Body Compartments and Fluid Shifts

Questions and Answers

The human body is composed of two main fluid compartments: the ______ and the extracellular compartments.

intracellular

The intracellular compartment accounts for approximately ______ of the total body fluid.

two-thirds

Fluid shifts between compartments are driven by ______ pressure.

osmotic

The movement of fluids between compartments occurs through the ______ wall.

cell Signup and view all the answers

What are the 3 types of body fluids?

Crystalloids, colloids, and blood products Signup and view all the answers

Crystalloids are fluids and electrolytes normally found in the body without ______

proteins Signup and view all the answers

One indication for crystalloids is to maintain ______ volume

fluid Signup and view all the answers

Crystalloids are easily able to treat dehydration because they move easily between ______

compartments Signup and view all the answers

A common side effect of crystalloids is ______

edema Signup and view all the answers

Isotonic fluids have the same concentration of solutes as ______

blood Signup and view all the answers

Normal saline, a common isotonic fluid, is composed of 0.9% ______

NaCl Signup and view all the answers

Lactated Ringers contains Na, K, and Ca in ______

water Signup and view all the answers

Lactated Ringers can be used to replace both fluid and ______

electrolytes Signup and view all the answers

Isotonic fluids are often used to treat low ______ or blood volume

BP Signup and view all the answers

Hypotonic fluids have a lower concentration of ______ than blood.

solutes Signup and view all the answers

When hypotonic fluids are administered, fluid shifts ______ the vascular space and into the tissues.

out of Signup and view all the answers

Common examples of hypotonic fluids include 0.45% or 0.25% ______.

sodium chloride Signup and view all the answers

Hypotonic fluids are indicated for conditions such as ______ and hypernatremia.

DKA Signup and view all the answers

Hypotonic fluids are administered to treat conditions where there is a high concentration of ______ in the blood.

solutes Signup and view all the answers

Hypertonic fluids cause fluid to shift from the cell into the ______

vascular Signup and view all the answers

Hypertonic fluids are indicated for severe symptomatic ______

hyponatremia Signup and view all the answers

D5W is an ______ solution that becomes hypotonic

isotonic Signup and view all the answers

D5W is indicated for ______

hypernatremia Signup and view all the answers

D5W is used to provide free water for the ______

kidneys Signup and view all the answers

Colloids are often referred to as '________ expanders'.

plasma Signup and view all the answers

Colloids contain large molecules such as albumin, globulin, and ______.

fibrinogen Signup and view all the answers

One indication for using colloids is in cases of ______.

shock Signup and view all the answers

Colloids do not contain ______ factors or carry oxygen.

clotting Signup and view all the answers

Dextran 40 is a type of colloid that is a ______ solution.

glucose Signup and view all the answers

Blood products increase plasma volume through ______ and hypertonic crystalloids.

colloids Signup and view all the answers

Fresh frozen plasma (FFP) contains ______ factors.

clotting Signup and view all the answers

Whole blood is given if over ______% of whole blood is lost.

25 Signup and view all the answers

Packed Red Blood Cells (PRBC's) are given to increase ______ carrying capacity.

oxygen Signup and view all the answers

Cryoprecipitate is high in clotting factors and ______.

fibrinogen Signup and view all the answers

Blood donations must be type and ______ matched to prevent anaphylaxis.

cross Signup and view all the answers

Blood products can only be administered with ______.

normal saline Signup and view all the answers

Fresh frozen plasma (FFP) is indicated for ______ of clotting factors.

an increase Signup and view all the answers

Cryoprecipitate is indicated for ______ bleeding.

acute Signup and view all the answers

Anemia, low H&H, and low blood volume are all indications for ______.

PRBC's Signup and view all the answers

Cryoprecipitate is high in clotting factors and ______.

fibrinogen Signup and view all the answers

Potassium is responsible for ______ contraction.

muscle Signup and view all the answers

Only ______% of potassium is in the blood.

5 Signup and view all the answers

Normal K+ levels are between ______-5.

3.5 Signup and view all the answers

Hyperkalemia can be caused by taking ______ diuretics.

K+ sparing Signup and view all the answers

Treatment of severe hyperkalemia may involve administration of ______ bicarbonate.

IV sodium Signup and view all the answers

In severe cases of hyperkalemia, ______ may be necessary to remove excess potassium.

hemodialysis Signup and view all the answers

Potassium is responsible for muscle and ______ function.

cardiac Signup and view all the answers

A common source of potassium is ______.

fruit Signup and view all the answers

Mild hyperkalemia can be treated by restricting dietary intake of ______.

potassium Signup and view all the answers

ACE inhibitors can lead to ______.

hyperkalemia Signup and view all the answers

One cause of hypokalemia is the use of ______ diuretics.

loop Signup and view all the answers

Common symptoms of hypokalemia include ______ and confusion.

lethargy Signup and view all the answers

The maximum rate of potassium administration should not exceed ______ mEq per hour.

10 Signup and view all the answers

A common side effect of potassium chloride is ______.

Nausea Signup and view all the answers

Patients may experience cardiac ______ as a sign of hypokalemia.

dysrhythmias Signup and view all the answers

Loop diuretics, Thiazide diuretics, and Corticosteroids are common causes of ______.

hypokalemia Signup and view all the answers

One of the signs and symptoms of ______ is hypotension.

hypokalemia Signup and view all the answers

The treatment of ______ often involves the administration of potassium chloride.

hypokalemia Signup and view all the answers

Giving potassium chloride through ______ is not recommended.

IV bolus Signup and view all the answers

A possible side effect of potassium chloride is ______.

hyperkalemia Signup and view all the answers

IV potassium chloride should be given _______.

IVPB Signup and view all the answers

Sodium is responsible for maintaining __________ balance.

fluid/electrolyte Signup and view all the answers

A normal level of sodium in the body is between __________.

135-145 Signup and view all the answers

Sodium can be found in sources such as __________ and fish.

salt Signup and view all the answers

Hyponatremia can cause symptoms such as __________ and stomach cramps.

lethargy Signup and view all the answers

Treatment for severe hyponatremia may involve administration of __________ normal saline or lactated ringers.

IV Signup and view all the answers

Oral sodium chloride tablets are used to treat mild hyponatremia with levels between ______.

130-135 Signup and view all the answers

IV normal saline or lactated ringers is indicated for ______ hyponatremia.

moderate Signup and view all the answers

Hypotonic fluids are administered to treat conditions where there is a high concentration of ______ in the blood.

sodium Signup and view all the answers

Treatment of severe hyperkalemia may involve administration of ______ bicarbonate.

sodium Signup and view all the answers

The normal range for magnesium is between 1.5 and ______.

2.5 Signup and view all the answers

A normal ______ level falls between 3.5 and 5.

K+ Signup and view all the answers

The normal range for ______ is 8.5 to 10.

Calcium Signup and view all the answers

Sodium levels should be between 135 and ______.

145 Signup and view all the answers

The normal phosphate level is _______.

2.5-4.5 Signup and view all the answers

When replacing K and Mg, always replace ___ first.

Mg Signup and view all the answers

Study Notes

Body Compartments

The body is divided into two main compartments: intracellular and extracellular.
The intracellular compartment makes up 2/3 of the body's fluid, while the extracellular compartment makes up 1/3.

Fluid Shifts

Fluid shifts occur between the two compartments due to osmotic pressure.
Fluid shifts occur through the cell wall, from an area of high concentration to an area of low concentration.

Maintaining Homeostasis

The goal is to maintain homeostasis, which requires monitoring input and output (I&O's).

Types of Fluids

There are three main types of fluids: crystalloids, colloids, and blood products.

Types of IV Fluids

Isotonic fluids have the same osmotic pressure as blood plasma and are used to replace lost fluids, electrolytes, and blood volume, with examples including 0.9% Sodium Chloride (normal saline) and Lactated Ringer's solution.
Hypotonic fluids have lower osmotic pressure than blood plasma and are used to provide free water and treat dehydration, with an example being 0.45% Sodium Chloride.
Hypertonic fluids have higher osmotic pressure than blood plasma and are used to treat severe hyponatremia, cerebral edema, and increased intracranial pressure, with examples including 3% Sodium Chloride and 7.5% Sodium Chloride.

Components of IV Fluids

Electrolytes in IV fluids include Sodium (Na+), Potassium (K+), Calcium (Ca2+), and Magnesium (Mg2+).
Buffering agents in IV fluids include Bicarbonate (HCO3-) and Phosphate (PO42-).
IV fluids can contain energy sources like Dextrose (glucose).

Indications for IV Fluid Administration

IV fluids are used for fluid resuscitation in cases of hypovolemic shock, burns, and trauma.
IV fluids are used for electrolyte replacement in cases of diarrhea, vomiting, and diuretic therapy.
IV fluids are used for medication administration, such as pain management, antibiotics, and chemotherapy.

Complications of IV Fluid Administration

Fluid overload can lead to pulmonary edema and heart failure.
Electrolyte imbalance can occur due to IV fluid administration, resulting in hypernatremia, hyponatremia, hypokalemia, and hyperkalemia.

Crystalloids

Definition: Fluids and electrolytes normally found in the body without proteins

Indications

Maintenance of fluid volume
Treatment of dehydration, as they can move easily between compartments
Volume replacement
Management of acute liver failure
Burns
Dialysis

Side Effects (SE)

Edema
- Peripheral edema
- Pulmonary edema

Isotonic Fluids

Have the same concentration of solutes as blood
Examples of isotonic fluids:
- Normal saline (0.9% NaCl)
- Lactated Ringers
Lactated Ringers composition:
- Sodium (Na)
- Potassium (K)
- Calcium (Ca) in water
Function of Lactated Ringers:
- Replaces fluids and electrolytes
- Used in cases of:
  - Low blood pressure (BP)
  - Low blood volume
- Indications:
  - Burn patients
  - Trauma patients
  - Malnourished patients

Hypotonic Fluids

Have a lower concentration of solutes compared to blood
Cause fluid to shift out of the vascular system and into the tissues
Examples of hypotonic fluids include:
- 0.45% sodium chloride
- 0.25% sodium chloride
Indications for use:
- Diabetic ketoacidosis (DKA)
- Hypernatremia

Hypertonic Fluids

Characterized by fluid shift from cells into the vascular compartment
Examples include 3% or 5% sodium chloride solutions
Indicated for severe symptomatic hyponatremia

D5W Solution

Initially an isotonic solution due to dextrose content
Becomes hypotonic once glucose is metabolized, leaving behind hypotonic solution
Characterized by fluid shift from vascular into tissues
Indicated for:
- Hypernatremia treatment
- Providing free water for kidney hydration

Colloids as Plasma Expanders

Colloids move fluid from cells to the vascular space by containing large molecules that cannot pass through, including albumin, globulin, and fibrinogen (three blood proteins in the body).
Compared to crystalloids, colloids require less fluid to cause a fluid shift.

Indications for Colloid Use

Shock
Burns
Plasma volume expansion is needed

Characteristics of Colloids

Usually well-tolerated without problems
Do not contain clotting factors or carry oxygen

Side Effects of Colloids

Bleeding possibility due to dilution of clotting factors with added fluid

Types of Colloids

Albumin (5% or 25%): naturally produced, requiring human donors
Dextran 40: a glucose solution

Blood Products

Increase plasma volume through colloids and hypertonic crystalloids, causing fluid shifts from cells into vascular.
Donated blood products require type and cross-matching to prevent anaphylaxis.

Administration

Administer blood products intravenously (IV) using a pump.
Can only be administered with normal saline.

Types of Blood Products

Fresh Frozen Plasma (FFP)

Contains clotting factors.
Indicated for increasing clotting factors, particularly for prevention of bleeding.

Cryoprecipitate

High in clotting factors and fibrinogen.
Indicated for acute bleeding, especially with 25% blood loss rapidly or 50% slowly.
Check hemoglobin and hematocrit (H&H) levels before administration, and consider its use when blood clotting is necessary.

Packed Red Blood Cells (PRBC's)

Does not contain plasma.
Indicated for increasing oxygen-carrying capacity, particularly for:
- Anemia
- Low H&H
- Low blood volume
- Blood loss up to 25%

Whole Blood

Contains plasma, protein, and red blood cells.
Indicated when more than 25% of whole blood is lost.

Blood Product Administration

Blood products can only be administered using an IV pump.
Normal saline is the only compatible solution for blood product administration.

Types of Blood Products

Fresh Frozen Plasma (FFP)
- Contains clotting factors
- Indicated for increasing clotting factors
- Used for bleeding prevention
Cryoprecipitate
- High in clotting factors and fibrinogen
- Indicated for acute bleeding
- Used when there is 25% blood loss rapidly or 50% slowly
- Check if H&H is low or if blood clotting is necessary
Packed Red Blood Cells (PRBC's)
- Does not contain plasma
- Indicated for increasing oxygen carrying capacity
- Used for anemia, low H&H, low blood volume, or blood loss up to 25%
Whole Blood
- Containing plasma, protein, and red blood cells
- Indicated when over 25% of whole blood is lost

Blood Products and Indications

Cryoprecipitate is indicated in acute bleeding cases where: • 25% blood loss occurs rapidly • 50% blood loss occurs slowly

Packed Red Blood Cells (PRBC's) Indications

PRBC's are given to increase oxygen carrying capacity in: • Anemia cases • Low Hemoglobin and Hematocrit (H&H) levels • Low blood volume situations

Electrolytes: Potassium

Responsible for muscle contraction, cardiac function, acid-base balance, and nerve impulse transmission
Given when levels are low due to inadequate diet or loss caused by medications
95% of potassium is found inside cells, with only 5% in the blood
Food sources: fruit, fish, veggies, meats, and dairy products
Normal potassium levels: 3.5-5 mmol/L

Hyperkalemia

Causes:
- K+ sparing diuretics
- ACE inhibitors
- K+ supplements
Signs and symptoms:
- Muscle weakness
- Paresthesia
- Ventricular fibrillation (V-fib)
- Cardiac arrest
Treatment of Mild Hyperkalemia:
- Restrict dietary intake of potassium
Treatment of Severe Hyperkalemia:
- IV sodium bicarbonate: increases pH level while removing potassium
- IV calcium: reduces risk of ventricular fibrillation
- IV insulin with dextrose: moves glucose into cells, taking potassium with it
- IV diuretic: if blood pressure is high enough
- Sodium polystyrene sulfonate (Kayexalate): slow, oral, or rectal administration
- Hemodialysis: fast and effective

Electrolytes: Potassium

Potassium is responsible for maintaining:
- Cardiac function
- Acid-base balance
- Nerve impulse transmission

Sources of Potassium

Food sources of potassium include:
- Fruit
- Fish
- Vegetables
- Meats
- Dairy products

Hyperkalemia (High Potassium Levels)

Hyperkalemia can be caused by:
- ACE inhibitors
- Potassium supplements

Signs and Symptoms of Hyperkalemia

Symptoms of high potassium levels include:
- Muscle weakness
- Paraesthesia (abnormal sensations)
- Ventricular fibrillation (V-fib)
- Cardiac arrest

Treatment of Mild Hyperkalemia

Treatment for mild hyperkalemia involves:
- Restricting dietary intake of potassium

Causes of Hypokalemia

Loop diuretics can cause hypokalemia
Thiazide diuretics can also lead to hypokalemia
Corticosteroids are another potential cause of hypokalemia
Vomiting and diarrhea can cause hypokalemia due to potassium loss
Crash diets with little to no nutrition can lead to hypokalemia
Consuming large amounts of licorice can cause hypokalemia

Symptoms and Signs of Hypokalemia

Hypotension is a symptom of hypokalemia
Lethargy is a common sign of hypokalemia
Confusion can occur in individuals with hypokalemia
Cardiac dysrhythmias are a potential symptom of hypokalemia
Neuropathy can be a sign of hypokalemia

Treatment of Hypokalemia

Potassium chloride is used to treat hypokalemia
Potassium chloride can be administered orally (PO) or intravenously (IV)
IV potassium chloride should be given via IVPB (intravenous piggyback)
IV potassium chloride should never be given as an IV bolus or undiluted
When administering IV potassium chloride, it should be done slowly using a pump
The maximum rate of IV potassium chloride administration is 10mEq per hour

Side Effects of Potassium Chloride

Nausea, vomiting, and diarrhea are potential side effects of potassium chloride
Gastrointestinal bleeding is a possible side effect of potassium chloride
Hyperkalemia is a potential side effect of potassium chloride administration

Causes of Hypokalemia

Loop diuretics and thiazide diuretics can cause hypokalemia due to potassium loss
Corticosteroids can lead to potassium depletion
Vomiting and diarrhea can cause hypokalemia due to potassium loss through gastrointestinal fluids
Crash diets with little to no nutrition can lead to potassium deficiency
Consuming large amounts of licorice can cause hypokalemia due to its potassium-lowering effects

Signs and Symptoms of Hypokalemia

Hypotension is a common symptom of hypokalemia
Neuropathy can occur as a result of potassium deficiency

Treatment of Hypokalemia

Potassium chloride is used to treat hypokalemia
It is administered via IVPB (intravenous piggyback) to prevent rapid increases in potassium levels
It should never be given as an IV bolus, IVP, or undiluted to avoid adverse effects

Side Effects of Potassium Chloride

Nausea, vomiting, and diarrhea are common side effects of potassium chloride administration
Gastrointestinal bleeding is a potential side effect of potassium chloride
Hyperkalemia can occur as a result of excessive potassium administration

Sodium Functions

Responsible for water distribution and fluid/electrolyte balance
Plays a crucial role in maintaining acid-base balance

Normal Sodium Level

Normal sodium level is between 135-145 mmol/L
Sodium is the most abundant electrolyte in extracellular fluid

Sodium Sources

Common sources of sodium include:
- Salt
- Fish
- Meat
- Seasonings

Hyponatremia

Hyponatremia is a condition characterized by low sodium levels
Symptoms of hyponatremia include:
- Lethargy
- Hypotension
- Stomach cramps
- Seizures
- Vomiting and diarrhea
Treatment of hyponatremia depends on severity:
- Mild hyponatremia (130-135 mmol/L):
  - Oral sodium chloride tablets
  - Restrict fluid intake
- Moderate hyponatremia (125-129 mmol/L):
  - IV normal saline or lactated ringers
- Severe hyponatremia (less than 125 mmol/L):
  - Requires urgent medical attention

Treatment of Hyponatremia

Mild hyponatremia (130-135 mmol/L) is treated with: • Oral sodium chloride tablets • Restricting fluid intake

Moderate Hyponatremia

Moderate hyponatremia (125-129 mmol/L) is treated with: • IV administration of normal saline • IV administration of lactated Ringer's solution

Fluids and Electrolytes

Hypotonic Fluids

Lower concentration of solutes than blood
Fluid shifts out of the vascular and into the tissues
Examples: 0.45% or 0.25% sodium chloride
Indications: DKA, hypernaturemia

Hypertonic Fluids

Higher concentration of solutes than blood
Fluid shifts from cells into the vascular
Examples: 3% or 5% sodium chloride
Indications: severe symptomatic hyponaturemia

Isotonic Fluids

Same concentration of solutes as blood
Examples: 0.9% sodium chloride (normal saline), lactated Ringer's solution
Indications: maintenance of fluid volume, dehydration, volume replacement, acute liver failure, burns, dialysis

Colloids (Plasma Expanders)

Moves fluid from cells to the vascular
Contains large molecules that cannot pass through cell membranes
Examples: albumin, globulin, fibrinogen (3 blood proteins in the body)
Indications: shock, burns, plasma volume expansion needed
Advantages: does not have to give as much fluid to cause fluid shift (compared to crystalloids)

Blood Products

Increases plasma volume
Fluid shifts from cells into vascular
Examples: fresh frozen plasma (FFP), cryoprecipitate, packed red blood cells (PRBC's), whole blood

Electrolytes

Potassium (K+)

Responsible for: muscle contraction, cardiac function, acid-base balance, nerve impulse transmission
Normal level: 3.5-5
Sources: fruit, fish, veggies, meats, dairy
Hyperkalemia: ACE inhibitors, K+ supplements, symptoms include muscle weakness, parasthesia, v-fib, cardiac arrest
Treatment of hyperkalemia: restrict dietary intake of K+, IV sodium bicarbonate, IV calcium, IV insulin with dextrose, IV diuretic, sodium polystyrene sulfonate (Kayexalate), hemodialysis

Sodium (Na+)

Responsible for: water distribution, fluid/electrolyte balance, acid-base balance
Normal level: 135-145
Sources: salt, fish, meat, seasonings
Hyponaturemia: symptoms include lethargy, hypotension, stomach cramps, seizures, V/D; treatment includes oral sodium chloride tablets, IV normal saline or lactated ringers, restricting fluid intake

Magnesium (Mg2+)

Normal level: 1.5-2.5

Phosphate (PO42-)

Normal level: 2.5-4.5

Calcium (Ca2+)

Normal level: 8.5-10

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Description

Learn about the two main body compartments, fluid shifts between them, and how they maintain homeostasis. Understand the role of osmotic pressure and concentration gradients.