FLUID DISTRIBUTION AND EDEMA Flashcards Preview

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Flashcards in FLUID DISTRIBUTION AND EDEMA Deck (69):
1

intracellular fluids

- 2/3 is water

2

whole vascular volume

- 5L
- 3L is plasma
- 40% RBC

3

total body weight

- 60% (60L) men
- 50% women more adipose tissue 5% breast

4

TBW

- 60L
40% intracellular fluid
20% extracellular fluid 2/3 is interstitial (in bet.cells)

5

ICF vs ECF

- fluid goes from ICF(6) to ECF(12) due to greater concentration

6

osmotic pressure/ osmolar pressure

- lift draw of water to the area of higher concentration
- balancing out electrical forces

7

hydrostatic pressure

- arteriolar

8

electrical pressure

- K+ and Na+ cation ions repel each other

9

2x Na concentration

- index for EXTRACELLULAR OSMOLARITY

10

ECF osmolarity INCREASES

- cell SHRINK
- sodium concentration with in the cell is INCREASING
- HYPEROSMOLAR

11

ECF osmolarity DECREASES

- cell SWELL
- cells becomes dehydrated

12

STEADY STATE SITUATION

- intracellular=extracellular concentration of water

13

osmolar pressure

- is the SODIUM

14

WATER PUT ON A BLOOD

- cells swell and burst patient dies
- D5W is used to prevent this

15

ICF

2/3 TBW

16

ECF

1/3 interstitial

17

TBW men

60L

18

TBW women

50L

19

blood minus cell

- plasma

20

serum

- clotting factors removed(post clotted blood)

21

plasma

- has the clotting factors
- physiologic

22

volume

- widening convergence and expansion

23

concentration

- vertical increase(hyperosmolar) and decrease(hypo osmolar)

24

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

- 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

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