F&E and nutrition

where is Extracellular Fluid (ECF)

outside the cells

What percent of the body is Extracellular Fluid (ECF)

1⁄3 of total body fluid

Extracellular Fluid (ECF) divisions

Intravascular fluid, Interstitial fluid

Intravascular fluid

liquid part of the blood (plasma), evaluated in CBC and BMP/CMP lab values

Interstitial fluid

between cells and blood vessels, acts as cushion/protection of organs and vessels

where is Intracellular Fluid (ICF)

“inside the cells”

how much Intracellular Fluid (ICF) is the body

2/3 total body fluid, bulk of fluid

Transcellular fluid:

specialized fluid contained within seprate compartments to Cushion/ protect organs

Transcellular fluid examples

Cerebrospinal fluid, synovial fluid, pleural fluid, peritoneal fluid

Osmosis

The movement of water across a semipermeable membrane from an area of

low solute concentration to an area of high solute concentration. Water wants to move where solutes are high to dilute them and equalize pressure.

Osmotic Pressure

inward-pulling force caused by particles in the fluid. Water wants to go to where there is more solutes

Diffusion

Passive movement of solutes across pressure gradient from an area of high concentration to an area of low concentration.This requires an open ion channel and is essential for nerve and muscle function.

Active transport

going against the pressure gradient. uses ATP

Hydrostatic pressure

pushes fluid against a surface driven by heart pump

Oncotic pressure

pulls fluid back into the capillary space from the interstitial space driven by large proteins colloids primarily albumin.

Fluid balance normal

Primarily through skin, lungs, GI tract, and kidneys

Osmolality measures

how concentrated a body fluid is (many particles (like sodium, glucose, and urea) are dissolved in one kilogram of water.)

Sodium (Na+) normal value

136 – 145 mEq/L

Sodium (Na+) plays an important role in

Maintaining fluid balance, Transmitting nerve impulses, Muscle contractions

Sodium (Na+) is influenced by

Salt intake, Processed foods, dairy, added salt, Aldosterone secretion, Urinary output

HYPERnatremia values

Serum sodium (Na+) level greater than 145 mEq/L

HYPERnatremia

Interstitial fluid is hypertonic = water leaves cells = cells shrivel

HYPOnatremia values

Serum sodium (Na+) level less than 136 mEq/L

HYPOnatremia

Interstitial fluid is hypotonic = water enters cells = cells swell

normal Urine output

0.5 ml/kg/hr

Intake

PO, tube feedings, and IV

BUN/creatinine ratio

15-20: 1

serum osmolarity normal value

285-295mosm/L

Fluid volume excess (FVE)

HYPERtension

Fluid volume deficit (FVD)

HYPOtension

Orthostatic changes

more than 15-20 mmHg drop in BP

Tachycardia relates to

FVE and FVD

Thready pulse

FVD

Bounding pulse

FVE

tote/tight skin

FVE

tenting skin, pinching skin

FVD

pulmonary edema leads to

FVE

Body Fuids are primarily composed of

water and solutes (electrolytes).

Electrolytes develop a electrical charge

when dissolved in water

cations

Sodium (Na+), Potassium (K+), Calcium (Ca2+), Magnesium (Mg2+)

Anions

Chloride (Cl-), Bicarbonate (HCO3-)

Cation Charge rule

Two possitivly charged cations cannot occupy the same space peacefully at high conce. There must be a exchange or balance between positive and negative charges.

ECF Primary Cation

Sodium (Na+)

ICF Primary Cation

Potassium (K+)

What does albumin do

Albumin ppulls fluid back into capillaries during diastole when vessels relax. In cases of FVD albumin is administered because it stays in the vessel to maintain volume.

thirst is triggered by

increased plasma osmolality and decreased BV

Non oral intake

IV fluids, rectal fluids, irrigation of body cavities

ADH

holds on to water, released by Posterior Pit

High osmolality relating to ADH

ADH increases retain water

Low osmolality relating to ADH

Decreases ADH excrete water

ADH impairment

brain injury, chronic alcoholism

Aldosterone

produced by adrenal cortex, regulates NA+ and water

What triggers release of Aldosterone

low BV, low serum Na+, high serum K+

what is the affect of Aldosterone

Retains Na+ and water and excretes K+

Serum Osmolality measures

how concentrated body fluid is. (sodium, glucose, urea) per kg of water

vomiting/ Diarrhea

wastes all electrolytes , significant loss of K+ and Na+

excessive sweat

Hypotonic loss, contains Na+ (risk for hyponatremia)

Hemorrhage

isotonic loss, fluid and solutes are lost at the same rate

Wound Drainage

Hypertonic loss

Burns/ trauma

Callular lysis (cell burst) dumps intracellular K+ into ECF, causing hyperkalemia risk. Drainage is hypertonic

Fever

Increases metabolic rate and diaphoresis

Hyperkalemia causes

Kidney failure (decreased excretion), cell lysis (burns/trauma), K+sparing diuretics (spironolactone), ACE inhibitors

Hyperkalemia symptoms

muscle twitches, cramps, paresthesia, irritability/ anxiety, decreased BP, dysthymias, abnormal cramping and diarrhea

Hypokalemia causes

loop, thiazide diuretics (lasix/furosemide), GI losses (vomiting/diarrhea), decreased intake

ACE inhibitors risk

hyperkalemia

SSRI Risk

hyponatrimia

Corticosteroids Risk

Hypokalemia and metabolic alkalosis

Loop/thiazide Diuretics risks

risk of low electrolytes (K+, Na+, Mg+) and FVD

Potassium sparing diuretics risk

Hyperkalemia

Laxatives Risk

risk of low electrolytes, FVD

Alcohol risk

acts as a diuretic, suppresses ADH

Weight rule

2.2kg = 1 L gain or loss

urine output standerd

.05mL/kg/hr

Specific Gravity value

1.005- 1.030

low Specific Gravity

Dilute urine

high Specific Gravity

conce urine

BUN/Creatinine ratio

15-20

Hct in FVD

elevated bc of hemoconcentration

blood pressure in FVE and FVD

Hypertension in FVE, Hypotension in FVD

Orthostatic hypotension

15-20 mmHg drop in systolic BP

Pulse in FVD EVE

tachycardia in both FVE and FVD, Thready pulse FVD, bounding FVE

JVD

distended in FVE, flat and sunken in FVD

Skin Turgor

taut/tight in FVE; tenting in FVD

for severe hyponatremia

use hypertonic saline 3%, 5%

for severe hypernatremia

use hypotonic fluid .45%

if sodium isnt corrected slowly

permanent brain damage

if potassium isnt corrected slowly

lethal cardiac arrest

Airway and breathing risks

pulmonary edeema risk in FVE

circulation/perfusion risk

elevated BUN/Creatinine indicates end-organ damage from poor perfusion

FVD replacements

oral fluids, IV fluids if severe

FVD meds

Antiemetics/antidiarrheals to stop GI loss

FVE restrictions

strict sodium and fluid restriction

FVE resp

high fowlers position, monitor lung sounds for crackles

FVE monitering

Monitor for pitting edema, strict I&O, daily weights

FVE pharmacology

diuretics

functions of water

Hydration, nutrient transport, temp regulation, waste removal

Dehydration mild

Thirst, dry mouth, fatigue, dizziness, and decreased urine output

Dehydration severe

Medical emergency, rapid Heartbeat, Low BP, confusion, fainting. Can lead to organ failure or death

water intoxication

excessive intake can dilute sodium levels, leading to hyponatremia (nausea, headache, confusion, seizures, death)

Carbohydrates

The primary energy source for brain, skeletal muscles and cell function