fluid and electrolytes Flashcards by Amanda S.

homeostasis

Volume and composition of each space remains constant. ie - disruption, vomiting, diaerrhea, ace inhibitors, diuretics

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water - how much is body weight? And needed for what? (water temp eliminates and transports)

Primary component of body
Accounts for approx 60% of body wt (varies by age)
Adequate balance is necessary for- maintenance of temp - elimination of waste products - all transportation within body.

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solutes - electrolytes

Chemical compounds that develop an ionic charge when dissolved in water. either + or - charge.
All body fluids contain electrolytes.

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Regulation of electrolyte levels is critical for (electra on acid with muscles and bad metabolism)

maintenance of body fluid osmolality (The concentration of particles dissolved in a fluid)
acid balance
neuromuscular function
cell metabolism

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nonelectrolytes - measured by what? and ex (not electra, weigh and love sugar, urea, crete, proteins)

Do not dissociate in solution
measured by wt
Glucose - Urea - Creatinine - Bilirubin - Proteins

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transcellular fluids and ex.

not subject to significant gains or losses) (aceities - a fluid collects in spaces within your abdomen)

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fluid spacing - 1st spacing

Normal distribution of fluid (homeostasis)

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movement of body fluids

Fluid constantly moves among intracellular, interstitial and vascular spaces to maintain body fluid balance
Moves through permeable membranes
- permits movement of water and some solutes

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osmosis - when is it important to consider? (intravenous is simply osmosis)

Osmosis stops when equilibrium is reached
Major force in body fluid movement
Important to consider with IV therapy

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osmotic pressure (Osmosis with pebbles)

holds the water. Protein in capillary draws water into it.

Refers to pulling power of a solution for water
The higher the osmolality of a solution, greater pulling power for water

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oncotic pressure (onka with colloids)

colloids (larger molecules, like protein) pull back into capillaries and plasma.

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filtration (filter the straw)

Movement of fluids and solutes from an area of high hydrostatic pressure to an area of low hydrostatic pressure into or out of the capillary
Dependent on forces favoring filtration & opposing it
Think of as a tug of war - pushing and pulling

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forces that work with filtration (oppposites - cap and inter)

Capillary hydrostatic pressure (blood pressure)
Interstitial oncotic pressure (water-pulling)

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forces favoring reabsorption (onca reabsorbs the plasma)

Plasma oncotic pressure (water-pulling)
Interstitial hydrostatic pressure

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Interstitial fluid to plasma - ex. (socks push plasma)

Fluid drawn into plasma space whenever there is increase in plasma osmotic or oncotic pressure

Wearing of compression stockings or hose is a therapeutic action on this effect

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active transport

Movement of solute from an area of lower solute concentration to an area of higher solute concentration
Depends on ATP
Example is Sodium- Potassium pump

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ADH

Hormone synthesized by hypothalamus
Secreted by posterior pituitary. it’s stimulated by a change in osmolarity. ie eating a lot of potato chips. ADH acts on kidneys to retain water

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regulation of body fluids - so basic it’s crazy…

Thirst Mechanism
Stimulated by thirst receptors in hypothalamus
Primary protection against hyperosmolality***
Normally occurs with even small fluid losses
Stimulates release of ADH and aldosterone

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causes of fluid volume excess (FVE)

Renal Disease
Too rapid infusion of IV fluids
Steroid Therapy
Production of ADH
Cardiac Disease

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causes of fluid volume deficit (FVD) and what type of spacing?

NPO
Drains
Surgery
Blood loss
Fluid loss from GI tract
Profuse sweating
polyuria
fever
third spacing
decreased intake

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intracellular elecrolytes (Ps indoors)

potassium and phosphorus

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extracellular (plasma) electrolytes - which ones are on the outside? (outdoor pool)

sodium and chloride

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most of our water in cells or plasma?

cells

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Second spacing - (the 2nd you walk, you have intertitial fluid) and ex.

Abnormal accumulation of interstitial fluid. ex. - increased bp and walking a long time, then have edema in lower extremities.

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third spacing (3rd base is tight) and ex.

Abnormal accumulation in areas that have no or little amt of fluid Fluid unavailable for use ex. ascities. body has the fluid but it's trapped in other areas, not for circulation.

hypotonic (cell is opposite of vj)

cell is swollen - more solute to water inside cell than water surrounding it. at risk for cerebral edema

hypertonic - and at risk for what?

at risk for lysing. neuro risks.

to correct edema, use what type of med? (which one shrinks?)

hypertonic med

facilitated diffusion

need a carrier. ex glucose.

diffusion

movement of solutes across concentration gradient. ex electroyltes, gases like 02. this is just solutes.

if you don't have protein in veins to pull fluid back in, the result will be

edema

renin angiotensin

glomerulus sense bp drop, secretes renin, to liver, then lung, then to adrenal for aldosterone.

aldosterone - and what med blocks it? (alden doesn't lisin)

will stimulate kidneys to retain Na and water will follow. constricts blood vessels. lisinapro (ace inhibitor - blocks angio 2, and keeps blood vessels open, lowers bp, inteferes with aldosterone)

increased aldosterone - lower levels of what? (just K)

lowers levels of K+ and higher levels of Na

2 syndromes that impact ADH and the alchy

SIADH alcohol can turn off ADH and put out more dilute urine - just water, not Na+. Might cause hypernatremia. Diabetes insipidus. damage to hypothalamus or pituatry .our kidneys will excrete more dilute urine. patient will develop dehydration.

ANP - opposite effect of ADH

kicks in with fluid volume overload. see it with heart failure or overload. promotes vasodilation, lower bp, and diuresis. when chemo receptors are overstretched.

one liter of water weighs

2.2 lbs, or 1 kg

factors that affect electrolyte ratio (young/old fat/skinny percentage)

factors that affect ratio - age, neonates about 90%, older about 45% , adipose - more fat less proportion of body water. more muscle - higher

transcellular fluid occurs where in the body? (think of linings)

CSF GI tract Pleural Synovial Peritoneal

Normally ICF and ECF are

isotonic with each other.

osmolality (Ozmolalities are small)

how many particles are in the blood per kilogram

osmolarity

particles per liter

hyperosmolarity (hyper lars has too much sugar and salt in his blood)

It is a condition in which the blood has a high concentration of salt (sodium), glucose, and other substances

thirst reflex depressed in older people*** older ppl at risk for

hypernatremia, hypo-osmolarity, and dehydration. I/o important, water stations, talk about fluids they like, pay attention.

what causes 3rd spacing? (space the 3 hearts among my capillaries)

heart failure, capillary leakage syndrome (biotherapy).

symptoms of 3rd spacing (3 muskateers, 3 crackles)

may have increased in HR, decrease in BP, decreases pulses, crackles on lungs, edema, decreased urine output. need to find a way to pull fluid back into vascular.

low Oz is... Low Oncotic is...

low Oz is edema in the cell. Intracellular. Low Oncotic is edema outside of the cell. Extracellular.

hydrostatic (hydro straw)

drives fluid out of the capillaries

meds for 3rd spacing (loop around 3rd base)

might use lasix or blood transfusion.

reabsorb?

oncotic

causes of SIADH (shada in my lungs)

pulmonary conditions, lung cancer, pneumonia will release of ADH, could trigger SIADH. Running in marathon could trigger SIADH. our body will hold onto water and can create hyponatremia.

SIADH v. insipidous

SIADH results in the retention of water, remember “SI” for “soaked inside.” For DI, excess fluid leaves the body, therefore think “dry inside.”

LOC with dehydration

disoriented

dehydration - is specific gravity high or low?

higher specific gravity and solute because you don't have fluids to lower solutes

the more particles in the urine (the more concentrated)

the higher the specific gravity

with deyhdration, hematocrit is

elevated. it's dilusional.

alcohol - suppresses what?

ADH - pee more.

dehydration causes increased or decreased bowel sounds?

decreased in all 4

daily weights is the best measure of

fluid volume. I/O is an approximation.

risk with SIADH

hyponatremia - altered mental status

treatment for 3rd spacing

lasix or blood transfusion

osmotic

pulling power of solutes in plasma?

oncotic

colloid pulling into vascular

filtration has to do with

hydrostatic pressure - pushing or pulling

if you want to hydrate a cell, use a

hypotonic solution - makes cell swell