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The Cellular Environment: Fluids and Electrolytes, Acids and Bases

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on 18 August 2014

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Transcript of The Cellular Environment: Fluids and Electrolytes, Acids and Bases

Gains for avg Adult
Total Body Water
Intracellular Fluid
Extracellular Fluid
interstitial Fluid
Intravascular Fluid
Revolución Industrial
LOCKE
BERKELEY
Método Científico
Experiencia
Razón
The Cellular Environment:
Fluids and Electrolytes, Acids and Bases
60%
of weight
Oral intake
as water : 1000 ml
in food: 1300 ml


Water of oxidation 200 ml
TOTAL: 2500 ml (2.5 L)
Losses for avg Adult
Urine: 1500 ml
Insensible losses:
Lungs 300 ml
Skin 500 ml
Feces: 200 ml
Total: 2500 ml (2.5 L)
WATER MOVEMENT BETWEEN ICF AND ECF
Na+ is the most abundant ECF ion

responsible for OSMOTIC balance of ECF space
WATER MOVEMENT BETWEEN PLASMA AND INTERSTITIAL FLUID
Result of changes
in
HYDROSTATIC PRESSURE
and
OSMOTIC FORCES
PLASMA PROTEINS (PARTICULARLY ALBUMIN)
ONCOTIC /OSMOTIC PRESSURE
WATER PULLED INTO CAPILLARY BY
Alterations in Water Movement: Edema
increase in HYDROSTATIC PRESSURE
FROM VENOUS OBSTRUCTION

OR
SALT AND H20 RETENTION
SODIUM, CHLORIDE AND WATER BALANCE
ALDOSTERONE: INCREASES REABSORPTION OF Na+ and SECRETION OF K+ BY DISTAL TUBULE OF KIDNEY
Chloride (Cl-) is major
anion in ECF in plasma

REM: Na+Cl-?????
Bicarbonate (HCO3-) is the other one

REM: Na+HCO3-????
HCO3- and Cl- concentration in ECF vary inversely b/c BOTH can bind to Na+
So....when HCO3 increases in the plasma, Cl- goes into the RBCs and vice versa.....
Water Balance
Secretion of ADH initiated by
increased plasma concentration
OR a decrease in circulating blood volume and lowered BP
Alterations in Na+, Cl- and H2O balance
Isotonic Alterations: (water AND electrolytes)
depletion: ECF volume contracts,
wt. loss, dry skin and mucus mem.
excess: plasma volume expands,
hypervolemia results
Hypertonic Alterations: (increase in
only electrolytes...especially Na+,
AND a decrease in water)
water attracted from ICF, cells dehydrate
Hypernatremia (Na+ level > 147)
Hyperchloremia (Cl- level > 105)
Water deficit (HA, thirsty, dry
skin and mucus membranes,
fever, wt. loss, oliguria, urine
concentrated)
Hypotonic Alterations: (ECF has
more water AND less
electrolytes)

Hyponatremia: serum Na+ < 135
water shifts from ICF to ECF
Na+/K+ pump failure!!!
Lethargic, HA, confusion, apprehension, seizures
Hypochloremia: either from loss
of Na+ or excess HCO3!
Vomiting (loss of HCl), diuretics
water excess: cerebral edema, confusion
Electrolytes
K+: ECF value is 3.5-5 mEq*
Major IC electrolyte
Levels regulated by KIDNEYS through
aldosterone
Insulin escorts into the cell with glucose
so watch diabetics on insulin for hypo!!!
Hyper- causes muscle weakness (especially the heart!)...bradydysrhythmias and decrease conduction of heart muscle leading to arrest
* mEq is a unit of chemical activity
ACID-BASE BALANCE
Hydrogen ion and pH:
Acids yield H+ ions, Bases accept H+ ions

pH of blood: 7.35-7.45
alkalinity of body fluids
3 regulatory mechanisms:
* Buffer systems in blood - instantaneous
* Lungs, which regulate carbonic acid
concentration - minutes to hours to
respond
* Kidneys which control H+ excretion and
Bicarb reabsorption - hours to days to
respond. NH3 is important buffer
Interrelations of Intracellular and Extracellular Fluid
Cell membrane divides

Capillaries impermeable to protein so interstitial has decreased protein

Cell membrane permeable to water but not Na+ or K+

Primary EC ions are Na+ and Cl-
Primary IC ions are K+ and Phosphate

Amt of Na determines ECF volume
Amt of K determines ICF volume

Overhydration – less common
- caused by too much IV fluid
- impaired renal function
- infants < 6 mos of age
- marathon runners
Third Spacing leads to Shock
Calcium
Ionized: freely floating in blood not attached to proteins

Serum: attached to proteins (9-11 mg/dL)

Necessary for heart function, muscle contraction, nerve
signaling and blood clotting

Assessed if kidney or parathyroid disease suspected

Regulated by PTH from parathyroid glands
Alterations of Acid-Base Balance
Acidosis: pH shifts to acid side of range
May be r/t excess carbonic acid or reduced
bicarb

Alkalosis: pH shifts to alkaline side of range
May be r/t decrease carbonic acid or increased bicarb
4 large categories:

Metabolic acidosis

Metabolic alkalosis

Respiratory acidosis

Respiratory alkalosis
Key:

Metabolic = bicarb disturbance

Respiratory = carbonic acid disturbance
NORMAL RANGES
pH: 7.35-7.45
HCO3: 22-26
pCO2: 35-45
Compensatory Mechanisms
If pH shifts out of range, buffers activated

If problem is metabolic, respiratory buffers

If problem is respiratory, kidney buffers
Metabolic Acidosis
Ketosis from fat metabolism
Common in untreated type I diabetes
Lactic acidosis from anaerobic glycolysis
Compensation: lungs increase rate and depth of R to reduce CO2
Kidneys excrete more H+ and retain more bicarb
Respiratory Acidosis
Usually r/t chronic lung disease such as emphysema

caused by CO2 retention

compensatory mechanism:
Kidneys form more bicarb
Metabolic Alkalosis
Loss of gastric juice from prolonged vomiting or use of antacids that neutralize gastric acid

Cl- depletion from severe v&d

compensatory mechanism inefficient

usually requires K+ correction to fix
Respiratory Alkalosis
Result of hyperventilation that lowers CO2 in alveoli

Excess bicarb and blood pH rises

Compensation: renal excretion of bicarb
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