Fluid Electrolytes 1 Flashcards by Jugurtha Kerchit

Homeostasis:

Volume and composition of each space
remains constant.
These can impact homeostasis:
- vomiting
-diarrhea
-ace inhibitors
-diuritics

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Composition of
Body Fluids Water:

Primary component of body
Accounts for approx 60% of body weight but it varies with age.
Adequate balance is necessary for
- maintenance of temp - elimination of
waste products - all transportation within
body

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Factors That
Affect Body
Water

Age is a huge factor.
neonates are made of 80% water vs older adults which is 45%.
Other factors that influence body water are:
The more adipose tissue the less body water you have. The more muscle mass you have the more water you have.

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Composition of
Body Fluids Solutes

Electrolytes: Chemical compounds that
develop an ionic charge when dissolved
in water
All body fluids contain electrolytes

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Electrolytes

Regulation of electrolyte levels is critical
for:
maintenance of body fluid osmolality
acid balance
neuromuscular function
cell metabolism

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Composition of
Body Fluids. Nonelectrolytes

Nonelectrolytes
Do not dissociate in solution
measured by wt
Glucose - Urea - Creatnine - Bilirubin
- Proteins

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Amount of plasma in the body :

Plasma: 3L
Interstitial fluid (IF): 10L
Intracellular fluid (ICF): 28L

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Body Fluid Compartments. Transcellular
Fluids. (not subject to significant
gains or losses)

They are available in very small amounts so their impact is small.
CSF (cerebrospinal fluid)
GI tract
Pleural (between layers of pleura)
Synovial (between joints)
Peritoneal (in peritoneum)

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Fluid Spacing

First spacing
a) Normal distribution of fluid

Second spacing
a) Abnormal accumulation of interstitial fluid

Third spacing
a) Abnormal accumulation in areas that
have no or little amt of fluid
b) Fluid unavailable for use

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Movement of
Body Fluids

1) Fluid constantly moves among intracellular,
interstitial and vascular spaces to maintain
body fluid balance
2) Moves through permeable membranes
- permits movement of water and some
solutes
3) Normally ICF and ECF are isotonic with
each other

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Osmosis

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

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Movement of
Body Fluids

Osmotic Pressure: It is specific to water and it means the movement of water from an area of low concentration of a solute to an area that has a higher consecration of solutes.

Refers to pulling power of a solution for
water
The higher the osmolality of a solution,
greater pulling power for water
Oncotic Pressure (it is a form of somotic pressure)
Refers to pulling force exerted by colloids

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Diffusion

Diffusion is the movement of molecules from a region of higher concentration to a region of lower concentration (Sugar cube in coffee)

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Facilitated Diffusion (glucose)

Facilitated diffusion is the diffusion of solutes through transport proteins in the plasma membrane. Facilitated diffusion is a type of passive transport. Even though facilitated diffusion involves transport proteins, it is still passive transport because the solute is moving down the concentration gradient.

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Movement of
Body Fluids: Filtration

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 it as a tug of
war - pushing and pulling

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Net Filtration

A) Forces favoring filtration
 Capillary hydrostatic pressure (blood pressure) Straw
 Interstitial oncotic pressure (water being pulled by the proteins in the interstitial fluid)
B) Forces favoring reabsorption
 Plasma oncotic pressure (water being pulled by albumin the BV)
 Interstitial hydrostatic pressure from interstitial space to BV

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Fluid Shifts: Interstitial fluid to plasma

Interstitial fluid to plasma (meaning BV )

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

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

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Movement of
Body Fluids. Active Transport

Movement of solute from an area of lower
solute concentration to an area of higher solute concentration
Depends on ATP so if you have inadequate phosphate then you run the risk of not having enough ATP which is requires for energy
Example is Sodium- Potassium pump.

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Renin-
Angiotensin (From Lippincott, Williams & Wilkins,
Check slide 22

(From Lippincott, Williams & Wilkins,
F&E Made Incredibly Easy Retrieved
From: https://web-a-ebscohost-
com.ccsf.idm.oclc.org/ehost/ebookviewe
r/ebook/ZTAwMHhuYV9fMTQ4NDM4
NV9fQU41?sid=e7406067-860e-4038-
8c58-
1d22daac1f8f@sessionmgr4008&vid=0
&format=EK&lpid=navPoint-4&rid=0)

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Aldosterone(From Lippincott, Williams &
Wilkins, F&E Made Incredibly
Easy) Check slide 23

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Regulation of
Body Fluids. Antidiuretic
Hormone (ADH)

Hormone synthesized by hypothalamus stored and Secreted by the posterior pituitary

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Regulation of Body Fluids

Thirst Mechanism:

1) Stimulated by thirst receptors in
hypothalamus
2) Primary protection against
hyperosmolality
3) Normally occurs with even
small fluid losses
4) Stimulates the release of ADH and
aldosterone
5) Depressed in older people: and this puts them at risk for hyper osmolarity and therefore hypernatrimia. It is important to monitor for I/O and have water stations.

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Regulation of
Body Fluids check slide

Atrial Natriuretic Peptide (ANP)

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Atrial Natriuretic Peptide (ANP). One liter of
water weighs:

2.2lbs/1kg

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Fluid Losses: Kidneys: Primary regulators Primary regulators of fluid and electrolyte of fluid and electrolyte balance

pprox 1500ml urine excreted/day

Fluid Losses. Skin

Ave of 500 - 600ml of sensible & insensible fluid sensible & insensible fluid lost via skin each day (Can lost via skin each day (Can be as great as 2l/hr)

Fluid Losses. Lungs

Approx 400ml insensible fluid

Fluid Losses. G.I. Tract

100-200ml

Fluid Losses. Abnormal Losses

varied

Fluid Losses. Third Space Losses

Unavailable

Fluid Volume Excess. Causes of FVE

1- Renal Disease 2- Too rapid infusion of IV fluids 3- Steroid Therapy 4- Production of ADH 5- Cardiac Disease

Brawny Edema

A change typical of chronic venous insufficiency, characterized by: thickening, induration, lipodermatosclerosis and non-pitting edema stopping above the ankle. the brawny color is due to hemosiderin from lysed red blood cells (RBCs) with chronic ischemia.

Fluid Volume Deficit. Causes of FVD

1- NPO 2- Drains 3- Surgery 4- Blood loss 5- Fluid loss from GI tract 6- Profuse sweating 7- polyuria 8- fever 9- third spacing 10- Decreased intake

What is crenation ?

When the cell shrinks

Most of the oxygen is inside the cell or outside the cell in the human body ?

Inside the cell

What is ascites ?

it is a condition in which fluid collects in spaces in your abdomen. Usually it accumulates in the peritoneal space. like the woman who runs the lake in oakland. She has a belly but she is not pregnant.

Second spacing example ?

If you have a pt who has an increased BP and have been standing for a long time they will get an edema due to fluid leaving the blood vessel and accumulating in the interstitial fluid due to high bp and fighting gravity.

Are the ICF and ECF isotonic with each other ?

Yes unless there is an issue

Oncotic pressure?

It is the same as osmotic pressure but it is stronger because proteins pull harder (this is because they are bigger) It draws more water towards it than other solutes. It is carried out by the protein albumin. This type of pressure helps put fluid back to the vasculature to maintain BP. Coz remember more water in the BV = more pressure and more perfusion

Facilitated diffusion ?

Some solutes can't move into a cell without help due to the phospholipid bailayer membrane. They require a carrier protein to attach to it and bring it inside the cell then disassociate. A perfect example is glucose which requires insulin to help carry it into the cell.

Hydrostatic pressure

Straw analogy.

Oncotic osmotic pressure is the same as calloid osmotic pressure

oui

What is an example of active transport ?

The sodium potassium pump. coz atp is used

In renin/ agiotenesin what senses a drop in BP ?

The Glomerulus

What cells secrete the enzyme renin after receiving a signal by the glomerulus?

The justaglumerular cells.

Explain the Renin angiotenisin system.

What do ACE inhibitos do ?

They prevent renin which is an enzyme from producing angiotensin 2 to (Ace inhibitor medications are used to lower BP)

What does ACE mean ?

It is an acronym for angiotenesin converting enzyme which in this case rennin

what is an example of an ACE inhibitor ?

Lisnopril: It helps block ACE (Rennin) which in turn helps the production of angiotenesin 2 which in turn blocks the production aldosterone. This causes the body not to hold on to NA and therefore water which causes a decrease in BP.

What happens to K when aldosterone in released and H2O and NA are retained?

K levels go down due to excretion. So more aldosterone means more NA and less K

Is the thirst mechanism the primary protection against hyperosmolarity ?

Yes.

What is another name for ADH?

Vasopressin

What is ADH where is made, stored and what stimulates its secrition.

Antidiuritic hormone. made in the hypothalamus and stored and secreted by the posterior pituitary gland when it senses an increase in osmolality.

Chemical compounds that develop an ionic charge when dissolved in water

Electrolytes

All body fluids contain

Electrolytes

Accounts for approx 60% of body weight

water

Do not dissociate in solution

Nonelectrolytes

Glucose - Urea - Creatnine - Bilirubin and Proteins are examples of ?

Nonelectrolytes

They are available in very small amounts so their impact is small.

Transcellular Fluids. (not subject to significant gains or losses)

Osmotic Pressure aka as osmosis?

It is specific to water and it means the movement of water from an area of low concentration of a solute to an area that has a higher consecration of solutes.

facilitated diffusion requires a source of ATP.

Simple diffusion does not require energy

yes

Causes the kidneys to retain water but not sodium NA to decrease osmolality

ADH

SIADH

syndrome of innapropriate secrition of the antidiuritic hormone (Too much release of ADH)

Running a marathon can cause SIADH because ?

you keep drinking water but you are not replacing the sodium which leads to hyponatrimia

Drugs that interfear with ADH secrition are

coffee or alcohol they act as a diuritic because they turn off our adh hormone. This makes us pee more diluted urine

what conditions can trigger SIADH

pulmonary conditions, lung cancer, pneumonia which causes us to produce to much ADH

In DI very little ADH is produces

true

Dry inside caused by ?

DI diabetes insipidus

Soaked inside caused by ?

SIADH

Definition of DI ?

A state in which we pee a lot coz our body doesn't produce enough ADH. so what happens is that we pee a lot of water and keep too much sodium which leads to hypernatremia

SIADH causes hypo or hypernatrimia ?

hypo

DI causes hypo or hypernatrimia ?

hyper

causes higher bp, swealling in the brain due to excessive amounts of water in the brain. It causes headaches and it can also cause seizures

SIADH

Stop urination sign of SIADH or DI?

SIADH

Hypoosmolality/ hyponatremia with NA levels less than 135

SIADH

Too much water in the head which means swelling

SIADH

Severe high bp and edema build-up

SIADH

To mitigate SIADH

Stop all fluids. This means no IV or drinking and the exception would be an IV saline with salt. We can also give diuretics to reduce H2O.

decreased Bp

Desmopressin/vasopressin

used for DI

brain damage such as brain surgery, ectopic tumors that secrete ADH (same as cushing syndrome) sepsis, or infections in the brain like meningitis and even pneumonia

Atrial natriuretic hormone ?ANP

A hormone secreted by the atria in the heart due to an increase in BP in the BV. ANP targets the kidneys and causes a decrease in NA reabsorption. + NA exits the body therefore h2o follows it by osmosis. ANP affects BV by causing vasodilation.

ANP increases glomerular filtration by vasodilating the afferent artriole in the nephron which brings blood into the glomerulus therefor increasing the amount of filtrate produced by the kidneys.

yes

other things are done by ANP

- inhibits rennin angiotenesin system -reduces the secrition of aldosterone by the adrenal cortex in the kidneys -it releases free fatty acids from adipose tissue

When do you usually see ANP

withh heart failure.

ANP when does it kick in?

only kicks in when there is fluid overload and causes diurises

hyponatremia is the most common chemical imbalance seen in hospital patients.

yes

another thing besides the rennin angiotensin system that can stimulate the release of aldosterone is an increase in K

oui

Major cation icf

Major anion ecf

Major cation ecf

ACE inhibitors

they are diuretics

Lisinopril is an ACE inhibitor

makes you pee

Major ecf cation

when you think of calcium you think?

muscle contractions and action potentials (so neuromuscular) and some heart arrhythmias

85 % of phosphorus is in bones 14 in soft tissues and of the remaining 1% the majority is in the ICF

oui

Most abundant extracellular anion

Most abundant extracellular cat

makes up for two-thirds plasma anions

Normal serum values 100-106 mEq/L

mainly in stomach as hydrochloric acid. HCl

Major cation in ICF

if we are going to hold on to NA

K will be excreted and viceversa

it helps drive K into the cell

insulin

furosemide/Lasix

loop diuretic (furosemide/Lasix it gets rid of K+)

Primary anion found in intracellular fluid

PO 3− 4

Activates enzymes involved in the metabolism of CHO & protein