Chapter 29 Fluids and Electrolytes LILLEY

What are colloids?

protein substances that increase the colloid oncotic pressure.

What is colloid oncotic pressure?

form of osmotic pressure exerted by protein in blood plasma that tends to pull water into the circulatory system.

crystalloids

substances in a solution that diffuse through a semipermeable membrane.

edema

abnormal accumulation of fluid in INTERSTITIAL SPACES.

Extracellular fluid (ECF)

portion of the body fluid comprising the interstitial fluid and intravascular fluid.

hyperkalemia

abnormally high potassium concentration in the blood, due to defective renal excretion but also caused by excessive dietary potassium or certain drugs, such as k sparing diuretics of ace inhibitors, or other meds that can cause acidosis.

Hypernatremia

abnormally high sodium concentration in the blood. due to defective renal excretion or caused by excessive dietary sodium or replacement therapy or loss of water.

Hyokalemia

inadequate amount of potassium in the blood stream, causes: diarrhea, diuretic use, and others.

Hyponatremia

inadequate amount of sodium in bloodstream caused by inadequate excretion of water or by excessive water intake.

Interstitial fluid

extracellular fluid that fills in the spaces between most of the cells of the body.

Intracellular fluid

fluid inside blood vessels

Isotonic

same concentrations of solutes as another solution , same osmotic pressure. ex. isotonic saline solution that contains an amount of salt equal to that found in the intracellular and extracellular fluid.

Osmotic pressure

pressure produced by a solution necessary to prevent the osmotic passage of solvent into it when the solution and solvent are separated by a semipermeable membrane.

plasma

watery, straw-colored fluid component of lymph and blood in which the leukocytes, erythrocytes, and platelets are suspended.

serum

clear, cell-free portion of the blood from which fibrinogen has also been separated during the clotting process.

transcellular fluid

fluid that is contained within specialized body compartments wuch as cerebrospinal, pleural, and synovial cavities.

What do body fluids provide?

transportation of nutrients to cells and carry waste products away from cells.

Approx. what percentage of the human body is made of water? This number is known as ?

60% total body water

The percent of body water is ? in infants and ? in older adults.

higher and lower.

Total body water is distributed in two main compartments:

intracellular fluid and extracellular fluid.

Extracellular fluid is divided into :

interstitial fluid and intravascular fluid.

Intracellular fluid (fluid within cells) contains solutes such as?

electrolytes and gluocose.

What is the main function of extracellular fluid?

transport nutrients to cells as well as transport waste products away from cells.

What is intravascular fluid?

volume of blood in circulatory system and contains protein rich plasma and large amounts of albumin.

What is different about the interstitial fluid and the intravascular fluid?

contains little to no protein.

The interstitial fluid compartment is further broken down into?

transcellular fluid which is contained within specialized body compartments such as synovial, cerbrospinal, and pleural cavities.

What are some internal control mechanisms for maintaining fluid balance?

thirst, antidiuretic hormone, and aldosterone.

Movement into and out of the cell is carried out through:

diffusion, filtration, active transport, and osmosis.

Fluid intake comes from?

liquids, solid foods, IV fluid, parenteral fluid.

Fluid loss is carried out by?

kidney, emesis or feces.

Insensible losses

skin, lungs, and Gi tract.

A sudden change in ? is a strong indicator of fluid balance.

weight gain.

Death often occurs when ? % of total body water is lost.

20-25%

? leads to a disturbance in the balance between the amount of fluid in the extracellular compartment and that in the intracellular compartment.

dehydration

? is the principle extracellular electrolyte and plays a primary role in maintaining water concentration.

sodium

In the initial stages of dehydration, water is lost first from the ? compartments.

extracellular

When fluid that has been lost needs to be replaced, there are three categories of agents that can be used to accomplish this:

crystalloids, colloids, and blood products.

Osmolality is used in reference to body fluids and is the ? of particles in the solution.

concentration.

normal osmolality of body fluids is between:

290-310 mOsm/kg

? is used in reference to Iv fluids and is the measurement of the concentration of IV fluids as compared with the osmolality of body fluids.

tonicity

? can also be defined as the measure of osmotic pressure.

tonicity

Describe isotonic

osmotic pressures inside and outside of the blood cell are the same.

hypotonic means?

the solution outside of the cell has a lower osmotic pressure than the inside the cell.

hypertonic means

the solution outside the cell has a higher osmotic pressure than inside the cell.

Isotonic solutions such as normal saline (0.9% NACL) or lactated ringers solution causes ? net movement.

no

hypotonic solutions (0.45% Nacl) causes fluid to move ? of the vein and into the tissues and cells. Can cause cells to ?

out ; burst

hypertonic solution (3% Nacl) causes fluid to move from the ? into the veins. Can cause cells to?

ISF ; shrink

The acid-base balance is regulated by?

the respiratory system and the kidney

What is an acid?

can donate or release hydrogen ions. Ex. cabonic acid or hydrochloric acid.

What is a base?

substance that can accept hydrogen ions such as bicarbonate.

The PH is a measure of the degree of ? and ? and is inversely related to hydrogen ion concentration.

acidosis and alkalinity

What is the normal ph for our bodies?

7.35-7.45

The respiratory system compensates for ? problems and ? by regulation of Co2

metabolic problems and ph imbalances.

In acidosis , CO2 can be exhaled to ? the lower ph

normalize

In alkalosis Co2 will be ? by the respiratory system to try and elevate the ph

retained

The kidneys compensates by reabsorbing and generating ? and excreting ? in acidosis to normalize the ph.

bicarbonate/hydrogen ions

Conversely, the kidney can excrete ? and retain ? to normalize ph seen with alkalosis.

bicarbonate and retain hydrogen ions

blood test to determine the influence of the respiratory system on ph?

arterial blood gas

blood test to determine the body on acid base balance that measures ?

total body co2 represented by HCO3.

Crystalloids are fluids given by IV that supply ? and ? to maintain the osmotic gradient between extravascular and intravascular compartments.

water and sodium

What are the most commonly used crystalloids?

0.9% NACLA Normal saline and lactated ringers solution.

? solutions contain fluids and electrolytes that are normally found in the body.

crystalloid

What do crystalloid solutions lack?

proteins

What do proteins do for the plasma compartment?

maintain colloid oncoti pressure and prevent water from leaving.

crystalloids are distrubted faster into the interstitial and intracellular compartments than ?

colloids

Crystalloid solutions are most commonly used as?

maintenance fluids.

What are crystalloids used for?

dehydration , replace fluids, and electrolyte disturbances

Crystalloids promote? flow.

urinary

What are some perks of using crystalloids?

cheaper than colloids and blood products, and no risk for viral transmission or anaphylaxis.

What are some common indications for crystalloid or colloid replacement therapy?

acute liver failure, burns, cardiopulmonary bypass, hypoproteinemia, renal dialysis, shock.

contraindications to using crystalloids

drug allergy to a specific product and hypervolemia.

What are some adverse effects of crystalloids?

safe, but can leak out of the plasma and into the tissues and cells. Can result in edema anywhere (peripheral edema and pulmonary edema) Also dilutes the proteins that are in plasma, which further reduces colloid oncotic pressure.

What is the most common concentration of normal saline (sodium chloride) ?

0.9% isotonic

What concentration is considered hypotonic for sodium chloride?

0.45% (half normal) and 0.25% (quarter normal)

What concentration is considered hypertonic for sodium chloride?

3% and 5% high alert solution.

sodium chloride contraindications

patients with hypernatremia and hyperchloremia.

Correcting sodium too rapidly with hypertonic saline can lead to ?

osmotic demyelination syndrome.

Colloids can increase plasma volume quicker than crystalloids because ?

crystalloids do not have any proteins in them.

Dextran 70, Dextran 40, Hetastarch, 5% Albumin, and 25% Albumin are commonly used ?

colloids

? are substances that increase the colloid oncotic pressure and move fluid from the interstitial compartment to the plasma compartment by pulling the fluid into the blood vessels.

colloids

What are the three blood proteins found in colloids?

albumin, globulin, and fibrinogen.

What is the normal range for our blood protein levels? What happens is proteins fall below the normal range?

5.3-7.4; fluid shifts out of the blood vessels and into the tissues.

What are commonly used colloids?

albumin, dextran, and hetastarch.

Since colloids cannot pass into the extravascular space, there is a higher concentration of colloid solutes inside the blood vessels than ? the blood vessels. Fluids move from the extravascular space into the blood vessels in attempt to make it ?

isotonic

colloids increase the blood volume, and they are sometimes called?

plasma expanders

What are colloids used to treat

shock and burns, patient requires plasma volume expansion.

Why are colloids superior to crystalloids?

because of their ability to maintain the plasma volume for a longer time.

colloids are significantly more ? and are more likely to promote ?

expensive / bleeding.

? are better than colloids for emergency short term plasma volume expansion.

crystalloids

What are contraindications with the use of colloids?

drug allergy to a specific product and hypervolemia

What do colloids lack?

oxygen carrying ability and no clotting factors.

What is a "perk" of using colloids?

quick onset and long duration of action.

Where are colloids metabolized and excreted?

in the liver and by the kidneys.

Where is albumin metabolized and excreted?

reticuloendothelial system and by the kidneys and intestines.

? is a synthetic colloid with properties similar to those of albumin and dextran.

hetastarch

? is a natural protein that is normally produced by the liver.

albumin

What is responsible for generating approx. 70% of the colloid oncotic pressure?

albumin

Albumin is contraindicated in patients with a known hypersentivity and in those with ? , severe enemia, or renal insufficiency.

heart failure

Dextran is a solution of?

glucose

What are the three concentrations dextran is available in?

dextran 40, 70, 75