Patho Exam 3 Flashcards
Arginine Vasopressin (AVP)
- other name?
- Osmotic release effect?
- Nonosmotic release effect?
Arginine Vasopressin (AVP)
- Antidiuretic Hormone (ADH)
- Osmotic release causes 1-2% change in osmolality
- nonosmotic release causes 6-10% change in osmolality
Water
- TBW in male?
- TBW in female?
Water
- 60% of TBW in male
- 50% of TBW in female
Serum Osmolality Equation
(2 x Na) + (Glu/18) + (BUN/2.8)
ECF
- % of TBW?
- 3 substances and % ?
ECF
- 40% of TBW
- Plasma - 20%
- IF - 80%
- Transcellulor fluid - <1%
ICF
- % of TBW
- 1 substance
ICF
- 60% of TBW
- cytosol
ECF Osmolality
-concentration of ?
ECF Osmolality
-Concentration of Sodium Salts
ICF Osmolality
-concentration of ?
ICF Osmolality
-Concentration of Potassium Salts
4 Principles of Regulation
- Homeostatic mechanisms respond to changes in ECF
- No receptors directly monitor fluid or electrolyte balance
- Water cannot be moved by active transport
- Losses do not equal gains cause imbalance
Hypothalmic osmoreceptors
-what do they do?
Hypothalmic osmoreceptors
-monitor plasma volume + osmotic concentration
How does water move through membrane?
- water follows salt by osmosis
- other mechanisms - ADH, Thirst Stimulate
Daily Water input
- Amount total?
- Amount in Food?
- Amount in Drink?
- Amount in Metabolic generation?
Daily Water Input
- 2500ml Total
- Food-1000ml
- Drink-1200ml
- Metabolic generation - 300ml
Daily Water Loss
Sensible- whats it mean?
Urine - Amnt ?
Stool - Amnt ?
Daily Water Loss
Sensible - can be measured
Urine - 1200ml
Stool - 150ml
Daily water Loss
insensible - meaning?
Respiratory - amnt?
Transcutuneous evaporation - amnt?
Daily Water Loss
Insensible - cannot be measured
Respiratory - 400ml
Transcutaneous evaportation - 750ml
What determines Fluid exchange between plasma and IF
-Determined by net colloid osmotic pressure vs. net hydrostatic osmotic pressure
Decreased Net Colloid Pressure
-Disease + Symptoms ?
Decreased Net Colloid Pressure
- Hypoalbunemia - Low Blood Albumin
- Liver Disease
- Increased accumulation of IF
Increased Net Hydrostatic Pressure
-Diseases + symptoms + causes ?
Increased Net Hydrostatic Pressure
- Heart Failure
- Renal Failure (oliguria or anuria)
- Increased accumulation of IF
- Lymphatic obstruction
- Increased capillary permeability
Fluid Shifts
- what speed?
- in response to what?
- how long until equilibrium?
- what direction in relation to osmolality?
Fluid Shifts
- occur rapidly
- in response to changes in osmotic concentration of the ECF
- Oppose the change in osmolality
Sodium Balance and ECF Volume
-what balances Na+ content in ECF?
Sodium Balance and ECF Volume
- Na content in ECF is balanced between dietary Na intake and Renal Na excretion
- change in Na content does not equal a change in Na concentration
- changes in Na content lead to changes in corresponding gain/loss of water which keeps the concentration constant
Euvolemia?
Euvolemic?
-Normal fluid volume in both TBW and intravascular
Hypervolemia
- excess fluid volume
- in intravascular space and interstitual fluid (edema)
- AKA fluid overload, volume overload, wet.
Hypovolemia
- Decreased fluid volume
- Total body water (dehydration)
- Intravascular (volume depleted)
Physical Exam Findings
- Behavior
- Skin turgor
- Skin moisture
- Capillary refill
- mucus membranes
- peripheral pules
- extremites
- Blood pressure
- Lungs
- External jugular vein
- Weight
Laboratories Findings
- Serum Sodium
- Serum Osmolality
- Urine specific gravity
- BUN:SCr ratio
- Hemoglobin/hematocrit
Subjective Findings
- Thirst
- Dizziness
Dehydration Manifestations
- increased plasma osmolality
- increased sodium
- increased BUN:Cr > 20
- Urine specific gravity >1.020
- CNS Disturbances
- -Irritable->hypeirritable->lethargic
- Excessive Thirst
- Dry mucous membranes –Decreased skin turgor
- Concentrated Urine
- Weight loss
TBW Depletion
-Loss of hypotonic fluid from all body fluid compartments
Dehydration Causes
- Inadequate oral intake in elderly
- Increased insensible losses
- Diabetes
- Insipidus
- Osmotic diuresis
- Impaired renal concentrating mechanisms
Intravascular Volume depeletion:
ECF Depletion
- Loss of isotonic fluid
- No primary disturbance of plasma osmolality
- tends to be more acute and require more aggressive treatment
Intravascular Volume depeletion causes
- External fluid losses
- -burns
- -hemorrhage
- -GI Losses
- Third Spacing
- -Sepsis
- -Ascites
Intravascular Volume Depletion PE Findings
- Orthostatis
- Tachycardia
- Acute Weight loss (3-10%)
- decreased urine output ->anuria
- increased hematorcrit
- BUN:SCr > 20
- CNS Disturbances
- -irritable -> hyperirritable -> lethargic
- Skin tenting
- Dry mucus membranes
- Delayed capillary refill (2 to >4 seconds)
- weak or not palpable pules
- external jugular vein not visible
Intravascular volume depletion labortory findings
- Serum sodium - within normal limites
- Serum osmolality - WNL
- Urine specifc gravity - WNL
Intravascular Volume Depletion Subjective Findings
- Thirst
- Dizziness
Hypervolumia
-symptoms?
- increased blood pressure
- moist skin
- jugular venous distension
- peripheral edema
- –clinically detectable increased in interstitial fluid volume – at least 2.5-3L excess in adults
- –usually due to heart, renal, or hepatic failure
- hypoxia
- orthopenwa
- shortness of breath
- dyspnea on exertion
- we
Peripheral edema
- whats it found in
- clincal detections
- causes
- manifestation of hypervolemia
- detectable in increased interstitual fluid volume
- 2.5-3L
- usually due to heart, renal, or hepatic failure
