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Block 4 > HRR: fluid balance > Flashcards

HRR: fluid balance Flashcards

1
Q

What is the total body water percentage in men?

A

Around 60%

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2
Q

What is the total body water percentage in women?

A

About 50-55%

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3
Q

What is the total body water percentage in infants?

A

About 70%

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4
Q

What is the total body water percentage in elderly patients?

A

About 50%

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5
Q

What fraction of total body water is in the extracellular space?

A

1/3

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6
Q

What fraction of total body water is in the intracellular space?

A

2/3

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7
Q

What are the two components of extracellular water?

A

Interstitial compartment and plasma compartment

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8
Q

How much water is in the interstitial fluid in the extracellular space?

A

¾

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9
Q

How much water is in the plasma in the extracellular space?

A

¼

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10
Q

How is plasma osmolality measured?

A

Freezing point depression

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11
Q

What electrolyte is most abundant in plasma?

A

Sodium

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12
Q

What is the formula for calculating plasma osmolality?

A

(2 x sodium) + [(BUN/28) x 10] + [(glucose/180) x 10]

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13
Q

What is the value for normal plasma osmolality?

A

270-290

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14
Q

What is a normal plasma osmolar gap?

A

Less than 10

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15
Q

What is a plasma osmolar gap?

A

The difference between what is measured and what is calculated; this is due to some other compound that we can’t account for with the calculation. This is abnormal.

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16
Q

What are likely culprits for increased plasma osmolar gap?

A

Ketones, alcohols, lactic acid

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17
Q

What are ineffective osmoles?

A

They freely cross membranes and increase osmolality but do not influence the movement of water. Urea and glucose are big examples.

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18
Q

What are effective osmoles?

A

Solutes impermeable to cell membranes. They change osmolality and influence water movement.

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19
Q

What is isotonicity?

A

Normal osmolality; no change in cell size or net water movement.

20
Q

What is hypertonicity?

A

High osmolality; cells shrink due to water leaving the cell to balance the osmolality.

21
Q

What is hypotonicity?

A

Low osmolality; cells swell due to water flooding into them to balance osmolality.

22
Q

Describe sodium as an influence on fluid movement.

A

Sodium cannot pass through the cell membrane, so it acts as a non-penetrating solute. In order to balance out concentration, the water will have to move as opposed to the sodium moving.

23
Q

What is the charge of plasma?

A

Electroneutral

24
Q

What is a normal anion gap?

A

Between 5-12

25
Q

What does it mean if there is an anion gap above 12?

A

There is an increase in anions other than chloride or bicarb.

26
Q

Which compartment has higher protein concentration: plasma or interstitial?

A

Plasma

27
Q

Compare the osmolality of intracellular, interstitial, and plasma compartments.

A

They’re all roughly the same! This is because they’re all permeable to water, so the water moves in order to balance out the osmolality.

28
Q

What generates outward hydrostatic force?

A

The heart

29
Q

What generates inward oncotic pressure?

A

Proteins

30
Q

What 3 forces cause edema?

A
  1. Increased net hydrostatic pressure 2. Decreased osmotic pressure due to lowered albumin or loss of proteins 3. Increased membrane permeability/loss of membrane integrity
31
Q

Are pulmonary capillaries leaky to protein?

A

Yes

32
Q

For edema to be clinically relevant, the interstitium must contain how much additional fluid?

A

3L

33
Q

Dextrose (D5W) is a ___ solution?

A

Isotonic

34
Q

When dextrose solution is given, where does the water go?

A

Proportionally with where water is; 2/3 in intracellular space, 1/3 in extracellular space

35
Q

Is dextrose an effective or ineffective osmole?

A

Ineffective

36
Q

When isotonic saline is given, where does the water go?

A

The water is only distributed within the ECC, mostly between the plasma space and interstitial space (3/4 in interstitial and ¼ in plasma)

37
Q

What does hypotonic saline do?

A

Add water to all 3 body water compartments; can treat hypernatremia and DKA

38
Q

What does hypertonic saline solution do?

A

Remove water from intracellular compartment; can treat severe hyponatremia

39
Q

What kind of solution is lactated ringers?

A

Isotonic; it contains similar electrolytes to plasma as well as lactate

40
Q

What are plasma expanders?

A

Solutions that are made of large molecules that cannot pass capillary walls. They increase plasma volume specifically.

41
Q

What are examples of plasma expanders?

A

Albumin, blood products, hetastarch

42
Q

What is iso-osmotic volume contraction?

A

Loss of iso-ismotic fluid; example is hemorrhage. Loss of extracellular volume.

43
Q

What is hyper-osmotic volume contraction?

A

Loss of pure H2O; sweating, fever, diabetes ins. Volume of all compartments is decreased and osmolality increased.

44
Q

What is hypo-osmotic volume contraction?

A

Loss of NaCl; adrenal insufficiency. Water shifts from extracellular to intracellular. Both have lower osmolality.

45
Q

What is iso-osmotic volume expansion?

A

Gain of iso-osmotic fluid; general edema, infusion of isotonic saline. Increase in extracellular volume.

46
Q

What is hyper-osmotic volume expansion?

A

Gain of NaCl; hypertonic saline infusion. Water shifts from intracellular to extracellular and osmolality of both increases.

47
Q

What is hypo-osmotic volume expansion?

A

Gain of pure H2O; SIDAH. Volume in both compartments are expanded and osmolality decreased.

Block 4 (28 decks)

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