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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 _______________