Fluids and Electrolytes Flashcards
What percentage of body weight is fluid in the adult?
60%
What percentage of body weight is fluid in the child?
75%
Body Fluid is water with
chemical compounds (electrolytes), & Blood cells
Body regulates 2 things to achieve balance:
- The volume of fluid in extracellular space
2. The water concentration of solutes (osmolarity) of all body fluids
Fluid Compartment within the cell
Intracellular
Fluid Compartment within the GI tract and eye
Transcellular
The fluid in here is water
Intracellular
All the fluid found outside of the cell
Extracellular
ECF broken into 2 spaces
Intravascular
Interstitial
To maintain balance of ECF btwn vascular & interstitial spaces depends on 3 things
Protein content of the blood
Integrity of the vascular endothelium
Hydrostatic pressure
Most important & regulated aspect of fluid balance
Vascular volume
Prolonged periods of low BP is called
Shock
Normal Body functioning depends upon
fluid & electrolyte balance
Most important aspect of body fluid is
volume
Fluid compartment with minimal amount of fluid
Transcellular
Fluid compartment that accounts for 2/3 of body
intracellular
Fluid compartment that accounts for 1/3 of body
Extracellular
ECF Space in vessels
intravascular
ECF Space between cells
interstitial
fluid compartment that resembles plasma
interstitial
ECF space that contains sodium, chloride, and bicarbonate
interstitial
Without fluid volume there is no…
Blood Pressure
ADH
Antidiuretic hormone
In a child, one large stool can
cause fluid imbalance
Fluid and electrolyte balance must be maintained for
survival
Water maintains…
blood volume, body temp, and elimination
liquid portion of blood
plasma
fluid compartment that has plasma
intravascular
hypovolemia
fluid volume deficit
Plasma is 0.9% or
normal saline and electrolytes
To maintain balance of ECF between vascular & interstitial spaces depends on 3 things
Protein content of the blood
Integrity of the vascular endothelium
Hydrostatic pressure
Protein in blood is needed for
balance
ECF keeps fluid in
vessels
Protein content of blood
albumin and globulin
Pressure within the vessels that tries to push fluids out
hydrostatic pressure
the minimum pressure which needs to be applied to a solution to prevent the inward flow of its pure solvent across a semipermeable membrane
osmostic pressure
If a person is in shock there is no
perfusion
most important & regulated aspect of fluid balance
Vascular volume
when there is not adequate volume, blood pressure will
Drop
What 3 things Regulate and control Volume?
Baroreceptors or stretch receptors in the vasculature
The renin – Angiotensin –Aldosterone System
Kidney’s, Lungs, & Adrenal glands
Natriuretic Peptide Hormone System (ANP)
ANP is released to help reduce volume by….
increasing sodium
Amino Acids are produced by
the cardiac atrium
an increase in volume triggers
ANP
The cardiac hormone whose main function is to lower blood pressure and to control electrolyte homeostasis .
atrial natriuretic hormone (ANP)
ANP
Natriuretic Peptide Hormone System
Shock is characterized by
Weak, thready tachycardia
pale, clammy skin
Decreased volume causes Renin from kidneys
to split angiotensinogen (produced by the liver)
angiotensinogen is produced by
the liver
Located in the major arteries and responds to stretching of arteries and monitors vascular volume
Baroreceptors
Decreased volume causes:
Angiotensin I is further converted by the lungs to II which causes
vasoconstriction
Decreased volume causes:
Angiotensin II stimulates secretion of Aldosterone which causes
sodium & H2O reabsorption by the kidneys.
Aldosterone is secreted by the.
adrenal glands
ICF Volume:
Water moves freely across the cell membrane &
Electrolytes move with active transport
Cells with too Much water
swell and burst
Cell with too Little water
shrivel and die
Fluids and the balance of electrolytes takes place in a ________ environment
ALKALINE
The PH range is
7.37-7.43
this is necessary for cellular metabolism
Normal ph range 7.37-7.43
PH is determined by
H+ ions
Acid, donates H+ ions to a solution while a Base is
a substance which decreases H+ ions in a solution.
Refers to the concentration of dissolved particles in a given weight of fluid (kilogram)
Osmolality
Concentration of dissolved substances in volume of fluid
Osmolarity
Cells in the brain monitor changes in
Body fluid osmolality
Cells respond by varying the secretion of
ADH
ADH Keeps water
Balanced
All body fluids contain
ELECTROLYTES
Compounds that in solution can conduct an electric charge
Electrolytes
In a solution, electrolytes break into charged particles called
Ions
Types of ions
+ & - ions
Electrolytes are measured in
mEq/liter
ADH is secreted when needed by the
hypothalamus
Occurs when the concentration of sodium in your blood is abnormally low .
Hyponatremia
A high concentration of sodium in the blood.
Hypernatremia
Positively charged ions are
Cations
Negatively charged ions are
Anions
What does maintaining electrolyte balance mean??
If one electrolyte moves out of a cell, another must take it’s place
All electrolytes have these general functions:
Promote neuromuscular irritability
Maintain body fluid volume & osmolality
Distribute water between compartments
Regulate acid-base balance
Controls/regulates volume of body fluids
Na+ (sodium)
Regulator of enzymes & H2O content
K+ (potassium)
Controls nerve impulse, blood clotting, muscle contraction, B12 absorption
Ca2+ (calcium ion)
Controls metabolism of carbohydrates & proteins, vital actions involving enzymes
Mg2+ (Magnesium ion)
Maintains osmotic pressure in blood, produces hydrochloric acid
Cl- (chloride ion)
Body’s primary buffer system
HCO3- (bicarbonate ion)
chemical involving cell division, energy metabolism, and hereditary traits
Phosphorus
Normal sodium level is
135 to 145 mEq/L
Na+
Sodium
Normal potassium level is
3.5 to 5.0 mEq/L
K+
Potassium
Normal calcium level is
8.9 to 10.1 mEq/L
Ca2+
Calcium
Normal magnesium level is
1.4 to 1.75 mEq/L
Mg2+
Magnesium
Normal Chloride level is
96 to 106 mEq/L
Cl-
Chloride
Normal Bicarbonate level is
22 to 26 mEq/L
HCO3-
Bicarbonate
Normal Phosphate level is
2.5 to 4.5 mEq/L
Insulin transports
potassium
Diabetics may have too much
potassium
Fluid movement occurs primarily by
Osmosis & Filtration
Osmosis & Filtration goes from
lower to higher
Electrolytes move via
diffusion, filtration & active transport
diffusion, filtration & active transport goes from
higher to lower
Types of passive transport
diffusion, filtration, and osmosis
Movement of solvent or solutes (molecule) move from an area of higher concentration to lesser concentration
Diffusion
Movement of fluid through a semi permeable membrane
Osmosis
A condition in which the blood has a high concentration of salt (sodium), glucose, and other substances.
Hyperosmolar
An abnormal decrease in the osmolarity of the body fluids.
Hypoosmolar
Transfer of water and dissolved substances through a permeable membrane
Filtration
Occurs within the kidney’s glomerular capillaries
Filtration
This is the energy required to move substances through the membrane(lesser to greater concentration- the Na K in the cell( sodium –potassium pump)
Active Transport
Prevents too much sodium in the cell so the cell won’t burst
Active transport
Force of attraction for water by undissolved particles helps keep fluid within blood vessels
Osmotic Pressure
Plasma proteins help osmotic pressure
– they attract water
_____, ______, and ______are major Extracellular substances that help move water between ECF and Cell
Sodium, chloride, & Glucose
Fluids affect on cell wall
Tonicity
_______ ________ enters- there is no movement of water across membranes …so cells maintain their normal size
Isotonic Solution
NORMAL SALINE IS
ISOTONIC (0.9% NaCl)
NORMAL SALINE causes
Vascular expansion, electrolyte replacement
concentration is less than blood plasma
HYPOTONIC SOLUTION
Moves fluid into cells & interstitial space
Cellular dehydration
Hypotonic solution
Isotonic, Hypotonic, & Hypertonic are
Crystalloid Solutions
Increase intravascular osmotic pressure (pressure of plasma proteins) within the intravascular space
Colloid Solutions
Restores serum protein
Colloid solutions
The pressure gradient pulls fluids into the vascular space.
Colloid solutions
Normal saline is a
Volume expander
Saline and electrolyte IV
Lactated Ringer
IV solution ordered when you lose extracellular volume
Lactated ringer
Isotonic solution but sugar metabolizes making it a hypotonic solution
D5 Water
TPN
Total Parenteral Nutrition
Solution given to alcoholics and anorexics
TPN
PPN
Peripheral Parenteral Nutrition
Has 20% to 50% dextrose and a lot of calories
TPN
Solution that is caustic and thick and given through a central line
TPN
Solution that is given for cerebral edema
Hypertonic
Causes filtration from an area of higher pressure to an area of lower pressure
Hydrostatic Pressure
Is created by the weight or force of a solution e.g.. The pressure caused by BP against the walls of vessels causes fluid to move out depending on the BP
Hydrostatic Pressure
Hydrostatic pressure minus osmotic pressure and tries to push fluids into tissue spaces
Filtration Pressure
Adults & Older Adults have decrease ______ in the Kidney
Nephrons
1 Liter of blood loss need how much solution?
3 to 4 bags of solution
Normally Fluid & Electrolyte lost are replaced by
adequate fluid intake
Fluid loss through Respiratory, stool & sweat is called
Insensible Loss
Average fluid loss through bowel movement
200 mL per day
Average fluid loss through sweat is
100 mL per day
ECF volume excess or deficit
Fluid imbalance
ECF volume influence only the
vascular and interstitial compartments
No change in _______ with ECF volume imbalances
cell volume
ECF is a ____% solution
0.9%
Most critical ECF volume imbalance –
ECF deficit
Refers to loss of water along with the salt that is normally in the water
Isotonic dehydration
Saline Deficit
Hyponatremia
Loss of fluid into a space it doesn’t belong. Has nowhere to go
third spacing
First sign of third spacing
Decreased urine output
Signs and symptoms of ECF Volume Deficit
Orthostatic/postural changes in Pulse &BP.
Decreased Urine Output
Signs and symptoms of decreased interstitial volume
Dry mucous membranes & poor skin turgor
Thirst
Treatment for ECF Volume Deficit
Oral Replacement
IV replacement
Safety
Extracellular fluid Volume Excess
Cannot be eliminated – causing Edema
Signs and Symptoms of Fluid volume excess
Rapid weight gain Increase BP Bounding Pulse Pulmonary Edema Neck Vein Distention Na levels WNL
Treatment of of Fluid volume excess
Restrict NA & saline & diuretics, find cause
Happens when water intake is increased or decreased
Or when water is retained or excreted excessively
Water or Osmolality Imbalance
Occurs when decrease in H2o intake, an increase in water loss, or excess intake of solute
Serum Na greater than 145 mEq/L
Water deficit (ICF Deficit) or Hyperosmolaltiy or Hypernatremia
Signs and Symptoms of Hyperosmolality or Hypernatremia
Confusion, agitation Seizures, coma maybe death,
SIADH
Syndrome of inappropriate ADH
Treatment for Hyperosmolality or Hypernatremia
Replace orally or IV D5W
Happens when there is an increase in water intake, abnormal secretion of ADH, or decreased urinary output of water
Serum Na of less than 135 mEq/L
Water Excess or Hypoosmolality or Hypnotremia
Signs and symptoms of Water Excess or Hypoosmolality or Hypnotremia
Lethargy, irritability, confusion personality changes, seizures, coma death
Treatment of Water Excess or Hypoosmolality or Hypnotremia
water restriction
Potassium is maintained by
sodium-potassium pump in the cells
K+ changes lead to
altered excitability of muscles, cardiac cells and neuro
Potassium is eliminated by
The kidneys
______ causes K+ to move out of ECF & into cells esp. skeletal muscle & liver cells!!!
Insulin
Potassium higher than 5 mEq/L is called
Hyperkalemia
Hyperkalemia is caused by:
renal failure, acidosis, massive tissue injury e.g. burns, self med errors, rapid IV infusion
Hyperkalemia signs and symptoms
muscle irritability, EKG changes
Treatment for Hyperkalemia
low Na+ diet, Kayexalate enemas or by po. IV Calcium Gluconate, IV Insulin. Can give diuretics if moderately elevated
Hypokalemia is
Potassium below 3.5 mEq/L
Hypokalemia can be caused by
vomiting, diarrhea, diuretics, aldostreone, alkalosis
Signs and symptoms of Hypokalemia
Impaired neuromuscular transmission which leads to decrease in reflexes, muscle weakness which can lead to muscle paralysis, anorexia, N/V, EKG changed, greater risk of digoxin toxicity
Treatment of Hypokalemia
Orally with Foods 2000-5500mg daily
Po supplements
IV
Phosphorus level below 2.5 is called
Hypophosphatemia
Hypophosphatemia is caused by
Alcoholism, Renal wasting, Uncontrolled diabetes Mellitus
Hypophosphatemia signs and symptoms
Neuromuscular dysfunction, weakness (especially respiratory muscles), Fatigue, Ventricle dysrhythmias, confusion
Hypophosphatemia treatment
Treat underlying cause, foods high in phosphorous, oral phosphorous replacement
Major functions of Calcium
Transmission of nerve impulses, cardiac contractions, blood clotting, formation of teeth & bone, and muscle contraction
Calcium is controlled by
Vit D, parathyroid hormone, and Calcitonin
Patients who’ve had thyroidectomy have problems
with calcium
Improper absorption from the GI tract, decreased fat soluble vitamins. Pancreatitis no parathyroids renal disease, & massive transfusions
Hypocalcemia
cells increased excitability- which leads to muscle twitching , tingling & parasthesias of face fingers & toes increased reflexes, chvostek’s sign & tetany
Signs and symptoms of hypocalcemia
Bone cancer, immobility, excessive antacid use hyperparathyroidism, and increase in Vit D
Causes of hypercalcemia
impaired nerve and muscle conduction, decreased tone, bone pain, kidney stones(calculi), confusion, memory impairment & lethargy
Signs and symptoms of hypercalcemia
Causes: prolonged malnutrition, surgery, alcohol abuse
hypomagnesium
tremors, cramps, increased BP, tachycardia, confusion & convulsions
Signs and symptoms of hypomagnesium
60% of this goes to the bones and the rest in tissues
Magnesium
Causes: kidney failure, excess ingestion of laxatives/ antacids
Hypermagnesium
lethargy, coma when > 2.5, weak, paralysis, decreased reflexes, bradycardia
Signs and symptoms
Ice cream is considered
A liquid
Document an excess amount of
sweat
Plasma osmolality norm
280-300 osmos per kg
Urine osmolality
50 -1200 osmos per kg (the higher, the more dehydrated)
Urine specific gravity norm
1.010 to 1.020
tube feeding is a common cause of
dehydration
