Fluid, Electrolytes, and Acid-Base Balance

Intracellular

The _____ space contains 65% of total body water

Extracellular

The _____ space contains 35% of total body water

Extracellular

Which space contains

• Interstitial space (tissues)—25% of total TBW

• Intravascular space (blood/plasma and lymph)—8%

• Transcellular fluid (basically other areas that don’t fit above—eyes, CSF,

synovial, etc)—3%

capillary filtration

pushing fluid out into interstitial space from the vessel

Capillary reabsorption

pulls fluid back into vessel from the interstitial space

Osmosis

passive movement of water from high concentrations to low

concentrations

metabolic water, food and drink

Water gains

• Output from things we don't measure

• breathing, cutaneous transpiration

Water loss

2500

We lose ______mL/day of water

output that is unavoidable

• Expired air, sweat, urine

Obligatory water loss

400

Minimum amount of urine you can make is _____mL/day in

homeostasis

Low

Losing water can result in ____ blood pressure

Secreted when we have issues with blood concentration

What is the anti-diuretic hormone (ADH)

Dehydration, drop in BP, vomiting

What can trigger ADH?

Posterior pituitary gland

ADH is produced in the

Negative

is ADH positive or negative feedback?

Group of hormone and enzymes to control blood pressure and maintain salt/water balance

Released when bp is low

Describe RAAS and how it acts in negative feedback

Osmolarity, increase

Dehydration causes ______ of blood to _____

Osmoreceptors

Which receptors are stimulated when thirsty

Drops, RAAS

blood pressure also _____ when you

are dehydrated which stimulates ____

Urine volume and concentration

_______ and ______ is the main way to regulate output

No, only slows down

Can kidneys reverse dehydration?

The kidneys adjust the volume of the urine by changing the

sodium concentration of the urine

Describe kidneys role in dehydration

Aquaporins

ADH tells kidneys to produce _____ which allows water to be reabsorbed from urine independent from sodium

Sodium

Water follows _______

Aldosterone

Which hormone works by telling kidneys to reabsorb more Na+

Outs, in

In disorders of fluid balances, ____ > ______

Volume depletion and dehydration

List 2 types of fluid deficiencies

Proportion amount of water and sodium/solute are lost without

replacement

Volume depletion is

hemorrhage, excessive diarrhea or vomiting, adrenal insufficiency

In what cases can volume depletion occur?

Low

_____aldosterone leads to sodium and water excretion

_____ is described as a loss of water is greater than the loss of sodium/solute

Yes

Do you lose more water than salt?

Healthy

A cup filled with ice describes a _____ kidney because of the filtration process

Unhealthy

A cup filled with ice that has a big drinking hole describes an ______ kidney because protein leaks out

Excess

Kidneys are better with keeping up with _____ fluid rather than too little fluid

Fluid sequestration

_________ Results in water being pushed out of intravascular space, thus lowering the blood volume

Liver

______ failure is an example of fluid sequestration

Determine electrical potential across cell membranes

• Affect the osmolarity of the blood, regulating fluid balance

Why are electrolytes so important?

300

Typical osmolarity = _____ mOsm/L

Magnesium and phosphate

Which electrolytes are not seen on basic metabolic panels and require additional ordering?

Sodium

_______ (ion) is a Principal cation in ECF and most significant in determining

distribution of water

Sodium

Dehydration can cause these cells to shrink

Sodium

_______ is regulated mostly by kidneys and aldosterone

Thirst

When salt concentration increases, ______ kicks in

Excess body water rather than excess sodium excretion

Hyponatremia is due to

Seizures

Patients with LOW sodium levels are at risk for

Potassium

_______ (ion) is the most abundant cation in the ICF

Potassium

_______ is regulated in kidneys by aldosterone

Potassium

_______ is highly prevalent in intracellular membranes

Lyse

Hyperkalemia causes cells to

Renal failure, acidosis, rythmias

List examples of hyperkalemia

Muscle cramps, excessive sweating, alkalosis

List examples of hypokalemia

Calcium

_______(ion) is found in bones, muscle contractions, blood clotting

ECC than ICC

There is more calcium in ______ than ____

A protein that binds stored ca2+ and inactivates it

What is calsequestrin?

Excess

Hypercalcemia is _____ bone resorption

Bones, stones, groans, psychiatric overtones

Hyperkalemia examples

Vitamin D deficiency, diarrhea, muscle spasms, tetany

Hypocalcemia examples

Magnesium

Bone, intracellular

________(ion) is 54% stored in ______ and 45% _______

Magnesium

________ is not measured in our standard lab

Rare

hypermagnesium is ______ but may be seen in renal disease

Magnesium

If potassium is LOW, check the _____ level

hyperirritability of cells

• Tremors, spasms, tetany, cardiac arrhythmias

Hypomagnesium can cause

Chloride

_______ (ion) is the most abundant anion in ECF

Chloride

Required for formation of HCl and chloride shift that accompanies the CO2 loading/unloading in RBCs

HyperCl

Excess dietary intake or IV saline

HypoCl

Hyponatremia, acidosis

Phosphate

______ (ion) is readily absorbed in the small intestine

Phosphate

Every process that depends on ATP depends on ______

H+ concentration

pH is determined by

Buffers

_____ resists pH changes

Chemical

The bicarbonate buffer system is a (chemical/physiological buffer)

Bicarbonate buffer

______ system works with the lungs and kidneys which can change the amount of CO2 or bicarb, respectively

Right, acidosis

Increasing the amount of CO2 causes this to shift to the ____, increasing the

[H+]→_____

Left, alkalosis

Increasing the amount of bicarb causes this to shift to ____, decreasing the

[H+]→______

phosphate buffer system

This system is more important for renal tubules and intracellular

compartments

Protein buffer system

This system is very important for ICF

Too much H+ ACIDOSIS

Too much CO2 =

Too little H+ ALKALOSIS

Too little CO2 =

respiratory alkalosis

Hyperventilating is an example of

O2

Patients that are hyperventilating are given non- rebreathers because ____ is reabsorbed

Renal control of pH

What is the best buffering system but takes longer

Renal control of pH

This describes which system?

Kidneys excrete H+ into tubular fluid which then binds to bicarb, ammonia, and phosphate buffers

• Then secreted in urine

7.35-7.45

Normal pH

7.35

Acidosis = pH < _____

7.45

Alkalosis = pH > _______

<7.0 or pH >7.7

We can't live for more than a few hours with a pH

Acidosis

In ________, H+ diffuses down its

concentration into cells

Alkalosis

In _______, H+ diffuses out of cells

and K+ diffuses into cells

More CO2

Why is venous blood more acidic?

Primary acid-base disorder

The _______ depends upon which system causes the pH changes

Respiratory depression

Opioids

Respiratory acidosis can cause ________, examples include

hyperventalating

A patient ________ is an example of respiratory alkalosis

Metabolic acidosis

_______ is Too much organic acids produced (lactic acidosis, keto acidosis)

Diarrhea

Example of metabolic acidosis

Metabolic alkalosis

________ is Too much base ingested (antacids)

Loss of stomach acid through vomiting

Example of metabolic alkalosis

NG

______ tubes can cause metabolic alkalosis

Compensation

________ refers to the opposite system being able to adjust pH