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Extracellular body fluids
Is the fluid outside the cell (interstitial, intravascular, and transcellular fluid)
Involves the movement of a pure solvent across a semipermeable membrane from an area of lesser solute concentration to an area of greater solute concentration
The concentration of a solution is measured in osmols, which reflects the amount of a substance in the form of molecules, ions, or both
The solutions on both sides of the semipermeable membrane are equal in concentration (expand the body's fluid volume without causing a fluid shift from one compartment to another).
A solution of higher osmotic pressure (pulls fluid from cells, causing them to shrink)
A solution of lower osmotic pressure (moves fluids into the cells, causing them to enlarge)
Random movement of a solute in a solution across a semipermeable membrane from an area of higher concentration to an area of lower concentration
Is the process by which water and diffusible substances move together across a membrane, in response to fluid pressure, moving from an area of higher pressure to one of lower pressure
Requires metabolic activity and expenditure of energy to move substances across the cell membrane
Is stored in the pituitary gland and is released in response to changes in the blood osmolarity
Causes massive selective vasoconstriction of blood vessels and relocates blood flow to kidneys and stimulates the release of aldosterone (when the sodium is low)
atrial natriuetic peptide
Plays a critical role in the balance of fluid and electrolytes and the maintenance of vascular tone
Insensible water loss
Is continuous and occurs through the skin and lungs, not perceived by the person
Function of Potassium
Is necessary for glycogen deposits in the liver and skeletal muscle, transmission and conduction of nerve impulses, normal cardiac conduction, and skeletal and smooth muscle contraction
Function of Calcium
Bone and teeth formation, blood clotting, hormone secretion, cell membrane integrity, cardiac conduction, transmission of nerve impulses, and muscle contraction
Function of Magnesium
Essential for enzyme activities, neurochemical activities, and cardiac and skeletal muscle excitability
Function of Chloride
Chloride is the major anion in extracellular fluid (ECF). The transport of _______ follows sodium.
Function of Bicarbonate
The ________ ion is an essential component of the carbonic acid-bicarbonate buffering system essential to acid-base balance.
Function of Phosphate
It assists in acid-base regulation. ______ and calcium help to develop and maintain bones and teeth. ________ also promotes normal neuromuscular action and participates in carbohydrate metabolism.
Regulatory Mechanism of Calcium
Absorbed from intestine, excreted by the kidneys and reabsorbed or deposited in bone Regulated by parathyroid hormone, vitamin D, and calcitonin
Regulatory Mechanism of Magnesium
regulated by dietary intake, renal mechanisms, and actions of the parathyroid hormone (PTH).
Regulatory Mechanism of Phosphate
normally absorbed through the gastrointestinal (GI) tract. It is regulated by dietary intake, renal excretion, intestinal absorption, and PTH
Three types of acid-base regulators in the body
c. Physiological buffering
Hyponatremia Lab Finding
Serum sodium level below 135 mEq/L, serum osmolality 280 mOsm/kg, and urine specific gravity below 1.010 (if not caused by syndrome of inappropriate antidiuretic hormone [SIADH])
Hyponatremia Signs and Symptoms
Apprehension, personality change, postural hypotension, postural dizziness, abdominal cramping, nausea and vomiting, diarrhea, tachycardia, dry mucous membranes, convulsions, and coma
Hypernatremia Lab Finding
Serum sodium levels above 145 mEq/L, serum osmolality 300 mOsm/kg, and urine specific gravity 1.030 (if not caused by diabetes insipidus
Hypernatremia Signs and Symptoms
Extreme thirst, dry and flushed skin, dry and sticky tongue and mucous membranes, postural hypotension, fever, agitation, convulsions, restlessness, and irritability
Hypokalemia Lab Finding
Serum potassium level below 3.5 mEq/L and electrocardiogram (ECG) abnormalities: flattened T wave; ST segment depression; U wave; potentiated digoxin effects (e.g., ventricular dysrhythmias)
Hypokalemia Signs and Symptoms
Weakness and fatigue, muscle weakness, nausea and vomiting, intestinal distention, decreased bowel sounds, decreased deep tendon reflexes, ventricular dysrhythmias, paresthesias, and weak, irregular pulse
Hyperkalemia Lab Finding
Serum potassium level above 5.0 mEq/L and ECG abnormalities: peaked T wave and widened QRS complex (bradycardia, heart block, dysrhythmias); eventually QRS pattern widens and cardiac arrest occurs
Hyperkalemia Signs and Symptoms
Anxiety, dysrhythmias, paresthesia, weakness, abdominal cramps, and diarrhea
Hypocalcemia Lab Finding
Serum ionized calcium level below 4.5 mEq/L or total serum calcium below 8.5 mg/dL and ECG abnormalities: ventricular tachycardia
Hypocalcemia Signs and Symptoms
Numbness and tingling of fingers and circumoral (around mouth) region, hyperactive reflexes, positive Trousseau's sign (carpopedal spasm with hypoxia), positive Chvostek's sign (contraction of facial muscles when facial nerve is tapped), tetany, muscle cramps, and pathological fractures (chronic hypocalcemia)
Hypercalcemia Lab Finding
Serum ionized calcium level above 5.5 mEq/L or total serum calcium level above 10.5 mg/dL; x-ray examination showing generalized osteoporosis, widespread bone cavitation, radiopaque urinary stones; and elevated blood urea nitrogen (BUN) level 25 mg/100 mL and elevated creatinine level 1.5 mg/100 mL caused by fluid volume deficit (FVD) or renal damage caused by urolithiasis; ECG abnormalities: heart block
Hypercalcemia Signs and Symptoms
Anorexia, nausea and vomiting, weakness, hypoactive reflexes, lethargy, flank pain (from kidney stones), decreased level of consciousness, personality changes, and cardiac arrest
Hypomagnesemia Signs and Symptoms
Muscular tremors, hyperactive deep tendon reflexes, confusion and disorientation, tachycardia, hypertension, dysrhythmias, and positive Chvostek's sign and Trousseau's sign
Hypermagnesemia Lab Finding
Serum magnesium level above 2.5 mEq/L; ECG abnormalities: prolonged QT interval, AV block
Hypermagnesemia Signs and Symptoms
Acute elevations in magnesium levels: hypoactive deep tendon reflexes, decreased depth and rate of respirations, hypotension, and flushing
Respiratory acidosis Lab Findings
Arterial blood gas alterations: pH < 7.35, PaCO2 > 45 mm Hg, PaO2 < 80 mm Hg, and bicarbonate level normal (if uncompensated) or >26 mEq/L (if compensated)
Respiratory acidosis Signs and Symptoms
Confusion, dizziness, lethargy, headache, ventricular dysrhythmias, warm and flushed skin, muscular twitching, convulsions, and coma
Metabolic acidosis Lab Findings
Arterial blood gas alterations: pH < 7.35, PaCO2 normal (if uncompensated) or < 35 mm Hg (if compensated), PaO2 normal or increased (with rapid, deep respirations), bicarbonate level < 22 mEq/L, and oxygen saturation normal
Metabolic acidosis Signs and Symptoms
Headache, lethargy, confusion, dysrhythmias, tachypnea with deep respirations, abdominal cramps, and flushed skin
Respiratory alkalosis Lab Findings
Arterial blood gas alterations: pH > 7.45, PaCO2 < 35 mm Hg, PaO2 normal, and bicarbonate level normal (if short lived or uncompensated) or < 22 mEq/L (if compensated)
Respiratory alkalosis Signs and Symptoms
Dizziness, confusion, dysrhythmias, tachypnea, numbness and tingling of extremities, convulsions, and coma
Metabolic alkalosis Lab Findings
Arterial blood gas alterations: pH > 7.45, PaCO2 normal (if uncompensated) or > 45 mm Hg (if compensated), PaO2 normal, and bicarbonate level > 26 mEq/L
Metabolic alkalosis Signs and Symptoms
Dizziness; dysrhythmias; numbness and tingling of fingers, toes, and circumoral region; muscle cramps; tetany
Risk factors for fluid, electrolyte and acid-base imbalances
a. Age—Very young; very old
c. Environment—Diet, exercise, and hot weather and sweating
d. Chronic diseases—Cancer; cardiovascular disease, such as congestive heart failure; endocrine disease, such as Cushing's disease and diabetes mellitus; malnutrition; chronic obstructive pulmonary disease; and renal disease
e. Trauma—Crush injuries, head injuries, burns
f. Therapies—Diuretics, steroids, intravenous (IV) therapy, and total parenteral nutrition (TPN)
g. Gastrointestinal losses - Gastroenteritis; nasogastric suctioning; fistulas
How can age affect fluid, electrolyte, and acid-base balances?
Infants and children have greater water needs and are more vulnerable to fluid volume alterations; fever in children creates an increase in the rate of insensible water loss; adolescents have increased metabolic processes; older adults have decreased thirst sensation, which often causes electrolyte imbalances
How can acute illness affect fluid, electrolyte, and acid-base balances?
Surgery, head and chest trauma, shock, and second- and third-degree burns place the clients at risk.
How can surgery affect fluid, electrolyte, and acid-base balances?
The more extensive the surgery and fluid loss, the greater the body's response
How can burns affect fluid, electrolyte, and acid-base balances?
The greater the body surface burned, the greater the fluid loss
How can respiratory disorders affect fluid, electrolyte, and acid-base balances?
Predispose to respiratory acidosis and/or respiratory alkalosis
How can head injury affect fluid, electrolyte, and acid-base balances?
Can result in cerebral edema and diabetes insipidus
How can chronic illness affect fluid, electrolyte, and acid-base balances?
Cancer, congestive heart failure (CHF), or renal disease
How can cancer affect fluid, electrolyte, and acid-base balances?
Depends on the type and progression of the cancer and its treatment (diarrhea and anorexia)
How can cardiovascular disease affect fluid, electrolyte, and acid-base balances?
Diminished cardiac output, which reduces kidney perfusion and decreases urine output
How can renal disorders affect fluid, electrolyte, and acid-base balances?
Causes an abnormal retention of sodium, chloride, potassium, and water (metabolic acidosis)
How can gastrointestinal disturbances affect fluid, electrolyte, and acid-base balances?
Gastroenteritis and nasogastric suctioning result in the loss of fluid, potassium, and chloride ions.
How can environmental factors affect fluid, electrolyte, and acid-base balances?
Vigorous exercise or exposure to extreme temperatures
How can diet affect fluid, electrolyte, and acid-base balances?
Recent changes in appetite or the ability to chew and swallow (breakdown of glycogen and fat stores, metabolic acidosis, hypoalbuminemia, edema)
How can lifestyle affect fluid, electrolyte, and acid-base balances?
History of smoking or alcohol consumption (respiratory acidosis)
How can medication affect fluid, electrolyte, and acid-base balances?
Diuretics—Metabolic alkalosis, hyperkalemia, and hypokalemia
Potassium supplements—GI disturbances, including intestinal and gastric ulcers and diarrhea
Respiratory center depressants (e.g., opioid analgesics)—Decreased rate and depth of respirations, resulting in respiratory acidosis
Antibiotics—Nephrotoxicity (e.g., vancomycin, methicillin, or aminoglycosides); hyperkalemia and/or hypernatremia (e.g., azlocillin, carbenicillin, piperacillin, ticarcillin, or Unasyn)
Calcium carbonate (Tums)—Mild metabolic alkalosis with nausea and vomiting
Magnesium hydroxide (Milk of Magnesia)—Hypokalemia
Nonsteroidal antiinflammatory drugs—Nephrotoxicity
Imbalances associated with Irritability
Metabolic or respiratory alkalosis, hyperosmolar imbalance, hypernatremia, hypokalemia
Imbalances associated with Lethargy
FVD, metabolic acidosis or alkalosis, respiratory acidosis, hypercalcemia
Imbalances associated with Dysrhythmias
Metabolic acidosis, respiratory alkalosis and acidosis, potassium imbalance, hypomagnesemia
Imbalances associated with Increased respiratory rate
FVE, respiratory alkalosis, metabolic acidosis
Imbalances associated with Hypertonicity of muscles on palpation
Hypocalcemia, hypomagnesemia, metabolic alkalosis
Imbalances associated with Increased temperature
Hypernatremia, hyperosmolar imbalance, metabolic acidosis
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