Hughes - Fluid and Electrolytes Part 1 Flashcards
body water composition decreases as ____ increases
adipose tissue
2/3 of water is ______
(intracellular or extracellular)
intracellular
the 1/3 of water that is extracellular – breakdown where it’s located
70% is intertitial and 30% is intravascular
so very small portion is actually in the vessels
3 major INTRAcellular ions
potassium
magnesium
phosphate
3 major EXTRAcellular ions
sodium
chloride
bicarbonate
water moves from ___ ti ___ osmolality
recap what osmolality is
low to high
particles/kg of water
all body fluids are maintained between ___-___mOsm/kg
280-295
the kidney is able to regulate osmolality through the activity of….
ADH
TRUE OR FALSE
decreased plasma tonicity causes an increase in ADH
FALSE - decrease
increased plasma tonicity causes a ___ in ADH
explain what happens
increase
more low-solute water will be retained in the body, and thus the urine will be more concentrated
kidney regulates volume through the movement of ____
aldosterone
what is the main extracellular osmol
sodium
what does entresto do to natriuretic peptide levels
increases them by preventing their breakdown
true or false
if a patient is literally visually blown up with fluid, they cannot be hypovolemic
FALSE - they can be – can still be hypovolemic intravascularly
whole body vs intravascular are different things
pt gets DVT in leg and it is swelling
are they hypervolemic?
NO
can be hypovolemic bc the fludi that’s supposed to be in the vessels is going to a compartment where it’s not supposed to be
the symptoms that occur from hypovolemia occur bc of what 2 things
-the underlying cause (ie - vomiting)
-decreased perfusion (fatigue, thirst, etc)
another name for hypervolemia
edema
3 things that can cause hypervolemia (edema)
increased renal sodium retention
hypoalbuminemia
increased capillary pressure (due to sepsis, trauma, etc)
orthopnea meaning
shortness of breath when lying down but improves when you sit up
name 3 cases of “hypervolemia” and what the symptoms would be
pulmonary edema - SOB, orthopnea
peripheral edema- swollen legs
ascites - (peritoneal cavity filled w fluid) - abdominal distention, dullness, SOB
symptoms of HYPERVOLEMIA are due to what 2 things
-the underlying cause (anuria from renal disease)
-where the fluid is
the more ______ the electrolyte abnormality, the more severe the signs and symptoms will be
ACUTE - ie - if sodium changes drastically in 1 day vs slowly over a long time
(also, the further out of range)
hyponatremia technically means….
explain how this can be complicated
low ratio of
total body sodium: total body water
if someone drinks more than 16 L a day (the most a kidney can excrete), the sodium can get diluted and appear low, even tho the level is normal
the clinical presentation for hyponatremia is mainly ____ effects
how?
NEUROLOGIC
because fluid shifts through the BBB – cerebral edema
if sodium gets very low (110-115) — can cause seizure and coma!!!!!!
as mentioned, hyponatremia can cause neurologic effects because water rushes through the BBB, causing cerebral edema
the brain adapts to this fluid within only a couple days. therefore….
we have to correct the sodium EXTREMELY SLOWLY – not too fast
no faster than 4-8 mEq in 24 hours
otherwise, can get CNS effects like behavioral changes, seizures, osmotic demyelination — brain shrinks – lot of damage – potential irreversible
treatment for hypovolemic hypotonic hyponatremia
replacement with IV normal saline is ideal – bc as the volume comes back, the kidneys will regain their function and be able to remove the sodium on their own
for mild cases, even just oral replacement solutions can be used (NOT water or gatorade - use pedialyte!!! need glucose AND electrolytes)
goal correction rate for hypotonic hypovolemic hyponatremia
4-8mEq/L/hour
treatment for HYPERVOLEMIC hypotonic hyponatremia
DO NOT GIVE IV FLUIDS!!!
reduce oral fluid intake, allow for some sodium (if bc of heart failure - not too high) in the diet, and use loop diuretics
(can also use vaptans)