Fluid Electrolytes 1 Flashcards
Homeostasis:
Volume and composition of each space
remains constant.
These can impact homeostasis:
- vomiting
-diarrhea
-ace inhibitors
-diuritics
Composition of
Body Fluids Water:
Primary component of body
Accounts for approx 60% of body weight but it varies with age.
Adequate balance is necessary for
- maintenance of temp - elimination of
waste products - all transportation within
body
Factors That
Affect Body
Water
Age is a huge factor.
neonates are made of 80% water vs older adults which is 45%.
Other factors that influence body water are:
The more adipose tissue the less body water you have. The more muscle mass you have the more water you have.
Composition of
Body Fluids Solutes
Electrolytes: Chemical compounds that
develop an ionic charge when dissolved
in water
All body fluids contain electrolytes
Electrolytes
Regulation of electrolyte levels is critical
for:
maintenance of body fluid osmolality
acid balance
neuromuscular function
cell metabolism
Composition of
Body Fluids. Nonelectrolytes
Nonelectrolytes
Do not dissociate in solution
measured by wt
Glucose - Urea - Creatnine - Bilirubin
- Proteins
Amount of plasma in the body :
Plasma: 3L
Interstitial fluid (IF): 10L
Intracellular fluid (ICF): 28L
Body Fluid Compartments. Transcellular
Fluids. (not subject to significant
gains or losses)
They are available in very small amounts so their impact is small.
CSF (cerebrospinal fluid)
GI tract
Pleural (between layers of pleura)
Synovial (between joints)
Peritoneal (in peritoneum)
Fluid Spacing
First spacing
a) Normal distribution of fluid
Second spacing
a) Abnormal accumulation of interstitial fluid
Third spacing
a) Abnormal accumulation in areas that
have no or little amt of fluid
b) Fluid unavailable for use
Movement of
Body Fluids
1) Fluid constantly moves among intracellular,
interstitial and vascular spaces to maintain
body fluid balance
2) Moves through permeable membranes
- permits movement of water and some
solutes
3) Normally ICF and ECF are isotonic with
each other
Osmosis
Osmosis stops when equilibrium is reached
Major force in body fluid movement
Important to consider with IV therapy
Movement of
Body Fluids
Osmotic Pressure: It is specific to water and it means the movement of water from an area of low concentration of a solute to an area that has a higher consecration of solutes.
Refers to pulling power of a solution for
water
The higher the osmolality of a solution,
greater pulling power for water
Oncotic Pressure (it is a form of somotic pressure)
Refers to pulling force exerted by colloids
Diffusion
Diffusion is the movement of molecules from a region of higher concentration to a region of lower concentration (Sugar cube in coffee)
Facilitated Diffusion (glucose)
Facilitated diffusion is the diffusion of solutes through transport proteins in the plasma membrane. Facilitated diffusion is a type of passive transport. Even though facilitated diffusion involves transport proteins, it is still passive transport because the solute is moving down the concentration gradient.
Movement of
Body Fluids: Filtration
Movement of fluids and solutes from an area of
high hydrostatic pressure to an area of low
hydrostatic pressure into or out of the
capillary
Dependent on forces favoring filtration &
opposing it
Think of it as a tug of
war - pushing and pulling
Net Filtration
A) Forces favoring filtration
Capillary hydrostatic pressure (blood pressure) Straw
Interstitial oncotic pressure (water being pulled by the proteins in the interstitial fluid)
B) Forces favoring reabsorption
Plasma oncotic pressure (water being pulled by albumin the BV)
Interstitial hydrostatic pressure from interstitial space to BV
Fluid Shifts: Interstitial fluid to plasma
Interstitial fluid to plasma (meaning BV )
Fluid is drawn into plasma space whenever there is an increase in plasma osmotic or oncotic pressure
Wearing of compression stockings or hose is a therapeutic action on this effect
Movement of
Body Fluids. Active Transport
Movement of solute from an area of lower
solute concentration to an area of higher solute concentration
Depends on ATP so if you have inadequate phosphate then you run the risk of not having enough ATP which is requires for energy
Example is Sodium- Potassium pump.
Renin-
Angiotensin (From Lippincott, Williams & Wilkins,
Check slide 22
(From Lippincott, Williams & Wilkins,
F&E Made Incredibly Easy Retrieved
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Aldosterone(From Lippincott, Williams &
Wilkins, F&E Made Incredibly
Easy) Check slide 23
Regulation of
Body Fluids. Antidiuretic
Hormone (ADH)
Hormone synthesized by hypothalamus stored and Secreted by the posterior pituitary
Regulation of Body Fluids
Thirst Mechanism:
1) Stimulated by thirst receptors in
hypothalamus
2) Primary protection against
hyperosmolality
3) Normally occurs with even
small fluid losses
4) Stimulates the release of ADH and
aldosterone
5) Depressed in older people: and this puts them at risk for hyper osmolarity and therefore hypernatrimia. It is important to monitor for I/O and have water stations.
Regulation of
Body Fluids check slide
Atrial Natriuretic Peptide (ANP)
Atrial Natriuretic Peptide (ANP). One liter of
water weighs:
2.2lbs/1kg
Fluid Losses: Kidneys: Primary regulators Primary regulators
of fluid and electrolyte of fluid and electrolyte
balance
pprox 1500ml urine
excreted/day
Fluid Losses. Skin
Ave of 500 - 600ml of
sensible & insensible fluid sensible & insensible fluid
lost via skin each day (Can lost via skin each day (Can
be as great as 2l/hr)
Fluid Losses. Lungs
Approx 400ml insensible
fluid
Fluid Losses. G.I. Tract
100-200ml
Fluid Losses. Abnormal Losses
varied
Fluid Losses. Third Space Losses
Unavailable
Fluid Volume Excess. Causes of FVE
1- Renal Disease
2- Too rapid infusion of IV fluids
3- Steroid Therapy
4- Production of ADH
5- Cardiac Disease
Brawny Edema
A change typical of chronic venous insufficiency, characterized by: thickening, induration, lipodermatosclerosis and non-pitting edema stopping above the ankle. the brawny color is due to hemosiderin from lysed red blood cells (RBCs) with chronic ischemia.
Fluid Volume Deficit. Causes of FVD
1- NPO
2- Drains
3- Surgery
4- Blood loss
5- Fluid loss from GI tract
6- Profuse sweating
7- polyuria
8- fever
9- third spacing
10- Decreased intake
What is crenation ?
When the cell shrinks
Most of the oxygen is inside the cell or outside the cell in the human body ?
Inside the cell
What is ascites ?
it is a condition in which fluid collects in spaces in your abdomen. Usually it accumulates in the peritoneal space. like the woman who runs the lake in oakland. She has a belly but she is not pregnant.
Second spacing example ?
If you have a pt who has an increased BP and have been standing for a long time they will get an edema due to fluid leaving the blood vessel and accumulating in the interstitial fluid due to high bp and fighting gravity.
Are the ICF and ECF isotonic with each other ?
Yes unless there is an issue
Oncotic pressure?
It is the same as osmotic pressure but it is stronger because proteins pull harder (this is because they are bigger) It draws more water towards it than other solutes. It is carried out by the protein albumin. This type of pressure helps put fluid back to the vasculature to maintain BP. Coz remember more water in the BV = more pressure and more perfusion
Facilitated diffusion ?
Some solutes can’t move into a cell without help due to the phospholipid bailayer membrane. They require a carrier protein to attach to it and bring it inside the cell then disassociate. A perfect example is glucose which requires insulin to help carry it into the cell.
Hydrostatic pressure
Straw analogy.
Oncotic osmotic pressure is the same as calloid osmotic pressure
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What is an example of active transport ?
The sodium potassium pump. coz atp is used
In renin/ agiotenesin what senses a drop in BP ?
The Glomerulus
What cells secrete the enzyme renin after receiving a signal by the glomerulus?
The justaglumerular cells.
Explain the Renin angiotenisin system.
What do ACE inhibitos do ?
They prevent renin which is an enzyme from producing angiotensin 2 to (Ace inhibitor medications are used to lower BP)
What does ACE mean ?
It is an acronym for angiotenesin converting enzyme which in this case rennin
what is an example of an ACE inhibitor ?
Lisnopril: It helps block ACE (Rennin) which in turn helps the production of angiotenesin 2 which in turn blocks the production aldosterone. This causes the body not to hold on to NA and therefore water which causes a decrease in BP.
What happens to K when aldosterone in released and H2O and NA are retained?
K levels go down due to excretion.
So more aldosterone means more NA and less K
Is the thirst mechanism the primary protection against hyperosmolarity ?
Yes.
What is another name for ADH?
Vasopressin
What is ADH where is made, stored and what stimulates its secrition.
Antidiuritic hormone. made in the hypothalamus and stored and secreted by the posterior pituitary gland when it senses an increase in osmolality.
Chemical compounds that
develop an ionic charge when dissolved
in water
Electrolytes
All body fluids contain
Electrolytes
Accounts for approx 60% of body weight
water
Do not dissociate in solution
Nonelectrolytes
Glucose - Urea - Creatnine - Bilirubin and Proteins are examples of ?
Nonelectrolytes
They are available in very small amounts so their impact is small.
Transcellular
Fluids. (not subject to significant
gains or losses)
Osmotic Pressure aka as osmosis?
It is specific to water and it means the movement of water from an area of low concentration of a solute to an area that has a higher consecration of solutes.
facilitated diffusion requires a source of ATP.
no
Simple diffusion does not require energy
yes
Causes the kidneys to retain water but not sodium NA to decrease osmolality
ADH
SIADH
syndrome of innapropriate secrition of the antidiuritic hormone (Too much release of ADH)
Running a marathon can cause SIADH because ?
you keep drinking water but you are not replacing the sodium which leads to hyponatrimia
Drugs that interfear with ADH secrition are
coffee or alcohol they act as a diuritic because they turn off our adh hormone. This makes us pee more diluted urine
what conditions can trigger SIADH
pulmonary conditions, lung cancer, pneumonia which causes us to produce to much ADH
In DI very little ADH is produces
true
Dry inside caused by ?
DI diabetes insipidus
Soaked inside caused by ?
SIADH
Definition of DI ?
A state in which we pee a lot coz our body doesn’t produce enough ADH. so what happens is that we pee a lot of water and keep too much sodium which leads to hypernatremia
SIADH causes hypo or hypernatrimia ?
hypo
DI causes hypo or hypernatrimia ?
hyper
causes higher bp, swealling in the brain due to excessive amounts of water in the brain. It causes headaches and it can also cause seizures
SIADH
Stop urination sign of SIADH or DI?
SIADH
Hypoosmolality/ hyponatremia with NA levels less than 135
SIADH
Too much water in the head which means swelling
SIADH
Severe high bp and edema build-up
SIADH
To mitigate SIADH
Stop all fluids. This means no IV or drinking and the exception would be an IV saline with salt. We can also give diuretics to reduce H2O.
decreased Bp
DI
Desmopressin/vasopressin
used for DI
brain damage such as brain surgery, ectopic tumors that secrete ADH (same as cushing syndrome) sepsis, or infections in the brain like meningitis and even pneumonia
DI
Atrial natriuretic hormone ?ANP
A hormone secreted by the atria in the heart due to an increase in BP in the BV. ANP targets the kidneys and causes a decrease in NA reabsorption. + NA exits the body therefore h2o follows it by osmosis. ANP affects BV by causing vasodilation.
ANP increases glomerular filtration by vasodilating the afferent artriole in the nephron which brings blood into the glomerulus therefor increasing the amount of filtrate produced by the kidneys.
yes
other things are done by ANP
- inhibits rennin angiotenesin system
-reduces the secrition of aldosterone by the adrenal cortex in the kidneys
-it releases free fatty acids from adipose tissue
When do you usually see ANP
withh heart failure.
ANP when does it kick in?
only kicks in when there is fluid overload and causes diurises
hyponatremia is the most common chemical imbalance seen in hospital patients.
yes
another thing besides the rennin angiotensin system that can stimulate the release of aldosterone is an increase in K
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Major cation icf
k
Major anion ecf
cl
Major cation ecf
Na
ACE inhibitors
they are diuretics
Lisinopril is an ACE inhibitor
makes you pee
Ca
Major ecf cation
when you think of calcium you think?
muscle contractions and action potentials (so neuromuscular) and some heart arrhythmias
85 % of phosphorus is in bones 14 in soft tissues and of the remaining 1% the majority is in the ICF
oui
Most abundant extracellular anion
Cl
Most abundant extracellular cat
NA
makes up for two-thirds plasma anions
Cl
Normal serum values 100-106 mEq/L
CL
mainly in stomach as hydrochloric acid. HCl
Cl
Major cation in ICF
k
if we are going to hold on to NA
K will be excreted and viceversa
it helps drive K into the cell
insulin
furosemide/Lasix
loop diuretic (furosemide/Lasix it gets rid of K+)
Primary anion found in intracellular fluid
PO 3− 4
Activates enzymes involved in the metabolism of CHO & protein
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