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Pathophysiology > Class 5 - Alterations in Fluid and Electrolytes, Acid-Base > Flashcards

Class 5 - Alterations in Fluid and Electrolytes, Acid-Base Flashcards

1
Q

Distribution of Body Fluids

A
  • 66% of body water is intracellular
  • 24% of body water is interstitial
  • 7% of body water is intravascular (plasma)
  • 2% of body water is transcellular
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2
Q

Water Body Content - Age Differences

A

Lower at younger age

Higher at older age

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3
Q

Isotonic Loss

A

Water and sodium are lost in proportion, not losing one more than the other

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4
Q

Dehydration

A

Caused by:

  • Vomiting
  • Diarrhea
  • Not replacing fluids and electrolytes after exercise
  • Sweating profusely

Signs and Symtpoms

  • Dry skin
  • Dry mucous membranes
  • Less urine, higher concentration
  • Weight loss
  • Increase thirst
  • Sunken eyes
  • Flat, peripheral and jugular veins
  • Poor turgor; skin tents
  • Blood pressure will decrease
  • Heart rate will increase

Treatment:
- Increase fluid intake

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5
Q

Intravascular Fluid Volume Excess - Fluid Overload

A

Isotonic gain
- Water and sodium are gained in proportion

Caused by

  • Over administration of saline
  • Too much fluid intake
  • Heart disease, liver disease, and kidney disease can aid in fluid overload

Signs and Symptoms
- Excessive urination

Treatment

  • Diuretics
  • Dialysis
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6
Q

Edema - Interstitial Space

A

Increased interstitial fluid volume “swelling”

Caused by

  1. Increased capillary hydrostatic pressure
    - Hydrostatic pressure pushes water out of the capillary membrane into the interstitial space; filtration
  2. Decreased capillary oncotic pressure
    - Oncotic pressure is a pulling force, sucks water back into the capillary from the interstitial space; reabsorption
  3. Lymphatic Obstruction
    - Lymphatics drain extra fluid from the interstitial space and returns it back into circulation
    - Lymph obstruction can occur by having breast and armpit lymph removal due to breast cancer and can increase edema
  4. Increased capillary permeability
    - Fluid will be able to flow more freely
  5. Increase interstitial oncotic pressure
    - Anything that decreases our plasma proteins will make us puffy
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7
Q

Manifestations of Edema

A
  • Localized edema
  • Dependent areas
  • Pitting edema
  • Generalized
  • Pulmonary edema: fluid in the lungs, shortness of breath, trouble breathing, hearing crackling sounds with stethoscope
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8
Q

Edema - Intracellular Space

A

Due to changes in tonicity/osmosis

  • Hypertonic
  • Hypotonic

Linked to sodium imbalances
- Major regulator of osmotic forces

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9
Q

Hypertonic Imbalances

A 
Concentration of the extracellular fluid is increased
Water will shift out of the cells
Causes cellular dehydration
Capillaries have high levels of sodium 
- Serum sodium > 145 mEq/L

Caused by

  • Sodium excess
  • Water deficit

Clinical Manifestations

  • Primarily related to cell dehydration
  • Neurological: agitation, restlessness, headache, seizures, coma and increased reflexes
  • Thirst and dry skin
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10
Q

Hypotonic Imbalances

A

Concentration of the extracellular fluid is decreased
Water will shift into the cells causing cellular edema
Serum sodium: < 135 mEq/L

Caused by

  • Sodium deficit
  • Water excess

Manifestations

  • Primarily related to cell swelling
  • Neurological: agitation, restlessness, headache, seizures, coma and increased reflexes
  • MSK: muscle cramps, weakness
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11
Q

Electrolyte Imbalances

A

Potassium is mostly intracellular

  • Most dominant intracellular cation
  • 150-160 mEq/L intracellular
  • 3.5-5.0 mEq/L extracellular
  • After crush injuries, potassium levels increase because cells will leak

Sodium is mostly extracellular

  • 12 mEq/L is intracellular
  • 135-145 mEq/L

Concentrations maintained by Na/K pump

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12
Q

Sodium Imbalances

A

+++ influence on osmosis
Hypernatremia (hypertonic)
Hyponatremia (hypotonic)
The major systems that show signs and symptoms are neuromuscular
- Movement of water into or out of brain cells and musular tissue
- CNS, LOC
- MSK: muscle cramps, weakness

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13
Q

Potassium Imbalances

A

Normal values 3.5-5.0 mEq/L
Major signs and symptoms
- Cardiac: dysrhythmias, cardiac arrest
- CNS: Reflexes, LOC

Hyperkalemia

  • Renal disease
  • Cell injury
  • Too much intake (IV admin)
  • Acidosis
  • Hyperaldosteronism
  • Medications (ACE inhibitors)

Hypokalemia

  • Diarrhea, NG suction
  • Too little intake (starvation)
  • Alkalosis
  • Hyperaldosteronism
  • Medications (some diuretics)
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14
Q

Calcium Imbalances

A 
Parathyroid disease
Vitamin D imbalance
Malignancies
The major systems that show manifestations include musculoskeletal and cardiac 
- Blood pressure
- Muscle tone
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15
Q

Hydrogen Ion Imbalances

A

H+ needed to maintain membrane potential integrity
Regulates speed of nerve impulse conduction and muscle fiber contraction
Maintains speed of enzyme reactions

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16
Q

pH Imbalances

A

pH scale measures the concentration of H+ in fluids
0-14, acidic-basic
Normal pH range in arterial blood is 7.35-7.45
Acids are formed as end products of protein, carbohydrate and fat metabolism
H+ must be neutralized by buffers or excreted via the lungs or kidneys

17
Q

Excretion of Acid

A

Volatile

  • Secreted by the lungs
  • Carbonic acid (only one)
  • Eliminated by the lungs as CO2 by increasing or decreasing ventilation rate

Nonvolatile

  • Sulphuric, phosphoric and other organic acids
  • Eliminated by the renal tubules

Renal system

  • Excreting or conserving acid: H+
  • Conserving or excreting base: bicarbonate (HC03-)
18
Q

Acid-Base Imbalances

A

Caused by respiratory or metabolic problems
Categorized as either acidosis or alkalosis
If one system has a dysfunction, the other system will try to compensate
Best evaluated by arterial blood gases

19
Q

Steps for Acid-Base Imbalance Questions

A
  1. Look at ph
    a. Normal, acidosis, alkalosis?
  2. Look at the PCO2 and HCO3-
    a. Will tell you the cause
    b. Will tell you if there’s compensation
  3. PCO2 = respiratory
  4. HC03- = metabolic
20
Q

Respiratory Acidosis

A

CO2 - acid. More CO2 = more acidity
HCO3 - base. More HCO3 decreases acidity
Normal values 35-45 mmHg

Too much CO2

  • PCO2 > 45
  • CO2 will convert to carbonic acid
  • pH < 7.35

Caused by

  • Slow and shallow breating
    eg. Head injury, SCI, drug overdoses
  • Poor gas exchange due to lung disease
    eg. Pneumonia and emphysema
21
Q

Respiratory Alkalosis

A

Too little CO2
- PCO2 < 35 mmHg

Less carbonic acid
- pH > 7.45

Caused by

  • Rapid and deep breathing
  • Respiratory failure (early)
  • Anxiety
  • Some neurological disorders
22
Q

Metabolic Acidosis

A

Not enough bicarbonate ion HCO3 to counteract acid

  • HCO3 < 22 mEq/L
  • pH < 7.35

Caused by

  • Loss of base (kidney dysfunction, diarrhea)
  • Excess production non-volatile acids (diabetic ketoacidosis, ASA overdose)
23
Q

Metabolic Alkalosis

A

Too much bicarbonate ion / not enough acid

  • HCO3 > 26 mEq/L
  • pH > 7.45

Causes

  • Excess loss of acid (kidney dysfunction, vomiting, gastric suction)
  • Excessive intake of base (antacid overdose)
24
Q

Compensation

A
  • The functional system that will try to correct the pH towards normal

Partial Compensation

  • The pH wil lmove towards normal but not within normal range
  • The one that doesn’t match the other two is the one that is trying to compensate

Full Compensation

  • pH will become fully within normal range
  • If the pH is leaning towards alkaline values, the problem is alkaline

Pathophysiology (21 decks)

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