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Membranes and Receptors > Lecture 1.2: Body Fluids > Flashcards

Lecture 1.2: Body Fluids Flashcards

1
Q

How much of the body is water (Total Body Water)?

A

60%

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2
Q

How much of TBW is intracellular?

A

40%

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3
Q

How much of TBW is extracellular? How is it split up?

A

20%
Interstitial (15%)
Intravascular (5%)

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4
Q

Does adipose or skeletal muscle tissue have more water?

A

Skeletal Muscle Tissue

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5
Q

What Cations are found in Extracellular Fluid?

A
  • High Sodium (Na +) ~140mmol.l-1
  • Low Potassium (K+) ~4.5mmol.l-1
  • Very low Calcium (Ca2+)
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6
Q

What Anions are found in Extracellular Fluid?

A
  • Chloride (Cl-) ~100mmol.l-1
  • Hydrogen Carbonate (HCO3-) ~26mmol.l-1
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7
Q

What Cations are found in Intracellular Fluid?

A
  • High Potassium (K+) ~160mmol.l-1
  • Low Sodium (Na+) ~10mmol.l-1
  • Very low Calcium (Ca2+)
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8
Q

What Anions are found in Intracellular Fluid?

A
  • Chloride (Cl-) – lower concentration than extracellular
    fluid
  • Lots of organic anions
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9
Q

What is Movement of Fluids driven by?

A
  • Osmotic forces
  • Oncotic pressure
  • Hydrostatic pressure
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10
Q

What generates osmotic forces?

A

Changes in the concentration of solute (electrolytes) in the fluid compartments

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11
Q

What is the volume of the Intracellular Compartment determined by?

A
  • Movement of water to and from the extracellular
    compartment
  • Mostly determined by solute concentration in the
    extracellular compartment
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12
Q

What is an Isotonic Solution?

A

Same solute concentration in intra and extracellular compartment

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13
Q

What is a Hypotonic Solution?

A

Lower solute concentration in extracellular compartment

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14
Q

What is a Hypertonic Solution?

A

Higher solute concentration in extracellular compartment

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15
Q

Changes in the Extracellular Composition damages cells through what mechanisms? (3)

A
  • Osmolality changes produce swelling or shrinkage of
    cells
  • Electrolyte changes alter excitable cell function
    (K+ and Ca2+ are very significant)
  • Changes in intravascular volume affect tissue
    perfusion leading to cell damage from lack of oxygen
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16
Q

What is the distribution of volume between INTERSTITIAL and INTRAVASCULAR
compartment determined by?

A

Exchange of water and solute with interstitial fluid at the capillaries

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17
Q

Where does Interstitial and Intravascular compartment
exchange occur? How does it occur? (4)

A
  • At the capillaries
  • Water and small solutes cross freely
  • Forced out of intravascular compartment by
    hydrostatic pressure
  • Drawn back in to intravascular compartment by
    oncotic pressure
  • Cells and large molecules do not cross freely
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18
Q

What is the pressure which is generated by the presence of large molecules called?

A

Colloid Osmotic Pressure

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19
Q

75% of oncotic pressure of the plasma comes from…?

A

Albumin (anion)

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20
Q

What is the aim of oncotic pressure?

A

To keep the fluid in the intravascular compartment

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21
Q

What causes water to move into the interstitial compartment from the intravascular compartment? (2)

A
  • Loss of protein intravascularly
  • Increase of protein in interstitial compartment
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22
Q

What complication arises from increased interstitial fluid?

A

Oedema

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23
Q

What is Hydrostatic Pressure?

A

The pressure that any fluid in a confined space exerts

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24
Q

What is the overall interaction of Oncotic and Hydrostatic pressure is known as?

A

Starling’s Principle

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25
Q

Daily values of fluid input? (3)

A
  • Oral Fluid Intake (~1500ml)
  • Food (~500ml)
  • Metabolism (~500ml)
  • Total ~2500ml
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26
Q

Daily values of fluid output?

A
  • Urine (~1500ml)
  • Insensible Loss (sweat, faeces, lungs) (~1000ml)
  • Total ~2500ml
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27
Q

What causes Risk of Fluid Deficit (11)

A
  • Vomiting
  • Diahorrea
  • Haemorrhage
  • Fistulae
  • Pyrexia
  • Burns
  • Diuresis
  • Diuretic Drugs
  • ‘3rd Space Losses’
  • Patient too ill to drink
  • Carer neglect
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28
Q

What causes Risk of Fluid Overload (4)

A
  • Acute or Chronic Renal Failure
  • Heart Failure
  • Liver Failure
  • Iatrogenic (i.e. excess IV fluids)
29
Q

What is the aim of Fluid Replacement Therapy? When are IV fluids prescribed?

A
  • Aim to replace what has been lost
  • Correct existing deficits and/or ongoing losses
  • IV fluids are prescribed when fluid needs can’t be met
    by enteral routes (oral)
30
Q

What is an important consideration when doing Fluid Replacement Therapy?

A
  • Need to consider the correct fluid therapy
31
Q

What are the 3 Types of Fluid Therapy?

A
  • Maintenance Fluids
  • Replacement Fluids
  • Fluid Resuscitation
32
Q

What do Maintenance Fluids deal with?

A

The daily necessary fluid requirements

33
Q

How are Maintenance Fluids administered?

A
  • Oral (minor dehydration)
  • Enteric (NBM/ severe dehydration- unable to take
    orally)
  • Intravascular route (dehydration, NBM etc)
34
Q

Maintenance Fluid Requirements (3)

A
  • 25-30ml/kg/day Water
  • 1mmol/kg/day Potassium, Sodium, Chloride
  • 50-100g/day Glucose (to limit starvation ketosis) this
    does not address patients nutritional need
35
Q

Maintenance Fluid Requirements: What demographic of patients should more cautious fluid prescription (20-25mls/kg) be done for?

A
  • Elderly
  • Patients with renal or cardiac failure
  • Patients at risk of re-feeding syndrome
36
Q

Maintenance Fluid Requirements: How are they adjusted for obese patients?

A
  • In obese patients you adjust the prescription
    (electrolyte need) to their ideal body weight and the
    lower range for volume/kg (25mls/kg)
  • Patients rarely need >3L/day
37
Q

What is Fluid Resuscitation?

A
  • It is the medical practice of replenishing bodily fluid
    lost through sweating, bleeding, fluid shifts or other
    pathologic processes
  • The primary goal of fluid resuscitation is to increase
    cardiac output and improve organ perfusion
38
Q

What are the 2 ways in which Fluid Resuscitation is used?

A

1) Maintain intravascular volume (In order to maintain
blood pressure in hypotensive or shocked patients)
2) To replace massive fluid loss

39
Q

What are the 2 (*3) Types of Fluids?

A
  • Colloids
  • Crystalloids
  • Blood
40
Q

What is the composition of Colloid Fluids?

A
  • Solution of larger organic molecules (protein), water
    and electrolytes
  • Albumin, Gelofusine, Gelaspan
41
Q

What is the composition of Crystalloids Fluids?

A
  • Solution of small molecules in water
  • Sodium Chloride, Hartmann’s, Dextrose
  • Physiological – A more physiologically balanced
    Crystalloid
42
Q

What is the MOA of Colloid Fluids?

A
  • The large particles (mostly proteins) are too large to
    pass the capillary membrane
  • Creates oncotic gradient holding the water in the
    intravascular space
  • Colloids remain in the intravascular space longer than
    crystalloids
  • Maintains high oncotic pressure in the intravascular
    space
43
Q

What Risk is associated with Colloid Fluids?

A

Anaphylaxis

44
Q

Examples of Crystalloids ?

A
  • 0.9% Saline +/- Potassium
  • Physiological crystalloids – Hartmann’s, Plasmalyte148
  • Glucose
45
Q

0.9% Saline Sodium Concentration

A

Sodium concentration higher (154 mmol/l) then
plasma (140 mmol/l)

46
Q

What risks are associated with 0.9% Saline? (2)

A
  • Extra Chloride (154) can lead to hyperchloraemic
    acidosis
  • No potassium can lead to hypokalaemia
47
Q

When is Glucose Solution useful? Why?

A
  • Useful in dehydration
  • Not helpful for resuscitation
  • Because it is relatively isotonic
48
Q

What happens to glucose when administered?

A

However glucose is rapidly metabolised = water in the
extracellular space

49
Q

What are Physiological Fluids? Examples?

A
  • Part of the Crystalloid family
  • Much closer in electrolyte & colloid composition to
    plasma
  • Less physiologically disruptive than 0.9% Saline
  • Hartmann’s
  • Plasmalyte148
50
Q

What is the half-life of Crystalloids?

A

30-60 mins

51
Q

What is the half-life of Colloids?

A

Several hours or days

52
Q

How much volume of Crystalloids is needed for fluid replacement?

A

3 times the volume needed for replacement

53
Q

How much volume of Colloids is needed for fluid replacement?

A

Replaces volume for volume

54
Q

What can excessive use of Crystalloids cause?

A

Peripheral or Pulmonary Oedema

55
Q

What can excessive use of Colloids cause?

A

Can precipitate cardiac failure

56
Q

How do Crystalloids affect the intravascular spaces?

A

Molecules small enough to freely cross capillary walls, so less fluid remains in intravascular spaces

57
Q

How do Colloids affect the intravascular spaces?

A

Molecules too large to cross capillary walls, so fluid remains in intravascular spaces for longer

58
Q

How costly are Crystalloids?

A

Inexpensive

59
Q

How costly are Colloids?

A

Expensive

60
Q

Can Crystalloids cause allergic reactions?

A

Non-Allergenic

61
Q

Can Colloids cause allergic reactions?

A

Can cause Anaphylaxis

62
Q

Are Crystalloids suitable for vegetarians and vegans?

A

Yes

63
Q

Are Colloids suitable for vegetarians and vegans?

A

Some preparations are not suitable for vegetarians and vegans

64
Q

Which Fluid should be used for Maintenance?

A

Crystalloid Solutions ideally a more
physiological fluid

65
Q

Which Fluid should be used for Resuscitation?

A
  • Crystalloid for initial fluid boluses of 500mls/<15mins
  • Up to 2000mls and then consider colloid
66
Q

Which Fluid should be used for Blood Loss?

A

Colloid (for rapid plasma expansion) while awaiting
blood

67
Q

Colloids and Crystalloids are plasma volume …..?

A

expanders

68
Q

What are the 5 R’s

A
  • Resuscitation – ABCDE assessment (initial fluid
    resuscitation with bolus)
  • Routine Maintenance – for those at risk of ongoing
    fluid loss
  • Replacement – ensure adequate: hydration, electrolyte
    balance
  • Redistribution – Be aware of redistribution into the
    tissues
  • Reassessment – Regular reassessment

Membranes and Receptors (19 decks)

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