Fluid & Electrolyte Embalances Flashcards
1
Q
what are body solutions composed of
A
solvents (water) & solutes (electrolytes)
2
Q
body fluid variations:
- men? (total water in %)
- women? (total water in %)
- fat content? men vs women
- age? elderly & newborns
A
men: 60% body water
women: 50% body water
fat content: men (more water, less fat); women (more fat, less water)
age: elderly (more fat, less water); newborns (less fat, more water)
3
Q
all fluid within the cell
- approximately 2/3
A
intracellular (ICF)
4
Q
fluid outside the cell
- approximately 1/3
A
extracellular (ECF)
5
Q
which body fluid compartment focuses on potassium
A
intracellular (ICF)
6
Q
which body fluid compartment focuses on sodium & chloride
A
extracellular (ECF)
7
Q
function of body fluids
A
- serves as a lubricant & as a solvent for chemical reactions called metabolism
- transports oxygen, nutrients, chemical messengers, & waste products to their destination
- regulation of body temperature
8
Q
what is unique about babies body fluid compartment compared to adults
A
babies ECF>ICF
- 1/3 inside ICF; 2/3 inside ECF (opposite from adults)
- high risk for fluid volume deficit
9
Q
normal serum osmolality
A
285-295
10
Q
what determines serum osmolality
A
sodium
11
Q
describe serum osmolality for hypotonic solutions
A
hypo- low
tonic- salt (sodium)
low Na; high water
(if serum osmolality is low; salt is low)
12
Q
describe serum osmolality for hypertonic solutions
A
hyper- high
tonic salt (sodium)
high Na; low water
(if serum osmolality is high; salt is high)
13
Q
describe serum osmolality for isotonic solutions
A
normal serum osmolality
- equal Na and water ratio
14
Q
water moves through semipermeable membrane from an area of lower particle concentration to an area of high particle concentrations until concentrations are equal on both sides
A
osmosis
15
Q
rule to remember when it comes to osmosis
A
water goes where salt is
- high salt extracellular (outside cell): then water goes from ICF to ECF
- low salt extracellular (outside cell): then water goes from ECF to ICF
16
Q
particles move from an area of higher particle concentration to area of lower particle concentration; may or may not be able to pass through semi-permeable membrane
A
diffusion
17
Q
requires energy in the form of ATP
A
active transport
18
Q
pushing force of a fluid generated by the heart’s pumping action
- at the arterial end of the capillary, HP pushes water out of the capillary into the tissue, carrying nutrients with it
- pushing pressure pushes fluid out of the artery
A
hydrostatic pressure
19
Q
pulling force exerted by colloids (proteins) in a solution
- at the venous end of the capillary, OP pulls water back into capillary, carrying waste with it
- pulling pressure that pulls fluid back into the vein
A
oncotic/colloid osmotic pressure (COP)
20
Q
filtration
A
movement into or out of the capillaries
21
Q
when does thirst occur
A
with a 2% water loss or increased osmolality
22
Q
describe the physiology of thirst
A
- osmoreceptors (hypothalamus) are activated by a dry mouth, hyperosmolality, or plasma volume depletion
- person experiences thirst
- plasma volume is restored & dilutes ECF osmolality after drinking water
23
Q
disorders affecting thirst mechanism
A
coma, inability to swallow, stroke
24
Q
stimulated when there is a water deficit, an increase in plasma osmolarity, or a decrease in plasma volume (BP drops)
A
Antidiuretic hormone (ADH)
25
when urine output is low; specific gravity is ___?
high
26
describe the physiology behind the antidiuretic hormone (ADH)
- osmoreceptors stimulate the release of ADH from the pituitary gland
- ADH increases the permeability of water in the distal tubules & collecting duct; decreasing urine output (increasing concentration)
- water is reabsorbed into blood plasma
- the increase in circulating blood plasma causes the BP to increase
27
disorders affecting ADH
- syndrome of inappropriate antidiuretic hormone (SIADH)
| - diabetes insipidus (DI)
28
excessive ADH secretion = excessive water retention
syndrome of inappropriate antidiuretic hormone (SIADH)
29
decreased ADH secretion= excessive water excretion
Diabetes Insipidus (DI)
30
primary regulator of sodium
aldosterone
31
when is aldosterone stimulated
when there is a decrease in Na levels or elevation in K levels through the renin angiotension aldosterone system (RAA)
32
describe chemical regulation of sodium balance
low Na balance causes kidney to secrete renin
- renin travels to the liver
- converts to Angiotensin I by enzymes
- then it travels to the lungs and coverts Angiotensin I to Angiotensin II
- aldosterone (secreted by angiotensin II) then reabsorbs Na and excretes K in the urine
- increased Na retention increases plasma osmotic pressure causing hypothalamus to secrete ADH, which increases water reabsorption
33
what does angiotensin II do to the body
1. causes vasoconstriction
| 2. causes kidneys to secrete aldosterone
34
ALDOSTERONE = ???
Na (sodium, salt)
35
activated w/ prolonged aldosterone elevation, chronic retention of fluid or excessive secretion
Atrial Natriuretic Peptide Hormone (ANP, BNP, NPA)
36
describe physiology/process of Atrial Natriuretic Peptide Hormone (ANP)
- inhibits the secretion of ADH
| - blocks the reabsorption of Na and water
37
large particles of the blood vessel
- BUN
- Cr
- Hgb
- Hct
38
describe BUN and Cr levels for dehydration
increased BUN
| normal creatinine
39
describe BUN and Cr levels for overhydration
decreased BUN
| normal creatinine
40
describe BUN and Cr for renal failure
increased BUN and increased creatinine
41
equal Na and water loss, normal serum osmolality
isotonic volume deficit (dehydration)
42
labs for isotonic volume deficit
```
when water is low (dehydration); large particles look high
Serum Osm: N
Na: N
Cl: N
K: N
BUN: high
Cr: N
Hct: high
Hgb: high
urine output: low
Sp gr: high
```
43
causes of isotonic volume deficit (dehydration)
anything that will cause you to lose fluid
- hemorrhage, decreased intake, vomiting, diarrhea, gastric suctioning, fever, environmental heat, excessive sweating, large burns, diuretics, third-space fluid shifts
44
symptoms of isotonic volume deficit (dehydration)
increased thirst, urine concentrated w/ high specific gravity, dry skin w/ tenting, dry tongue, decreased tearing, tachycardia, weak, thready pulse, tachypnea, sunken eyeballs, flat neck veins, increased body temp, acute weight loss
45
treatment of isotonic volume deficit (dehydration)
monitor VS, isotonic IV fluids (NS or RL), monitor intake and output, daily weights, monitor labs
46
equal gain of Na and water, normal serum osmolality
isotonic volume excess (overhydration)
47
labs for Isotonic volume excess (overhydration)
```
when water is high (overhydration); large particles look low
serum osm: N
Na: N
Cl: N
K: N
BUN: low
Cr: N
Hgb: low
Hct: low
urine output: high
Sp Gr: low
```
48
causes of isotonic volume excess (overhydration)
renal failure, CHF, excessive IV fluids and water
49
symptoms of isotonic volume excess (overhydration)
acute weight gain, dependent and generalized edema, hypertension, full bounding pulse, JVD, pulmonary edema (SOB, dyspnea, crackles, cough)
50
treatment of isotonic volume excess (overhydration)
monitor VS, Na and water restriction (restrict fluids to 1000-1200 ml/day), monitor intake and output, daily weights, monitor labs, diuretics
51
small particles
Na
Cl
K
52
different types of isotonic IV solutions
- D5W
- 0.9% NaCl or NS
- Lactated Ringer's; LR
53
uses of D5W
fluid loss and dehydration
| - should never be used as a primary IV fluid
54
special considerations for D5W
solution is isotonic initially, becomes hypotonic when dextrose is metabolized
55
cautions of D5W
may cause:
- hyperglycemia (high bloos sugar) w/ resuscitation
- fluid overload in renal and cardiac disease
56
uses of 0.9% NaCl or NS
shock, blood transfusions, resuscitation, fluid challenges, hypercalcemia, dehydration
57
special considerations of 0.9% NaCl or NS
- since this replaces ECF, don't use in patients w/ CHF, edema, or hypernatremia (can lead to overload)
- monitor patients for signs of fluid overload
58
uses of Lactated Ringer's; LR
burns, lower GI tract fluid loss, acute blood loss
59
special considerations of Lactated Ringer's; LR
- contains K, don't use w/ renal failure, can cause hyperkalemia
- don't use in liver disease bc the patient can't metabolize lactase; functional liver converts it to bicarbonate
- don't give if ph >7.5
60
excess Na in proportion in water, high serum osmolality
hypertonic fluid volume deficit (cellular dehydration)
61
labs for hypertonic fluid volume deficit
```
serum osm: high
Na: high
Cl: high
K: low
BUN: high
Cr: N
Hct: high
Hgb: high
urine output: low
Sp Gr: high
```
62
treatment for hypertonic fluid volume deficit
decreasing Na and replacing water with hypotonic IV fluids
63
hypotonic IV solution
- 0.45% NaCl; 1/2 NS
64
use of hypotonic solutions
- water replacement
| - hypertonic dehydration (hypertonic fluid volume deficit)
65
special considerations for hypotonic IV solutions
can cause sudden fluid shift from blood vessels into cells, resulting in cardiovascular collapse from intravascular fluid depletion and increased ICP from fluid shift into brain cells
66
contraindications of hypotonic IV solutions
head trauma, or neurosurgery, strokes
67
low Na in proportion to water, low serum osmolality
hypotonic fluid volume excess (cellular overhydration)
68
labs for hypotonic fluid volume excess (cellular overhydration)
```
serum osm: low
Na: low
Cl: low
K: high
BUN: low
Cr: N
Hgb: low
Hct: low
urine output: high
Sp Gr: low
```
69
hypertonic IV solution
3% NS
| - only administered in ICU
70
use of hypertonic IV solution
hypotonic overhydration (hypotonic fluid volume excess)
71
special considerations for hypertonic solutions
- don't give to a patient w. impaired heart or kidney function (his system can't handle the extra fluid)
- monitor serum glucose levels closely
72
classifications of edema
- localized
- generalized
- dependent
- third space shifting
73
Edema
| - sprain or organ system (brain, lungs, heart, peritoneal cavity)
localized
74
Edema
| - more uniform distribution in interstitial spaces
generalized
75
Edema
| - gravity dependent areas (legs, sacral area)
dependent
76
Edema
- excess fluid trapped in interstitial spaces, causing extreme changes in capillary permeability. cells may become dehydrated
third space shifting
77
causes of third space shifting (4)
- increased hydrostatic pressure
- decreased blood osmotic pressure
- increased capillary membrane permeability
- lymphatic obstruction
78
symptoms of edema
acute weight gain, edema in dependent areas
79
treatment of edema
- goal is to mobilize fluid to intravascular compartment to increase glomerular filtration
- restrict Na and fluid intake
- diuretic therapy
- adequate dietary intake (protein)
- support hose
80
normal sodium level
135-145 mEq/L
81
sodium is directly regulated by?
aldosterone
82
sodium is indirectly regulated by?
ADH, ANP
83
sodium deals with what system?
nervous system
84
functions of sodium
- regulates osmotic pressure in ECF
- transmits nerve & fiber impulses
- combines w/ bicarb & Cl to regulate acid/base in kidneys
85
hyponatremia level
< 135 mEq/L
86
describe characteristics of hyponatremia
```
low Na; high H2O
cell swells (water moves into the cell)
```
87
causes of hyponatremia
- excess Na loss, excess water (decreased intake, diuretics, adrenal insufficiency, hypotonic IV fluids)
- excess water gain (polydipsia, inadequate excretion of water from renal disease - SIADH, brain lesions, hypotonic fluids
88
symptoms of hyponatremia
- neurological (cerebral edema): headache, personality changes, confusion, lethargy, weakness, coma
- GI: nausea, vomiting
- edema: peripheral, polyuria, decreased thirst
- labs: Na below 135, low Cl, elevated K
- decreased serum osmolality, decreased hematocrit, BUN
- urine output increased, specific gravity decreased
89
treatment of hyponatremia
restrict fluids, oral sodium replacement, use of IV fluids cautiously (hypertonic), avoid hypotonic fluids
90
hypernatremia level
> 145 mEq/L
91
hypernatremia characteristics
```
high Na; low H2O
cell shrink (water moves out of cell)
```
92
causes of hypernatremia
- excess water loss over Na intake: watery diarrhea, excessive diaphoresis, hypertonic fluids, polyuria
- decreased water intake: impaired thirst sensation, dysphagia
- excessive Na intake and salt-water near drowning
93
symptoms of hypernatremia
- neurological (cerebral shrinking): agitation, restless, seizures, coma
- CV: tachycardia, hypotension, weak & thready pulse
- intracellular dehydration: dry skin, & mucous membranes, tough & fissured tongue, increased thirst, oliguria, anuria
94
labs for hypernatremia
Na level above 145, increased Cl, decreased K, increased serum osmolality, increased hematocrit, increased BUN, urine output decreased, specific gravity increased
95
treatment for hypernatremia
increase water intake, decreased Na intake, hypotonic IV fluids
96
normal chloride level
96-106 mEq/L
97
regulation of chloride
- Cl & Na changes in direct proportion to one another
| - Indirectly affected by aldosterone
98
Cl deals with what system ?
respiratory system (respirations)
99
functions of chloride
- assists Na in maintaining serum osmolality
| - component of hydrochloric acid in stomach, thereby maintaining acid/base balance
100
hypocloremia level
< 96 mEq/L
101
causes of hypocloremia
- excessive loss: excessive diarrhea or sweating, burns, fever
- loss of HCl in GI secretions: NG suctioning, vomiting
- diuretics: loop and osmotics
102
symptoms of hypocloremia
respiratory: shallow, depressed, mimic hyponatremia
103
treatment of hypocloremia
increase intake: salty broth, tomato juice, cola, Cl supplements
104
hyperchloremia level
> 106 mEq/L
105
causes of hyperchloremia
- increased intake
| - dehydration, cushing syndrome, hyperventilation, anemia, renal failure
106
symptoms of hyperchloremia
respiratory: rapid, deep, (Kussmaul's)
107
treatment of hyperchloremia
IV: Ringer's Lactate or Na Bicarb, avoids foods high in Cl
108
normal potassium levels
3.5-5.0 mEq/L
109
what 2 systems does potassium deal with?
heart & muscles
110
regulation of potassium
- Kidneys: 80% (lose 40mEq/L), feces: 20% (K stores are depleted in 2-3 days w/o replacement)
- Reciprocal relationships w/ Na & H
- Regulated by aldosterone
111
functions of potassium
neuromuscular excitability, rate of force of cardiac contractility, acid/base balance
112
hypokalemia range
< 3.5 mEq/L
113
causes of hypokalemia
inadequate intake, excessive renal loss (diuretics, renal failure - diuretic phase),
excessive GI loss (vomiting, diarrhea, NG suctioning)
114
symptoms of hypokalemia
- cardiac: u waves on EKG
- skeletal muscles: weakness, fatigue, cramps
- GI: vomiting
115
treatment for hypokalemia
foods high in K, K supplements w/ diuretics (K-dur), IV administration (KCl) 20-40 mEq/L over 1 hr monitored
116
hyperkalemia range
> 5.0 mEq/L
117
causes of hyperkalemia
excessive intake, cellular damage (burns), inadequate renal loss (renal failure, potassium sparing diuretics, ACE inhibitors)
118
symptoms of hyperkalemia
Cardiac: wide QRS, peaked or tall T waves, prolonged PR interval
Muscles: cramping, weakness & flaccid paralysis, digital numbness & tingling
GI: diarrhea
119
treatment of hyperkalemia
diuretics, resins (kayexalate), Na Bicarb, calcium chloride
120
regulation of calcium
absorbed in sm intestine in presense of Vit D. Vit D promotes absorption, P inhibits
121
parathyroid hormone and calcium
- PTH promotes Ca transfer from bones to plasma, aids intestinal & renal absorption.
- Decreased Ca level stimulates PTH release, which allows Ca to be released from bones into plasma.
- Increased Ca level stimulates the thyroid gland to release calcitonin which inhibits Ca release from bones and reduces PTH production, decreases Ca reabsorption
- Calcitonin aids Ca transfer from plasma to bone
122
describe the process of protein binding in relation to calcium
- Calcium is 50% protein bound & 50% ionized (free). - The lower the protein level the higher the Ca level.
- The higher the protein level the lower the Ca level.
- An alkaline state enhances Ca binding to the protein (Ca levels drop)
- An acidotic state decreases Ca binding (Ca level increase)
123
functions of calcium
- maintains cell structure, function, and permeability
- cardiac and skeletal muscle contraction
- blood coagulation
- structure & function of teeth & bones
- inverse relationship with P
124
causes of hypocalcemia
- decreased Ca intake, hypoparathyroidism (Ca unable to be mobilized from bone), Vit D deficiency, loop diuretics
125
symptoms of hypocalcemia
- Neuromuscular: skeletal muscle cramps
- Tetany: pos Chvostek (facial tapping and spasms) & pos Trousseau's sign (carpal pedal spasms in the arm)
- Bone: deformities, fractures
126
treatment of hypocalcemia
calcium gluconate, calcium chloride, magnesium replacement, vit D supplements, increase exercise
127
causes of hypercalcemia
excess vit D, excess Ca intake, hyperparathyroidism, prolonged immobilization, thiazide diuretics, chemotherapy agents, blood or bone cancer, renal insufficiency, theophylline
128
symptoms of hypercalcemia
renal (flank pain, kidney stones), GI (constipation), neuromuscular (muscle weakness, atrophy, CNS depression, stupor, coma)
129
treatment of hypercalcemia
IV normal saline, loop diuretics, foods high in Na, corticosteroids, P salts orally, rectally, or IV
130
calcium has an inverse relationship with
phosphate
131
regulation of phosphate
review in Ca regulation
- 80% exists in bone in combination w/ Ca.
- 1:2 ration of P to Ca
132
functions of phosphate
- essential for generation of bony tissue
| - metabolizes glucose & lipids for energy
133
causes of hypophosphatemia
decreased intestinal absorption (antacids, severe diarrhea, vit D deficiency, alcoholism), increased renal elimination (hyperparathyroidism)
134
symptoms of hypophosphatemia
muscle weakness, bone pain, osteomalacia, anorexia, tremors, hyporeflexia, seizures, bleeding disorders
135
treatment of hypophosphatemia
oral phosphate supplements, potassium phosphate
136
causes of hyperphosphatemia
impaired elimination (kidney faulure, hypoparathyroidism, hypocalcemia)
137
symptoms of hyperphosphatemia
signs of hypocalcemia
138
treatment of hyperphosphatemia
dietary restrictions, hemodialysis if chronic renal failure
139
closely related to Ca and P
magnesium
140
how much magnesium is contained in bone
60%
141
function of magnesium
- activates intracellular enzymes & acts in carbohydrate and protein metabolism
- acts on myoneural junction: affecting neuromuscular irritability and contractility of cardiac and skeletal muscle
- essential in blood coagulation
142
causes of hypomagnesemia
```
impaired intake or absorption (alcoholism, malnutrition, malabsorption, small bowel resection)
increased loss (diuretics, cirrhosis)
```
143
symptoms of hypomagnesemia
tetany, dysrhythmias, muscle tremors
144
treatment of hypomagnesemia
Mg replacement: magnesium sulfate
145
causes of hypermagnesemia
excess intake (excess mg supplements), stop antacids & laxatives, increase fluid intake, calcium gluconate, mg antagonist
