Renal - Body Fluid Compartments Flashcards
How can water be synthesized by the body?
from carbohydrate metabolism
How is water lost from the body
insensible loss, sweat loss, loss in feces, loss by kidneys
Extracellular fluid includes
interstitial fluid and blood plasma
Intracellular fluid amount
28 L
Extracellular fluid amount
14 L (intersitial 11 L and plasam 3L)
Most abundant extracellular cation
Na
Most abundant extracellular anion
Cl
Most abundant Intracellular cation
K
Most abundant intracellular anion
Phos
When two solutions containing ions are separated by membrane that is permeable to some of the ions and not to others and electrochemical equilibrium is established. Electrical and chemical energies on either side of the membrane are equal and opposite each other.
Gibbs Donnan Equilibrium
Gibbs Donnan Equilibrium creates an additional pull on either side of the ______
membrane
Review slide 7
The principle of conservation of mass
Distribution of fluids between intracellular and extracellular compartments determined by _____ ______ of small solutes
osmotic effect
__________ or small ions (i.e. sodium and chloride) determine distribution of fluids across the semi-permable cell membrane
electrolytes
________ factors cause fluids to shift between compartments
osmotic
RATE OF OSMOSIS - Because cell membranes are relatively impermeable to most solutes but HIGHLY permeable to _____ (i.e selectively permeable), whenever there is a higher concentration of solute on one side of the cell membrane, ______ diffuses across the membrane toward the region of ______ ______ concentration.
water / water / higher solute
RATE OF OSMOSIS - Thus, if a solute such as sodium chloride is added to the extracellular fluid, water diffuses rapidly from the _______ through the cell membranes into the _______ fluid until the water concnentration of both sides of the membrane become equal. Conversely, if a solute such as sodium chloride is removed from the extracellular fluid, water diffuses from the extracellular fluid thorught the cell membranes and into the _______.
cells / extracellular /cells
The rate of diffusion of WATER is call the rate of _______
osmosis
______ is the term defining a specific quantity of moelcules
mole
_______ refers to the number of particles in solution rather than molar concentration
osmole
One osmole (osm) =
1 mole (mol) (6.02 x 10^23)
total number of particles in a solution is measured in ______
osmoles
molecules (mole) which contain more than one paritcle dissociate into separate ions when dissolved in solution (osmole). Give an example
1 mole of NaCl dissolved into solvent (1L). Concentration of 2 osm/L solution
osmotic activity of solutes in body expressed in milliosmole (mOsm) which equal
1/1000 osmole
osmolality
osmoles / kg of water
osmolarity
osmoles / liter of solution
_______ is the net diffusion of water across a selective membrane
osmosis
osmosis is going from a _____ water concentration to a _____ water concentration
high / low
____ ______ refers to the amount of pressure required to prevent osmosis
osmotic pressure
osmotic pressure OPPOSES _______
osmosis
Osmotic pressure of a solution is ________ to the concentration of osmotically active particles
proportional
Osmotic pressure is independent of _____ ______
molecular size
Molecules which disassociate when dissolved into solution have more _____ ______
osmotic effect
Osmolarity of Body fluids FACTS - Interstitial fluid and plasma
80% due to sodium and chloride, plasma is 1 mOsm/L > interstital fluid, plasma proteins maintain 20 mmHg greater pressure in capillaries than surrounding tissue
Osmolarity of Intracellular fluid
almost 50% due to potassium ions, remainder divided among other intracellular substances, total osmolarity of each compartment @ 300 mOsm/L
Osmolarity should be about ____ of Na
twice
Large osmotic pressures can develop across cell membranes with relatively small changes in _____ ______
solute concentrations
Small changes in concentration of impermeable solutes cause tremendous changes in ____ ______
cell volume
Hypotonic - cell _____
swells
Hypertonic - Cell _______
shrinks
Review slide 17
Effects of abnormal fluid conditions
Hyponatremia
excess water and loss of sodium
hypnoatremia conditons
diarrhea and vomiting, diuretic abuse, Addison’s disease, excess water retention (ADH)
Hypernatremia
loss of water and Excess sodium
Hypernatremia conditons
Lack of ADH, diabetes insipidus, dehydration, aldosterone secretion
Review slide 19
Na abnormalities
Rapid chagnes in cell volume as a result of hyponatremia can have profound effects on tissue and organ function, especially the ______. A rapid reduction in plasma sodium concentration, for example, can cause brain cell _____ and neurological symptoms, including headache, nausea and disorientation.
brain / edema
If plasma soidum concentration rapidly falls below ___ to ____ mOsm/L, brain swelling may lead to seizures, coma, damage, death. Brain can’t increase its volume by more than ___% without it being forced down neck (herniation)
115 to 120 / 10%
Causes of hypernatremia
water loss OR excess sodium
Primary loss of water from the extracellular fluid result in ________ and ________
hypernatremia / dehydration
ADH helps the kidneys to ________ water
conserve
An inability to secrete ADH, which is needed to conserve water. As a result of lack of ADH, the kidneys excrete large amounts of _______ _____, a disorder referred to as _______ ______ ______ which causes dehydration and INCREASED concentration of sodium chloride din the ECF
dilute urine / central diabetes insipidus
In certain types of renal diseases, the kidneys can’t respond to ADH, causing a type of ________ _______ _______
nephrogenic diabetes insipidus
Hypernatremia can also occur when excessive sodium chloride is added to the ______ ________. This often results in _________-________ because excess extracellular sodium chloride is usually associated with at least some degreee of _______ __________ by the kidneys as well.
extraceullular fluid / hypernatremia-overhydration / water retention
Excessive secrertion of the sodium-retaining hormone ___________ can cause mild degree of hypernatremia and overhydration
aldosterone
Sodium retention caused by increased aldosterone secretion also stimulates secretion of ADH and causes the _______ to also reabsorb greater amounts of water
kidneys
Edema is excess fluid body in ______
tissue
Edema occurs mostly in the _______ _________ ________
extraceullular fluid compartment
T/F Intraceullular edema can occur in certain condtions
TRUE
What are the 3 conditions prone to cause INTRACELLULAR swelling?
hyponatremia, depression of the metabolic systes of the tissues, AND lack of adequate nutrition to the cells (from decreased blood flow which reduces oxygen and nutrient supply)
As it relates to Intracellular edema, inflammation has a direct effect on increasing cell membrane _________.
permeability
Ionic pumps of cell membrane require oxidative metabolism (ATP) to remove ______ _______
intracellular sodium
Two general causes for extracellular edema
abnormal leakage from plasma AND lymphatic failure to return fluids to blood
Abnormal leakage from plasma can be due to excessive capillary filtration rate, which filtration is dependent on ________ and _____ ______ of capillary, AND ________ pressure and _________ osmotic pressure
permeability and surface area / hydrostatic / colloid
Lymphatic failure to return fluids to blood is caused by lymphatic blockage preventing return of ______ to plasma, increased interstitial ______ _____ _____ , and cancer, surgery, infection (filaria nematodes)
proteins / colloid osmotic pressure
What do the following cause? Increased capillary filtration coefficient, increased capillary hydrostatic pressure and decreased plasma collooid osmotic pressure
increase the capillary filtration rate
Extracellular edema as it relates to Increased Capillary Pressure caused by excessive retention of salt and water
acute or chronic kidney failure, mineralcorticoid excess
Extraceulluar edema as it relates to Increased Capillary Pressure from high venous pressure and venous constriction
heart failure, venous obstruction, failure of venous pumps (paralysis of muscles, immobilization of parts of the body, failure of venous valves)
Extracellular edema as it relates to Increased Capillary pressure caused by decreased arteriolar resistance
excessive body heat, insufficiency of SNS, vasodilator drugs
Extracellular edema as it relates to decreased plasma proteins as it relates to loss of proteins in urine
nephrotic syndrome
Extracellular edema as it relates to decreased plasma proteins from denuded skin areas
burns and wounds
Extraceulluar edema as it relates to decreased plasma proteins due to failure to produce proteins
liver disease and serous protein or caloric malnutrition
Extracellular edema as it relates to increased capillary permeability
immune reactions that cause release of histamine and other immune products, toxins, bacterial infections, vitamin deficiency (especially Vit C), prolonged ischemia, Burns
Extracellular edema as it relates to blockage of lymph return
cancer, infections, (filaria nematodes), surgery, congential absence or abnormality of lymphatic vessels
When edema is caused by heart failure, the heart fails to pump blood normally from the veins into the arteries, which raises venous pressure and capillary pressure, causing increased ______ ______
capillary filtration
With edema caused by heart failure, the arterial pressure tends to _______, causing decreased excretion of _____ and ______ by the kidneys, which causes still more edema
fall / salt / water
With edema caused by heart failure, blood flow to the kidneys is reducedd and this reduced blood flow stimulates secretion of ______, causing increased formation of ____________ and increased secretion of _______, both of which cause additional salt and water ______ by the kidneys.
renin / angiotensin II / aldosterone / retention
Capillary pressure can ______ before significant edema occcurs
double
Three major factors that prevent edema
low interstitial compliance ( -3 mmHg), ability to increase lymphatic drainage, “wash down” of interstitial fluid proteins (as lymphatic flow increases proteins are WASHED AWAY)
total safety factor against edema is about ______ mmHG
17 mmHg
Kidneys are responsible for what?
regulation of fluid volume and body fluid composition, excretion of metabolic waste and foreign chemicals, secretion of certain hormones
Plasma filtration happens in the _________
glomerulus
The kidneys receive ____% of the cardiac output which is about ______ ml/min
22% / 1100 ml/min
Renal blood flow path
Renal artery -> segmental arteries -> interlobar arteries -> arcurate arteries -> interlobular arteries -> afferent arterioles -> glomerular capillaries
Oxygen consumption in the kidney varies directly with active transport of ____
Na+
Highest metabolism is in the _____ ______
renal cortex
On a per gram basis, renal blood flow is the _______ of any organ
highest
A-V 02 difference gives information on oxygen uptake which is ____ml/L in the kidney, ___ml/L skeletal muscle and ___ml/L in heart
14 / 60 / 140
The kidneys do not need a lot of oxygen but they do need a lot of _____ _____
blood flow
The functional unit of the kidney
nephron
Each kidney has _____ nephrons
1.25 million
Two types of nephrons
cortical and juxtamedullary
Cortical nephrons have short ____ ____ _____ and outnumber juxtamedullary nephrons __:___
loops of henle / 7:1
Juxtamedullary nephrons extend deep into the ______ with LONG ____ ____ ______ and play a big role in ________ urine
medulla / loops of henle / concentrating
LOH has a THIN ______ loop and THICK ________ loop
descending / ascending
The bowman’s capsule is a funnel-like structure and considered the _____ of the nephron
beginning
The glomerulus is a ____ pressure capillary bed and is the site of _____ ____
high / blood filtration
Each nephron has it’s own indepenent ____ ______
blood supply (renal arterioles and veins)
