Week 3- Fluid, Electrolytes And Acid Base Imbalances

Question 1

Where is water contained in the body

Answer 1

1. Intracellular fluid: K+ (approx. 35%)
2. Extracellular – the interstitial fluid which
   bathes the cells, Na+ salts (approx. 12%)
3. Plasma (also extracellular, consists of mainly
   proteins. Approx. 4-5%)
   • Small amounts in bone, digestive secretions and
   cerebrospinal fluid (CSF)

Question 2

What does fluix and electrolyte balance play an important role in

Answer 2

Homeostasis

It is a dynamic process crucial for life

Question 3

An imbalance is fluid and electrolytes is often a sign of what

Answer 3

Disease

Question 4

Name the cations and anions electrolytes that regulate electrical charge on cells and flow across membranes

Answer 4

Cations: (positive) NA+ K+ H+
Anions: CL- HCO3- Phosphate

Question 5

What is osmotic pressure

Answer 5

Hydrostic pressure exerted by a solution across a partially permeable membrane from a pure solvent

Question 6

Briefly describe osmosis terminology

Answer 6

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

Question 7

What is oncotic pressure
What is this fluid balances by

Answer 7

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

Question 8

What is hypovolemia
List signs

Answer 8

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

Question 9

What is hypervolemia

Answer 9

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

Question 10

What is the name of different sodium imbalances

Answer 10

Deficit = hypoatremia
Excess= hypernatremia

Question 11

What is the name of different potasium imbalances

Answer 11

Deficit= hypokaleamia
Excess= hyperkalemia

Question 12

What is the name of different magnesium imbalances

Answer 12

Deficit= hypomagnesaemia
Excess= hypermagnaesaemia

Question 13

What is the name of different calcium imbalances

Answer 13

Deficit= hypocalcaemia
Excess= hypercalcaemia

Question 14

What is the name of different phosphate imbalances

Answer 14

Deficit= hypophosphaetemia
Excess= hyperphosphatemia

Question 15

Describe hyponatraemia

Answer 15

• 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

Question 16

Describe hypernatremia

Answer 16

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

Question 17

Describe hypomagnesaemia

Answer 17

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)

Question 18

Describe hypermagnesaemia

Answer 18

Occurs normally in patients with kidney disease given mg containing laxatives

Weakness
Hyporeflexia- reduced/ no reflex
Respiratory paralysis

Question 19

Calcium function and role

Answer 19

Major component of bone and teeth

Transmits nerve impulse
Regulates Muscle contraction, relaxation (including cardiac muscle)

Question 20

Describe hypocalcaemia

Answer 20

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

Question 21

Describe the process of elicitng chvosteks sign

Answer 21

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

Question 22

Describe hypercalcaemia

Answer 22

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

Question 23

Describe hypokalaemia

Answer 23

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

Question 24

Describe hyperkalaemia

Answer 24

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

Question 25

Describe hypophosphateaetremia

Answer 25

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

Question 26

Describe hyperphosphatemia

Answer 26

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

Question 27

List the phases of clotting (haemostasis)

Answer 27

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)

Question 28

What would u name a high volume and low volume solution

Answer 28

High- hypervolemic
Low- hypovolemic

Question 29

How does Angiotensin 2 affect bp

Answer 29

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

Question 30

Function of angiotensin 1

Answer 30

It is a blood protein which deactivates bradykinin which causes vasodilation

This allows vasoconstriction which is the function of angiotensin 2

Question 31

What is there function of the renin- angiotensin- aldosterone system (RAAS)

Answer 31

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