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Pathological Liars > Fluid + Electrolyte Disorders > Flashcards

Fluid + Electrolyte Disorders Flashcards

1
Q

Total Body Water (TBW) is distributed into:

A

Intracellular fluid (ICF) - 2/3 of TBW

Extracellular fluid (ECF) - 1/3 of TBW
- Transcellular
- Interstitial fluid (ISF)
- Intervascular fluid (IVF)

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2
Q

Intravascular Fluid of ECF

A
  • the fluid in vessels and capillaries
  • also called “plasma water”
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3
Q

Interstitial Fluid of ECF

A
  • often called tissue space/fluid
  • the fluid not inside vessels or cells
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4
Q

Transcellular Fluid of ECF

A
  • isolated
  • does NOT exchange easily with ISF or IVF spaces
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5
Q

What is Edema?

A
  • palpable swelling due to the expansion of Interstitial Fluid Volume
  • accumulation of excess fluid in ISF
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6
Q

Edema is caused by:

A

a disturbance in hydrostatic or osmotic pressure:
- increased capillary HYDROSTATIC pressure
- decreased capillary ONCOTIC pressure
- impaired lymphatic drainage

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7
Q

What is hydrostatic pressure?

A

the pressure required to push fluid OUT of vessels or capillaries

  • out of IVF and into ISF
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8
Q

What is oncotic pressure? What is it directly correlated to?

A
  • the pressure to SUCK fluid in
  • helpful when dehydrated
  • directly correlated to the amount of PROTEIN in the body
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9
Q

What is Starlings Law?

A
  • official name for exchange of capillary fluid
  • hydrostatic/oncotic exchange
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10
Q

Generalized vs. Dependent Edema

A

Generalized: fluid swelling all over body

Dependent: increased capillary pressure –> fluid accumulate in dependent body areas
- ex: ankles swollen from standing too long

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11
Q

Different ways to assess Edema

A
  1. touch using fingers - determine different stages
  2. weight gain
  3. measurement
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12
Q

How can increased capillary permeability cause Edema? What are some things that would cause increased capillary permeability?

A

increased capillary permeability can be caused by burns or localized inflammation
- damages outer layer of blood vessels

leads to loss of plasma proteins, which can cause:
- decreased capillary oncotic pressure
- higher tissue oncotic pressure

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13
Q

How does systemic decreased plasma protein production cause Edema?

A

less plasma protein –> decreased capillary oncotic pressure –> edema

capillaries don’t need to suck in as many proteins, which decreases overall pressure

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14
Q

How does increased capillary hydrostatic pressure cause edema?

A

as the ability to push fluid out of the capillaries increased, the fluid is pushed into the ISF

net movement/accumulation of fluid in ISF –> Edema

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15
Q

How does lymph vessel obstruction cause edema?

A

lymph system serves to move fluid out of the blood
- blockage –> no drainage –> accumulation of fluid inside ISF
- lymph vessels can’t absorb ISF, so more accumulates causing edema

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16
Q

What is Third Spacing?

A
  • the movement of a large amount of bodily fluid FROM ECF –> INTO transcellular compartments inside serious cavities
  • exchange of extracellular fluid between interstitial spaces, capillaries, and transcellular spaces of serious cavities
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17
Q

Where are serous cavities located and what are they closely linked with?

A

located in areas of continuous movement
- joints, bladder, etc.

closely linked with lymphatic drainage system
- blockages –> fluid buildup in serous cavities

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18
Q

Third space fluid contribute to ____ but not to ____ or _____

A

contribute to: body weight

not to: fluid reserve or function

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19
Q

Causes of third spacing:

A
  1. systemic inflammatory response syndrome
  2. severe liver failure
  3. 3rd degree burns
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20
Q

Volume Imbalance

A

Isotonic
- equal loss/gain of water and electrolytes (sodium)

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21
Q

Volume imbalances cause changes in:

A

mainly in ECF volume

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22
Q

osmolarity definition and types

A

relationship between molecules and water

hyperosmolar - more molecules, less water
hypoosmolar - less molecules, more water

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23
Q

Osmolarity Imbalance types

A
  • hypertonic
  • hypotonic
  • unequal loss/gain of water and electrolytes
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24
Q

Osmolarity Imbalances causes changes in…

A

ICF volume

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25
Q

hyPERtonic fluid shift

A

ICF –> ECF

inside cell –> outside

deflates: think hyper –> so excited that it makes you tired and deflate

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26
Q

hyPOtonic fluid shift

A

ECF –> ICF

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27
Q

Example of increased capillary hydrostatic pressure

A

clot

venous obstruction

heart failure

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28
Q

How does Hypovolemia affect ECF?

A
  • ECF volume deficit
  • Isotonic (equal) fluid loss from ISF and IVF spaces
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29
Q

Common causes of Hypovolemia

A
  1. dehydration
  2. GI loss
  3. Third spacing (fluid trapped in serous cavities - technically dehydrated)
  4. sweat
  5. kidney failure
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30
Q

Effects of mild Hypovolemia

A

thirst

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31
Q

Effects of moderate Hypovolemia

A
  • worsening thirst
  • poor skin turgor
  • decreased BP and urine output
  • increased HR (orthostatic hypotension), HgB
  • slow filling of peripheral veins
32
Q

Effects of severe Hypovolemia

A

same as moderate plus:
- pallor
- worse drop in BP and urine output
- tachycardia (weak pulse)
- disorientation

33
Q

Effects of potentially fatal Hypovolemia and range

A

Above 8% decrease
- anuria
- Hypovolemic shock (severe drop in BP)

34
Q

How does Hypervolemia affect ECF?

A
  • ECF excess
  • Isotonic (equal) gain of water and sodium in ECF
35
Q

Does tonicity change in Hypovolemia or Hypervolemia?

A

No –> changes mainly seen in ECF compartments

36
Q

3 Common causes of Hypervolemia

A
  1. water retention from kidney dysfunction
  2. excess salt intake
  3. liver + heart failure
37
Q

Effects of Hypervolemia

A
  • increase in BP
  • decrease in pulse
  • venous distention (vein in side of neck)

often leads to edema:
- initially dependent
- may travel to lung –> pulmonary edema (fluid accumulation around lung, crackles)

38
Q

Osmolarity Imbalances are due to:

A
  • an overall excess or deficiency of sodium

less common cause: hyperglycemia in diabetes mellitus

39
Q

What causes Hyponatremia?

A
  • low plasma osmolarity –> water moves INTO the cell (ECF –> ICF)
  • low sodium: LESS THAN 135 mEq/L
40
Q

Serum Sodium Range

A

135 - 145 mEq/L

41
Q

Hyponatremia etiologies

A
  1. Sodium loss
  2. GI loss: diarrhea, vomiting, sweating)
  3. Dilutional - too much H2O intake dilutes amount of Na in body
  4. Water retention
42
Q

Hyponatremia manifestations

A
  • muscle cramps
  • decreased reflexes
  • weakness/lethargy
  • seizures
  • coma
43
Q

Hyponatremia treatment

A

based on cause:
- dilution: food restriction
- Na loss: stop the medication affecting kidneys

44
Q

What is Hypernatremia?

A
  • high plasma osmolarity causes water to shift ICF –> ECF
  • serum sodium level is ABOVE 145 mEq/L
45
Q

Hypernatremia is a key/cardinal sign of:

A

dehydration

true dehydration of cells

46
Q

Hypernatremia etiologies:

A
  • water loss
  • sodium retention
47
Q

Hypernatremia manifestations:

A

similar to Isotonic Fluid Volume Deficit
- thirst
- CNS changes: lethargy –> irritability –> seizures –> coma
- increased body temperature
- dry mucous membranes
- oliguria

48
Q

Hypernatremia treatment

A

give fluids: sugar H2O

49
Q

Serum Potassium Range

A

3.5 - 5.1 mEq/L

50
Q

Potassium helps:

A
  • muscle contraction (particularly cardiac)
  • maintain level intracellular fluids
  • maintain normal BP
51
Q

What is Hypokalemia?

A
  • when serum potassium levels are LESS THAN 3.5 mEq/L
52
Q

Hypokalemia etiologies:

A

potassium deficit
- Loss in GI tract (nausea, vomiting, diarrhea)
- redistribution of K+ ions between ECF and ICF
- renal loss (heart failure, diuretics affecting kidneys)

53
Q

Hypokalemia manifestations:

A
  • fatigue
  • muscle weakness or cramps
  • decreased deep tendon reflexes
  • flattened/depressed T waves on EKG
54
Q

Hypokalemia treatment

A
  • IV fluids
  • K+ pills
  • Bananas

If chronic –> special diet

55
Q

What is Hyperkalemia?

A
  • serum potassium level are ABOVE 5.1 mEq/L
  • ICF –> ECF
56
Q

Hyperkalemia etiologies

A
  • decreased renal function
  • too much K+ in ECF –> abnormal redistribution
  • kidneys don’t secrete K+
57
Q

Hyperkalemia manifestations

A
  • above 8 = severe emergency
  • muscle fatigue and weakness
  • dyspnea: shortness of breath
  • dysrhythmias
  • Peaked T waves
58
Q

Hyperkalemia treatment

A

medications that
- eliminate K+ through digestive GI tract
- cause K+ to shift from ECF back into ICF

59
Q

Serum Calcium Range

A

8.6 - 10.6 mg/dl

60
Q

Bones + Calcium function

A
  • bones are storage unit for calcium

calcium helps:
- muscles contract
- nerve function
- stabilize neuromuscular response

61
Q

Non-ionized calcium

A
  • does not function well in body
  • solidifies like bone matrix
62
Q

Ionized calcium

A

stabilizes neuromuscular excitability –> decreases nerve cells’ sensitivity to stimuli

this is the form we measure in the serum

63
Q

What is Hypocalcemia?

A
  • serum calcium is LESS THAN 8.6 mg/dL
64
Q

Hypocalcemia etiologies

A
  • body’s impaired ability to pull Calcium from the bones
  • abnormal calcium excretion from kidneys
65
Q

Hypocalcemia manifestations’ severity depends on:

A
  • underlying cause
  • quickness of onset
  • accompanying electrolyte disorders
  • extracellular pH
66
Q

Hypocalcemia Actue manifestations

A
  • muscle cramps
  • convulsions
  • spasms

signs: Chvostek, paresthesia, Trousseau

67
Q

Paresthesia

A
  • relates to Hypocalcemia
  • tingling around mouth and in extremities
68
Q

Chvostek signs

A
  • relates to Hypocalcemia
  • tap cheek and causes uncontrollable mouth twitches
69
Q

Trousseau signs

A
  • relates to Hypocalcemia
  • Take BP cuff off –> non-stop hand and arm spasms
70
Q

Hypocalcemia Chronic manifestations

A

skeletal + skin manifestations
- bone pain, fragility, and fractures (from parathyroid hormone)
- dry + scaling skin
- brittle nails
- dry hair
- development cataracts

71
Q

Hypocalcemia treatments

A

oral or IV calcium

72
Q

What is Hypercalcemia?

A
  • when serum calcium levels are ABOVE 10.6 mg/dL
73
Q

Hypercalcemia etiologies

A
  • Ca+ movement into circulation overwhelms the kidneys ability to remove excess ions –> increase
  • increased bone resorption: body pulls more calcium from bones faster than it should (tell tale sign of cancer)
  • prolonged immobility
  • excess intake of calcium carbonate (tums)
  • hyperparathyroidism: parathyroid gland releases too much hormone –> Ca level increases
74
Q

Hypercalcemia manifestations

A
  • decrease in neuromuscular excitability
  • GI discomfort –> constipation, nausea, bloating
  • slowing of peristalsis
  • CNS effects
  • cardiac effects: increase in contractability –> pumps too hard –> cardiac arrest
  • renal calculi
75
Q

Hypercalcemia treatment

A

fluid

specific diuretics - lasix

Pathological Liars (7 decks)

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