Third Spacing and Edema

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Questions and Answers

What percentage of an adult's weight consists of fluid?

70%

40%

50%

60% (correct)

What is the purpose of using normal saline 0.9% NaCl?

To treat DKA

To treat Hypernatremia

To increase intravascular volume (correct)

To treat HHNS

What type of fluid is 0.45% Sodium chloride?

Isotonic

Hyperosmotic

Hypotonic (correct)

Hypertonic

What percentage of body fluid is intravascular?

One-fourth Signup and view all the answers

What type of fluid moves fluid out of cells and interstitial spaces and into blood vessels?

Hypertonic Signup and view all the answers

What is the distribution of body fluid?

Two-thirds intracellular and one-third extracellular Signup and view all the answers

Why do obese people have less body fluid?

Because fat cells contain little water Signup and view all the answers

What is the purpose of using 1.5% NaCl?

To move fluid out of cells and interstitial spaces and into blood vessels Signup and view all the answers

What is the definition of third spacing?

Accumulation and sequestration of trapped extracellular fluid in a body space Signup and view all the answers

What is edema?

Accumulation of fluid in the interstitial space Signup and view all the answers

What is a solute?

Substance dissolved in a solution Signup and view all the answers

What is a solvent?

Liquid that contains a substance in solution Signup and view all the answers

What is permeability?

Capability of a substance, molecule, or ion to move across a membrane Signup and view all the answers

What happens to the fluid in the intracellular compartment during dehydration?

It moves into the plasma and interstitial fluid spaces Signup and view all the answers

What is the characteristic of isotonic dehydration?

Equal proportion of fluid and electrolyte loss Signup and view all the answers

What is the function of semi-permeable membranes in cells?

To allow fluid and solutes to pass into and out of the cell Signup and view all the answers

What is the result of capillary hydrostatic pressure?

Fluid moves outward from capillaries to interstitial spaces Signup and view all the answers

What happens to the cells during hypotonic dehydration?

They swell Signup and view all the answers

What is the term for a condition where edema occurs throughout the body?

Anasarca Signup and view all the answers

What is the percentage of weight loss in moderate ECFVD?

5% Signup and view all the answers

What happens to the circulating blood volume in isotonic dehydration?

It decreases Signup and view all the answers

What is the water loss in severe ECFVD?

5-10 L Signup and view all the answers

What percentage of water is found in muscles and brain cells?

70% Signup and view all the answers

What is the main function of water in the body in terms of nutrients?

To act as a solvent for essential nutrients Signup and view all the answers

What is the ratio of water to body weight in leaner people compared to obese people?

Greater in leaner people Signup and view all the answers

What is the function of water in regulating body temperature?

It regulates body temperature Signup and view all the answers

What is the approximate daily urine volume in an adult?

1 to 2 L Signup and view all the answers

What is the general rule for urine output in all age groups?

1mL of urine per kilogram of body weight per hour Signup and view all the answers

What is the main function of water in the skin?

To lose water and electrolytes through sweating Signup and view all the answers

What are the chief solutes in sweat?

Sodium, chloride, and potassium Signup and view all the answers

What is a manifestation of fluid volume deficit in the cardiovascular system?

Thready, increased pulse rate Signup and view all the answers

Which of the following is a sign of fluid volume deficit in the integumentary system?

Dry mouth Signup and view all the answers

What is a common respiratory symptom of fluid volume deficit?

Dyspnea Signup and view all the answers

What is a laboratory finding associated with fluid volume deficit?

Increased hematocrit Signup and view all the answers

What is a neuromuscular symptom of fluid volume deficit?

Decreased central nervous system activity Signup and view all the answers

What is a gastrointestinal symptom of fluid volume deficit?

Decreased bowel motility Signup and view all the answers

What is a renal symptom of fluid volume deficit?

Decreased urine output Signup and view all the answers

What is a sign of fluid volume deficit in the cardiovascular system?

Decreased central venous pressure Signup and view all the answers

Study Notes

Fluid and Electrolytes

Third spacing: accumulation and sequestration of trapped extracellular fluid in a body space due to disease or injury, resulting in a volume loss and unavailability for normal physiological processes.
Examples of third spacing include pericardial, pleural, peritoneal, or joint cavities, bowel, abdomen, or soft tissues after trauma or burn.

Edema

Accumulation of fluid in the interstitial space due to alteration in oncotic pressure, hydrostatic pressure, capillary permeability, or lymphatic obstruction.
Localized edema: occurs after traumatic injury, such as an accident, burn, or surgery.
Generalized edema (anasarca): occurs throughout the body as a result of conditions like cardiac failure, renal failure, or hepatic failure.

Fluid Compartments

A solute is a substance dissolved in a solution.
A solvent is a liquid that contains a substance in solution.
Permeability refers to the capability of a substance, molecule, or ion to move across a membrane.
Cells have semi-permeable membranes that allow fluid and solutes to pass in and out of the cell.
Blood vessels have semi-permeable membranes that bathe and feed the cells.

Starling Forces

Capillary hydrostatic pressure tends to move fluid outward from capillaries to interstitial spaces.
Oncotic pressure tends to move fluid into the capillaries from the interstitial spaces.

Fluid Types

Isotonic fluids: have the same osmolarity as blood (e.g., normal saline, lactated Ringers).
Hypertonic fluids: have a higher osmolarity than blood (e.g., 1.5%, 3%, or 5% NaCl, D5NS, D%LR, D10W).
Hypotonic fluids: have a lower osmolarity than blood (e.g., 0.45% sodium chloride, 0.33% or 0.2% sodium chloride, 2.5% dextrose in water).

Body Water Distribution

Water represents 45% to 75% of the body's total weight.
About two-thirds of body fluid is intracellular, while one-third is extracellular.
One-fourth of extracellular fluid is intravascular (blood plasma and lymph), and three-fourths is interstitial fluid.
Bones contain nearly one-third water, muscles and brain cells contain 70% water, and body fat is essentially water-free.

Functions of Body Water

Water acts as a solvent for essential nutrients.
Water transports nutrients and oxygen from the blood to the cells and removes waste materials and other substances from the cells and returns them to the blood for excretion by the body.
Water gives shape and form to cells, regulates body temperature, acts as a lubricant in joints, and cushions body organs.

Routes of Gains and Losses

Kidneys: the usual daily urine volume in an adult is 1 to 2 L, and the output is approximately 1 mL of urine per kilogram of body weight per hour (1 mL/Kg/h) in all age groups.
Skin: water and electrolyte loss (insensible) through the skin (sweating), with the chief solutes in sweat being sodium, chloride, and potassium.

Fluid Volume Deficit (FVD)

Iso-osmolar fluid volume deficit/isotonic dehydration: equal proportion of fluid and electrolyte loss, resulting in a decrease in circulating blood volume and inadequate tissue perfusion.
Hypo-osmolar fluid volume deficit/hypotonic dehydration: electrolyte loss is greater than fluid loss, resulting in fluid moving from the plasma and interstitial fluid spaces into the intracellular compartment, causing plasma volume deficit and cell swelling.

Clinical Manifestation of FVD

In mild FVD, 1 to 2 L of water or 2% of body weight is lost.
In moderate FVD, 3 to 5 L of water loss or 5% weight loss.
In severe FVD, 5 to 10 L of water loss or 8% of body weight loss.

Assessment of Fluid Volume Deficit

Cardiovascular: thready, increased pulse rate, decreased blood pressure, and decreased central venous pressure.
Integumentary: dry skin, poor turgor, dry mouth, and decreased motility and bowel sounds.
Respiratory: increased rate and depth of respiration, dyspnea, and orthopnea.
Neuromuscular: decreased central nervous system activity, lethargy to coma, and skeletal muscle weakness.
Renal: decreased urine output.
Laboratory findings: increased osmolality, increased hematocrit, increased serum sodium, and increased urine specific gravity.

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Description

This quiz covers the concepts of third spacing and edema, including the accumulation and sequestration of trapped extracellular fluid in the body and its effects on physiological processes.