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FLUID AND ELECTROLYTES
IMBALANCE
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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!$0h eap!rati!*!- per'pirati!*
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Factors Aecting Total Body Water
• AG (&e'' ith a0e)
a-ter 1 y34 !"y ater "e+rea'e' t!567 8 !- t!ta& !"y ei0ht9
I*-a*t6 :76;78 !- ater y ei0ht3
• G!"# (ma&e <-ema&e)
• A$&!T F B"' FAT (-at +e&&'+!*tai* &itt&e ater4< pr!p!rti!* !-ater t! t!ta& !"y ei0ht i' &e''3
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FLUID COM=ARTMENTS
Water i' "i'tri$te" i*t! ( )a*or co)+art)ents,
-.-ntracellular /-F12
(34 F TTA5 B"' F5&-"
!TA-!7 WAT# A!" 5T#5'T7-!7-" T8 55
--. 9tracellular /F12
:34 F TTA5 B"' F5&-"• -!T#7T-T-A5 F5&-" ;<%
• -!T#A=A7&5A# (0%
• T#A!755&5A#2<%1
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F > E ima&a*+e? F&$i"
C!mpartme*t'
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Electrolyte Composition of Body Fluid Compartments
LeMone, page 188
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=ROTEINS IN F&$i" C!mpartme*t'
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DIFFUSION
I' a mea* !- +assive trans+ort
I' the pr!+e'' y hi+h parti+&e' ('!&i". &i@$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.
•
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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$1
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Type' !- "i$'i!*
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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)
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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 '!&$ti!* t! "ra ater a+r!'' a memra*e
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Figure 10–3 %smosis. &ater molecules moe t!roug! a selectiely permea"le mem"rane from an
area of lo# solute concentration to an area of !ig! solute concentration
'o(ier, page 1)*+
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TONICITY
• re-er' t! the os)olality !- a '!&$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 '!&$te +!*+e*trati!* tha*p&a'ma
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Figure 10–4 !e effect of tonicity on red "lood cells. A, -n an isotonic solution, BCs neit!er gain
nor lose #ater, retaining t!eir normal "iconcae s!ape. B, -n a !ypertonic solution, cells lose #ater
and s!rin/ in si(e. C , -n a !ypotonic solution, cells a"sor" #ater and may "urst 0!emolysis
LeMone, page 1$+
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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$+
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Figure 10–4 (continued) !e effect of tonicity on red "lood cells. A, -n an isotonic solution, BCs
neit!er gain nor lose #ater, retaining t!eir normal "iconcae s!ape. B, -n a !ypertonic solution, cells
lose #ater and s!rin/ in si(e. C , -n a !ypotonic solution, cells a"sor" #ater and may "urst
0!emolysis.
LeMone, page 1$+
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Figure 31.2 Moement of fluids and solution tonicity
02dams, C!apter 33, page 45$
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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)+
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Fa+i&itate" "i$'i!* '3 A+tie
tra*'p!rt
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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$1
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Fi&trati!*
• i' a pr!+e'' herey @uid and solutes )ove together across a )e)brane -r!m !*e +!mpartme*t t! a*!ther3
• The m!eme*t i' -r!m a* area !- higher liuid +ressure to one of lower liuid+ressure.
• E%3? m!eme*t !- #$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
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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
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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$1
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F > E ima&a*+e? M!eme*t !- H2O
Hy"r!'tati+ pre''$re !r p$'h -!r+eJ
O'm!ti+ pre''$re !r p$&&J Kattra+ti!* -!r+e
∆in “pull or push” → fluid movement& volume in the compartment
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F > E ima&a*+e? Capi&&ary E%+ha*0e
• Capi&&ary E%+ha*0e
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F > E ima&a*+e? M!eme*t !- H2O?
hy"r!'tati+ pre''$re
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F > E ima&a*+e? M!eme*t !- H2O
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EDEMA
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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"
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E"ema +a$'e'
1.↑ capillary hydrostatic pressure (or ↑ BP d/t hypervolemia)
2.Low colloid osmotic pressure due to:
• Liver disease (low synthesis of proteins),
• kidney disease (excess loss of plasma proteins),
•↑ capillary permeability (ex. Inflammation, infection)
Loss of plasma proteins (ex. Albumin → ↓plasma osmotic pressure; more
fluid leaves & less returns)
3.Excessive Na in the ECF
4.Obstruction of the Lymphatic circulation:
Removal of lymphatic nodes, (ex. CA)
Infection (elephantitis)
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F > E Ima&a*+e? E"emaee+t'
:. "ecreased +erfusion3bl. Flow to tissue,• L!+a& 'e&&i*06 ti''$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)
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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
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Dehy"rati!*
O O O
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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
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F > E ima&a*+e? M!eme*t !- H2O
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DEHYDRATION
A "e+rea'e i* i*traa'+$&ar. i*ter'titia& a*"!ri*tra+e&&$&ar #$i" Mi&" "ehy"rati!* 4 "e+rea'e !- 28 i* !"yei0ht
M!"erate "ehy"rati!* 4 "e+rea'e !- 8 i*!"y ei0ht
Seere "ehy"rati!* 4 "e+rea'e !- ;8 i* !"yei0ht
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CAUSES
9cessive @uid losses
-r!m the I tra+t are the m!'t +!mm!* +a$'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 $ri*e
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F > E Ima&a*+e?
Dehy"rati!*? Ca$'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'
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F > E Ima&a*+e?Dehy"rati!*?
• < 'eri!$' -!r i*-a*t' a*" e&"er&y
• H2O &!'' a++!mpa*ie" y Lyte'
"ep&eati!*
• -sotonic "ehy"rati!*
• 8y+otonic "ehy"rati!* (&!'' <Lyte'9
PH2O)
• 8y+ertonic "ehy"rati!* (&!'' <H2O9 P Lyte')
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TY=ES OF DEHYDRATION
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F > E Ima&a*+e?
Dehy"rati!*? Ee+t'
• Dry m$+!$' memra*e
• De+rea'e '/i* t$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$'
• COM=ENSATION
• M!re ADH. a&"!'ter!*e
• a'!+!*'tri+ti!*
• i*+rea'e" the 'pe+iQ+ Uri*e 0raity3
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Manifestations of de!ydration
CONTROL OF FLUID
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CONTROL OF FLUIDBALANCE
• THIRST MECHANISM
• ADH
• RAAS
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F > E ima&a*+e? M!eme*t !- H2O+!*tr!& re0$&ati!*
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F > E ima&a*+e? M!eme*t !- H2O? ADH
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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
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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
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DRUS USED FOR DIURESIS
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=ep!ron Functions
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Figure 30.1 !e nep!ron
02dams, C!apter 3), page 41*
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Dr$0' U'e" t! treat
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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
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!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
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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'
'$'i"i*09
• See/ MD +are i- &!!" re'e*t i* 't!!&9
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Oer the C!$*ter Dr$0'
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Fluids and electrolytes +art --
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E&e+tr!&yte'Na
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E&e+tr!&yte'?
G
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Multisystem Effects of ypo/alemia
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E&e+tr!&yte'? Ca&+i$m
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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.
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Figure 10–13 A, 7ositie C!oste/>s sign. B, 7ositie rousseau>s sign.
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Figure 10–13 (continued) A, 7ositie C!oste/>s sign. B, 7ositie rousseau>s sign.
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