1. venous or lymphatic obstruction 2. increased vascular volume (increased hydrostatic pressure) 3. plasma protein loss 4. increased capillary membrane permeability (decreased plasma oncotic pressure)

Fluids & Electrolytes, Acids & Bases Flashcards by Michelle Stephens

Net Filtration

Forces favoring filtration - forces opposing filtration

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Capillary hydrostatic pressure

blood pressure

-facilitates the outward movement of water from the capillary to the interstitial space

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Capillary oncotic pressure

osmotically attracts water from the interstitial space back into the capillary.

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Interstitial hydrostatic pressure

facilitates the inward movement of water from the interstitial space in to the capillary

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Interstitial oncotic pressure

osmotically attracts water from the capillary into the interstitial space

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Forces that favor filtration

-capillary hydrostatic pressure
-interstitial oncotic pressure

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Forces that oppose filtration

-capillary oncotic pressure
-interstitial hydrostatic pressure

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Causes of Edema

venous or lymphatic obstruction
increased vascular volume (increased hydrostatic pressure)
plasma protein loss
increased capillary membrane permeability (decreased plasma oncotic pressure)

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Effusion

Fluid accumulation in a body cavity or space (aka third space)

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Difference between interstitial fluid, extra cellular fluid and transcellular fluid

Interstitial fluid: fluid surrounding the cells and found in the spaces between cells but not within blood vessels

Extracellular fluid: fluid outside the cells including interstitial, intravascular and transcellular fluids.

Transcellular: fluids contained in epithelial-lined cavities (pleural, synovial, peritoneal, pericardial, intraocular, gastric juice, saliva, bile, pancreatic juice, ileal fluid, cecal fluid, CSF and sweat)

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What is the difference between a volatile and non volatile acid

Volatile: can be eliminated as CO2 gas

Nonvolatile: can only be eliminated by the kidney

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Difference between acidemia and acidosis

Acidemia: state in which the pH of arterial blood is less than 7.35

Acidosis: systemic increase in H+ concentration or a loss of base

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What regulates sodium?

Aldosterone which is controlled by
renin and angiotensin enzymes

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Osmolarity vs Osmolality

Osmolarity: number of osmoles of solute per L of solution

Osmolality: number of osmoles of solute per KG of solution

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Causes of hyperchloremia

Hypernatremia & elevated bicarbonate concentrations

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What is the predominant EXTRA cellular fluid electrolyte

Sodium

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What is the predominant INTRA cellular fluid electrolyte

Potassium

What are the 5 essential functions of calcium

bone structure
blood clotting
hormone secretion
function of cell receptors
membrane stability

Phosphate

-buffer in acid-base balance
-energy for muscle contraction

HYPOcalcemia
Value & causes

<9.0mg/dL

Causes:
1. inadequate absorption
2. deposition into bone or soft tissue
3. blood administration
4. decreased PTH and Vit D

HYPERcalcemia
Value & causes

> 10.5mg/dL

causes:
1. hyperparathyroidism
2. bone metastases
3. sarcoidosis
4. excess vit D

HYPOphosphatemia
Value & Causes

<2.0mg/dL

causes:
1. intestinal malabsorption
2. increased renal excretion

HYPERrphosphatemia
Value & Causes

> 4.7mg/dL

Causes:
acute or chronic renal failure with loss of GF

HYPOmagnesmia
Value & Causes

<1.5mEq/L

Causes: malabsorption

HYPERmagnesmia

>3.0 mEq/L causes: renal failure (still rare)

What are the primary plasma pH buffers

1. bicarbonate 2. phosphate 3. protein (Hb)

What is the sole volatile acid

carbonic acid

What are the nonvolatile acids (5)

1. Lactic acid 2. phosphoric acid 3. sulfuric acid 4. acetoacetic acid 5. beta-hydroxybutyric acid

Aquaporins

Family of water channel proteins that provide water permeability

Hypovolemic HYPERnatremia What it is and causes

It is: loss of Na is accompanied by a relatively greater loss of body water. Causes: look diuretics, diuretic stages or renal disease, osmotic diuresis from DM hyperglycemia or mannitol.

Isovolemic HYPERnatremia

Loss of electrolyte free water with a near normal sodium concentration. causes: inadequate H2O intake, excessive sweating, fever with hyperventilation, increased water loss from lungs, burns, vomiting, diarrhea and DI (central or nephrogenic)

HYPERvolemic HYPERnatremia

increase in TBW with a greater increase in total body Na --> hypervolemia with high Na. causes: hypertonic saline, over secretion of ACTH or aldosterone, or deliberate over consumption (salt water or soy sauce)

HYPERnatremia Clinical symptoms, evaluation and treatment

Sx: Weakness, lethargy, hyperreflexia, muscle twitching, confusion, coma and seizures Eval: lab tests, H&P. serum Na >145 & urine specific gravity > 1.030, Hct & plasma protein will be elevated if water loss Treatment: isovolemic and hypovolemic hypernatremia is H2O PO or D5 SLOW! Hypervolemic hypernatremia is loop diuretics. (frequent Na checks)

Isovolemic HYPOnatremia

loss of Na without significant loss of water Causes: water retention SAIDH, hypothyroidism, PNA, glucocorticoid deficiency.

Dilutional hypotonic hyponatremia (water intoxication) Causes

intake of large amounts of electrolyte free water or replacement of fluid loss with D5, tap water enemas, aspiration of fresh water in nonfatal drowning, SSRIs and SAIDH.

HYPERvolemic HYPOnatremia Definition and causes

total body Na is increased AND there is excess water --> increase in ECF decreasing serum Na. causes: heart failure, cirrhosis, nephrotic syndrome.

HYPERtonic HYPOnatremia Definition and causes

Shift of water from the ICF to the ECF. Osmotic fluid shift to the ECF dilutes the concentration of Na and other electrolytes Causes: hyperglycemia, hyperlipidemia, and hyperproteinemia.

Hyperchloremia Value and causes

<97mEq/L causes: with hyponatremia, elevated bicarbonate, metabolic alkalosis, restricted NaCl intake, diuretics, vomiting, Cystic fibrosis.

Potassium adaptation

ability of the body to adapt to increased levels of K+, sudden increases can be fatal but slow intake

Familial hypokalemic periodic paralysis

Rare genetically transmitted disease that causes potassium to shift into the intracellular space with episodes of extreme muscle weakness.