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Patho module 2 Alterations in fluids and solutes - Increased blood osmolality (pathologic water LOSS)

Terms in this set (22)

the most common mechanism for an increase in blood osmolality is (LOSS OR GAIN) of water

a. there are many permutations of fluid loss & subsequent shifts; we will be
discussing only pure water loss.
LOSS
b. pathologic water loss can occur via:
INADEQUATE INTAKE OR OUTPUT
simple diagram: disease causing a continuing water loss from body water
loss from bloodincreased blood osmolalitywater loss from cells overall
____________.
simple diagram: disease causing a continuing water loss from body water
loss from bloodincreased blood osmolalitywater loss from cells overall
dehydration.
step-by-step example of fluid shifts when there is water loss, such as in severe diarrhea caused by intestinal _______:
step-by-step example of fluid shifts when there is water loss, such as in severe diarrhea caused by intestinal infection:
a. in certain intestinal infections, a microbe causes disruption in the integrity of the walls of millions of capillaries that line the intestines water "leaks" from the capillaries into the ________ of the intestines (the increase in fecal liquid is part of what causes the diarrhea).
a. in certain intestinal infections, a microbe causes disruption in the integrity of the walls of millions of capillaries that line the intestines water "leaks" from the capillaries into the lumen of the intestines (the increase in fecal liquid is part of what causes the diarrhea).
B. as water leaks from the local capillaries, eventually the blood of the entire circulatory system is becoming more _________ than the surrounding tissues all over the body (thus, as per the rule, the vascular compartment is the first to change its composition)
as water leaks from the local capillaries, eventually the blood of the entire circulatory system is becoming more concentrated than the surrounding tissues all over the body (thus, as per the rule, the vascular compartment is the first to change its composition)
C. next, there is a domino effect of fluid shifting: since the plasma compartment (ie, the bloodstream all over the body) now has a higher _________ than the next door tissue compartment (all over the body), water will be PULLED INTO the plasma compartment, leaving the tissue cells ________ & shrunken. (ie, ultimate shift of fluid is T to B)
. next, there is a domino effect of fluid shifting: since the plasma compartment (ie, the bloodstream all over the body) now has a higher osmolality than the next door tissue compartment (all over the body), water will be PULLED INTO the plasma compartment, leaving the tissue cells dehydrated & shrunken. (ie, ultimate shift of fluid is T to B)
3. S&S caused by T-to-B fluid shift such as example above
A. think "dehydration;" in nursespeak, we would think of this state as a "fluid volume deficit."


b.as tissue cells have their water "pulled out" into the vascular system, which is now more concentrated than the tissues (CONCENTRATION CALLS), the tissues eventually show dehydration all over the body in the following ways:

1) dry mucus membranes
2) poor skin turgor -- skin loose, "tents" when pinched, won't "snap back.
3) sunken eyes
4) sunken fontanels in babies
5) diminished urinary output (oliguria) & also urine concentration increases.
6) sometimes low BP (blood pressure) if dehydration bad enough
7) acute CNS (central nervous system) changes related to dehydrated brain cells-- restlessness, confusion, unconsciousness, convulsions.

c. if we did lab work, we would see a high serum osmolality (we would consider this patient's blood to be hyperosmolar.
- state of flexibility or tightness of the skin cells due to how much water they have. A certain amount of water in these cells is desired for good elasticity & protection. If the skin is pulled up & snaps back, it has good recoil and elasticity, indicating adequate hydration of the skin cells—this is called "good skin turgor," or "good recoil." If there is too much water in the tissue (edema), the skin will be tight. If there is not enough, the skin will be loose and have little recoil; when pulled, it "tents" up. This is called "poor skin turgor" or "tenting" and indicates dehydration.
Skin turgor
diminished urinary output (_________) & also urine concentration increases.
diminished urinary output (oliguria) & also urine concentration increases.
6) sometimes ____ BP (blood pressure) if dehydration bad enough
6) sometimes low BP (blood pressure) if dehydration bad enough
acute CNS (central nervous system) changes related to dehydrated ______ cells-- restlessness, confusion, unconsciousness, convulsions.
acute CNS (central nervous system) changes related to dehydrated brain cells-- restlessness, confusion, unconsciousness, convulsions.
if we did lab work, we would see a _______ serum osmolality (we would consider this patient's blood to be hyperosmolar.
high
the body has certain intrinsic hormonal compensatory mechanisms to correct fluid volume deficit (and/or low blood pressure). WHAT IS IT?
RAAS - renin-angiotensin aldosterone system
increased renin is secreted by the kidneys in the following situations:

a) when blood osmolality is _____ (usually because of water loss)
and/or
b) when fluid volume in the circulation is low due to blood loss
and /or
c) BP is _____
increased renin is secreted by the kidneys in the following situations:

a) when blood osmolality is high (usually because of water loss)
and/or
b) when fluid volume in the circulation is low due to blood loss
and /or
c) BP is low
renin stimulates secretion of angiotensin I becomes
_____________with the "help" of ACE (angiotensin converting enzyme)
angiotensin II
angiotensin II has two important duties: stimulates _________ vasoconstriction & increases _________ of aldosterone from the adrenal gland
peripheral
secretion
peripheral vasoconstriction means ______ blood will flow into the constricted blood vessels in the periphery & will stay in the central circulation.
less
aldosterone causes kidney tubules to "hold on" to ______+ water follows Na+ back into _______ instead of going out with urine urine output ______water in blood and general circulatory volume increases
aldosterone causes kidney tubules to "hold on" to Na+ water follows Na+ back into circulation instead of going out with urine urine output decreaseswater in blood and general circulatory volume increases
summary: _________ causes increased circulatory fluid volume and compensates for (ie, "fixes") the initial problem of low fluid volume (as
in water loss), low total blood volume (as in bleeding), &/ or low BP.
summary: RAAS causes increased circulatory fluid volume and compensates for (ie, "fixes") the initial problem of low fluid volume (as
in water loss), low total blood volume (as in bleeding), &/ or low BP.
5) when fluid volume is high, the RAAS is suppressed.
5) when fluid volume is high, the RAAS is ________
5) when fluid volume is high, the RAAS is suppressed.
b. ADH-- antidiuretic hormone secretion assists ________.
RAAS
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