Distribution of Body Fluids

Distribution of Body Fluids
 Body fluids are:

 Intracellular (within the cell)
 Extracellular (outside the cell)
• Intravascular
• Interstitial
• Transcellular
Extracellular Fluid
 Makes up approximately 1/3 of the total body
water
 Transports nutrients, oxygen, and waste
products to and from cells
 Is regulated by renal, metabolic, and
neurologic factors
 Is high in sodium content
Intravascular Fluid
 The fluid within the blood vessels
 Consists of plasma and fluid within the blood
cells
 Contains large amounts of protein and
electrolytes, which help maintain
intravascular volume
Transcellular Fluids
 Aqueous humor (in the eyes)
 Saliva
 Cerebrospinal fluid
 Pleural, peritoneal, synovial, and pericardial
fluids
 Gastrointestinal secretions
 Fluid in the urinary tract
 Lymphatic system fluids
Movement of Fluids and
Electrolytes
 Water taken in by ingesting fluids and food and
through metabolism
 Thirst mechanism in the hypothalamus
regulates thirst based on concentration of
electrolytes and solutes in circulation
 Kidney the main organ of water secretion, with
some loss in feces, perspiration, and breathing.
Water retention based on aldosterone levels,
antidiuretic hormone (ADH) levels, and atrial
natriuretic peptide levels.
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved. Slide 5
Fluid, Electrolyte, and Nutrient
Transport Mechanisms
 Diffusion—passive transport
 Process by which substances move back and
forth across the membrane until evenly distributed
throughout the available space
 Substances move from high to low concentration
until concentration on both sides of the membrane
is equal
 Glucose, oxygen, carbon dioxide, water, and other
small ions and molecules move by diffusion
Figure 25-2A: Diffusion
 Osmosis—passive transport
 Movement of pure solvent (liquid) across a
membrane
 Water moves from area of less solute
concentration to area of greater concentration until
the solutions in the compartments are of equal
concentration
 Takes place via a semipermeable membrane
Figure 25-2B: Osmosis
 Filtration—passive transport
 Movement of water and suspended
substances outward through a
semipermeable membrane
 Hydrostatic pressure
 Causes fluid to press outward on the vessel
 The force promotes filtration, forcing movement of
water and electrolytes through the capillary wall to
the interstitial fluid
Figure 25-2D: Filtration
 Active transport
 Requires cellular energy
 Can move molecules into cells regardless of their
electrical charge or the concentrations already in
the cell
 The energy source for the process is adenosine
triphosphate (ATP)
 Can move amino acids, glucose, iron, hydrogen,
sodium, potassium, and calcium through the cell
membrane
Figure 25-2C: Active transport
Fluid Volume Deficit
 At risk:
 Patients unable to take in enough fluid
• Impaired swallowing, extreme weakness, disorientation
or coma, or unavailability of water
 Patients who lose excessive amounts of fluid
• Prolonged vomiting, diarrhea, hemorrhage, diaphoresis
(sweating), or excessive wound drainage
 Result is dehydration
Dehydration
 Dehydration
 When too little water in the plasma, water drawn
out of the cells by osmosis to equalize
concentration, and the cells shrivel
 Treated by fluid administration, either orally or
intravenously
Signs and Symptoms of
Dehydration
 Thirst  Dry mucous
 Weakness membranes
 Dizziness  Thick saliva
 Postural hypotension  Dry, scaly skin
 Decreased urine  Poor tissue turgor
production  Flat neck veins
 Concentrated urine  Increased pulse rate
 Dry, cracked lips  Weak, thready pulse
 Elevated temperature
Figure 25-3: Testing for tissue turgor
and signs of dehydration
Fluid Volume Excess
 Healthy people do not ordinarily drink too
much water
 When people become ill they may take in
more water than they excrete
 Receive intravenous fluid too quickly
 Given tap-water enemas
 Drink more fluids than they can eliminate
Fluid Volume Excess (cont’d)
 Signs of overhydration
 Weight gain
 Crackles in the lungs (wet lungs)
 Slow bounding pulse
 Elevated blood pressure
 Possibly edema
Figure 25-4: Example of pitting edema
Electrolyte Imbalance: Sodium
 Hyponatremia
 Sodium deficit; can be from decreased sodium or
increased water intake and retention
 May be caused by excessive vomiting or diarrhea
 Hypernatremia
 Sodium excess; most commonly from water
loss from fever or respiratory infection
Electrolyte Imbalance: Potassium
 Hypokalemia
 Occurs with excess potassium or loss of body
water; may be from poor diet, vomiting, diarrhea,
excessive sweating, or diuretic therapy
 Hyperkalemia
 Occurs with burns, crush injuries, uncontrolled
diabetes mellitus, and renal failure
Electrolyte Imbalance: Calcium
 Hypocalcemia
 Occurs with nutritional deficiency of calcium or
vitamin D or in bone disorders such as metastatic
cancer of the bone
 Hypercalcemia
 Most cases related to hyperparathyroidism or
malignancy such as multiple myeloma
Electrolyte Imbalance: Calcium (cont’d)
 Calcium imbalances
 Hypocalcemia
• Calcium level drops below 8.4 mg/dL
• Can occur from nutritional deficiency of calcium or
vitamin D
• Occurs in disorders in which there is a shift of calcium
into the bone
 Hypercalcemia
• Calcium level above 10.6 mg/dL
• Most cases are related to hyperparathyroidism or
malignancy in which there is metastasis with bone
resorption
Electrolyte Imbalance: Magnesium
 Hypomagnesemia
 Results from malabsorption, malnutrition, renal
tubular dysfunction, thiazide diuretic use,
extensive gastric suction, or diarrhea
 Hypermagnesemia
 Occurs only in presence of renal failure
Electrolyte Imbalances
 Anion imbalances
 Hypochloremia
• Chloride level below 96 mEq/L is associated with
hyponatremia
 Hyperchloremia
• Chloride level above 106 mEq/L
• Occurs along with hypernatremia and a form of metabolic
acidosis
Electrolyte Imbalances (cont’d)
 Anion imbalances
 Hypophosphatemia
• Occurs when the level of phosphate falls below 3.0
mg/dL
• May result from use of aluminum-containing antacids,
from vitamin D deficiency, or from hyperparathyroidism
 Hyperphosphatemia
• A phosphate level above 4.5 mg/dL
• Commonly occurs in renal failure
Question 1
Kimberly’s patient is on strict intake and output
measurements. Her patient’s total output is
2200 mL. What should the total be for an
average adult?
1) 1200 mL
2) 2000 mL
3) 2400 mL
4) 3800 mL
Question 2
The predominant electrolyte in extracellular fluid
is _________________ and the predominant
electrolyte in intracellular fluid is
______________________.
1) potassium, sodium
2) calcium, magnesium
3) sodium, potassium
4) magnesium, calcium
Question 3
Amanda’s patient is going home from the hospital. Her
patient has a history of congestive heart failure. She
includes in her discharge teaching for the patient to weigh
herself:
1) at the same time in the evening, on the same scale,

wearing the same clothes.
2) in the morning with the same scale and same clothes.
3) weekly in the morning with the same scale and same
clothes.
4) weekly in the evening with the same scale and same
clothes just before going to bed.
Question 4
After Amanda’s patient goes home, she notices her
rings are tighter around her fingers. She has gained 5 lb
in 2 days. She is experiencing fluid overload. In fluid
overload, a patient’s vital signs change. Which of the
following might be anticipated regarding the blood
pressure?
1) A rise in the systolic blood pressure

2) A rise in the diastolic blood pressure
3) A fall in the systolic blood pressure
4) A fall in the diastolic blood pressure
Chapter 25
Lesson 25.2
Copyright © 2014, 2009 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Learning Objectives
Theory
5) State the main signs and symptoms of acid-
base imbalances
Clinical Practice
5) Identify patients who might be at risk for an
acid-base imbalance.
Acid-Base Balance
 Important in maintaining homeostasis
 pH: measure of the degree of acidity or alkalinity
 Normal serum pH is 7.35 to 7.45
 Death may occur if pH is less than 6.8 or greater
than 7.8
 Balance between bicarbonate and carbonic acid
 Carbonic acid retained or removed by respiratory
system
 Bicarbonate retained or removed by kidneys
Acid-Base Balance (cont’d)
 Bicarbonate
 Normal range is 22 to 26 mEq/L
 Acts as buffer to neutralize excess acids in the
body and maintain bicarbonate-to-carbonic acid
ratio at 20:1
 Kidneys selectively reabsorb or excrete
bicarbonate to regulate serum levels and help
maintain acid-base balance
Acid-Base Balance (cont’d)
 Control mechanisms
 Blood buffer system
• Consists of weak acids and weak bases
 Lungs
• Carbon dioxide and water are expired from the lungs
 Urinary system
• Enzymes promote the dissociation of carbonic acid to
free hydrogen ions
Acid-Base Balance:
Respiratory Acidosis
 Increased carbon dioxide levels from:
 Airway obstruction
 Pneumonia, asthma
 Chest injuries
 Opiate intake
 Chronic obstructive lung disease
Acid-Base Balance:
Metabolic Acidosis
 An excessive loss of bicarbonate ions or
retention of hydrogen ions caused by:
 Kidney disease
 Diabetic ketoacidosis
 Circulatory failure
 Shock states
Acid-Base Balance:
Respiratory Alkalosis
 Usually caused by:
 Anxiety
 High fever
 Hyperventilation
 Salicylate poisoning (ASA overdose)
 Encephalitis
Acid-Base Balance:
Metabolic Alkalosis
 Caused by:
 Vomiting
 Gastric suctioning
 Excessive antacid consumption
 Diuretic therapy
 Potassium deficit
Question 5
Terry’s patient is critical. She has poor
circulation, uncontrolled diabetes, a history of
renal failure, and diarrhea. She is at high risk for
which acid-base imbalance?
1) Respiratory acidosis
2) Metabolic acidosis
3) Respiratory alkalosis
4) Metabolic alkalosis

Distribution of Body Fluids

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Distribution of Body Fluids

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Distribution of Body Fluids

 Body fluids are:

1) at the same time in the evening, on the same scale,

1) A rise in the systolic blood pressure

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