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Osmolality
concentration of how many particles...higher osm the higher the concentration
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hyperosmolality
more concentration than normal
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hypo-osmolality
more diluted
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hydrostatic pressure
- pressure of blood vessels on blood.
- pushes out of vessels
- low when you want to keep blood
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colloid osmotic pressure
pressure exerted within the cardiovascular system by proteins found in blood plasma.
- Maintaining the proper pressure ensures that the body tissues maintain the proper levels of liquid and that too much liquid does not escape from the capillaries. Under normal conditions, oncotic pressure tends to cause fluid to be drawn into the capillaries.
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filtration pressure
- a combination of blood pressure pushing the plasma against the walls of the capillaries
- and osmotic pressure drawing water into the capillaries.
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volume regulations
GAins
- ingestion
- metabolism
- iv infusion
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volume regulation losses
- respiration (can't measure it) ...resp increases 10% every degree
- skin evaporations(sweating, HIV_night sweats., TB
- feces-diarrhea
- urine=obligatory loss of 700ml/day or 25-30cc/hr
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REgulatory Mechanisms
ADH
Antidiuretic hormone
- makes you hold on to urine volume
- saves water
- made in the hypothalamus and stores in posterior pituitary
brain trauma or tumors...doesn't regulate well too much ADH=no urine......gain wt in edema
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REgulatory Mechanisms ALDOSTERONE
- SAVE NA+
- adrenal cortex(produced and released on kidneys)
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REgulatory Mechanisms
others
- Thirst -respond to 1% change in volume changes...h20 will move out of cells and into blood ,causing cells to shrink
- GI tract -absorb h20
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Hypo-osmolar imbalance
- loss of sodium or gain of water
- more diluted
- less concentrated
- too much water or lost all na
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Hypo-osmolar imbalance
loss of sodium
- thiazide diuretics(urinated all Na+)
- loss of gi fluid high in sodium
- loss salt-less concentrated
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sodium loss symptoms(volume loss)
- tachycardia
- weight loss
- signs of extracellular fluid(ECF) deficit
- sodium less that 135(normal 136-145)
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Hypo-osmolar imbalance
gain of water
- water intoxication(drank too much)
- water intake impaired renal function (drink but no output)
- SIADH- too much adh
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Hypo-osmolar imbalance
water excess symptoms
- swelling of cells...water moves from less concentrated blood to the cells... when in brain it causes a headache
- headache
- muscle cramps, weakness, fatigue
- ECF volume excess symptoms
- sodium less than 135 -because the fluid is so dilute that na is low
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Hyper-osmolar imbalance
gain of sodium or loss of water
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Hyper-osmolar imbalance : LOSS OF water
volume deficit examples:
- diabetes-diuresis(polyuria) ..sugar pulls water with it ...low vascular volume
- hyperosmolar tube feedings without water(usually an accident)
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Hyper-osmolar imbalance: gain of sodium
- hyper osmolar iv solution-na in iv
- saltwater drowning-inhaled salt
- hyper-aldosteronism=save NA
- sodium bicarbonate overdose=alkalosis decreases concentration
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Hyper-osmolar imbalance symptoms
- thirst
- serum sodium higher than 145
- decreased reflexes
- dehydration-all volume from cells trying to fix blood..muscle cells shrink
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ISOTONIC deficit
- loss of sodium and water from ECF
- lost both salt and water equally
- measure na-would be the same as normal
- need both NA and H20
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ISOTONIC deficit etiology
loss of volume
- third spacing(fluid in wrong area) ex: liver failure, with big belly..blood protein loss fluid moves out of cell causing big belling
- hemorrhage-common
- vomiting/diarrhea
- profuse diaphoresis(usually sweat is more hypotonic (more salt loss))
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Isotonic deficit symptoms
- wt loss (volume loss)
- tachycardia/tachypnea (pump whats left fast)
- low urine output(not enough fluid to filter)
- postural hypotension(decompensation of vascular bed)
- low grade temp
- normal sodium
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isotonic treatment
isotonic iv fluids= lactated ringers(Na,Cl, K) esp base ....or .9%naCl
oral rehydration
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isotonic excess
and etiology
- gain both sodium and water
- -CHF
- -cirrhosis
- -renal failure
- -steroids
- too much iv solution
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isotonic excess symptoms
- wt gain
- pulmonary edema
- neck vein distention
- hypertension
- bounding pulse
- pitting edema (filtration pressure is hight..blood vessel is too hight
- normal sodium
- GI is swollen and causes them not to be hungry
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isotonic excess treatment
- diuretics(specific to loss of na and water)
- assessment
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dehydrated and thirsty?
- hyperosmotic problem
- treat with normal saline>dilute a little better like 1/2 saline ...even better D5 W
if diabetic 1/2 normal saline
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