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85 Cards in this Set

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Why is F/E balance important?
To maintain health and function in all systems
What groups of people may have problems in maintaining normal F/E balance?
1. Unhealthy
2. Immobile
3. Older/Younger
4. Decreased LOC
O DUI
What systems are involved in I/O of water and electrolytes
Renal
Hormonal
Neural
RHN
What are electrolytes (2 definitions)?
Ions that are dissolved into body fluids
Are vital to many body functions
What are non-electrolytes? Give 3 examples.
Complex molecules dissolved in body fluid but that remain as a complete molecule.
Glucose, creatinine, urea
GCU
What are 4 main uses of water in the body?
1. universal solvent
2. moisture for reactions
3. regulates body T (sweating)
4. Transports solutes/ carries wastes
How much water does an adult have?
~45L or 60% of adult weight
What are two distinct fluid compartments?
ICF
ECF
Where is most body fluid?
ICF has 62% of all
What is the distribution of body fluid?
ICF = 62%
ISF = 30%
IVF = 8%
Where the the stablest portion of body fluid?
ICF
What are the components of ECF?
ISF = b/w cells
IVF = plasma = w/in bl vessels
TCF = intraocular, CSF, pleural, peritoneal, synovial...
What is first spacing?
Normal distribution of fluid in ICF and ECF
What is second spacing?
abnormal interstitial t/f ECF
eg. edema
What is third spacing?
When fluid becomes trapped in a body part that does not easily exchange fluid with rest of ECF - ascities, burn edema, peritonitis
What electrolytes are present in higher concentrations in ICF
K, P, Mg
What ions are present in higher concentrations in ISF?
Na
What is considered to be reserve fluid?
ISF = it can replace fluid in either the bl vessels or the cells
What ions are present in IVF?
Na, Cl,
Which fluid is the least stable?
IVF
Which ion is the major regulator of body fluid volume? Where is it mostly found?
Na
ECF
What is the purpose of plasma protein?
Keeps fluid in intravascular space - oncotic pressure
What is the most common plasma protein?
albumin
What organs are involved in F/E balance?
kidney
heart
liver
adrenals
pituitary
nervous
What affects the F/E balance?
1. fluid volume
2. distribution of fluids
3. concentration of solutes
What is the normal range for Na?
Where is it mainly found?
135-145mmol/L
ECF
What is the normal range for K?
Where is it mainly found?
3.5-5.0 mmol/L
ICF
What is the normal range for Cl?
Where is it mainly found?
95-105
ECF
What is the normal range for Bicarbonate?
Where is it mainly found?
22-26 (arterial)
EFC
What is the normal range for Calcium?
Where is it mainly found?
4.5-5.5
equal in ECF and ICF
What is the normal range for Mg?
Where is it mainly found?
0.6-1.0
ICF
What is the normal range for P?
Where is it mainly found?
1.0-1.5
ICF
What 3 pressures/forces influence fluid movement?
1. Membrane permeability
2. Oncotic pressure
3. Hydrostatic pressure
How are membranes permeable?
Water passes through easily,
ions and molecules are selective
What is oncotic pressure
AKA Colloid osmotic pressure
pressure exerted by non-diffusible plasma protein
What is hydrostatic pressure?
Pressure exerted by pumping of the heart
- pushing force
What 4 processes move F/E across semi-permeable membranes?
1. osmosis
2. diffusion
3. filtration
4. active transport
What 2 processes move solutes?
1. Diffusion
2. active transport
What 2 processes move fluid?
1. osmosis
2. capillary filtration/reabsorption
What is osmosis?
mvmt of water from lower solute concentration to higher solute concentration across a semi permeable membrane to equalise concentration on both
What is osmolality?
AKA - tonicity
Force that pulls water into/out of cell
What is diffusion?
mvmt of solute across a semi-permeable membrane from an area of low concentration to
Movement of O2/CO2 in lungs is an example of?
Diffusion
What is filtration?
What moves with filtration?
Where is filtration common?
Mvmt from higher hydrostatic pressure to lower pressure
Water and solutes
capillary beds
By what 2 processes do F/E move across capillary walls?
1. Capillary filtration
2. Capillary reabsorption
What is capillary filtration?
Hydrostatic pressure higher at arterial end of capillary, forces F/E into ISF
What is capillary reabsorption?
Hydrostatic pressure lower on venous end of capillary, so F/E move back into capillary
How does CHF alter fluid balance?
Higher venous hydrostatic pressure so movement of fluid back into capillaries is reduced, resulting in edema
What is colloid/oncotic pressure
colloid refers to albumin
capillaries have albumin, so after capillary filtration it pulls water back due to concentration gradient
what is active transport?
requires energy, moves material against their concentration gradient
What processes control body fluids (homeostasis)?
1. hormonal
2. fluid intake
3. fluid output
What are 3 hormonal fluid control systems?
1. RAA
2. Aldosterone
3. ADH
What is renin?
When is it released (3)?
Enzyme secreted by kidney in response to
- low blood volume,
- changes in arterial pressure
- low sodium in plasma
What does renin do?
Converts angiotensin to AgT1
Where is AgT1 converted to AgTII?
What does it do (3)?
In the lungs,
- Powerful vasoconstrictor
- regulates release of aldosterone
- increases Na reabsorption
What is aldosterone?
hormone secreted by adrenal glands in response to
- low Na, high K in ECF
- decreased circulating volume
- raised AgTII
What does aldosterone do?
increases Na and water reabsorption and K excretion by kidney
--> increases blood pressure
What 5 things cause a relase in aldosterone?
High K
Low Na
Low BV
Low CO
Low aBP
--> all cause decreased renal perfusion
What is ADH?
AKA Vasopressin
- regulates water retention
- released by pituitary
- high Na
- hypotension
What does ADH do?
Increased water reabsorption
--> increased BP
How is thirst controlled?
Hypothalamus stimulated with increased serum osmolality
When is thirst stimulated (5)?
When 2% of body weight lost through hypovolemia, RAA, K depletion, psycological, mouth dry
What would D5NS do to thirst?
Increase, since it is a hypertonic solution it would increase plasma osmolality
What organs (4) are involved with fluid output?
Kidney
Skin
Lungs
GI
How much urine is normally produced per day?
1200-1500 mL
What is insensible water loss?
Through skin and lungs - can't tell it is being lost
Assists temperature control
around 900mL/day
ONLY WATER (no electrolytes like with sweating)
What is sensible water loss?
Excessive sweating caused by fever or exercise - large WATER and ELECTROLYTE loss
How much fluid is lost per day from GI?
100-200 mL
What is atrial natriuretic peptide?
ANP released from R atrium when overstretched
Blocks ADH - promotes diuresis
Block aldosterone release - promotes Na excretion (and water)
Vasodilation
What is the primary way in which fluids move between ICF and ECF?
Osmotic forces
What is the Starling hypothesis?
Net filtration = forces favouring filtration - forces opposing filtration
Overall - filtration = arterial end
Reabsorption = venous end
What forces favour filtration?
hydrostatic pressure
interstitial oncotic pressure
What forces oppose filtration?
Plasma oncotic pressure
interstitial hydrostatic pressure
Water and Cl follow what electrolyte?
Na
What is the primary regulator of water balance?
ADH (Posterior pituitary)
What is the primary regulator of Na?
Aldosterone by adrenal cortex, promotes reabsorption in renal tubules
What are causes of F/E imbalances?
Illness - CHF, burns
Therapeutic - IV fluids, diuretics
What is the effect of hypernatremia at a cellular level?
Water moves out of cell into ECF - cellular dehydration
What is the primary protection against hyperosmolality/hypernatremia?
Hypothalamus development of thirst
- therefore, frail, elderly, LOC down all have inability to obtain fluids
What are some clinical conditions that can produce hypernatremia?
Central diabetes insipidus - ADH decrease
Nephrogenic diabetes insipidus - decrease kidney response to ADH
hyperosmolar tube feed
osmotic diuretic
hyperglycemia (DM) result in dilute urine production
excessive sweating
What are S&S of hypernatremia?
intense thirst, lethargy, agitation, seizures, coma
+ volume imbalance
What is a cause of hyponatremia?
loss of Na containing fluid or from excess water loss causing water shift into cells
What are common causes of water excess?
add too much water
lose Na -
What are symptoms of hyponatremia?
related to cellular swelling
- irritability, apprehension, confusion, headache, lassitude, apathy, weakness, confusion, muscle spasm, seizures, coma
What are the rules of fluid replacement?
Blood - blood
plasma - colloid (plasma/albumin)
resuscitate - colloid
ECF with saline
Rehydrate with dextrose