Body fluids, Edema and IV fluids Flashcards by Tariq Ziad

Q

Isotonic Loss

Body Osmolality, ECF volume, ICF volume, RAAS response, ADH response

A

No change
Decrease
No change
Increase
Increase

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Q

Isotonic Gain

Body Osmolality, ECF volume, ICF volume, RAAS response, ADH response

A

No change
Increase
No change
Decrease
Decrease

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Q

Hypotonic Loss

Body Osmolality, ECF volume, ICF volume, RAAS response, ADH response

A

Increase
Decrease
Decrease
Increase
Increase

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Q

Hypotonic Gain

Body Osmolality, ECF volume, ICF volume, RAAS response, ADH response

A

Decrease
Increase
Increase
Decrease
Decrease

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Q

Hypertonic Loss

Body Osmolality, ECF volume, ICF volume, RAAS response, ADH response

A

Decrease
Decrease
Increase
Increase
No change (???)

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Q

Hypertonic Gain

Body Osmolality, ECF volume, ICF volume, RAAS response, ADH response

A

Increase
Increase
Decrease
Decrease
No change (???)

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Q

Isotonic Loss

Causes

A

Hemorrhage
Diarrhea
Vomiting
Isotonic urine

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Q

Isotonic Gain

Causes

A

Isotonic saline

- Hyperaldosteronism

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Q

Hypotonic Loss

Causes

A

Dehydration
Alcoholism
DI

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Q

Hypertonic Loss

Causes

A

Adrenal insufficiency

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Q

Hypertonic Gain

Causes

A

Salt ingestion
Hypertonic saline
Mannitol

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Q

Hypotonic Gain

Causes

A

Hypotonic saline
Water intoxication
SIADH

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Q

Aldosterone

Regulators

A

Plasma angiotensin II (stimulate release)

- Plasma K+ (stimulate release)

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Q

ADH

Regulators

A

Plasma osmolality (directly related)

- Blood pressure/volume (inversely related)

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Q

Renin

Regulators

A

Perfusion pressure to the kidneys (inversely related)
Sympathetic stimulation to the kidneys (direct effect via beta-1 receptors)
Na+ delivery to macula densa (inversely related)

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Q

Starling Equation

Study These Flashcards

A

Qf = k [(Pc + Oif) - (Pif + Oc)]
Qf is fluid movement
k is filtration coefficient
P is hydrostatic pressure
O is oncotic pressure
c is capillary
if is interstitium

Q

Capillary hydrostatic pressure

Regulators

Study These Flashcards

A

Blood flow (regulated by arteriole)
Venous pressure
Blood volume

Q

Interstitial oncotic pressure

Regulators

Study These Flashcards

A

Interstitial protein concentration (regulated by lymphatics)

Q

Capillary oncotic pressure

Regulators

Study These Flashcards

A

Capillary protein concentration

Q

Interstitial hydrostatic pressure

Regulators

Study These Flashcards

A

Lymphatic flow

Q

Filtration Coefficient

Regulators

Study These Flashcards

A

Capillary permeability

Q

Peripheral Edema

Primary Causes

Study These Flashcards

A

Increased capillary hydrostatic pressure (Pc)
Increased interstitial oncotic pressure (Oif)
Decreased capillary oncotic pressure (Oc)
Increased capillary permeability (k)
Lymphatic obstruction/removal (lymphedema)

Q

Increased capillary hydrostatic pressure (Pc)

Causes

Study These Flashcards

A

Marked increase in blood flow like vasodilation in a given vascular bed
Increasing venous pressure like venous obstruction or HF
Elevated blood volume (Na+ retention) like in HF

Q

Increased interstitial oncotic pressure (Oif)

Causes

Study These Flashcards

A

Thyroid dysfunction (elevated mucopolysaccharides in the interstitium that act as osmotic agents resulting in fluid accumulation)
Lymphedema

Decreased capillary oncotic pressure (Oc) | Causes

- Liver failure | - Nephrotic syndrome

Increased capillary permeability (k) | Causes

- Circulating agents like tumor necrosis factor-alpha (TNF-alpha), bradykinin, and histamine - Cytokines related to burn trauma

Lymphatic obstruction/removal (lymphedema) | Causes

- Filarial (W. bancrofti [elephantiasis]) - Bacterial lymphangitis (streptococci) - Trauma - Surgery - Tumors

Pulmonary Edema | Causes

- Cardiogenic (elevated Pc) associated with increased pulmonary wedge pressure - Non-cardiogenic (adult respiratory distress syndrome [ARDS] due to increased permeability) that can be due to sepsis, bacterial pneumonia, trauma and gastric aspirations. Pulmonary wedge pressure is normal or low

Volume of Distribution

- V = A / C - V: volume of compartment to be measured - A: amount of tracer - C: concentration of tracer in the compartment to be measured

Tracers used to measure Plasma | Characteristics, Examples

- It should not cross the capillary membranes | - Albumin

Tracers used to measure ECF | Characteristics, Examples

- It should cross the capillary membranes but not the cell membranes - Inulin, mannitol, sodium and sucrose

Tracers used to measure Total body water | Characteristics, Examples

- It should cross both the capillary and cell membranes | - Tritiated water and urea

Blood volume | Calculation

- Blood volume = plasma volume / (1 - hematocrit) | - 7% of body weight in kgs

Angiotensin II | Effects

- Direct vasoconstrictive effect - Increases aldosterone secretion - Increases ADH release from posterior pituitary - Increases thirst - Increases Na+ reabsorption in the proximal tubule

Cortisol | Factoids

- Zona fasciculata/reticularis - Steroid - Catabolic - Immunosuppression - Increase appetite

Cortisol | Effects on Metabolism

- Increases lipolysis - Increases protein degradation - Increases gluconeogenesis

Cortisol | Permissive effects

- Enhances catecholamines effect on alpha receptors (vasculature) and beta receptors (especially in lung and liver) - Enhances effects of glucagon

Cortisol | Other effects

- Anti-inflammatory effect by stimulating Lipocortin synthesis which is a phospholipase A2 inhibitor - Increases bone breakdown by increasing RANK-L and decreasing OPG - Binds to mineralocorticoids receptors (Aldosterone-like)