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GEP Fluid / Electrol
GEP Fluid / Electrolytes 2009
| Question | Answer |
|---|---|
| Intracellular fluid (ICF) | Fluid inside cells <BR> 2/3 of total body water <BR> high K, Mg, Phosphates, Proteins <BR> low Na, Cl |
| Extracellular fluid (ECF) | 1/3 of total body weight <BR> high Na, Cl, bicarbonate <BR> low K, Phosphates, Mg <BR> |
| ECF Types | Intravascular - Plasma, high in protein, 25% of ECF <BR> Interstitial - Fluid between cells and vasculature, low in protein, 75% of ECF <BR> Trans-Cellular - Digestive juices, Lymphatic fluid, Pleural fluid, Eye fluid, Cerebrospinal fluid, 1% of ECF |
| Passive Transport | Movement of solutes from area of high concentration to area of low concentration <BR> Requires no energy |
| Active Transport | Movement of solutes from area of low concentration to area of high concentration <BR> Requires energy (ATP) <BR> Ex: Na/K pump |
| Osmosis | Movement of fluid from area of low solute concentration to area of high solute concentration |
| Oncotic (Colloid Osmotic) Pressure | Pressure determined by protein amounts <BR> Want to draw fluid toward them |
| Hydrostatic Pressure | Pressure from fluid <BR> Want to push fluid away |
| Fluid movement at arterial capillaries | HS Pressure = 35mmHg <BR> OS Pressure = 25mmHg <BR> Net Pressure = +10mmHg <BR> Fluid moves from arterial capillary into interstitial fluid for filtration |
| Fluid movement at venous capillaries | HS Pressure = 10mmHg <BR> OS Pressure = 25mmHg <BR> Net Pressure = -15mmHg <BR> Fluid moves from interstitial space into venous capillary |
| Vasodialation Effect on Fluid Shift | Vasodialation increases HP at arterioles <BR> Increased fluid shift into interstitial spaces <BR> Results in edema |
| Congestive Heart Failure <BR> Effect on Fluid Shift | CHF ... fluid backs up in ventricles and atria <BR> Venous return is opposed by greater heart pressure, so venous HS Pressure is increased <BR> This keeps fluid in interstitial spaces and causes edema |
| Protein Deficiency Effect on Fluid Shift | Deficient intake leads to lower plasma protein levels <BR> Decrease in fluid return to venous capillaries causes edema |
| Plasma Osmolality | Osmoles of solute per Kg of solvent<BR> Normal = 285 - 295 mOsm/Kg <BR> If you're dehydrated, higher osmolality <BR> If you're overhydrated, lower osmolality |
| Anti Diuretic Hormone (ADH) | Released by pituitary <BR> High Osmolality ... ADH release to retain water <BR> Low Osmolality ... ADH suppressed to get rid of water |
| Aldosterone | Secreted by adrenal cortex of kidney <BR> Promotes Na-reabsorption to retain water |
| Atrial Natriuretic Factors (ANF) | Released from atrium in response to excess fluid <BR> Potent diuretic to get rid of excess Na and water |
| Third Spacing | Fluid is lost from intravascular space and sequestered somewhere (pleural, peritoneal, or pericardial). Fluid is unavailable for use, so it is like fluid volume deficit |
| Clinical Manifestations of Fluid Volume Deficit | Sudden weight loss <BR> Orthostatic hypotension <BR> Decreased skin turgor <BR> Increased small vein filling time <BR> Longitudinal furrows in tongue |
| Extracellular Fluid Volume Excess <BR> Risk Factors | Increased hydrostatic pressure <BR> Decreased Oncotic Pressure |
| Diuretics Effect on the Kidneys | Increase Na excretion = Increase water excretion <BR> Inhibit Na reabsorption at different segments of renal tubular system <BR> Give 2 diuretics that act on diff. segments ... synergistic effect |
| Insensible fluid loss | Not measurable <BR> Perspiration, exhalation <BR> About 300-500mL per day |
| Loop Diuretics | Inhibit reabsorption of Na, K, & Cl and increase excretion of Na, K, Cl, Mg at ascending Loop of Henle <BR> Most powerful diuretics |
| Thiazide Diuretics | Block reabsorption of Na in early distal tube <BR> Less potent diuretic, dependent on GFR |
| K-Sparing Diuretics | Antagonize aldosterone action at distal tubule <BR> Weak diuretic, block Na/K pump in distal tubule to retain K |
| Osmostic diuretics | Mannitol - simple sugar <BR> creates high Oncotic pressure in lumen to block water reabsorption <BR> Only diuretic to pull fluid from brain |
| Isotonic Solution Uses | Increase intravascular fluid volume <BR> Replace lost fluid during surgery, trauma, draining wounds, burns |
| Hypotonic Solution Uses | Lower Na content than plasma, decreases osmolality of plasma so water moves from intravascular to interstitial and then from interestitial to intracelluar <BR> Used to treat Dialysis patients w/ dehydrated cells, hyperglycemia, high blood pressure |
| Hypertonic Solution Uses | Increases plasma osmolality so water moves from intracellular & interstitial spaces into intravascular space <BR> Used to treat edema, low blood pressure <BR> Used to increase urine output |
| Colloid Solution Uses | Contain protein or starch too big to pass through capillary memb, so they stay in vasculature <BR> Increase oncotic pressure to draw fluid from intracellular and interstitial spaces <BR> Used to treat edema while increasing plasma volume |
| Hyponatremia | Norm. Na level = 135-145 mEq/L <BR> Hyponatremia < 135 mEq/L <BR> Decreases plasma osmolality, so water moves from intravascular to intracellular <BR> Swollen cells + Hypovolemia, orthostatic hypotension |
| Hyperkalemia | Norm. K level = 3.5 - 5.5 mEq/L <BR> Hyperkalemia > 5.5 <BR> Occurs most due to renal failure - can't excrete K or move K from intravascular to intracellular <BR> |
| Hyperkalemia ECG Changes | ECG Changes - peaked, narrow T wave, wide QRS complex, depressed ST segment, widened PR interval, depressed P wave |
| Hyperekalemia Treatments | Mild - Loop or Thiazide diuretics Severe - 10% Dextrose + 10-15 U insulin moves K back into cells, sodium bicarb IV moves K back into cells, Calcium gluconate decreases K effects on heart, Sodium polystyrene sulfonate exchanges Na for K in intestine |
| Trousseau's Sign | Test for hypocalcemia (< 8.5 mg/dL) <BR> Inflate BP cuff above systolic BP for 3 min., causes palmar flexion |
| Hypercalcemia | Norm. Ca level 8.5 - 10 mg/dL <BR> Hypercalcemia > 10 mg/dL <BR> Decreased cardiac and SM activity, renal stones, weakened bones, Digoxin toxicity, arrhythmias <BR> |
| Hypercalcemia Treatments | Mild - hydrate w/ 0.45 or 0.9% NS IV promotes Ca excretion in urine, also give Lasix to prevent fluid vol overload <BR> Inorganic phosphate salts - neutra-Phos (oral) prevents kidney stones, Fleet enema stimulates Ca excretion <BR> |
| More Hypercalcemia Treatments | Calcitonin Sub Q - thyroid hormone, stimulates Ca deposit into bone<BR> Didronel, Gallium Nitrate - decrease osteoclastic activity |
| Potassium Chloride IV Administration | Give for mod/severe hypokalemia <BR> ALWAYS DILUTED - irritating to vein <BR> Can give through central line w/ pump <BR> NEVER give IM <BR> NEVER give as IV bolus - Cardiac Arrest |
Created by:
frolickinglizard
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