chloride found here
Follows sodium
Gastric juice
Buffer in exchange of oxygen and carbon dioxide
Phosphate
Major anion of ICF. Also found in bone, skeletal muscle and nerve tissue, ECF
Normal phosphate serum levels
2.5- 4.5 mg/dL
Who has more phosphate?
Newborns, children
Growth
Where to get phosphate
Meat, fish, poultry, milk, legumes
Bicarbonate
In both ECF and ICF. Regulating acid/base balance. Buffering
Who regulates bicarbonate?
Kidneys
Where to get bicarbonate
Produced through metabolic process
Acid
Substance that releases hydrogen ions in a solution
Bases
Low hydrogen ion concentration, can accept hydrogen ions in a solution
pH
Inverse reflection of hydrogen ion concentration
Water has a pH of
7, neutral
Normal pH of arterial blood
7.35-7.45
Buffers
Bind or release hydrogen ions
Major buffer in ECF
Bicarbonate and carbonic acid system
Acidosis
pH drops. Bicarbonate depleted in neutralizing acid
Alkalosis
pH rises. Adding a strong base depletes carbonic acid
Respiratory regulation
Eliminating or retaining carbon dioxide.
Carbonic acid breaks down into
Carbon dioxide and water
Renal regulation
Kidneys are ultimate long term regulator of acid-base balance. Slower response, longer lasting
How kidneys regulate acid-base balance
Excretion or conserving bicarbonate and hydrogen ions
Factors affecting body fluid, electrolytes, and acid-base balance
Age, sex, body size, environmental, lifestyle
Two basic types of fluid imbalances
Isotonic and osmolar
Isotonic imbalances
Water and electrolytes are lost or gained in equal proportions. Osmolality of body fluids remains constant
Osmolar imbalances
Loss or gain of only water, osmolality of serum is altered
Hyperosmolar imbalance
Dehydration.
Hypo osmolar imbalance
Over hydration
Fluid volume deficit
FVD
Body loses water and electrolytes from ECF in similar proportions
Hypovolemia
In FVD, fluid is initially lost from intravascular compartment
FVD usually happens when
Abnormal loss through skin, GI, kidney
Decreased fluid intake,
Bleeding, third space syndrome
Third space syndrome
Fluid shifts from vascular space where it is not accessible
Third spacing has two distinct phases
Loss and reabsorption
Fluid volume loss
Body retains both water and sodium in similar proportions to normal ECF
Hypervolemia
Increased blood volume
FVE is always secondary to
Increase in body sodium content
Causes of FVE
Excessive intake of sodium chloride
Administering sodium solution too fast
Disease that changes regulatory mechanisms
Edema
Excess interstitial fluid
Causes of edema
Increased capillary hydrostatic pressure, decreased serum osmotic pressure, increased capillary permeability
Dehydration
Hypersomolar fluid imbalance. No water, excess sodium
Over hydration
Hypo osmolar fluid imbalance. Water and electrolytes gained. Low osmolality low sodium
Hyponatremia
Sodium deficit. Water drawn into interstitial spaces and cells (edema in brain)
Hypernatremia
Excess sodium. Fluid moves into the ECF. Cells are dehydrated
Hypokalemia
Potassium deficit
Hyperkalemia
Potassium excess
Potassium must ALWAYS
Be diluted properly
Potassium must NEVER
Be given IV push
Compensation
Healthy regulatory systems will attempt to correct acid-base imbalance
Respiratory acidosis
pH falls below 7.35
Carbon dioxide retention
Respiratory alkalosis
Hyperventilating
pH rises
Loss of carbonic acid falls
Metabolic acidosis
pH falls Low bicarbonate levels Higher carbonic acid Renal failure Starvation Ketoacidosis
Metabolic alkalosis
Too much bicarbonate
Normal serum osmolality
280-300 mOsm/kg water
Hematocrit
Measures percentage of the volume of whole blood that is actually RBC
BUN
Blood, urea, nitrogen
Serum osmolality
Specific gravity
Indicator of urine concentration that correlates with urine osmolality
Normal specific gravity
1.005 to 1.030
Arterial blood gases
Acid base balance and oxygenation
Volume expanders
Increase blood volume after severe blood loss
Peripherally inserted central venous catheter PICC
Inserted through basilic or cephalic vein
Tip rests in superior Vena cava
CVAD
Central venous access device
Lower one third of superior vena cava, above right atrium
Trousseau sign
Hypo calcium
Spasm of hand and wrist
Chvostek sign
Hypocalcemia
Spasm of wrist