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Water, Electrolyte, Acid-Base, Hemodynamic Disorders > Water and Electrolyte Disorders > Flashcards

Water and Electrolyte Disorders Flashcards

1
Q

What are the body fluid compartments?

A

ICF and ECF

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2
Q

ECF is subdivided into what components?

A

Interstitial, vascular

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3
Q

What is the major ECF cation?

A

Na

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4
Q

What is the major ICF cation?

A

K

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5
Q

What is the major ECF anion?

A

Cl

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6
Q

What is the major ICF cation?

A

Phosphate

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7
Q

Define plasma osmolality.

A

The number of solutes in plasma

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8
Q

POsm = ?

A

2(serum Na) + (serum glucose/18) + (BUN/2.8)

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9
Q

What is a normal POsm?

A

275-295 mOsm/kg

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10
Q

What is the major determinant of plasma osmolality?

A

Na

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11
Q

How does effective osmolality (EOsm) differ from plasma osmolality?

A

POsm - BUN/2.8 (urea diffuses between ICF and ECF and thus does not affect the osmotic gradient)

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12
Q

Detail the movement of water between ECF and ICF compartments of differing osmolalities.

A

Water from from low solute concentration to high solute concentration

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13
Q

What effect does hyponatremia have on the movement of water?

A

Water moves from ECF to ICF

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14
Q

What effect does hypernatremia/hyperglycemia have on the movement of water?

A

Water moves from ICF to ECF

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15
Q

Decreased TBNa presents with what clinical exam findings?

A

Signs of volume depletion- Decreased skin turgor, dry mucous membranes, decreased BP, increased pulse

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16
Q

The movement of fluid across a capillary into the interstitial space is driven by Starling forces. What changes result in the movement of fluid out of capillaries into the interstitial space?

A

Decrease in plasma oncotic pressure and/or increased hydrostatic pressure

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17
Q

Define isotonic fluid loss.

A

Net isotonic loss of Na + H2O

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18
Q

Give an example of isotonic fluid loss.

A

Secretory diarrhea (adults)

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19
Q

What clinical signs indicate isotonic fluid loss.

A

Signs of volume depletion

20
Q

What are the expected values for POsm and serum sodium with isotonic fluid loss?

A

Normal- hypovolemic normonatremia

21
Q

Detail the osmotic gradient between the ICF and ECF with isotonic loss of fluid.

A

No gradient or fluid shifts between compartments. ECF volume is contracted, but ICF volume remains the same.

22
Q

Define isotonic gain of fluid.

A

Net isotonic gain of Na + H2O

23
Q

What are the expected values for POsm and serum sodium with isotonic fluid gain?

A

Normal- hypervolemic normonatremia

24
Q

Detail the osmotic gradient between the ICF and ECF with isotonic gain of fluid.

A

No gradient or fluid shifts between compartments. ECF volume is expanded, but ICF volume remains the same.

25
Q

What is the composition of normal saline?

A

9g NaCl/L = 0.9%

26
Q

How can you treat isotonic gain of fluid?

A

Restrict sodium and water. Loop diuretics

27
Q

What physical exam finding may be present in a patient with an isotonic gain of fluid?

A

Pitting edema

28
Q

What is always present with hypotonic fluid disorders?

A

Hyponatremia

29
Q

Detail the osmotic gradient between the ECF and the ICF with hypotonic fluid disorders.

A

Fluid moves from ECF into ICF

30
Q

What processes can lead to a hypotonic fluid disorder.

A

Loss of hypertonic solution, gain of pure water, or gain of hypotonic solution

31
Q

Define hypertonic loss of fluid.

A

Loss of Na in excess of water

32
Q

What are the expected values for POsm and serum sodium with hypertonic fluid loss?

A

Decreased- hypovolemic hyponatremia

33
Q

Detail the osmotic gradient between the ICF and ECF with hypertonic loss of fluid.

A

Fluid flows from ECF into ICF. ECF is volume is contracted. ICF volume is expanded.

34
Q

List examples of conditions that can lead to hypertonic fluid loss.

A

Loop diuretics/thiazides (excessive), Addison disease, 21-hydroxylase deficiency

35
Q

What is the treatment for hypertonic fluid loss?

A

Normal saline

36
Q

Why are sodium containing fluids given slowly, especially in alcoholics?

A

Avoid central pontine myelinolysis

37
Q

What are the expected values for POsm and serum sodium with a gain in pure water?

A

Decreased- euvolemic hyponatremia

38
Q

Detail the osmotic gradient between the ICF and the ECF with gain in pure water.

A

Fluid moves from ECF into ICF. ECF and ICF are volume expanded.

39
Q

When checking skin turgor in a patient with gain in pure water, what finding would you expect?

A

Normal, because TBNa is normal

40
Q

What conditions lead to a gain in pure water?

A

SIADH, compulsive water drinking

41
Q

What is the treatment for gain in pure water?

A

Restrict water

42
Q

A serum sodium less than 120 indicates what disease process?

A

SIADH

43
Q

What are the expected values for POsm and serum sodium with a gain of hypotonic solution?

A

Decreased- hypervolemic hyponatremia

44
Q

Detail the change in volume of the ICF and the ECF with gain of hypotonic solution.

A

Expansion of both compartments.

45
Q

How is pitting edema related to gain of hypotonic solution.

A

With RHF (increased venous hydrostatic pressure) or cirrhosis/nephrotic syndrome (decreased oncotic pressure), CO is decreased. This is because fluid is trapped in the interstitial space. Decreased CO results in activation of the renin-angiotensin-aldosterone system. This causes the kidney to reabsorb a slightly hypotonic solution. When this occurs the fluid ends up in the interstitial space, which exacerbates pitting edema.

46
Q

What conditions lead to hypervolemic hyponatremia?

A

RHF, cirrhosis, nephrotic syndrome

47
Q

How do you treat gain in hypotonic solution (hypervolemic hyponatremia)?

A

Restrict water and salt. Diuretics

Water, Electrolyte, Acid-Base, Hemodynamic Disorders (6 decks)

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