patho (Fluid, Electrolyte, & Acid-Base Homeostasis)

males compared to females have ________% more solids and ________% less fluids

5; 5. men total 40 solid 60 fluid. (remember this bc men have more muscle than fat compared to women and muscle cells store water unlike fat cells

Fluids, electrolytes, and pH all share a dynamic relationship in which imbalances in one area can cause imbalances in the other two. Additionally, the other areas can serve to ________ for those imbalances. When compensatory mechanisms fail to reestablish homeostasis, many bodily functions are impaired, and serious consequences can result. In such a case, medical interventions will be necessary to reestablish stability.

compensate

Newborns and infants have less body fat, so they have higher amounts of water compared to adults. While water levels may be high in this age group, their compensatory mechanisms are immature, so water losses (e.g., vomiting and diarrhea) can have serious consequences. The amount of body water decreases as the child ages until ______, at which time adult ratios are reached. With ____, both adipose tissue and muscle mass often decrease. Additionally, compensatory mechanisms decline with ____. ______, regardless of age, results in lower body water. Due to all of these factors, those individuals who are obese, very young, or very old are more susceptible to fluid imbalances, especially dehydration.

puberty, age, age, obesity

____________ fluid: fluid inside the cells primarily defined as _____

The ________________ _______ serves as a barrier through which substances and water must pass to move to or from this component

Intracellular fluid (ICF), cytoplasm

plasma membrane

____________ fluid: fluid outside the cells

• Interstitial fluid (ISF): _____ the _____

• Intravascular fluid: _____ the ______ ______

• Transcellular fluid (TSF): (i.e., CSF; pleural/pericardial/peritoneal cavities; joint spaces, lymph, eyes, GI tract)

Extracellular fluid (ECF)

between the cells

inside the blood vessels

___ is 40% of body weight and is rich in potassium, magnesium, and proteins. ___ is rich in sodium, chloride, and bicarbonate (80% of this is ___ 20% is ____ composed of plasma) transcellular fluid is 1% of body fluid

intracellular fluid (ICF), extracellular fluid (ECF), interstitial fluid (ISF), intravascular fluid (IV)

osmolarity vs osmosis

Osmolarity is the concentration of solute particles in a solution, it affects

osmosis which is the process of water diffusion from an area of low solute concentration to an area of high solute concentration.

osmosis depends on hydrostatic (push or pull?) like BP and osmotic (push or pull?) pressures like water moving from low to high solute conc

Hydrostatic pressure () fluid out of the capillary, osmotic pressure draws () it back in

push, pull

Hydrostatic pressure PUSHES fluid out of the capillary, osmotic pressure draws PULLS it back in

___________: osmotic pressure of two solutions separated by a semipermeable membrane; capability of a solution to modify the volume of cells by altering their water content. The effect of a solution on cell volume

____________ solutions: same conc in and out the cell no fluid shift

In ________ osmolality, extracellular fluid (blood/plasma) having equal solute as inside the cells

____________ solutions: lower solute concentrations outside the cell, causing fluids to shift out of the intravascular compartment into intracellular space

In ________ osmolality, solute concentration in cells is greater than in blood aka extracellular fluid (blood/plasma) having less solute than inside the cells

___________ solutions: higher solute concentration outside the cell compared to inside the cell. This causes fluid to shift out of the cell, into the intravascular space

In _______ osmolality, solute concentration in cells is less than in blood aka extracellular fluid (blood/plasma) having more solute than inside the cells

Tonicity

isotonic

hypotonic

Hypertonic

iso,hyper,hypo

difference between osmosis and diffusion?

osmosis is water going across a semipermeable membrane from low to high to dilute for equilibrium. diffusion is particles going from high to low for equilibrium

Osmotic pressure is regulated by the plasma protein ________

Albumin. read the image!

in the _______ end, blood pressure is higher than osmotic pressure bc it is close to the strongly pumping heart and net pressure is pushing OUT away from heart

At this end of a capillary, blood pressure (hydrostatic pressure) is higher than osmotic (oncotic) pressure because the blood is freshly pumped from the heart — it's still under the strong pressure wave generated by ventricular contraction

oncotic pressure is a type of osmotic pressure specific to proteins(ex albumin sponges for capillary

Arterial

in the _______ end, osmotic pressure is higher than blood pressure and net pressure is IN toward the heart

At this end, low blood/hydrostatic pressure allows oncotic/osmotic pressure to dominate, so fluid returns to the capillary.

oncotic pressure is a type of osmotic pressure specific to proteins(ex albumin sponges for capillary

Venous

In health care, the external solution described in relation to tonicity is an intravenous solution—specifically, IV solutions containing electrolytes (crystalloids) and other solutes (e.g., glucose) that are used to treat a variety of patient conditions (e.g., dehydration and shock). These solutions are classified based on their tonicity as either isotonic, hypotonic, or hypertonic

yay

fluid sources (oral intake or IV solutions) can be iso-, hypo-, or hypertonic

oooo

2 Sensible fluid losses

2 Insensible fluid losses

Urine and stool (measurable)

Sweat and respiration (immeasurable)

ADH keeps water

Aldosterone thus RAAS keeps sodium and dumps potassium

ADH stops water losses through urine. Released from the pituitary gland in times of decreased fluid volume and increased osmolarity, ADH promotes the reabsorption of water into the blood from the renal tubules.

aldosterone hormone tells kidneys to increase reabsorption of sodium … increases blood volume bc water stays as well to balance the salty conc

aldosterone is part of RAAS (left side of image chart) ADH is not

ANP is released when the atria of the myocardium become overstretched, indicating increased fluid volume. This peptide stimulates renal vasodilation, thereby increasing urinary output. Additionally, atrial natriuretic peptide suppresses aldosterone secretion and STOPS RAAS, further increasing urinary output.

Decreased fluid volume or increased osmolarity (solute concentration) triggers the thirst mechanism in the (), which prompts the individual to increase oral intake of fluids.

-one of the best regulators of water balance

This thirst sensation can decrease with age, a phenomenon called ()

hypothalamus

hypodispia

Fluid excess is referred to by several names depending on the compartment affected by poor fluid distribution. when it is excess fluid in interstitial space ______ this is an issue with fluid distribution not always overload and anasarca is the word for generalized this, excess fluid in intravascular space _______ this is from excessive sodium or water intake w insufficient water losses to compensate, in intracellular space ______ this may lead to lysis of cell w cerebral cells being most sensitive to this

edema; hypervolemia; water intoxication

what causes Hypervolemia? Excessive _______or______ intake and insufficient _______or______ losses

Excessive sodium/water intake and insufficient sodium/water losses

Polydipsia

excessive thirst

What can cause excessive sodium or water intake?

-High-sodium diet

-Psychogenic polydipsia (drinking too much water bc anxiety or ocd or schizophrenic bc your mind thinks u need it not bc any somatic reason)

-Hypertonic fluid administration

-Free water

-Enteral feedings

-High-sodium diet

-Psychogenic polydipsia (drinking too much water bc anxiety or ocd or schizophrenic bc your mind thinks u need it not bc any somatic reason)

-Hypertonic fluid administration

-Free water

-Enteral feedings

What can cause inadequate sodium/water elimination? (3 ____ failure and 3 conditions

-Hyperaldosteronism

-Cushing's syndrome (a condition w excessive corticosteroids, which act like aldosterone)

-Syndrome of inappropriate antidiuretic hormone (excessive ADH)

-Renal failure (kidney unable to eliminate fluid or waste)

-Liver failure (less albumin→fluid leaks out of blood vessels into tissues causing edema→low blood volume so RAAS is activated→fluid overload but poor distribution→worse edema

-Heart failure (unable to pump effectively so less blood to kidney)

Manifestations of fluid excess

1. Rapid weight _____

2. Anasarca/Peripheral/periorbital/cerebral ___

3. ______ fontanelles (in infants)

🫁

6. ____pnea

7. _______ thus pulmonary _____

❤

8. ______ pulse

9. _____cardia

10. ____JV (flat or distended)

11. ____BP

12. ___heart sound

🚽

12. ____uria

13. anorexia

14. nausea

🧠

15. changes in LOC (level of consciousness)

16. confusion

17. headaches

18. seizures

🦵 Edema / Swelling:

1. Rapid weight gain

2. Anasarca/Peripheral/periorbital/cerebral edema

3. Bulging fontanelles (in infants)

🫁 Respiratory:

6. Dyspnea (shortness of breath)

7. Crackles (fluid in lungs) thus pulmonary congestion

❤ Cardiac:

8. Bounding pulse

9. Tachycardia

10. Jugular vein distension (JVD)

11. Hypertension

12. S3 heart sound

🚽 Kidneys / Output:

12. Polyuria (pale, high-volume urine)

13. anorexia

14. nausea

🧠 Neuro:

15. changes in LOC (level of consciousness)

16. confusion

17. headaches

18. seizures

What are some cardiovascular effects that can happen from fluid excess?

-bounding pulse

-high BP

-jugular vein distention

-S3 heart sound

-Tachycardia

What are some neurologic effects that can happen from fluid excess?

-changes in LOC (level of consciousness)

-confusion

-headaches

-seizures

What is a respiratory side effect of fluid excess?

Pulmonary congestion

________ and ______ are side Gastrointestinal side effects of fluid excess

Anorexia and nausea

Why would a hematocrit (% of blood that is made up of RBC) on a patient with fluid excess be reduced?

plasma volume (the liquid part of blood) increases.

• But # of RBCs stays the same.

• So the RBCs become diluted in all that extra fluid.

• This makes the percentage of RBCs (hematocrit) go down — even though the actual number of RBCs hasn’t changed.

bc of all the excess fluid, there is more water than sodium, so sodium concentrations will be reduced too

_______ _______: when total body fluid levels are insufficient to meet the body's needs

fluid deficit results in () which is when body loses more fluid than it takes in

Fluid deficit

dehydration

Decreased fluid in the intravascular space

Hypovolemia

does fluid deficit only occur from electrolyte defect?

no, it can also occur independently without electrolyte defects

Decrease in fluid level leads to... (3)

___BP

______conc of blood solutes

cells _____

-increase in level of blood solutes

-cell shrinkage

-hypotension (low BP

what are the 2 causes of inadequate fluid intake? (one is the obvious dietary the other is … in the hospital… the nurse has to do what to IV fluid?

-poor oral intake

-inadequate IV fluid replacement

Excessive fluid or sodium losses can occur from...

GI how?

from skin how?

respiratory how?

bloodhow?

renal how?

🧻 1. Fluid Loss from the GI Tract

• Gastrointestinal losses (vomiting, diarrhea, suction)

💦 2. Loss from the Skin or Respiratory System

• Excessive diaphoresis (sweating)

• Burns

• Open wounds

• Prolonged hyperventilation (water loss through breathing)

🩸 3. Blood/Plasma Loss

• Hemorrhage

• Ascites (fluid shifts into the abdomen)/ Effusions (fluid shifts into pleural or pericardial spaces)

  These are examples of third-spacing. Fluid shifts out of the vasculature into spaces like the abdomen or pleura. Even though total body water is still present, it’s not in the right place and cannot be used for perfusion thus—your body acts like it's dehydrated

🧠 4. Renal Losses (Kidneys)

• Nephrosis (loss of protein and fluid in urine)

• Diabetes mellitus (glucose pulls water → osmotic diuresis)

• Diabetes insipidus (loss of water due to lack of ADH)

• Excessive use of diuretics

• Osmotic diuresis

Manifestations of fluid deficit

Neuro(3): _____, altered ____, mood? Cardio: ____BP, ____cardia, ____JV (flat or distended) Resp: _____resp (increased or decreased resp) Renal: ___guria Edema: weight _____, _____fontalles (sunken or bulging), _____ mucous membranes, ____skin turgor aka ________

Neuro

Thirst, altered LOC, confusion/restless

Cardio Resp

low BP, tachycardia, weak pulse, flat JVs increased resp

Renal

Oliguria

Edema

Weight loss, sunken fontanelles, Dry mucous membranes, ↓ skin turgor so tenting

Positively charged electrolytes () negatively are ()

what 3 functions/roles do electrolytes have?

Cations (na,mg,k,ca) anions (chloride and bicarb)

role in homeostasis, muscle and neural activity, acid-base and fluid balance

does the kidney eliminate or reabsorb sodium?

where is sodium found?

what 2 major roles does sodium play as an electrolyte?

reabsorbs

extracellular fluid (ECF)

it regulates fluid volume and neurological function

what 2 major roles does potassium play as an electrolyte?

where is potassium found?

does the kidney eliminate or reabsorb potassium?

-muscle contraction, cardiac conduction

intracellular fluid (ICF)

eliminate

3 major roles of calcium as an electrolyte:

insufficiency in calcium leads to

-bone health, neuromuscular function, cardiac function

osteoporosis

5 major electrolytes

sodium, potassium, chloride, calcium, magnesium

where is magnesium found?

magnesium plays a role in (2)

intracellular fluid (ICF) & in bone tissue

keeping bone healthy and many cellular functions

alcoholism leads to low levels of electrolytes, which one is most affected/decreased

Magnesium

where is chloride found?

chloride binds to

chloride is essential for

extracellular fluid (ECF)

other ions

HCL production (hydrochloric acid)

normal range of sodium

135-145 mEq/L

the most significant cation and prevalent electrolyte in ECF

sodium

what controls serum osmolality and water balance?

Sodium

sodium facilitates muscles and nerve impulses through the ___________________

sodium-potassium pump

main source for sodium is

sodium is excreted through the _____ and ______

does sodium play a role in the acid-base balance?

dietary intake

kidneys and GI tract

yes

__________: increase in membrane potential / less polar

__________: restoration of resting potential / more polar

Depolarization

Repolarization

resting membrane potential

-70mV

really helpful action potential video link

https://www.youtube.com/watch?v=W2hHt_PXe5o

Hypernatremia is when sodium levels are greater than _______ mEq/L

145

2 causes of Hypernatremia. which is more common?

-excessive sodium

-deficient water

usually from water loss not sodium gain. sodium gain is from more unusal things like (too much dietary sodium, cushings, hypertonic IV saline, corticosteroid use)

what are 4 examples of causes that could cause excessive sodium?

-too much dietary sodium

-hypertonic IV saline

-Cushing's

-corticosteroid use

what are 6 examples of causes that could cause hypernatremia from deficient water?

answer me this…. one of the options is either diabetes mellitus or diabetes insipidus… which is it?

-insufficient intake

-third spacing

-excessive output

-prolonged hyperventilation

-diuretic use

-diabetes insipidus

manifestations of hypernatremia:

C- cardiac (____cardia, ____ pulse, BP____,

H- head (fever, flushed skin, headache, seizure)

F- fluid (___(thirsty or dehydrated?), ____ urine output, _____fluid retention, edema, ___ mouth, _____ mucous membranes, ___phagia)

M- mood (______________ at first while neurons start to _________ this can lead to _______ in extreme then ____________ as the neurons _______ this leads to ____in extreme)

cardiac head fluid mood

C- cardiac (tachycardia, thready pulse, BP changes,

H- head (fever, flushed skin, headache, seizure)

F- fluid (thirsty, decreased urine output, increased fluid retention, edema, dry mouth, dry/sticky mucous membranes, dysphagia)

M- mood (restless/irritable/agitated at first while neurons start to excite/shrink this can lead to seizure in extreme then slow/lethargy/weakness as the neurons shut off/lose function this leads to coma in extreme)

hypernatremia pic

when a patient has hypernatremia, the __________ ________ releases ADH (antidiuretic hormone) to

pituitary gland;

recover water from urine in kidneys to put water back in blood

Hyponatremia is when sodium is less than

135 mEq/L

serum osmolarity ___________ in hyponatremia

decreases

2 casues of hyponatremia:

-deficient sodium

-excessive water

Hyponatremia related to deficient sodium can be a result of...

diuretic use,

gastrointestinal losses,

diaphoresis,

insufficient aldosterone,

adrenal insufficiency,

dietary sodium restrictions

what is diaphoresis,

sweating excessively from disease or drug side effect

Hyponatremia related to excessive water can be a result of...

hypotonic IV saline,

hyperglycemia,

water intake,

renal failure,

syndrome of inappropriate antidiuretic hormone,

heart failure

manifestations of hyponatremia:

C- cardiac (_____ BP/pulse)

R- resp (_____ respiration

G- GI (anorexia, abdominal cramping/GI upset

M- muscle weak/spasm/diminished deep tendon reflexes,

F- fluid (edema, dry mucous membranes, skin turgor bad)

N- neuro (coma, seizure, headache, confusion, lethargy)

C- cardiac (changed BP/pulse)

R- resp (shallow respiration

G- GI (anorexia, abdominal cramping/GI upset

M- muscle weak/spasm/diminished deep tendon reflexes,

F- fluid (edema, dry mucous membranes, skin turgor bad)

N- neuro (coma, seizure, headache, confusion, lethargy)

hyponatremia pic

normal chloride electrolyte range

98-108 mEq/L

which electrolyte is a mineral electrolyte and major extracellular anion?

Chloride

__________ can bind and travel with cations (sodium, potassium, calcium)

Chloride

how does chloride assist in fluid distribution?

where is chloride found? (4)

by attaching to water or sodium

-gastric secretions, pancreatic juices, bile, cerebrospinal fluid

what is the main source for chloride?

where is chloride excreted?

chloride plays a role in the acid-base balance when it is bound to

dietary intake;

through the kidneys

hydrogen

hyperchloremia is when chloride levels are greater than ________ mEq/L

2 causes of hyperchloremia:

manifestations of hyperchloremia:

108

-increased chloride intake, decreased chloride excretion

reflect the underlying causes manifestations

hypochloremia is when chloride levels are less than ______ mEq/L

2 causes of hypochloremia:

manifestations of hypochloremia

98

-decreased chloride intake, increased chloride excretion

reflect the underlying causes manifestations

causes of decrease chloride intake (4)

causes of increased chloride intake: (4)

DECREASED CHLORIDE INTAKE

Hyponatremia,

administration of 5% dextrose in water intravenous solution,

water intoxication,

hypokalemia

INCREASED CHLORIDE INTAKE

hypernatremia,

hypertonic intravenous solution,

metabolic acidosis,

hyperkalemia

causes of increase chloride excretion (4)

causes of decreased chloride excretion: (3)

INCREASED EXCRETION

Diuretics, vomiting,other gastrointestinal losses, metabolic alkalosis,

DECREASED EXCRETION

hyperparathyroidism, hyperaldosteronism, renal failure

normal potassium range

3.5-5 mEq/L

The primary intracellular cation

Potassium (K+)

Plays a role in electrical conduction (nervous, musculoskeletal, cardiovascular), acid-base balance, and metabolism

Potassium

main source of potassium

dietary intake

where is potassium excreted?

-kidneys

-GI tract

Serum __________ cannot fluctuate much without causing serious issue.

potassium

Hyperkalemia pic

>5 mEq/L

hyperkalemia

3 main causes of hyperkalemia:

-deficient excretion

-excessive intake

-increased release from cells

causes of Hyperkalemia through deficient potassium excretion:

renal failure,

Addison’s disease,

certain medications,

Gordon’s syndrome

oral potassium supplements, salt substitutes, rapid intravenous administration of diluted potassium

these are causes of __________ through ______________

excessive potassium intake

causes of Hyperkalemia through increased release from cells:

acidosis,

blood transfusions,

burns or any other cellular injuries

manifestations of Hyperkalemia:

muscle, resp, cardio, urine, nerve, gastro

M- muscle weakness

R- respiratory rate decrease

C- heart (bradycardia,dysrhythmias, cardiac arrest, EKG changes)

U- urine (oliguria/anuria)

N- nerve(paresthesia,flaccid paralysis, reflexes)

G- gastro (abdominal cramping, nausea, diarrhea)

Potassium <3.5 mEq/L

hypokalemia

3 main causes of Hypokalemia:

-excessive loss

-deficient intake

-increased shift into the cell

some causes of Hypokalemia related to excessive loss:

some causes of Hypokalemia related to deficient intake (3):

causes of Hypokalemia related to increased shift into the cell (2):

vomiting, diarrhea, nasogastric suctioning, fistulas, laxatives, potassium-losing diuretics, Cushing’s syndrome, and corticosteroids

malnutrition, extreme dieting, and alcoholism

alkalosis and insulin excess

manifestations of Hypokalemia:

gut cant move normally

G- GI (contipation, abdomen distended, decrease bowel sound, ileus

C- cardiac (hypotension, thready pulse, arrhythmia, ECG changes, cardiac arrest)

M- muscle (weakness, leg cramp,

N- nerve (paresthesia, light reflexes hyporeflexia, weak, confused, irritable)

normal range of calcium:

4–5 mEq/L

main source of calcium

where is calcium absorbed?

calcium is excreted in

5 roles of calcium

dietary intake

GI tract (small intestine

urine and stool

(5) blood clotting, hormone secretion, receptor functions, nerve transmission, muscular contraction

calcium has an inverse relationship with ___________ and a synergistic relationship with _____________

______________________ aids calcium absorption

what 3 things regulate calcium?

phosphorus;

magnesium

vit D

vitamin K, parathyroid hormone, calcitonin

Calcium >5 mEq/L

hypercalcemia

hypercalcemia causes related to increased intake or release:

hypercalcemia causes related to deficient excretion:

increased intake or release: calcium antacids, calcium supplements, cancer (esp bone but also others), immobilization, corticosteroids, vitamin D deficiency, hypophosphatemia

deficient excretion: renal failure, thiazide diuretics, hyperparathyroidism

manifestations of hypercalcemia

(reflect decreased cell membrane excitability and are often nonspecific. affect cardiac, nervous, musculoskeletal, gastrointestinal, and renal systems )

cardiac	dysrhythmias, EKG changes, high BP, arrest
GI	Abdominal pain, nausea, vomiting, constipation, anorexia
Musculoskeletal	Bone pain/weak, muscle weakness, , decreased deep tendon reflexes
Renal	Renal calculi(kidney stones), polyuria ((high calcium levels interfere with ADH, resulting in increased water excretion), polydipsia, dehydration, pancreatitis
Neuro	Lethargy, fatigue, malaise, confusion, depression, memory loss, headache, stupor, coma,

hypocalcemia is levels less than _______ mEq/L

4