58 terms

Fluid Disorders

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
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
Main ECF cation
Main ICF anion
P (as PO4)
Main ECF anion
Cation used in coagulation
Cation used in enzyme rxns
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
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
Hypoparathyroidism, Acute Pancreatitis, Vit D deficiency, chemo
Hypocalcemia EKG
Extended QT-interval
Hypercalcemia causes
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
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
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
Severe edema of all tissues, esp subcutaneous tissue
Usual cause of Pitting Edema
Fluid collection in body cavity
Pleural effusion: fluid in lung cavity
Pericardial effusion: fluid in cardiac space
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)