Regulation/Metabolism week 1-

Tuesday Chapter 2

Body fluid homeostasis (balance)

Body fluid compartments:
- Intracellular (ICF): within cells
- Extracellular (ECF): outside cells
 Intravascular (IVF): within blood vessels
 Interstitial (ISF): outside of blood vessels, between cells
 Transcellular: within minor compartments
Fluid imbalances
- Fluid volume deficit (FVD-dehydration or hypovolemia)
 Results from too little water in and/or too much water out
 Decreased thirst mechanism
 Excessive sweating
 Excessive urination
 Diarrhea
 Prolonged, increased respirations
 Clinical manifestations result from decreased intravascular fluid and decreased
interstitial fluid
 Vital signs
 Decreased blood pressure (hypotension)
 Tachycardia
 Increased body temp
 Physical findings
 Skin tenting- decreased skin turgor
 Dry mucosa membranes
 Sunken eyes
 Weakness
 Thirst
 Weight loss
 Labs
 Increased hematocrit
 High urine specific gravity
 Increased electrolytes
- Fluid volume excess (FVE-overload/ hypervolemia)
 Results from too much water in and/or retain too much water
 Decreased urine output (renal failure)
 Excessive fluid intake (usually from IV fluid administration)
 Clinical manifestations result from increased intravascular fluid and/or increased
interstitial fluid
 Vital signs
 Increased blood pressure (hypertension)
 Bradycardia
 Bounding pulse
 Physical findings
 Pale skin color
 Localized swelling (hands, feet, ascites)
  Preorbital edema
 Lethargy
 Pulmonary congestion, rales, cough
 Labs
 Decreased hematocrit
 Low urine specific gravity
 Decreased serum sodium
Fluid distribution at the capillary level
- Movement of the fluid in the body takes place at the level of the capillary
- Fluid is important for movement of nutrients and O2 into the interstitial and removal of
wastes and CO2 into the vessels for elimination
- Osmosis and diffusion promote movement of fluid across the semi-permeable membranes

- Osmosis is the movement of fluid from an area of low solute concentration to an area of
higher concentration until the areas are equal concentration
- Diffusion is the movement of solutes from an area of greater concentration to an area of
lesser concentration leading to an equal concentration of solutes

- Hydrostatic pressure
 Pushing out of intravascular space
- Osmotic pressure
 pulling into intravascular space
 from increased osmolarity caused by
 colloids (plasma protein): proteins exert osmotic pressure known as
colloid osmotic pressure (COP)
 dissolved solutes: dissolved particles in blood exert osmotic pressure
Tonicity/Osmolarity
- Hypotonic/hypo-osmolar: less osmolarity than plasma (less concentrated)
 Water moves out of the intravascular compartment, causing the cells to swell and
burst (decrease osmotic pressure)
- Isotonic/iso-osmolar: same osmolarity as plasma
 Fluid remains in the intravascular compartment
- Hypertonic/hyper-osmolar: greater osmolarity than plasma (more concentrated)
 Water moves out of the cell into the intravascular compartment, causing the cells to
shrink
Causes of edema
- Increase in capillary hydrostatic pressure
 Increase BP from
 Hypervolemia (fluid volume excess)
 Vasoconstriction
- Decrease in osmotic pressure
 Decreased plasma proteins
 malnourished
- Increased capillary permeability
 inflammation
- Lymph vessel obstruction or removal
 Venous obstruction
Thursday Chapter 2

Electrolytes
- Sodium
 135-145 mEq/L, major ECF cation (this includes inside the blood vessel and the
interstitial)
 Primary determinant of ECF volume and osmolality, activates nerve & muscle cells:
necessary for muscle contraction and transmission of nerve impulses, essential
electrolyte in the sodium-potassium pump
- Potassium
 3.5-5.0 mEq/L, Major cation of ICF, 98% of K+ is in the cell
 80% of K+ excreted daily leaves the body through the kidneys
 Necessary for transmission of electric impulses, particularly in nerve, heart, skeletal,
intestinal, & lung tissue
 Assists in regulation of acid-base balance by cellular exchange with H+
- Calcium
 8.5-10.4 mg/L Varies for different ages
 Most abundant electrolyte in the body, more than 99% of body’s calcium is located in
the skeletal system
 Necessary for nerve impulse transmission; muscle contraction, including cardiac
muscle
 Necessary for blood clotting and for strong bones & teeth
 Vitamin D assists with absorption of Ca++ in GI tract

Acid-Base balance
- Concentration of H+ (hydrogen ions) in the blood
 larger # of H+ ions = low pH = acid
 small # of H+ ions = high pH = alkaline (base)

Acid-Base imbalance
- Metabolic Acidosis
 HCO3 loss, acid retention
 Possible causes: diarrhea>>lose HCO3, DKA, renal disease
 Clinical manifestations: rapid deep breathing, fruity breath, HA, lethargy, N.V
- Metabolic Alkalosis
 HCO3 retention, acid loss
 Possible causes: vomiting>>lose HCL, gastric secretion, excess anti-acid intake
 Clinical manifestations: slow, shallow respirations, restless, confused
- Respiratory Acidosis
 Excess CO2 retention
 Possible causes: airway obstruction, slow shallow respirations
 Clinical manifestations: hypoventilation, headache, weakness, confusion, lethargy
- Respiratory Alkalosis
 Excess excretion of CO2
 Possible causes: hyperventilation (anxiety, pain, fear)
 Clinical manifestations: hyperventilation, lightheaded, paresthesia, anxiety
1. Describe the function of sodium, potassium, and calcium.
- Refer to previous page

2. What is the relationship between sodium and water?

- Water goes where ever sodium goes

3. For each imbalance, how would the increase or decrease in electrolyte levels lead to the
clinical manifestations?

4. What are the normal ranges for sodium, potassium, and calcium?
- Sodium: 135-145
- Potassium: 3.5-5.0
- Calcium: 8.5-10.4