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Daily fluid exchange

≈2 L/day:
Lungs: 0.3 L
Sweat: 0.5 L
Feces: 0.2 L
Urine: 1.0 L

Thirst receptor location

Hypothalamus

Three paths for fluid return

Capillary return;
Lymphatic return;
Entrance to intracellular compartment

Hypovolemia def & causes

Fluid volume of blood is low;
extreme sweating, v/d, hemorrhage, burns

Hypervolemia def & causes

Fluid volume of blood is too high;
CHF, Chronic RF, Excess IV

Main ICF cation

K

Main ECF cation

Na

Main ICF anion

P (as PO4)

Main ECF anion

Cl

Cation used in coagulation

Ca

Cation used in enzyme rxns

Mg

Serum [Na]

135-145 mEq/L

Hyponatremia causes

SIADH, Addison's, vomiting/diarrhea, heat stroke, renal failure

Hypernatremia causes

Dehydration, diabetes insipidus, loop diuretics, hyperaldosteronism

Serum [K]

(Na levels, drop "1") 3.5-5.0 mEq/L

Hypokalemia causes & EKG

AAAA + DDD (should ADD K)
Alkalosis, Alcoholism, Anorexia, (hyper)Aldosteronism, Diarrhea/vomiting, Diuretics, Diabetes Insipidus

Hypokalemia EKG

Flat T; U-wave appears. A tach, PVCs --> V tach

Hyperkalemia causes

ABC/RF
Acidosis/Addisons, Burns, Crushing injuries, Renal failure

Hyperkalemia EKG

Peaked T; AV block --> V tach --> V fib --> Arrest

Serum [Ca]

8.9-10.1 mg/dL

Hypocalcemia causes

"HAPPY VD"
Hypoparathyroidism, Acute Pancreatitis, Vit D deficiency, chemo

Hypocalcemia EKG

Extended QT-interval

Hypercalcemia causes

"PHAG"
Pheochromocytoma, Hyperparathyroidism, Adrenal insufficiency, Grave's disease

Hypercalcemia EKG

Shortened QT-interval

Serum [PO4]

2.5-4.5 mg/dL

Hypophosphatemia causes

"Triple A-P-G-S"
Alcoholism, Antacids, Acidosis, pancreatitis, G- sepsis, steroids

Hyperphosphatemia causes

Hypoparathyroidism, tumor lysis (lymphomas) renal insufficiency, rhabdo

Serum [Mg]

1.5-2.5 mEq/L

Hypomagnesemia causes

Hypercalcemia, malnutrition

Hypermagnesemia causes

"DKA-- Lost Insulin Ruins Hearts"
DKA, Hemolysis, Lithium intoxication, Renal failure

Hypervolemia

Excess ISOTONIC fluid in ECC

Hypervolemia causes

Burns, congestive heart failure, cirrhosis, nephrotic syn, IV

Hypervolemia S/s

Edema, low HCT, normal [Na], low BUN

Hypovolemia

Low ISOTONIC fluid in ECC

Hypovolemia causes

Fluid loss (hemorrhage, diabetes, diuretics, vomiting) 3rd space shifts (burns, CHF, peritonitis, hypoalbuminemia)

Hypovolemia S/s

Acute weight loss, dizziness, polydipsia, tachy, hypotension

Hyponatremia S/s

Weakness, Neurological path (Brain swells!-- Headache, confusion, seizures, coma)

Hypernatremia S/s

Cardiovascular( tachycardia, hypotension) and Renal (hypernatremic renal failure), polydipsia

Hypokalemia S/s

Atrial tachycardia, V-tach and V-fib. Anorexia, n/v, Weakness, Paresthesias, Dysrhythmias (U wave), sensitivity to digitalis

Hyperkalemia S/s

Dysrhythmias (Peaked T's) MI, Weakness, Paralysis, n/v

Hypocalcemia S/s

Tetany (muscle Clamping), Convulsions, increased QT interval

Hypercalcemia S/s

"Stones, Bones, Groans, Moans & CCCC-QT"
Cramps/weakness, Lack of Coordination, Constipation, Confusion, Cardiac dysrhythmias Shortened QT interval

Anasarca

Severe edema of all tissues, esp subcutaneous tissue

Usual cause of Pitting Edema

Transudate

Effusion

Fluid collection in body cavity

Hydrothorax

Pleural effusion: fluid in lung cavity

Hydropericardium

Pericardial effusion: fluid in cardiac space

Ascites

Peritoneal effusion: fluid in abdominal cavity

Two classes of edema

Low protein (transudate) & High protein (exudate)

Two types of low protein (Transudate) edema

Hydrostatic & "back pressure"

Two types of hydrostatic, Low Protein edema

Hypervolemic & Hypernatremia

Causes of Hypervolemic Edema

Hypervolemia: Burns, CHF, Cirrhosis, RF, IV infusion

Causes of Hypernatremia Edema

Hypernatremia: Cushing's; Hyperaldosteronism 2/2 CHF; Loop diuretics

Causes of "Back pressure" Edema

CHF (L-sided causes Pulmonary edema), R-sided causes Portal/Hepatic edema); Venous thrombosis (causes localized edema)

Causes of Osmotic Edema

Cirrhosis & Glomerulonephritis

Two types of high protein edema

Inflammatory & Lymphedema

Characteristics of inflammatory edema

Usually localized, allergic urticaria or Autoimmune

Three types of lymphedema

Scarring (eg, filiriasis [Wucheraria bancrofti]);
Obstructivre (CA);
Surgical (Resection)

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