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2023 Systems Phys > Renal - Fluid Balance > Flashcards

Renal - Fluid Balance Flashcards

1
Q

Define

Internal Pool

A

The quantity of a substance in the ECF

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2
Q

Define

Balance Concept

A

Inputs and outputs must be equal to main balance of the renal system

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3
Q

Types of input to the internal pool

A

Ingestion
Metabolic produced

Input from external environment

Inhalation, absorption through body surface, or artificial injection

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4
Q

Types of outputs from the internal pool

A

Excretion
Metabolic Consumption (O2 to CO2)

Excretion to external environment

Through kidneys, lungs, digestive tract, or body surface, e.g. sweat, tears, sloughed skin

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5
Q

Types of reversible incorporation to internal pool

A

Reversible incorporation into more complex molecular structures

Fulfills a specific function

Iron incorporated into hemoglobin in RBC -> RBC breaks down and iron is released

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6
Q

Balance Concept

Total body input =

A

Total body output

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7
Q

What type of balance exists when

Input > output

A

positive balance exists

in Children - Growth Phase - positive Nitrogen Balance

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8
Q

What type of balance exists when

Input < output

A

Negative Balance

In older people - negative Nitrogen Balance

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9
Q

Control of:

Input

A

Input of substances is poorly/not controlled

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10
Q

Why is the input of substances poorly controlled?

A

Eating and drinking is variable
H+ is uncontrollably generated internally

Eating and drinking is based on want not need

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11
Q

Control of:

Output

H20, salt, and H+

A

H20, salt, and H+ can be lost to external environment uncontrolably

Through vomiting, sweating, dead skin, etc.

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12
Q

How do the kidneys maintain the outputs of the internal pool?

A

Kidney used urinary excretion to balance output with input

very controlled

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13
Q

Define

Fluid Balance

A

Maintenance of H2O and salt balance

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14
Q

Fluid Balance

How does sex effect % of H2O in individuals?

A

Estrogen promotes fat deposition, which decreases water

Fat - tissue without water
Increases fat content, decreases water

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15
Q

Fluid Balance

How does age effect % of water in individuals?

A

H20% decreases with age

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16
Q

Fluid Balance

A low body water content is associated with

A

Obesity

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17
Q

Fluid Balance

A high water body content is associated with…

A

leanness

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18
Q

Which of the following individuals would have the lowest percentage of body H20?
A. A chubby baby
B. A well-proportioned female college student
C. A well-proportioned male college student
D. An obese, elderly woman
E. A lean, elderly man

A

D. An obese, elderly woman

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19
Q

How is water distributed between the 2 major fluid compartments?

A

ICF - 2/3
ECF - 1/3

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20
Q

What are the two major fluid compartments in the body?

A

Intracellular Fluid (ICF)
Extracellular Fluid (ECF)

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21
Q

Define

Intracellular Fluid (ICF)

A

Fluid inside the cell

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22
Q

Define:

Extracellar Fluid (ECF)

A

Fluid outside the cell

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23
Q

What barrier lives between the ICF and ECF?

A

Cell membrane

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24
Q

What barrier exists between the two major components of the ECF?

A

Capillary Wall

Endothelial Cells of the capillary wall

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25
Q

What are the 2 major components of ECF?

A

Plasma
Interstitial Fluid

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26
Q

Characteristics of barrier between plasma and interstitial fluid:

Capillary Wall Barrier

A

Thin, pore-lined
Free exchange, except plasma membranes
Nearly identical composition

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27
Q

Characteristics of barrier between ECF and ICF:

Cell Membrane Barrier

A

Highly selective
Unequal distribution of Na+ and K+ due to Na+-K+ pump

ICF has presence of proteins that cannot leave the cell unless lysed

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28
Q

K+ concentration is higher _ cell

A

inside

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29
Q

Na+ concentration is higher _ cell

A

Outside

30
Q

Ion composition of ECF compartments

What are the major cations found in the plasma/interstitial fluid of the ECF?

A

Na+

31
Q

Ion composition of ECF compartments

What are the major anions found in the Plasma/Interstitial of the ECF?

A

Cl-, HCO3-

32
Q

Ion composition of ICF compartment

What are the major cations found in the ICF?

A

K+

33
Q

Ion composition of ICF compartment

What are the major anions found in the ICF?

A

PO4^3-
Proteins and anions

34
Q

What governs water movement vs capillary wall?

A

Starling Forces

Hydrostatic Pressure (BP), Oncotic Pressure (Plasma Proteins)

Starling Forces influence filtration or reabsorption

35
Q

What governs water movement vs plasma membrane?

A

Osmotic Effects alone

36
Q

The only fluid that can be directly acted on to control volume and composition

A

Plasma

37
Q

How does altering plasma control volume and composition?

A

Alter plasma -> alter intersitial fluid -> ICF is influences as membrane allows

38
Q

What two factors regulate Fluid Balance?

A

ECF Volume
ECF Osmolarity

39
Q

Importance

ECF Volume

A

Important in long term regulation of blood pressure

40
Q

How does ECF regulate BP in the long term?

A

By maintaining salt balance in plasma

41
Q

Salt Balance

What causes input of salt?

A

Ingestion

Not well controlled - based on want

42
Q

Salt Balance

What causes salt output?

A

Sweat
Feces
Urine

urine is altered to match input

43
Q

Salt Balance

What controls sweat output of salt?

A

Aldosterone can decrease Na+ loss

44
Q

Salt Balance

What controls feces output of salt?

A

Nothing

not under control

45
Q

Salt Balance

What controls urine output of salt?

A

The kidneys alter it to match input to maintain balance

46
Q

Salt Balance

How do the kidneys adjust sodium output?

A

Kidneys adjust Na+ via adjusting GFR and tubular reabsorption

47
Q

Regulating Fluid balance

ECF Osmolarity prevents

A

Prevents swelling or shrinking of cells

48
Q

Regulating Fluid Balance

What controlls ECF Osmolarity?

A

Controlled by water balance in plasma

49
Q

ECF Osomolarity

Losing H2O in ECF

A

Cell becomes hypertonic

>300 mosm/l

Concentration is higher outside cell (in ECF), water leaves cell

50
Q

ECF Osmolarity

Gain water in ECF

A

Cell becomes hypotonic

<300 mosm/l

Concentration is greater inside cell (ICF), water moves into cell

51
Q

Define

Hypertonic

A

Cell shrinkage

52
Q

Define

Hypotonic

A

Cell swells

Hypo Hippo Cell Swells

53
Q

Changes in ECF Osmolarity

What is the result of water loss in the ECF?

A

Dehydration
Cell shrinkage

increase ECF osmolarity, cell loses water

54
Q

Changes in ECF Osmolarity

How does water loss in the ECF cause dehydration?

A

Insufficient water intake
Excessive water loss
Diabetes insipidus

55
Q

Changes in ECF Osmolarity

Symptoms and effects of water loss in ECF:

A

Shrinking of brian neurons
Circulatory distrubances
Dry skin, sunken eyeballs, dry tongue

Shrinkage of brain neurons -> confusion , irritablity delirium, convulsions, coma
Circulatory distrubances -> lowering of BP, circulatory shock

56
Q

Changes in ECF Osmolarity

What is the result of gaining water in the ECF?

A

Overhydration
Cells tend to swell

Can’t excrete water

water enters cell
higher concentration in cell

57
Q

Changes in ECF Osmolarity

What are the causes of overhydration in a cell?

A

Patients with renal failure
H2O is rapidly ingested
inappropriate secretion of ADH

58
Q

Changes in ECF Osmolarity

What are symptoms and effects of gaining water in ECF?

A

Swelling of brain cells
Circulatory distrubances
Weakness

Swelling of brain cells - confusion, irritability, headache, dizziness, vomiting, drowsiness, convulsions, coma, death
Circulatory Distrubances - hypertension and edema
Weakness - swelling of muscle cells

59
Q

Why is H2O balance crucial?

A

Cells do not function properly when shrunken or swollen

60
Q

What causes water input?

A

Drinking
Water in food
Metabolically produced

Fruits/veggies = most
Grains = least

61
Q

What causes water output?

A

Expired air contains water vapor
Urine

62
Q

Maintaining water balance

Thirst

A

Increases water input

63
Q

Maintaining water output

Urine Formation

A

Decreases water output

ADH

64
Q

ADH and Thirst

What controlls ADH and thirst?

A

Hypothalamic osmoreceptors

Located near ADH-secreting cells and thirst center

65
Q

ADH and Thirst

How does increasing osmolarity effect ADH secretion and thirst?

A

Increase osmolarity -> neuron shrinkage -> opens cation channels -> depolarization -> increase AP firing rate -> increase ADH secretion and thirst

Na+ leaves cell for ECF, ECF is hypertonic, rapid depolarization

66
Q

ADH and Thirst

How does decreasing osmolarity effect ADH secretion and thirst?

A

Decrease osmolarity -> neuron swelling -> close cation channels -> less depolarization -> decrease AP firing rate -> decrease ADH secretion and thirst

ECF is hypotonic

67
Q

What stimulates production of ADH?

A

Increasing ECF Osmolarity
Decreasing ECF Volume

68
Q

General

What happens if we need to save water?

A

Increase renin -> increase Angiotensin II -> increases ADH and Aldosterone

Renin (enzyme) - triggers cascade to save water
Ang II - triggers thirst, and production of ADH/Aldosterone
ADH - vasopressin
Aldosterone - triggers Na+ retention

69
Q

Fluid Balance

Normal Body

A

ICF - 2/3
ECF - 1/3
input and output are equal

70
Q

Fluid Balance

What happens to ECF and ICF when 2L of pure water is added to the ECF?

A

Fluid moves from ECF to ICF until balance is regained
Volume increases and Osmolarity decreases in both

71
Q

Fluid Balance

What happens to ECF and ICF when 2L of isotonic saline is added to the ECF?

Like gatorade

A

Osmolarity stays the same in ICF and ECF
Volume decreases in ECF
Fluid exchange is maintained

72
Q

What happens to the body when 1.0L of 5% NaCl is added to the ECF?

0.9% saline solution would be isotonic

A

Fluid moves from ICF to ECF
ECF volume decreases
Osmolarity decreases in both

2023 Systems Phys (41 decks)

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