Water, Electrolyte, And Acid-Base Balance

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Intracellular water is about...

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63% of water

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Extracellular makes up about

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37% of water in the body

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Intracellular is the fluid

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In between cells

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Intravascular fluid (IVF)

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It's the fluid in the blood vessels (plasma)

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Fluid in lymphatic vessels (lymph)

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Makes up the majority of the ECF

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Transcellular fluid is CSF is located

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Eyes, synovial fluid, serous fluid in body cavities, and glandular secretion.

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Blood plasma

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It's the liquid portion of blood

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1/3 of the total body water volume

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Plasma and interstitial fluid

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2/3 of the total water volume

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Intracellular fluid

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Extracellular has higher levels of

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Na+, Cl, HCO3

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Plasma has higher

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Protein than any other CHF

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Normal Saline has the same

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Concentration of plasma

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Intracellular fluid has higher levels

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K+, Phosphorus, and magnesium

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Water and electrolytes

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Can move from one compartment to another

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The average water intake

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2500 mls per day

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Water intake is from

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Breakdown of food, from food, and fluid intake

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Water leaves the body

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Kidney, lungs, digestive track, sweat

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Thirst center

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Hypothalamus in the brain

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Kidneys is assisted by what hormone for output

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Autidiuretic hormone (ADH)

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ADH is released in

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The posterior pituitary of the brain

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When not enough water the ADH

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Is released and the body hangs on to the water and increases blood volume.

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Whole bunch of water

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ADH backs off, and your body releases water.

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Hormone that assist with water balance

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Aldosterone

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Dehydration

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When outtake exceeds intake

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Skin turgor normal

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Less then 2 seconds when pinched.

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Dehydrated Skin turgor

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Greater then 2 seconds when pinched

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Lower blood circulation turns into

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Low blood pressure and can lead to hypovolemic shock.

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Fluid restriction

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Edema

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Fluid shift is normal

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For homeostasis

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Fluid shift pushing and pulling effect

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With the capillaries whether it be filtration pressure, osmotic pressure, or trapped plasma protein in surrounding tissues.

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Fluid spacing 1 spacing

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Normal fluid distribution

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Fluid spacing 2nd spacing

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Excess fluid hangs out in the interstitial space. Edema

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Fluid shift Third spacing

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Is where fluid hangs out and does not have fluid. (Abdominal cavity ascites)

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1 lTR of fluid

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2.2 pounds

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Electrolyte def

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Are the substances that break up into electrical charged ions when dissolved in water

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Electrolyte are

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Controlled by the kidneys

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Signs of hyponatremia

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Muscle cramp, seizure, dry skin, weight gain, edema, weakness

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Signs of hyponatremia labs

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Deceased NA, decreased osmolaltiy, and decreased BUN

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Signs of hypernatremia

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Thirst, increased body temp, swollen dry tongue, Seizures, hyper-reflexia

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Signs of hypernatremia labs

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Increased NA, Osmolaltiy, and BUN

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Examples of hypernatremia

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Prolonged use of diuretics, uncontrolled diabetes, elderly who are post opt.

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Examples of hyponatremia

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Excess loss of sodium or fluid retention, drinks to much water, heart failure patients

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Potassium primary regular

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Aldosterone

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Aldosterone stimulates

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The nephron to excrete K+

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Signs of Hypokalemia

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High heart rate, low B/P, fatigue. Paresthesias, decreased GI mobility

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Signs of Hypokalemia

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Deceased heart rate, increased

B/P, dysrhythmia flaccid paralysis, ABD distention, leg cramps, muscle fatigue

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Potassium is lost

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With diarrhea and vomiting

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Calcium is necessary

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For bone and tooth formation, muscle contraction, nerve impulse formation and blood clotting.

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Calcium primary regulator

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Parathyroid hormone

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Signs of Hypercalcemia

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Low blood pressure, abnormal heart rate,numbness, tetany, hyperactive tendon reflexes, anorexia, depression, constipation, fatigue

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Signs of hypocalcemia

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Increased heart rate, high B/P, polyuria, hypoactive tendon reflexes, numbness, cramping. Life-threatening.

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Magnesium important

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I'm the function of the heart, muscles, and nerves.

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Signs of Hypermagnesemia

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Abnormal heart rate, low B/P and HR, kidney disease, magnesium-containing acids, comma

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Signs of Hypomagnesemia

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High blood pressure, abnormal heart rate, positive Trousseau/Chvostek sign, hyperactive tendon reflexes, tetany, tremors,

Surgical removal of thyroid, seen in critically ill patients

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Hypomagnesemia can cause

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Hypocalcemia and hypokalemia

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Chief extracellular anion

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Cl-

sodium

K+

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Chloride affects

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Acid-base balance this had to do with the bicarb (HCO3)

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Signs of Hypochloremia

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Low B/P, low HR/RR

Agitation, tremors, hypertonicity, tetany, seizures, hyperactive tendon reflexes.

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Signs of Hyperchloremia

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High HR/RR. Deceased LOC

High B/P decreased CO, dyspnea, enema, dysrhythmias, weakness, severe diarrhea

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Phosphate

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Primary regulator, excreted and reabsorbed through your kidneys

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Bicarbonate works

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With sodium, chloride, and potassium

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Bicarb normal labs

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22-26

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Blood brings bicarb

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To your lungs and exhaled as carbon dioxide

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Hypophosphite signs

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High BP low HR/RR

Paresthesias, bone pain, cardiomyopathy, Resp failure, tissue hypoxia,

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Acid-Base balance has 3 mechanisms

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Buffers, respiratory system, and kidney function

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2 parts of a buffer

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Base and acid

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Buffer pairs

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Sodium Bicarb, protein, and phosphate

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Buffers job if excess of acid

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The base part of the blood removes the H+

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Buffers job if it's a decrease in acid...

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The acid part of the blood gives H+

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Lungs act as a second line of defense

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CO2 removes LTR from the blood each day

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Third line of defence acid babe balance

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Kidneys

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People with kidney failure

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Are usually acidotic

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Normal acid base level

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7.35 to 7.45

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Metabolic acidosis

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No respiratory problems.

Headaches decrease blood pressure hyperkalemia, muscle twitching, flushed warm skin, nausea vomiting diarrhea changes in LOC

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Metabolic alkalosis

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No respiratory issues restlessness followed by lethargic, confusion, nausea vomiting diarrhea, triggers muscle cramps tingling and fingers and toes, hypochalemia, trachycardia, hyperventilation

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Respiratory acidosis signs

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Hyperventilation hypoxia, drowsiness dizziness and disorientation, muscle weakness hyperflexia, decreased blood pressure with vasodilation, dyspnea, headache.

Causes decreased respiratory stimuli drug overdose COPD pneumonia

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Respiratory alkalosis signs

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Seizures, deep rapid breathing, hyperventilation, turkey cardia, decreased or normal bp, hyperkalemia, numbness and tingling to extremities, lethargic, confusion, lightheadedness, nausea vomiting, causes hyperventilation anxiety PE fear mechanical ventilation.