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intracellular in the cell intravascular in the blood vessels interstitial in the tissue spaces between blood vessels and cells functions of the fluid provides an extracellular transportation route to deliver nutrients to the cells and carry waste products from the cells; provides a medium in which chemical reactions or metabolism, can occur within the cell; acts as a lubricant for tissues; aids in the maintenance of acid-base balance; assists in heat regulation via evaporation fat this contains relatively little water; the leaner the ind, the greater the proportion of water in total body weight body water is found in cell, tissue space, blood vessel the more obese an ind the lesser is the percentage of body water intracellular fluid extracellular fluid is lost from the body more rapidly than intracellular fluid largest of the two compartments and contains the fluid inside the billions of cells within the body extracellular fluid contains any fluid outside the cell; divided into interstitial and intravascular compartments extracellular fluid compartments interstitial fluid and intravascular fluid interstitial fluid between the cells or in the tissue; accounts for approximately 27% of the fluid in the body; examples lymph, cerebrospinal fluid and GI secretions intravascular fuid plasma within the vessels; makes up 7% of fluid volume intake and output the normal daily loss of fluids must be met by the normal daily intake; daily water I&O is 2500 mL; fluid leaves the body through the kidneys, lungs, skin and GI tract; water loss is replenished by ingestion of liquids and foods and by metabolism of food and body tissues intake includes all fluids entering the body fluids can be liquids taken orally or consumed in food, incl foods that assume a liquid consistency at room temp; this also includes tube feedings and parenteral intake such as IV fluids, blood components, and total parenteral nutrition output includes all fluids leaving body urine, diarrhea, vomitus, nasogastric suction and chest tube drainage; also included is drainage from surgical wounds and drainage collected ins urgical receptacles suh as the Jackson Pratt, Davol, Hemovac systems kidneys this plays an extremely important role in fluid balance, if this isn't functioning properly, the body has great difficulty in regulating fluid balance glomerular filtration rate nephrons filter blood at a rate of 125 l per min, or about 180 L per day; this leads to output of 1 to 2 L of urine per day 30 ml/hr the kidneys must excrete a minimum of urine to eliminate waste products from the body kidneys react to fluid excessess by excreting a more dilute urine; this rids the body of excess fluid and conserves electrolytes 1 L of fluid equals 1 kg (2.2 lb) simple and accurate method of determining water balance is to weigh the patient under exact conditions extracellular fluid substances entering the body begin their journey in here; they must cross the semipermeable membrane surrounding eah body cell to enter the ell; the fat and protein moleules that make up the membrane are arranged so that soe substances can enter the cells and others cannot passive transport no cellular energy is required to move substances from a high concentration to a low concentration active transport cellular energy is required to move substances from a low concentration to a high concentration diffusion this is the movement of particles in all directions through a solution or gas; solutes move from an area of higher concentration to an area of lower concentration, which eventually results in an equal distribution of solutes within the two area osmosis this is the movement of water from an area of lower concentration to an area of higher concentration; it equalizes the concentration of ions or molecules on both sides of the membrane; the flow of water will continue until the number of ions or molecules on both sides are equal hypertonic solutions a solution of higher osmotic pressure; pulls fluid from the cells isotonic solutions a solution of same osmotic pressure; expands the body's fluid volume w/o causing a fluid shift hypotonic solutions a solution of lower osmotic pressure; moves into the cell, causing them to enlarge filtration this is the transfer of water and dissolved substances from an area of higher pressure to an area of lower pressure; a fore behind this is called hydrostatic pressure or the force pressing outward on a vessel wall; the pumping action of the heart is responsible for the amount of force of the hydrostatic pressure that causes water and electrolytes to move from the capillaries to the interstitial fluid; requires energy; fore that moves molecules into cells w/o regard for their positive or negative charge and against concentration factors that would rpevent entry via diffusion; moves fluid and eletrolytes from an area of low to high; substances actively transported through the cell membrane incl sodium, K, Ca, Fe, H, aa, glucose electrolytes develop tiny electrical charges when they dissolve in water and break up into particles known as ions; a balance exist between these; for each positively charged cation there must be a negatively charged anion sodium a cation; most abundant electrolyte in the body; normal level 134-142 mEq/L; major source is from diet; frequently myst be limited functions of sodium regulates water balance, controls extracellular fluid volume, increases cell membrane permeability, stimuates conduction of nerve impulses and helps maintain neuromuscular irritability, controls contractibility of muscles hyponatremia greater than normal concentration of sodium in the blood; Na level less than 134 mEq/L; can occur when there is a sodium loss or a water excess; body attempts to compensate by decreasing water excretion; pt likely to also have a K imbalance due to fluid being moved in the cells and K shifting out of the cells hypernatremia greater than normal concentration of Na in the blood; Na level greater than 145 mEq/L; can ocur when there is a Na exess or a water loss; body attepts to correct the imbalance by conserving water through renal reabsorption; causes fluid to shift from the cells to the interstitial spaes resulting in cellular dehydration potassium dominant intracellular cation; normal level 3.5-5 mEq/L; well-balanced diet usually provides adequaate K; approx 65 mEq is required each day; routes of K excretion are the kidneys, in the feces, and through perspiration; the kidneys contrl the excretion of K function of potassium regulation of water and electrolyte content within the cell hypokalemia derease in body's potassium to a level below 3.5 mEq/L; the major cause of loss is renal excretion; the kidneys do not conserve K and excrete it even when the body needs it; K can be depleted due to excessive GI losses from gastric suctioning or vomiting and the use of diuretics; this can affect skeletal and cardiac function hyperkalemia increase in the body's serum K level above 5 mEq/L; gained through intake and lost by excretion; the major cause of exess K is renal disease; severe tissue damage causes K to be released from the cell; excessiveness increase in foods high in K can cause serum levels to increase; this can cause cardiac arrest chloride extracellular anion; normal level is 96-105 mEq/L; chief anion in interstitial and intravascular fluid; it has the ability to diffuse quikly between the intracellular and extracellular ompartments and combines easily with sodium to form sodium chloride or with potassium to form potassium chloride; daily requirement is equal to that of sodium; the main route of excretion is the kidneys hypochloremia it usually occurs when sodium is lost because sodium and chloride are frequently paired; the most common causes of hypochloremia are vomiting and prolonged nasogastric or fistual drainage hyperchloremia it rarely occurs but may be seen when bicarbonate levels fall calcium positively charged ion; normal level is 4.5 mEq/L; 99% is in bones and teeth; deposited in the bones and mobilized as needed to help keep the blood level constant during any period of ins intake; vitamin D, calcitonin, and parathyroid hormone are necessary for absorption and utilization of calcium; the best food sources are milk and cheese hypocalcemia develops when the serum level is below 4.5 mEq/L; a deficiency may be aused by infusion of excess amounts of citrated blood, excessive loss through diarrhea, inadequate dietary intake, surgical removal of parathyroid function, pancreatic disease or small bowel disease; s/s are neuromusclar irritation and increased excitability and tetany hypercalcemia it occurs when calcium levels exceed 5.8 mEq/L; it may occur when calcium stored in the bones enters the circulation; occurs with immobilization; an increased intake of calcium or vitamin D also may be a cause; neuromuscular activity is depressed and renal calculi may develop phosphorus chiefly an intracellular anion; normal level is 4 mEq/L; this and calcium have an inverse relationship in the body; an increase in one causes a decrease in the other; the majority is found in bones and teeth combined with calcium; dietary intake is usually 800-155 mg per day; an adequate intake of vitamin D is necessary for the absorption of both calcium and this hypophosphatemia can occur from a dietary insufficiency, impaired kidney function, or maldistribution of phosphate; muscle weakness possible hyperphosphatemia most commonly occurs as a result of renal ins; also can occur with increased intake of phosphate or vitamin D; s/s tetany, numbness and tingling around the mouth and muscle spasms magnesium second most abundant cation in the intracellular fluid; normal level is 1.5-2.4 mEq/L; although only small amounts are in the blood, it is imiportant in maintaining normal body function; the majority is found in bone, muscle, and soft tissue; dietary intake is usually 200-400 mg per day; commonly distributed in foods: whole grains, fruits, veges, meat, fish, legumes and dairy products; the major route of excretion is the kidneys hypomagnesemia develops when blood levels fall below 1.5 mEq/L; a decreased level often parallels decreased potassium; s/s increased neuromuscular irritabiity similar to those observed with hypocalcemia; major auses are increased excretion by the kidneys, impaired absorption from the GI tract and prolonged malnutrtion hypermagnesemia develops when blood levels exceed 2.5 mEq; it rarely occurs when kidney functin is normal; major causes are impaired renal function, excess magnesium administration and diabetic ketoacidosis when there is severe water loss;an excess of magnesium severely restricts nerve and muscle activity bicarbonate main anion of the extracellular fluid; normal level is 22-24 mEq; it is an alkaline electrolyte who major function is the regulation of acid-base balance; it acts as a buffer to neutralize acids in the body and maintain the 20:1 bicarbonate/carbonic acid ratio needed to keep the body in homeostasis; the kidneys selectively regulate the amount of bicarbonate retained or excreted acid-base balance means homeostasis of the hydrogen ion concentration in the body fluids; hydrogen ion concentration is determined by the ratio of carbonic acid to bicarbonate in the extracellular fluid; the ratio needed for homeostasis is 1 part carbonic acid to 20 parts bicarbonate; the symbol used to indicate hydrogen ion balance is pH; arterial blood gases determine whether a solution is acid, neutral, or alkaline; the more hydrogen ions in a solution, the more aid is the solution, and the fewer hydrogen ions the more alkaline is the solution blood buffers circulate throughout the body in pairs, neutralizing excess acids or bases by contributing or accepting hydrogen ions lungs by speeding up or slowing down respirations, this an increase or decrease the amount of carbon dioxide in the blood kidneys the excrete varying amounts of acid or base the three systems that work together to maintain a normal hydrogen ion concentration kidneys, lungs, blood buffers respiratory acidosis caused by hyperventilation; respirations that increase in rate, depth, or both can result in loss of excessive amounts of carbon dioxide with a resultant lowering of the carbonic acid level in the blood; the pH rises bcause of the decrease in arbonic acid being blown off with eah exhalation; treatment is sedatio and reassurane; breathing into a paper bag will cause rebreathing of the exhaled carbon dioxide metabolic acidosis this can result from a gain of hydrogen ions or a loss of bicarbonate: retaining too many acids or losing too many bases; w/o sufficient bases, the pH of the blood falls below normal; the bicarbonate level will also drop; the effect is hyperventilation, as the lungs attempt to compensate by blowing off carbon dioxide to lower the PCO2 level; treatment is the administration of sodium bicarbonate metabolic alkalosis this results when a significant amount of acid is lost from the ody or an inrease in the bicarbonate level occurs; the most common cause is vomiting gastric content, normally high in acid; occur in patients who ingest excessive amounts of alkaline agents, suh as bicarbonate containing antacids; the CNS is depressed; treatment is aimed at the cause