Unit 2 Pathophysiology - Chapter 3 The Cellular Environment Flashcards
Does ICF (Intracellular fluid) have most body water weight?
distribution of body fluids
Yes @ 40%
Total body water (TBW) for newborn infant
distribution of body fluids
70-80% d/t less fats stored
Total body water in childhood
distribution of body fluids
60-65%
Total body water in adults
distribution of body fluids
50-60%
What are the four forces hat determine if fluid moves out of the capillary to interstitial space? (as plasma flow from arteries to venous end of the capillary)
- capillary hydrostatic pressure (blood pressure)
- capillary (plasma) oncoctic pressure
- interstitial hydrostatic pressure
- interstitial oncotic pressure
distribution of body fluids
What is the overall movement between capillaries, interstitial, and lympathtic system?
distribution of body fluids
capillaries
a) aterial end - capillary hydrostatic pressure greater than capillary oncotic forces means water goes into interstitial (some water pulled into capillary d/t oncotic forces)
b) loss of water decreases capillary hydrostatic pressure at venous end; causing fluids to be attracted back into circulation
AS A RESULT => filtration (Arterial end) => reabsorption at venous end
interstitial hydrostatic/oncotic pressure + intracellular osmotic pressure (move to cells + lympathic)
Edema - increased capillary hydrostatic pressure
Alterations in Water Movement
Venous obstruction, or sodium and water retention.
- usually behind obstruction
- Rt congestive heart failure, renal failure, cirrhosis => water and sodium retention
Edema - decreaed capillary oncotic pressure
Alterations in Water Movement
results from losses or diminished production of plasma albumin => fluid moves out from capillary => d/t decreased synthesis of plasma protein, liver disease, protein malnutrition, glomerular diseases of the kidney, hemorrhage, serous drainage from open wounds or burns
Edema - increased capillary permeability
Alterations in Water Movement
inflammation and immune response; trauma, burns, crush injuries, neoplastic disease, allergic reactions, infection // more proteins enter interstitial space increasing interstitial oncotic pressure drawing even mroe water! => edema gang
edema - Lymphatic obstuction
Alterations in Water Movement
infection or tumor; protein and fluids are not reasorbed and accumulate in interstitial space // can happen after surgical removal of axillary or femoral lymph nodes (cancer tx)
In general pathophysiologic process that leads to edema favors what?
Alterations in Water Movement
fluid filtration from capillaries to tissues
Edema sx
Alterations in Water Movement
swelling, puffiness, tighter-fitting clothes, limited movement, weight gain
Sodium important for what other “functions”?
Sodium, Chloride, and Water Balance
neuromuscular irritability for conduction of nerve impulses (conjunction w/ potassium and calcium). regulates acid-base balance (na+ bicarb / phosphate), cellular chemical reactions, transport of substasnce across membrane
Daily intake of sodium?
Sodium, Chloride, and Water Balance
500 mg
Aldosterone
Sodium, Chloride, and Water Balance
Kidney secrete renin (when renal blood flow and blood pressure, or Na+ are low) =>
angiotensinogen (liver) => react with renin (to form angiotensin 1)
angiotensin I (converted in pulmonary vessels) => to angiotensin II via ace (released from lungs)
angiotensin II causes elevated systemic blood pressure and secretion of aldosterone (mineralcorticoid, adrenal cortex as end product of renin-angiotensin-aldosterone system) =>
aldosterone promotes sodium and water reabosrption by proximal tubules while secreting potassium (end result: conserve Na+, increase blood volume and pressure)
Natriuretic hormone (ANP or BNP)
Sodium, Chloride, and Water Balance
During incresaed transmural atrial pressure d/t incresaed intraatrial volume (possibly heart failure) => ANP and BNP inc sodium and h2o excretion by kidnyes, which lowers blood volume and pressure
antagonist to renin-angiotensin-aldosterone system
remeber natriuretic (prevents reabsorption of Na+ from urine)
Urodilatin
Sodium, Chloride, and Water Balance
released from distal tubular kidney cells when there is increased arterial pressure and increased renal blood flow. Decrease sodium reabsoption
It inhibits salt and water reabsorption.
Urodilatin (a natriuretic peptide) inhibits sodium and water reabsorption from the medullary part of collecting duct, thereby producing diuresis.
Antidiuretic hormone (ADH)
Sodium, Chloride, and Water Balance
Also called vasopressin, plasma osmolality high, blood volume low, or blood pressure drops => produce less urine, constrict vessels, reabsorb more water
Isotonic
Alterations in Sodium, Water, and Chloride Balance
changes in total body water accompanied by proportional changes in concentrations of electrolytes
Hypertonic
Alterations in Sodium, Water, and Chloride Balance
osmolality of ECF is elevated above normal, d/t increased Na+ or lack of water (cell would shrink)
Hypotonic
Alterations in Sodium, Water, and Chloride Balance
osmolality lower than normal; water gain or solute loss (cells swell)
Euvolemic hypernatremia
Alterations in Sodium, Water, and Chloride Balance
Hypernatremia with euvolemia is a decrease (normal or minimal) in TBW with near-normal total body sodium (pure water deficit).
Loss of free water with near normal body sodium concentration; poor water intakae, excessive sweating, fever, water loss from lungs, burns, vomiting, diarrhea, diabetes insipidus (A disorder of salt and water metabolism marked by intense thirst and heavy urination)
Dehydration
Alterations in Sodium, Water, and Chloride Balance
Water loss + sodium loss
Hypervolemic hypernatremia
Increased total body water, greater Na+ concentration; hypertonic solution (w/ renal impairment, heart failure, GI loss), oversecretion ACTH or aldosterone (cushing, adrenal hyperplasia), near salt water drowning
hypercholremia
Alterations in Sodium, Water, and Chloride Balance
often accompanies hypernatremia + plasma bicarbonate deficits (hyperchloremic metabolic acidosis)
metabolic acidosis characterized by a decrease in serum pH and serum bicarbonate [HCO3–] with a matched rise in serum chloride level (due to retention of chloride in the serum) which maintains a normal anion gap
Hypernatremia sx
Alterations in Sodium, Water, and Chloride Balance
weakness, lethargy, muscle twitching, hyperrflexia, confusion, coma, seizures (d/t shinking of brain cells)
What can hyponatremia cause?
Alterations in Sodium, Water, and Chloride Balance
Cause water to enter cells!
Potassium
Alterations in Potassium, Calcium, Phosphate, and Magnesium Balance
Regular ICF osmolality, maintain resting membrane potential, deposit glycogen in liver + skeletal muscle cells
Euvolemic hyponatremia
Alterations in Sodium, Water, and Chloride Balance
total body water increases, but the body’s sodium content stays the same
Caused by SIADH (antidiuretic) - water retention, hypothyroidism (decreased cardiac output), pneumonia (hypercapnia), glucosteroid deficiency (retain less na+)
Syndrome of inappropriate antidiuretic hormone (inc water reabsorption in distal nephron producing a conc urine and diluted plasma)