Fluids and Electrolytes Flashcards by Audrey Mejia

What percentage of body weight is fluid in the adult?

60%

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What percentage of body weight is fluid in the child?

75%

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Body Fluid is water with

chemical compounds (electrolytes), & Blood cells

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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

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Fluid Compartment within the cell

Intracellular

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Fluid Compartment within the GI tract and eye

Transcellular

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The fluid in here is water

Intracellular

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All the fluid found outside of the cell

Extracellular

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ECF broken into 2 spaces

Intravascular

Interstitial

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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

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Most important & regulated aspect of fluid balance

Vascular volume

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Prolonged periods of low BP is called

Shock

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Normal Body functioning depends upon

fluid & electrolyte balance

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Most important aspect of body fluid is

volume

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Fluid compartment with minimal amount of fluid

Transcellular

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Fluid compartment that accounts for 2/3 of body

intracellular

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Fluid compartment that accounts for 1/3 of body

Extracellular

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ECF Space in vessels

intravascular

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ECF Space between cells

interstitial

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fluid compartment that resembles plasma

interstitial

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ECF space that contains sodium, chloride, and bicarbonate

interstitial

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Without fluid volume there is no…

Blood Pressure

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ADH

Antidiuretic hormone

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In a child, one large stool can

cause fluid imbalance

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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