Body Fluid Dynamics

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sensible fluids

urine, sweat, feces, vomit, iatrogenic

insensible fluids

respiration, skin

decreased fluid needs

heart/renal failure, fluid overload

Electrolytes in ECF

Na, Cl, Ca

Electrolytes in ICF

K, Mg

Osmolality

/kg

Osmolarity

/L

tonicity

osmotic pressure

normal range for serum osmolality

280-295 (mOsm/kg)

Aldosterone

Na retention (what causes this)

ADH

H2O retention (what causes this)

ANP

H2O, Na excretion (what causes this)

increases ADH

high Na, Osm, hypovolemia, aldosterone, nicotine, morphine (what these do to ADH)

decreases ADH

hypervolemia, dec. osm., ethanol (what these do to ADH)

increases aldosterone

decreased BP, blood volume, Na, increased K (what these do to aldosterone)

decreases aldosterone

ANP (what is does to aldosterone)

increases ANP

volume expansion

isotonic solutions

.9% NS, LR

hypotonic solutions

1/2 NS, D5W

hypertonic solutions

D5W 1/2 NS, D5W 1/4 NS, colloids

free water IV fluids

D5W 1/4 NS, D5W 1/2 NS, 1/2 NS, D5W

NOT free water IV fluids

.9% NS, LR

C/I in liver/renal failure

LR (C/I)

not useful for IV meds

LR (IV meds?)

good for hyperglycemia

LR (diabetes?)

euvolemia

ins match outs

ins

liquids, food, cellular respiration

iso-osmotic

water balance (Na regulated)

from hypothalamus

ADH (where from?)

from adrenal gland

Aldosterone (where from?)

from atria

ANP (where from?)

___causes tachycardia

volume depletion causes ___

___increase stroke volume, catecholamine release, increased PVR

fluid retention causes___

hypovolemia vs dehydration

hypovolemia includes loss of electrolytes

Lisinopril

ACEinh. (vasodilation)

Spironolactone

aldosterone antagonist (excrete Na, retain K)

DDAVP

vasopressin (agonist, increases BP)

Aliskerin

renin inh (vasodilation)

used in px with hypernatremia

hypotonic fluids (.45 NS, D5W)

when to use hypertonic fluids

dehydrated states (what type of fluids to use)

which type distributes freely throughout ECF

crystalloids

which type keeps in intravascular space

(where it goes)colloids

useful in sodium restricted px

D5W (useful in who)

IV medication diluents

D5W, NS (IV meds?)

useful in shock, resuscitation, metabolic, acidosis, head injuries

NS (useful when)

caution in heart failure, edema, hypernatremia

NS (caution when)

expands intravascular fluid volume

LR, NS, Glucose mixes (what it does to intravascular fluid volume)

NS in diabetics?

sure

useful in water replacement, sodium/chlorid depletion, gastric fluid losses

1/2 NS (useful for_)

caution for CV collapse due to hypotonicity

1/2 NS (caution)

colloids

albumin, hetastarch, dextran

plasma expander

also called colloids

colloid with greater potential for anticoagulant effect

dextran

high alert IV's

>0,9% NS

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