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Patho Semester 2 Midterm > Chapter 31 Disorders of Fluid and Electrolyte Balance > Flashcards

Chapter 31 Disorders of Fluid and Electrolyte Balance Flashcards

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1
Q

Which cellular compartment has a higher concentration of K+

A

intracellular compartment

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2
Q

which cellular compartment has a higher concentration of Na+

A

extracellular compartment

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3
Q

Does the extracellular or intracellular compartment have more of the TBW?

A

intracellular

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4
Q

What makes up extracellular fluid compartments?

A

interstitial space, tissues, fluid around organs, blood vessels

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5
Q

What is the composition of the ECF?

A

large amounts of Na, Cl, moderate amounts of bicarb, small amounts of K, Mg, Ca, and P

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6
Q

What is the composition of the ICF?

A

Large amounts of K, moderate amounts of Mg, small amounts of Na, Cl, bicarb, and P. Almost no Ca

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7
Q

Why would high amounts of Ca+ be dangerous in the ICF?

A

Because it can open ion channels and other pathways

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8
Q

What is an isotonic?

A

Where the concentrations are similar, causes the cell to neither shrink nor swell

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9
Q

What is a hypotonic?

A

Lower water concentration inside the cell – Causes water to diffuse into the cell = swelling

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10
Q

What is a hypertonic?

A

Lower water concentration outside the cell (dehydration) that causes the shift of fluids to outside the cell = shrinking

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11
Q

Which direction of concentration does water follow?

A

High concentrations to low concentrations

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12
Q

Where is the accumulation of fluid in edema?

A

in the ECF

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13
Q

Pitting edema is caused by swelling from …

A

fluid

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14
Q

non-pitting edema is caused by swelling from …

A

fluid and plasma proteins and other things

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15
Q

What are the physiologic mechanisms that contribute to the formation of edema?

A

increase in capillary filtration pressure, decrease in capillary colloid osmotic pressure, increase in capillary permeability, an obstruction to lymph flow

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16
Q

What is dependent edema?

A

edema due to gravity – think of in pregnant women where the fluid does not return as quickly and collects in the feet/ankles

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17
Q

What are the physiologic mechanisms assisting in regulating body water?

A

thirst, ADH, changes in EC osmolality and volume

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18
Q

How does thirst regulate water intake?

A

there are osmo receptors in the hypothalamus that tell us if the blood is getting thick then sends signals to the thirst center to get us to drink water

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19
Q

How does ADH regulate water intake?

A

allows water to be reabsorbed by the kidney tubules

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20
Q

What is the percentage of TBW for infants, young males and females, older males and females and obese people?

A

Infants: 75-80%
Young males: 60%
Young females: 50%
Older males: 50%
Older females: 40%
Obesity: 30-40%

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21
Q

A person requires how many mL of water for every 100 calories metabolized?

A

100 mL

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22
Q

What are insensible losses?

A

Water loss that you don’t feel you are losing – losing through every day processes that you aren’t really aware of

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23
Q

What are the main regulators of sodium?

A

the kidney

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24
Q

How does the kidney regulate sodium?

A

retains sodium when pressure is decreased and eliminates it when arterial pressure is increased, the RAAS system helps reabsorb sodium, and ANP is released when blood pressure is high and causes excretion of sodium (and water) to get the blood pressure down

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25
What is a disorder of ADH expression?
Diabetes Insipidus
26
What is Diabetes Insipidus and how does it work?
There is a deficiency in ADH or a decreased response to ADH. Patients are unable to concentrate urine during periods of water restriction (like at night) and then excrete large volumes of urine
27
What is neurogenic diabetes insipidus?
defect in ADH synthesis or release -- you are either unable to make it or unable to release it
28
What is nephrogenic diabetes insipidus?
kidneys do not respond to ADH
29
What are the disorders of sodium and water balance?
isotonic fluid volume deficit and excess, hyponatremia and hypernatremia
30
What is isotonic fluid volume deficit?
regular dehydration
31
What are the clinical manifestations of isotonic fluid volume deficit?
tachycardia, weak pulse, postural hypotension, headache, dry skin, dry mucous membranes
32
What is the treatment for isotonic fluid volume deficit?
giving isotonic solutions for rehydration - like Gatorade or Pedialyte
33
What is isotonic fluid volume excess?
fluid is being retained in the body - either by decreased sodium and water elimination due to impaired renal function, heart failure, liver failure, or corticosteroid excess
34
What are the clinical manifestations for isotonic fluid volume excess?
weight gain, edema, ascites
35
What is the treatment for isotonic fluid volume excess?
low sodium diet, use of diuretics
36
What is hyponatremia?
low levels of sodium in the blood, less than 135 mmol/L
37
What is the cause of hyponatremia?
diuretics (can cause too much sodium loss), diarrhea, vomiting, excessive water intake = water toxicity. Too low of sodium or too much water
38
How does hyponatremia affect the cells?
the decrease in ECF osmotic pressure so water moves into the cell via osmosis = swelling
39
what are the clinical manifestations of hyponatremia?
lethargy, headache, confusion, apprehension, seizures, coma
40
What is the treatment for hyponatremia?
address the underlying cause (like diarrhea or vomiting), restrict water intake, administer IV fluids
41
What is hypernatremia?
High levels of sodium over 145 mmol/L
42
What causes hypernatremia?
sodium gain or water loss (dehydration)
43
How does hypernatremia affect the cells?
water leaves the cell to go into the ECF = shrinking
44
What are the clinical manifestations of hypernatremia?
decreased urine output, dry mucous membranes, headache, agitation, seizures, coma
45
What is the treatment for hypernatremia?
Oral rehydration therapy (ORT) that contains sodium
46
What is the intracellular concentrations of potassium?
140-150 mmol/L
47
what is the extracellular concentration of potassium?
3.5-5 mmol/L
48
How is plasma potassium regulated?
renal mechanisms that either conserve or get rid of plasma potassium, and the transcellular shift between the ICF and ECF
49
What is hypokalemia?
low potassium levels in the ECF, less than 3.5 mmol/L
50
What causes hypokalemia?
inadequate intake of K, excessive GI, renal and skin loss of K (think about the gastric suctioning putting people at risk for hypokalemia) or the redistribution of K between the ICF and ECF (too much is going into the cell and not enough staying out)
51
What is the treatment for hypokalemia?
oral potassium, eating foods rich in potassium, IV potassium (cautiously to avoid hyperkalemia and cardiac dysfunction)
52
What are the clinical manifestations of hypokalemia?
muscle cramps, pain, weakness, fatigue, paralysis, constipation, resp failure
53
What is hyperkalemia?
high potassium levels in the ECF above 5.0 mmol/L
54
What causes hyperkalemia?
decreased renal elimination of potassium, rapid administration of potassium, movement of K from ICF to ECF
55
What are the clinical manifestations of hyperkalemia?
abdominal pain, diarrhea, nausea, vomiting, chest pain, heart palpitations, arrhythmia, muscle weakness
56
What is the treatment for hyperkalemia?
diuretics to excrete excess potassium, potassium binders to attach excess potassium to stool and then have it be eliminated, Insulin to move potassium into blood cells, dialysis, give calcium which antagonizes the potassium, sodium bicarbonate to move K to the ICF,
57
How would you diagnose a potassium disorder?
physical exam - muscle weakness Plasma potassium levels ECG - potassium causes hyperpolarization of the membrane (causes low p wave, widening of QRS, and elevated T wave)
58
For every 2 _____ inside the cell there are 3 _____ outside the cell
2 potassium inside 3 sodium outside
59
What are the 3 things that help maintain calcium equilibrium?
Vitamin D, Calcitonin, Parathyroid Hormone
60
How does vitamin D maintain calcium equilibrium?
increases the absorption of calcium and phosphate from the intestine to sustain normal plasma levels
61
How does Calcitonin maintain the calcium equilibrium?
it tells osteoblasts to take calcium out of circulation and deposit it into the bones
62
How does Parathyroid Hormone maintain the calcium equilibrium?
increases plasma levels by increasing absorption from the kidneys and resorption from the bone
63
What is hypocalcemia?
Low levels of calcium
64
What causes hypocalcemia?
impaired ability to mobilize calcium stores from the bone, loss of calcium from kidneys (can happen in kidney disease) increased protein binding
65
What are the clinical manifestations of hypocalcemia?
increased neuromuscular excitability, hypotension, lowering of the strength of the heart contractions, muscle cramps, dry scaly skin, confusion, memory problems, muscle aches, muscle spasms, arrhythmias...
66
What is the treatment for hypocalcemia?
IV calcium solution or oral calcium supplement
67
What is hypercalcemia?
too much calcium
68
What are the causes of hypercalcemia?
increased bone resorption of calcium, excessive vitamin D and calcium absorption, decreased elimination of calcium with use of thiazide diuretics and lithium therapy
69
What are the clinical manifestations of hypercalcemia?
muscle weakness, increases cardiac contractility, arrhythmias...
70
What is the treatment for hypercalcemia?
increase urinary excretion and decrease bone resorption

Patho Semester 2 Midterm (10 decks)

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