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Pathophysiology I > week 3 - Fluid homeostasis and imbalances > Flashcards

week 3 - Fluid homeostasis and imbalances Flashcards

1
Q

What are fluid distribution (%) of ECF and ICF?

A

ECF 34%
- interstitial space
- plasma
- lymph

ICF 66%

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2
Q

Approximately what % of body mass is water in following each group?

Which group(s) is/are more at higher risk and why?

Adults
Young Infants
Older adults

A

Adults - 60%
Young infants - 75%
Older adults - 50%

Young infants and older adults are more vulnerable to fluid inbalance

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3
Q

RAAS (Renin-Angiotensin-Aldosterone System)

Be able to explain the system
- triggers
- how they are released

A

Study diagram

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4
Q

What are 3 triggers of renin release?

A
  1. Juxtaglomerular (baro receptor) cells detect decreased BP in afferent arteriole
  2. Macula densa (chemo receptor) cells at DCT (distal convoluted tubule) detect decreased Na+ concentration
    –> communicate to juxtablomerular cells via connective tissue
  3. increased SNS innovation
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5
Q

Where is angiotensinogen stored?

A

Liver

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6
Q

What are 5 main functions of angiotensin II?

A
  1. General vasodilation
    –> for BP increase
  2. Constrict efferent arteriole
    –> for increase body fluid volume for BP increase
    –> Glomerular Filteration Rate increase
    –> slow filtration cause more Na+ absorption in DCT (distal convoluted tubule)
  3. Stimulate adrenal cortex to release aldosterone
  4. Stimulate hypothalumus to produce antidiuretic hormone
    –> released from posterior pituitary gland
  5. Activation of SNS
    Stimulate osmoreceptors in hypothalamus
    –> motor response to thirst (action to drink!)
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7
Q

What is the main function of aldosterone?
And what happens because of the function?

A

Main function:
Increase Na+ reabsorption (to serum) at kidney –> water follows –> helps to increase fluid volume in the body –> helps to increase BP

Since Na+ is sent out of renal system, K+ is trade off and K+ is excreted in urine.

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8
Q

What triggers release of aldosterone?

A

angiotensin II

Elevated serum K+

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9
Q

What is the main functions of antidiuretic hormone?

A
  1. Increase water reabsorption at DCT and collecting duct
  2. Increase blood volume
  3. Increase blood pressure
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10
Q

What promote ADH release?

What inhibit ADH release?

A

Promote: Angiotensin II, osmoreceptor at hypothalamus (detect blood osmorality increase = higher blood concentration

Inhibit: Atrial Naturetic Peptide

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11
Q

What following vocabularies mean, at capillary bed?

Filtration

Reabsorption

A

Filtration:
When hydrostatic pressure is greater than oncotic pressure, fluid exits the capillary

Reabsorption:
When hydrostatic pressure is less than oncoic pressure, fluid reenters the capillary

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12
Q

Explain how body works when plasma osmorality increases

ADH: trigger to release & functions
Motor region

A

Trigger:
- increased blood osmolarity (= blood concentration)
- Osmoreceptor @ hypothalamus sense the increase –> order to pituitary gland

ADH Release:
Posterior pituitary gland release ADH

ADH Function:
@ Renal Tubule
- Signal to renal tubule / collecting duct
- Renal tubule open aqua pores
- Renal tubule to reabsorb water
–> water moves from kidney tubules back into interstitial space & blood

Motor region:
- Osmoreceptor @ hypothalamus sense the increase of blood osmolarity
- Feel Thirst
- Signal to motor region
- Action of drinking water

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13
Q

Fluid imbalance - which is more common, concentration issue or volume issue?

A

Volume issue (related to aldosterone) is more common than concentration issue (related to ADH).
ADH usually works very efficiently

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14
Q

Define perfusion

A

circulation in blood

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15
Q

What is the fluid ratio between vascular and interstitial space?

A

2/3 interstitial space
1/3 vascular

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16
Q

Know different type of IV fluid

  • Isotonic
  • hypotonic
  • hypertonic
A

Isotonic
- NaCl concentration same as cell
- Normal Saline (NS)
- 0.9% NaCl
- Lactated Ringer’s (w/ K+, Ca2+, Na-Lactate) = water with electrolytes
—> because the concentration is same as cells, no osmosis. Water goes into only extracellular space
(No Net Change)

Hypotonic
- 0% NaCl
- D5W
—> water goes into cell due to osmosis

Hypertonic
- 5% NaCl
—> water goes from cell to extracellular space due to osmosis

17
Q

What is Clinical Dehydration?

A

Combination of ECV deficit and hypernatremia

18
Q

How do humans lose fluid?
What is lost most in daily life?

A

Insensible perspiration (purely water)
respiratory loss (purely water)
sweating (salt & water)
diarrhea (lots of salt & water)
urine (dilute/little salt & water)

MOSTLY WATER IS LOST

Everyday salt + water + MORE WATER is need

19
Q

Where does isotonic IV fluid go (if the patient does not have any fluid imbalance issue)?

A

Isotonic IV fluid is 0.9% NaCl, that is the same concentration as cells.
Therefore, there’s no osmotic differences between ECF and ICF.
The IV fluid goes to extracellular space only (1/3 vascular, 2/3 interstitial space)

20
Q

What is considered severe dehydration, and what is necessary?

A

10% or more volume loss.

IV fluid replacement needed

21
Q

What is the early sign of ECV deficit / hypovolemia?

What medication can be an issue?

A

Increased heart rate

Beta blocker blocks SNS signals to heart. HR may stay calm.

22
Q

Know ECV excess (hypervolemia) and ECV deficit (hypovolemia)

  • risk factors
  • clinical assessment
  • teaching
  • compensatory responses (for hypovolemia)
A

See list

23
Q

What are clinical signs of ECV deficit / hypovolemia?

A

Early Sign:
- Increased HR
- Increased RR
- Orthostatic hypotension

Later sign:
- Decreased BP

Other:
- Pale, cool, moist skin
- Anxiety
- Heart palpations
- Dizziness, syncope (= fainting) <– vasoconstriction / low perfusion to brain
- Oliguria
- Decreased skin turgor

24
Q

What is hypovolemic shock?
How it happens?

A

Definition:
Multi-system organ failure due to hypovolemia

  1. Decreased perfusion / oxygenatoin (low cardiac output <– not enough fluid anymore)
    2) Cellular hypoxia –> anaerobic metabolism
    (metabolis acidosis –> too low pH –> increase of RR to balance pH)
    3) Decreased ATP production –> Na+/K+ pump failure
    4) Cell swelling / cell edema
    5) Cell death = necrosis (at multiple organs)
    6) Multi-system Organ Failure
    7) DEATH
25
Q

What are clinical signs of hypovolemic shock

(be able to explain why/how signs happen)

A

Tachycardia <– low blood flow
Increased RR <– metabolic acidosis
Hypotension SBP <90
- BP may compensate for a while
- Orthopnea is more evident
Oliguria
Cool, clammy skin (low skin turgor)
Nausea <– low oxygen at brain
Decreased level of consciousness

26
Q

What is the normal range of serum Na+ (sodium ion)?

A

135 - 145 mEq/liter

27
Q

What hormone contributes to serum Na+ balance?

What stimulates the hormone?

A

ADH

Stimulated by:
- increased osmolarity (high concentration in blood)
- Severe ECV deficit
- Pain
- Nausea
- Stressors
- Trauma
- Anesthesia (post surgical fluid retention)

28
Q

NSAIDs

A

nonsteroidal anti-inflammatory drugs

e.g. ibuprofen

Pathophysiology I (4 decks)

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