Term
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Definition
| The goal in managing fluid, electrolyte imbalances is to reestablish and maintain homeostasis |
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Term
| Average amounts of fluid in the body: |
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Definition
Average male of 70kg: 60% of body is fluid (40L)
Average female of 70kg: 55% of body is fluid (36.5L)
Geriatric: 10% less fluid
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Term
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Definition
60% of total body fluid
Primarily in skeletal muscle mass |
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Term
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Definition
40% of total body fluid
Interstitital - 80% of ECF 11L
Intravascular- 20% of ECF 3L Plasma
Transcellular -1 L (not counted in fluid calculations) |
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Term
| What do the transcellular fluids include? |
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Definition
digestive secretions; perspiration; and cerebrospinal, pleural, synovial, intraocular, gonadal, and pericardial fluids.
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Term
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Definition
Pressure exerted by the fluid on the walls of the blood vessel
Regulate fluid movement |
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Term
Capillary hydrostatic pressure
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Definition
Internal capillary blood pressure pushing out against walls
Decreases as blood moves from arteriole end to venule end
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Term
Interstitialhydrostatic pressure
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Definition
Remains constant but increases in relationship to capillary hydrostatic pressure as blood moves through capillary
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Term
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Definition
Force that pulls water towards the compartment with higher concentration of solutes
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Term
| Capillary Osmotic Pressure: |
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Definition
from plasma proteins, primarily albumin
Increases towards venule end of capillary as fluid leaves capillary and proteins become more concentrated in remaining fluid
Also called “oncotic pressure” or “colloid oncotic pressure”
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Term
| Interstitial Osmotic Pressure: |
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Definition
Much lower than capillary oncotic pressure
Remains constant but increases in force related to decreasing capillary hydrostatic pressure as blood moves through capillary
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Term
So hydrostatic pressure ________ fluid from area of more pressure to area of lower pressure, while osmotic pressure ______fluid towards area of higher concentration of solutes (in this case the solutes are the proteins).
FILL IN THE BLANKS.
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Definition
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Term
Remember that hydrostatic pressure forces water _______ of a solution, whereas osmotic pressure draws water _____a solution.
FILL IN THE BLANKS.
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Definition
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Term
| Homeostatic response to Hypovolemia: |
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Definition
↓ intravascular volume:
↓ net hydrostatic pressure
Hemoconcentration leads to ↑ net osmotic pressure
Results in:
↑ fluid entering the capillary from the interstitial fluid space
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Term
| Homeostatic response to hypervolemia: |
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Definition
↑ intravascular volume
•↑ volume leads to net ↑ hydrostatic pressure
•Dilution leads to ↓ net osmotic pressure
Results in:
•↑ fluid going to the interstitial fluid space from the capillary
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Term
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Definition
Sodium—main extracellular ion
Fluid follows Na+ via osmosis
Na+ retention=fluid retention
Normal Na+: 135-145 mEq/L
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Term
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Definition
Potassium—main intracellular ion
If extracellular K+ is low, it pulls from K+ from cells
If there is significant cellular damage (ex. Trauma, crush injury), intracellular K+ released into extracellular space & pt can develop hyperkalemia.
Normal K+: 3.8-5.0 mEq/L
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Term
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Definition
The sodium-potassium pump is the key to functions such as cardiac and renal activity, as well as all general transport processes into and out of the cell. The pump forms the basis for our ability to absorb a considerable number of nutrients, excrete waste products from the kidneys and regulate the water balance in the cells. If this little pump stopped pumping sodium ions out of the cells, the latter would rapidly swell up because of the infiltration of water and finally burst.
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Term
| Sensible vs Insensible Fluid: |
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Definition
Sensible (noticeable) fluid loss refers to fluid loss that is visible, just as urine, stool, blood loss in surgery, and perspiration.
Insensible fluid loss is not visible and not really measurable.
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Term
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Definition
*Regulate the volume and osmolarity of body fluids by controlling the excretion of water and electrolytes
*Filter 180L of plasma/day—99% reabsorbed and only 1000-1500mL of urine produced
*Respond autonomously and to hormones
*ADH
*Aldosterone
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Term
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Definition
Baroreceptors detect pressure and send impulses to respond
Autonomic nervous system responses: Sympathetic & parasympathetic
*HR
*Contractility
*Vascular responses
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Term
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Definition
Intake of flood and fluids
*8L of fluid/24 hours but most reabsorbed in small intestine so only 100-200ml/day lost in stool
*Vomiting & diarrhea can cause significant fluid & K+ loss
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Term
| Endocrine: Anti-diuretic hormone (ADH) |
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Definition
Released by pituitary when plasma osmolarity increases (sensed by osmoreceptors)
Stimulates the kidneys to increase water reabsorption & decrease urine output
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Term
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Definition
Renin released in response to decreased renal perfusion→ → angiotensin II → aldosterone
Angiotensin: vasoconstricts & increases arterial pressure (perfusion) and stimulates thirst
Aldosterone: increases reabsorption of water and sodium.
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Term
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Definition
Interstitial fluid loss
*Only fluid loss so always hypernatremic
*>5% dehydration detectable on exam
*Causes: vomiting, diarrhea, decreased fluid intake, profuse sweating, drugs (diuretics, BP meds)
*See Fig. 13-7 in Iggy
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Term
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Definition
Intravascular fluid loss
*Decreased perfusion
*>8% dehydration causes hypovolemia
*Causes: dehydration, bleeding, drugs (diuretics, BP meds), third spacing (significant edema or ascites)
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Term
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Definition
*MS changes: irritability; confusion; dizziness,
*Weakness; anorexia; extreme thirst
*Dry skin and mucous membranes; sunken eyeballs; poor skin turgor (check for skin turgor over sternum or forehead in elderly pt); tongue furrows
*Decreased urine output
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Term
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Definition
*Same as dehydration plus
*Orthostatic hypotension
*SBP drops 20 mmHg or DBP drops 10 mmHg of lying BP
*HR increase 15-30 bpm
*Monitor for symptoms: dizziness, pre-syncope
*Shock if > 25% loss of intravascular volume or if fluid loss is rapid.
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Term
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Definition
↑ BUN, normal creatinine
*↑ Hct
*Sodium and/or potassium may be elevated or reduced, depending on the cause
*↓ K+ with GI & renal fluid loss
*↑ Na with dehydration
*Urine specific gravity—measures ability of kidneys to excrete or conserve urine.
*Normal 1.010 to 1.025 (compare to distilled water 1.000)
*Osmolality—measures solute concentration in blood or urine.
*Urine osmolality 200-800 mOsm/kg
*Serum osmolality 280-300 mOsm/kg
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Term
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Definition
Fluid replacement
*Oral if not acute or severe
*IVF for rapid rehydration or if patient unable to take PO
*If UO remains low (<30 ml/hr)
*Fluid challenge (usually 250-500ml over 15-30 min), and monitor for increase in BP and UO within 1 hr
*If no response, may be acute tubular necrosis (acute kidney injury) r/t prolonged hypoperfusion and may need supportive dialysis
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Term
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Definition
Abnormal retention of fluid and sodium
*Always related to sodium but serum sodium concentration WNL
*Primarily of concern in patients who can’t manage fluid because of underlying cardiac, renal, or liver disease
*Causes:
*Heart failure
*Renal failure
*Liver failure (cirrhosis)
*Fluid overload
*Excess sodium consumption (food or fluid)
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Term
| Symptoms of Hypervolemia: |
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Definition
CV: tachycardia, increased BP, edema, JVD
*Resp if underlying HF: crackles, dyspnea, orthopnea, increased RR, decreased oxygen saturation
*Increased weight
*May have increased or decreased UO (depending on renal function)
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Term
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Definition
| Loop diuretics and thiazide diuretics will pull potassium and magnesium out with UO |
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Term
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Definition
| Potassium-sparing diuretics (Aldactone/spironolactone) |
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Term
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Definition
| A Normal blood sodium level is 135 - 145 milliEquivalents/liter |
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Term
| Normal blood potassium levels: |
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Definition
| The normal blood potassium level is 3.5 - 5.0 milliEquivalents/liter |
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Term
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Definition
| The normal serum range for chloride is 98 - 108 mmol/L. |
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Term
| Normal Basic chemistry panel levels: |
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Definition
- BUN: 7 to 20 mg/dL
- CO2 (carbon dioxide): 20 to 29 mmol/L
- Creatinine: 0.8 to 1.4 mg/dL
- Glucose: 64 to 128 mg/dL
- Serum chloride: 101 to 111 mmol/L
- Serum potassium: 3.7 to 5.2 mEq/L
- Serum sodium: 136 to 144 mEq/L
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Term
| Higher than normal BUN values can be due to: |
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Definition
Congestive heart failure
- Excessive protein levels in the gastrointestinal tract
- Gastrointestinal bleeding
- Hypovolemia
- Heart attack
- Kidney disease, including glomerulonephritis, pyelonephritis, and acute tubular necrosis
- Kidney failure
- Shock
- Urinary tract obstruction
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Term
| Abnormal BUN test values can be due to: |
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Definition
- Liver failure
- Low protein diet
- Malnutrition
- Over-hydration
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Term
High potassium levels can be due to:
Hyperkalemia |
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Definition
- Addison's disease (rare)
- Blood transfusion
- Certain medications
- Crushed tissue injury
- Hyperkalemic periodic paralysis
- Hypoaldosteronism (very rare)
- Kidney failure
- Metabolic or respiratory acidosis
- Red blood cell destruction
- Too much potassium in your diet
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Term
Low levels of potassium can be due to:
Hypokalemia |
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Definition
- Chronic diarrhea
- Cushing syndrome (rare)
- Diuretics such as hydrochlorothiazide, furosemide, and indapamide
- Hyperaldosteronism
- Hypokalemic periodic paralysis
- Not enough potassium in the diet
- Renal artery stenosis
- Renal tubular acidosis (rare)
- Vomiting
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Term
Higher than normal sodium levels:
hypernatremia |
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Definition
- Cushing syndrome
- Diabetes insipidus
- Hyperaldosteronism
- Increased fluid loss due to excessive sweating, diarrhea, use of diuretics, or burns
- Too much salt or sodium bicarbonate in your diet
- Use of certain medicines, including birth control pills, corticosteroids, laxatives, lithium, and NSAIDs such as ibuprofen or naproxen
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Term
Lower than normal Sodium levels can be due to:
hyponatremia |
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Definition
- Addison's disease
- Dehydration, vomiting, diarrhea
- An increase in total body water seen in those with heart failure, certain kidney diseases, or cirrhosis of the liver
- Ketonuria
- SIADH
- Too much of the hormone vasopressin
- Use of medications such as diuretics (water pills), morphine, and SSRI antidepressants
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Term
Normal H&H Levels:
Hemaglobin |
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Definition
Hemoglobin is the oxygen-carrying protein pigment in the blood, specifically in the red blood cells.
- Adult males: 14-18 gm/dl
- Adult women: 12-16 gm/dl
- Men after middle age: 12.4-14.9 gm/dl
- Women after middle age: 11.7-13.8 gm/dl
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Term
Normal H&H levels:
Hematocrit |
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Definition
The hematocrit is the proportion, by volume, of the blood that consists of red blood cells.
- Adult males: 42-54%
- Adult women: 38-46%
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Term
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Definition
3.5-10.5 billion cells/L
(3,500 to 10,500 cells/mcL) |
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Term
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Definition
For someone who doesnt have diabetes: 4.5 to 6 percent
Prediabetic: 5.7 and 6.4 percent
Diabetic: 6.5 percent or higher on two separate tests |
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