FLUIDS AND ELECTROLYTES SLIDES-student (1).pptx

7/23/2019 FLUIDS AND ELECTROLYTES SLIDES-student (1).pptx

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FLUID AND ELECTROLYTES

IMBALANCE



WATER (H2O)

• Water

• the primary !"y #$i"

• appr!%imate&y 60% of the average adult body weight i'ater

• thi' !&$me remai*' re&atie&y +!*'ta*t

• Functions of Water

• pr!i"e' a me"i$m -!r meta!&i+ rea+ti!*' ithi* +e&&'

• tra*'p!rt' *$trie*t'. a'te pr!"$+t' t! a*" -r!m the +e&&'

• a+t' a' a &$ri+a*t

• pr!i"e' i*'$&ati!*

• a'!r' 'h!+/

• re0$&ate' a*" mai*tai*' !"y temperat$re thr!$0h eap!rati!*!- per'pirati!*



Factors Aecting Total Body Water

• AG (&e'' ith a0e)

a-ter 1 y34 !"y ater "e+rea'e' t!567 8 !- t!ta& !"y ei0ht9

I*-a*t6 :76;78 !- ater y ei0ht3

• G!"# (ma&e <-ema&e)

• A$&!T F B"' FAT (-at +e&&'+!*tai* &itt&e ater4< pr!p!rti!* !-ater t! t!ta& !"y ei0ht i' &e''3



FLUID COM=ARTMENTS

Water i' "i'tri$te" i*t! ( )a*or co)+art)ents,

-.-ntracellular /-F12

(34 F TTA5 B"' F5&-"

!TA-!7 WAT# A!" 5T#5'T7-!7-" T8 55

--. 9tracellular /F12

:34 F TTA5 B"' F5&-"• -!T#7T-T-A5 F5&-" ;<%

• -!T#A=A7&5A# (0%

• T#A!755&5A#2<%1



F > E ima&a*+e? F&$i"

C!mpartme*t'



Electrolyte Composition of Body Fluid Compartments

LeMone, page 188



=ROTEINS IN F&$i" C!mpartme*t'



DIFFUSION

I' a mea* !- +assive trans+ort

I' the pr!+e'' y hi+h parti+&e' ('!&i". &i@$i". !r 0a') m!e-r!m a* area !- hi0her +!*+e*trati!* t! !*e !- &!er+!*+e*trati!*. down their concentration gradient.

Ty+es of diusion• a. 7i)+le diusion2fat2 soluble m!&e+$&e' "i$'e

"ire+t&y thr!$0h the &ipi" i&ayer !- the p&a'ma memra*e.i* hi+h they +a* "i''!&e. /eg. o9ygen ( fat2soluble vita)ins and alcohol1.

• Facilitated diusion2 m!e' &ar0e. li+id2insoluble)olecules /e.g. glucose1 a+r!'' the memra*e afterbinding to a trans)e)brane carrier +rotein.

•



Figure 10–5 Diffusion. Solute molecules moe t!roug! a semipermea"le mem"rane from an area

of !ig! solute concentration to an area of lo# solute concentration.

LeMone, page 1$1



Type' !- "i$'i!*



Factors aecting the rate of diusion,

3The 'ie !- the m!&e+$&e' (larger m!&e+$&e'm!e )ore slowly tha* 'ma&&er !*e' e+a$'e&ar0e m!&e+$&e' re@$ire m!re e*er0y t! m!e)3

23 The +!*+e*trati!* !- the '!&$ti!* (them!&e+$&e' m!e fro) a solution of higher +!*+e*trati!* to a '!&$ti!* !- &!er +!*+e*trati!*)

3 The temperat$re !- the '!&$ti!* (I*+rea'e' i*temperat$re i*+rea'e' the rate !- m!ti!* !-m!&e+$&e')

4. whether the chemical is fat-soluble or liquid-soluble (fat soluble is faster)



OSMOSIS

• ITS A DIFFUSION OF WATER

s)olality i' $'e" t! "e'+rie the +!*+e*trati!* !- !"y #$i"'

The !'m!&a&ity !- the e%tra+e&&$&ar #$i" "epe*"' mai*&y !*'!"i$m (Na) +!*+e*trati!* i* the ECF9 0&$+!'e a*" $rea a&'!+!*tri$te t! !'m!&a&ity

p!ta''i$m (G). 0&$+!'e a*" $rea are the primary +!*tri$t!r'

t! the !'m!&a&ity !- i*tra+e&&$&ar #$i"

s)otic >ressure

• the p!er !- a '!&$ti!* t! "ra ater a+r!'' a memra*e



Figure 10–3 %smosis. &ater molecules moe t!roug! a selectiely permea"le mem"rane from an

area of lo# solute concentration to an area of !ig! solute concentration

'o(ier, page 1)*+



TONICITY

• re-er' t! the os)olality !- a '!&$ti!*

• re-er' t! the ee+t a '!&$ti!*' !'m!ti+ pre''$re ha' !*ater m!eme*t a+r!'' the +e&& memra*e' !- +e&&' ithi*the '!&$ti!*

• isotonic '!&$ti!*' hae the 'ame +!*+e*trati!*' !- '!&$te'a' p&a'ma

• hy+ertonic '!&$ti!*' hae a 0reater +!*+e*trati!* !-

'!&$te' tha* p&a'ma

• hy+otonic '!&$ti!*' hae a &!er '!&$te +!*+e*trati!* tha*p&a'ma



Figure 10–4 !e effect of tonicity on red "lood cells. A, -n an isotonic solution, BCs neit!er gain

nor lose #ater, retaining t!eir normal "iconcae s!ape. B, -n a !ypertonic solution, cells lose #ater

and s!rin/ in si(e. C , -n a !ypotonic solution, cells a"sor" #ater and may "urst 0!emolysis

LeMone, page 1$+



Figure 10–4 (continued) !e effect of tonicity on red "lood cells. A, -n an isotonic solution, BCs

neit!er gain nor lose #ater, retaining t!eir normal "iconcae s!ape. B, -n a !ypertonic solution, cells

lose #ater and s!rin/ in si(e. C , -n a !ypotonic solution, cells a"sor" #ater and may "urst 0!emolysis

LeMone, page 1$+



Figure 10–4 (continued) !e effect of tonicity on red "lood cells. A, -n an isotonic solution, BCs

neit!er gain nor lose #ater, retaining t!eir normal "iconcae s!ape. B, -n a !ypertonic solution, cells

lose #ater and s!rin/ in si(e. C , -n a !ypotonic solution, cells a"sor" #ater and may "urst

0!emolysis.

LeMone, page 1$+



Figure 31.2 Moement of fluids and solution tonicity

02dams, C!apter 33, page 45$



ACTIE TRANS=ORT

• A+tie tra*'p!rt6!++$r' he* '$'ta*+e'+a* m!e a+r!'' +e&& memra*e fro) a

less concentrated solution to a )ore

concentrated !*e ith the use of)etabolic energy .

• a+tie tra*'p!rt i' imp!rta*t i* mai*tai*i*0

the "iere*+e' i* '!"i$m a*" p!ta''i$mi!* +!*+e*trati!*' !- ECF a*" ICF ?sodiu)2+otassiu) +u)+



Fa+i&itate" "i$'i!* '3 A+tie

tra*'p!rt



Figure 10–7 !e sodium6potassium pump. Sodium and potassium ions are moed across t!e cell

mem"ranes against t!eir concentration gradients. !is actie transport process is fueled "y energy

from 27.

LeMone, page 1$1



Fi&trati!*

• i' a pr!+e'' herey @uid and solutes )ove together across a )e)brane -r!m !*e +!mpartme*t t! a*!ther3

• The m!eme*t i' -r!m a* area !- higher liuid +ressure to one of lower liuid+ressure.

• E%3? m!eme*t !- #$i" a*" *$trie*t' -r!m the +api&&arie' !- the arterie' t! the ISFar!$*" the +e&&'3

• What creates a hydrostatic +ressure• i' the pre''$re e%erte" y a #$i" ithi* a +&!'e" 'y'tem9

• The hy"r!'tati+ pre''$re !- &!!" i' the -!r+e e%erte" y &!!" a0ai*'t the a'+$&ara&&' (e303 the artery a&&')3

• The #$i"' m!e -r!m the area !- 0reater pre''$re t! the area !- &e''er pre''$re3

• What creates an os)otic +ressure

• O'm!ti+ pre''$re repre'e*t' the "rii*0 -!r+e !- ater3 It re-er' t! the pre''$rethat ha' t! e app&ie" t! pree*t m!eme*t a+r!'' a 'e&e+tie&y permea&ememra*e3

• I* the !"y. p&a'ma pr!tei*' e%ert a* !'m!ti+ p$&& +a&&e" colloid os)otic+ressure or oncotic +ressure p$&&i*0 ater -r!m the ISS i*t! the a'+$&ar+!mpartme*t'3



CA=ILLARY

Blood @ow arteries arteriolesca+illariesvenules

veins

a+illaries are 'ma&&er ra*+he' !-arteri!&e'3

E%treme&y *arr!. mi+r!'+!pi+

&!!" e''e&' ith a a&& +!mp!'e"!- !*&y one layer of endothelialcells.

a+illary beds (*et!r/ !- ma*y+api&&arie') are pre'e*t i* a&& re0i!*'

!- the !"y9ea+h '$pp&ie' the *ee"' !-*ei0h!ri*0 +e&&'9

N$trie*t' a*" a'te m!&e+$&e' aree%+ha*0e" !*&y a+r!'' their thi*

a&&'99 en and lucose diuse out



Figure 10–6 Fluid "alance "et#een t!e intraascular and interstitial spaces is maintained in t!e

capillary "eds "y a "alance of filtration at t!e arterial end and osmotic dra# at t!e enous end.

LeMone, page 1$1



F > E ima&a*+e? M!eme*t !- H2O

Hy"r!'tati+ pre''$re !r p$'h -!r+eJ

O'm!ti+ pre''$re !r p$&&J Kattra+ti!* -!r+e

∆in “pull or push” → fluid movement& volume in the compartment



F > E ima&a*+e? Capi&&ary E%+ha*0e

• Capi&&ary E%+ha*0e

http://www.youtube.com/watch?v=Q530H1WxtOw&feature=fvwrel

http://www.youtube.com/watch?v=Q530H1WxtOw&feature=fvwrel



F > E ima&a*+e? M!eme*t !- H2O?

hy"r!'tati+ pre''$re






EDEMA



F > E Ima&a*+e? E"ema

• de)a 6 the a++$m$&ati!* !- #$i" i* thei*ter'titia& 'pa+e. hi+h may impair ti''$e -$*+ti!*3

• O'm!&arity K +!*+e*trati!* !- '!&$te i* the #$i"(m!&L !- '!&$ti!*)

• s)olality K +!*+e*trati!* !- '!&$te i* '!&e*t(/0)

(m!&/0)3 Ea'ier t! ea&$ate

• i'i&e i*i'i&e

• Depe*"e*t

• =r!&!*0e"



E"ema +a$'e'

1.↑ capillary hydrostatic pressure (or ↑ BP d/t hypervolemia)

2.Low colloid osmotic pressure due to:

• Liver disease (low synthesis of proteins),

• kidney disease (excess loss of plasma proteins),

•↑ capillary permeability (ex. Inflammation, infection)

Loss of plasma proteins (ex. Albumin → ↓plasma osmotic pressure; more

fluid leaves & less returns)

3.Excessive Na in the ECF

4.Obstruction of the Lymphatic circulation:

Removal of lymphatic nodes, (ex. CA)

Infection (elephantitis)













F > E Ima&a*+e? E"emaee+t'

:. "ecreased +erfusion3bl. Flow to tissue,• L!+a& 'e&&i*06 ti''$e +!mpre'' &!+a& &3 e''e&'9

• I*+rea'e" !&$me !- ISF i*+rea'e "i'ta*+e here!%y0e* a*" *$trie*t' "i$'e t! ti''$e +e&&'9

• I*+rea'e I*ter'titia& pre''$re6 may re'tri+t arteria& #!i*t! area pree*t' *!rma& +e&& -$*+ti!*. repr!"$+ti!*

ti''$e *e+r!'i' (susceptible for tissue break down; ulceration)

2. Functional Impairment:

• functional impairment (joints, GI (absorbtion), Respiratory

systems gas exchange)

3 ↑ weight, pain, appearance (shinny tight skin)



F > E Ima&a*+e? Thir"6Spa+i*0

• Shi-t !- #$i" -r!m the a'+$&at$re t! the *!t rea"i&ya++e''i&e area ( e%3 perit!*ea& !r p&e$ra& +aitie')

• D!e' a per'!*' ei0ht +ha*0e' • Hyper!&emia (H2O > Na retai*e"9 &ee&' 6 *!rma&)

• What are '!me !- the +!*"iti!*' that may &ea" t!hyper!&emia

• CHF. Re*a& -ai&$re. +irrh!'i' !- &ier. C$'hi*0''y*"r!me



Dehy"rati!*

O O O



REULATION OF BODYFLUIDS

• N!rma&&y. i*ta/e !- ater 4 !$tp$t !-ater

• ater a&a*+e e%i't' he* i*ta/e 4!$tp$t






DEHYDRATION

A "e+rea'e i* i*traa'+$&ar. i*ter'titia& a*"!ri*tra+e&&$&ar #$i" Mi&" "ehy"rati!* 4 "e+rea'e !- 28 i* !"yei0ht

M!"erate "ehy"rati!* 4 "e+rea'e !- 8 i*!"y ei0ht

Seere "ehy"rati!* 4 "e+rea'e !- ;8 i* !"yei0ht



CAUSES

9cessive @uid losses

-r!m the I tra+t are the m!'t +!mm!* +a$'e'. '$+h a'-r!m !miti*0. "iarrhea. I '$+ti!*i*0. i*te'ti*a& "rai*a0e

Other' +a$'e' !- #$i" &!'' i*+&$"e e%+e''ie 'eati*0.

hem!rrha0e. +hr!*i+ a$'e !- &a%atie' a*"!r e*ema' re*a& &!''e' "$e t! /i"*ey "i'ea'e. i*a"e@$ate ADH a*"

a&"!'ter!*e &ee&'

r" 'pa+e &!''

-nsuCcient water intaDe

&ncontrolled diabetes ith &!'' !- #$i". e&e+tr!&yte' a*"

0&$+!'e i* the $ri*e



F > E Ima&a*+e?

Dehy"rati!*? Ca$'e'

• !miti*0 > Diarrhea

• E%+e''ie 'eati*0 (Na. H2O)

• Diaeti+ Get!a+i"!+i'9

• I*'$+ie*t H2O i*ta/e

• C!*+e*trate" -!rm$&a -!r i*-a*t'



F > E Ima&a*+e?Dehy"rati!*?

• < 'eri!$' -!r i*-a*t' a*" e&"er&y

• H2O &!'' a++!mpa*ie" y Lyte'

"ep&eati!*

• -sotonic "ehy"rati!*

• 8y+otonic "ehy"rati!* (&!'' <Lyte'9

PH2O)

• 8y+ertonic "ehy"rati!* (&!'' <H2O9 P Lyte')



TY=ES OF DEHYDRATION



F > E Ima&a*+e?

Dehy"rati!*? Ee+t'

• Dry m$+!$' memra*e

• De+rea'e '/i* t$r0!r

• L! B=. ea/ p$&'e. -ati0$e

• I*+rea'e" Hemat!+rit (m!re RBC tha* H2O i*&!!")

• De+rea'e me*ta& 'tat$'

• COM=ENSATION

• M!re ADH. a&"!'ter!*e

• a'!+!*'tri+ti!*

• i*+rea'e" the 'pe+iQ+ Uri*e 0raity3



Manifestations of de!ydration

CONTROL OF FLUID



CONTROL OF FLUIDBALANCE

• THIRST MECHANISM

• ADH

• RAAS



F > E ima&a*+e? M!eme*t !- H2O+!*tr!& re0$&ati!*



F > E ima&a*+e? M!eme*t !- H2O? ADH



Flo# C!art of Mec!anisms egulating Sodium and &ater Balance to elp

Maintain Blood 7ressure omeostasis 0Marie", 8t! edition, C!apter 19

Figure 10 9 !e renin angiotensin aldosterone system Decreased "lood olume and renal



Figure 10–9 !e renin:angiotensin:aldosterone system. Decreased "lood olume and renal

perfusion set off a c!ain of reactions, leading to release of aldosterone from t!e adrenal corte;.

-ncreased leels of aldosterone regulate serum '< and =a<, "lood pressure, and #ater "alance

t!roug! effects on t!e /idney tu"ules.

LeMone, page 1$5



DRUS USED FOR DIURESIS



=ep!ron Functions



Figure 30.1 !e nep!ron

02dams, C!apter 3), page 41*



Dr$0' U'e" t! treat



Dr$0' U'e" t! treatDiarrhea

( )a*or grou+s,

3 s+eciEc antidiarrheal drugs

6"r$0' that treat the $*"er&yi*0 +a$'e !- the"iarrhea

6i*+&$"e the a*ti6i*-e+tie "r$0' a*" "r$0'

$'e" t! treat ma&a'!rpti!* 'y*"r!me

23 nons+eciEc antidiarrheal drugs

6a0e*t' that a+t !* !r ithi* the !e& t!

pr!i"e 'ympt!mati+ re&ie-

6the'e "r$0' "! *!t i*#$e*+e the a+t$a& +a$'e



!ons+eciEc antidiarrheal agents

>rototy+e drug, 5o)otil / di+heno9ylate atro+ine1

Actions,6a+tiate !pi!i" re+ept!r' i* the I tra+tects,6 i*te'ti*a& m!ti&ity (+eristalsis) a*" th$' '&! i*te'ti*a&tra*'it. allowing )ore ti)e for absor+tion of @uids and

electrolytes6 the 'e+reti!* !- #$i" i*t! the 'ma&& i*te'ti*e a*" a'!rpti!* !- #$i" a*" 'a&t i*t! the 'ma&& i*te'ti*e

6net eect is to present the large intestine with less water

6a' a re'$&t. the #$i"ity a*" !&$me !- the 't!!&' are re"$+e". a'i' the -re@$e*+y !- "e-e+ati!*

7ide ects,6at the "!'e' $'e" -!r "iarrhea. '$e+tie ee+t' a*"

"epe*"e*+e "! *!t !++$r6e%+e''ie "!'e' +a* e&i+it m!rphi*e6&i/e '$e+tie ee+t'

A ti"i h & " N i



A*ti"iarrhea& "r$0'? N$r'i*0

C!*'i"erati!*

Assess &ier. /i"*ey -$*+ti!* pri!r t!a"mi*i'trati!* "$e t! e%+reti!* i* /i"*ey

• D$e t! p!''i&e "ii*e'' a"i+e *! "rii*09

• Otai* a'e&i*e ita& Si0*'. a*" per-!rm

a"!mi*a& a''e''me*t9

• Di'+!*ti*$e me"i+ati!* !*+e "iarrhea i'

'$'i"i*09

• See/ MD +are i- &!!" re'e*t i* 't!!&9



Oer the C!$*ter Dr$0'



Fluids and electrolytes +art --



E&e+tr!&yte'Na









E&e+tr!&yte'?

G



Multisystem Effects of ypo/alemia



E&e+tr!&yte'? Ca&+i$m



Figure 10–12 Lo# calcium leels 0!ypocalcemia trigger t!e release of parat!yroid !ormone

07, increasing calcium ion leels t!roug! stimulation of "ones, /idneys, and intestines.





Figure 10–13 A, 7ositie C!oste/>s sign. B, 7ositie rousseau>s sign.



Figure 10–13 (continued) A, 7ositie C!oste/>s sign. B, 7ositie rousseau>s sign.



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FLUIDS AND ELECTROLYTES SLIDES-student (1).pptx