Fluid and electrolytes

loss from skin and lungs that can't be measured

fluids lost during urination, defecation, wounds, and other means that can be measured

Na+ and Cl-, Ca+ and phos -

test--distinguishing types and causes of acit base imbalances bc reflects serum anion cation balance

135-145 mEq/L

3.5-5.0

8.5-10

275-295 (# of solutes dissolved in a solution)

1.010-1.035

All fl outside cells

• Fl between cells and the blood vessels
• Reserve fluid replacing either fluid in bl vessels or cells depending on need (shift in or out)

• All fluid inside cells
• *Most boyd fluids are inside the cells

• Fluid within blood vessels
• Liquid portion of blood
• Transports O2 and nutrients to cells and waste products away from cells

Vascular fluid--quickly lost or gained in response to fluid intake and losses

• Helps nerve and muscle cells interact
• Numbness, tingling, seizures

• Helps maintain osmotic pressure
• Gastric mucosal cells--need to produce HCL acid for food breakdown

• Stabilizes cell membrane and reduces permeability to Na+
• Transmits nerve impulses
• Contract muscles
• Coagulates blood
• Forms bones and teeth

• Cell excitability refulation
• Nerve impulse conduction
• Muscle contraction and myocardial membrane respnsiveness
• Intracellular osmolality control

• Energy metabolism
• Combines with Ca+--key role w bone and tooth mineralization
• helps maintain acid-base balance

• *cardio and nervous
• Enzyme reactions
• neuromuscular contractions (more)
• *given to calm nervous in prego women--preeclampsia--give mag sulfate

• Same solute concentration as another solution (NS is one)
• NS 0.9%, LR--same concentration

• Lower solute concentration than another solution
• 0.45% NaCl--lower solute concentration plasma--swell and H2O move in

• Higher solute concentration than another solution
• (solutes greater than pts blood)
• D 5% in 0.45% NS, D5 in 0.9% nS
• Greater # of solutes than plasma--H2O drawn out of solution

Effect of osmotic pressure of solution on cells within that solution

• hypo= may cause too much fl to move from veins into cells and cells can swell
• hyper=may cause too much fl to be pulled from cells into blstream and cells can shrink

Passive movement fl across membrane from area of lower solute concentration and high fluid to area of higher solute concentration and less fluid

• Concentration of all solutes within a body fluid compartment
• Normal of both ICF and ECF= 275-295

• Solutes move from area of higher solute concentration to area of lower solute concentration
• Passive transport

• Simple (random movement solutes)
• Facilitatied (large H2O soluble mol)

• H2O and colutes move across capillary membranes driven by fluid pressure (hydrostatic)
• Movement of greater pressure to lesser pressure

Created by pumping action of ht by gravity

Process prevents too much fl from leaving the capillaried no matter how much hydrostatic pressure exists in capillaries

• Protein that remainds behind in the diminishing volume of water when fl enters thru a capillary
• Can't pass thru cap membranes
• Albumin is a "WATER MAGNET" it keeps water in intravascular space

• Allows molecules to move across cell membranes into are of higher solute concentration -- like swimming upstream
• May need energy ATP
• Sodium potassium pump

• Thirst (altered LOC vulnerable)
• Kidneys (primary respon ofregulation of fl and elc balence)
• -Nephron--forms urine and is workhouse of kidneys (glomerulous and tubule) filters 1-2 L/day.... Nephron reabsorbs remaining 178 L/day
• Antidiuretic hormone *Vasopressin* Body hold H2) when fl levels drop--releases ir when fl level rises

Urine output

• ADH not produced
• Impaired reabsoprtion in kidney-result copious dilute urine output
• Thirst mechanism stim--drinks additional fluids--maintaining high urine output

Excess ADH released--more reabsorbed - fl col increases and urine output scant and concentrated

• Helps maintain intravascular fluid bal and bp
• Fall in bp-- basically constricts bl vessels and increases bp and thirst--release aldosteron from adrenal cortex which retains Na+ and H2), which restores bl volume

• released from atria--response to stretching from fl overload
• Inhibits renin secretion--opposing renin angiotensin aldosteron system and effects of aldosteron
• Result=promotes Na+ and H2O loss and causes bl vessesl to dilate--decreasing bp and reducing intravasculat bl volume

• s&s
• fatigue, tachy, weak thready p
• Labs
• inc serum osmolality, hematocrit, urine spec gravity

• s&s
• htn, tachy, full bounding p, inc resp rate, crackles, wheezes, dependednt edema
• Labs
• dec serum o, hematocrit, u spec gravity

injury, inflamm which causes cap permeability allowing fl and elec and protein to leak from vessels--- ascites

lokk up pg 100!!!!

• Lg amt of fl given rapidly over short amt of time; NS or LR (crystalloids) followed by prbcs------
• has low bp, urine output and watch output to see therapeutic response and challange kidneys

• Ferosemide (Lasix)
• pg 106=more

Hydrochlorothiazide

Spironolactone (Aldactone)

• Less than 135
• Affects function of col and invol muscles, Headache, hyperreflexia, musc twitching
• Monitor lithium levels (bipolar meds)

• H2O moves out of cell= cellular dehydration
• Dehydration in brain cells= neurologic s&s confusion and dec LOC
• Cellular dehydration= dry, sticky mucous membranes