antidiuretic hormone "vasopressin" - hypothalamus senses low blood volume or increased osmolality - signals pituitary gland to secrete ADH - ADH causes kidneys to retain water - blood volume increases and osmolality decreases

Fluid and Electrolytes Flashcards by Carmen Dawson

ICF

Intracellular Fluid

fluid inside the cells

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ECF

Extracellular Fluid

fluid outside of the cell

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intake for 24hrs

2600 ml

fluids: 1500 ml
solids: 800 ml
oxidation: 300 ml

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output for 24hrs

2600ml

kidneys: 1500 ml
lungs: 400 ml
skin: 600 ml
intestines: 100 ml

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particles with pulling power (oncotic pressure)

sodium, glucose, albumin

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isotonic solution

same solute concentration as another solution

balanced

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hypotonic solution

amount of solute concentration is lower than another solution
lower osmolality
make cells swell (swollen like a hippo)

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hypertonic solution

amount of solute concentration is higher than another solution
higher osmolality
pulls fluid from intracellular space
causes cells to shrink

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body regulation of fluids

thirst
ADH
Renin-Angiotensin-Aldosterone System
BNP

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ADH

antidiuretic hormone “vasopressin”

hypothalamus senses low blood volume or increased osmolality
signals pituitary gland to secrete ADH
ADH causes kidneys to retain water
blood volume increases and osmolality decreases

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Renin-Angiotensin-Aldosterone system

blood flow to glomerulus drops
juxtaglomerular cells secrete renin
renin goes to liver and converts angiotensinogen to angiotensin I
angiotensis I goes to lungs and gets converted to angiotensin II by ACE
angiotensis II goes to adrenal glands and stimulates them to make aldosterone
aldosterone increases resorption of Na and water
retention leads to increased volume which increases BP

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BNP

brain natriuretic peptide
cardiac hormone
secreted when ventricles stretch
used to assess HF
normal <100 pg/ml

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dehydration

fluid loss > fluid intake
increased tonicity
cells shrink

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dehydration risk factors

confused
comatose
bedridden
elderly
infants
kidneys can't concentrate
highly concentrated tube feedings without adding water

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dehydration causes

anything that accelerates fluid loss
-DI
-prolonged fever
GI: diarrhea, emesis, NG drainage
renal failure
hyperglycemia
meds: diuretics, laxatives
excessive diaphoresis
fistulas

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cardiac sx of dehydration

TACHYCARDIA
DECREASED BP
weak, thready pulse
orthostatic hypotension
diminished peripheral pulses

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neuromuscular sx of dehydration

MENTAL STATUS CHANGES
SEIZURES
DIZZINESS
WEAKNESS
EXTREME THIRST
FEVER

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renal sx of dehydration

DECREASED URINE OUTPUT

integumentary sx of dehydration

DRY SKIN
POOR SKIN TURGOR
DRY MUCOUS MEMBRANES

GI sx of dehydration

WT LOSS
THIRST
constipation
decreased bowel sounds

lab findings for dehydration

*increased osmolality
*increased HCT
*increased Na
*increased urine specific gravity
increased BUN

dehydration tx

replace fluids
PO preferred
AVOID hypertonic solutions
IV replacement
--hypotonic preferred
--isotonic if low BP
--replace slow to avoid cell swelling (cerebral edema)

hypervolemia

excess of isotonic solution
cells expand
can cause HF and pulmonary edema

cardiac sx of hypervolemia

BOUNDING, RAPID PULSE
INCREASED BP
DISTENDED VEINS (JVD)
S3 SOUNDS
**progressed: decreased BP and decreased CO

respiratory sx of hypervolemia

increased RR dyspnea crackles pulmonary edema

neuromuscular sx of hypervolemia

altered LOC HA visual disturbance

renal sx of hypervolemia

increased urine output if kidneys can compensate

integumentary sx of hypervolemia

pitting EDEMA

GI sx of hypervolemia

diarrhea WT GAIN ascites

lab findings for hypervolemia

``` decreased osmolality decreased HCT normal Na+ decreased BUN decreased K+ pulmonary congestion on xray ```

hypervolemia tx

restrict fluid and sodium meds to prevent HF and pulmonary edema (furosimide) tx cause monitor I&O

Na+

``` sodium 135--145 mEq/L major cation of ECF helps maintain acid-base balance activate nerve/muscle cells loss and gain coincide with water loss and gain ```

hyponatremia value

Na+ <135 mEq/L serum Na decreases = ECF moves into cells less Na available to depolarize nerves CNS cells most vulnerable

hypovolemia and hyponatremia sx

``` POOR SKIN TURGOR DRY, CRACKED MUCOUS MEMBRANES WEAK, RAPID PULSE LOW BP ORTHOSTATIC HYPOTENSION ```

hypervolemia and hyponatremia

EDEMA HTN WT GAIN RAPID, BOUNDING PULSE

lab findings for hyponatremia

Na+ <135 mEq/L serum osmolality <280 (dilute blood) urine specific gravity < 1.010 elevated HCT and plasma protein

hyponatremia tx

hypervolemia: restrict fluids, PO Na supplements hypovolemia: isotonic IV (NS), high sodium foods severe: ICU, hypertonic solutions slowly with diuretics

hypernatremia causes

``` inability to ingest fluids hypothalmic disorders water deficit HHNS DI excess intake meds: kayexelate Cushing's excess IV fluid ```

hypernatremia sx

neuro: huge impact on brain; neuromuscular: Early: twitch, hyperreflexia, ataxia, tremors, restless, anorexia, N/V Late: weak, lethargic, confusion, stupor, seizure, coma fever, flushed skin, intense thirst if Na gain: hypervolemia, increased BP, bounding pulse, dyspnea if water loss: hypovolemia, dry mucous membranes, oliguria, orthostatic hypotension FRIED: fever, restless, irritable/increased BP and increased fluid retention, edema, decreased urine output and dry mouth

lab findings for hypernatremia

Na+ > 145 mEq/L urine specific gravity > 1.030 serum osmolality > 300

hypernatremia tx

``` correct underlying cause PO fluid, IV if needed fluids over 48 hrs IV--salt free (D5W) restrict sodium intake diuretics with fluids ```

potassium

``` 3.5--4.5 mEq/L main ICF cation skeletal/cardiac muscle contraction nerve impulse transmission exchanged for H+ ions for pH ```

hypokalemia causes

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