Week 3- Fluid, Electrolytes And Acid Base Imbalances Flashcards
Where is water contained in the body
- Intracellular fluid: K+ (approx. 35%)
- Extracellular – the interstitial fluid which
bathes the cells, Na+ salts (approx. 12%) - Plasma (also extracellular, consists of mainly
proteins. Approx. 4-5%)
• Small amounts in bone, digestive secretions and
cerebrospinal fluid (CSF)
What does fluix and electrolyte balance play an important role in
Homeostasis
It is a dynamic process crucial for life
An imbalance is fluid and electrolytes is often a sign of what
Disease
Name the cations and anions electrolytes that regulate electrical charge on cells and flow across membranes
Cations: (positive) NA+ K+ H+
Anions: CL- HCO3- Phosphate
What is osmotic pressure
Hydrostic pressure exerted by a solution across a partially permeable membrane from a pure solvent
Briefly describe osmosis terminology
Hypertonic= cells shrivel due to a higher conc of solutes outside thr cell. Water move out cell
Isotonic: same conc
Hypotonic: cell swells as water moves in cell as it is more conc
What is oncotic pressure
What is this fluid balances by
Acts to retain fluid within the vessel
Net flow of fluid outwards is balances by the suction into the lymphatics
Cell membrane imperable to na and k
What is hypovolemia
List signs
Decreased blood volume
Reduction of blood plasma
-thirst,
muscle cramps,
nausea, vomiting,
postural dizziness,
hypotension,
confusion,
loss of skin elasticity
Increased JR
Tachacardia
Low jugular venous pressure
Cold skin
What is hypervolemia
Fluid volume increase
Increased extracellular volume
An excesses of total body sodium and water
Signs:
Odema
Weight gain
Increased jugular venous pressure
Lung crackles
Pulmonary odema
Cramping
High BP
Heart failure
Haptic cirrhosis
Nephrotic syndrome
What is the name of different sodium imbalances
Deficit = hypoatremia
Excess= hypernatremia
What is the name of different potasium imbalances
Deficit= hypokaleamia
Excess= hyperkalemia
What is the name of different magnesium imbalances
Deficit= hypomagnesaemia
Excess= hypermagnaesaemia
What is the name of different calcium imbalances
Deficit= hypocalcaemia
Excess= hypercalcaemia
What is the name of different phosphate imbalances
Deficit= hypophosphaetemia
Excess= hyperphosphatemia
Describe hyponatraemia
• A loss of sodium (Na <135 mmol/L)
• Aetiology:
Extrarenal: Vomiting, diarrhoea, haemorrhage, burns, pancreatitis
Kidney: Osmotic diuresis, diuretics, Addison’s disease (adrenocortical
insufficient renal disease)
• Clinically: Similar to volume depletion
Hyponatraemia encephalopathy
* H/A, confusion, restless leading to drowsiness, myoclonus jerks, convulsion, coma
Describe hypernatremia
A higher than normal sodium level (>145mmol/L)
Causes:
Gain of sodium and water deficit
Inadequate water intake
Increased serum sodium concentration
Cushing’s disease
Conn Syndrome (Primary aldosterone)
*
Clinical features: nausea, vomiting, fever, confusions, polyuria, polydipsia,
increased reflexes, dehydration, fatigue
Describe hypomagnesaemia
Caused: GT disorders
Kidney
Medication
Diabetes
Alcoholism
Treatment:
Oral mg
Intravenous mg (severe)
Symptoms: cramp
Fatigue / weakness
Numbness/ tingling
Abnormal heart rhythms
Aseizures
Personalit change/ confusion
Can be by defective absorption excessive gut loss or acute pancreatic (inflammation)
Describe hypermagnesaemia
Occurs normally in patients with kidney disease given mg containing laxatives
Weakness
Hyporeflexia- reduced/ no reflex
Respiratory paralysis
Calcium function and role
Major component of bone and teeth
Transmits nerve impulse
Regulates Muscle contraction, relaxation (including cardiac muscle)
Describe hypocalcaemia
Conditions which cause decrease in production of parathyroid hormone (which allows calcium to synthesis) may cause this. These are
Parathyroid/ thyroid issues
Chrnoic renal failure
Elevated phosphorus
Chrnoic alcoholism
Vitamin d
Describe the process of elicitng chvosteks sign
Detects hypocalcemia depending on severity
Ask patient to relax facial muscles. Tap facial nerve inferior to zygomatic arch. + response is twitching of corner of mouth to spasm of all facial muscles
Describe hypercalcaemia
Excess calcium in plasma
Mortality rate is less than 50% if not treated
Hyperactive parathyroid hormone
Prolonged immobilisation
Bit D overdose
Thiazide diuretics
Signs= weak muscles, abscent reflexes, bowl sounds, kidney stone formation
Sign- involuntary contraction of muscles of hand and wrist after inflammation of blood pressure cuff as neurons are less stable
Describe hypokalaemia
Critical for cellular and metabolic functions
Renal disease
Dietary deficiency
GI ( diarrhoea)
MC diuretic tX= Hormones regulating aldosterone for balance of NA and K
Hyperalosteronism (too much aldosterone which regulates bp by regulating NA and K)
Signs= lethargy, low respiration, loss of urine, leg cramps, limp muscles, low bP/HR
Describe hyperkalaemia
Excess K intake
Post vigorous exercises
Renal failure
Shift of K out of cel due to injury or fever
Addison’s disease= glands do not produce enough aldosterone
Signs= muscle weakness, reduced urinary output, muscle twitches
Describe hypophosphateaetremia
Symptoms= irritability/ confusion
Weakness
Trouble breathing
Loss of appetite
WBC dysfunction
If untreated=
Seizures
Chronic coma, rah boo, bones soften
Caused by= alcohol abuse
Maluntrition
Burns
Hyperventilation
Describe hyperphosphatemia
Symptoms= calcium deposits (soft tissues)
Low calcium in blood (cramps/ spasms)
Signs- ectopic calcification
-hyper parathyroid is m
-renal ostiopystraphy
Aetiology= necrosis- cellular injury
-kidney failure
-psudo and normal hypothyroidism
-diabetic keto acidosis
-tumourlysis syndrome
List the phases of clotting (haemostasis)
1.Vasoconstriction (response to vessel injury)
2.Vasoconstriction (mediated by endothelial-1)
3.Platelet adhesion (roll along vessel walls and adhere to areas of exposed sub-endothelial collagen)
4. Platelet activation (irreversible changes in shape and secrete cytoplasmic granules)
5. Platelet aggregation (fibrinogen aids platelet plug)
What would u name a high volume and low volume solution
High- hypervolemic
Low- hypovolemic
How does Angiotensin 2 affect bp
It can cause vasoconstriction to increase bp by cancelling bradykinin (which cause vasodilation)
It can cause the release of ADH which signal kidney to retain water which would increase bp
Promotes release of Aldosterone which causes kidney to retain na and water. Na stays in collecting duct
Angeiotensin can increase the cardiac output by promoting fluid retention. Increase in blood pressure.
Can cause a decrease by increasing the after load: decrease it SV and heart needs to pump harder.
No beta blockers allows increase in BP
Function of angiotensin 1
It is a blood protein which deactivates bradykinin which causes vasodilation
This allows vasoconstriction which is the function of angiotensin 2
What is there function of the renin- angiotensin- aldosterone system (RAAS)
Hormonal system that regulates bp, fluid balance, electrolyte homeostasis. Maintains cardiovascular stability and response to change in blood volume and bp
Renin= secreted by kidney to low bp
Low na conc in renal tubules
Stimulation of sympathise nervous system
Angiotenin 2= vasoconstriction, ADH release,
Aldosterone= increase na reabsorption and k excretion
Promote water retention leading to increase bp
