Fluids & Electrolytes/Acid Base Imbalances Flashcards
Total Body Water (TBW)
- varies w/ age, weight, etc
- 60% of weight
Extracellular
- def
- What are the 2 types?
- outside the cell
- 20% of body weight
- outside the cell
2a. Interstitial fluid
- around the cell
2b. Intravascular fluid
- blood plasma
Intracellular
- inside cell
- 40% of body weight
Movement of Water:
- Diffusion
- movement of charged and noncharged particles along concetration gradiant
- moves from HIGH –> LOW concentration
- Osmosis
- movement of water acros semi-permiable membrane
- Moves from LOW –> HIGH concentration
- Osmotic Pressure
a. osmality
- pressure required to stop osmotic flow of water
- determined by osmality
a. osmality:
- concentration of molecules/particles per kilo
- Hydrostatic Pressure
- force of water pushing against cellular membranes
- pushes water our of vascular space
- Onoctic Pressure
- pressure exerted by colliods (proteins)
- draws water in d/t plasma proteins
Between Intracellular and Extracellular Fluids
- osmotic balance
- func of osmotic forces
- Osmotic balance:
- water moves until osmotic equilibrium balanced
- ECF = Na
- ICF = K
Between Plasma and Interstitial Fluid
- movement d/t changes in hydrostatic pressure
- pushes water out of capillaries
- osmotic forces pull water in at capillaries
Alterations in Water Movement:
Edema
- def
- accumulation of fluid in interstitial places
What is the cause of edema?
- Cause:
a. inc hydrostatic pressure
- d/t inc fluid
b. dec plasma oncotic pressure
- d/t leakage because of poor albumin
c. inc capillary permeability
- d/t trauma, injury
d. obstructive lymph flow
- tumor
What are the types of treatment for edema?
- diuretics
- dec hydrostatic pressure d/t less fluid
2 albumin
- pulls water into blood stream
Regulation of Body Water:
A. Thirst
- What stimulates it?
a. Hyperosmolaity
- stimulates osmo receptors to make you drink
b. low K
c. Dec in blood vol
- stimulates osmo receptors
B. Renal Concentration Mechanism- ADH
- ADH causes kidneys to retain water
- antidiuretic to keep in water
- controlled by osmolality and vol
- osmolality inc = ADH secreted
- blood vol dec
What are the normal values of osmoality?
280-294
294 = dehydrated, not enough particles
- found in blood sample
ECF Imbalances
A. ECF DEFICIT
- dec intake
- inc loss d/t: - diarrhea - vomit - diuretics - burn victims
What are S/S of ECF DEFICIT?
- thirst
- weight loss = measure fluid vol
- dec urine output = dark
- dec BP
- inc HR
- inc serum osmality
- shock
- weakenss
B. ECF EXCESS
- inc intake
- dec loss
What are S/S of ECF EXCESS?
- weight gain
- edema
- SOB = fluid in lungs
- ab distention = fluid in cavit
- Na retention
- swollen brain cells = seizures, coma
What are sodiums func?
- osmolality of ECF
- neuromuscular func
- acid base
- regulated by aldosterone
Where is sodium lossed?
- urine
- skin
- GI tract
Hyponatremia
- excess water intake
- dilutes Na level
- dec water loss
- dilutes Na level
- inc Na loss
What are clinical manifestations of hyponatremia?
- CNS symptoms
- GI disturbances
- inc intracellular
What are S/S of hyponatremia?
- weight gain
- neuro changes
- confusion
- lethargy
- coma
- seizure
Hypernatremia
- inc water loss
- dec intake of water
- excess Na
- inc Na intake d/t diet, IV solution
What are S/S of hypernatremia
- thirst
- dry mucous membranes
- inc HR
- restlessness
Potassium
- Func?
- get potassium from diet and excreted through urine
- osmolarity of ICF
- neuromuscular control and regulation
- acid base balance
- enzyme reaction
- HR
How is potassium regulated?
- change of K in distal tubules, serum
- inc K = excretion
- adosterone
- promotes excretion
- inc K = inc aldosterone = loss of K - potassium hydrogen ion exchange
- acidosis = hyperkalemia
- K leaves cell
- alkalosis= hypokalemia
- K enters cell
What is hypokalemia caused by?
-*deficit
- dec intake
- excess GI loss
- excess renal loss
- intrcellular shift = alkalosis
What are S/S of hypokalemia?
- cardiac dysrhythmias
- weakness
- dec GI motility
- loss in vomit, diuretics
- cramping os skeletal muscles
- skeletal muscle weakness
- smooth muscle weakness = slows GI tract → constipation
- CNS depression
What type of treatment is used for hypokalemia?
- diet inc K
ex: banana, nuts, some fruits
What is hyperkalemia caused by?
*excess
- excess intake/gain
- dec renal loss
- extracellular shifts
- acidosis
- massive cell destruction
What are S/S of hyperkalemia?
- abnormal conduction pathways
- smooth muscle = inc activity
- EKG changes
- cardiac arrest
- muscle weakenss
What is used to treat hyperkalemia?
- diet to dec intake
- diuretics to de K (if no renal problem)
- resin
- drink called Kexalate
- eliminates through stool - emergency
- insulin to remove K into liver –> muscle
- also give glucose
What is the func of calcium?
- transmits nerve impulses and muscle contractions
- enzyme reactions
- maintains cell membrane perm
- inverse relation w/ phosphate
What is hypocalcemia caused by?
- hypoparathyroidism
- pancreatitis
- renal failure
- lack of vit D
- low magnesium
What are S/S of hypocalcemia
- deficit
- inc nerve excitability
- tingling
- numbness
- tetany
- hyperreflex
- cramps
- seizures
What is hypercalcemia caused by?
- excess
1. bone tumor
2. hyperparthyroidism
3. prolonged immobility
What are S/S of hypercalcemia?
- dec neuromuscular activity
- weakness
- constipation
- dysrrhytmias
What is the func of phosphate?
- bone formation
- metabolic processes (ATP)
- essential part of nucleic acids and membrane
- normal func of WBC and platelets
- deliver O2 to cells
What is the cause of hypophosphatemia?
- antacid use
- malnutrition
- diarrhea
- lack of vit D
What are S/S of hypophospatemia?
- tremos
- hypoflexia
- confusion
- sezures
- numbness
- dysfunc of WBC and platelets
What is hphyerphosphatemia caused by?
- renal faulure
2. hypoparathyroidism
What are the S/S of hyperparathyrodism?
- like low Ca
What is the func of magnesium?
- cofactor in enzyme reactions
- affects neuromuscular func
What is hypomangnesia caused by?
- imparited intake/absorption
2. inc loss
What are S/S of hypomangnesmia?
- deficit
- CNS hyperirritability
- tremors
- inc HR
What are the func of hypermagnesemia?
- rare
- d/t intake or renal insufficiency
What are S/S of hypermagnesmia?
- sedation of CNS
- muscle weakness
- confusion
- dec BP
Acid/Base
- normal ph?
- equation?
ph = 7.35-7.45
CO2 + H2O → H2CO3→ H+ HCO3
Acidosis
- process causes acidemia
- acid condition of blood ph = < 7.35
Alkalosis
- process causing alkalemia
- alkaline condition of blood ph = >7.45
Regulation of pH:
- Carbonic acid-bicarbonate buffering
a. respiratory
b. renal
a. resp = regulated CO2 level = acid
- CO2 inc = acidosis = hypoventilation
- CO dec = alkalosis = hypoventilation
b. renal = metabolic
- regulate HCO3 = base
- produce either acid/base urine
-HCO3 inc = alkalosis
HCO3 dec = acidosis
Acid/Base Imbalance:
A. Resp Acidosis
- retain CO2 = accumulate
- ph <7.335
What is resp acidosis caused by?
- hypoventilation
- pneumonia
- NM disease
- CNS depression
- lethargy, confusion, coma
- COPD
What are S/S of resp acidosis?
- depressed CNS
- headache
- weakness
- twitch
- deep,shallow resp
- acidic urine
B. Resp Alkalosis
- blow off CO2 = loss
- ph >7.45 = less acidic (more base)
What is resp alkalosis caused by?
- compensation?
- hyperventilation
- compensation = alkaline urine
What are S/S of resp alkalosis?
- excited CNS
- numb, tingly fingers/toes
- palpations
- sweating
C. Metabolic acidosis
- retain acid
- HCO3 dec
- ph <7.35
What is metabolic acidosis caused by?
- renal failure = dec urine ouput
- incr acid levels
- diarrhea
- loss of bicarb
- shocks
- lactic acid
What are S/S of metabolic acidosis?
- compensation?
- depression of CNS
- weak, fatigue
- confusion
- compensation:
- inc RR
- Kussmaul resp
- acidic urine
What is treatment for metabolic acidosis?
- give sodium bicarb
D. Metabolic alkalosis
- loss of acid
- HCO3 inc
- ph > 7.45
- excess base or loss of acid
What is metaboli alkalosis caused by?
- ingestion of base = anacids
- vomit
- excess aldosterone
- diuretic therapy = alkalosis
What are S/S of metabolic alkalosis?
Compensation
- Excited CNS
- hyperreflexes
- convulsions
- weakness
- confusion
Compensation:
- dec RR
- retain acid
- alkaline urin
What is tx for metabolic alkalosis
- id reason
Analysis of Arterial Blood Gases Test
- ph
7.35-7.45
- PaCo2
35-45
- CO2 level is high = acidosis
PaO2
80-100
HCO2
22-26
- high bicarb = alkalotic
- low bicarb = acidic
How to figure our ABG
- look at pH = acidemia/alkalemia?
- find primary cause
- look at PCO2 and HCO3
a. CO2 abnormal and matches pH problem = respiratory
- if HCO3 off and matches ph change
b. inverse match = metabolic
- if HCO3 and matches pH changes
- look at other values to see if compensation
