Fluids, Electrolytes and Acid Base Balance

Understand the compartments and relative amount of fluid in each

- The Intracellular Fluid makes up about 60 percent of the total water in the human body, and in an average-size adult male, the ICF accounts for about 25 liters (seven gallons) of fluid. This fluid volume tends to be very stable, because the amount of water in living cells is closely regulated. -The Extracellular Fluid accounts for the other one-third of the body's water content. Approximately 20 percent of the ECF is found in plasma. Plasma travels through the body in blood vessels and transports a range of materials, including blood cells, proteins (including clotting factors and antibodies), electrolytes, nutrients, gases, and wastes. Gases, nutrients, and waste materials travel between capillaries and cells through the IF.

Chemical buffers; types and where they are found - know acid and conjugate base for each (do not need to memorize formulas)

-Buffers, solutions that can resist changes in pH, are key to maintaining stable H+ start superscript, plus, end superscript ion concentrations in biological systems -one of the buffers that maintain the pH of human blood involves carbonic acid (H2CO3) and its conjugate base, the bicarbonate ion HCO3- -Carbonic acid is formed when carbon dioxide enters the bloodstream and combines with water, and it is the main form in which carbon dioxide travels in the blood between the muscles (where it's generated) and the lungs (where it's converted back into water and CO2 ​​ start subscript, 2, end subscript, which is released as a waste product).

Know general function of calcium, magnesium, phosphate and chloride

-Chloride, in the form of hydrochloric acid, is also a major component of gastric juice, which in turn digests and absorbs essential nutrients from food. -Calcium is the most abundant electrolyte mineral in your body, and it plays a crucial role in the health of your bones and teeth. -Every organ in your body relies on magnesium. It helps your body maintain the proper calcium, potassium, zinc, copper and vitamin D levels. It also helps your body produce energy. -Like calcium, phosphorus helps you maintain strong bones and teeth. It plays a role in the growth, repair and maintenance of your cells as well. It also helps your body produce energy from carbohydrates and fat.

Understand aldosterone's affect on sodium and potassium

-Exchanges sodium for potassium, therefore more sodium reabsorption means more potassium excretion -Causes the conservation of sodium in the kidneys

Dietary Gains-Understand that dietary sodium enters through cotransporters using other ions or with nutrients like glucose

-Glucose and galactose are taken into the enterocyte by cotransport with sodium using the same transporter. Fructose enters the cell from the intestinal lumen via facilitated diffusion through another transporter.

Know avg loss and gain and responsible areas in the body

-In the normal resting state, input of water through ingested fluids is approximately 1200 ml/day, from ingested foods 1000 ml/day and from aerobic respiration 300 ml/day, totaling 2500 ml/day -The majority of fluid output occurs via the urine, approximately 1500 ml/day (approx 1.59 qt/day) in the normal adult resting state. Some fluid is lost through perspiration, some sources say insensible losses account for 500 to 650 ml/day of water is lost threw sweat.

Understand how pH homeostasis is maintained by both resp and renal

-Removes the uric acid from the body -Supply body with O2 and dispose of carbon dioxide

Understand how Natriuretic peptides functions to maintain fluid balance

-Secreted by cardiac muscle cells -Are secreted in response to high ECF volume and pressure by at least 3 mechanisms: increased renal excretion of salt and water, vasodilation, and increased vascular permeability.

Understand how Aldosterone functions to maintain fluid balance

-Secreted by the adrenal cortex -Are secreted in response to low ECF volume and pressure -Aldosterone helps maintain blood pressure (BP) and water and salt balance in the body by helping the kidneys retain sodium and excrete potassium. When aldosterone production falls too low, the kidneys are not able to regulate water and salt balance, leading to a drop in both blood volume and BP.

Understand how PTH, Calcitriol and Calcitonin affect Ca and phosphate levels

-The hormones calcitriol, calcitonin and parathyroid regulate body calcium. Specialized cells in the kidneys produce the hormone calcitriol, a form of vitamin D, when calcium levels in the blood are too low. This hormone increases the body's uptake of calcium from food and the release of calcium from the bones. Parathyroid hormone, or PTH, is secreted by the parathyroid glands and increases blood levels of calcium by stimulating bones to release calcium, stimulating kidney cells to reclaim calcium from urine before excretion, and increasing calcium absorption by the intestine. -PTH and calcitriol also regulate phosphate in the body. PTH helps lower blood phosphate levels. It does this by reducing the reabsorption of phosphates dissolved in urine in the kidneys, causing more excretion of phosphates. Calcitriol raises the level of phosphate in the blood by promoting its absorption by the intestine

Describe the systems that maintain acid-base homeostasis

-The kidneys help maintain the acid-base balance by excreting hydrogen ions into the urine and reabsorbing bicarbonate from the urine. The kidneys have two very important roles in maintaining the acid-base balance: 1.They reabsorb bicarbonate from urine. 2.They excrete hydrogen ions into urine. -Urinary system -Respiratory system

Know that the two main causes of electrolyte imbalances are dietary and hormonal

-kidney disease -prolonged periods of vomiting or diarrhea -poor diet

Urine chem stix interpretation

A urine test strip or dipstick test is a basic diagnostic tool used to determine pathological changes in a patient's urine in standard urinalysis.

Understand how to determine what kind of acid base imbalance exists as well as common cause for each

Acidosis: The blood has too much acid (or too little base), resulting in a decrease in blood pH. Alkalosis: The blood has too much base (or too little acid), resulting in an increase in blood pH. Metabolic acidosis and metabolic alkalosis are caused by an imbalance in the production of acids or bases and their excretion by the kidneys. Respiratory acidosis and respiratory alkalosis are caused primarily by changes in carbon dioxide exhalation due to lung or breathing disorders.

Renal compensation

An adjustment of pH by changing the rate of H+ secretion by the renal tubules

Know general different between genders

Approximately 60% of body weight in males constitutes total body fluid, with 52% in females. MEN HAVE MORE FLUID IN THEIR BODY A reduction in body fluids can have major effects on the body: a reduction of 5% will cause thirst, a reduction of 8% will cause illness and a 10% reduction in fluid can cause death (Carroll, 2000).

Describe how water is moved around by electrolyte distribution and that we can only measure ECF to determine fluid status

Body fluids and electrolytes constantly shift between compartments (ICF & ECF) to meet a variety of metabolic needs, transport materials, and preserve/support cell life all to maintain homeostasis. Compartments are separated by membranes that are capable of selective permeability. Cell membranes permits selective movement of water and solutes between compartments. 4 ways of moving fluid and electrolytes 1. Osmosis - passive (the water moves from the more dilute compartment to the side that is more concentrated) 2. Diffusion - passive (high to low) 3. Active transport - active ("PUMPING UHILL") 4. Filtration- passive (Moves from an area of high pressure to low pressure.)

Respiratory compensation

Changes in ventilation correct the pH of the body fluids by retaining or expelling CO2

Describe the 3 classes of acids and examples of each

Fixed acids- acids that do not leave solution. Remain in body fluids before being eliminated at the kidneys. Ex: sulfuric acid and phosphoric acid Organic acids- are acid participants in, or by-products of, cellular metabolism. Ex: lactic acid and ketone bodies Volatile acids- can leave the body by entering the atmosphere at the lungs. Ex: carbonic acid, formed through the interaction of water and carbon dioxide.

Describe signs and symptoms as well as common causes of hyperkalemia and hypokalemia

Hyperkalemia is the medical term that describes a potassium level in your blood that's higher than normal. -Acute kidney failure -Chronic kidney disease Hypokalemia,is a low level of potassium (K+) in the blood serum. -Prescription medications that increase urination -Vomiting

Describe hypovolemia and hypervolemia and major causes (particularly dehydration)

Hypovolemia is a state of decreased blood volume; more specifically, decrease in volume of blood plasma. -Loss of blood -Loss of plasma -Loss of sodium Hypervolemia, also called fluid overload, is the condition of having too much water in your body. While the body normally has a certain amount of fluids in it, too much fluid can damage your health. -Heart failure -Pregnancy -Drinking to much water

Calculating fluid replacement

Step 1 - Calculate the total fluid deficit Step 2 - Calculate the hourly rate and "front load" Step 3 - Pick a fluid Step 4 - Write the order

Describe the effects of age on fluid, electrolyte and acid-base balance

The ageing changes put the elderly person at increased risk of either sodium retention or loss and of water retention or loss. The impaired homeostasis of the many systems affecting fluid balance in the elderly is readily influenced by many of the disease states and medications which are often present in the elderly with resultant adverse clinical consequences.

Metabolic regulation- know role of kidneys and aldosterone

The aldosterone hormone is a hormone produced by the adrenal gland. The hormone acts mainly in the functional unit of the kidneys to aid in the conservation of sodium, secretion of potassium, water retention and to stabilize blood pressure.

Understand the AG and its importance in determining type of metabolic acidosis

The anion gap is the difference between the measured cations (positively charged ions) and the measured anions (negatively charged ions) in serum, plasma, or urine. The magnitude of this difference (i.e., "gap") in the serum is often calculated in medicine when attempting to identify the cause of metabolic acidosis, a lower than normal pH in the blood. If the gap is greater than normal, then high anion gap metabolic acidosis is diagnosed.

Understand how ADH functions to maintain fluid balance

The permeability of the distal tubule and collecting duct is controlled by ADH ADH increases the permeability of the distal tubule and collecting duct, so more water is reabsorbed This causes the urine becomes more concentrated