Fluids and Electrolytes

intracellular fluid (ICF) ____ of fluids

two thirds

Extracellular fluid (ECF) _____ of fluid

one third

Extra Cellular Fluid Compartments

Interstitial, Intravascular (plasma), Transcellular

Electrolytes

Substances that release ions in water

Cation

positively charged

Anions

negatively charged

ICF Prevalent cation is

k+

ICF prevalent anion is

PO43-

ECF Prevalent cation is

Na+

ECF Prevalent anion is

Cl-

Simple Diffusion

Movement of molecules from high to low concentration

Facilitated diffusion

Uses carrier to move molecules

Active transport

molecules move against concentration gradient

Osmosis

Movement of WATER against concentration gradient

osmotic Pressure

Amount of pressure required to stop osmotic flow of water

Isotonic

same solutes as body fluid

Hypotonic

less solutes than body fluids

Hypertonic

More solutes than body fluids

Hypotonic ____ the cells with water, makes it fragile

overfills

Isotonic ____ Normal cells

equals

Hypertonic ____ the cells

dehydrates

Hydrostatic pressure

generated by heart contraction

Onconic Pressure

Osmotic pressure caused by plasma proteins

Water is pushed out by _______ pressure, brought back in by ______ pressure

hydrostatic, osmotic

In older adults _______ ______ ability to conserve water

decreased kidneys

Hormonal changes in older adults cause a ______ in renin and aldosterone

decrease

Hormonal changes in older adults cause an ______ in ADH and ANP

increase

loss of subcutaneous tissue leads to _______ loss of moisture.

increased

Reduced thirst mechanism results in ______ fluid intake

decreased

Orthostatic Hypotension

dangle on the bedside before ambulating

ECF volume deficit (hypovolemia)

Abnormal loss of fluids, inadequate intake, or plasma-to-interstitial fluid shift

ECF volume deficit (hypovolemia) Treatment

Replace water and electrolytes with balanced IV solutions

Hypernatremia Manifestations

Thirst, lethargy, agitation, seizures, and coma

Hypernatremia Treatment

Replace fluid orally or IV with isotonic or hypotonic fluids

Normal Level of Na

35-45

Hyponatremia treatment

Fluid replacement with sodium containing solutions (slowly)

Normal Level of k+

3.5-5

Potassium is necessary for

nerve and muscle impulses

Cell growth

Heart beat

Acid-base balance

Potassium is regulated by

kidneys

Hyperkalemia manifestations

Crampy leg pain

Weak muscles

Diarrhea

Cardiac dysrhythmias

Hyperkalemia treatment

IV insulin, Sodium bicarbonate if acidosic

Hypokalemia Manifestations

Cardiac

Leg weakness

Difficulty breathing

Decreased GI motility

Hypokalemia Treatment

KCl supplements orally or IV

ACE Inhibitors greater excretion of _____ and ______ in urine

Water, sodium

ACE inhibitors lower blood pressure by

locking angiotensin II receptors

Normal levels of Ca

9.0-10.5

Calcium Functions

Blood clotting, cardiac function, nerve impulses, muscle contractions, bone formation

Calcium balance is controlled by

PTH and TCT

Hypercalcemia/Hypophosphatemia Manifestations

Cardiac changes, Anorexia, lethargy, weakness, depressed reflexes

Hypercalcemia Treatment

isotonic saline infusion and low calcium diet

Hypocalcemia/Hyperphosphatemia Manifestations

Cardiac dysrhythmias, positive Trousseau's or Chvostek's sign, dysphagia

Hypocalcemia Treatment

Oral or IV calcium supplement

Hypophosphatemia Manifestations

CNS depression, confusion, muscle weakness and pain, dysrhythmias

hypophosphatemia Treatment

Oral supplementation

foods high in phosphorus

IV administration of sodium or potassium phosphate

D5W

Used to replace water losses and treat hypernatremia

Normal Saline (NS or NSS)

Expands IV volume - preferred fluid for immediate response

Lactated Ringer's Solution

Expands ECF-treat burns and Gl losses

D5 ½ NS

Common maintenance fluid, Hypertonic

D10W

Hypertonic, no electrolytes, used to keep bg high

Plasma Expanders

Stay in vascular space and increase osmotic pressure

Hypokalemia caused by

Increased loss of k+ via kidneys and GI, increase shift between ECF to ICF

Hypercalcemia caused by

Hyperparathyroidism, Malignancy, immobilization

Hypocalcemia causes

Acute pancreatitis, Multiple blood transfusions, Decreased production of PTH

Hypophosphatemia caused by

Alcohol withdrawal, Malnourishment/malabsorption, phosphate-binding antacids