Applied Pathophysiology: Altered Fluid and Electrolyte Balance Flashcards


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1

Locations of Electrolytes

Sodium- ECF

Potassium- ICF

Calcium, phosphorus, chloride and bicarb- in the bone

2

Fluid Balance

Total body water

  • composes 60% of body weight
  • Occupies 2 fluid compartments
    • intracellular- 40%
    • extracellular- 20%

3

Fluid Balance Transport

Fluid transport- compartments: intravascular and interstitial

Processes: osmosis, reabsorption, filtration

4

Fluid Balance Forces

Hydrostatic

Osmotic

Albumin maintains tonicity of the vessel and keeps fluid where it should be

5

Fluid Regulation Cycle

Regulation

  • Hypothalamus senses volume and kicks in thirst mechanism
  • RAAS- only works on the kidneys to increase supply to the kidneys. Increases sodium retention to increase vascular volume
  • ADH- excretes water
  • Diuretics
  • Aldosterone excretes potassium

Tonicity

6

Altered Fluid Balance

Hypovolemia- hemorrhage, dehydration

Hypervolemia- water intoxication, edema

7

Cirrhosis

Liver disease characterized by interference of local flow and hepatocyte damage. Often caused by hepatitis and alcohol abuse. Altered fluid balance, reduced local blood flow, portal hypertension, hepatocyte damage.

The liver becomes hard and fatty which drives venous pressure up because it can't pass smoothly through the portal vein. Normal venous pressure is 5.

8

Cirrhosis Manifestations

Ascites- abdominal discomfort, increased girth, increased weight, sodium retention, hyponatremia, renal failure

Albumin maintains water balance. If the liver is backed up, albumin gets forced into the interstitial space causing ascites.

Backup causes varices, hemorrhoids, thrombocytopenia, splenomegaly. The liver stops making clotting factors BLEEDING

9

Cirrhosis Diagnosis

Physical exam, body weight, abdominal girth measurement, lab analysis- ascites fluid analysis, liver and renal function, cardiac function

10

Cirrhosis Treatment

Paracentesis- to remove abdominal fluid. Albumin looks like amber beer with a frothy top layer.

Diuresis

Intravenous albumin

11

Dehydration

Alteration in fluid and electrolyte balance- sodium imbalance, negative fluid balance

Causes- decreased fluid intake, increased fluid output (diarrhea), fluid shift between compartments (ascites)

12

Dehydration Manifestations

Decreased LOC, prolonged capillary refill time, dry mucous membranes, decreased or absent tears, change in vital signs, depressed fontanel, sunken eye, decreased or absent urine output

Hypotensive and tachycardia. If normal tensive but tachycardic, they have lost 20% of volume

13

Dehydration Diagnosis

History and PE: fluid intake/output, characteristics of urine, stools, emesis, sweat; nutrition, fever

Labs: blood concentrations of electrolytes, bicarb, BUN, creatinine, specific gravity. Hematocrit measures the % of RBCs to blood. Elevated hematocrit. Creatinine goes up, GFR goes down, BUN goes up

14

Dehydration Treatment

Rehydration: oral, IV

Correction of electrolyte imbalance

15

Hypoparathyroidism

Hypocalcemia. There are 4 parathyroids, so it is hard to be in this condition without surgical damage to the parathyroid

Altered calcium balance, negative feedback regulation by parathyroid glands, produce parathyroid hormone when calcium is low, parathyroid hormone mobilizes calcium by the hypothalamus which stimulates the thyroid to release T3, T4, and calcitonin. Calcium levels rise, hormone production stops. Impaired parathyroid function leads to decreased blood calcium levels.

16

Hypoparathyroidism Manifestations

Hair dryness and loss, nail ridges and breakage, skin dryness, bone loss, tingling in extremities (paresthesia), visual changes, muscle cramps, seizures, fatigue

17

Hypoparathyroidism Diagnosis

Medical and surgical hx

PE

Labs: parathyroid hormone, blood calcium, phosphorus, magnesium, urinary calcium

18

Hypoparathyroidism Treatment

Supplementation: calcium- carbonate, citrate. Vitamin D- calcitrol

Recombinant parathyroid hormone