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58 terms

Fluid Disorders

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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
Hypothalamus
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
K
Main ECF cation
Na
Main ICF anion
P (as PO4)
Main ECF anion
Cl
Cation used in coagulation
Ca
Cation used in enzyme rxns
Mg
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
ABC/RF
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
"HAPPY VD"
Hypoparathyroidism, Acute Pancreatitis, Vit D deficiency, chemo
Hypocalcemia EKG
Extended QT-interval
Hypercalcemia causes
"PHAG"
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
Hypervolemia
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
Hypovolemia
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
Anasarca
Severe edema of all tissues, esp subcutaneous tissue
Usual cause of Pitting Edema
Transudate
Effusion
Fluid collection in body cavity
Hydrothorax
Pleural effusion: fluid in lung cavity
Hydropericardium
Pericardial effusion: fluid in cardiac space
Ascites
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)