Solubility and Electrolyte Imbalances
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Questions and Answers

What is the reason for intubating people?

  • Due to Henry's Law not applying to respiratory gases
  • Due to O2 deficiency
  • Due to nitrous oxide toxicity
  • Due to CO2 buildup... you can always add more O2 (correct)

    • Why do many diffusing impairments present with hypercarbia before hypoxia?

  • Because diffusing impairments affect O2 more than CO2
  • Because Henry's Law does not apply to respiratory gases
  • Because O2 is more soluble in tissues than CO2
  • Because CO2 is more soluble in tissues than O2 (correct)

    • What happens to the solubility of gases with an increase in temperature?

  • Solubility decreases (correct)
  • Solubility remains constant
  • Solubility is unaffected by temperature
  • Solubility increases

    • What is the relationship between the number of gas molecules dissolved in a liquid and its partial pressure above the liquid (Henry's Law)?

    <p>Directly proportional</p> Signup and view all the answers

    What is the solubility coefficient of CO2 compared to O2?

    <p>20x more soluble</p> Signup and view all the answers

    What is the contraindication for nitrous oxide in certain medical procedures?

    <p>All of the above</p> Signup and view all the answers

    What is the Meyer-Overton Hypothesis related to?

    <p>The potency of an anesthetic agent is related to its lipid solubility</p> Signup and view all the answers

    What is the primary factor that determines the rate of diffusion of a gas according to Fick's Law?

    <p>The gradient of the concentration (liquid) or partial pressure (gas)</p> Signup and view all the answers

    What is the purpose of ultrafiltration and reabsorption in the body?

    <p>To regulate the distribution of ECF between plasma and interstitial spaces</p> Signup and view all the answers

    What is the unit of measurement for osmotic activity?

    <p>Osmole</p> Signup and view all the answers

    What is the effect of a hypertonic solution on a cell?

    <p>The cell will shrink and crenate</p> Signup and view all the answers

    What is the osmotic pressure of a solution?

    <p>The pressure at which osmosis of a solvent into a semi-permeable membrane is prevented</p> Signup and view all the answers

    What is the effect of mannitol on the brain in cases of elevated ICP?

    <p>It increases the concentration of the plasma, causing water to move from the brain to the plasma</p> Signup and view all the answers

    What is the main purpose of the partition coefficient in anesthesia?

    <p>To compare the concentration of anesthetics in different solvents</p> Signup and view all the answers

    Which of the following is an example of a non-ionizing solution?

    <p>Carbon-based solution</p> Signup and view all the answers

    What is the primary determinant of the rate of diffusion according to Fick's Law?

    <p>Gradient of the concentration or partial pressure</p> Signup and view all the answers

    What is the effect of a hypotonic solution on a cell?

    <p>It causes the cell to burst</p> Signup and view all the answers

    What is the relationship between the oil-gas partition coefficient and the fat-gas partition coefficient?

    <p>They are directly proportional</p> Signup and view all the answers

    What is the effect of mannitol on the brain in cases of elevated ICP?

    <p>It decreases ICP</p> Signup and view all the answers

    According to Henry's Law, what is the effect of increasing the partial pressure of a gas above a liquid on the number of gas molecules dissolved in the liquid?

    <p>The number of gas molecules dissolved in the liquid increases</p> Signup and view all the answers

    What is the significance of the partition coefficient in the context of inhalation anesthetics?

    <p>It is a measure of the anesthetic's solubility in different solvents (fat, blood, muscle, brain, etc)</p> Signup and view all the answers

    What is the effect of an increase in temperature on the solubility of gases in a liquid?

    <p>The solubility of gases decreases with an increase in temperature</p> Signup and view all the answers

    Vapor pressure decreases with increasing solute concentration

    <p>True</p> Signup and view all the answers

    Osmotic pressure increases with increasing solute concentration

    <p>True</p> Signup and view all the answers

    When is nitrous oxide contraindicated during surgery?

    <p>In all of the above</p> Signup and view all the answers

    What is the relationship between the length of a surgical case and the solubility of an anesthetic in fat?

    <p>As the length of the surgical case increases, the solubility of the anesthetic in fat increases.</p> Signup and view all the answers

    What is unique about desflurane administration in obese patients?

    <p>Quicker anesthesia emergence due to lower blood gas coefficient of desflurane</p> Signup and view all the answers

    What is the relationship between the rate of diffusion of gases through a porous membrane and the molar mass of the gas, according to Graham's Law?

    <p>Inversely proportional to the square root of the molar mass</p> Signup and view all the answers

    What two types of flow combine to create bulk flow?

    <p>Ultrafiltration and reabsorption</p> Signup and view all the answers

    What happens when the pressure inside the capillary exceeds the osmotic pressure of the blood plasma?

    <p>Fluid is pushed out through the pores in the capillary wall (arterial ultrafiltration)</p> Signup and view all the answers

    When the osmotic pressure of the blood plasma exceeds the outward pressure on the venous side, what occurs?

    <p>Increased reabsorption</p> Signup and view all the answers

    What is 1 osmole equivalent to?

    <p>1 mole (Avogadro's number) of particles dissolved in a solution that cannot diffuse through a semipermeable membrane</p> Signup and view all the answers

    What is the direction of water flow during osmosis?

    <p>From a less concentrated side to a more concentrated side through a semi-permeable membrane</p> Signup and view all the answers

    What factors affect the rate of diffusion?

    <p>Solubility of the gas and nature of the membrane</p> Signup and view all the answers

    Ionizing solutions will dissociate into solutions

    <p>True</p> Signup and view all the answers

    At 0 degrees C, 1 GMW (gram molecular weight) or GAW (gram atomic weight) of any substance dissolved in 22.4 L of water will exert a pressure of 1 atm

    <p>True</p> Signup and view all the answers

    Tonicity = osmotic pressure of a solution relative to that of other body fluids

    <p>True</p> Signup and view all the answers

    Molar solution of any solute contains 1 mol/L

    <p>True</p> Signup and view all the answers

    What is the treatment for dehydration (water deficit)?

    <p>Hypotonic saline (D5 in water)</p> Signup and view all the answers

    What occurs when the osmotic pressure of the blood plasma exceeds the outward pressure on the venous side during reabsorption?

    <p>Fluid flows into the capillary</p> Signup and view all the answers

    What is the effect of hyponatremia on cells?

    <p>Cells swell due to water gain secondary to decreased ECF osmotic pressure</p> Signup and view all the answers

    What is the usual cause of hyperchloremia?

    <p>Hypernatremia or bicarb deficit</p> Signup and view all the answers

    What is the treatment for water intoxication?

    <p>Fluid restriction and hypertonic saline</p> Signup and view all the answers

    What is the primary determinant of fluid volume in adults?

    <p>Muscle vs fat composition</p> Signup and view all the answers

    What is the primary function of aquaporins in the cell membrane?

    <p>To facilitate water transport</p> Signup and view all the answers

    What is the primary cause of edema?

    <p>All of the above</p> Signup and view all the answers

    What is the primary function of the renin-angiotensin-aldosterone system (RAAS)?

    <p>To regulate sodium and water balance</p> Signup and view all the answers

    What is the primary cause of pure water deficit (hypertonic volume depletion)?

    <p>All of the above</p> Signup and view all the answers

    What is the effect of a hypertonic solution on a cell?

    <p>Water movement out of the cell</p> Signup and view all the answers

    What is the primary function of antidiuretic hormone (ADH)?

    <p>To increase water reabsorption in response to increases in plasma osmolality or decrease in circulating blood volume</p> Signup and view all the answers

    What is the primary determinant of osmolality?

    <p>Total solute concentration</p> Signup and view all the answers

    What is the effect of aldosterone on potassium levels?

    <p>Increases potassium excretion in the distal tubule of kidney</p> Signup and view all the answers

    What is the treatment for water intoxication?

    <p>Fluid restriction</p> Signup and view all the answers

    Which of the following is a characteristic of obese individuals in terms of total body water?

    <p>They have a decreased percentage of total body water in relation to body weight.</p> Signup and view all the answers

    Which of the following is a force favoring filtration in the Starling hypothesis?

    <p>Capillary hydrostatic pressure.</p> Signup and view all the answers

    What is the term for the accumulation of fluid in the interstitial spaces?

    <p>Edema.</p> Signup and view all the answers

    What is the term for a solution that has the same osmotic pressure as blood?

    <p>Isotonic.</p> Signup and view all the answers

    What is the primary determinant of fluid volume in adults?

    <p>Muscle vs fat composition.</p> Signup and view all the answers

    What is true about lean people and total body water (TBW) in relation to body weight?

    <p>They have an increased percentage of TBW</p> Signup and view all the answers

    What does the Starling hypothesis state about net filtration?

    <p>Net filtration is equal to the forces favoring filtration minus the forces opposing filtration</p> Signup and view all the answers

    What primarily determines capillary oncotic pressure (water pulling)?

    <p>Albumin</p> Signup and view all the answers

    What are the forces opposing filtration in the capillaries?

    <p>Capillary oncotic pressure</p> Signup and view all the answers

    What other pressure is the capillary hydrostatic pressure related to?

    <p>Blood pressure</p> Signup and view all the answers

    What are the forces favoring filtration?

    <p>Capillary Hydrostatic pressure (blood pressure)</p> Signup and view all the answers

    What is edema typically related to?

    <p>Decreased plasma oncotic pressure</p> Signup and view all the answers

    What are the effects of estrogen and progesterone on sodium reabsorption?

    <p>Estrogen increases sodium reabsorption, while progesterone decreases it</p> Signup and view all the answers

    What effect do glucocorticoids have on sodium reabsorption?

    <p>Increase sodium reabsorption</p> Signup and view all the answers

    What is the primary ion in regulating osmotic forces?

    <p>Sodium</p> Signup and view all the answers

    What ion follows sodium in concentrations and provides electroneutrality in the human body?

    <p>Chloride</p> Signup and view all the answers

    Which of the following substances regulate sodium concentrations in the human body?

    <p>Aldosterone and natriuretic peptides</p> Signup and view all the answers

    How do ANP and BNP regulate sodium?

    <p>By decreasing tubular reabsorption in the kidneys and promoting urinary excretion of sodium</p> Signup and view all the answers

    What primarily regulates water regulation in the body?

    <p>Thirst perception and ADH</p> Signup and view all the answers

    What is the relationship between osmolality receptors in the hypothalamus and thirst perception?

    <p>They stimulate the release of ADH, which causes thirst perception</p> Signup and view all the answers

    What effect does the stimulation of baroreceptors from depleted plasma volume have on ADH?

    <p>Increased ADH secretion</p> Signup and view all the answers

    What is the primary treatment for hypernatremia?

    <p>Administer isotonic salt-free fluids</p> Signup and view all the answers

    Hypernatremia is related to sodium gain or water loss

    <p>True</p> Signup and view all the answers

    Hypotonic alterations in Na, Cl, and water lead to a decreased osmolarity

    <p>True</p> Signup and view all the answers

    What is a result of sodium deficits?

    <p>Plasma hypoosmolality and cellular swelling</p> Signup and view all the answers

    What are the causes of hypochloremia?

    <p>All of the above</p> Signup and view all the answers

    What shifts usually result in hypochloremia?

    <p>Hyponatremia and elevated bicarb</p> Signup and view all the answers

    Which electrolyte is essential for the transmission and conduction of nerve impulses, normal cardiac rhythms, and skeletal and smooth muscle contraction?

    <p>Potassium</p> Signup and view all the answers

    What facilitates K+ out of cells?

    <p>All of the above</p> Signup and view all the answers

    Which electrolyte facilitates ICF osmolarity and deposits glycogen in liver and skeletal muscles?

    <p>Potassium</p> Signup and view all the answers

    What are the causes of hypokalemia?

    <p>All of the above</p> Signup and view all the answers

    What are the causes of hyperkalemia?

    <p>All of the above</p> Signup and view all the answers

    Which of the following are manifestations of hyperkalemia?

    <p>All of the above</p> Signup and view all the answers

    How does insulin affect serum potassium levels?

    <p>Insulin decreases serum potassium levels by promoting movement of potassium into cells</p> Signup and view all the answers

    How does bicarbonate affect potassium levels?

    <p>Bicarbonate decreases potassium levels by exchanging potassium ions with hydrogen ions.</p> Signup and view all the answers

    Why is calcium used to treat hyperkalemia?

    <p>To promote cardiac myocardial stability; Ca does not lower K levels</p> Signup and view all the answers

    What agents help push K+ into cells in hyperkalemia?

    <p>Insulin and beta-2 agonists and bicarbonate</p> Signup and view all the answers

    What is the most common cause of hyperkalemia?

    <p>Renal failure</p> Signup and view all the answers

    Where are calcium and phosphate mostly found in the human body?

    <p>Bones</p> Signup and view all the answers

    What role does calcium play in the body?

    <p>Bone structure, blood clotting, hormone secretion, cell receptor function, and muscle contractions</p> Signup and view all the answers

    What is true about the relationship between calcium and phosphate levels in the body?

    <p>They are inversely proportional</p> Signup and view all the answers

    Which intracellular anion acts as a buffer?

    <p>Phosphate</p> Signup and view all the answers

    How does the parathyroid hormone regulate calcium levels?

    <p>By increasing plasma calcium levels via kidney reabsorption</p> Signup and view all the answers

    How does calcitonin affect calcium levels?

    <p>Decreases calcium levels</p> Signup and view all the answers

    How does vitamin D affect calcium levels?

    <p>It increases calcium levels by stimulating calcium absorption from the GI tract</p> Signup and view all the answers

    How are the levels of calcium and phosphate altered in renal patients?

    <p>Calcium levels decrease, phosphate levels increase</p> Signup and view all the answers

    What are the normal serum levels of calcium?

    <p>8.5-10.5 mg/dL</p> Signup and view all the answers

    What are some causes of hypocalcemia?

    <p>Decreases in PTH and vitamin D</p> Signup and view all the answers

    What are the manifestations of hypocalcemia?

    <p>Increased neuromuscular excitability, muscle spasms, Chvostek and Trousseau signs, convulsions, and tetany</p> Signup and view all the answers

    Which calcium replacement has more elemental calcium in it?

    <p>Calcium chloride</p> Signup and view all the answers

    What are the causes of hypercalcemia?

    <p>All of the above</p> Signup and view all the answers

    What are the manifestations of hypercalcemia?

    <p>Decreased neuromuscular excitability, weakness, kidney stones, heart block, and constipation</p> Signup and view all the answers

    What is the primary treatment for hypercalcemia?

    <p>Calcitonin administration</p> Signup and view all the answers

    What is a consequence of severe magnesium depletion?

    <p>Renal wasting of potassium</p> Signup and view all the answers

    What is true about magnesium depletion and hypokalemia?

    <p>It can cause hypokalemia that is refractory to KCl therapy</p> Signup and view all the answers

    What is the primary cause of hypermagnesemia?

    <p>Kidney failure</p> Signup and view all the answers

    D5W is physiologically hypotonic because the dextrose is rapidly metabolized

    <p>True</p> Signup and view all the answers

    1 mOsm of solute / L = 19.3 mmHg

    <p>True</p> Signup and view all the answers

    Hypotonic solutions <270 mOsm

    <p>True</p> Signup and view all the answers

    Isotonic 275-310 mOsm

    <p>True</p> Signup and view all the answers

    Hypertonic >310 mOsm

    <p>True</p> Signup and view all the answers

    Hydrochloric acid dissociates in water into 2 parts - H+ and Cl-

    <p>True</p> Signup and view all the answers

    How do natriuretic peptides affect sodium levels?

    <p>Decrease sodium levels by stimulating the kidneys to excrete sodium ions</p> Signup and view all the answers

    How does aldosterone affect sodium, potassium, and water levels?

    <p>Increases sodium and water reabsorption and potassium excretion, thus increasing serum sodium and water</p> Signup and view all the answers

    How does aldosterone affect intracellular and extracellular potassium levels?

    <p>Aldosterone increases intracellular potassium levels and decreases extracellular potassium levels.</p> Signup and view all the answers

    What role does ADH (antidiuretic hormone) have on body water concentrations?

    <p>Water retention</p> Signup and view all the answers

    What are characteristics of a water deficit (dehydration)?

    <p>Sodium and water loss</p> Signup and view all the answers

    Hypokalemia can present with a U wave on EKG

    <p>True</p> Signup and view all the answers

    Study Notes

    Solubility

    • CO2 is 20 times more soluble in tissues than oxygen
    • Solubility of CO2 and O2 in tissues is important for respiratory gas exchange
    • Henry's Law: the number of gas molecules dissolved in a liquid is directly proportional to its partial pressure above the liquid
    • Solubility coefficients: Bunsen and Ostwald
    • Solubility of gases decreases with temperature, while solubility of liquids and solids increases with temperature

    Partition Coefficient and Anesthetics

    • Partition coefficient: the ratio of the concentration of anesthetic in one phase or solvent compared to another
    • Comparison of blood-gas, brain-blood, liver-blood, kidney-blood, muscle-blood, and fat-blood partition coefficients
    • The longer the case, the more anesthetic will go to fat
    • Desflurane will go off faster in obese patients, and nitrous oxide doesn't get absorbed

    MAC and Oil Solubility

    • MAC (Minimum Alveolar Concentration) is the lowest concentration of an anesthetic that prevents movement in 50% of patients
    • Isoflurane MAC is 1.17%
    • Meyer-Overton Hypothesis: potency of an anesthetic agent is related to its lipid solubility
    • High potency correlates with slow onset
    • Oil-gas partition coefficient is proportional to fat-gas partition coefficient

    Diffusion and Osmosis

    • Fick's Law: rate of diffusion is proportional to the gradient of the concentration (liquid) or partial pressure (gas)
    • Graham's Law: rate of diffusion of gases through a porous membrane is inversely proportional to the square root of the molar mass of the gas
    • Bulk flow: ultrafiltration and reabsorption
    • Ultrafiltration: fluid is pushed out through the pores in the capillary wall (on arterial side)
    • Reabsorption: when the osmotic pressure of the blood plasma exceeds the outward pressure (on venous side)

    Osmosis

    • Osmosis: movement of water through a semi-permeable membrane
    • Water flows to the more concentrated side
    • In events of elevated ICP, use mannitol or hypertonic saline to increase concentration of plasma
    • Hypertonic solutions shrink cells, while hypotonic solutions cause lysis and bursting

    Osmolality and Osmotic Pressure

    • Osmole: unit of measurement for osmotic activity
    • 1 mole of particles dissolved in a solute that cannot diffuse through a semi-permeable membrane
    • Osmotic pressure: pressure at which osmosis of a solvent into a semi-permeable membrane is prevented
    • Non-ionizing solutions: carbon-based solutions with covalent bonds (won't dissociate)
    • Ionizing solutions: salts with ionic bonds (will dissociate)
    • Osmolarity of body fluids at body temperature: important for understanding osmosis and tonicity

    Tonicity and Cellular Effects

    • Tonicity: osmotic pressure of a solution relative to that of other body fluids
    • Molar solution of any solute contains 1 mol/L
    • Effects of mOsm on cells:
      • Hypotonic: cells swell and burst
      • Isotonic: cells remain normal
      • Hypertonic: cells shrink and crenate

    Solubility

    • CO2 is 20 times more soluble in tissues than oxygen
    • Solubility of CO2 and O2 in tissues is important for respiratory gas exchange
    • Henry's Law: the number of gas molecules dissolved in a liquid is directly proportional to its partial pressure above the liquid
    • Solubility coefficients: Bunsen and Ostwald
    • Solubility of gases decreases with temperature, while solubility of liquids and solids increases with temperature

    Partition Coefficient and Anesthetics

    • Partition coefficient: the ratio of the concentration of anesthetic in one phase or solvent compared to another
    • Comparison of blood-gas, brain-blood, liver-blood, kidney-blood, muscle-blood, and fat-blood partition coefficients
    • The longer the case, the more anesthetic will go to fat
    • Desflurane will go off faster in obese patients, and nitrous oxide doesn't get absorbed

    MAC and Oil Solubility

    • MAC (Minimum Alveolar Concentration) is the lowest concentration of an anesthetic that prevents movement in 50% of patients
    • Isoflurane MAC is 1.17%
    • Meyer-Overton Hypothesis: potency of an anesthetic agent is related to its lipid solubility
    • High potency correlates with slow onset
    • Oil-gas partition coefficient is proportional to fat-gas partition coefficient

    Diffusion and Osmosis

    • Fick's Law: rate of diffusion is proportional to the gradient of the concentration (liquid) or partial pressure (gas)
    • Graham's Law: rate of diffusion of gases through a porous membrane is inversely proportional to the square root of the molar mass of the gas
    • Bulk flow: ultrafiltration and reabsorption
    • Ultrafiltration: fluid is pushed out through the pores in the capillary wall (on arterial side)
    • Reabsorption: when the osmotic pressure of the blood plasma exceeds the outward pressure (on venous side)

    Osmosis

    • Osmosis: movement of water through a semi-permeable membrane
    • Water flows to the more concentrated side
    • In events of elevated ICP, use mannitol or hypertonic saline to increase concentration of plasma
    • Hypertonic solutions shrink cells, while hypotonic solutions cause lysis and bursting

    Osmolality and Osmotic Pressure

    • Osmole: unit of measurement for osmotic activity
    • 1 mole of particles dissolved in a solute that cannot diffuse through a semi-permeable membrane
    • Osmotic pressure: pressure at which osmosis of a solvent into a semi-permeable membrane is prevented
    • Non-ionizing solutions: carbon-based solutions with covalent bonds (won't dissociate)
    • Ionizing solutions: salts with ionic bonds (will dissociate)
    • Osmolarity of body fluids at body temperature: important for understanding osmosis and tonicity

    Tonicity and Cellular Effects

    • Tonicity: osmotic pressure of a solution relative to that of other body fluids
    • Molar solution of any solute contains 1 mol/L
    • Effects of mOsm on cells:
      • Hypotonic: cells swell and burst
      • Isotonic: cells remain normal
      • Hypertonic: cells shrink and crenate

    Fluid Volume and Composition

    • Fluid volume varies with age, and in adults, it's largely determined by muscle vs fat composition.
    • Obese people have a decreased percentage of total body water (TBW) in relation to body weight, while lean people have an increased percentage.
    • Fluid distribution is divided into:
      • Intra Cellular Fluid (ICF)
      • Extra Cellular Fluid (ECF) = interstitial, intravascular, CSF, sweat, urine, and organ fluids

    Electrolytes and Non-Electrolytes

    • Electrolytes are ions that have an electric charge:
      • ICF: K, Mg, Phosphate
      • ECF: Na, Bicarb, Cl
    • Non-electrolytes do not have an electric charge:
      • Glucose, urea, protein, lipids, creatinine

    Water Balance and Osmolality

    • Osmolality is the measure of solute concentration.
    • Osmotic forces include Na (ECF) and K (ICF).
    • Aquaporins form pores in the cell membrane for water to pass through.
    • Water moves freely through cell membranes.
    • When osmolality of the plasma changes, water moves to reestablish equilibrium.

    Water Movement between Plasma and Interstitial Fluid

    • Starling hypothesis: net filtration is equal to the forces favoring filtration minus the forces opposing filtration.
    • Forces favoring filtration:
      • Capillary hydrostatic pressure (BP)
      • Interstitial oncotic pressure (water pulling)
    • Forces opposing filtration:
      • Capillary oncotic pressure (water pulling) is determined mostly by albumin
      • Interstitial hydrostatic pressure

    Edema

    • Edema is the accumulation of fluid in the interstitial spaces.
    • Causes:
      • Increased capillary hydrostatic pressure (venous obstruction)
      • Decreased plasma oncotic pressure (losses or diminished production of albumin)
      • Increased capillary permeability (inflammation and immune response)
      • Lymphatic obstruction (lymphedema)
    • Clinical manifestations:
      • Localized vs generalized
      • Dependent edema
      • Pitting edema
      • Third space
      • Weight gain
    • Treatment:
      • Elevation of edematous limbs
      • Use compression
      • Avoid prolonged standing
      • Restrict salt intake
      • Take diuretics

    Water Regulation

    • Water losses: skin, lungs, urine, and feces
    • Fluid intake and diet
    • Levels of ADH (antidiuretic hormone)
    • Tonicity and cells:
      • Hypertonic
      • Isotonic
      • Hypotonic

    Sodium Regulation

    • Aldosterone
    • ANP (atrial natriuretic peptide)
    • Baroreceptors
    • Estrogen enhances Na reabsorption
    • Progesterone decreases Na reabsorption
    • Glucocorticoids enhance Na reabsorption
    • Sodium is the primary ECF cation:
      • Regulates osmotic forces
      • Plays a role in neuromuscular irritability, acid-base balance, cellular reactions, and transport of substances
      • Is regulated by aldosterone and natriuretic peptides
    • Water follows sodium

    Chloride

    • Primary ECF anion
    • Provides electroneutrality
    • Follows sodium

    RAAS (Renin-Angiotensin-Aldosterone System)

    • Aldosterone increases excretion of K by the distal tubule of the kidney
    • Natriuretic peptides (ANP, BNP):
      • Decrease tubular reabsorption and promote urinary excretion of sodium
      • Urodilation

    Water Regulation and ADH

    • Thirst perception:
      • Osmolality receptors are located in the hypothalamus
      • Signal posterior pituitary to release ADH
      • Increase water intake
    • Baroreceptors:
      • Stimulated from depleted plasma volume
      • Cause release of ADH
    • ADH = arginine vasopressin:
      • Is released when there is an increase in plasma osmolality or decrease in circulating blood volume
      • Increases water reabsorption

    Abnormalities in Water and Electrolyte Balance

    • Pure water deficit = hypertonic volume depletion
    • Isotonic alterations in Na, Cl, and water:
      • TBW change with proportional electrolyte change
      • Isotonic fluid loss (dehydration and hypovolemia)
      • Isotonic fluid excess (hypervolemia)
    • Hypernatremia:
      • Na > 145
      • Related to sodium gain or water loss
      • Water movement from the ICF to ECF leads to intracellular dehydration
      • Manifestations: cerebral hemorrhage, seizures, muscle twitching, hyperreflexia
      • Treatment: isotonic salt-free fluids
    • Water deficit:
      • Dehydration – sodium and water loss
      • Manifestations: hypotension, weak pulse, postural hypotension, elevated Hct and Na, headache, dry skin, mucous membranes
      • Treatment: oral fluids, hypotonic saline (D5 in water)
    • Hyperchloremia:
      • Occurs with hypernatremia or a bicarb deficit
      • Usually secondary to a pathophysiologic process
      • Is managed by treating the underlying disorders
    • Hypotonic alterations in Na, Cl, and water:
      • Decreased osmolality
      • Hyponatremia or free water excess
      • Hyponatremia decreases the ECF osmotic pressure and water moves into cell
      • Water excess:
        • Compulsive water drinking causing water intoxication
        • Cellular edema
        • Manifestations: cerebral edema, pulmonary edema
        • Treatment: fluid restriction, hypertonic saline
    • Hyponatremia:
      • Na < 135
      • Manifestations: cerebral edema, pulmonary edema
      • Treatment: fluid restriction, hypertonic saline

    Fluid Volume and Composition

    • Fluid volume varies with age, and in adults, it's largely determined by muscle vs fat composition.
    • Obese people have a decreased percentage of total body water (TBW) in relation to body weight, while lean people have an increased percentage.
    • Fluid distribution is divided into:
      • Intra Cellular Fluid (ICF)
      • Extra Cellular Fluid (ECF) = interstitial, intravascular, CSF, sweat, urine, and organ fluids

    Electrolytes and Non-Electrolytes

    • Electrolytes are ions that have an electric charge:
      • ICF: K, Mg, Phosphate
      • ECF: Na, Bicarb, Cl
    • Non-electrolytes do not have an electric charge:
      • Glucose, urea, protein, lipids, creatinine

    Water Balance and Osmolality

    • Osmolality is the measure of solute concentration.
    • Osmotic forces include Na (ECF) and K (ICF).
    • Aquaporins form pores in the cell membrane for water to pass through.
    • Water moves freely through cell membranes.
    • When osmolality of the plasma changes, water moves to reestablish equilibrium.

    Water Movement between Plasma and Interstitial Fluid

    • Starling hypothesis: net filtration is equal to the forces favoring filtration minus the forces opposing filtration.
    • Forces favoring filtration:
      • Capillary hydrostatic pressure (BP)
      • Interstitial oncotic pressure (water pulling)
    • Forces opposing filtration:
      • Capillary oncotic pressure (water pulling) is determined mostly by albumin
      • Interstitial hydrostatic pressure

    Edema

    • Edema is the accumulation of fluid in the interstitial spaces.
    • Causes:
      • Increased capillary hydrostatic pressure (venous obstruction)
      • Decreased plasma oncotic pressure (losses or diminished production of albumin)
      • Increased capillary permeability (inflammation and immune response)
      • Lymphatic obstruction (lymphedema)
    • Clinical manifestations:
      • Localized vs generalized
      • Dependent edema
      • Pitting edema
      • Third space
      • Weight gain
    • Treatment:
      • Elevation of edematous limbs
      • Use compression
      • Avoid prolonged standing
      • Restrict salt intake
      • Take diuretics

    Water Regulation

    • Water losses: skin, lungs, urine, and feces
    • Fluid intake and diet
    • Levels of ADH (antidiuretic hormone)
    • Tonicity and cells:
      • Hypertonic
      • Isotonic
      • Hypotonic

    Sodium Regulation

    • Aldosterone
    • ANP (atrial natriuretic peptide)
    • Baroreceptors
    • Estrogen enhances Na reabsorption
    • Progesterone decreases Na reabsorption
    • Glucocorticoids enhance Na reabsorption
    • Sodium is the primary ECF cation:
      • Regulates osmotic forces
      • Plays a role in neuromuscular irritability, acid-base balance, cellular reactions, and transport of substances
      • Is regulated by aldosterone and natriuretic peptides
    • Water follows sodium

    Chloride

    • Primary ECF anion
    • Provides electroneutrality
    • Follows sodium

    RAAS (Renin-Angiotensin-Aldosterone System)

    • Aldosterone increases excretion of K by the distal tubule of the kidney
    • Natriuretic peptides (ANP, BNP):
      • Decrease tubular reabsorption and promote urinary excretion of sodium
      • Urodilation

    Water Regulation and ADH

    • Thirst perception:
      • Osmolality receptors are located in the hypothalamus
      • Signal posterior pituitary to release ADH
      • Increase water intake
    • Baroreceptors:
      • Stimulated from depleted plasma volume
      • Cause release of ADH
    • ADH = arginine vasopressin:
      • Is released when there is an increase in plasma osmolality or decrease in circulating blood volume
      • Increases water reabsorption

    Abnormalities in Water and Electrolyte Balance

    • Pure water deficit = hypertonic volume depletion
    • Isotonic alterations in Na, Cl, and water:
      • TBW change with proportional electrolyte change
      • Isotonic fluid loss (dehydration and hypovolemia)
      • Isotonic fluid excess (hypervolemia)
    • Hypernatremia:
      • Na > 145
      • Related to sodium gain or water loss
      • Water movement from the ICF to ECF leads to intracellular dehydration
      • Manifestations: cerebral hemorrhage, seizures, muscle twitching, hyperreflexia
      • Treatment: isotonic salt-free fluids
    • Water deficit:
      • Dehydration – sodium and water loss
      • Manifestations: hypotension, weak pulse, postural hypotension, elevated Hct and Na, headache, dry skin, mucous membranes
      • Treatment: oral fluids, hypotonic saline (D5 in water)
    • Hyperchloremia:
      • Occurs with hypernatremia or a bicarb deficit
      • Usually secondary to a pathophysiologic process
      • Is managed by treating the underlying disorders
    • Hypotonic alterations in Na, Cl, and water:
      • Decreased osmolality
      • Hyponatremia or free water excess
      • Hyponatremia decreases the ECF osmotic pressure and water moves into cell
      • Water excess:
        • Compulsive water drinking causing water intoxication
        • Cellular edema
        • Manifestations: cerebral edema, pulmonary edema
        • Treatment: fluid restriction, hypertonic saline
    • Hyponatremia:
      • Na < 135
      • Manifestations: cerebral edema, pulmonary edema
      • Treatment: fluid restriction, hypertonic saline

    Fluid Volume and Composition

    • Fluid volume varies with age, and in adults, it's largely determined by muscle vs fat composition.
    • Obese people have a decreased percentage of total body water (TBW) in relation to body weight, while lean people have an increased percentage.
    • Fluid distribution is divided into:
      • Intra Cellular Fluid (ICF)
      • Extra Cellular Fluid (ECF) = interstitial, intravascular, CSF, sweat, urine, and organ fluids

    Electrolytes and Non-Electrolytes

    • Electrolytes are ions that have an electric charge:
      • ICF: K, Mg, Phosphate
      • ECF: Na, Bicarb, Cl
    • Non-electrolytes do not have an electric charge:
      • Glucose, urea, protein, lipids, creatinine

    Water Balance and Osmolality

    • Osmolality is the measure of solute concentration.
    • Osmotic forces include Na (ECF) and K (ICF).
    • Aquaporins form pores in the cell membrane for water to pass through.
    • Water moves freely through cell membranes.
    • When osmolality of the plasma changes, water moves to reestablish equilibrium.

    Water Movement between Plasma and Interstitial Fluid

    • Starling hypothesis: net filtration is equal to the forces favoring filtration minus the forces opposing filtration.
    • Forces favoring filtration:
      • Capillary hydrostatic pressure (BP)
      • Interstitial oncotic pressure (water pulling)
    • Forces opposing filtration:
      • Capillary oncotic pressure (water pulling) is determined mostly by albumin
      • Interstitial hydrostatic pressure

    Edema

    • Edema is the accumulation of fluid in the interstitial spaces.
    • Causes:
      • Increased capillary hydrostatic pressure (venous obstruction)
      • Decreased plasma oncotic pressure (losses or diminished production of albumin)
      • Increased capillary permeability (inflammation and immune response)
      • Lymphatic obstruction (lymphedema)
    • Clinical manifestations:
      • Localized vs generalized
      • Dependent edema
      • Pitting edema
      • Third space
      • Weight gain
    • Treatment:
      • Elevation of edematous limbs
      • Use compression
      • Avoid prolonged standing
      • Restrict salt intake
      • Take diuretics

    Water Regulation

    • Water losses: skin, lungs, urine, and feces
    • Fluid intake and diet
    • Levels of ADH (antidiuretic hormone)
    • Tonicity and cells:
      • Hypertonic
      • Isotonic
      • Hypotonic

    Sodium Regulation

    • Aldosterone
    • ANP (atrial natriuretic peptide)
    • Baroreceptors
    • Estrogen enhances Na reabsorption
    • Progesterone decreases Na reabsorption
    • Glucocorticoids enhance Na reabsorption
    • Sodium is the primary ECF cation:
      • Regulates osmotic forces
      • Plays a role in neuromuscular irritability, acid-base balance, cellular reactions, and transport of substances
      • Is regulated by aldosterone and natriuretic peptides
    • Water follows sodium

    Chloride

    • Primary ECF anion
    • Provides electroneutrality
    • Follows sodium

    RAAS (Renin-Angiotensin-Aldosterone System)

    • Aldosterone increases excretion of K by the distal tubule of the kidney
    • Natriuretic peptides (ANP, BNP):
      • Decrease tubular reabsorption and promote urinary excretion of sodium
      • Urodilation

    Water Regulation and ADH

    • Thirst perception:
      • Osmolality receptors are located in the hypothalamus
      • Signal posterior pituitary to release ADH
      • Increase water intake
    • Baroreceptors:
      • Stimulated from depleted plasma volume
      • Cause release of ADH
    • ADH = arginine vasopressin:
      • Is released when there is an increase in plasma osmolality or decrease in circulating blood volume
      • Increases water reabsorption

    Abnormalities in Water and Electrolyte Balance

    • Pure water deficit = hypertonic volume depletion
    • Isotonic alterations in Na, Cl, and water:
      • TBW change with proportional electrolyte change
      • Isotonic fluid loss (dehydration and hypovolemia)
      • Isotonic fluid excess (hypervolemia)
    • Hypernatremia:
      • Na > 145
      • Related to sodium gain or water loss
      • Water movement from the ICF to ECF leads to intracellular dehydration
      • Manifestations: cerebral hemorrhage, seizures, muscle twitching, hyperreflexia
      • Treatment: isotonic salt-free fluids
    • Water deficit:
      • Dehydration – sodium and water loss
      • Manifestations: hypotension, weak pulse, postural hypotension, elevated Hct and Na, headache, dry skin, mucous membranes
      • Treatment: oral fluids, hypotonic saline (D5 in water)
    • Hyperchloremia:
      • Occurs with hypernatremia or a bicarb deficit
      • Usually secondary to a pathophysiologic process
      • Is managed by treating the underlying disorders
    • Hypotonic alterations in Na, Cl, and water:
      • Decreased osmolality
      • Hyponatremia or free water excess
      • Hyponatremia decreases the ECF osmotic pressure and water moves into cell
      • Water excess:
        • Compulsive water drinking causing water intoxication
        • Cellular edema
        • Manifestations: cerebral edema, pulmonary edema
        • Treatment: fluid restriction, hypertonic saline
    • Hyponatremia:
      • Na < 135
      • Manifestations: cerebral edema, pulmonary edema
      • Treatment: fluid restriction, hypertonic saline

    Fluid Volume and Composition

    • Fluid volume varies with age, and in adults, it's largely determined by muscle vs fat composition.
    • Obese people have a decreased percentage of total body water (TBW) in relation to body weight, while lean people have an increased percentage.
    • Fluid distribution is divided into:
      • Intra Cellular Fluid (ICF)
      • Extra Cellular Fluid (ECF) = interstitial, intravascular, CSF, sweat, urine, and organ fluids

    Electrolytes and Non-Electrolytes

    • Electrolytes are ions that have an electric charge:
      • ICF: K, Mg, Phosphate
      • ECF: Na, Bicarb, Cl
    • Non-electrolytes do not have an electric charge:
      • Glucose, urea, protein, lipids, creatinine

    Water Balance and Osmolality

    • Osmolality is the measure of solute concentration.
    • Osmotic forces include Na (ECF) and K (ICF).
    • Aquaporins form pores in the cell membrane for water to pass through.
    • Water moves freely through cell membranes.
    • When osmolality of the plasma changes, water moves to reestablish equilibrium.

    Water Movement between Plasma and Interstitial Fluid

    • Starling hypothesis: net filtration is equal to the forces favoring filtration minus the forces opposing filtration.
    • Forces favoring filtration:
      • Capillary hydrostatic pressure (BP)
      • Interstitial oncotic pressure (water pulling)
    • Forces opposing filtration:
      • Capillary oncotic pressure (water pulling) is determined mostly by albumin
      • Interstitial hydrostatic pressure

    Edema

    • Edema is the accumulation of fluid in the interstitial spaces.
    • Causes:
      • Increased capillary hydrostatic pressure (venous obstruction)
      • Decreased plasma oncotic pressure (losses or diminished production of albumin)
      • Increased capillary permeability (inflammation and immune response)
      • Lymphatic obstruction (lymphedema)
    • Clinical manifestations:
      • Localized vs generalized
      • Dependent edema
      • Pitting edema
      • Third space
      • Weight gain
    • Treatment:
      • Elevation of edematous limbs
      • Use compression
      • Avoid prolonged standing
      • Restrict salt intake
      • Take diuretics

    Water Regulation

    • Water losses: skin, lungs, urine, and feces
    • Fluid intake and diet
    • Levels of ADH (antidiuretic hormone)
    • Tonicity and cells:
      • Hypertonic
      • Isotonic
      • Hypotonic

    Sodium Regulation

    • Aldosterone
    • ANP (atrial natriuretic peptide)
    • Baroreceptors
    • Estrogen enhances Na reabsorption
    • Progesterone decreases Na reabsorption
    • Glucocorticoids enhance Na reabsorption
    • Sodium is the primary ECF cation:
      • Regulates osmotic forces
      • Plays a role in neuromuscular irritability, acid-base balance, cellular reactions, and transport of substances
      • Is regulated by aldosterone and natriuretic peptides
    • Water follows sodium

    Chloride

    • Primary ECF anion
    • Provides electroneutrality
    • Follows sodium

    RAAS (Renin-Angiotensin-Aldosterone System)

    • Aldosterone increases excretion of K by the distal tubule of the kidney
    • Natriuretic peptides (ANP, BNP):
      • Decrease tubular reabsorption and promote urinary excretion of sodium
      • Urodilation

    Water Regulation and ADH

    • Thirst perception:
      • Osmolality receptors are located in the hypothalamus
      • Signal posterior pituitary to release ADH
      • Increase water intake
    • Baroreceptors:
      • Stimulated from depleted plasma volume
      • Cause release of ADH
    • ADH = arginine vasopressin:
      • Is released when there is an increase in plasma osmolality or decrease in circulating blood volume
      • Increases water reabsorption

    Abnormalities in Water and Electrolyte Balance

    • Pure water deficit = hypertonic volume depletion
    • Isotonic alterations in Na, Cl, and water:
      • TBW change with proportional electrolyte change
      • Isotonic fluid loss (dehydration and hypovolemia)
      • Isotonic fluid excess (hypervolemia)
    • Hypernatremia:
      • Na > 145
      • Related to sodium gain or water loss
      • Water movement from the ICF to ECF leads to intracellular dehydration
      • Manifestations: cerebral hemorrhage, seizures, muscle twitching, hyperreflexia
      • Treatment: isotonic salt-free fluids
    • Water deficit:
      • Dehydration – sodium and water loss
      • Manifestations: hypotension, weak pulse, postural hypotension, elevated Hct and Na, headache, dry skin, mucous membranes
      • Treatment: oral fluids, hypotonic saline (D5 in water)
    • Hyperchloremia:
      • Occurs with hypernatremia or a bicarb deficit
      • Usually secondary to a pathophysiologic process
      • Is managed by treating the underlying disorders
    • Hypotonic alterations in Na, Cl, and water:
      • Decreased osmolality
      • Hyponatremia or free water excess
      • Hyponatremia decreases the ECF osmotic pressure and water moves into cell
      • Water excess:
        • Compulsive water drinking causing water intoxication
        • Cellular edema
        • Manifestations: cerebral edema, pulmonary edema
        • Treatment: fluid restriction, hypertonic saline
    • Hyponatremia:
      • Na < 135
      • Manifestations: cerebral edema, pulmonary edema
      • Treatment: fluid restriction, hypertonic saline

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