fluid and electrolytes

what is the sodium levels?

135-145

What is the potassium levels?

3.5-5.0

What is the levels for chloride?

98-106

What is the CO2 levels ?

22-26

BUN levels

10-20

creatinine levels

0.6-1.2

glucose

74-110

hga1c

less than 5.7%, diabetics is less than 6.5

calcium

8.6-10

magnesium

1.6-2.6

phosphate

3-4.5

what is homeostasis?

the maintenance of a relatively constant and favorable environment for the wells

what does water do in the body?

digestion for food, wbc in blood, joints

What percent of water is in the body?

60%

What type of fluid is found in the body?

intracellular fluid, interstitial fluid and extracellular fluid

Where are the intracellular fluid compartments?

fluid inside the cells

what are the extracellular fluid compartments?

• intravascular fluid - blood

• interstitial fluid - sweat, hormones, neurotransmission

• cerebrospinal fluid

• transcellular fluid - fluid within the epithelium lined cavities

how does water move in the body?

the amount of water entering the body should equal the amount of water leaving the body

fluid intake vs fluid loss

fluid intake - ingestion of solid flood, water or intravenous fluid

fluid loss- urine, feces, sweat, exhaled air

what is the semipermeable membrane?

water can easily pass through cell and capillary membranes

• small solutes move across membrane

• large solutes (glucose, proteins) have a harder time crossing

what does the permeability of the membrane move through?

body fluid circulates throughout the body and moves from one area to the next depends

• Water easily moves through biological membranes because water molecules are small and uncharged

How does water and solutes move between the ICF, ISF, and ECF compartments

• diffusion - HIGH concentration to LOW concentration

• filtration - movement of water and solutes from blood (HIGH pressure to LOW pressure)

• osmosis - LOW solute concentration to HIGH concentration

• active transport - movement of solutes using a carrier and energy from low concentration to high concentration

explain diffusion

the movement of solutes from high concentration to low concentration

where is sodium found in the body?

mainly in extracellular fluid

where is the potassium found in the body?

intracellular fluid

What is filtration ?

the movement of water and solutes from blood to ISD area

how does exhaled hair is fluid loss?

its insensible loss. for example, if a patient has pneumonia and they are rapidly breathing, your mouth starts to get dry because you loses moisture through respirations

Where is sodium mainly found in the body?

Extracellular fluid

Where is the potassium mainly found in the body?

Intracellular fluid

What bodily mode is filtration mainly related to?

blood pressure

explain filtration in capillary arterioles

the movement of water and solutes from blood to ISF area

• ISF meaning the space in between the cells but no blood vessels

• HIGH pressure (in the vessel) to pressure LOW (outside of the vessel in the space in between cells)

explain high blood pressure in relation to filtration

when you have high blood pressure, MORE fluid will be getting pushed out of the blood pressure (ESF) into the ISF

Explain hydrostatic pressure

PUSHINGGGG force exerted by water in the blood stream

• hearts pumping action to get water to the other cells and tissues

How does water get back into the capillary (ESF)

osmosis

explain osmosis

LOW SOLUTE CONCENTRATION (ISF) to HIGH CONCENTRATION (Blood)

Use albumin as an example for osmosis

the force that PULLS water into the bloodstream (ECF) from the ICF and ISF

What helps to pull fluid back into the tissue from the blood vessel (osmotically)?

albumin

What happens when we have low albumin? High albumin?

Edema; increased intravascular volume

DIfference between filtration and osmosis

Filtration: Hydrostatic pressures PUSHES from Blood vessel into the tissue

Osmosis: PULLS water into the blood vessel from tissue (reabsorption)

How can we tell is a patient has fluid and electrolyte balance?

input and output, blood osmolality

What is blood osmolality?

osmolality measure the number of dissolved particles (solutes) in serum/plasma per unit volume

if you have a fluid overload, what does that mean for the serum osmolilty test?

• Blood is diluted

• increased water

• increased blood pressure

• increased blood volume

• DECREASED SERUM OSMOLALITY TEST

if you have dehydration, what does that mean for the serum osmolality test?

• Increase serum osmolality

• decreased water

• decreased blood pressure

• decreased blood volume

explain osmolality in terms of blood pressure

• Decreased water in the blood = decreased BP

• Increased water in the blood = HIGH BLOOD PRESSURE

  • think cause the increased volume of water in the blood makes the heart pump HARDER

What are the feedback mechanisms for water balance?

• thirst

  • increased osmolality on the blood= you get thirsty

• ADH

  • reabsorptions of water in the body

• RAAS

• SNP and BNP

why does adh make urine output low?

because adh reabsorbs water back into the body when you are thirsty/dehydrated.

why does raas system make urine output low

a feedback loop to show that the body is thirst and reabsorb that

which system helps the body get rid of fluid?

Natriuresis: ANP and BNP

explain how ANP and BNP get water out of the body.

it does excretion of a large amount of both sodium and eater by the kidneys in response to excess ECF volume

• lower bp

• blocks the raas system

explain exercetion vs secretion

• execration- removing waste

• secretion- process of moving a substance within the body (release of hormone)

Isotonic IV fluids aka normal saline; lactated ringers

IV fluids solutes are equal to solute concentration in the cell

• no water movement in or out of the cell = no cell changes

• osmolality in cell and outside cell are the same

hypotonic IV solutions ().45% or 1/2)

Hypotonic IV fluids have lower osmolality than blood (ECF)

osmosis moves water from blood into concentrated cell to dilute.

what are the potential risks for hypotonic 0.45 solutions

increased risk of cerebral edema (brain swelling)

increased risk for depleting intravascular volume (lower BP)

Hypertonic IV fluids 3% or mannitol

HIGHER osmolality than blood

pulls water by high osmotic pressure

CELL SHRINKS

• increased risk for intravascular fluid excess

explain tonicity

• hypotonic - swells

• isotonic- the same

• hypertonic-— cell shrinks

How does tonicity affect the neuron?

mental status changes will be present when seeing hypo and hyper tonic solutions in the body

what is fluid volume excess?

• neurologic changes (headache, LOC)

• high bp and bounding pulse

• pulmonary congestion

• nausea

• pitting edema

if a heart failure patient has fluid volume overload, what would this mean?

they cannot tolerate it because it will further exacerbate the heart and respiratory problems

What are the 3 causes of edema?

• increased capillary hydrostatic pressure

• decreased plasma oncotic pressure to do loss of albumin

• increased blood vessel capillary membrane permeability

Explain how increased capillary hydrostatic pressure contributes to edema

• increased pressure PUSHES fluid out of capillaries into tissue → EDEMA

• increased blood volume so we get kidney failure, congestive heart failure, and excessive IVS

Explain how decreased plasma pressure due to loss of albumin contributes to edema

hypoalbuminemia

decreased ability to pull water back into blood vessel from tissue

• kidney disease (albumin leaks into urine)

• liver cirrhosis

• protein malnutrition

What are normal albumin serum levels in the body

3.5-5.0 g/dl

explain increased blood vessel capillary membrane permeability

• inflammation and infection responses

• proteins escape from the vessel along with WBCs into interstitial space

• increased fluid movement form blood vessel to ISF

  • hypovolemia

what are causes for dehydration?

• vomiting and diarrhea

• excessive loss of sodium and water

  • third spacing

• DKA

• Insufficient water intake

which groups are most susceptible to decrease water intake?

older adults

unconscious people

people with unsafe drinking water

compare the signs of fluid excess and fluid deficit

fluid excess

• localized swelling

• pale, gray, and red skin color

• weight pain

• low bounding pulse

• high bp

• lethargic

• pulmonary congestion

Fluid Deficit

• Sunken, soft eyes

• decreased skin turgor

• dry mucous membranes

• thirst

• weight loss

• rapid, weak pulse

• fatigue

• increase body temp

Hypovolemic hyponatremia (LOW water, LOW sodium)

• low sodium (under 135)

• sodium and water are lost together

• prolonged vomiting or NG suction

• Severe diarrhea

• Inadequate secretion of aldosterone

• renal losses of sodium from diuretics and chronic real insufficiency

explain how an inadequate secretion of aldosterone contributes or hypovolemic hyponatremia

aldosterone reabsorbs water and sodium back into the body, without it is gets excreted as waste. in this case, low aldosterone means high levels of water and sodium leaving the body.

in hyponatremia does the cell shrink or swell?

swell because its moving the water into the cell and out of the blood vessel

what are the clinical manifestation of Hypovolemic Hyponatremia

clinical manifestations have to with cells swelling and hypovolemia

• decreased BP

• irritability/ headache/ confusion- mental status changes

• muscle cramps

explain hypervolemic hyponatermia

• sodium is less than 135, water is fluid overload

• occurs in HIGH blood volume - sodium is diluted with excess free water in blood

• excessive oral intake of water - water intoxication (HYPER)

• Over secretion of ADH

  • too much water is getting reabsorbed back into the body

What are the clinical manifestations related to HYPERvolemic hyponatemia

• EDEMA

• Increased blood pressure

• Mental status changes - confusion, irritability, headaches

• muscle cramps

• osmolality will be DILUTED

Hypovolemic hypernatremia causes

• sodium greater than 145

• excessive water loss with increased sodium concentration

• not enough ADH (Diabetes insipidus) not enough water getting reabsorbed back into the blood)

• high fever = excessive sweating

• heat stroke = excessive sweating

• diaherra

• diuretics

• prologner rapid respiration

• inadequate water intake

in hypovolemic hypernatremia, does the cell shrink or swell?

shrink

hypovolemia hypernatumia

hypervolemic hypernatremia

rare

• higher than 145

• over secretion of aldosterone- too much water and sodium

what are the clinical manifestations of hypervolemic hypernatremia

• mental status changes

• intestine thirst

• FLUSHED SKIN

• Increased BP

• weight gain

• BOUNDING PULSE

what is the serum level for chloride?

98-106

how does potassium influence diabetic ketoacidosis?

• insulin promotes movement of potassium into cells

• abnormal potassium levels cause cardiac conduction issues

what is hypokalemia?

potassium in the body less than 3.5

what are causes of hypokalemia?

• excessive losses cause by diarrhea

• excessive loss of potassium in urine from diuretics (potassium wasting loop and thiazide diuretics)

• excessive aldosterone or glucocorticoids

• decreased dietary intake

• treatment of diabetic ketoacidosis with insulin

explain how hypokalemia comes from loop and thiazide diuretics?

• potassium wasting

how to hypokalemia contribute to diabetic ketoacidosis?

the treatment of DKA with insulin drive potassium into the cells

when your body is in hypervolemic hypernatremia,

Too much RAAS → too much angiotensin II → too much aldosterone → excessive Na⁺ + water retention → hypertension/volume expansion + hypokalemia.

What hyperkalemia?

greater than 5

what are the causes of hyperkalemia?

• Renal failure

• deficit of aldosterone

• potassium sparing diuretics

• leakage of intracellular potassium into extracellular fluids

• displacement of potassium from cells by prolonged or severe acidosis

how does a deficit of aldosterone contribute to hyperkalemia

potassium increases because there is a decreased excretion of potassium by the distal kidney tubules

what is one similarity between hypokalemia and hyperkalemia?

cardiac arrhythmias and cardiac arrest

what is the difference between hypokalemia and hyperkalemia?

hypo

• POLYURIA- large amounts of urines

• alkalosis

• shallow breathing

Hyper

• Oliguria- small amounts of urine

• acidosis

what is the normal value for calcium?

8.6-10

what is the main thing of calcium

muscle contractions

what is hypocalcemia levels?

8.6

what are the causes of hypocalcemia?

• §Hypoparathyroidism

  §Malabsorption syndrome

  §Deficient serum albumin

  §Increased serum pH level

  §Renal failure (increased phosphorus)

how does hypocalcemia and hypoparathyroidism effected?

• abnormally low parathyroid hormone

• low levels of PTH then the body cant successfully accomplish these tasks

• cannot increase movement of calcium out of the bones

• cannot increased GI absorption

What is the effect of hypocalcemia?

increase in the permeability and excitability of nerve membrane

• muscle twitching

weak heart contractions

What are the key signs of hypocalcemia?

muscle twitching

• Chvostek signs

  • spams of lip and face

• Trousseau’s sign

  • Carpal spasm

    • Abnormal contraction of fingers

What are the causes of hypercalcemia?

• uncontrolled release of calcium ions from bones

  • neoplasms

• hyperparathyroidism

• increased calcium intake

what are the effects of hypercalcemia ?

• depressed neuromuscular activity

  • muscle weakness

• interference with ADH function

• Increased strength in cardiac contractions

calcium imbalance

what effect does calcium and phosphate have?

• Increased calcium

• Decrease phosphate

  • inverse relationship