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Life Sciences
Fluids and Electrolytes
| Question | Answer |
|---|---|
| Body Composition | 60% Water, 18% Protein, 16% Fat, 6% Minerals |
| Water Composition differences in infants, adults and elderly: | Infants: 70% Adults: 60-65% Elderly: 50-55% |
| Intake = Output = | Fluid Balance |
| Sensible losses | ▪ Urination ▪ Defecation ▪ Wound drainage |
| Insensible losses | ▪ Evaporation from skin ▪ Respiratory loss from lungs |
| Total body water intracellular or extracellular percentages | 66% Intracellular 33% Extracellular |
| Of the extracellular breakdown of body water in the body, how much is transcellular, plasma or interstitial | transcellular <1% plasma 7% interstitial 25% |
| PASSIVE TRANSPORT SYSTEMS | Diffusion (Membrane) Permeable Semi permeable Impermeable Filtration Osmosis |
| ACTIVE TRANSPORT SYSTEM | ■ Pumping ■ Requires energy expenditure |
| Cations (+) | –Sodium –Potassium –Calcium –Magnesium |
| Anions (-) | ■ Chloride ■ Bicarbonate ■ Phosphate ■ Sulfate |
| Electrolytes - brain storm | • Charged particles in solution • Cations (+) • Anions (-) • Integral part of metabolic and cellular processes |
| • Major extracellular cation • Attracts fluid and helps preserve fluid volume • Combines with chloride and bicarbonate to help regulate acid-base balance | Sodium : Normal range of serum sodium 135 - 145 mEq/L |
| Sodium Potassium Pump | Try to swap inside outside cells to create an electrical charge. |
| Types of Hyponatremia - Dilutional | results from Na+ loss, water gain |
| Types of Hyponatremia - Depletional | insufficient Na+ intake |
| Types of Hyponatremia - Hypovolemic | Na+ loss is greater than water loss; can be renal (diuretic use) or non-renal (vomiting) |
| Types of Hyponatremia - Hypervolemic | water gain is greater than Na+ gain; edema occurs |
| Types of Hyponatremia - Isovolumic | normal Na+ level, too much fluid |
| Types of Hypernatremia - | Excess Na+ relative to body water Occurs less than hyponatremia Thirst is body’s main defense When hypernatremia occurs, fluid shifts outside the cells May be caused by water deficit or over ingestion of Na+ Also may result from diabetes insipidus |
| Major intracellular cation Untreated changes in K+ levels can lead to serious neuromuscular and cardiac problems | Potassium - Normal K+ levels = 3.5 - 5 mEq/L |
| Balancing Potassium | Most K+ ingested is excreted by the kidneys Three other influential factors in K+ balance : –Na+/K+ pump –Renal regulation –pH level |
| Potassium ions and hydrogen ions exchange freely across cell membranes (pH) | Acidosis hyperkalemia (K+ moves out of cells) Alkalosis hypokalemia (K+ moves into cells) |
| • Major extracellular anion • Sodium and chloride maintain water balance • Secreted in the stomach as hydrochloric acid • Aids carbon dioxide transport in blood | Chlorine |
| 2nd most prevalent extracellular anion Concentration increases in blood passing through systemic capillaries picking up CO2 CO2 combines with H2O to form carbonic acid which dissociates Drops in pulmonary capillaries when CO2 exhaled | Bicarbonate HCO₃- Kidneys = main regulators of blood HCO₃- Can form/release HCO₃- when low/excrete excess |
| Fluid balance- Net filtration Pressure governs fluid movement between | capillaries and interstitial tissue |
| What is Net Filtration Pressure effected by? | Net Filtration Pressure is a function of Blood Hydrostatic Pressure and Osmotic Pressure. Blood Hydrostatic Pressure Blood Hydrostatic Pressure pushes fluid out of capillaries through filtration. |
| Hypertonic | H2O out |
| Isotonic | Fluid balance of H2O |
| Hypotonic | H2O in, cells burst |
| • No fluid shift because solutions are equally concentrated • Normal saline solution (0.9% NaCl) | Isotonic solution |
| • Lower solute concentration • Fluid shifts from hypotonic solution into the more concentrated solution to create a balance (cells swell) • Half-normal saline solution (0.45% NaCl) | Hypotonic Solution |
| • Higher solute concentration • Fluid is drawn into the hypertonic solution to create a balance (cells shrink) • 5% dextrose in normal saline (D5/0.9% NaCl) | Hypertonic Solution |
| • Dehydration • Hypovolemia • Hypervolemia • Water intoxication Are all results of what? | Fluid balances |
| • Loss of body fluids increased concentration of solutes in the blood and a rise in serum Na+ levels • Fluid shifts out of cells into the blood to restore balance • Cells shrink from fluid loss and can no longer function properly | Dehydration |
| Patients at Risk | • Confused • Comatose • Bedridden •Infants • Elderly • Enterally fed |
| Hypovolemia - what do you see in pt? • Isotonic fluid loss from the extracellular space • Can progress to hypovolemic shock ■ Caused by: ■ Excessive fluid loss (hemorrhage) ■ Decreased fluid intake ■ Third space fluid shifting | • Irritability • Confusion • Dizziness • Weakness • Extreme thirst • urine output • Fever • Dry skin/mucous membranes • Sunken eyes • Poor skin turgor • Tachycardia |
| Hypervolemia - what do you see in pt? Excess fluid in the extracellular compartment, result of fluid/ sodium retention, excessive intake, or renal failure Occurs when compensatory mechanisms fail to restore fluid balance Leads to CHF & pulmonary edema | • Mental status deterioration • Thirst • Tachycardia • Delayed capillary refill ■ Orthostatic hypotension ■ Urine output < 30 ml/hr ■ Cool, pale extremities ■ Weight loss |
| Oedema - what do you see in pt? • Fluid is forced into tissues by the hydrostatic pressure • First seen in dependent areas • Anasarca - severe generalized edema • Pitting edema • Pulmonary edema | • Tachypnea • Dyspnea • Crackles • Rapid, bounding pulse • Hypertension • S3 gallop ■ Increased CVP, pulmonary artery pressure and pulmonary artery wedge pressure (Swan-Ganz) ■ JVD ■ Acute weight gain ■ Oedema |
| Water Intoxication - what do you see in pt? Hypotonic extracellular fluid shifts into cells to attempt to restore balance Cells swell Causes: SIADH, Rapid infusion of hypotonic solution, Excessive tap water NG irrigation /enemas, Psychogenic polydipsia | • Tachypnea • Dyspnea • Crackles • Rapid, bounding pulse • Hypertension • S3 gallop ■ Increased CVP, pulmonary artery pressure and pulmonary artery wedge pressure (Swan-Ganz) ■ JVD ■ Acute weight gain ■ Oedema |
| Signs and symptoms of increased intracranial pressure Early vs Late | Early: change in LOC, N/V, muscle weakness, twitching, cramping Late: bradycardia, widened pulse pressure, seizures, coma |
| What three hormones regulate renal Na+ and Cl- reabsorption? | 1. Aldosterone promotes urinary Na+ and Cl reabsorption (and water by osmosis) when dehydrated 2. Atrial natriuretic peptide (ANP) 3. Antidiuretic hormone (ADH) |
| How does ANP help control body fluid levels and blood pressure? | Released by cells of atria Promotes excretion of Na+ and Cl- followed by water excretion to decrease blood volume Lowers blood pressure by causing vasodilation |
| Major hormone regulating water loss is antidiuretic hormone (ADH) also known as... | vasopressin |
| antidiuretic hormone ADH /vasopressin produced by which gland? | Produced by hypothalamus, released from posterior pituitary |
| How does ADH work? | • Osmoreceptors in hypothalamus sense solute concentration • Kidneys reabsorb fluid • Produces concentrated urine • Increases peripheral arterial constriction |
| Homeostasis- Sequences of responses that stops bleeding. Three mechanisms reduce blood loss: | 1 Vascular spasm 2. Platelet plug formation 3.Blood clotting cascade |
Created by:
paramedicscienceUK
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