1.  What percent of total body water is found intracellularly?

2. What percent of total body water is found extracellularly?

3. Extracellular fluid, outside the cell includes 3 types of fluid.  What are they are where are they found?

1. 63% is intracellular

2. 37% is extracellular

3. Intravascular fluid (within blood vessels), Interstitial fluid (between cells and blood vessels), Transcellular (cerebrospinal, pericardial, synovial)

1. Positively charged electrolye

2. Negatively charged electrolyte

1. Cation

2. Anion

What are the two major electrolytes found in Intracellular fluid?

What are the two major electrolytes found in Extracellular fluid?

Intracellular- Potassium, Phosphate (K.P.)

Extracellular- Sodium, Chloride

1. Substance dissolved
2. solution in which it is dissolved in

1. solute

2. solvent

• Process by which a solute in solution moves
• Molecules move from an area of higher concentration to an area of lower concentration
• Passive transport/requires no energy

gas exchange in the lungs occurs by ______.

molecules that readily cross the plasma membrane enter or leave by ______.

• A carrier system that moves substance across a membrane faster than it would with simple diffusion.
• Substance still only moves from an area of higher concentration to one of lower concentration

What is an example of this?

Facilitated Diffusion

movement of glucose with assistance of insulin across cell membrane into cell

______ is the diffusion of water across a membrane. Like other molecules, water will move from an area of ____ concentration to an area of ____ concentration.

A solution with a higher solute concentration is called a ______ solution. Conversely, a solution with a lower solute concentration is called a ______ solution. If two solutions have the same concentration, they are ______.

Osmosis - high to low

Hypertonic , Hypotonic, Isotonic

Pull that draws solvent through the membrane to the more concentrated side (or side with solute).

Amt determined by relative number of particles of solute on side of greater concentration

0.9% sodium chloride

5% dextrose in water (D₅W)

Lactated Ringers

HYPOTONIC OR HYPERTONIC

1. Solution of lower osmotic pressure
2. Solution of higher osmotic pressure
3. If infused into blood, water moves out of cells and into solution (cells wrinkle or shrivel)
4. If infused into blood, RBCs draw water into cells (can swell & burst)

1. Hypotonic
2. Hypertonic
3. Hypertonic (if you're a cell and you're hyper, you are running around a lot and lose weight, causing you to shrink)
4. Hypotonic 

What is the osmolality of Plasma (serum)?

What is the osmolality of urine?

ECF osmolality is determined by ______.

280-300mOsm/kg

50-1400mOsm/kg

Sodium

Urine specific gravity measures what?

What is the specific gravity of urine?

It measures the kidney's ability to excrete or conserve water

Specific gravity of urine is 1.010 to 1.025

Moves molecules or ions uphill against concentration (from an area of lower concentration to higher concentration) and osmotic pressure

Requires ATP

Requires specific "carrier" molecule and specific enzyme (ATPase)

Which electrolytes require active transport to mass through cell membrane?

Active Transport

sodium, potassium, calcium, magnesium, some sugars & amino acids

Force of the fluid pressing outward against vessel wall

(with blood, it not only refers to weight of fluid against capillary wall but to force with which blood is propelled with heartbeat)

Large quantities of fluid from the intravascular compartment shift into the interstitial space; is inaccessible to the body

What can this be seen with?

Third spacing

Can be seen with trauma, inflammation, disease

osmoreceptors in the hypothalamus

An increase in osmotic pressure of body fluids initiates thirst

____ is made in the hypothalamus; known as the water conservation hormone

If blood volume decreases, then ___ is released & water is reabsorbed in kidney.  Urine output will be ____ but concentration will be _____.

ADH

ADH, lower, increased

1. concentration of water in blood decreases
2. increase in osmotic pressure of body fluids stimulates osmoreceptors in hypothalamus in brain
3. hypothalamus signsls posteriour pituitary to release ADH
4. blood carries ADH to kidneys
5. ADH causes distal convoluted tubules and collecting ducts to increase water reabsorption by osmosis
6. Urine concentrates, and urine volume decreases 

What are the compensatory mechanisms associated with Hypovolemia (FVD)

What can severe hypovolmia cause?

• Increased sympathetic nervous system stimulation
• increase in heart rate & cardiac contraction
• thirst
• release of ADH & aldosterone

hypovelemic shock or renal failure

• Abnormal GI fluid loss
• Abnormal fluid loss from skin
• Increased water vapor from lungs (hyperpnea)
• Diuretics
• Decrease in fluid intake
• third-space shift (ascites or trauma)

• dry mucous membranes
• weight loss
• orthostatic hypotension & increased pulse
• subnormal body temp
• flat neck veins
• decreased urinary output & altered sensorium

• Monitor I&O
• If urine output is below 30mL/hr, notify physician
• check urine spec grav q8h
• daily weight
• monitor skin turgot, oral membranes, and labs

A decrease in hematocrit, serum Na, serum osmolality, urine spec. gravity,

increase BUN

• short of breath & orthopnea
• edema & weight gein
• distended neck veins & tachycardia
• increased blood pressure
• crackles & wheezes
• maybe ascites & pleural effusion
• increase in CVP

• monitor I&O
• daily weight and edema assessment
• restrict sodium intake
• limit intake of fluids
• watch for signs of K+ imbalance
• monitor for pulmonary edema
• place in semi-fowler's position

What are the normal lab value ranges for the following and what do they measure?

BUN, Creatinine, and Hematocrit

BUN: 10-20 mg/dL

Creatinine 0.7-1.5mg/dL

Hematocrit (m) 44-52%, (f) 39-47%

BUN -blood urea nitrogen; made up of urea and end-product of protein metabolism

Creatinine- end product of muscle metabolism; better indicator of renal function

Hematocrit: vol % of RBC's in whole blood

Increased with GI bleeding, dehydration, inc. protein intake, fever, & sepsis

Decreased with starvation, end-stage liver dx, low protein diet, expanded fluid vol(pregnancy)

What balances the positive charge of sodium in osmolarity?

(creates colloid osmotic pressure which pulls in and holds water in the bascular bed as well as pulling water from interstitial space into vascular bed- "water magnet"

ADH

Is stored in the ____ ____ ____.

Acts on ____ _____ ____ to regulate _______ or elimination of water.

posterior pituitary gland

renal collecting tubule to regulate reabsorption

ALDOSTERONE

Produced by ____ _____.

Acts on ____ ___ _____ _____.

Responsible for reabsorption of ____ and ____ into the bascular compartment

Produced by adrenal cortex

Acts on renal distal convoluted tubule

sodium/water

Released by kidneys in resonse to decreased blood volume (lower blood pressure)

Causes angiotension to split and produce angiotension I and Angiotension II

Angiotension II causes the adrenal cortex to release aldosterone.

Resulting in an increased tubular reabsorption of sodium, which causes increased water reabsorption in order to increase blood volume and blood pressure

Affects fluid volume and concentration in ECF

Regulated by Aldosterone, Renal blood flow, Renin secretion, Antidiuretic hormon (ADH), Estrogen, Carbonic anhydrase enzyme

Diuretics

Loss of GI fluids

 Gain of H₂o

Excessive admin of D5W

Aldosterone Deficiency

Poor skin turgor

Orthostatic hypotension

Dry mucosa/ decreased saliva

headache

Abdominal cramping

muscle twitching

altered mental status

seizures/coma

H2O Deprivation

heatstroke

burns

salt water drowning

thirst

Increased temp

swollen, dry tongue

Hallucinations

lethargy

restlessness

seizures

increased pulse/bp

LABS: increased Na+, Decreased urine Na+

Increase in urine spec. gravity & osmolarity

Potassium wasting diuretics (thiazides, loop diuretics)

GI loss: vomiting, GI suction

Diarrhea

corticosteroid admin

alkalosis

fatigue

anorexia

muscle weakness

polyuria

decreased bowel motility

v-fib

decreased BP

hypoactive reflexes

EKG: elevated U wave; flat or inverted T wave

decreased renal excretion of k+

rapid admin of k+

potassium sparing diuretics

metabolic acidosis

burns
MEDS: ace-inhibitors, NSAIDS

EKG: peaked, narrow T wave