Chapter 13 And 15 Fluid Electrolytes Basics


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Chapter 13 And 15 Fluid Electrolytes Basics

  1. 1. Fluid and Electrolytes Basics Peggy D. Johndrow 2009
  2. 2. Fluid Compartments <ul><li>Intracellular fluid (ICF) </li></ul><ul><li>Extracellular fluid (ECF) </li></ul><ul><ul><li>Intravascular (plasma) </li></ul></ul><ul><ul><li>Interstitial </li></ul></ul><ul><li>Transcellular </li></ul><ul><ul><li>Cerebrospinal fluid </li></ul></ul><ul><ul><li>Gastrointestinal (GI) tract </li></ul></ul><ul><ul><li>Pleural spaces </li></ul></ul><ul><ul><li>Synovial spaces </li></ul></ul><ul><ul><li>Peritoneal fluid spaces </li></ul></ul>
  3. 3. Fluid and Electrolyte Movement <ul><li>Diffusion </li></ul><ul><li>Facilitated Diffusion </li></ul><ul><li>Active Transport </li></ul><ul><li>Osmosis </li></ul><ul><ul><li>Measurement of Osmolality </li></ul></ul><ul><ul><li>Osmotic Movement of Fluids </li></ul></ul><ul><li>Hydrostatic Pressure </li></ul><ul><li>Oncotic Pressure </li></ul>
  4. 4. Filtration <ul><li>Blood pressure - hydrostatic filtering force </li></ul><ul><li>Difference between hydrostatic pressure of capillary bed and interstitial determines whether fluid leaves the blood vessels and enters the tissue spaces (interstitial fluid) </li></ul>
  5. 5. Diffusion <ul><li>Diffusion - free movement of most electrolytes, atoms, and molecules through cell membranes (selective and impermeable) </li></ul><ul><li>Movement of molecules from an area of high concentration to low concentration; occurs in liquids, solids, and gases </li></ul><ul><li>Membrane separating two areas must be permeable to substance for diffusion to occur </li></ul>
  6. 6. Diffusion
  7. 7. Facilitated Diffusion <ul><li>Very similar to diffusion </li></ul><ul><li>Specific carrier molecules involved to accelerate diffusion </li></ul><ul><li>Glucose cannot cross the cell membrane without insulin </li></ul>
  8. 8. Osmosis <ul><li>Osmosis and filtration act together in capillary fluid dynamics to control extracellular fluid (ECF) and intracellular fluid (ICF) volumes </li></ul><ul><li>Thirst mechanism - example of how osmosis helps maintain homeostasis </li></ul>
  9. 9. Active Transport <ul><li>Cells use active transport to control cell volume and intracellular concentrations of many substances </li></ul><ul><li>Process in which molecules move against concentration gradient </li></ul><ul><li>Example: sodium-potassium pump </li></ul><ul><li>ATP is energy source </li></ul>
  10. 10. Sodium-Potassium Pump
  11. 11. Fluid Movement in Capillaries <ul><li>Fluid Shifts </li></ul><ul><ul><li>Shifts of Plasma to Interstitial Fluid </li></ul></ul><ul><ul><ul><li>Elevation of venous hydrostatic pressure </li></ul></ul></ul><ul><ul><ul><li>Decrease in plasma oncotic pressure </li></ul></ul></ul><ul><ul><ul><li>Elevation of interstitial oncotic pressure </li></ul></ul></ul><ul><ul><li>Shifts of Interstitial Fluid to Plasma </li></ul></ul>
  12. 12. Regulation of Water Balance <ul><li>Hypothalamic Regulation </li></ul><ul><li>Pituitary Regulation </li></ul><ul><li>Adrenal Cortical Regulation </li></ul><ul><li>Renal Regulation </li></ul><ul><li>Cardiac Regulation </li></ul><ul><li>Gastrointestinal Regulation </li></ul><ul><li>Insensible Water Loss </li></ul>
  13. 13. Sodium (Na) <ul><li>Normal plasma sodium level 136 - 145 mEq/L </li></ul><ul><li>Sodium - major cation in extracellular fluid; responsible for maintaining extracellular fluid (ECF) osmolarity; responsible for skeletal muscle and cardiac contraction, nerve impulse transmission, normal extracellular fluid osmolarity and normal extracellular volume </li></ul>
  14. 14. Calcium (Ca++) <ul><li>Calcium levels 9.0 - 10.5 mg/dL </li></ul><ul><li>Calcium: important in maintenance of bone strength and density, activation of enzymes or reactions, skeletal and cardiac muscle contraction, nerve impulse transmission, and blood clotting </li></ul>
  15. 15. Phosphorous (P) <ul><li>Phosphorous plasma levels 3.0 - 4.5 mg/dL </li></ul><ul><li>Phosphorous function: activating B-complex vitamins, forming and activating ATP, assisting in cell division, and cooperating in CHO, protein, and lipid metabolism </li></ul><ul><li>Phosphorous balance and calcium balance inverse proportion </li></ul>
  16. 16. Magnesium (Mg2+) <ul><li>Free magnesium plasma levels 1.3 - 2.1 mg/dL </li></ul><ul><li>Functions: skeletal muscle contraction. carbohydrate metabolism, adenosine triphosphate formation (ATP), B-complex vitamin activation, DNA and protein synthesis </li></ul><ul><li>Extracellular magnesium regulates blood coagulation and skeletal muscle contractility </li></ul>
  17. 17. Chloride (Cl) <ul><li>Chloride normal plasma level 98 -106 mEq/L </li></ul><ul><li>Functions: works with sodium to maintain extracellular fluid osmotic pressure, important in the formation of hydrochloric acid in stomach, bicarbonate anion most commonly exchanged for chloride </li></ul>
  18. 18. Assessment Fluid Electrolyte Balance <ul><li>History </li></ul><ul><ul><li>Medical/surgical history </li></ul></ul><ul><ul><li>Medication </li></ul></ul><ul><ul><li>Food/fluid </li></ul></ul><ul><li>Physical assessment </li></ul><ul><ul><li>S/S edema, dehydration, electrolyte imbalance </li></ul></ul><ul><li>Psychosocial assessment </li></ul><ul><li>Diagnostic assessment </li></ul><ul><ul><li>Lab studies: blood, urine </li></ul></ul>