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2 Compartments of Body Fluid

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Intracellular Fluid and Extracellular Fluid

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Intracellular Fluid

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Comprises all the fluid contained within the cells.

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Extracellular Fluid

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Comprises all the fluid outside the cells including interstitial fluid (the space between cells and outside blood vessels) and intravascular fluid (blood plasma).

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Total Body Water (TBW)

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Sum of fluids within all compartments. Decreases with age as there is an increase of body fat.

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Standard Value of TBW

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60% of a 70kg adult male (42 liters) Intracellular - 64% Interstitial - 25% Intravascular Plasma - 8%

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Most abundant ECF ion

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Na

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Ion that Maintains Osmotic Balance of ECF

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Na

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Ion that Maintains the Balance of ICF

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K

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Changes in ECF Osmolarity results in:

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The movement of water from one compartment to another until osmotic equilibrium is reached.

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Hydrostatic (blood) Pressure

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Pushing of water at arterial and venous ends.

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Osmotic Pressure

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Pulling of water at arterial and venous ends.

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ECF is Hypotonic to:

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Blood. Water is always pulled into the blood vessel due to osmotic pressure and pressure remains constant across the entire capillary.

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Tonicity

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The tension or effect the osmotic pressure of a solution exerts on cell size due to water movement.

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Isotonic Tonicity

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No changes. .9% NaCl

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Hypotonic Tonicity

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Swell. Distilled water.

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Hypertonic Tonicity

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Shrink. 3% NS

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Hydrostatic (blood) Pressure

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An outward pressure due to the blood pushing on the walls of the capillary. Pressure is not constant throughout the capillary. More pressure on the arteriole side because it is closer to the heart.

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Edema

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Accumulation of fluid within the interstitial spaces. Problem of fluid distribution, does not necessarily mean excess fluid.

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Pathophysiology of Edema

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Increased capillary hydrostatic pressure. Lost or diminished plasma protein production. Increased capillary permeability. Lymphatic obstruction.

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Venous Obstruction

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Obstruction that causes increased capillary hydrostatic pressure pushes fluid from capillary into interstitial spaces.

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Causes of Venous Obstruction

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Thrombophlebitis (inflammation of veins), hepatic obstruction, tight clothing around extremities, prolonged standing.

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Lost/Diminished Plasma Protein Production results in:

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Decreased oncotic pressure, which causes capillary fluid to move into the interstitial space causing edema.

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Causes of Lost/Diminished Plasma Protein Production

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Glomerular disease of kidney, serious drainage of open wounds, hemorrhage, burns, cirrhosis of the liver.

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Increased Capillary Permeability results in:

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Proteins escaping from vascular space causing decreased capillary oncotic pressure and interstitial fluid protein accumulation causing edema.

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Causes of Increased Capillary Permeability

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Inflammation and immune responses, burns or crushing injuries, neoplastic disease, allergic reactions.

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Lymphatic Obstruction results in:

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Accumulation of proteins and fluids in the interstitial space causing lymphedema.

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Causes of Lymphatic Obstruction

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Inflammation, tumors.

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Localized Edema

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Edema limited to the site of trauma.

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Generalized Edema

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Edema manifested by a more uniform distribution of fluid in interstitial spaces associated with weight gain, tight clothing, and limited movement of affect joints.

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Mechanisms that Assist Regulating Body Water

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Thirst and ADH

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Thirst

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Primary regulator of water input.

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Antidiuretic Hormone (ADH)

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Primary regulator of water output.

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Hypodipsia

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Decrease in the ability to sense thirst associated with cerebral lesions in the hypothalamus.

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Polydipsia

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Excessive thirst.

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RAA System

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Regulates Blood Pressure. Low circulating renal blood volume causes renin to be released from kidney which stimulates formation of Angiotensin I which converts to Angiotensin II.

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Angiotensin II functions

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Stimulates secretion of aldosterone, promotes Na and water reabsorption, and vasoconstriction to elevate BP and restore renal perfusion.

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ADH

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Also known as arginine vasopressin. Secreted by the posterior pituitary. Regulates water balance.

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Causes for Increased ADH synthesis

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Stress situations, severe pain, nausea, trauma, surgery, narcotics, anesthesia, nicotine.

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Sodium

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Accounts for 90% of ECF cations. Regulates osmotic forces and therefore regulates water balance.

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Chloride

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Major anion in the ECF. Provides electroneutrality particularly in relation to Na. Transport is passive and follows the active transport of Na.

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Bicarbonate

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Another major anion in the ECF.

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Isotonic Fluid Volume Deficit

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Loss of Na and Water including hemorrhage, wound drainage, diuresis, intestinal losses, Addison disease, acute weight loss.

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Compensatory Mechanisms for Isotonic Fluid Volume Deficit

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Increased thirst, increased ADH-oliguira, and increased specific gravity.

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Treatment for Isotonic Fluid Volume Deficit

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Fluid replacement, correct underlying cause.

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Isotonic Fluid Volume Excess

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Expansion of ECF (increased interstitial fluid and plasma) due to Na retention due to liver failure, inadequate Na and water elimination, or excessive IV fluids.

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Edema Characteristics of Isotonic Fluid Volume Excess

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Lowered hematocrit and plasma protein concentration caused by diluting effect of excess plasma volume.

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Hypotonic Solution %

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.2% or .45% NaCl

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Isotonic Solutions %

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.9% Normal Saline, 5% Dextrose

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Hypertonic Solutions %

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10% Dextrose

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Isotonic Fluids

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No change in serum osmolarity. Fluid stays in the vessels. Indicated for hypotension due to hypovolemia.

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Hypertonic Fluids

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Increase in serum osmolarity. Pulls fluid into the blood vessels. Reduces risk of edema.

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Hypotonic Fluids

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Lower osmolarity than the serum. Pulls fluid out of the blood vessel and into the cells and interstitial spaces where osmolarity is higher. Used when diuretic therapy dehydrates cells.

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Hyponatremia

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Sodium concentration in serum is less than 135 mEq/L (milliequivalents per liter)

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Hypernatremia

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Sodium concentration in serum is more than 145 mEq/L. Hypertonicity of ECF = cellular dehydration.

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Normal Na Concentrations

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135-145 mEq/L

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Common Causes of Hypernatremia

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Inadequate water intake, inappropriate admin of hypertonic saline solution, Cushing's syndrome, oversecretion of aldosterone.

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Symptoms of Hypernatremia

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Serious: Convulstions and Pulmonary edema Other: Thirst, fever, dry mucous membranes, hypotension, tachycardia, low JVD, restlessness.

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Treatment of Hypernatremia

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Isotonic salt-free fluid (D5Water) until serum Na returns to normal.

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Common Causes of Hyponatremia

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Diuretics, vomiting, diarrhea, Gi suctioning, burns, low Na diets, water retention (shift of water from ICF to ECF spaces).

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Symptoms of Hyponatremia

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Lethargy, H/A, confusion, apprehension, water intoxication, seizure, coma.

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Treatment of Hyponatremia

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Treat contributing disorder, restrict water in cases of dilutional hyponatremia.

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Normal Cl Concentrations

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96-106 mEq/L

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Hypochloremia

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<96 mEq/L caused by vomiting, Na deficit, cystic fibrosis.

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Normal ICF K Concentration

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150-160 mEq/L

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Normal ECF K Concentration

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3.5-4.5 mEq/L

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Functions of K

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Regulate ICF osmolarity, deposit glycogen in liver and skeletal muscles, and maintains the resting membrane potential, maintains normal cardiac rhythms, transmits nerve impulses, muscle contraction.

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Cell Firing Basics

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1. Resting Membrane Potential is negative charged. 2. Depolarization. Stimulus cause Na+ gates to open and diffuse in making the cell more positive. 3. Action potential responds by contacting. 4. Repolarization. K+ channels open diffusing K+ out, making it more negative again.

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Hyperkalemia

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K >5.0 mEq/L. Condition that raises the resting potential toward threshold so cells fire more easily.

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Hypokalemia

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K <3.5 mEq/L. Condition that lowers the resting potential away from threshold so cells fire less easily.

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K+ is regulated by:

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Kidneys, changes in pH (acidosis cause K to shift out of a cell; alkalosis causes K to shift into a cell), aldosterone secretion (K into urine), and insulin (K into liver/muscles).

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Causes of Hyperkalemia

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Shift of K from ICF to ECF (cell trauma, acidosis, insulin deficiency, cell hypoxia), and decreased renal excretion.

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Symptoms of Hyperkalemia

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Muscle weakness or paralysis, restlessness, diarrhea, cramping, cardiac arrhythmia.

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Causes of Hypokalemia

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GI loss of K through diarrhea, intestinal drainage tubes, laxative abuse, diuretics, K shift from ECF to ICF (respiratory alkalosis).

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Symptoms of Hypokalemia

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Loss of smooth muscle tone, constipation, intestinal distention, anorexia, paralytic ileus.

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Calcium

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Necessary cation for bones and teeth, blood clotting, hormone secretion, and plasma membrane stability and permeability.

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Phosphate

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Acts as a buffer in the regulation of the acid-base balance, provides energy for muscle contraction (ATP).

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Calcium and Phosphate Balance

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Regulated by 3 hormones: PTH, Vitamin D, and Calcitonin. If one concentration increases, the other decreases.

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Hypocalcemia

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<8.5 mg/dl. Caused by Vitamin D deficiency, removal of parathyroid glands, blood transfusions, pancreatitis.

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Symptoms of Hypocalcemia

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Confusion, Paresthesias around mouth, muscle spams in hands and feet, hyperreflexia, Chvostek sign, adn Trousseau sign.

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Chvostek Sign

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Sign of Hypocalcemia elicited by tapping on the facial nerve just above the temple. Positive sign is a twitch of the nose or lip.

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Trousseau Sign

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Sign of Hypocalcemia characterized by the contraction of the hand an fingers when arterial blood flow in the arm is occluded for 5 minutes.

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Hypercalcemia

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>12 mg/dl. Caused by hyperparathyroidism, calcium resorption, sarcoidosis, excessive Vitamin D.

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Symptoms of Hypercalcemia

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Fatigue, weakness, lethargy, anorexia, nausea, constipation, behavior changes, kidney stones, EKG changes.

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Hypophosphatemia

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<2.0 mg/dl. Caused by intestinal malabsorption.

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Symptoms of Hypophosphatemia

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Lowered capacity for oxygen transported by RBCs, leukocyte and platelet dysfunction, irritability, confusion, numbness, coma, muscle weakness causing respiratory failure.

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Hyperphosphatemia

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>4.5 mg/dl. Caused by cellular destruction associated with chemotherapy, long-term use of phosphate containing enemas, hypoparathyroidism.

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Symptoms of Hyperphosphatemia

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Prolonged can cause clarifications of soft tissues in the lungs, kidneys, and joints.

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Treatment of Hyperphosphatemia

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Aluminium hydroxide binds with phosphate and then is eliminated.

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Magnesium

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Major intracellular cation regulated by the Kidneys.

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Hypomagnesium

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<1.5 mEq/L. Caused by malnutrition, malabsorption syndromes, alcoholism, diabetes mellitus.

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Symptoms of Hypomagnesium

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Symptoms similar to hypocalcemia. Depression, increased reflexes (Homan's sign), ataxia (muscle weakness), nystagmus, convulsions.

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Hypermagnesium

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>2.5 mEq/L. Rare. Usually caused by renal failure.

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Symptoms of Hypermagnesium

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Muscle weakness, hypotension, bradycardia, repsiratory depression.

Pathophysiology – Fluid & Electrolytes – Flashcards

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