Fluids and Electrolytes Flashcards
3 Types of extracellular fluids:
- Intravascular: inside vessels (blood/plasma)
- Interstitial: fluid between cells and outside vessels
- Transcellular (special: synovial/spinal/pleural)
This type of movement of fluids is found in the kidneys:
Filtration.
It is the movement of water AND solutes
What kind of receptors help regulate fluids in our body?
Osmoreceptors
This hormone helps regulate fluid balance by acting on the kidneys to hold on to/reabsorb water and Na:
AdH
Antidiuretic hormone
This organ is the major regulator of fluid/electrolyte balance:
Kidney
By eliminating or holding on to water and or electrolytes.
Is sensible or insensible water loss easily measured?
Sensible
Urine
Stool
Drains/blood
Vomit
Insensible (skin and lungs): sweat/perspiration, respiration
About how much of water do we lose every day by insensible water loss?
600 - 800 mL
Need to keep this is the back of our minds when considering measurements I’s and O’s)
The loss of water but electrolytes remain:
Dehydration
Pulls fluids from intracellular fluid… cells shrink.
WE can cause imbalance by not making sure patient is drinking water.
Loss of electrolytes AND water:
Hypovolemia
Loss particularly of sodium
Fluid volume excess:
Hypervolemia
Not gaining any electrolytes, just water.
Fluid intake exceeds fluid out.
What is the most accurate way to determine (measure) whether a person has gained or lost fluids?
By weighing them daily at the same time and same amount of clothing.
If they’re on a bed scale, make sure to take off blankets, etc., that can skew accuracy.
What is the first sign of fluid volume deficit?
Thirst
Later: tachycardia, hypotension, fever
Why do we see tachycardia with fluid volume deficit?
Heart races to try to pump the fluids to meet the needs of the tissues but there’s not enough to support a normal heart rate.
Why do we see hypotension with fluid volume deficit?
Blood pressure goes down because volume is low, not much to pump.
Why do we see fever with fluid volume deficit?
Water regulates our body temperature (buffer), if low water then can not regulate as well. It is also used to cool our bodies by evaporation.
What is the most sensitive measure of fluid loss?
WEIGHT
1 kg (2.2 lbs) = 1 L of fluid loss
If a patient is experiencing hypertension what fluid imbalance could they be experiencing?
Hypervolemia : Fluid volume excess
What type of fluid imbalance could bradycardia or a bounding pulse demonstrate?
Fluid volume excess : Hypervolemia
If urine contains a low specific gravity what does that mean?
Excess urine output (diluted)
High specific gravity would mean it is concentrated and dark.
What type of fluid imbalance could be the cause of jugular vein distention?
Fluid volume excess.
These two signs may be the first indicators of things going awry with fluid excess:
Lung crackles
Ascites (3rd spacing: fluid in abdomen - difficult to eliminate)
Substances that when dissolved in water or a solvent become electrically charged ions:
Electrolytes
Cations +charge
Anions -charge
What organ regulates our K levels in the blood?
Kidney
Hyperkalemia is seen in chronic kidney failure
Where’s our resevoir for K?
In our cells.
Hypokalemia is seen in acute diarrhea
When you think of K, you think of ?
Think HEART.
Regulates conduction of cardiac rhythm.
Also is major electrical impulses in the GI and important with acid base balance.
Where is our resevoir for Ca and Na?
Bones
Hypercalcemia: parathyroid regulates Ca levels, those who have impaired parathyroid glands, patients with cancer. Too calm, flaccid.
Hypocalcemia: lack of vit D, condition with parathyroids, pancreas, or kidneys. Leeches Ca from bones. Will experience muscle twitches or inactivity - constipation.
When you think of Calcium, think ?
MUSCLE
How are electrolytes measured (rate):
mEq/L = grams of electrolyte in liter of fluid
milequivalents
Major cation in extracellular fluid:
Na+
Which ion is the fluid volume regulator?
Na+
This condition is when this electrolyte is too low… you may see a change in level of consciousness (like confusion):
Hyponatremia
If the brain is low sodium then it is also low water (because water follows sodium).
This ion’s “big job” is stimulating nerve impulse conduction:
Sodium.
Also interacts with calcium-muscle contraction.
This condition is when there is excess of a certain ion, leading to possible seizures due to over-impulse conduction:
Hypernatremia
Includes thirst, restlessness and fatigue.
Due to lack of proper hydration.
This is due to the loss of water AND electrolytes:
Hypovolemia
particularly sodium
Loss of water but keeps electrolytes:
Dehydration
How do we lose K+?
Diuretics and Diarrhea
Which electrolyte is the key to cellular metabolism?
K+
Is the major cation of Intracellular Fluid
Before you see dysrhythmias you will likely see nausea/vomiting first:
Hyperkalemia/Hypokalemia
Hyper: hyper bowel sounds/movements, and dysrhthmias
Hypo: muscle weakness (diaphragm), hypo bowel sounds, nausea/vomiting, dysrhthmias
