Professional Documents
Culture Documents
Liquidos y Electrolitos
Liquidos y Electrolitos
PROGRAMA DE MEDICINA
SISTEMAS FUNCIONALES EFECTORES
in a 60 kg individual:
TOTAL BODY WATER = 0.6 x body wt.
(36 L)
is divided into:
Extracellular Fluid (ECF) Intracellular Fluid(ICF)
=0.2 x body wt. =0.4 x body wt.
= 12L = 24L
Osmolarity terminology
Osmotic considerations
not all dissolved molecules contribute to osmotic pressure
ineffective osmoles
penetrating solutes
Administration of IV fluids:
isotonic saline (0.9g/dL = 0.15M NaCl) does NOT generate osmotic pressure gradient
o expands ECF only
solutions with few effective osmols
o 0.15M NaCl or isotonic (5%) glucose (D5W) distribute into both ECF and ICF
limits: max metabolism of glucose - 0.5g/kg/hr
about 600mmol (1/2 NaCl, 1/2 urea) must be excreted each day
o min. volume = 600 mmol / 1200 mmol/L = 0.5 L
o max volume = 18L
what is "normal" urine osmolarity?
o depends on
water intake
solute intake
direct measurement often based on melting point changes based on solute content
urine specific gravity
= mass of urine / mass of water
Sp. Gr. Osmolality
1.000 0 mmol/kg
1.010 350
1.020 700
1.030 1050
Disturbances in Fluid and electrolyte balance
Monitoring Hydration status (partial list)
o physical signs (hypotension/hypertension, dry mucous membranes, low CVP)
o hematocrit
o body weight
ECF Hypertonicity
water loss without equal electrolyte loss (dehydration)
o insufficient water intake
o heavy sweating (loss of hypotonic fluid: 1.5 L/hr)
o vomiting, osmotic diarrhea (eg. from unabsorbed lactose in colon) - more H2O
lost than electrolyte
o diabetes insipidus (lack of vasopressin release from pituitary, renal tubules
can't reabsorb H2O)
o diabetes mellitus (glucose can't enter cells, elevating plasma levels; glucose
spills into urine creating an osmotic gradient for urinary fluid loss)
plasma Na+ can be used to estimate fluid loss:
fluid deficit = TBW - (140 x TBW)/serum [Na+]
ECF Hypertonicity
RESULT: H2O moves out of cells until ICF equilibrates with ECF; cells shrink
o neuron function in brain can be compromised: coma
ECF Hypotonicity
Excess of water relative to electrolytes:
= overhydration
o e.g. rapid water ingestion without electrolyte
o stress-induced vasopressin release
RESULT:
o fluid moves from ECF to ICF: cell swelling: confusion, headache, vomitting,
coma
Isotonic ECF disturbances
Equivalent loss of fluid and electrolytes
o eg. Hemorrhage, chronic diarrhea
o no fluid shift out of cells since no change in osmolarity (unless other
mechanisms at work)
isotonic fluid GAIN:
o eg. Isotonic saline infusion
o no osmotic gradient so expansion of ECF only
3. ¿Qué porcentaje de nuestro peso corporal corresponde al agua y qué factores pueden
hacer variar este porcentaje?
7. El compartimiento líquido que contiene aproximadamente las 2/3 del agua total del
cuerpo es:
A. Transcelular
B. Plasma
C. Intersticial
D. Intracelular
E. Extracelular
8. Glóbulos rojos, originalmente rodeados por plasma son ahora re- suspendidos en una
solución 250 mOsm. De NaCl . Cabe esperar que el volumen de las células
A. Aumente
B. Disminuya
C. No cambie
9. Señale cual(es) de los siguientes cambios en los compartimientos líquidos del cuerpo
ocurren en una hemorragia
Disminuye el volumen del LIC
Aumenta la osmolaridad del LEC
No hay cambios en el volumen del LIC
Disminuye el volumen del LEC
Aumenta la osmolaridad del LEC
B. Ingesta
aumentada
de sal
C. Sudoración
excesiva
D. Diarrea
severa