Term
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Definition
-Fluid contained within all of the cells of the body
comprises 40% body water |
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Term
| Major cations intracellular fluid |
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Definition
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Term
| Major Cations Extracellular Fluid |
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Definition
Na+
-small amount of K, Ca, Mag |
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Term
| Major Anion Extracellular Fluid |
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Definition
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Term
| Extracellular Compartment |
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Definition
-Contains all of the fluids outside the cell
-Consists of plasma and interstitial compartment |
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Term
| Potential sources of Na Loss |
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Definition
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Term
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Definition
hyperlipdemic and hyproteinemic states result in an isotonic expansion of of the circulating plasma volume
causes a decrease in serum Na+ concentration, although total body Na+ remains the same |
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Term
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Definition
hyperglycemia may result in transient fluid shift from the intracellular to the extracellular compartment, thus diluting the serum sodium concentration
Rapid infusion of hypertonic solutions of glucise, mannitol and glycine may have similar effect on Na+ concentration |
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Term
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Definition
classified on the basis of extracellular fluid volume
generally develops as a consequence of the administration and retention of hypotonic fluids
rarely occurs from the loss of salt-containing fluids alone |
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Term
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Definition
-Net movement of water across a semi-permeable membrane in response to a change in concentration.
-water can freely move determined by exertion of physical forces across the semipermeable membrane
-that cell membrane does not allow proteins across |
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Term
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Definition
-number of osmoles/liter of solution
-number of osmotically active particles
-normally determined by sodium and its attendant anions-Cl- and HCO3- |
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Term
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Definition
-Fluid pressures generated by concentrations of nondiffusable protein in the plasma
-largely responsible for the movement of fluid back into the capillary
-plasma protein cannot pass through the semi-permeable membrane
-generated by concentrations of protein
main plasma protein is albumin |
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Term
| Major anions intracellular fluid |
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Definition
| phosphate, sulfates, proteins |
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Term
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Definition
-Primary oncotic protein in plasma
-accounts for high colloid osmotic pressure |
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Term
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Definition
-Most of the body's sodium is in the extracellular compartment
-accounts for most of the osmotic activity in the ECF |
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Term
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Definition
| -Acts directly on the renal tubules in increase sodium reabsorption
-formed by the conversion of ACE I to ACE II in the lungs
-strong vasoconstrictor, which increases peripheral vascular resistance and blood pressure
-stimulates aldosterone secretion from the adrenal gland, which increases sodium and water retention by the kidney
-acts directly on the kidney to decrease the elimination of sodium and water |
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Term
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Definition
-enzyme that is synthesized, stored and released by the kidneys in response to an increase in sympathetic nervous system activity or a decrease in blood pressure, extracellular fluid volume or extracellular sodium concentration
-most of the the renin that is released leaves the kidney and enters the blood stream, where it converts angiotensin to angiotensin I |
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Term
| Isotonic fluid volume deficit |
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Definition
-reflects a decrease in ECF volume
-results when water and electrolytes are lost in isotonic proportion
-almost always caused by loss of body fluids
-can by caused by blood loss
-often caused by decrease in fluid intake, loss of GI fluids from vomiting or diarrhea, polyuria or excessive sweating |
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Term
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Definition
-Can be from receiving too much hypotonic fluid instead of isotonic fluid
-isotonic: general expansion of the extracellular space from isotonic solution
-bowel surgery causes third space loss in the bowel for the first 24-36 hours. Typically on day 3 they start to sequester the fluid and pee it out. |
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Term
| Hypotonic fluid volume excess |
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Definition
-inappropriate administration of salt poor fluid for replacement of isotonic loss
-using D5W as a volume resucitation fluid |
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Term
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Definition
-Administration of high sodium loads not balanced with water can lead to ECF expansion
- |
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Term
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Definition
| -serum sodium less then 135 |
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Term
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Definition
-look at their glucose, lipids and protein
-if there's an isotonic expansion of the vascular space secondary to glucose, lipids or proteins
-correct for pseudohyponatremia by asking for a plasma K instead of a serum K |
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Term
| Tests to assess for volume status |
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Definition
-Serum and urine Na
-serum and urine Osmo
-pH |
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Term
| Hypervolemic hyponatremia |
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Definition
-urine Na >20, suspect renal failure
-most common cause for increased extracellular fluid
-may respond to water restriction |
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Term
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Definition
-hypervolemic hyponatremia
-urine Na <20
-Kidneys think the body is hypovolemic, so they conserve sodium, |
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Term
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Definition
| could be because the kidneys are seeing low ineffective circulating volume, but the circulating volume could be high due to heart failure, kidneys are contributing to the problem by causing more retention of water but not sodium |
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Term
| Causes of euvolemic hyponatremia |
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Definition
-if urine osmo <100, then psychogenic polydipsia
-if urine osmo >100, the SIADH
-can see in cortisol deficiency, severe hypothyroid, but less likely |
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Term
| Causes of hypovolemic hyponatremia |
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Definition
-increasedn excellular water
fluid losses with replacement with hypotonic fluids
-overdiuresis of both sodium and water
-if urine Na is high, most common cause is renal failure
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Term
| Treatment for severe hyponatremia |
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Definition
-Don't replace too fast!!
-Treat to safe, which is 125-130 |
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Term
| Equation to replace sodium deficit |
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Definition
(# treating to-measured Na) x (0.6xkg) (which is total body water)
use adjusted body weight if patient is >30% over TBW
-If woman, .5 x weight
no more then half the calculated volume in the first 12-18 hours, then the rest of the replacement in the next 24-48 hours |
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Term
| Treatment of hypernatremia |
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Definition
-no more then 1mmol/liter/hr
-go slow
-check serial serum Na
-you can give free water by PO, PEG or NGT
-can be replaced oraly as well as IV |
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Term
| Replacement Fluid deficits in hypernatermia |
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Definition
-no more then 50% in first 12-24 hours
-for pure water loss, use D5W
-patients with associated Na losses and predominately dehydrated-NSS
if neuro symptoms predominant-.45 saline |
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Term
| How to calculate Osmolarity |
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Definition
| 2x(Na) +(glucose/18) + BUN/2.8 |
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Term
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Definition
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Term
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Definition
| It patient's actual body weight is greater then 30% of their ideal body weight |
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Term
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Definition
| increases the body's amount of sodium and water |
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Term
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Definition
an isotonic transfer of fluid from a -functional fluid compartment to a non-functional fluid compartment
-no longer in the effective circulatioln |
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Term
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Definition
-Absolute volume loss of both water and solute losses together
-depletion of ECF |
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Term
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Definition
-less water loss compared to solute loss
-causes are inappropriate ADH, large evaporative losses |
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Term
| Treatment for isotonic losses |
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Definition
-could be from vomiting or NGT loss
-1/2NS with potassium added
-if hemondynamically unstable, give a liter or more of isotonic crystalloid |
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