• thirst drive from hypothalamus
• output of urine by kidneys

• glucose
• sodium
• potassium
• urea

body fluids made up or water

(a liquid, solid or gas that dissolves the other liquid, solid or gas)

·         Solvent

·         Carrier vehicle for wastes

o   Urine

o   Feces

o   Lungs

o   skin

·         As a metabolite in intracellular chemical reactions

·         Cushion for protection

·         Lubrication

·         Insulation

·         Mechanism to regulate temperature

the free movement of particles down a concentration gradient until equilibrium is established

·         the movement of water molecules across a membrane, to the area of highest solute concentration (water follows salt)

• Interstitial (between cells) - 80% ECF
• Intravascular (within blood vessels) - 20% ECF

• Saliva
• Pleural
• CSF
• Intraocular

• Solvent
• Carrier Vehicle for Wastes
• Cushion for Protection
• Lubrication
• Insulation
• Mechanism for Temp Regulation

• High
• Low

• Volume and viscosity of the blood, force of beating heart, resistance of vasculature
• Pushes oxygenated blood into the tissues

• Liver failure leads to decr osmotic pressure, so the fluid is not pulled back into the veins/venules
• Albumin is generated in the liver, so less is produced which decr oncotic pressure

• Incr capillary pressure
• Decr colloid oncotic pressure
• Incr capillary permeability
• Lymphatic obstruction

• Pleural
• Peritoneal
• Cardiac

• Sudden weight loss
• Decr BP
• Dizziness
• Decr UO (high SG)
• Skin tenting
• Dry mucous membranes
• Hard stools
• Constipation
• Sunken eyeballs
• Fissured tongue
• No tears in a crying child
• No sweat despite high ambient temp

• Water loss from ECF is greater than solute loss
• Results in incr osmolarity of plasma
• Which makes the ECF hypertonic
• Shifts water out of the ICF, resulting in dehydration of cells

• Hypernatremia (because of high Na+ in the ECF)
• Intense thirst

• Excessive perspiration
• Hyperventilation
• Ketoacidosis
• Severe hyperglycemia
• Watery diarrhea
• Hypertonic fluid replacement

• Loss of solutes from ECF greater than loss of water
• Water shifts into cells
• Results in ECF dehydration with compensatory mechanisms kicking in from volume loss

• Hypertonic Dehydration
• Water would come out of cells into ECF, decr the fluid in the brain, and resulting in cellular dehydration

• Hypotonic Dehydration
• Water would go into cells, ceausing cerebral edema

• Regulates osmolarity by maintaining osmotic pressure
• Essential in neuromuscular excitability
• Water follows salt rule

• Ascites
• Diarrhea
• Vomiting
• Excessive hypotonic fluid
• Incr ADH
• Incr water
• Diuretic therapy
• Burns (edema accumulation at burn site)
• Psychogenic polydipsia
• Adrenal insufficiency

• Cellular swelling (from decr ECF osmolarity)
• Cerebral edema
• Peripheral and pulmonary edema
• N/V
• Muscular weakness

• Decr ADH
• Escessive dietary Na+
• Incr aldosterone
• Diaphoresis with impaired thrist
• Renal failure
• CHF
• Decr renal perfusion
• Decr GFR
• Incr Na reabsorption

• Thirst
• Cellular shrinking from incr ECF osmolarity
• Mental status changes
• Muscular irritability
• Twitching

• Influences excitability
• Contributes to ICF osmotic pressure
• When it moves out of cells, H+ and Na+ move in
• K controls H+ concentration (and thus, pH)

• Decr intake
• Incr loss
• Renal wasting
• Alkalosis
• K-depleting drugs
• Elevated glucocorticoid levels
• Cushing's
• Laxative abuse
• Hyperaldosteronism

• Muscle cramping
• Fatigue
• Weakness
• Cardiac irritability
• Paralytic ileus
• Hypotension from cardiac dysrhythmias

• Renal failure
• Excessive administration of K-conserving drugs
• Hypoaldosteronism
• Acidosis
• Hemolysis of RBCs

• Cardiac depression
• Dysrhythmias
• Cardiac arrest
• Muscle weakness
• Paralysis
• Paresthesias of face/feet/hands
• Rare without renal disfunction
• N/V/D

• Essential for cell membrane permeability
• Nerve impulse transmission
• Blood coagulation

• Ionized
• Non-ionized

• Hypoparathyroidism
• Acute pancreatitis
• Inadequate vit D or Ca in diet
• Hyoalbuminemia
• Transfusion of citrated blood
• Hyperhosphatemia
• Poor absorption

• Hyperexcitable neurons
• Skeletal muscle cramping
• Seizures
• Diarrhea
• Cardiac changes
• Prolonged ST/QT intervals
• Trousseau (migratory thrombophlebitis associated with carcinomas of the lung and pancreas)
• Chevostek (abnormal reaction to the stimulation of the facial nerve)

• Immobility
• Hyperparathyroidism
• Blood/bone malignancies
• Renal insufficiency

• Hypoexcitable neurons
• Muscle weakness
• Muscle flaccidity
• Renal stones
• CNS depression
• Stupor
• Coma
• Constipation
• Bone loss
• Bone function risk
• Cardiac changes
• Shortened St/QT interval
• Bradycardia

• Represents the activity of H+ ions in a solution
• Affects many body systems

• Carbonic Acid (H2CO3)
• Metabolic Acid

• CO2
• H2O

• Carbohydrate
• Fat

• Phosphate
• Sulfur

• Buffer
• Respiratory
• Renal

• Bicarbonate (HCO3-)
• Carbonic Acid (H2CO3)

• H+ + HCO3- <--> H2CO3 --> CO2 + H2O
• Lots of metabolic acids, pH decr
• CO2 and H2) excreted by lungs

• H2CO3 <--> H+ + HCO3-
• When base builds up (HCO3-), pH incr and H2CO3- then releases H+ to lower pH

• Reabsorption of filtered HCO3- as H+ secreted into renal tubular filtrate (takes place in PCT)
• Formation of titratable acid
• Excretion of NH4 in urine

• Low pH - Basic portion of the buffer pair accepts H+
• High pH - Acidic portion of buffer pair releases H+

• Low pH - Incr rate/depth of respiration
• High pH - Decr rate/depth

• Low pH - Incr secretion of H+, incr reabsorption of HCO3-, incr NH3
• High pH - Decr secretion of H+, decr reabsorption of HCO3-, decr NH3

• Interstitial fluids are rich in bicarbonate
• Loss of bicarbonate leads to acidosis

• Stomach acids are acidic
• Loss of acid leads to alkalosis

• Anything that decr ventilation or respiration
• Cor pulmonale

• Excreting more metabolic acid, causing:
• Incr HCO3- in serum
• Renal compensation is slow (3-5 days)

• Intake of acids or substances converted to acids
• Incr rate of metabolism
• Production of unusual acids secondary to altered normal processes
• Decr renal excretion of acid
• HCO3- can be lost in urine or through the GI tract (v/d)

• Acid can be lost through urine and GI tract
• Acid can be moved into cells to decr levels in blood
• Base can be gained through incr intake of things that are converted to bincarbonate

• If outside normal range, compensation
• If inside normal range, no compensation

Lungs blow of CO2 to raise pH

or Lungs retain CO2 to lower pH

Question File AC has 3 clinical problems: HF, COPD, and stroke (CVD-related). Thus, you already know the following:

• Oxygenation is likely impaired
• He definitely needs a heart transplant
• He has diabetes
• He could have a combination of chronic bronchitis and emphysema
• A,D
• None

Question File Because of AC's HF and COPD, he is at high risk for which acid-base disturbance?

• Acidemia/acidosis
• Alkalemia/alkalosis
• Hyponatremia
• Hyperkalemia

Question File AC is bedridden and is receiving enteral tube feedings. Based on what you know about his diagnoses, why do you think enteral tube feedings are necessary?

• History of MI
• If he has emphysema, it must be difficult to eat because it's hard to expire air
• He is 79...that's pretty old...
• The stroke may have compromised his ability to eat, or eat safely

Question File AC has both heart failure and diarrhea. For which fluid imbalance is he at risk?

• Volume overload
• Volume depletion
• Should balance each other out, so no imbalance
• A, B

Question File Because AC is bedridden, which is the priority nursing consideration?

• Ambulation
• Catheter
• Pressure ulcer prevention
• Bone loss
• None
• C, and consider D

Question File AC is at risk for hypernatremia. Why?

• Takes Lasix
• Volume loss from diarrhea
• Takes digoxin
• Enteral tube feedings are hypertonic
• A, B, D

Question File AC is at risk for respiratory acidosis due to his COPD. If PaCO2 was increased, how would AC compensate for the imbalance?

• Incr rate/depth of respiration
• Hypoxic vasoconstriction would kick in, pulmonary vasculature
• Incr release of carbonic anhydrase
• Incr secretion of H+/incr production of HCO3- by kidneys