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Pharmacology and Pathophysiology Own notes > Fluids, acids, & electrolytes > Flashcards

Fluids, acids, & electrolytes Flashcards

1
Q

a solvent that dissolves and transports body salts, nutrients, and wastes.

A

water

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2
Q

What does water regulate?

A

Water regulates body temperature, lubricates joints and membranes, and is the medium for food digestion

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3
Q

Total body water is expressed as a percentage (%) of body weight; I litre of water = ??

A

1 litre of water= 1kg (2.2lbs)

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4
Q

What is the percentage of water found in each of the following:
Adults
Infants
Older adults

A

Adults: 60%
Infants: 70-80%
Older adults: 45-55%

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5
Q

The intracellular fluid accounts for what percentage of body mass?

A

42%

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6
Q

What are the two types of extracellular fluid?

A

interstitial

intravascular

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7
Q

space between cells and outside blood vessels (15% TBW)

A

interstitial

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8
Q

plasma - the fluid component of the blood vessels (5% TBW)

A

Intravascular

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9
Q

the extracellular fluid makes up what percentage of body mass?

A

20%

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10
Q

What is transcellular fluid?

A

fluid found in the cerebrospinal, gastric, pleural, synovial, peritoneal fluids

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11
Q

occurs when too much fluid moves from the intravascular space (blood vessels) into the interstitial or “third” space-the nonfunctional area between cells

A

third spacing

can cause hypotension, edema and reduced cardiac output

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12
Q

What is the total daily intake (mL) and totally daily output for water?

A

intake: 2400-3200
output: 2400-3200

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13
Q

What are electrolytes?

A

Substances whose molecules dissociate or split when placed in solution

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14
Q

What are electrolytes composed of?

A

ions

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15
Q

What is an ion?

A

electrically charged particles

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16
Q

What is a cation?

A

positively charged ions

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17
Q

What are some examples of cations?

A

Sodium (Na+)
Potassium (K+)
Calcium (Ca2+)
Magnesium (Mg2+)

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18
Q

What are anions?

A

negavtiely charged ions

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19
Q

What are some examples of anions?

A

Bicarbonate (HCO-3)
Chloride (Cl-)
Phosphate (PO3-

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20
Q

Most proteins bare what type of charge? What does this classify them as?

A

Negative; anions

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21
Q

What is the international standard for measuring electrolytes?

A

Milliemoles (mmo/L)

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22
Q

substance that is capable of dissolving a solute(liquid or gas

A

solvent

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23
Q

homogenous mixture of solutes dissolved in a solvent

Solute: substance that is dissolved in a solvent

A

solution

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24
Q

a substance that is dissolved in a solvent

A

solute

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25
Q

What is the most prevalent cation in intracellular fluid?

A

potassium

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26
Q

What is the most prevalent anion in intracellular fluid?

A

phosphate

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27
Q

What is the most prevalent anion in extracellular fluid?

A

chloride

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28
Q

Plasma has a substantial amount of this.

A

protein

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29
Q

all fluid that resides inside the cell is known as?

A

intracellular fluid

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30
Q

all fluid that resides outside the cell is known as?

A

extracellular fluid

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31
Q

In all fluids, which has the greatest amount of protein?

A

intracellular fluid of ICF

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32
Q

What is diffusion?

A

the movement of molecules from an area of high concentration to an area of low concentration

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33
Q

What type of permeability must the membrane have in order for diffusion to occur?

A

must be permeable

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34
Q

What type of energy is required for diffusion?

A

no energy

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35
Q

What is facilitated diffusion?

A

the movement of molecules from an area of high concentration to an area of low concentration BUT they need carrier molecule to facilitate the rate of diffusion

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36
Q

What is active transport?

A

a process requiring energy in which molecules move against the concentration gradient

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37
Q

during active transport, _________ moves out of the cell and _______ moves in the cell to maintain its concentration difference

A

sodium; potassium

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38
Q

what is the energy source for the sodium potassium pump and where is it produced?

A

Adenosine triphosphate (ATP)

mitochondria

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39
Q

What is osmosis?

A

Movement of water between two compartments separated by a membrane permeable to water but not to solutes

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40
Q

In osmosis, water moves from an area of _____ solute to _____ solute

A

low; high

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41
Q

Does osmosis require energy? How does this process stop?

A

No.

When the concentration gradient is equal OR hydrostatic pressure is high enough to oppose water movement

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42
Q

measures milliosmoles of solute per volume solution. (ie. mOsm/Liter of water) VOLUME

A

Osmolarity

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43
Q

this measurement of solute per volume is used to describe fluids outside the body (IV soln., meds)

A

osmolarity

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44
Q

measures osmotic force in terms of unit of weight of solution (ie. mmol/kg of water) WEIGHT

A

Osmolality

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45
Q

this measurement of force is used to describe fluids inside the body

} Body fluids concentration = individual’s hydration status
} aka - tonicity

A

osmolality

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46
Q

What is osmolality typically test for?

A

the concentration of proteins, glucose & AMP; lipids in plasma or urine

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47
Q

What does osmolality indicate?

A

indicates the water balance of the body

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48
Q

What is the normal plasma osmolality between?

A

♣ 285 and 295 mmol/kg

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49
Q

What are the major determinants of plasma osmolality?

A

♣ Glucose, sodium, and urea calculate the effective plasma osmolality based on the concentrations of those compounds

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50
Q

fluids with the same osmolality as the cell interior

A

isotonic fluid (same inside and outside cell)

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51
Q

fluids with less concentration of solutes (hypo-osmolar) than the cell interior

A

Hypotonic Fluid (cell expands)

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52
Q

fluids with higher concentration of solutes (hyper-osmolar) than the cell interior

A

hypertonic fluid (cell shrinks)

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53
Q

The ECF and the ICF are isotonic or hypotonic to one another? What does this create?

A
  • isotonic

- zero net movement occurs because it is equal

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54
Q

What happens if a cell is surrounded by hypotonic fluid?

A

♣ Water moves into the cell, causing it to swell with potential to burst

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55
Q

What happens if a cell is surrounded by hypertonic fluid?

A

♣ Water moves out of the cell to dilute the ECF; the cell shrinks and may eventually die

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56
Q

Movement of water, nutrients and waste between intravascular and interstitial spaces occurs due to changes in these pressure systems.

A 
hydrostatic 
osmotic (oncotic) pressure
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57
Q

What is the major force of hydrostatic pressure?

A

the pressure of water pushing out of the intravascular system at the capillary level

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58
Q

What is the major force of osmotic (oncotic) pressure?

A

proteins or colloids

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59
Q

What is the major colloid in the vascular system that contributes to the total osmotic pressure?

A

proteins

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60
Q

♣ What are protein molecules attracted to and what do they do with it during oncotic pressure?

A

Water; pull fluid from tissue space to the intravascular space (blood vessels)

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61
Q

♣ What causes the movement of fluid to move out of the capillaries to interstitial space?

A

Capillary hydrostatic pressure (BP)

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62
Q

What causes the movement of fluids from the interstitial space into the capillaries?

A

interstitial hydrostatic pressure

63
Q

What occurs at the arterial end of the capillary?

A

Hydrostatic (capillary) pressure exceeds osmotic (plasma) pressure and fluid is moved into the interstitium

64
Q

What occurs at the venous end of the capillary?

A

fluid is drawn back into the capillary by the osmotic pressure created by plasma proteins

65
Q

What is it called when any fluid moves out of the capillaries into interstitial space?

A

filtration

66
Q

What is it called when any fluid moves into capillaries from the interstitial space?

A

reabsorption

67
Q

What fluid shifts can cause edema?

A
  • venous hydrostatic pressure rises
  • plasma oncotic pressure decreases
  • interstitial oncotic pressure rises
68
Q

What occurs when there is an increase of venous hydrostatic pressure?

A

Increase in the pressure at the venous end of the capillary inhibits fluid movement back into the capillary

Causes: congestive heart failure, liver failure, obstruction of the venous vein return to the heart

69
Q

What occurs when there is a decrease in plasma omostic pressure?

A

Fluid remains in the interstitium if the plasma oncotic pressure is too low to draw fluid back into the capillaries

♣ Causes: renal disorders, deficient protein synthesis or protein intake

70
Q

What happens when there is increased ECF Osmolality?

A

water shifts out of cells until the ECF and ICF have similar osmolality; causes cells to shrink

71
Q

What happens when there is decreased ECF Osmolality?

A

water shifts into cells until the ECF and ICF have similar osmolality; causing cells to swell

72
Q

BODY FLUID EXCESS=

_______ plasma OSMOLALITY

73
Q

BODY FLUID DEFICIT=________ PLASMA OSMOLALITY

74
Q

What is fluid spacing?

A

a term used to describe the distribution of body water

75
Q

What is first spacing?

A

♣ First spacing; describes the normal distribution of fluid in the ICF and ECF compartments

76
Q

What is second spacing?

A

♣ Second spacing: an abnormal accumulation of interstitial fluid (edema)

77
Q

What is third spacing?

A

♣ Third spacing: occurs when fluid accumulates in a portion of the body from which it is not easily exchange with the rest of the ECF, rendering the fluid trapped and unavailable for functional use

78
Q

What are some examples of third spacing?

A

♣ Ascites, sequestrastion of fluid in the abdominal cavity with peritonitis, and edema associated with burns

79
Q

A fluid deficit or increase in plasma osmolality is sensed by these receptors.

A

hypothalamic osmoreceptors

80
Q

What do hypothalamic osmoreceptors do?

A

stimulate thirst and ADH release

81
Q

Where does water reabsorption occur in the kidneys?

A

♣ Renal distal and collecting tubules

82
Q

What two actions increase free water in the body and decrease plasma osmolality?

A

ADH and thirst

83
Q

This hormone causes the distal tubule’s in the collecting ducks in the kidneys to regulate water retention by becoming more _________ to water

A

♣ ADH; permeable

84
Q

Where does water go once absorbed from the tubular filtrate in the kidneys?

A

the bladder

85
Q

what are some factors that stimulate ADH release?

A

Plasma osmolality, stress, nausea, nicotine, morphine

86
Q

What is SIADH? Syndrome of inappropriate ADH

A

Abnormal ADH production in CNS disorders (brain tumors, brain injury), malignancies (small cell lung CA)

87
Q

This disorder is a result from abnormal water retention, decreased plasma osmolality and increased urine osmolality with decreased urine output

88
Q

This disease has an abnormal reduction in the release or action of ADH where the renal tubules and collecting ducts do not reabsorb water, resulting in
copious amounts of dilute urine

A

Diabetes Insipidus

89
Q

These hormones primarily have an anti-inflammatory effect and increase serum glucose levels

A

Glucocorticoids

90
Q

What is an example of Glucocorticoids?

91
Q

These hormones enhances sodium retention and potassium excretion

A

Mineralocorticoids:

92
Q

Give an example of Mineralocorticoids.

A

aldosterone

93
Q

What occurs when sodium is re-absorbed in the cells?

A

Water follows because of osmotic change

94
Q

In large doses, this hormone acts like a mineralocorticoid; when large doses are released in response to stress, they exert Na+ and water retention action.

95
Q

What is/are the primary organ/s for regulating fluid and electrolyte balance?

96
Q

What is serum?

A

blood plasma not containing fibrinogens

97
Q

What is the result of the release of hormone Atrial Natriuretic factor (ANF) by the atria in response to increased atrial pressure?

A

decreased blood volume due to vasodilation and increased urinary exertion of Na+

98
Q

What system accounts for mot of the fluid intake?

99
Q

What is the invisible evaporation of fluid from the lungs and skin (not sweat from sweat glands – this is sensible perspiration d/t fever, high environmental temperatures)
known as?

A

insensible water loss

100
Q

What is the normal insensible water loss?

A

900mL daily

101
Q

Mild fluid and electrolyte imbalances can be corrected with oral rehydration solutions containing these.

A

water, lytes, glucose

102
Q

What are the three classifications of solutions?

A

isotonic
hypotonic
hypertonic

103
Q

What Iv solution has the same osmolality or concentration of solutes as ICF or ECF
280-300 mOsm/L (same as serum)

104
Q

What IV has a lower concentration of solutes =
more dilute than ICF or ECF
< 280 mOsm/L

A

Hypotonic Solution:

105
Q

What IV has a higher concentration of solutes = more concentrated than ICF or ECF
> 300 mOsm/L

A

Hypertonic Solution

106
Q

Isotonic IV solutions expand the ICF or the ECF?

A

ECF (intravascular, interstitial)

107
Q

What is the indication for using isotonic solutions?

A

fluid replacement for ECF volume deficit

108
Q

What are the solutions for using an isotonic solution when there is ECF volume deficit?

A
  • lactated ringers
  • normal saline (NS-0.9% NaCl)
  • dextrose 5% in water (isotonic in the bag, hypotonic in the bloodstream)
109
Q

Where do IV isotonic solutions stay when infused?

A

they stay where they are infused, in the intravascular space

110
Q

What are the risks associated with isotonic IV solutions?

A

fluid overload, esp. with older adults, CHF

111
Q

What element manages the osmotic balance of the ECF?

A

Na+ sodium

112
Q

What element manages the osmotic balance of the ICF?

A

potassium K+

113
Q

What is hypernatremia?

A

♣ An electrolyte problem that is defined as a rise in serum sodium concentration to a value exceeding 145 mmol/L.

114
Q

♣ What is the primary protection against the development of hyperosmolality?

A

Thirst; as plasma osmolality increase, the thirst center in the hypothalamus is sitmluated, and the individual seeks fluid

115
Q

What are other causes of hypernatremia?

A
  • sodium gain (IV administration of hypertonic saline or sodium bicarbonate), deficit in ADH, mannitol, decrease in kidney response to ADH
116
Q

This electrolyte problem is defined as a hyperosmolar or condition caused by a decrease in total water relative to electrolyte content

A

hypernatremia

117
Q

What is hyponatremia?

A

♣ An electrolyte problem that results from loss of sodium containing fluids or from water excess

118
Q

What can come from hyponatremia?

A

extracellular hyposmolality

119
Q

What causes hyponatrmeia?

A

♣ it can be caused by water excess and inappropriate use of sodium-free or hypotonic IV fluids.

120
Q

What percentage does Potassium is in ICF?

121
Q

♣ The sodium-potassium pump maintaints 140 mmol/L of potassium in the body by pumping ________ into the cell and _________ out of the cell.

A

o Potassium; sodium

122
Q

♣ What type of osmolality does potassium regulate?

A

o Intracellular osmolality and promotes cellular growth

123
Q

♣ How do the kidneys regulate the ECF concentrations of sodium?

A

The kidneys excrete or retain water under the influence of ADH (antidiuretic hormone)

124
Q

What is hyperkalemia?

A

♣ High serum potassium

125
Q

What causes hyperkalemia?

A

A massive intake of potassium, impaired renal excretion, shift of potassium from the ICF to the ECF, or a combination of these factors
o

126
Q

What is the most common cause of hyperkalemia?

A

kidney failure

127
Q

This condition is associated with the shift of potassium ions from the ICF to the ECF as hydrogen ions move into the cell, producing large amounts of acids.

A

metabolic acidosis

128
Q

What are some clinical complications of metabolic acidosis?

A

causes membrane depolarization, altering cell excitability. Skeletal muscles become paralyzed or weak
o cramping, leg pain
o ventricular fibrillation or cardiac standstill may occur
o dysrhythmia

129
Q

What are the treatments for someone with metabolic acidosis?

A
  • Treated by illuminating oral and parenteral potassium intake
  • The use of diuretics and increased fluid intake
  • Force potassium from the ECF to the ICF vi IV insulin
  • Administer calcium gluconate intravenously
130
Q

how many moles of sodium are in the body?

A

135-155 mmol/L

131
Q

how many moles of potassium are in the body?

A

3.5-5.0 mmol/L

132
Q

What is the primary intracellular cation?

133
Q

What percentage does potassium make up in the ICF?

A

98% ((ICF 150-160 mEq/L vs. ECF 3.5-5.0 mEq/L))

134
Q

What is potassium maintained by?

A

sodium-potassium pumps

135
Q

potassium is primarily excreted by what?

A

the kidneys

136
Q

What are some functions of potassium?

A
  • Regulates ICF osmolality and fluid balance
  • Regulates intracellular neutrality in relation to H+ and Na+
  • Deposits glycogen and glucose in the liver and muscles
  • Maintains the resting potential in the transmission/conduction of nerve impulses
  • Maintains normal cardiac rhythm
  • Maintains contraction of skeletal and smooth muscle
137
Q

Serum Ca2+ has an inverse relationship with which element or compound?

A

PO4- phosphate

138
Q

What are some functions of calcium?

A
  • Transmission of nerve impulses
  • Muscle contraction including the myocardium
  • Blood clotting
  • Formation of teeth and bones
139
Q

What are the three types of serum

A

Free or ionized Ca2+ – biologically active

Bound to protein - albumin

Complexed with phosphate, citrate, carbonate

140
Q

What are the functions of phosphate?

A

Essential to function of muscle

  • RBCs, nervous system
  • Acid-base balance
  • Energy production (ATP)
141
Q

What is the second most abundant intracellular cation?

142
Q

Where is 50-60% of magnesium stored?

143
Q

How is magnesium regulated?

A

by the GI absorption and renal exertion

144
Q

This element influences Mg2+ balance, and the manifestations of these imbalances mimic each other

145
Q

What are some functions of magnesium?

A
  • Assists in metabolism of protein and carbohydrates
  • Smooth muscle contraction/relaxation
  • Important for cardiac function
146
Q

Sodium has an inverse relationship with what element in the kidneys?

A

potassium K+

147
Q

What is an inverse relationship?

A

one in which one molecule decreases the other increases

148
Q

♣ Potassium is critical for many cellular and metabolic functions. What are these fucntions?

A

o The transmission and conduction of nerve impulses, maintenance of normal cardiac rhythms, and skeletal and smooth muscle contractions

149
Q

this solutions push fluids into the cells and interstitial spaces

A

Hypotonic solutions

150
Q

this solution pull fluids from the cells and interstitial space into the intravascular space.

A

hypertonic solutions

151
Q

what are some risks of hypertonic solutions?

A

fluid overload, cellular dehydration

152
Q

normal sodium levels

A

135-145 mmol/L

153
Q

normal potassium levels

A

3.5-5.0 mmol/L

Pharmacology and Pathophysiology Own notes (9 decks)

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