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PHYSIOLOGY > FLUID DISTRIBUTION AND EDEMA > Flashcards

FLUID DISTRIBUTION AND EDEMA Flashcards

1
Q

intracellular fluids

A
  • 2/3 is water
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2
Q

whole vascular volume

A
  • 5L
  • 3L is plasma
  • 40% RBC
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3
Q

total body weight

A
  • 60% (60L) men

- 50% women more adipose tissue 5% breast

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4
Q

TBW

A
  • 60L
    40% intracellular fluid
    20% extracellular fluid 2/3 is interstitial (in bet.cells)
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5
Q

ICF vs ECF

A
  • fluid goes from ICF(6) to ECF(12) due to greater concentration
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6
Q

osmotic pressure/ osmolar pressure

A
  • lift draw of water to the area of higher concentration

- balancing out electrical forces

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7
Q

hydrostatic pressure

A
  • arteriolar
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8
Q

electrical pressure

A
  • K+ and Na+ cation ions repel each other
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9
Q

2x Na concentration

A
  • index for EXTRACELLULAR OSMOLARITY
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10
Q

ECF osmolarity INCREASES

A
  • cell SHRINK
  • sodium concentration with in the cell is INCREASING
  • HYPEROSMOLAR
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11
Q

ECF osmolarity DECREASES

A
  • cell SWELL

- cells becomes dehydrated

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12
Q

STEADY STATE SITUATION

A
  • intracellular=extracellular concentration of water
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13
Q

osmolar pressure

A
  • is the SODIUM
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14
Q

WATER PUT ON A BLOOD

A
  • cells swell and burst patient dies

- D5W is used to prevent this

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15
Q

ICF

A

2/3 TBW

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16
Q

ECF

A

1/3 interstitial

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17
Q

TBW men

A

60L

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18
Q

TBW women

A

50L

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19
Q

blood minus cell

A
  • plasma
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20
Q

serum

A
  • clotting factors removed(post clotted blood)
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21
Q

plasma

A
  • has the clotting factors

- physiologic

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22
Q

volume

A
  • widening convergence and expansion
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23
Q

concentration

A
  • vertical increase(hyperosmolar) and decrease(hypo osmolar)
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24
Q

loss of isotonic fluid (hemorrhage loss of intracellular fluid as RBC volume not changing concentration), isotonic urine, diarrhea or vomiting

A
  • losing only plasma
  • extracellular fluid loss
  • volume
  • no movement of fluids in either direction because ICF and ECF has the same 300 mosm concentration
  • DECREASE ECF VOLUME
  • NO CHANGE IN BODY OSMOLARITY AND ICF VOLUME
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25
loss of hypotonic fluid sweating, hypotonic urine, diabetes insipidus, dehydration, ALCOHOLISM (nephrogenic DI) inhibit ADH loss of free water
- salt retention increase osmolality ECF - increasing concentration decreasing volume - effect on ICF fluid move out of the cells to compensate hence ICF volume is decreasing - DECREASE IN ECF AND ICF VOLUME - INCREASE IN BODY OSMOLARITY
26
salt tablets
- increase osmolality - dehydrate the cells - ECF concentration will increase
27
tap water or distilled water has the lowest sodium content, IVF
- ECF osmolality decreases | - ICF concentration decrease
28
patient hypotensive, sepsis, GI bleeding, burns volume loss
- you want the volume in the vascular space | - normal saline IVF is used
29
major blood volume loss
- IVF used normal saline .9 or lactated ringer isotonic solution it will expand ECF
30
infusion of isotonic saline normal saline, 0.9%, ringers lactate
- no osmotic draw - INCREASE ECF VOLUME - NO CHANGE IN BODY OSMOLARITY AND ECF VOLUME
31
hypertonic saline in hge, mannitol
- it will cause seizures because of the rises in osmolality - expand plasma volume increase - INCREASE ECF VOLUME AND BODY OSMOLARITY - DECREASE ICF VOLUME
32
high sodium affects the
- CNS seizures
33
primary adrenal insufficiency
- loss of aldosterone - function of aldosterone retain sodium excrete hydrogen ions and potassium - decrease osmolality due to loss of sodium, chloride and water cause decrease in volume(hypo osmolality) - decrease blood pressure
34
HYPOTONIC SALINE, water intoxication
- INCREASE ECF AND ICF VOLUME - DECREASE BODY OSMOLARITY - dehydrate the cells
35
arteriolar constriction and dilation(has circular muscles) of the afferent and efferent
- hydrostatic forces(water pressure) | - hydrostatic pressure constant in the the afferent and efferent is maintained by
36
GFR
- 20% is filtered
37
efferent and afferent arteriole
- pressure is the same hydrostatic pressure
38
constrict and dilate
- arterioles
39
cannot constrict and dilate
- venules - large arteries(AORTA, femoral artery, brachial artery) - capillaries - veins
40
after load
- arteriolar resistance
41
capillaries(very thin)
- highly permeable because they cannot constrict and dilate - can diffuse in and out - protein can leak out in the interstitial
42
oncotic pressure
- is protein
43
hydrostatic pressure
- capillary - push fluid out in the arteriolar capillary (FILTRATION) - if it is in the INTERSTITIAL FLUID(reabsorption), forces push IN
44
oncotic pressure
- interstitium - pull OUT the fluid into the interstitial fluid capillary (FILTRATION) - if it is in the capillaries (reabsorption), forces pulls IN
45
Pc plus ^^if 25 + 1
- 26
46
Pif plus ^^c 20 + 2
- 22
47
rate fo flow is
- 26 minus 22 = 4mm Hg
48
decrease hydrostatic pressure in the interstitial FLUID/space
- will INCREASE THE FORCE OF FILTRATION
49
tracers
- dye injected IV 300mg - trace divided by blood concentration 0.05mg/ml= volume of distribution - 300mg/0.05mg/ml=6000ml
50
inulin
- is filtered but not reabsorb nor secreted
51
the lower the hct
- the higher the plasma
52
the higher the hct
- the lower the plasma
53
ECF
- saline and mannitol pass the cellular membrane will go to interstitial space
54
higher water concentration
- low osmolality
55
low water concentration
- high osmolality
56
urea changes the osmolality equally
- no net movement of water
57
mannitol can
- increase osmolality
58
EDEMA
- INCREASE hydrostatic pressure with in the capillary it pushes fluid in the interstitial space - STARLING FORCE - retention of sodium and water in the kidney - CHF no intravascular volume, afferent constricts, JG constricts, start making renin, angiotensin, angiotensin II aldosterone causing hypotension
59
non pitting edema (lymphedema)
- lymphedema - does not respond to diuretics - develops after removal of systemic tissue (e.g. removal of axillary lymph node in breast cancer)/altered normal lymphatic drainage/configuration
60
pitting edema (MOST COMMON)
- RESPOND TO DIURETICS | - common causes include nephrotic syndrome,CHF, cirrhosis
61
retention of sodium and water by the kidney causing decrease renal perfusion
- cirrhosis - nephrotic - CHF - pericarditis
62
pulmonary edema (CHF)
- anything that blocks the return of fluid in the LEFT ATRIUM from pulmonary veins then drains into the left ventricle - back up of fluid due to left ventricular dysfunction at the pulmonary capillary system - increase capillary pressure causing pulmonary edema - LEFT VENTRICLE ==>LEFT ATRIUM=>PULMONARY VEIN=>PULMONARY CAPILLARIES==> INCREASE HYDROSTATIC PRESSURE==> puts fluid in the interstitial space and in the alveoli= causing pulmonary edema(FLUID BACK UP) - HYDROSTATIC PRESSURE> ONCOTIC PRESSURE - decrease in albumin
63
normal person
- no protein in the alveoli | - alveolus should be empty kept by tight junctions( in drowning alveolus has water)
64
alveolar proteinosis
- protein in the alveoli | - with oncotic pressure in the alveoli
65
DIURETICS ARE GIVEN
- to DECREASE hydrostatic pressure in the pulmonary capillaries
66
most common form of pulmonary edema
- CARDIOGENIC PULMONARY EDEMA - lower plasma proteins predispose to cardiogenic edema - increase left atrial pressure, venous return, capillary pressure and filtration - MOST COMMON SIGN DYSPNEA - caused by low plasma proteins - pulmonary wedge pressure (LEFT ATRIAL PRESSURE)confirms the diagnosis IS INCREASE - sitting upright relieves the pressure - treatment goal: reduce LEFT ATRIAL PRESSURE diuretics DECREASES HYDROSTATIC PRESSURE
67
DIURETICS
- empty the lungs
68
non cardiogenic edema( FRIED LUNGS)
- due to direct injury of the alveolar epithelium - severe lung injury (ARDS) - MOST COMMON CAUSE: GASTRIC ASPIRATION AND SEPSIS - presence of protein containing fluid the the alveoli inactivates the surfactant - NO HYDROSTATIC PRESSURE INVOLVED - ARDS direct damage the capillaries, BURNS, ATELECTASIS, amniotic fluid embolus, DIC
69
lymphatics
- cleans the lungs by taking all the proteins

PHYSIOLOGY (40 decks)

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