patio week 5 lecture - fluid and electrolytes

What is the role of sodium in fluid balance?

Sodium helps regulate fluid balance by controlling the movement of water in and out of cells.

What is a hypertonic solution?

A hypertonic solution has a higher concentration of solutes outside the cell, causing water to move out and the cell to shrink.

What is a hypotonic solution?

A hypotonic solution has a lower concentration of solutes outside the cell, causing water to move in and the cell to swell.

What is the effect of hypertonic solutions on bacterial cells?

Hypertonic solutions can shrink bacterial cells by drawing water out of them.

What is the significance of calcium in the body?

Calcium is essential for muscle contraction, nerve function, and blood clotting.

What can cause increased thirst?

Increased thirst can be caused by dehydration, high sodium intake, or certain medical conditions.

What is the relationship between potassium and fluid balance?

Potassium helps maintain fluid balance and is crucial for proper muscle and nerve function.

What is the role of Vitamin D in calcium regulation?

Vitamin D enhances calcium absorption in the intestines and helps maintain calcium levels in the blood.

What is respiratory acidosis?

Respiratory acidosis occurs when the lungs cannot remove enough carbon dioxide, leading to increased acidity in the blood.

What are the symptoms of dehydration?

Symptoms of dehydration include decreased thirst, dry mouth, fatigue, and dark-colored urine.

What is the function of the renin-angiotensin system?

The renin-angiotensin system regulates blood pressure and fluid balance by controlling sodium and water retention.

What is the effect of alkalosis on the body?

Alkalosis can cause muscle twitching, hand tremors, and confusion due to decreased acidity in the blood.

What is the significance of bicarbonate in the body?

Bicarbonate acts as a buffer to maintain pH balance in the blood and neutralize acids.

What is the normal pH range for human blood?

The normal pH range for human blood is approximately 7.35 to 7.45.

functions of body fluids

- Transport gases, nutrients, and wastes

- Help generate the electrical activity needed to power body functions

- Take part in the transforming of food into energy

- Maintain the overall function of the body

intracellular compartment (ICF)

1) fluid within cells

2) ~2/3 of body water

3) site of ↑ K+, moderate amounts of Mg2+

Extracellular Compartment (ECF)

-Contains the remaining one third of body water

-Contains all the fluids outside the cells, including that in the interstitial or tissue spaces and blood vessels

-High concentration of Na+

composition of ECF

-large amounts of sodium and chloride

-reasonable large amounts of bicarbonate ions

-small amounts of potassium, calcium, magnesium, phosphate, and organic acid ions

BABY W/ CHLORIDE AND CALCIUM EARS AND SODIUM AND BICARBONATE HAIR

composition of ICF

-almost no calcium

-small amounts of sodium, chloride, bicarbonate, and phosphorus

-moderate amounts of magnesium

-large amounts of potassium

ADULT WITH EYES MADE OF POTASSIUM AND PHOSPHORUS AND MAGNESIUM MOUTH

potassium concentration is highest inside of or outside of the cell?

Inside

sodium concentration is highest inside of or outside of the cell?

outside

which ion is in the highest concentration in the ICF

potassium

concentration gradient

difference in concentration over a distance

diffusion

the movement of charged or uncharged particles along the concentration gradient from an area of higher concentration to one of lower concentration

osmosis

the movement of water access a semipermeable membrane from the side of the membrane with the lesser number of particles and greater concentration of water to the side with the greater number of particles and lesser concentration of water

tonicity

The tension or effect that the effective osmotic pressure of a solution with impermeable solutes exerts on cell size because of water movement across the cell membrane

isotonic

fluid balance equal

neither shrink or swell

hypotonic

less particles outside the cell so water flows into the cell

SWELLS

hypertonic

more particles outside the cell, fluid leaves the cell

shrinks

lyse

when a cell bursts from too much water (hypotonic)

3rd spacing

loss or trapping of ECF in the transcellular space

examples: pericardial sac, peritoneal cavity, pleural cavity

contributes to body weight but nit fluid reserve

causes of 3rd spacing

leaky capillary syndrome (pancreatitis)

liver failure

intestinal obstruction

crush injury

burns

edema

increase cap filtration pressure and permeability

decrease capillary osmotic pressure

obstructs lymph flow

body water is ?% of body weight

60

physiologic mechanisms assisting in regulation of body water

thirst (primary)

ADH (regulates water output)

both respond to changes in ec osmolaty and volume

hypodipsia

Decrease in the ability to sense thirst associated with cerebral lesions in the hypothalamus.

can lead to: stroke, confusion, sensory deficits, motor disturbances

polydipsia

symptomatic/true thirst

false thirst

compulsive thirst

symptomatic/true thirst

due to loss of body water; resolved when water is replaced

false thirst

from increased angiotensin (CHF< DM< CKD) or anticholinergic drugs

compulsive water drinking

psychogenic polydipsia, most common in schizophrenic patients. Some antipsychotic drugs (and cigarettes) can increase antidiuretic hormone, but still mysterious. Could lead to water intoxication

baroreceptors

regulate effective volume

how kidneys control PH

main regulator of sodium

monitors arterial pressure (retains sodium when decreased and eliminates it when increased)

rate coordinated by sympathetic nervous systems and RAAS

ANP may also regulate sodium excretion by kidney

how lungs control PH

Via carbonic acid concentration, PCO2

RAAS

renin-angiotensin-aldosterone system

diabetes insipidus

antidiuretic hormone is not secreted adequately, or the kidney is resistant to its effect leading to large concentrations of urine output (very light colored)

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

fails to use the negative feedback system that regulates the release and inhibition of ADH

decreased urine production, very darl

assessment of body fluid loss

heart rate (thready/fast, or bounding/slow)

BP low

fluid volume deficit

inadequate eintake

GI loss (vomit, diarrhea)

renal

skin

3rd spacing

fluid volume excess

excessive fluid and/or sodium intake

inadequate elimination: renal, hear, liver failure, corticosteroid excess

water intoxication

causes lysis of cells which can lead to death

very important to follow directions for baby formula

potassium distribution and regulation

Body stores: depend on body size & muscle mass

Source: dietary intake

Regulation:

Renal mechanisms → conserve or excrete K⁺

Transcellular shifts → movement between ICF & ECF

ICF K+ concentration

140-150 mEq/L

ECF K+ concentration

3.5-5.5 mEq/L

hypokalemia

Low potassium levels in the blood (below 3.5)

d/t inadequate intake, excessive loss, or redistribution between ICF and ECF

hyperkalemia

high levels of potassium in the blood (greater than 5)

d/t decreased renal elimination

rapid administration

movement from ICF to ECF

diagnoses of potassium disorder

exam: muscle weakness, signs of volume depletion

labs: potassium an ECG

treatment of potassium disorder

Calcium: stabilizes membranes

NaHCO₃: shifts K⁺ → ICF

Insulin: lowers ECF K⁺

Other: ↓ intake/absorption, ↑ renal excretion, ↑ cellular uptake

Hypokalemia signs

flat/inverted t waves

polyuria

alkalosis

hyperkalemia signs

peaked t waves

oliguria or anuria

acidosis

calcitonin

acts on the kidney and bone to remove calcium from the ECF

PTH and Vitamin D

stimulate calcium absorption

calcium lab value

8.5-10.5 mg/dL

hypocalcemia

hypoparathyroidism

vit d deficiency

abnormal calcium loss

increased protein binding

soft tissue sequestration

hypocalcemia tx

IV calcium gluconate o chloride Ca supplement

hypercalcemia

increased intestinal absorption

increased bone reabsorption

decreased elimination

hypercalcemia tx

fluid replacement (NaCl)

diuretics

biphosphonates

hypocalcemia signs

C - Convulsions

A- Arrhythmias

T - Tetany

S - Spasms and stridor

heart failure

muscle cramps

hypercalcemia signs

decreased concentration

increased sleep

depression

confusion and coma

death

arrhythmia and bradycardia

muscle weakness

alterations in_____ result in hypercalcemia?

vitamin d

role of phosphate

-bone formation

-atp formation

-nucleic acid formation

- delivery of o2 to rbc

-normal function of other blood cells

phosphate and calcium have an ______ relationship?

inverse

hypermagnesia causes

Renal insufficiency, excessive consumption or IV administration

hypomagnesia causes

prolonged fasting or starvation, chronic alcoholism, diuretics

hypermagnesia s/s

lethargy

n/v

loss of reflexes

respiratory and cardiac arrest

hypomagnesia s/s

confusion

hyperactive reflexes

tremors

seizures

cardia dysrhythmias

hypermagnesia tx

Dialysis if severe, restrict magnesium in diet, increase fluids

hypomagnesia tx

Oral, IV or IM magnesium

increase consumption of green veggies, nuts, banana, oranges, peanut butter, chocolate

PH levels

7.35-7.45

acidic

less than 7.35

basic

more than 7.45

regulation of PH

concentration of metabolic acids and bicarbonate base is regulated but he kidney

CO2 concentration is regulated by respiratory system

PH lab tests

arteriole blood gasses and pH

CO2 and bicarbonate levels

base excess or deficit

anion gap

increased CO2

acidosis

decreased CO2

alkalosis

respiratory acidosis

increased pCO2 levels

raised by impaired alveolar ventilation (medulla impairment, lung disease, chest injury, weakness of respiratory muscles, airway obstruction)

respiratory alkalosis

caused by conditions that cause hyperventilation and reduction of pCO2 levels

anxiety, hypoxia, lung disease, stimulation of respiratory center, mechanical ventilation

losing acid (vomit)

m alkalosis

losing base (diarrhea)

m acidosis

metabolic acidosis

decrease in HCO3 and hP caused by

excess production/accumulation acid

diarrhea, ostomy, keto/lactic acidosis

metabolic alkalosis

high pH, high HCO3

caused by H+ ion loss or HCO# ion gain

NG tube, vomiting, OD of bicarbonate. or antiacids

HCO3 levels

22-26 mEq/L

kussmauls breathing

hyperventilation that accompanies metabolic acidosis in which the body attempts to compensate (give off excess body acids) by blowing off carbon dioxide through deep and rapid breathing

PCO2 lab

35-45