The Cellular Environment Flashcards
Define Total Body of Water (TBW)?
The sum of all fluids within all the compartments of the body constitutes TBW. TBW = 55 to 60% of total body weight.
Ratio of Intercellular Fluid (ICF) to Extracellular Fluid (ECF) in the body?
1) ICF = 40% of TBW ~ 28L
2) ECF = 20% (4% IV and 16% Interstitial) of TBW ~ 14L
What is the percentage of TBW in the following populations:
1) Newborn
2) Childhood
3) Adults
4) Older Adults
1) Newborn - 75 to 90%
2) Childhood - 60 to 65%
3) Adults - 60%
4) Older Adults - declines with age
Define Aquaporin
A family of water channel proteins that provide permeability to water.
What allows water to move between plasma and the interstitial fluid?
Osmotic and hydrostatic pressure gradients
Describe Starling’s Law of Capillaries and Net Filtration Pressures on the arterial side?
Starling’s Law describes net filtration of arterial capillary pressures as follows:
1) Capillary Hydrostatic pressure - 35mmHg
2) Interstitial Fluid Hydrostatic Pressure - 2mmHg
Net Hydrostatic Pressure (pushing in) = 33mmHg
1) Capillary Oncotic Pressure - 24mmHg
2) Interstitial Fluid Oncotic Pressure - 0mmHg
Net Oncotic Pressure (pushing out) = 24mmHg
Net Filtration Pressure = 33 - 24 = 9mmHg
Describe Starling’s Law of Capillaries and Net Filtration Pressures on the venous side?
Starling’s Law describes net filtration of venous capillary pressures as follows:
1) Capillary Hydrostatic pressure - 18mmHg
2) Interstitial Fluid Hydrostatic Pressure 1mmHg
Net Hydrostatic Pressure (pushing in) = 17mmHg
1) Capillary Oncotic Pressure -25mmHg
2) Interstitial Fluid Oncotic Pressure 0mmHg
Net Oncotic Pressure (pushing out) = 25mmHg
Net Filtration Pressure = 17 - 25 = -8mmHg
What is Starling’s Equation? What does each component mean?
Ԛ=K(Pc -Pi)-σ(πc -πi) (gives the net hydrostatic pressure - oncotic pressure out of the capillary
1) Q = Flow out of capillary
2) K = Filtration coefficient (k of H20 perm. of the cap.)
3) Pc = Capillary hydrostatic pressure
4) Pi = Interstitial hydrostatic pressure
5) σ = reflection coefficient (relates cap. protein perm)
6) πc = capillary oncotic pessure
7) πi = interstitial oncotic pressure
What is Edema? What causes it?
Edema is the accumulation of fluid in the interstitial spaces caused y and increase in filtration or a decrease in reabsorption.
5 specific cause of Edema as mentioned in the Pos?
1) Increased capillary hydrostatic pressure from HTN or venous obstruction or insufficiency.
2) Decreased blood colloid osmotic pressure from low albumin, liver disease or malnutrition.
3) Increased capillary permeability from inflammation or severe burns.
4) Lymph obstruction aka lymph edema
5) Kidney disease causing sodium retention and/or protein loss.
Why is periopererative fluid mgmt important?
1) maintains intravascular volume
2) Augments CO
3) Maintains tissue perfusion
4) Promotes O2 delivery
5) Corrects/maintains electrolyte balance
6) facilitates delivery of nutrients
7) clearance of metabolic wastes
8) Vital component of ERAS (enhanced recovery after surgery) protocol
What are crystalloids? 3 most common?
Aqueous electrolyte solutions that are close to tonicity of plasma.
1) Plasmalyte/normosol
2) Lactated Ringers
3) 0.9% NaCl
Crystalloids are preferable for the resuscitation of dehydration from conditions leading to hypertonicity. Name 4 examples of such conditions?
1) Prolonged fasting states
2) Active GI losses
3) Polyuria
4) Hypermetabolic conditions
Even though 0.9% NaCl is the most commonly used isotonic solution, it is the least physiologic. What pH condition results if too much NaCl is given?
Hyperchloremic metabolic acidosis can happen because too much Cl- in the NaCl kicks out HCO3- via the kidney.
The only isotonic fluid that contains Phosphate, Mag, Acetate, and gluconate?
Plasmalyte/Normosol
What are Colloids?
Suspensions with high-molecular weight molecules in electrolyte solutions used for their plasma volume-increasing factors.
How do Colloids increase plasma volume?
Colloids increase πc (capillary oncotic pressure) & interacts with glycocalyx to decrease transcapillary filtration
(T/F?) Albumin is the only naturally occurring colloid available for infusion (besides PRBCs)?
True
What are the 3 types of Synthetic Colloids?
1) Hydroxyethyl Starches (Hetastarch)
2) Dextrans
3) Gelatins
Characteristics of Hetastarches?
1) Have allergic potential
2) Associated with coagulopathies
3) Can accumulate in interstitial tissues/organs causing nephrotoxicity.
Characteristics of Dextrans?
1) Oldest artificial colloid
2) Can cause ARF and coagulopathies
Characteristics of Gelatins?
1) Derived from bovine components
2) High incidence of anaphylaxis
3) Can transmit spongiform encephalopathy
What is the preferred replacement for blood volume in patients with intact endothelial glycocalyx undergoing acute volume loss.
Colloids
What will happen if you use Albumin and other colloids in patients with endothelial injuries?
Use of colloids in PT’s with endothelial injuries may lead to pulmonary edema and other end organ complications (i.e. hyperglycemia and sepsis).