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Chapter 25

Fluid, Electrolyte, and Acid-Base Balance

What are the four main function of water in the body? -act as a vehicle for transport -aid heat regulation by providing perspiration -assist in maintenance of hydrogen balance in the body -serve as a medium for enzymatic action of digestion
Electrolytes minerals or salts that are dissolved in body fluid
Sodium normal range 135-145 mEq/L
Potassium normal range 3.5-5 mEq/L
Calcium normal range 8.4-10.6 mg/dL
Magnesium normal range 1.3-2.1 mg/dL
Phosphate normal range 2.7-4.5 mg/dL
Chloride normal range 96-106 mEq/L
Bicarbonate normal range 22-26 mEq/L
Extracellular fluid -1/3 of total body water -transports water, nutrients, oxygen, waste to and from cells -High in sodium content
Intravascular fluid -fluid within blood vessels -contains large amounts of protein/electrolytes
Interstitial fluid -fluid in spaces surrounding the cells -high in sodium content
Transcellular fluid -includes aqueous humor, saline, cerebrospinal, pleural, peritoneal, synovial, and pericardial fluids & urinary/lymphatic systems
Intracellular fluid -2/3 of total body fluid -contained within cell walls, most permeable to water -high in potassium
Diffusion process by which substances freely move back and forth across the membrane until they are evenly distributed throughout the available space
Osmosis movement of a pure solvent (liquid) across a membrane
Isotonic concentration outside of cells is equal to concentration inside of cells
Hypertonic Concentration outside of cells is greater than the concentration within the cells
Hypotonic Concentration outside of cells is lesser than the concentration within the cells
Filtration movement of water and suspended substances outward through a semipermeable membrane
Hydrostatic pressure pressure exerted by fluid -causes fluid to press outward on the vessel
Active transport -requires cellular energy -may move substances from an area of lower concentration to an area of higher concentration
How does the healthy kidney regulate fluid and electrolyte balance? by regulating the volume and composition of ECF
Who is at risk for deficient fluid volume? -patients unable to take in sufficient fluid due to impaired swallowing, weakness, disorientation, coma, unavailable water -patients who lose excessive fluid through prolong vomiting, diarrhea, hemorrhage, diaphoresis, or excessive wound drainage
Turgor degree of elasticity
Dehydration loss of water from the cells
Edema excessive accumulation of interstitial (tissue) fluid
What are the causes of generalized edema? -kidney failure -heart failure -liver failure -hormonal disorders - overproduction of aldosterone & ADH
Hyponatremia -deficit of sodium in blood -most common electrolyte imbalance
Hyponatremia causes -sodium loss/excess of water -excessive vomiting, diarrhea when replaced with plain water -decreased secretion of aldosterone -heart failure, liver disease, chronic renal failure, ascites
Ascites abnormal accumulation of fluid within the peritoneal cavity
Hyponatremia signs/symptoms: Sodium less than 135 mEq/L CNS/neuromuscular changes, mental confusion, headache, altered level of consciousness, anxiety, coma, anorexia, nausea, vomiting, muscle cramps, seizures, decreased sensation
Hypernatremia signs/symptoms: Sodium greater than 145 mEq/L dry mucous membranes, loss of skin turgor, intense thirst, flushed skin, oliguria, possible elevated temp, weakness, lethargy, irritability, twitching, seizures, coma, intracranial bleeding
Hypokalemia sings/symptoms: Potassium less than 3.5 mEq/L abdominal pain, gaseous distention of intestines, cardiac arrhythmias, muscle weakness, decreased reflexes, paralysis, paralytic ileum, urinary retention, lethargy, confusion, ECG changes, increased urinary pH
Hyperkalemia signs/symptoms: Potassium greater than 5.0 mEq/L muscle weakness, hypotension, paresthesias, paralysis, cardiac arrhythmias, ECG changes
Hypocalcemia signs/symptoms: Calcium less than 8.4 mg/dL paresthesias, seizures, muscle spasms, tetany, hand spasms, positive Chvostek sign, positive Trousseau sign, cardiac arrhythmia, wheezing, dyspnea, difficulty swallowing, colic, cardiac failure
Hypercalcemia signs/symptoms: Calcium greater than 10.6 mg/dL anorexia, abdominal pain, constipation, polyuria, confusion, renal calculi, pathologic fractures, cardiac arrest
Hypomagnesemia signs/symptoms: Magnesium less than 1.3 mEq/L insomnia, hyperactive reflexes, leg/foot cramps, twitching, tremors, seizures, cardiac arrhythmia, positive Chvostek sign, positive Trousseau sign, vertigo, hypocalcemia, hypokalemia
Hypermagnesemia signs/symptoms: Magnesium greater than 2.1 mEq/L hypotension, sweating/flushing, nausea/vomiting, muscle weakness, paralysis, respiratory depression, cardiac dysrhythmias
Hypophosphatemia signs/symptoms: Phosphate less than 2.7 mg/dL confusion, numbness, weakness, possible come, chronic state my cause rickets & osteomalacia
Hyperphosphatemia signs/symptoms: Phosphate is greater than 4.5 mg/dL anorexia, nausea, vomiting
Alkalosis excess of alkaline or decrease of acid substances in the blood and body fluids
What ist he normal serum pH? 7.35-7.45
What is the normal range of Bicarbonate (HCO3)? 22-25 mEq/L
What are the three control mechanisms for pH? -blood buffer system -lungs -urinary system
Acidosis increase in hydrogen ions, decrease in pH
Respiratory acidosis causes: hypoventilation, resp. congestion/obstruction, COPD, severe pneumonia, excessive sedation, respiratory muscle weakness
Respiratory acidosis signs/symptoms: hypoventilation, dyspnea, anxiety, confusion
Metabolic acidosis causes: shock, diabetic ketoacidosis, lactic acidosis, renal failure, diarrhea, starvation
Metabolic acidosis signs/symptoms: Kussmaul respirations, headache, confusion, malaise
Respiratory alkalosis causes: hyperventilation due to pain or anxiety, mechanical ventilation, high fever, ASA overdose, encephalitis
Respiratory alkalosis signs/symptoms: hyperventilation, confusion, lightheadedness
Metabolic alkalosis causes: vomiting, prolonged gastric suction, hypokalemia, medications, diuretics, antacids or bicarbonate, mineralocorticoids
Hyperventilation a rapid respiratory rate -results in respiratory alkalosis
Tetany characterizes by severe muscle cramps, carpopedal spasms, laryngeal spasms, and stridor
Why are changes in vital signs pertinent when assessing fluid and electrolyte imbalances? -fever increase fluid loss -PR greater than 100bpm can be early sign of decreased vascular volume -weak, thready pulse - volume deficit -bounding, full pulse - fluid volume overload -Irregular PR - Magnesium/Potassium
Sodium: water regulation and balance
Potassium nerve impulse transmission, muscle contraction, plasma, acid-base balance
Calcium muscle activity, blood coagulation
Magnesium nerve impulse transmission, muscle contraction
Phosphate ATP production
Chloride hydrochloric acid production, acid-base balance
Bicarbonate Acid-base balance
Why is bicarbonate necessary for acid-base balance? buffer that neutralizes excess acids in the body, helps regulate acid-base balance
Nonelectrolytes amino acids (proteins), glucose, and fatty acids remain bound together when dissolved in body fluid
What is the normal circulating blood volume? What is it composed of? 4-6L erythrocytes - 44% platelets/leukocytes - 1% plasma 55%
Why is increased production of ADH a compensatory response? because volume is decreases, urinary output will be decreased
Signs/symptoms of dehydration: thirst, weakness, dizziness, postural hypotension, decreased urine production, concentrated urine, dry cracked lips, dry mucous membranes, thick saliva, dry scaly skin, poor tissue turgor, flat neck veins, increased bpm, weak, thready pulse, high temp
Signs of fluid volume excess: weight gain, crackles in the lungs, slow bounding pulse, elevated blood pressure, possibly edema
Why is the pulse rate increased with dehydration? decreased fluid/plasma volume
Why is the blood pressure increased with fluid volume excess? increased fluid/plasma volume
Hyponatremia causes: sodium deficit, can be from decreased sodium or increased water intake and retention -may be caused by excessive vomiting and diarrhea
Hypernatremia causes: sodium excess, commonly from water loss from fever or respiratory infection
Hypokalemia causes: excess potassium or loss of body water -may be from poor diet, vomiting, diarrhea, excessive sweating, diuretic therapy
Hyperkalemia causes: occurs with burns, crash injuries, uncontrolled diabetes mellitus, renal failure
Hypocalcemia causes: nutritional deficiency of calcium or vitamin D or in bone disorders such as metazoic cancer of the bone
Hypercalcemia causes: most cases related to hyperparathyroidism or malignancy such as multiple myeloma
Hypomagnesemia causes: malabsorption, malnutrition, renal tubular dysfunction, thiazide diuretic, extensive gastric suction, or diarrhea
Hypermagnesemia causes: occurs only in presence of renal failure
Hypochloremia cause low chloride level associated with hyponatremia
Hyperchloremia cause high chloride level occurs along with hypernatremia and a form of metabolic acidosis
Hypophosphatemia causes: may result from aluminum containing antacids, vitamin D deficiency, or hyperparathyroidism
Hyperphosphatemia causes: occurs in renal failure
Balance between bicarbonate and carbonic acid carbonic acid retained or removed by respiratory system bicarbonate retained or removed by kidneys
Control mechanisms: Blood buffer system consists of weak acids and weak bases
Control mechanisms: Lungs carbon dioxide and water are expired from the lungs
Control mechanisms: Urinary system enzymes promote the dissociation of carbonic acid to free hydrogen ions
Increases carbon dioxide levels cause: airway obstruction, pneumonia, asthma, chest injuries, opiate intake, chronic obstructive lung diseases
Excessive loss of bicarbonate ions caused by: kidney disease, diabetic ketoacidosis, circulatory failure, shock states
Created by: ahoyyitbeaddi
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