1. Fluid, Electrolyte and Acid-Base Balance

2. Total Fluid Volumes by Age and Sex

4. Fluid Compartments Extracellular Interstitial Intracellular Intravascular Intracellular

5. Fluid is in both compartments 50-60% of body weight ¾ of ECF ¼ of ECF

8. Filtration

10. Filtration Pressures in a Capillary

11. Problem Examples: Edema Congestive heart failure

12. Diffusion - movement of solutes against a concentration gradient; tries to to balance cations + with anions -

14. Active Transportation of Glucose

15. Na-K Pump: For every molecule of ATP, 3 molecules of Na move to outside of cell and 3 molecules of K move inside the cell

18. Osmosis and Tonicity Na is the main determinant of plasma tonicity . Thirst and ADH release Swelling of cells

19. Problem Examples: Edema Congestive heart failure

20. Tonicity HYPO 0.45% saline (1/2 normal) Moves fluid into cells

21. Tonicity ISO Same osmolarity as plasma 0.9 % saline (Normal saline) – no fluid shift

22. Tonicity HYPER 3% saline Pulls fluid from cells

23. Tonicity

24. Electrolytes + - - - - - + + + +

35. Renal failure, chemoTx, enemas containing Malnourished, alcohol withdrawal, phosphate- binding antacids Muscle, RBC’s, CNs, w/ Calcium in bones and teeth 1.7-4.6 Phos Phosphate Maalox and Milk of Magnesia in patients with renal failure Diarrhea, vomiting, NG Suction, hyper aldosteronism Muscle, RBC’s and CNS, metabolism 1.5-2.5 Mg Magnesium Mult. Myeloma, thiazide diuretics, malignancies, Chronic renal failure, Vit D deficiency, pancreatiti,s, loop diuretics, diarrhea hyporparathyroidism Transmission of nerve impulses, cardiac contractions, bone, blood clotting 4.5-5.5 Ca Calcium Acidosis Renal disease K containing drugs K salt substitute GI Losses – diarrhea, vomiting, duretics, diaphoresis Major ICF cation; cellular and metabolic functions including cardiac rhythms 3.5-5.0 K Potassium High fever, heatstroke due to insensible water loss, diabetes insipidus GI Losses Diuretics, burns, wound drainage Maintains concentration of ECF 135-145 Na Sodium Hyper Causes Hypo Causes Function Normal Value Symbol Name Serum Electrolytes

37. Central Venous Pressure or Jugular Venous Distention

39. plasma expander Isotonic (308 mOsm/L) 10% Dextran 40 in 0.9%NS closely resemble the electrolyte composition of normal blood serum and plasma; will need additional K; does not provide calories or free water; used to treat losses from lower GI tract and burns. Isotonic (273 mOsm/L) Lactated Ringer’s Solution provides free water (hypotonic) to the extracellular and intracellular spaces, as the dextrose is quickly metabolized; promotes renal elimination of solutes; treats hypernatremia; does not provide electrolytes; one liter is 170 calories Isotonic (252 mOsm/L) D5W - 5% Dextrose in water to treat fluid volume deficit; for daily maintenance of body fluids and nutrition; basically the same as NS, except provides 170 calories per liter Hypertonic (559 mOsm/L) D5NS - 5% Dextrose & 0.9NaCl to promote renal function and excretion; basically the same as .45NS except provides 170 calories per liter Hypertonic (406 mOsm/L) D5 1/2 NS - 5% Dextrose & 0.45NaCl assists with renal function; provides free water, Na and Cl.; replaces normal hypotonic daily fluid losses- assists with daily body fluid needs, but not with electrolyte replacement or provision of calories. Hypotonic (154 mOsm/L) 1/2 NS - 0.45%NaCl replaces NaCl deficit and restores/expands extracellular fluid volume; the only solution that may be administered with blood products --does not provide free water that causes hemolysis of red blood cells Isotonic (308mOsm/L) NS - 0.9% NaCl Usage and Limitations Osmolality Solution

40. Third Spacing: Loss of fluid into a space that cannot contribute to ICF/ECF equilibrium S&S: Urine output decreases Increased heart rate Decreased BP Decreased CVP Increased body weight Edema I & O imbalance Causes: Burns Ascites Peritonitis Bowel obstruction Massive bleeding into joint or body cavity

42. Acid Base Balance Two systems work to maintain correct pH. Respiratory System by adjusting respirations. Metabolic system by adjusting serum HCO3

43. Acid Base Balance

44. Acidosis pH < 7.4 Increased paCO2 Decreased HCO3

48. Alkalosis pH > 7.4 Decreased CO2 Increased HC03