FLUIDS AND ELECTROLYTES Flashcards by Erika Maecel Erese

A __, together with its environment in any part of the body, is primarily composed of __

cell
FLUID.

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__ - The maintenance of the body’s internal environment within a narrow range of normal values.

__ - a solution of solvent and solute

__ - a liquid substance where particles can be dissolved

__ - a substance, either dissolved or suspended in a solution

Homeostasis

Fluids

Solvent

Solute

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refers to any fluid produced by a living organism.

Body Fluids

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Body Fluid Compartments (__)

Intracellular (__ )
Extracellular (___)

Interstitial (__)
plasma (__)

60% Total body water

40% 2/3 of TBW
20% 1/3 TBW

15%
5%

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Body Compartment Volumes
➢ neonates reach adult values by 2 yrs and are about half-way by 3 months
➢ average values ~ 70 ml/100g of lean body mass
➢ percentage of water varies with tissue type,

A. __ ~ 60-80%
B. __ ~ 20-25%
C. __ ~ 10-15%

lean tissues
bone
fat

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➢ ___ refers to the concentration of particles in a solution

Tonicity

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➢ the weight in grams of a substance producing an osmotic pressure of 22.4 atm. when dissolved in 1.0 litre of solution
➢ (gram molecular weight) / (no. of freely moving particles per molecule)

Osmole

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THE Normal DYNAMICS OF BODY FLUIDS

The methods by which electrolytes and other solutes move across biologic membranes are

Osmosis, Diffusion, Filtration and Active Transport.

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___ are passive processes, while ___ is an active process.

Osmosis, diffusion and filtration

Active transport

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➢ This is the movement of water/liquid/solvent across a semi-permeable membrane from a lesser concentration to a higher concentration

OSMOSIS

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➢ The movement of particles/solutes/molecules from an area of higher concentration to an area of a lower concentration

Also called as___ or __

DIFFUSION

➢ “Brownian movement” or “downhill movement”

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➢ This is the movement of BOTH solute and solvent together across a membrane from an area of higher pressure to an area of lower pressure

FILTRATION

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➢ Process where substances/solutes move from an area of lower concentration to an area of higher concentration with utilization of ENERGY

➢ It is called an ____

➢ Usually, a ___ is required. An __ is utilized also.

ACTIVE TRANSPORT

“uphill movement”

carrier
Enzyme

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___
➢ Energy is obtained directly from the breakdown of ATP
➢ One example is the ___

Primarily Active Transport

Sodium-Potassium pump

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____

➢ This system regulates sodium and water balance in the ECF
➢ The formation of __ is the main mechanism
➢ Substance released to regulate water balance is ___.

RENIN activates Angiotensinogen to Angiotensin-I, A-I is enzymatically converted to ____ ( a powerful vasoconstrictor)

Renal Regulation (RAS)

urine

Renin

Angiotensin-II

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➢ The primary regulator of water intake is the ___, controlled by the thirst center in the hypothalamus (anterolateral wall of the third ventricle)

➢ ___ is synthesized by the hypothalamus and acts on the collecting ducts of the nephron

➢ ADH increases rate of water reabsorption

➢ The adrenal gland helps control F&E through the secretion of ___ - a hormone that promotes sodium retention and water retention in the distal nephron

thirst mechanism

Anti-diuretic hormone (ADH)

ALDOSTERONE

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➢ The ____ digests food and absorbs water

GIT

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➢ Healthy adult ingests ___ as part of the dietary intake.
➢ 90% of intake is from the ___
➢ 10% of intake results from the products of ____
➢ Usual intake of adult is about ___ per day
➢ The other sources of fluid intake are: __

fluid

ingested food and water
cellular metabolism

2, 500 ml

IVF, TPN, Blood products, and colloids

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➢ The average fluid losses amounts to __ per day, counterbalancing the input:

➢ The routes of fluid output are the following:

➢ SENSIBLE LOSS- ___,___,___

➢ INSENSIBLE LOSS- though the __ & __

2, 500 ml

Urine, feces or GI losses, sweat
skin and lungs as water vapor

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This is the loss of extra cellular fluid volume that exceeds the intake of fluid. The loss of water and electrolyte is in equal proportion.

➢ ____ refers to loss of __ alone, with increased solutes concentration and sodium concentration

Fluid Volume Deficit or Hypovolemia

Dehydration
WATER

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➢ Refers to the isotonic expansion of the ECF caused by the abnormal retention of water and sodium

➢ There is excessive retention of water and electrolytes in equal proportion. Serum sodium concentration remains ___

FLUID VOLUME EXCESS: HYPERVOLEMIA

NORMAL

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__ are charged ions capable of conducting electricity and are solutes found in all body compartments

Electrolytes

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positively charged ions; examples are

➢ CATIONS

sodium, potassium, calcium

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➢ ___ play a role in this type of regulation:

__ promotes Na retention and K excretion
__promotes Na excretion
__ promotes Ca retention and PO4 excretion
__ promotes Ca and PO4 excretion

hormones

Aldosterone
ANF
PTH-
Calcitonin

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➢ occurs by the process of glomerular filtration, tubular reabsorption and tubular secretion

a) Renal Regulation

➢ The most abundant cation in the ECF ➢ Normal range in the blood is ___ mEq/L

SODIUM 135-145

➢ Refers to a Sodium serum level of less than 135 mEq/L. This may result from excessive sodium loss or excessive water gain.

SODIUM DEFICIT: HYPONATREMIA

* Water intoxication, compulsive water drinking where sodium level is diluted with increased water intake

Dilutional hyponatremia

The serum sodium must NOT be increased by greater than 12 mEq/L because of the danger of __

pontine osmotic demyelination

➢ Serum Sodium level is higher than 145 mEq/L ➢ There is a gain of sodium in excess of water or a loss of water in excess of sodium.

SODIUM EXCESS: HYPERNATREMIA

CELLULAR SHRINKAGE

Hypertonic hypernatremia

A primary characteristic of hypernatremia is __.

thirst

➢ The most abundant cation in the ICF ➢ Normal range in the blood is ___ mEq/L.

POTASSIUM 3.5-5

Potassium should NEVER be given via

IV bolus or IM

➢ Serum potassium greater than 5.5 mEq/L

POTASSIUM EXCESS: HYPERKALEMIA

2. Institute emergency therapy to lower potassium level by: a. Administering ___ - antagonizes action of K on cardiac conduction b. Administering ____ -causes temporary shift of K into cells c. Administering ___ -alkalinizes plasma to cause temporary shift d. Administering Beta-agonists e. Administering ____ (cation-exchange resin)-draws K+ into the bowel

IV calcium gluconate Insulin with dextrose sodium bicarbonate Kayexalate

➢ Majority of __ is in the bones and teeth ➢ Small amount may be found in the _&_ ➢ Normal serum range is ___ mg/dL

CALCIUM ECF and ICF 8.5 – 10.5

➢ Regulations: 1. GIT- absorbs ca+ in the ___; Vitamin _ helps to increase absorption 2. Renal regulation- Ca+ is filtered in the __ and reabsorbed in the __: 3. Endocrine regulation: __ from the parathyroid glands is released when Ca+ level is __. PTH causes release of calcium from bones and increased retention of calcium by the kidney but __ __ from the thyroid gland is released when the calcium level is __. This causes excretion of both calcium and PO4 in the kidney and promoted deposition of calcium in the bones.

intestine D glomerulus tubules Parathyroid hormone low PO4 is excreted Calcitonin high

➢ The major Anion of the ECF ➢ Normal range is mEq/L

CHLORIDE 95-108

➢ The major Anion of the ICF ➢ Normal range is ___ mg/dL

PHOSPHATES 2.5 to 4.5

➢ Present in both ICF and ECF ➢ Regulates __ balance together with hydrogen ➢ Normal range is ___ mEq/L

BICARBONATES acid-base 22-26

___ ➢ substances that can donate or release protons or hydrogen ions (H+); examples are HCl, carbonic acid, acetic acid. ➢ __ or __ ➢ substances that can accept protons or hydrogen ions because they have ___ concentration.

Acids Bases or alkalis low H+

➢ __ are constantly produced in the body ➢ Because cellular processes need normal pH, __ & __ must be balanced continuously ➢ __ & __ are crucial in maintaining the balance ➢ A ratio of __ & __ is maintained at 20:1 ➢ Several body systems (like the __,__,__) together with the chemical buffers are actively involved in the normal pH balance ➢ The major ways in which balance is maintained are the process of acid/base secretion, production, excretion and neutralization

Acids acids and bases CO2 and HCO3 HCO3 and Carbonic acid respiratory, renal and GIT

➢ ___ are present in all body fluids functioning mainly to prevent excessive changes in the pH.

Buffers

2. REGULATION OF ACID-BASE BALANCE BY RESPIRATORY SYSTEM ➢ ___ is the powerful stimulator of the respiratory center

Carbon dioxide

3. REGULATION OF ACID-BASE BALANCE BY THE KIDNEY ➢ When excess H+ is present (__), pH falls kidney reabsorbs and generates Bicarbonate and excretes H+ ➢ When H+ is low and HCO3 is high (_). pH rises kidney excretes HCO3 and H+ is retained.

(acidic) (alkalotic)

Normal Arterial Blood Gas Values 1. pH –

7.35-7.45

➢ Infants have higher fluid ___ due to immature kidney and rapid respiratory rate ➢ __ have higher body fat content but lesser water content ➢ __ body has higher water content ➢ ___ affect fluid balance ➢ ___ will lead to nutritional depletion ➢ ___ situations will increase metabolism, increase ADH causing water retention and increased blood volume ➢ Trauma and burns release __ in the blood ➢ Cardiac dysfunction will lead to __&__ ➢ ___, ____&, ____ may cause imbalances

turn-over Women Lean Climate and heat and humidity Anorexia nervosa Stressful K+ edema and congestion Suctioning, diuretics and laxatives

➢ A base bicarbonate excess ➢ A result of a loss of acid and the ➢ accumulation of bases ➢ S/S - serum pH > 7.45, increased serum ➢ HCO3, serum K level less than 4, tetany, confusion and convulsions ➢ Nursing Interventions - watch for s/s of ___, LOC and __ precautions

Metabolic Alkalosis hypokalemia seizure

➢ A base bicarbonate deficit ➢ Comes from too much acid from metabolism and loss of bicarbonate ➢ S/S - Serum pH <7.35, Increased K+ level, DKA (Kussmaul’s Respirations), Shock, stupor, coma ➢ Nursing Intervention - Give ___/Monitor __ levels

Metabolic Acidosis HCO3 K+

➢ A deficit of carbonic acid caused by hyperventilation ➢ S/S - decreased levels of CO2 and increased levels of pH, HCO3 near normal ➢ Nursing Interventions - monitor for ___ and observe for signs and symptoms of __

Respiratory Alkalosis anxiety tetany

___ A carbonic acid excess Caused by an condition that interferes with the release of CO2 from the lungs (sedatives, COPD, narcotics etc.) S/S - serum pH < 7.35, increased serum CO2 levels> 45 mm Hg, serum K increased, cyanosis Nursing Interventions - Provide __, __ position, ___ precaution

Respiratory Alkalosis O2 Semifowlers seizure

Interpretation Arterial Blood Gases ➢ If acidosis the pH is __ ➢ If alkalosis the pH is ➢ The respiratory function indicator is the __ ➢ The metabolic function indicator is the __

down up PCO2 HCO3

➢ a homogeneous mixture of 2 or more substances of dissimilar molecular structure ➢ usually applied to solids in liquids but applies equally to gasses in liquids

Solution

is the fluid within cells

- The intracellular fluid (ICF)

Interstitial space

- is part of the extracellular fluid (ECF) between the cells not in the blood.

- the fluid component of the blood

Plasma

➢ The normal tonicity or osmolarity of body fluids is ____ mOsm/L

250-300

➢ Same as plasma tonicity

1.Isotonic

➢ higher or greater concentration of solutes

Hypertonic

➢ have a lesser or lowers solute concentration than plasma

2.Hypotonic

➢ the number of osmoles of solute per kilogram of solvent

Osmolality

➢ the number of osmoles of solute per litre of solution

Osmolarity

➢ that number of molecules contained in 0.012 kg of C12, or, ➢ the molecular weight of a substance in grams = Avogadro's number = 6.023 x 1023

Mole

➢ the number of moles of solute per kilogram of solvent

Molality

➢ is the number of moles of solute per litre of solution

Molarity

➢ is the power of a solution to draw water across a semi-permeable membrane

Osmotic pressure

➢ ___ (also called ___) is the osmotic pull exerted by plasma proteins

Colloid osmotic pressure oncotic pressure

___ is a type of diffusion, which uses a carrier, but no energy is expended. One example is fructose and amino acid transport process in the intestinal cells. This type of diffusion is ___.

➢ Facilitated Diffusion saturable

➢ is the pressure exerted by the fluids within the closed system in the walls of the container

Hydrostatic pressure

____ ➢ Energy is derived secondarily from stored energy in the form of ionic concentration difference between two sides of the membrane. ➢ One example is the ____ co-transport; also the ____ counter-transport

Secondary Active Transport Glucose-Sodium Sodium-Calcium

is released by the atrial cells of the heart in response to excess blood volume and increased wall stretching. It promotes sodium excretion and inhibits thirst mechanism

➢ ATRIAL NATRIURETIC factor (ANF)

__ * Excessive secretion of ADH causing water retention and dilutional hyponatremia ➢ ___ of plasma water from the intravascular space will move out and go to the intracellular compartment with a higher concentration cell swelling ➢ Water is pulled ___ the cell because of decreased extracellular sodium level and increased intracellular concentration

SIADH Hyponatremia hypotonicity INTO

2. pO2 –

80-100 mmHg

3. pCO2 –

35-45 mmHg

4. Hco3 –

22-26 mEq/L

5. Base deficit/Excess –

(+/-)2

6. O2 saturation –

98-100%

➢ ___ - is an ultra-filtrate of blood. The normal output is __ ml/day or 30-50 ml per hour or 0.5-1 ml per kilogram per hour. Urine is formed from the filtration process in the ___ ➢ FECAL loss- usually amounts to about ___ in the stool ➢ ___ - occurs in the skin and lungs, which are not noticeable and cannot be accurately measured. ___ goes out of the lungs and skin.

URINE 1,500 Nephrons 200 ml Insensible loss Water vapor

- negatively charged ions; examples are

ANIONS chloride and phosphates

➢ The major ICF cation is ____; the major ICF anion is ___

potassium (K+) Phosphates

➢ The major ECF cation is __; the major ECF anion is

Sodium (Na+) Chloride (Cl-)

➢ Major contributor of the plasma Osmolality

Sodium

- tight tourniquet and hemolysis of blood sample, marked leukocytosis

Pseudohyperkalemia

The major base in the body is

BICARBONATE (HCO3)

is considered to be acid or base depending on its chemical association

Carbon dioxide

➢ When assessing acid-base balance, carbon dioxide is considered ___ because of its relationship with carbonic acid. ➢ Because ___ cannot be routinely measured, carbon dioxide is used.

ACID carbonic acid

➢ ___- is the measurement of the degree of acidity or alkalinity of a solution. This reflects the relationship of hydrogen ion concentration in the solution. ➢ The higher the hydrogen ion concentration, the acidic is the solution and pH is ___ ➢ The lower the hydrogen concentration, the alkaline is the solution and the pH is ___ ➢ Normal pH in the blood is between ____

pH LOW HIGH 7.35 to 7.45