Fluid, Electrolyte, and Acid-Base Imbalances Chapter 17 Overview Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Water Content of Body Body Fluid Compartments Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Water Content of Body Fig. 17-2. Relative volumes of three body fluids. Values represent fluid distribution in a young male adult. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Electrolytes Fig. 17-3. Electrolyte content of fluid compartments. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Mechanisms Controlling Fluid and Electrolyte Movement Diffusion Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Mechanisms Controlling Fluid and Electrolyte Movement Fig. 17-4. Diffusion is the movement of molecules from an area of high concentration to an area of low concentration. Eventually the sugar molecules are evenly distributed. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Mechanisms Controlling Fluid and Electrolyte Movement Facilitated Diffusion Active Transport Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Mechanisms Controlling Fluid and Electrolyte Movement Fig. 17-5. Sodium-potassium pump. As sodium (Na+) diffuses into the cell and potassium (K+) diffuses out of the cell, an active transport system supplied with energy delivers Na+ back to the extracellular compartment and K+ to the intracellular compartment. ATP, Adenosine triphosphate. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Mechanisms Controlling Fluid and Electrolyte Movement Osmosis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Mechanisms Controlling Fluid and Electrolyte Movement Fig. 17-6. Osmosis is the process of water movement through a semipermeable membrane from an area of low solute concentration to an area of high solute concentration. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Mechanisms Controlling Fluid and Electrolyte Movement Osmosis, continued Measurement of osmolality Osmotic movement of fluids Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Mechanisms Controlling Fluid and Electrolyte Movement Fig. 17-7. Effects of water status on red blood cells. A, Hypotonic solution (H2O excess) results in cellular swelling. B, Isotonic solution (normal H2O balance) results in no change. C, Hypertonic solution (H2O deficit) results in cellular shrinking. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Mechanisms Controlling Fluid and Electrolyte Movement Hydrostatic Pressure Oncotic Pressure Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Fluid Movement in Capillaries Fig. 17-8. Dynamics of fluid exchange between a capillary and tissue. An equilibrium exists between forces filtering fluid out of the capillary and forces absorbing fluid back into the capillary. Note that the hydrostatic pressure is greater at the arterial end of the capillary than at the venous end. The net effect of pressures at the arterial end of the capillary causes a movement of fluid into the tissue. At the venous end of the capillary, there is net movement of fluid back into the capillary. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Fluid Movement in Capillaries Fluid Shifts Shifts of plasma to interstitial fluid Elevation of venous hydrostatic pressure Decrease in plasma oncotic pressure Elevation of interstitial oncotic pressure Shifts of interstitial fluid to plasma Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Regulation of Water Balance Hypothalamic Regulation Pituitary Regulation Adrenal Cortical Regulation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Regulation of Water Balance Fig. 17-9. Factors affecting aldosterone secretion. ACTH, Adrenocorticotropic hormone. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Regulation of Water Balance Fig. 17-10. Effects of stress on fluid and electrolyte balance. ACTH, Adrenocorticotropic hormone; ADH, antidiuretic hormone; CRH, corticotropin-releasing hormone. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Regulation of Water Balance Renal Regulation Cardiac Regulation Gastrointestinal Regulation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Regulation of Water Balance Insensible Water Loss Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Gerontologic Considerations Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Fluid and Electrolyte Imbalances Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Calcium Imbalances Hypercalcemia Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Calcium Imbalances Hypocalcemia Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Magnesium Imbalances Fig. 17-10. Effects of stress on fluid and electrolyte balance. ACTH, Adrenocorticotropic hormone; ADH, antidiuretic hormone; CRH, corticotropin-releasing hormone. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Acid-Base Imbalances pH and Hydrogen Ion Concentration Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Acid-Base Imbalances Table 17-11. Terminology Related to Acid-Base Physiology. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Acid-Base Imbalances Fig. 17-6. Osmosis is the process of water movement through a semipermeable membrane from an area of low solute concentration to an area of high solute concentration. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Acid-Base Imbalances Acid-Base Regulation Buffer system Respiratory system Renal system Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Acid-Base Imbalances Alterations in Acid-Base Balance Respiratory acidosis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Acid-Base Imbalances Fig. 17-17. Kinds of acid-base imbalances. A, Respiratory imbalances caused by carbonic acid (CA) excess and carbonic acid deficit. B, Metabolic imbalances caused by base bicarbonate (BB) deficit and base bicarbonate excess. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Acid-Base Imbalances Alterations in Acid-Base Balance, continued Respiratory alkalosis Metabolic acidosis Metabolic alkalosis Mixed acid-base disorders Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Acid-Base Imbalances Clinical Manifestations Blood gas values Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Acid-Base Imbalances Table 17-15. Normal Arterial Blood Gas Values * Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Acid-Base Imbalances Table 17-16. Arterial Blood Gas (ABG) Analysis. Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Assessment of Fluid, Electrolyte, and Acid-Base Imbalances Subjective Data Important health information Past health history Medications Surgery or other treatments Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Assessment of Fluid, Electrolyte, and Acid-Base Imbalances Subjective Data, continued Functional health patterns Health perception–health management pattern Nutritional-metabolic pattern Elimination pattern Activity-exercise pattern Cognitive-perceptual pattern Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Assessment of Fluid, Electrolyte, and Acid-Base Imbalances Objective Data Physical examination Laboratory values Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Oral Fluid and Electrolyte Replacement Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Intravenous Fluid and Electrolyte Replacement Solutions Hypotonic Isotonic Hypertonic Intravenous additives Plasma expanders Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.