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Intracellular Fluid
Fluid inside the cell
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Extracellular Fluid
Fluid outside the cell
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Intravascular Fluid
Fluid inside the vasculature
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Interstitial Fluid
Fluid outside of the cell membrane but not within the circulatory system
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Dehydration
Abnormal decrease in total body water
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Overhydration
Retention of abnormally high amount of body fluid
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Electrolytes
- Substances that seperate into electrically charged particles
- Cations have a positive charge (+)
- Anions have a negative charge (-)
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Types of Cations
- Sodium (Na+)
- Potassium (K+)
- Calcium (Ca++)
- Magnesium (Mg++)
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Sodium (Na+)
- Most prevalent cation in extracellular fluid
- "Water follows sodium"
- Important in transmission of nervous impulses
- Hypernatremia is an abnormal increase in sodium
- Hyponatremia is an abnormal decrease in sodium
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Potassium (K+)
- Most prevalent cation in the intracellular fluid
- Important in transmission of electrical impulses
- Hyperkalemia is an abnormally high potassium level
- Hypokalemia is an abnormally low potassium level
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Calcium (Ca++)
- Plays a major role in muscle contraction as well as nervous impulse transmission
- Hypercalcemia is an abnormally increased calcium level
- Hypocalcemia is an abnormally decreased calcium level
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Magnesium (Mg++)
- Necessary for several biochemical processes
- Closely associated with phosphate
- Hypermagnesemia is an abnormally increased level of magnesium
- Hypomagnesemia is an abnormally decreases level of magnesium
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Types of Anions
- Chloride (Cl-)
- Bicarbonate (HCO3-)
- Phosphate (HPO4-)
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Chloride (Cl-)
- Negative charge balances the positive charge of cations
- Major role in fluid balance and renal function
- Associated with sodium
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Bicarbonate (HCO3-)
- Principle buffer of the body
- Neutralizes the hydrogen ion and other organic acids
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Phosphate (HPO4-)
- Important in body energy stores
- Closely associated with magnesium in renal function
- Acts as a buffer, primarily in the intracellular space
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Diffusion
The movement of a substance from an area of greater concentration to an area of lower concentration
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Types of Solutions
- Isotonic
- Hypertonic
- Hypotonic
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Isotonic
Solutions on opposite sides of a membrane are equal concentration
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Hypertonic
The concentration of a given solute is greater on one side of a membrane than the other
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Hypotonic
The concentration of a given solute is less on one side of a membrane than the other
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Osmosis vs. Solutes
- Osmosis is the movement of water from an area of higher WATER concentration to an area of lesser WATER concentration
- Because water is a solvent, it moves from an area of lower SOLUTE concentration to an area of higher SOLUTE concentration
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Active Transport
- The movement of a substance across the cell membrane against the osmosis gradient (towards the side that already has more substance)
- Faster than diffusion
- Requires energy
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Facilitated Diffusion
- Certian molecules can move across the cell membrane with the assistance of "helper proteins"
- Glucose is one example
- Depending on the substance, this movement may or may not require energy
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Osmotic Pressure
Pressure exerted my the concentration of solutes on one side of a semipermeable membrane
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Oncotic Force (Colloid Osmotic Pressure)
Osmotic pressure exerted by large protein particles
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Starling's Hypothesis
Net filtration=Forces favoring filtration-Forces opposing filtration
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Edema
Accumulation of water in the interstitial space due to disruption in the forces and mechanisms that normaly keep net filtration at zero
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Fluid Imbalances
The body maintains a constant balance between intake and excretion of waterAmount gained every day approximately equals the amount lost
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Classifications of Dehydration
- Isotonic
- Hypernatremic
- Hyponatremic
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Isotonic Dehydration
Loss of sodium and water in equal amounts
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Hypernatremic Dehydration
Loss of water in excess of sodium
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Hyponatremic Dehydration
Loss of water in excess of water
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Isotonic Dehydration
- Causes
- Severe or long term diarrhea or vomiting
- Systemic infection
- Intestinal obstruction
- Signs and Symptoms
- Dry skin or mucous membranes
- Poor turgor
- Oliguria (less urinary output)
- Anuria (no urinary output)
- Acute weight loss
- Depressed or sunken fontanelles in infants
- Management
- IV infusion of isotonic fluid
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Hypernatremic Dehydration
- Causes
- Excessive or misuse of diuretics
- Continued administration of sodium in absence of water intake
- Excessive loss of water without loss of sodium
- Profuse, watery diarrhea
- Inhalation or ingestion of salt water
- Signs and Symptoms
- Dry, sticky mucous membranes
- Flushed skin
- Intense thirst
- Oliguria or Anuria
- Increased body temperature
- AMS
- Management
- Volume replacement with isotonic solution or hypotonic based on serum sodium levels
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Hyponatremic Dehydration
- Causes
- Use of diuretics
- Excessive perspiration
- Salt loosing renal disorders
- Increased water intake
- Inhalation or ingestion of fresh water
- Signs and Symptoms
- Abdonimal or muscle cramps
- Seizures
- Rapid thready pulse
- Diaphoresis
- Cyanosis
- Management
- IV replacement with normal saline or lactated ringers
- Occasionally, hypertonic saline
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Overhydration
- An increase in body water with a decrease in solute concentration
- May result from..... Parenteral administration of too much water,Impaired cardiac function, Impaired renal function, Some endocrine dysfunctions
- Signs and Symptoms
- SOB
- Puffy eyes
- Edema
- Polyuria
- Moist crackles in the lungs
- Acute weight gain
- Management
- Cause dependent
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Electrolyte Imbalance: Potassium
- A very narrow range of serum level must be maintained for normal function 3.5 to 5.0 mEq
- Loses areusually minimal and are replenished through dietary intake
- Excessive potassium is usually excreted through the kidneys
- Imbalances interfer with neuromuscular functions
- May cause sudden death
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Hypokalemia
- Possible CausesReduced dietary intake
- Poor potassium absorption by the body
- Medications
- Diuretics
- Steroids
- Theophyline
- Signs and SymptomsMalaise
- Skeletal muscle weakness
- Decreased reflexes
- Weak pulses
- Faint or distant heart sound
- Shallow respirations
- Low blood pressure
- GI problems
- Anorexia
- Vomiting
- Gaseous distention
- Excessive thirst
- Management
- Based on exact serum level
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Hyperkalemia
- Causes
- Acute or chronic renal failure
- Burns
- Crush injuries
- Severe infections in which large amonts of potassium is released
- Excessive use of potassium salts
- Signs and Symptoms
- Irriability
- Abdominal distension
- Nausea
- Diarrhea
- Oliguria
- Weakness to Paralysis
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Electrolyte Imbalance: Calcium
- Essential for body function
- Neuromuscular transmission
- Cell membrane permeability
- Hormone secretion
- Growth and ossification of body
- Muscle contraction
- Calcium intake in a normal balanced diet is sufficient for needs
- Calcium is excreted through :Urine, Feces, Perspiration
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Hypocalcemia
- A decrease in serum calcium
- Possible causes
- Endocrine dysfunction
- Renal insufficiency
- Decrease in intake or malabsorption
- Deficiency, malabsoption or inability to activate Vitamin D
- Signs and Symptoms
- Paresthesia
- Tetany
- Abdominal cramps
- Neural excitability
- Personality changes
- Abnormal behavior
- Convulsions
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Hypercalcemia
- Possible causes
- Various neoplasms (tumors)
- Parathyroid dysfunction
- Diuretic therapy
- Excessive administration of Vitamin D
- Calcium can be deposited into various body tissue, including organ systems: GI System, CNS, Neuromuscular System, Cardiovascular System
- Signs and Symptoms
- Decreased muscle tone or tension
- Renal stones
- AMS
- Deep bone pain
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Electrolyte Imbalance: Magnesium
- Activates many enzymes
- Approximately 50% of the body's magnesium is in insoluble state in the bones
- 45% as an intracellular cation
- 5% as an extracellular solution
- Excreted by the kidneys
- Has physiological effects on the nervous system silimalr to those seen with calcium
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Hypomagnesemia
- Possible Causes
- Alcoholism
- Malabsorption
- Starvation
- Diarrhea
- Diuresis
- Certain disease states
- Characterized by irritability of the nervous system
- Signs and Symptoms
- Tremors
- Nausea and Vomiting
- Diarrhea
- Hyperactive reflexes
- Confusion
- Muscle spasms or seizures
- Cardiac dysrhythmias
- Management
- IV magnesium sulfate
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Hypermagnesemia
- Possible Causes
- Chronic renal insufficienct
- Ingestionof large amounts of magnesium compunds such as anacids
- Magnesium Citrate
- Magnesium Sulfate
- Magnesium Hydroxide
- May cause
- CNS depression
- Profund muscle weakness
- Areflecia (absence of reflexes)
- Cardiac rhythm disturbances
- Signs and Symptoms
- Sedation
- Confusion
- Muscle weakness
- Respiratory paralysis
- Management
- Hemodialysis
- Calcium salts
- IV glucose and insulin
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