MNT 2 Fluid, Electrolyte, and Acid Base Balance

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Intravascular water

Water inside blood vessels; plasma=

Interstitial Water

Water btw and around cells: lymph, spinal fluid, secretions (intercellular fluid)

Edema

Abnormal accumulation of fluid in intercellular spaces or body cavities, usually best seen in periphery

Anasarca

Generalized massive edema

Intracellular fluid

What type of fluid accounts for 60% of body fluid?

Intracellular

_________ fluid decreases during dehydration to shift fluid out of cells (decrease cell mass)

Third space edema

Edema that is associated with disease or injury (CHF, cirrhosis, burns), due to decrease plasma protein, may reduce blood volume

Osmotically active

Changes in albumin concentration can change the osmolarity of blood plasma-- fluid shifts into or out of this and other compartments=

Capillary Filtration

A process which helps manage fluid balance

Diffusion

Movement of particles across a permeable membrane from an area of high concentration to low concentration

Osmosis

Movement of a solvent (usually water) across a semipermeable membrane from low solute concentration to high solute concentration

osmosis

Body fluids are transported through cell membranes through the process of _________

lesser solute concentration to one of greater solute concentration

Water moves from an area of _______ concentration to one of _______ concentration, until equilibrium is established

GI tract, kidneys, and brain

Homeostasis maintained by ....

Hypovolemia

Low volume blood=

Fluid volume deficit and is accompanied by hyperatremia

Hypovolemia or dehydration=__________ and is accompanied by what?

Fluid volume excess and is accompanied by hypoatremia

Hypervolemia or overhydration= ___________ and is accompanied by what?

Kidney (main regulator), GI tract (fecal), and active sweat

Sensible water loss=

lungs, skin

Insensible water loss=

Kidneys

__________ manages fluid balance by minimizing fluid losses or increasing urine o/p capillary filtration in the glomerulus and reabsorption in the renal tubules

Obligatory fluid excretion

Barest minimum amt of fluid required for removal of urinary waste materials=

Urea, Sodium, Potassium, and Chloride-- comprise the renal solute load

Urinary Waste Materials are.... and comprise the ___________

1200-1400 mOsm/L

Normal adult kidneys can concentrate urine 12000-1400 mOsm/L

7-9 L

How many L of digestive juice produced daily, most reabsorbed in ileum and colon?

3-5 L

Total Plasma Volume=

100-150 mL

Normal GI fluid losses=

30-35 ml/kg or 1ml/kcal

Water Needs for Adults

Kidneys inefficiency in managing renal solute load, higher percentage of body weight, large TBSA per unit body wt

Why do infants have increased water needs?

decrease renal, decrease thirst sensation

Why do older adults have increased water needs?

hypothalamus and stimulated by increased osmolality or decreased extracellular fluid (ECF)

Fluid intake is controlled by thirst response, governed by _____ and stimulated by...

Osmotic pressure

Measured in mOsm, described as osmolality

Osmolality

# osmotic particles/kg solvent

Osmolarity

Osmotic particles per liter of solution

Isotonice

Conc equal on both sides

Oncotic Pressure

Colloid osmotic pressure is maintained by proteins (albumin)

Lactate which converts to lactic acid (acidosis)

What needs to be monitored when using a lactated ringer?

Water Intoxication

Fluid overload and ICF Volume with Osmolar dilution (Less than 285 mOsm/kg)=

Dehydration

Depletion of ICF volume, osmolar concentration greater than 295 mOsm/kg

150

The sum of the concentration of all serum cations is about ____ mEq/L and is about equal to the sum of serum anions

ATPase Pump- Active transport system (Sodium and Potassium dependent)

Maintains ionic concentration, manages cell volume and osmolality, requires ATP and comprises 40% BEE

Sodium

What electrolyte is the principal determinant of serum osmolality?

Sodium

What electrolyte is predominant cation in the ECF, regulates size of ECF, contributes to osmotic equilibrium, acid base balance, and is regulated by kidney?

Isotonic dehydration

Dehydration that is proportional loss of water and sodium, as in GI losses, burns, osmotic diuresis, excessive sweating (concentrated blood but not sodium)

Give water and sodium (normal saline)

What is treatment for isotonic dehydration?

Hypertonic dehydration

Dehydration that is Water loss greater than Na loss as in inadequate fluid intake, loss of solute-free water from GI tract , renal dz with defective concentrating function=

Give hypotonic, non or low electrolyte solutions sufficient to replace (D5W)

Treatment for Hypertonic Dehydration=

Hypotonic Dehydration

Dehydration that is excess serum H2O relative to sodium, i.e. sodium loss > water losses=

Based on etiology an renal fx

What is treatment for Hypotonic dehydration?

Hypotonic dehydration (hypoatremia)

What is most common type of imbalance in hospitalized patients

Diuretics and fluid restriction

What is the treatment of excess water and sodium?

40%

Table salt is _____% of NaCl

Potassium

What electrolyte is most prevalent intracellular cation, crucial in maintaining cell volume, contributes to fluid balance, osmotic equalibrium, muscle tissue formation, neuromuscular activity?

Kidneys

Potassium balance managed by.....

Hypokalemia

Low Potassium=

ECF

Serum Potassium is measured in ______

Hyopkalemia

Disorder of Serum electrolyte associated with muscle weakness, leg cramps, irregular pulse, paralysis, and respiratory disturbances

Chloride

Which electrolyte is the principal anion of ECF; helps maintain osmotic equilibrium and water balance?

in urine and sweat

How is chloride excreted?

food, toxins

Exogenous Acidifiers (Cause acidity)=

normal tissue metabolism, metabolism of phosphates and sulfur, production of lactate and ketones, and CO2

Endogenous Acidifiers=

bicarbonate

If Acidic ph then give _____ to correct

Respiratory System

Which acid base balance is the fastest acting system regulation?

Renal System

Which acid base balance is the slowest acting regulatory system?

CO2

Lungs control pH by manipulating _____ content of plasma via respiratory rates

H+ excretion and HCO3 reabsorption

Kidneys manage excretion of _____ and ____ reabsorption

Metabolic acidosis

What type of acid base imbalance is caused by renal failure and accumulation of H+ and urea, lactic acidosis, ketoacidosis, excess loss of HCO3 via GI tract?

Metabolic alkalosis

What type of acid base imbalance is caused by severe gastric fluid losses, excessive urinary acid losses, severe hypokalemia?

Respiratory Acidosis

What type of acid base imbalance is caused by depressed ventilation-- sleep apnea, asthma, airway obstruction?

Respiratory Alkalosis

What type of acid base imbalance is cause by head injuries, brain tissue disturbances e.g. stroke or tumor?

35-45= Normal

Normal PCO2 which reflects respiratory function=

Greater than 80

Normal PO2 level=

22-28

HCO3 is reflective of metabolic function, normal range=

Hypoalbuminemia

Main cause for low anion gap is...

metabolic compensation

When a primary acid base imbalance develops, body attempts to restore normal pH by compensating with a secondary acid-base disorder. This is called _______________

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