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Fluid Balance
14.
Pressure Gradient: the difference in pressure between two
points. So fluid will flow from areas of higher hydrostatic pressure to
lower hydrostatic pressure at the arterial end of the capillary and the
colloid osmotic pressure is higher intravascularly than the tissue colloid
osmotic pressure, so the intravascular colloid osmotic pressure pulls
the fluid back into the vascular system at the venous end of the
capillary.
15.
Regulators of fluid balance:
a. Thirst
b. Sodium: water follows sodium. If FVD (fluid volume deficit)
kidneys hold unto more sodium and water follows (More
concentrated urine)
c. Protein, albumin: increases osmotic pressure thus pulling more
fluid into the vascular space. If low on albumin due to poor diet
= less osmotic pressure. If albumin or other proteins get out into
the tissues pull fluid out into the tissues ascites or edema
d. Antidiuretic hormone (ADH): produced in hypothalamus, stored
in back of pituitary gland, secreted if body senses low volume,
ECFVD (extracellular fluid volume deficit) or an increased
osmolality (increase in solutes - like high sodium levels). ADH
causes water reabsorption in kidneys.
e. Renin: comes from juxtaglomerular cells in kidney, released
when kidneys get less blood flow kidneys interpret low blood
flow to mean low blood volume or dehydration. Renin causes
angiotensinogen to convert to angiotensin I, which then is acted
on to convert to angiotensin II, a potent vasoconstriction and the
release of aldosterone sodium and water retention in kidneys
vasoconstriction of vascular system increase in vascular
volume and Bp and increased blood flow to the kidneys.
f. Aldosterone: comes from Adrenal cortex, promotes sodium,
chloride & water reabsorption in kidneys.
Fluid Balance
16.
a.
b.
c.
17.
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
18.
Tonicity of IV solutions:
Isotonic D5W, 0.9 NS, RL
Hypotonic 0.45 NS, 2.5% dextrose & water
Hypertonic 2 3% sodium chloride, D5W & .9 NS (D5W and
anything adding up the solutes in both mixtures make it
hypertonic) (something to think about in later years of practice
once D5W [5% dextrose in water] is metabolized, the sugar
dextrose is metabolized, it becomes a hypotonic solution)
Causes of fluid volume deficit (dehydration)
Vomiting/diarrhea (Influenza)
GI fistula (Crohns disease)
GI suctioning (Post gastric surgery)
Increased salt intake
Intestinal obstruction (Tumor)
Perforated ulcer
Fever
Profuse diaphoresis
Burns (especially full thickness burns)
Diabetic Ketoacidosis
Massive trauma (especially hip fractures or large bone fractures,
internal abd. Injuries)