fluids final 24th march 2013

8/13/2019 Fluids FINAL 24th March 2013

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Fluid, Electrolyte andAcid-Base Dynamics

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DefinitionsOsmoles:The concentration of an osmotic

solution.

A milliequivalentis equal to 0.001

equivalent weight.

An equivalent weight is equal to 1 mole

divided by the valenceof the substance.

A MOLEis the molecular weight in gramsper litre.


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Concentration of

Solutions Percent Salt

0.9% NaCl (Normal Saline)

Milliosmoles

300 milliosmoles/Liter

Milliequivalents

325 milliequivalents/Liter


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The passage of a liquid from a weak solution to a more

concentrated solution across a semipermeable membrane that

allows passage of the solvent (water) but not the dissolved

solids.

Osmosis


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Osmosis


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Hypertonic Solution

0.9%

NaCl

3% NaCl

Red Cell


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Cells Crenate in a

Hypertonic Solution


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Isotonic Solution

0.9%

NaCl

0.9% NaCl

No movement of liquid will occur as the concentration of Sodium

Chloride in the Red Cell and surrounding fluid are of equal strength.

Normal

Saline


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310 mosm

300 mosm

Which Way Will Fluid Move?


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Problem 1

A patient has recently started working

outdoors in the hot weather.

After a few days he experienced headaches,low blood pressure and a rapid heart rate.

His blood sodium was down to 125 meq/L.

The normal is 144 meq/L. How do you

explain this?


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Answer to Problem 1

The patient lost sodium by perspiration.

The low sodium in his blood allowed fluid

to move into cells by osmosis.Lack of fluid lowered his blood pressure to

give him a headache.

The increased heart rate was his bodiesway of trying to increase blood pressure.


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Problem 2

A patient has hypertension.

His doctor has advised her eat a lowsalt diet. She consumed a lot of salt

the day before her last checkup.

Her blood pressure was up. Why?


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Answer to Problem 2

The extra salt she consumed

made her blood hypertonic.Hypertonic blood will attract

fluids from body cells by

osmosis.


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Electrolyte vs..

Non electrolyte

NaCl Na++ Cl-

Glucose Glucose


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Aldosterone

Hormone secreted

from the adrenal

cortex Stimulates kidneys

Retain sodium

Retain water

Secrete potassiumKidney

Adrenal Gland


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Estrogen

Female hormone from the

ovaries

Similar to aldosterone

Stimulates the kidneys to retain

sodium Increases fluid retention


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Cortisol

Hormone from the adrenal cortex

Converts lipids and protein to glucose

Depress inflammation

Stimulates the kidneys to retain sodium

Increases fluid retentionElevated levels cause edema


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Antidiuretic Hormone

ADH

ADH

Hypertonic

Interstitial Fluid

Collecting

Duct

H2O

Urine


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Estrogen

CalciumBLOOD


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Parathormone

CalciumBLOOD


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Blood pH = 7.4

(7.35-7.45)

Blood pH regulated by

1. Kidneys

2. Lungs

3. Buffers in blood


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H+ Secreted

HCO3-

Rebsorbed

Blood

Kidney

NephronHCO3

-

H

+

Urine

H+= Hydrogen Ions

HCO3-= Bicarbonate Ions


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Kidneys Regulate pH

by

Excreting excess hydrogen ions &

retaining bicarbonate

if pH is too low Retaining hydrogen ions &

excreting bicarbonate

if pH is too high


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Lungs Regulate pH

Breathe faster to get rid of excess

carbon dioxide if pH is too low.

Carbon dioxide dissolves in

blood to forms carbonic acid.

Breathe slower to retain carbondioxide if pH is too high.


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Carbon Dioxide and Acid

CO2

+H2

O H2

CO3

H++ HCO3

-Carbonic Acid Bicarbonate

The enzyme, Carbonic anhydraseaccelerates the reaction

The reaction is reversable

LUNGS


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More Carbon Dioxide = More Acid

= Lower pH

Breathing slower will retain CO2

pH will decrease(more acid)

Breathing faster will eliminate more CO2

pH will increase(less acid)


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Blood pH Drops to 7.3

How does the body

compensate?

Breathe faster to getrid of carbon dioxide

eliminates acid


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Blood pH Increases to 7.45

How does the body

compensate?

Breathe slower to retain

more carbon dioxide

retains more acid


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A patient is taking Narcotics for Pain.

The narcotics have depressed his breathing

rate. What will happen to his blood pH?

pH will decreasebecause he willretain excess carbon dioxide which

will increase the amount of acid in

the blood


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Buffers Regulate pH

Chemicals that resist changes in pH.

Prevent large pH changes when an

acid or base is added.

Strong AcidAcid that releases many hydrogen ions

e.g. HCl

Weak AcidAcid that releases only a few hydrogen ions

e.g. Carbonic Acid


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Buffers Change Strong Acids

to Weak Acids

HCl +NaOHStrong

Acid

BaseH2CO3+ NaClWeak Acid Salt


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Bicarbonate : Carbonic Acid

Ratio 20:1 = pH 7.4

21:1 = pH more than7.4 19:1 = pH less than7.4


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Acidosis

pH below 7.35

Depresses the nervous system

coma

Alkalosis

pH above 7.45Overexcites the nervous system

convulsions - Tetany


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Respiratory Acidosis.

Respiratory Alkalosis.

Metabolic Acidosis.

Metabolic Alkalosis.


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Respiratory Acidosis

Any condition that impairs breathing

Carbon dioxide increases in blood

Excess carbon dioxide lowers pH


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Respiratory Alkalosis

Hyperventilation

Carbon dioxide decreases in blood

Low carbon dioxide raises pH


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Metabolic Acidosis

Not caused by breathing or carbondioxide imbalance.

Excess acid in blood

Renal disease, Diabetes or

Starvation.

Deficiency of bicarbonate in blood.Diarrhea


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Metabolic Alkalosis

Not caused by breathing or carbon

dioxide imbalance.

Deficiency of acid in the blood. Vomiting, Diuretics.

Excess bicarbonate in the blood.

Ingesting sodium bicarbonate.

S di


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Sodium Attracts water into the ECF.

(Extra Cellular Fluid) Nerve impulse.

Muscle contractions.

HypernatremiaExcess sodium in the blood.

Hypertension.Muscle twitching.

Mental confusion.

Coma.


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HyponatremiaDeficiency of sodium in the blood

Hypotension (Low blood pressure)

Tachycardia (Fast heart beat above 100BPM)

Muscle weakness


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Potassium

Attracts water into the ICF(Intracellular Fluid)

Nerve impulse

Muscle contractions

HyperkalemiaExcess potassium in the blood

Cardiac arrhythmias and cardiac arrest

Elevated T wave in ECG

Muscle weakness


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HypokalemiaDeficiency of potassium in the blood

Cardiac arrhythmias and cardiac arrest

Flattened T wave in ECG

Muscle weakness


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Calcium

Mostly in bones and teeth

Blood clotting

Nerve impulse

Muscle contraction


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HypercalcemiaExcess calcium in the blood

Kidney stones Bone pain

Cardiac arrhythmias Cancer


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HypocalcemiaDeficiency of calcium in the blood

Tetany

(uncontrolled muscle contraction)

Weak heart muscle

Increased clotting time


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Aldosteronism

Excess production of aldosterone

Elevated sodium levels

Depressed potassium levels

Hypertension


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Addisons Disease

Hyposecretion of the Adrenal Cortex Hyposecretion of Aldosterone

Hyposecretion of Glucocorticoids Hormones that convert protein sugar

Hypotension Sodium deficiency

Low blood sugar Not enough glucocorticoids


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Cushings Syndrome

Excess glucocorticoids

Tumor of adrenal gland

Side effect of steroid drugscortisone

Hyperglycemia

Fat accumulationAbdomen

Back of neck (buffalo hump)


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Insulin

Glucose

Cell

Blood


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Antidiuretic Hormone

ADH

ADH

Hypertonic

Interstitial Fluid

CollectingDuct

H2O

Urine


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Diabetes Insipidus

Hyposecretion of ADH

Increased urine volume Diabetes insipidus is caused by a

problem with your pituitary gland

or your kidneys.


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fluids final 24th march 2013

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