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Pathophysiology & Pharmacology > Fluid & Electrolyte Embalances > Flashcards

Fluid & Electrolyte Embalances Flashcards

1
Q

what are body solutions composed of

A

solvents (water) & solutes (electrolytes)

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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)

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3
Q

all fluid within the cell

- approximately 2/3

A

intracellular (ICF)

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4
Q

fluid outside the cell

- approximately 1/3

A

extracellular (ECF)

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5
Q

which body fluid compartment focuses on potassium

A

intracellular (ICF)

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6
Q

which body fluid compartment focuses on sodium & chloride

A

extracellular (ECF)

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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
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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
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9
Q

normal serum osmolality

A

285-295

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10
Q

what determines serum osmolality

A

sodium

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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)

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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)

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13
Q

describe serum osmolality for isotonic solutions

A

normal serum osmolality

- equal Na and water ratio

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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

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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
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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

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17
Q

requires energy in the form of ATP

A

active transport

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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

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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)

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20
Q

filtration

A

movement into or out of the capillaries

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21
Q

when does thirst occur

A

with a 2% water loss or increased osmolality

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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
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23
Q

disorders affecting thirst mechanism

A

coma, inability to swallow, stroke

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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)

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25
Q

when urine output is low; specific gravity is ___?

A

high

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26
Q

describe the physiology behind the antidiuretic hormone (ADH)

A
  • 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
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27
Q

disorders affecting ADH

A
  • syndrome of inappropriate antidiuretic hormone (SIADH)

- diabetes insipidus (DI)

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28
Q

excessive ADH secretion = excessive water retention

A

syndrome of inappropriate antidiuretic hormone (SIADH)

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29
Q

decreased ADH secretion= excessive water excretion

A

Diabetes Insipidus (DI)

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30
Q

primary regulator of sodium

A

aldosterone

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31
Q

when is aldosterone stimulated

A

when there is a decrease in Na levels or elevation in K levels through the renin angiotension aldosterone system (RAA)

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32
Q

describe chemical regulation of sodium balance

A

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
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33
Q

what does angiotensin II do to the body

A
  1. causes vasoconstriction

2. causes kidneys to secrete aldosterone

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34
Q

ALDOSTERONE = ???

A

Na (sodium, salt)

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35
Q

activated w/ prolonged aldosterone elevation, chronic retention of fluid or excessive secretion

A

Atrial Natriuretic Peptide Hormone (ANP, BNP, NPA)

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36
Q

describe physiology/process of Atrial Natriuretic Peptide Hormone (ANP)

A
  • inhibits the secretion of ADH

- blocks the reabsorption of Na and water

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37
Q

large particles of the blood vessel

A
  • BUN
  • Cr
  • Hgb
  • Hct
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38
Q

describe BUN and Cr levels for dehydration

A

increased BUN

normal creatinine

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39
Q

describe BUN and Cr levels for overhydration

A

decreased BUN

normal creatinine

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40
Q

describe BUN and Cr for renal failure

A

increased BUN and increased creatinine

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41
Q

equal Na and water loss, normal serum osmolality

A

isotonic volume deficit (dehydration)

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42
Q

labs for isotonic volume deficit

A 
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
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43
Q

causes of isotonic volume deficit (dehydration)

A

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

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44
Q

symptoms of isotonic volume deficit (dehydration)

A

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

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45
Q

treatment of isotonic volume deficit (dehydration)

A

monitor VS, isotonic IV fluids (NS or RL), monitor intake and output, daily weights, monitor labs

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46
Q

equal gain of Na and water, normal serum osmolality

A

isotonic volume excess (overhydration)

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47
Q

labs for Isotonic volume excess (overhydration)

A 
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
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48
Q

causes of isotonic volume excess (overhydration)

A

renal failure, CHF, excessive IV fluids and water

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49
Q

symptoms of isotonic volume excess (overhydration)

A

acute weight gain, dependent and generalized edema, hypertension, full bounding pulse, JVD, pulmonary edema (SOB, dyspnea, crackles, cough)

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50
Q

treatment of isotonic volume excess (overhydration)

A

monitor VS, Na and water restriction (restrict fluids to 1000-1200 ml/day), monitor intake and output, daily weights, monitor labs, diuretics

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51
Q

small particles

A

Na
Cl
K

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52
Q

different types of isotonic IV solutions

A
  • D5W
  • 0.9% NaCl or NS
  • Lactated Ringer’s; LR
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53
Q

uses of D5W

A

fluid loss and dehydration

- should never be used as a primary IV fluid

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54
Q

special considerations for D5W

A

solution is isotonic initially, becomes hypotonic when dextrose is metabolized

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55
Q

cautions of D5W

A

may cause:

  • hyperglycemia (high bloos sugar) w/ resuscitation
  • fluid overload in renal and cardiac disease
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56
Q

uses of 0.9% NaCl or NS

A

shock, blood transfusions, resuscitation, fluid challenges, hypercalcemia, dehydration

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57
Q

special considerations of 0.9% NaCl or NS

A
  • 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
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58
Q

uses of Lactated Ringer’s; LR

A

burns, lower GI tract fluid loss, acute blood loss

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59
Q

special considerations of Lactated Ringer’s; LR

A
  • 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
Q

excess Na in proportion in water, high serum osmolality

A

hypertonic fluid volume deficit (cellular dehydration)

61
Q

labs for hypertonic fluid volume deficit

A 
serum osm: high
Na: high 
Cl: high
K: low
BUN: high
Cr: N
Hct: high
Hgb: high
urine output: low 
Sp Gr: high
62
Q

treatment for hypertonic fluid volume deficit

A

decreasing Na and replacing water with hypotonic IV fluids

63
Q

hypotonic IV solution

A
  • 0.45% NaCl; 1/2 NS
64
Q

use of hypotonic solutions

A
  • water replacement

- hypertonic dehydration (hypertonic fluid volume deficit)

65
Q

special considerations for hypotonic IV solutions

A

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
Q

contraindications of hypotonic IV solutions

A

head trauma, or neurosurgery, strokes

67
Q

low Na in proportion to water, low serum osmolality

A

hypotonic fluid volume excess (cellular overhydration)

68
Q

labs for hypotonic fluid volume excess (cellular overhydration)

A 
serum osm: low 
Na: low 
Cl: low 
K: high 
BUN: low 
Cr: N
Hgb: low 
Hct: low 
urine output: high
Sp Gr: low
69
Q

hypertonic IV solution

A

3% NS

- only administered in ICU

70
Q

use of hypertonic IV solution

A

hypotonic overhydration (hypotonic fluid volume excess)

71
Q

special considerations for hypertonic solutions

A
  • 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
Q

classifications of edema

A
  • localized
  • generalized
  • dependent
  • third space shifting
73
Q

Edema

- sprain or organ system (brain, lungs, heart, peritoneal cavity)

A

localized

74
Q

Edema

- more uniform distribution in interstitial spaces

A

generalized

75
Q

Edema

- gravity dependent areas (legs, sacral area)

A

dependent

76
Q

Edema
- excess fluid trapped in interstitial spaces, causing extreme changes in capillary permeability. cells may become dehydrated

A

third space shifting

77
Q

causes of third space shifting (4)

A
  • increased hydrostatic pressure
  • decreased blood osmotic pressure
  • increased capillary membrane permeability
  • lymphatic obstruction
78
Q

symptoms of edema

A

acute weight gain, edema in dependent areas

79
Q

treatment of edema

A
  • 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
Q

normal sodium level

A

135-145 mEq/L

81
Q

sodium is directly regulated by?

A

aldosterone

82
Q

sodium is indirectly regulated by?

A

ADH, ANP

83
Q

sodium deals with what system?

A

nervous system

84
Q

functions of sodium

A
  • regulates osmotic pressure in ECF
  • transmits nerve & fiber impulses
  • combines w/ bicarb & Cl to regulate acid/base in kidneys
85
Q

hyponatremia level

A

< 135 mEq/L

86
Q

describe characteristics of hyponatremia

A 
low Na; high H2O
cell swells (water moves into the cell)
87
Q

causes of hyponatremia

A
  • 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
Q

symptoms of hyponatremia

A
  • 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
Q

treatment of hyponatremia

A

restrict fluids, oral sodium replacement, use of IV fluids cautiously (hypertonic), avoid hypotonic fluids

90
Q

hypernatremia level

A

> 145 mEq/L

91
Q

hypernatremia characteristics

A 
high Na; low H2O
cell shrink (water moves out of cell)
92
Q

causes of hypernatremia

A
  • 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
Q

symptoms of hypernatremia

A
  • 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
Q

labs for hypernatremia

A

Na level above 145, increased Cl, decreased K, increased serum osmolality, increased hematocrit, increased BUN, urine output decreased, specific gravity increased

95
Q

treatment for hypernatremia

A

increase water intake, decreased Na intake, hypotonic IV fluids

96
Q

normal chloride level

A

96-106 mEq/L

97
Q

regulation of chloride

A
  • Cl & Na changes in direct proportion to one another

- Indirectly affected by aldosterone

98
Q

Cl deals with what system ?

A

respiratory system (respirations)

99
Q

functions of chloride

A
  • assists Na in maintaining serum osmolality

- component of hydrochloric acid in stomach, thereby maintaining acid/base balance

100
Q

hypocloremia level

A

< 96 mEq/L

101
Q

causes of hypocloremia

A
  • excessive loss: excessive diarrhea or sweating, burns, fever
  • loss of HCl in GI secretions: NG suctioning, vomiting
  • diuretics: loop and osmotics
102
Q

symptoms of hypocloremia

A

respiratory: shallow, depressed, mimic hyponatremia

103
Q

treatment of hypocloremia

A

increase intake: salty broth, tomato juice, cola, Cl supplements

104
Q

hyperchloremia level

A

> 106 mEq/L

105
Q

causes of hyperchloremia

A
  • increased intake

- dehydration, cushing syndrome, hyperventilation, anemia, renal failure

106
Q

symptoms of hyperchloremia

A

respiratory: rapid, deep, (Kussmaul’s)

107
Q

treatment of hyperchloremia

A

IV: Ringer’s Lactate or Na Bicarb, avoids foods high in Cl

108
Q

normal potassium levels

A

3.5-5.0 mEq/L

109
Q

what 2 systems does potassium deal with?

A

heart & muscles

110
Q

regulation of potassium

A
  • 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
Q

functions of potassium

A

neuromuscular excitability, rate of force of cardiac contractility, acid/base balance

112
Q

hypokalemia range

A

< 3.5 mEq/L

113
Q

causes of hypokalemia

A

inadequate intake, excessive renal loss (diuretics, renal failure - diuretic phase),
excessive GI loss (vomiting, diarrhea, NG suctioning)

114
Q

symptoms of hypokalemia

A
  • cardiac: u waves on EKG
  • skeletal muscles: weakness, fatigue, cramps
  • GI: vomiting
115
Q

treatment for hypokalemia

A

foods high in K, K supplements w/ diuretics (K-dur), IV administration (KCl) 20-40 mEq/L over 1 hr monitored

116
Q

hyperkalemia range

A

> 5.0 mEq/L

117
Q

causes of hyperkalemia

A

excessive intake, cellular damage (burns), inadequate renal loss (renal failure, potassium sparing diuretics, ACE inhibitors)

118
Q

symptoms of hyperkalemia

A

Cardiac: wide QRS, peaked or tall T waves, prolonged PR interval
Muscles: cramping, weakness & flaccid paralysis, digital numbness & tingling
GI: diarrhea

119
Q

treatment of hyperkalemia

A

diuretics, resins (kayexalate), Na Bicarb, calcium chloride

120
Q

regulation of calcium

A

absorbed in sm intestine in presense of Vit D. Vit D promotes absorption, P inhibits

121
Q

parathyroid hormone and calcium

A
  • 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
Q

describe the process of protein binding in relation to calcium

A
  • 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
Q

functions of calcium

A
  • maintains cell structure, function, and permeability
  • cardiac and skeletal muscle contraction
  • blood coagulation
  • structure & function of teeth & bones
  • inverse relationship with P
124
Q

causes of hypocalcemia

A
  • decreased Ca intake, hypoparathyroidism (Ca unable to be mobilized from bone), Vit D deficiency, loop diuretics
125
Q

symptoms of hypocalcemia

A
  • 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
Q

treatment of hypocalcemia

A

calcium gluconate, calcium chloride, magnesium replacement, vit D supplements, increase exercise

127
Q

causes of hypercalcemia

A

excess vit D, excess Ca intake, hyperparathyroidism, prolonged immobilization, thiazide diuretics, chemotherapy agents, blood or bone cancer, renal insufficiency, theophylline

128
Q

symptoms of hypercalcemia

A

renal (flank pain, kidney stones), GI (constipation), neuromuscular (muscle weakness, atrophy, CNS depression, stupor, coma)

129
Q

treatment of hypercalcemia

A

IV normal saline, loop diuretics, foods high in Na, corticosteroids, P salts orally, rectally, or IV

130
Q

calcium has an inverse relationship with

A

phosphate

131
Q

regulation of phosphate

A

review in Ca regulation

  • 80% exists in bone in combination w/ Ca.
  • 1:2 ration of P to Ca
132
Q

functions of phosphate

A
  • essential for generation of bony tissue

- metabolizes glucose & lipids for energy

133
Q

causes of hypophosphatemia

A

decreased intestinal absorption (antacids, severe diarrhea, vit D deficiency, alcoholism), increased renal elimination (hyperparathyroidism)

134
Q

symptoms of hypophosphatemia

A

muscle weakness, bone pain, osteomalacia, anorexia, tremors, hyporeflexia, seizures, bleeding disorders

135
Q

treatment of hypophosphatemia

A

oral phosphate supplements, potassium phosphate

136
Q

causes of hyperphosphatemia

A

impaired elimination (kidney faulure, hypoparathyroidism, hypocalcemia)

137
Q

symptoms of hyperphosphatemia

A

signs of hypocalcemia

138
Q

treatment of hyperphosphatemia

A

dietary restrictions, hemodialysis if chronic renal failure

139
Q

closely related to Ca and P

A

magnesium

140
Q

how much magnesium is contained in bone

A

60%

141
Q

function of magnesium

A
  • 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
Q

causes of hypomagnesemia

A 
impaired intake or absorption (alcoholism, malnutrition, malabsorption, small bowel resection)
increased loss (diuretics, cirrhosis)
143
Q

symptoms of hypomagnesemia

A

tetany, dysrhythmias, muscle tremors

144
Q

treatment of hypomagnesemia

A

Mg replacement: magnesium sulfate

145
Q

causes of hypermagnesemia

A

excess intake (excess mg supplements), stop antacids & laxatives, increase fluid intake, calcium gluconate, mg antagonist

Pathophysiology & Pharmacology (6 decks)

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