Fluids and electrolytes Flashcards by Quennie Ann Silverio

Total body water (TBW) is approximately__ of your

body weight.

60%

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Two-third of your total TBW is comprised by

________

Intracellular fluid (ICF)

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one-third is comprised of

_____

Extracellular fluid (ECF).

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ECF: 1/4

plasma

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ICF: 3/4

interstitial fluid

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Contain mainly in skeletal muscle (highest)

INTRACELLULAR (⅔)

40% of body weight
60% of TBW

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Intracellular Cations

K, Mg

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Intracellular Anions

PO3, SO3, Proteins

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Interstitial Fluid (fluid that is in between your cells
and blood vessels) + Plasma Volume (All the fluid
that contain inside your BV)

EXTRACELLULAR (⅓)

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EXTRACELLULAR cation

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EXTRACELLULAR anion

Cl, HCO3

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transports 3 Na molecules out vs.
2 K molecules in (K accumulates inside the cell;
Na accumulates outside the cell resulting in a
gradient)

Na/K ATPase

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T or F
Most significant gains and losses of body fluid
comes from the ICF compartment. Due to
vomiting and diarrhea and blood loss.

*intracellular

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15 % of body weight

* 25% of total body water

INTERSTITIAL FLUID

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• 10% of total body water
• has high protein (organic anions) content
• 7% of body weight (in kg) = estimate of blood
volume

PLASMA

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osmosis is determined by the ________ on

each side of the membrane

concentration of solutes

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Fluid will move to move towards the container that has the

_______ concentration of solutes

higher

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DETERMINANTS OF OSMOLALITY

Sodium (Na)
Blood Glucose
Blood Urea Nitrogen (BUN)

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are the watery fluid that you
can measured and see. This are your oral fluid and
amount of solid food you eat. We can also have
measured urine, intestinal fluid, sweat.

Sensible water losses

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are the water that you lose
through metabolism. i.e oxidation. It is water that we
lose through respiration and through our skin.

Insensible water losses

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Kidneys must excrete a minimum of_____ ml /

day of urine to clear products of metabolism

500 to 800

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▪ Specialized sensors that detect small chances

fluid osmolality

OSMORECEPTORS

▪ Act through the kidneys

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Dehydration: ↑ plasma osmolality →

o ↑ thirst & water consumption +
hypothalamus
o VASSOPRESSIN → ↑ water
reabsorption in the kidney

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Baroreceptors are located in ______

aortic arch & carotid sinus

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Modulate volume in response to changes in BP & blood volume (If your blood pressure is low, they have to calibrate it in order to increase your blood pressure)

BARORECPTORS

Acute Volume Deficit =

CVS & Nervous system | signs

Chronic Volume Deficit =

``` Tissue signs (skin turgor, CVS & nervous system signs ```

ECF diagnostics

▪ ↑ BUN (if severe enough to ↓ glomerular filtration) ▪ Hemoconcentration (If you do CBC, you’ll see that your hematocrit is higher than normal as your blood is concentrated) ▪ ↑ Urine osmolality (very concentrated urine) > Serum osmolality ▪ ↓ Urine NA < 20 meq/L

▪ ↑ both plasma + interstitial volumes

ECF VOLUME EXCESS

Causes of ECF volume excess

o Iatrogenic (excess IVF) o 2° (secondary) to renal dysfunction, congestive heart failure (CHF), liver cirrhosis

T or F Changes in Na are usually inversely proportional to TBW

Normal Na =

130 - 150 mEq/L

▪ serum Na ≤ 130 mEq/L | ▪ occurs when ECF > serum Na

HYPONATREMIA

Usually has very severe neurological symptoms: | Acute cerebral edema, seizures, coma

ACUTE HYPONATREMIA

▪ Well-tolerated up to levels of 110 meq/L well below ▪ confusion, decreased mental status, irritability, ↓ Deep tendon reflexes

CHRONIC HYPONATREMIA

o Form of paralysis that occurs because of overcorrection of Na o Sodium-Potassium pumps cannot handle the load quickly enough o Destroys CNS neurons- very sensitive to electrolytes. Myelin sheath is destroyed

▪ CENTRAL PONTINE MYELINOLYSIS

▪ Solute excess / osmotic particles in ECF ▪ Na is not the only particle that determines your serum osmolality. It also includes your BUN and your blood glucose. These two components crowd out the sodium and the sodium becomes proportionately lower ▪ The kidneys try to compensate so you urinate more (like in diabetes) so you lose more water and sodium (collateral damage).

HYPEROSMOLAR HYPONATREMIA

Drug that is given to decrease CNS swelling. It is a diuretic=removes Na. You decrease blood volume in brain and pressure.

Mannitol

▪ Na ≥150 mEq/L ▪ From o Loss of free water (↓ ECF o Gain in Na > ECF

HYPERNATREMIA

``` Volume deficit with free water loss> Na loss - Insensible H2O loss from GIT/skin - Thyrotoxicosis - Hypertonic glucose solutions (peritoneal dialysis) -- Diabetes insipidus - Diuretics - High output urine output from polyuric phase of ATN ```

• NORMOVOLEMIC HYPERNATREMIA

• NORMOVOLEMIC HYPERNATREMIA: TREATMENT

``` Replace water with PNSS Free water deficit (L)= 𝑆𝑒𝑟𝑢𝑚 𝑁𝑎 − 140 140 × 𝑇𝐵𝑊 ½ deficit = replace in 1st 8 hours ½ deficit = replace in next 16 hours Once adequate volume achieved: replace water deficit with D5W or D5NSS or oral H2O Titrate to achieve ↓Na by: Acute HyperNa= 1 mEq/L & 12 mEq/day Chronic HyperNa = 0.7 mEq/hou ```

- Urine Na > 20 mEq/L - Urine osmolality > 300 mOsm/L --Mineralocorticoid excess - Hyperaldosteronism - Cushing’s Syndrome - Congenital adrenal hyperplasia

HYPERVOLEMIC HYPERNATREMIA

Serum Ca =

1% of total body Ca

o Ionized Ca (50%) = responsible for__________

neuromuscular stability

▪ When serum calcium is > 10.5 mEq/ L or increase in | ionized Ca > 4.8 mg/dL

HYPERCALCEMIA

It is Symptomatic HyperCa - if

> 12 mg/dL

Critical Level of HyperCa =

15 mg/dL

The most common cause of hypercalcemia in admitted patients inside the hospital is actually _________

Cancer.

``` The most common cause of hypercalcemia in outpatient setting (in the rest of the population) is __________ ```

Primary Hyperparathyroidism.

HYPERCALCEMIA TREATMENT

▪ Aggressive Isotonic IVF Resuscitation - diuresis and excretion of Ca from kidneys ▪ Furosemide – for diuresis, ▪ Meds to Stop Osteoclastic Activity

– It is a calcinamatic, it attaches to parathyroid glands and signals to stop releasing parathyroid harmone.

Calcitonin

Serum Ca < 8.5 mEq/L or Ionized Ca < 4.2 mEq/L

HYPOCALCEMIA

The most common cause of hypocalcemia is ________-

thyroid surgery (Thyroidectomy)

This occurs due to damage to parathyroid gland, and most common cause of that is thyroid surgery, because it accidentally damages parathyroid. Hypoparathyroidism (most common cause)

Transient Hypocalcemia or Postoperative | hypocalcemia for < 6 months (post thyroidectomy).

in hypoproteinemia | (low albumin) state.

Asymptomatic Hypocalcemia

Classic signs of Hypocalcemia

Peri-oral numbness Cramps Chvostek's sign Trosseau's sign

HYPOCALCEMIA TREATMENT

▪ Asymptomatic - oral supplementation with 500 mg Calcium Carbonate 2 tabs TID ▪ Symptomatic - monitored & treated o IV calcium gluconate

▪ The 1o intracellular divalent anion ▪ Increase in metabolically active cells ▪ Involved in energy production during glycolysis ▪ Controlled by renal excretion. . ▪ It is present in increased amounts in highly metabolically active cells like your bone, GIT.

PHOSPHOROUS

PAROXYSMAL RHABDOMYOLISIS causes ________

hyperphosphatemia

MALIGNANT HYPERTHERMIA | causes________

hyperphosphatemia

HYPERPHOSPHATEMIA TREATMENT

``` ▪ Oral: o PHOSPHATE BINDERS - Sucralfate / Aluminum-containing antacids o Ca Acetate Tabs - if associated with simultaneous hypocalcemia ▪ Dialysis ```

Hypophostanemia (intracellular shift acute cases)

Respiratory alkalosis Insulin therapy Refeeding syndrome Hungry bone syndrome

HYPOPHOSPHATEMIA TREATMENT

``` ▪ Oral o Neutra Phos packets - 2 packets Q6 per NGT ▪ IV o Potassium phosphate (KPHO4) o NaP04 IV ```

▪ 4th most common mineral in the body ▪ Mainly intracellular o Present in every cell type, binds to ATP, required for enzymes

MAGNESIUM

Magnesium total body content:

2000 mEq

HYPERMAGNESEMIA TREATMENT

▪ Ca Chloride (5-10 mL) - given IV to antagonize cardiovascular events o Hemodialysis o Correct acidosis and volume deficits

▪ Common in critically ill hospitalized patients ▪ Can produce hypocalcemia and lead to persistent hypokalemia

Hypomagnesemia

HYPOMAGNESEMIA TREATMENT

``` C. IV o Magnesium Sulfate Drip - recheck Mg level in 3 days D. Oral o Milk of magnesia per NGT ```

• 3 SYSTEMS THAT MAINTAIN pH RANGE

1. Carbon Dioxide: excreted by lungs to maintain normal CO2 2. Strong Ions: completely dissociate in water (Na, Cl, Ca, Mg, K) 3. Weak Acids: buffering systems of water (protein, phosphates)

• pH < 7.35

ACIDOSIS

• pH will decrease when

o ↑ pCO2 concentration or ↓ HCO3 concentration o ↑ concentration of strong anions o ↑ concentration of weak acid

● From ↑ CO2 retention secondary to decreased alveolar | ventilation

RESPIRATORY ACIDOSIS

• RESPIRATORY ACIDOSIS TREATMENT

o ↑ Alveolar ventilation o Reversing agents for drug overdose o Intubation with mech ventilation to clear CO2

• From loss of HCO3, intake of acids, or ↑ | generation of acids

METABOLIC ACIDOSIS

Fluids and electrolytes Flashcards

(74 cards)