Fluids and Electrolytes

total body water account for _______% of body weight

60

what are the factors to which TBW (total body water) depends on?

1. age - the elderly are more at risk for dehydration due to declining bodily functions as the kidneys is not cycling the sodium efficiently, and baby or younger kids as their systems are not as developed to keep the water

2. body compositions - someone with more lean muscle (e.g., atheletes) has more water compared to individual who has more fat content

3. nutritional status - hydrated/dehydrated? → eating food high in sodium also increased TBW due to increased water retention

4. comorbidities - heart failure, kidney dysfunction, etc

what are the two category that TBW (total body weight are split into)?

1. intracellular fluid (2/3)

2. extracellular fluid (1/3)

intracellular fluid comprised of ________ TBW and extracellular fluid comprised of _________ TBW

2/3; 1/3 respectively

what is the intracellular fluid and what are the main electrolytes that are present?

1. fluid contained within the cells

2. the main electrolytes that are present are potassium, phosphate, and sulfate (PPS Kids!)

what is the extracellular fluid and what are the main electrolytes that are present?

1. fluid outside of the cells in the nooks and crannies :) (e.g., intravascular, interstitial, and transcellular)

2. the main electrolytes that are present are sodium, chloride, and bicarbonate (SCB - salty cold beverage)

what is the transcellular fluid?

specialized extracellular fluids located in epithelial-lined body cavities (e.g., CSF, GI juices, etc)

intracellular fluid have the ________ (same/different) as extracellular fluid (why?)

osmolarity; as there are shifting of electrolyte back and forth constantly so the concentration of the particles are relatively the same and balanced

what are the functions of nephron inside our kidneys?

1. filter blood plasma

2. reabsorbs water and solutes as needed

3. maintain fluid and electrolyte balance

true or false: the kidney absorbs about 99% of the sodium present in the blood (only about 1% are excreted in the urine)

true

what is the glomerular filtration rate (GFR)?

basically it is how well/fast the kidney is filtering stuff out of the blood

what are the two lows that would decrease the GFR?

1. low blood pressure

2. low blood volume

how can the body response to increase GFR when there are low blood pressure and low blood volume?

retain sodium → release renin → angioteniogogen → angiotensin I → angiotensin II → increases blood pressure by causing vasocontriction and stimulate the release of aldosterone & antidiuretic hormone → which increase the retention of sodium and excretion of sodium (aldosterone) and decrease urine formation (antidiuretic)

what is the role of aldosterone in hormonal regulation of volume?

stimulate the retention of sodiym while increasing the excretion of potassium (potassium need to be excreted in order to reabsorp sodium) which increase water retention

true or false: aldosterone is a mineral corticoid (and that basically mean that…)

means it acts to regulate the balance of water and salt in the body, primarily by promoting sodium and water reabsorption and potassium excretion in the kidneys

what is the role of ADH (antidiuretic hormone) in term of hormonal regulaton of volume?

1. no pee hormone

2. stimulate the body retention of water without directly controlling the flow or any hormone (e.g., aldosterone) or electrolyte (e.g., potassium, sodium, etc)

3. they control the retention of water inside the body by contorlling the movement of water channels at each cells of the kidney called aquapoint

when the body is high in ADH, the patient is at risk for ___________

hyponatremia because the high concentration of water in the body dilutes the sodium concentration prsent

when is aldosterone and ADH released?

both of these hormone are release when angiotensin II is released which would indicate that the blood pressure and blood volume is low and there need to be retention of sodium and water!

where is aldosterone & ADH produced and stored?

1. aldosterone is produced and stored in the adrenal gladn

2. ADH is produced by the hypothalamus but is store din the posterior pituitary gland

what is diffusion?

movement of molecules from an area of higher concentrationt oa na rea of lower concentration

what is osmosis?

movement of fluid (e.g., water) through a semi-permeable membrane (e.g., capillary & cell walls)

what is active transport?

a type of cellular transport that require input of energy to move molecules across a membrane from an area of lesser concentration to an areas of higher concentration

what is filtration?

the transfer of water and dissolved substances through a permeable membrane froma n area of high pressure to an area of low pressure

what are the source of output that the nurse can and would need to assess for fluid balance?

1. urine

2. stool

3. bleeding

4. emesis (vomitting)

what is obligatory urine ‘output’?

the minimum amount of urine the body need to make to get rid of the toxin that build up in the body throughout one whole day

what is isotonic fluid volume deficit (FVD)? are there any changes in osmolarity?

1. the loss of water equal to the loss of sodium

2. no changes in the osmolarity

what is hypertonic fluid volume deficit (FVD)? are there any changes in osmolarity?

1. the loss of water is greater than the loss of sodium

2. there are changes in osmolarity as the fluid shift from intracellular to extracellular leading the cells to shrink

what are some of the common causes of isotonic fluid volume deficit (iFVD)?

proportionate loss of sodium and water

1. vomiting

2. diarrhea

3. excesive sweeting

4. fever

5. severe bleeding (e.g., hemmorrhage, etc)

6. burn

7. dehydration

what are the signs and symptoms of isotonic volume deficit?

1. low blood pressure

2. increase heart rate to over compensate for low blood pressure

3. increased respiratory rate to overcompensate for decrease blood volume and pressure by increasing oxygen delivery

4. weak/not patent pulse due to low blood pressure/volume

5. low capillary refill due to weak perfusion

6. hypoactive bowel sounds because blood is diverted away from the system that is considered non-essential at the moment

isotonic volume deficit is also known as ___________

hypovolemia

what would be the nursing diagnosis and related fators for isotonic fluid volume deficit?

1. nursing diagnosis: deficient fluid volume

2. related factors: prolonged or marked loss of body fluids, prolonged or marked decreased in fluid intake, and diuretic use

what is the similarities etween isotonic fluid volume excess and hypotonic fluid volume excess?

increased circulating volume

what is isotonic volume excess and is there a change in osmolarity?

1. equal retention of both water and sodium - an increase in circulating volume

2. no change in serum osmolarity

what is hypotonic fluid volume excess and is there a change in osmolarity?

1. there is a higher rention of water at a greater rate than sodium leading to an increase in circulating volume with decrease in serum osmolarity

what is hemodilutions?

a process that decreases the concentration of blood components, such as red blood cells, plasma proteins, and electrolytes, by increasing the volume of blood

does hypotonic fluid volume excess

hypertonic causes the cell to _________ while hypotonic causes the cell to ________

shrink; swell

does hypotonic fluid volume excess cause the cell to swell or shrink?

swell

can hypotonic fluid volume excess be fatal if untreated?

YES! it can lead to pulmonary and cerebral edema

what causes isotonic fluid volume excess?

1. heart failures

2. kidney failure

3. cirrhrosis

4. excessive administration of isotonic IV solutions

5. high-sodium diet

6. use of certain medication like corticosteroids

isotonic fluid volume excess is also known as ___________

hypervolemia

what are the signs and symptoms of hypotonic fluid volume excess?

1. rapid weight gain

2. edema

3. increased blood pressure

4. increased heart rate to try to compensate for the increase blood volume which the heart try to maintain adequate circulation

5. mental status changes (e.g., confusion & lethargy)

6. headaches

7. nausea

8. seizures

9. shortness of breath (due to pulmonary edema)

what are the treatment for hypotonic fluid volume excess?

1. use diuretic to remove excvess fluid

2. a low-sodium diet to decrease the rate of water retention

3. fluid restriction to help the body elimate the excess fluid

4. dialysis or parecentesis if needed

what is the difference between osmolarity and osmolality?

1. osmolarity: number of solute in a L of water

2. osmolality: number of solute in a Kg of water

what is the WDL range of serum osmolarity?

270-300 mOsm/L

what is specific gravity?

basically how concentrated a fluid is