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Pathophys Block II > Fluid Balance > Flashcards

Fluid Balance Flashcards

1
Q

ICF

A

intracellular fluid, 2/3 of total body water (~60%)

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2
Q

ECF

A

extracellular fluid, 1/3 of total body water (~40%)

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3
Q

plasma volume

A

intravascular fluid, 1/4 of ECT (1/12 of total body water)

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4
Q

interstitial fluid

A

separated from plasma by capillary wall (3/12 of total body water)

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5
Q

ADH function

A

stimulates water conservation in nephron, secreted by hypothalamus to cause thirst and retain H2O.

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6
Q

third spacing

A

movement of ECT into space between skin and fascia, fluid is unavailable for use or exchange w/ intravascular fluid. different from acites; associated w/ burns and pancreatitis.

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7
Q

osmosis

A

net movement of water or other solvent to an area of higher solute concentration

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8
Q

osmolarity

A

concentration of a solution (number of particles/liter)

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9
Q

tonicity

A

relative concentration of two solutions, that determines the direction of diffusion

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10
Q

isotonic

A

two solutions separated by a membrane have the same concentration

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11
Q

hypertonic

A

solution that has a higher solute concentration than the solution on the opposite side of a membrane

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12
Q

hypotonic

A

solution that has a lower solute concentration than the solution on the opposite side of a membrane

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13
Q

what is the primary ion present in ECF?

A

Na+

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14
Q

what is the primary ion present in the ICF?

A

K+

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15
Q

what is the main determinant of osmolality in the body?

A

[Na+]

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16
Q

what 4 factors change in parallel to help maintain a somewhat constant volume in the body?

A
  1. ECF volume
  2. vascular volume
  3. arterial BP
  4. cardiac output
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17
Q

what factors regulate Na+?

A
  1. SNS (stretch receptors)
  2. renal (JG apparatus)
  3. CV control (ANP: atrial natriuretic peptide)
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18
Q

function of Na+

A

determines osmolality of ECF

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19
Q

what factors regulate K+?

A
  1. plasma [K]
  2. aldosterone
  3. nephron tubular flow rates
  4. distal nephron tubular [Na]
  5. acidosis/alkalosis
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20
Q

function of K+

A

critical for cell cycle, cell membrane exciteability

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21
Q

function of Ca2+

A

intracellular ion, 99% stored in bone, involved in cell cycle, membrane excitability, bone formation, coagulation

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22
Q

what factors regulate Ca2+?

A

regulated in the kidney, GI tract, and bone

  1. parathyroid hormone
  2. calcitriol (activated vit D)
  3. calcitonin
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23
Q

function of H+

A

very low concentration in body, determines pH

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24
Q

what factors regulate H+?

A

regulated by the kidneys and lungs

  1. intracellular pH
  2. aldosterone
  3. [K+]
25
Q

function of bicarbonate

A

predominant buffer system in body

26
Q

what structures help regulate bicarbonate?

A

regulated by kidneys and lungs

27
Q

where is bicarbonate resorbed in the nephron?

A

very efficiently reabsorbed in the proximal tubule (not via direct absorption of HCO3-)

28
Q

what factors regulate Cl-?

A

coupled w/ Na+absorption in the nephron, passively follows Na+ to keep electrolyte balance

29
Q

function of phosphate

A

component in many organic molecules (ATP, DNA, RNA etc.); imporatnat urinary and bone buffer

30
Q

what factors and structures regulate phosphate?

A
  1. PTH
  2. calcitriol (via GI tract)
  3. kidneys
    4 .bone
31
Q

what is the main challenge to diagnosing patients with fluid/electrolyte disorders?

A

symptoms are often very nonspecific

32
Q

what happens to the cells if a patient is hyponatremic?

A

cells swell, this can be very dangerous for the brain

33
Q

what is the treatment for a patient w/ hypervolumic hyponatremia?

A

diuretics, fluid restriction

34
Q

what is the treatment for a patient w/ hypovolumic hyponatremia?

A

saline

35
Q

what is the treatment for a patient w/ euvolumic hyponatremia?

A

fluid restriction, in some cases, saline plus loop diuretics

36
Q

what happens to the cells if a patient is hypernatremic?

A

cells shrink, this can be very dangerous for the brain

37
Q

what is the treatment for a patient w/ hyperkalemia?

A
  1. CaGluconate IV to stabilize cardiac arrhythmia
  2. shift K+ into cells (insulin/glucose, beta agonist-albuterol, bicarbonate)
  3. K+ excretion in urine (diuretics or dialysis if in renal failure)
  4. K+ excretion in stool (kayexelate)
38
Q

what is the treatment for a patient w/ hypokalemia?

A

oral or IV K+

39
Q

what is the treatment for a patient w/ hypocalcemia?

A

depends on severity and acuity, give Ca2+ IV for acute and symptomatic hypocalcemia

40
Q

what are the clinical presentations of a patient w/ hypocalcemia?

A

tetany, muscle spasms/cramps, seizures, arrhythima, hypotension, bradycardia

41
Q

what diagnostics tests would you use to diagnose hypocalcemia?

A
  1. Mg
  2. PTH
  3. Vit D
  4. Phos level
42
Q

what are the clinical presentations of a patient w/ hypercalcemia?

A

“stones, groans, psychiatric overtones”

  1. HTN
  2. GI symptoms
  3. mental status changes
  4. polyuria
43
Q

what diagnostic tests would you use to diagnose hypercalcemia?

A
  1. PTH
  2. Phos level
  3. vit D
44
Q

what is the treatment for a patient w/ hypercalcemia?

A
  1. increase urinary excretion of Ca (loop diuretic/saline)

2. consider dialysis if in renal failure

45
Q

what are the clinical presentations of a patient w/ hyponatremia?

A

fatigue, impaired concentration, anorexia, N/V, seizures, coma and death

46
Q

what diagnostic tests would you use to diagnose hyponatremia?

A
  1. urine Na+
  2. serum osmolality
  3. urine osmolality
  4. Hx and physical
  5. basic chemistry
47
Q

what are the clinical presentations of a patient w/ hypernatremia?

A

fatigue, thirst, impaired concentration, anorexia, N/V, seizures, coma and death

48
Q

what diagnostic tests would you use to diagnose hypernatremia?

A
  1. urine osmolality
  2. serum osmolality
  3. urine Na+
49
Q

what are the clinical presentations of a patient w/ hypokalemia?

A

paresthesias, muscle cramps, weakness, ileus, cardiac arrhythmia, abnormal EKG (flat T waves, ST depression)

50
Q

what diagnostic tests would you use to diagnose hypokalemia?

A
  1. Hx and physical
  2. FeK
  3. chemistries
51
Q

what are the clinical presentations of a patient w/ hyperkalemia?

A

paresthesias, muscle weakness, cardiac arrest, abnormal EKG (peaked T waves, PR prolongation, QRS widening)

52
Q

what diagnostic tests would you use to diagnose hyperkalemia?

A
  1. Hx and physical
  2. chemistries
  3. urine K+ excretion
53
Q

what are the clinical presentations of a patient w/ hypophosphatemia?

A

myalgials, weakness, rhabdomyolysis, MS changes

54
Q

what are the clinical presentations of a patient w/ hyperphosphatemia?

A

hypocalceima, tetany, metastatic soft tissue calcificatnion and secondary hyperPTH

55
Q

how would you treat a patient w/ hypophosphatemia?

A

repleting

56
Q

what are the clinical presentations of a patient w/ hypomagnesemia?

A

myoclonus, neurologic symptoms, EKG abnormalities (flat T waves, prolonged PR/QT/QRS), hypocalcemia, and hypokalemia

57
Q

what diagnostic tests would you use to diagnose hypomagnesemia?

A
  1. Hx and physical

2. full chemistry panel

58
Q

what is the treatment for a patient w/ hypomagnesemia?

A
  1. oral for mild to moderal deficiency

2. IV magnesium for severe deficiency

Pathophys Block II (8 decks)

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