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Questions and Answers
What percentage of total body weight does total body water (TBW) typically represent?
Which compartment's volume is critical for normal cell function?
What condition can significantly alter intracellular fluid volume in the brain?
What is the primary concern when assessing a patient's clinical fluid status?
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What sign might indicate dehydration based on changes in cognitive function?
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What symptom is common in infants experiencing dehydration?
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When blood volume and serum osmolality are disturbed, what physiological response is typically affected?
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What is a characteristic sign of dehydration noted in older children and adults?
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What impact does osmotic pressure have on fluid distribution?
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What physical sign is indicative of dehydration caused by poor skin turgor?
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What is the typical daily maintenance fluid requirement for hydration?
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What is the expected outcome of encouraging fluid intake in a mildly dehydrated patient?
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What is the first sign of edema often observed in patients?
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Which of the following fluids is classified as isotonic?
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What causes pitting edema primarily?
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What medication class is typically used to increase renal sodium excretion?
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In patients with pulmonary edema, which of the following symptoms is least likely to present?
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What dietary recommendation is typically made to manage edema related to heart failure?
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What fluid replacement option is classified as hypertonic?
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Which of the following diuretics is considered a loop diuretic?
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Study Notes
Total Body Water
- Represents 45-60% of total body weight
- Distributed into two main compartments:
- Intracellular fluid (ICF): Inside cells
- Extracellular fluid (ECF): Outside cells, divided into interstitial fluid and intravascular fluid
Fluid Balance
- Osmotic pressure maintains distribution of fluids between compartments
- Water moves freely across cell membranes to maintain osmotic equilibrium
- ICF volume is critical for normal cell function
- ECF volume is essential for tissue perfusion
Conditions Related to Fluid Status
- Clinical assessment mainly focuses on ECF volume (interstitial water and intravascular water)
- Blood volume and serum osmolality are tightly regulated
- Homeostasis can be disrupted by various diseases and drug therapy
Dehydration
- Signs and symptoms include:
- Dry mucous membranes
- Skin tenting (poor skin turgor)
- Decreased urine output
- Postural changes: dizziness, increased heart rate, decreased blood pressure
- Cool extremities
- Decreased capillary refill
- Decreased cognitive function
- Sunken eyes (orbital depression)
Dehydration in Infants and Young Children
- Signs and symptoms include:
- Dry mouth and tongue
- Lack of tears when crying
- No wet diaper for 3 hours
- Sunken eyes, cheeks
- Sunken soft spot on top of skull
- Listlessness or irritability
- Seek medical attention immediately if these signs are present
Dehydration Management
- Typical maintenance fluid intake is 2000-3000 mL/day (6-8 glasses of water)
- Encourage drinking water, oral rehydration solutions (ORS), or sports drinks for mild dehydration
- Medical referral and intravenous fluid replacement may be necessary for severe dehydration
Fluid Tonicity and Distribution
- D5W (5% Dextrose): Hypotonic, 666 mL ICF, 333 mL ECF
- 0.45% NaCl (Half normal saline): Hypotonic, 333 mL ICF, 666 mL ECF
- Lactated Ringer's: Isotonic, 30 mL ICF, 970 mL ECF
- 0.9% NaCl (Normal saline): Isotonic, 0 mL ICF, 1000 mL ECF
- 3% NaCl (Hypertonic saline): Hypertonic, -2000 mL ICF, 3000 mL ECF
- Dextrose is an ineffective osmole
Edema
- Excess fluid volume in the ECF
- Often caused by heart, kidney, or liver failure, also occurs in pregnancy and malnutrition
- First sign is often swelling in feet, ankles, and lower legs (pitting edema)
- Pulmonary edema is a serious complication, characterized by increased respiratory rate, shortness of breath, and crackles on auscultation
- Other signs include weight gain, increased jugular venous pressure, and positive hepatojugular reflux
Edema Management
- Correct the underlying cause
- Sodium restriction (1000-2000 mg/day)
- Medications: diuretics
- Loop diuretics: furosemide, ethacrynic acid
- Thiazide diuretics: hydrochlorothiazide, chlorthalidone, metolazone
- Potassium sparing diuretics: triamterene, amiloride, spironolactone
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Description
This quiz covers vital concepts related to total body water, fluid balance, and the conditions associated with fluid status. It highlights the importance of intracellular and extracellular fluid and the physiological implications of dehydration. Test your knowledge on how fluid volume affects normal cell function and overall health.
