Module #1_Fluid Disorders (Part 1)

60%

Total body water of ADULT MALES

50%

Total body water of ADULT FEMALES/ELDERLY MALES

45%

Total body water of ELDERLY FEMALES

60-70%

Total body water of PEDIATRICS

Vehicle

Water inside the body acts as \_______________ for the different solutes such as the electrolytes (K, Na, Mg, etc.)

Medium for chemical reactions

Water inside the body acts as \_______________ since some chemical reactions requires water before proceeding and some reactions produce water

Lubricant and shock absorber

Water inside the body acts as \_______________ such as synovial fluid in the joint, Cerebrospinal Fluid. Brain is made up of around 75% water

Acts as regulatory mechanisms

Water inside the body acts as \_______________ such as Acid-base balance, Hydro-electrolytic balance, and Temperature regulation

Higher

The total body water is \__________ in pediatric patients compared to elderly

Lower

The total body water is \________ in females than in males

TRUE

\[TRUE/FALSE] The greater the weight of the patient, the tendency is to have a decreased TBW, especially for those in obese patients due to fat or adipose tissues

2/3

The intracellular fluid compartment comprises \_____ of the TBW.

1/3

The extracellular fluid compartment comprises \_____ of the TBW.

Interstitial Fluid (ISF)

Fluid in the interstitial spaces between cells, ¾ of ECF

Intravascular Fluid (IVF)

Fluid in the plasma of the blood (or fluid inside the blood vessels), ¼ of ECF

3/4

The interstitial fluid comprises \____ of the ECF.

1/4

The intravascular fluid comprises \____ of the ECF.

Potassium

Most abundant cation in the intracellular fluid

Potassium (K+)

This cation functions as:

> Resting membrane potential

> Action potentials

> Maintain intracellular volume

> Regulation of pH

Phosphates and proteins

Most abundant anions in the intracellular fluid

Extracellular fluid compartment

This compartment comprises water outside the cells, 1/3 of TBW

Intracellular fluid compartment

This compartment includes water inside the cells, 2/3 of TBW.

Sodium (Na+)

This cation functions as:

> Muscle contraction

> Impulse transmission

> Fluid and electrolyte balance

> Highly correlated to the fluid levels

Sodium

Most abundant cation in the extracellular fluid.

Chloride

Most abundant anion in the extracellular fluid.

Chloride (Cl-)

This anion functions as:

> Balances levels of anions in different compartments

> Regulates osmotic pressure

> Forms HCl in gastric acid

Tonicity

Fluid tension between ECF (Extracellular Fluid) and ICF (Intracellular fluid); reference point for IV solutions

Higher; Lower

In Osmosis: movement of water to an area of \________ concentration of water molecules to an area of \________ concentration of water molecules

Effective osmoles

Solutes that cannot freely cross membranes, examples are sodium, glucose, and albumin

Isotonic

When the solution has the same tonicity as compared to plasma; has a net change of 0

Hypertonic

When the solution has higher solute particles vs plasma; causes shrinkage of cells; has a net change of positive

Hypotonic

When the solution has lower solute particles compared to plasma; causes swelling of cells; has net change of negative

Osmolality

Number of solutes in 1kg of water

FALSE

\[TRUE/FALSE] Osmolality and Osmolarity is NOT interchangeable since the human body is made up of different components.

280-295 mOsm/kg

Normal measured plasma osmolality.

Hypotonic

If the osmolality of the IV solution is 240 mOsm/kg H2O, it is \___________

Hypertonic

If the osmolality of the IV solution is 310 mOsm/kg H2O, it is \___________

Sodium

Biggest contributor in osmolarity

Low water content

Implications of a high serum osmolarity (more concentrated serum) where the patient may be dehydrated

High water content

Implications of a low serum osmolarity where the patient may have hypertension, Heart Failure, Edema

135-145 mmol/L

Normal range/ lab values for sodium

Thirst

A water regulatory mechanism to increase water intake

Stimuli: Increase pOsm, decrease ECF, decrease BP

Arginine Vasopressin

A water regulatory mechanism which is the major determinant of water loss; Synthesized by hypothalamus and secreted by posterior pituitary gland in response to the following stimulus:

Sensible water intake/loss

Conscious water intake/loss (drinking, urination)

Insensible water intake/loss

Water intake or loss without observing (Metabolism, and via skin/lungs)

TRUE

\[TRUE/FALSE] Ideally, Water intake should be equal to water loss (approx. 2.5 L)

V1a

Vasopressin receptor that acts on the vascular smooth muscle which causes Vasoconstriction, cardiac hypertrophy

V1b

Vasopressin receptor that is reactive to stress which releases adrenocorticotropic hormone (ACTH) & endorphin

V2

Vasopressin receptor that acts on the renal collecting duct for the resorption of water from the urine back to the blood/ systemic circulation through the aquaporin-2 water channel

1-2.5 L

Final urine volume excreted per day

Oliguria/ Anuria

Decreased urine output (< 1L/day)

FALSE

\[TRUE/FALSE] Body detects low water levels so there will be low levels of water in the blood --\> Pituitary gland will release less ADH, increasing water volume in the blood

TRUE

\[TRUE/FALSE] Body detects high water levels --\> Pituitary gland will release less ADH, prompting urination to decrease water content in the body

HYPOVOLEMIA

\[HYPOVOLEMIA/HYPERVOLEMIA] Clinical manifestations in the CNS: Lethargic, weak, dizzy

HYPERVOLEMIA

\[HYPOVOLEMIA/HYPERVOLEMIA] Clinical manifestations in the pulmonary: Crackles, Dyspnea

HYPERVOLEMIA

\[HYPOVOLEMIA/HYPERVOLEMIA] Clinical manifestations in the CV system: High BP, Low HR

HYPOVOLEMIA

\[HYPOVOLEMIA/HYPERVOLEMIA] Clinical manifestations in the renal system: Low urine output

HYPOVOLEMIA

\[HYPOVOLEMIA/HYPERVOLEMIA] Clinical manifestations in the skin: Pallor, decreased skin turgidity, decreased perfusion

TRUE

\[TRUE/FALSE] One goal of the management of fluid deficit disorders is to administer supporting fluids and medications to stabilize patient

Vital signs

This includes volume status assessment of Blood pressure, Heart rate, Orthostatic changes

Physical examination

This includes volume status assessment of Mental status, Capillary refill, Extremity temperature, Skin turgor, Skin perfusion, Urine output

Laboratory tests

This includes volume status assessment of Fractional excretion of sodium and urea, Blood lactate level, Mixed venous oxygen saturation

TRUE

\[TRUE/FALSE] If patient has low blood levels, they will have a Decrease BP

FALSE

\[TRUE/FALSE] If patient has low blood levels, they will be bradycardic as a compensatory mechanism

TRUE

\[TRUE/FALSE] If you're dehydrated the tendency is the skin will not immediately go back to its normal appearance

TRUE

\[TRUE/FALSE] If patient is dehydrated, they will have pale skin (pallor) since with low water levels, different parts of the skin are not perfused adequately

FALSE

\[TRUE/FALSE] There is increased urine output when patient is dehydrated.