Fundamental 41s Fluid, Electrolyte, and Acid-Base Balance Flashcards
What is Hypernatremia
Loss of relatively more water than salt: Diabetes insipidus, Osmotic diuresis, Greatly increased insensible perspiration & respiratory water output without water increased water intake, gain of relatively more salt than water: overuse of salt tablets, administration of tube feeding or hypertonic parenteral fluids, difficulty swallowing fluids, as in Parkinsons lack of access to water or deliberate water deprivation, inability to respond to thirst(immobility, aphasia), or dysfunction of osmoreceptor-driver thirst drive.
What are the physical and laboratory signs of hypernatremia?
Extreme thirst, dry and flushed skin, postural hypotension, fever, restlessness, confusion, agitation, coma, seizures if develops rapidly or is very severe. Lab: Serum Na+ level >145mEq/kg, and serum osmolality >295 mOsm/Kg, urine specific gravity 1.030.
What is hyponatremia?
Gain of relatively more water than salt. Excessive ADH, Psychogenic polydipsia or forced excessive water drinking, Excessive IV administration of 5% dextrose in water(D5W), use of hypotonic irrigating solutions, Tap-water enemas, Loss of more salt than water, Renal salt-wasting disease, Replacement of large body fluid output (diarrhea, vomiting, gastric suction) with water but not salt.
What are the physical and Laboratory signs of hyponatremia?
Apprehension, nausea & vomiting, headaches, decreased level of consciousness(confusion, lethargy, muscle weakness, coma), seizures if develops rapidly or is very severe. Serum Na+ <135mEq/L and serum osmolality 280 mOsm/kg or less, urine specific gravity below 1.010.
What contains K+
Fruits, Potatoes, instant coffee, Molasses, Brazil nuts.
What is Hypokalemia
Its abnormally low potassium concentration in the blood. It results from decreased potassium intake and absorption, a shift of potassium from the ECF into cells, and an increased potassium output.
Common Causes of Hypokalemia are:
Increased output of potassium such as diarrhea, repeated vomiting, and use of potassium wasting diuretics.
What are the physical and laboratory signs of Hypokalemia?
Bilateral muscle weakness that begins in the quads and may ascend to respiratory muscles, abdominal distention, decreased bowel sounds, constipation, cardiac dysrhythmias; signs of digoxin toxicity at normal digoxin levels. Serum K+ < 3.5mEq/L; possible ECG abnormalities.
What is Hyperkalemia?
Its abnormally high potassium ion concentration in the blood. Its general causes arte increased potassium intake and absorption, shift of potassium from cells into the ECF, decreased potassium output. People with oliguria (decreased urine output) are at high risk for hyperkalemia, so remember to check urine output before administering IV solutions containing Potassium.
What are the physical and laboratory signs of Hyperkalemia?
Bilateral muscle weakness in quadriceps, transient abdominal cramps & diarrhea, cardiac dysrhythmias, cardiac arrest. Serum K+ >5mEq/L possible ECG abnormalities.
What is Hypocalcemia?
Abnormally low calcium concentration in the blood.
Related causes of hypocalcemia:
Decreased intake & absorption of Ca+, calcium deficient diet, Vitamin D deficiency(end-stage renal disease), Chronic diarrhea, laxative misuse, steatorrhea(eg., pancreatitis because calcium binds to undigested fat in their feces & is excreted), shift of Ca+ from ECF into bone or inactive form: hypoparathyroidism, Alkalosis, Hyperphosphatremia (end-stage renal disease), increased Ca+ output: Steatorrhea, or Chronic diarrhea.
What are the physical and laboratory signs of hypocalcemia?
positive Chvostek’s sign ( contraction of facial muscles when facial nerve is tapped), positive Trousseau’s sign (carpal spasm with hypoxia), numbness & tingling of fingers & circumoral (around the mouth) region, hyperactive reflexes, muscle twitching and cramping, tetany, seizure, laryngospasms, cardiac dysrhythmias. Total serum Ca+ <4.5mg/dL, ECG abnormalities possible.
What is Hypercalcemia?
Abnormally high calcium concentration in the blood. Hypercalcemia results from increased calcium from bones into the ECF, &decreased calcium output.
Imbalances and related causes of Hypercalcemia:
Increased Ca+ intake & absorption, milk-alkali syndrome, shift of Ca+from bone into ECF: Prolonged immobilization, hyperparathyroidism, Bone tumors, Nonosseous cancers that secrete bone-resorbing factors factors, decreased Ca+ outpute: use of thiazide diuretics.
What are physical and laboratory signs of Hypercalcemia?
Anorexia, nausea & vomiting, constipation, fatigue, diminished reflexes, lethargy, decreased level of consciousness, confusion, personality change, cardiac dysrhythmias possible flank pain from renal calculi; with hypercalcemia caused by shift of calcium from bone: pathological fractures; signs of digoxin toxicity at normal digoxin levels. Total serum Ca+>10.5mg/dL, or serum ionized Ca>5.3mg/dL; possible ECG abnormalities.
What is Hypomagnesemia?
Its abnormally low magnesium concentration in the blood. It’s general causes are decreased magnesium intake & absorption, shift of plasma magnesium to its inactive bound form, & increased magnesium output.
What are the imbalances and related causes of hypomagnesemia?
Decreased Mg+ intake & absorption, malnutrition, chronic alcoholism, chronic diarrhea, laxative misuse, steatorrhea (eg,. pancreatitis), shift of Mg+ into inactive form: Rapid administration of citrated blood, increased Mg+ output: Aldosterone excess, use of thiazide or loop diuretics, Steatorrhea, chronic diarrhea or other GI losses.
What are the physical and laboratory signs of hypomagnesemia?
Postive Chvosteks & Trouseau’s signs, hyperactive deep tendon reflexes, insomnia, muscle cramps& twitching, grimacing, dysphagia, tachycardia, hypertension, tenaty, seizures, cardiac dysrhythmias; signs of digoxin toxicity at normal digoxin levels. Serum Mg+ level < 1.5mEq/L.
What is hypermagnesemia?
Its abnormally high magnesium concentration in the blood.
What are the imbalances and related causes of hypermagnesemia?
Increased Mg+ intake & absorption: Excessive use of Mg+ containing laxative and antacids, Parenteral overload of magnesium, decreased Mg+ output: End-Stage renal disease, Adrenal insufficiency..
What are the physical and laboratory sign of hypermagnesemia?
Lethargy, hypoactive deep tendon reflexes, bradycardia, hypotension; acute elevation in magnesium levels: flushing, sensation of warmth; severe hypermagnesemia: flaccid muscle paralysis, decreased rate & depth of respirations, cardiac dysrhythmias, cardiac arrest. Serum Mg+ level >2.5mEq/L possible ECG abnormalities.
What does the term fluid mean?
Fluid means water that contains dissolved or suspended substances such as glucose, mineral salts, and proteins. Fluid amount = Volume, Fluid concentration = Osmolality, Fluid composition (electrolyte concentration), Degree of acidity = pH. People who are more acidic tend to have more health issues.
What is ECF?
Fluid outside the cells. ECF has 2 major divisions (intravascular fluid and interstitial fluid) and minor division(transcellular fluids). ECF contains 1/3 of total body water. The extracellular fluid compartment includes all water and electrolytes outside of cells (interstitial fluid, plasma, and lymph).
What is intravascular fluid?
Its the liquid portion of the blood(plasma).
What is Interstitial fluid?
It located between the cells & outside the blood vessels. The fluid between the cells which is sometimes called the “third space.” This can be blood, lymph, bone, and connective tissue water and the transcellular fluids.
What are transcellular fluids?
cerebrospinal, pleural, peritoneal, & synovial fluids are secreted by epithelial cells.
What are electrolytes?
fluid in the body compartments contains mineral salts known technically as electrolytes. An electrolyte is a compound that separates into ions (charged particles) when it dissolves in water. Ions that are positively charged are called cations: ions that are negatively charged are called anions.
What is osmolality?
Osmolality of a fluid is a measure of the number of particles per kilogram of water.
What determines the tonicity of a fluid?
Particles that can’t cross the cell membrane easily.
What is isotonic?
Fluid with the same concentration of nonpermeant particles as normal blood. Isotonic solution is the same concentration as blood plasma; expand fluid volume without causing fluid shift.
What is hypotonic?
Its a solution thatt is more dilute than the blood. Hypotonic solution: Lower concentration than blood plasma; moves fluid into the cells causing them to enlarge.
What is hypertonic?
A solution is more concentrated than normal blood. Hypertonic solution: higher concentration than blood plasma; pulls fluid from cells causing them to shrink.
What electrolytes are higher in concentration in ECF than in the ICF?
Na+, Cl-, & HCO-3
What electrolytes are higher in concentration in ICF than in ECF?
K+, Mg+, and PO3/4-
How do cells maintain their high intracellular electrolyte concentration?
By Active Transport.
Active Transport:
Requires energy in the form of ATP to move electrolytes across cell membrane against the concentration gradient ( from areas of lower concentration to areas of higher concentration). Example is the sodium-potassium pump, which moves Na+ out of a cell & K+ into it, keeping ICF lower in Na+ and higher in K+ than the ECF. Active transport = Movement of ions against osmotic pressure to an area of high pressure; require energy (ATP).
What is diffusion?
Diffusion is passive movement of electrolytes or other particles down the concentration gradient (from areas of high concentration to areas of lower concentration). Within a body compartment electrolytes diffuse easily by random movements until the concentration is the same in all areas.
What is osmosis?
Water moves across cell membrane by a process in which water moves through a membrane that separates fluids with different particle concentrations.
What is osmotic pressure?
An inward-pulling force caused by particles in the fluid. Osmotic pressure = drawing power of water(osmolality).
What is filtration?
Fluid moves into and out of capillaries (between vascular ad interstitial compartments. Filtration Is the net effect of four forces, two that tend to move fluid out of capillaries and small venules and two that tend to move fluid back into them. Filtration can also be described as the movement of fluid through a cell or blood vessel membrane because of hydrostatic pressure differences on both sides of the membrane.
What is Hydrostatic pressure?
Its the force of the fluid pressing outward against a surface. Example such as capillary hydrostatic pressure is a relatively strong outward-pushing force that helps move fluid from capillaries into the interstitial area. Interstitial fluid hydrostatic pressure is a weaker opposing force that tends to push fluid back into capillaries. Another description of hydrostatic pressure is it a “water pushing” pressure, because it is the force that pushes water outward from a confined space through a membrane.
What are colloids?
Blood that contains albumin and other proteins. These proteins are much larger than electrolytes, glucose and other molecules that dissolve easily. Most colloids are too large to leave capillaries in the fluid that is filtered, so they remain in the blood.
What is colloid osmotic pressure?
Its also called oncotic pressure which is an inward-pulling force caused by blood proteins that helps move fluid from the interstitial area back into the capillaries. Colloid or Oncotic pressure = keeps fluid in the intravascular compartment by pulling water from the interstitial space back into the capillaries.
What is edema?
Accumulation of excess fluid in the interstitial space. Diseases such as heart failure is an example when venous congestion from a weakened heart, which no longer pump effectively, increasing capillary hydrostatic pressure, causing edema by moving excessive fluid into the interstitial space. Another example of edema is inflammation which happens when capillary blood flow and allows capillaries to leak colloids into the interstitial space. The resulting increased capillary hydrostatic pressure and increased interstitial colloid osmotic pressure produce localized edema in the inflamed tissues.
Fluid output normally occurs through four organs:
The skin, lungs, GI tract, and kidneys. Abnormal fluid output includes vomiting, wound drainage, or hemorrhage.
