Nur 307 Pathophysiology

I. Fluids
A. Functions
1. Maintain cell shape.
2. Maintain body temperature.
3. Transport nutrients, gases, solutes, and wastes.
B. Balance and Distribution
1. The proper balance of fluid must be maintained for proper functioning.
2. Therefore the amount of fluid gained during the day must equal the amount of fluid lost.
3. The skin, lungs, kidneys and intestines are involved in fluid loss.
4. Fluids are distributed in different compartments in the body. The main compartments are
the intracellular and the extracellular.
5. Fluid inside the cell is intracellular fluid. Extracellular fluid is outside the cell and includes
interstitial and intravascular fluid.
6. Intracellular and extracellular fluid need to be kept in balance.
C. Fluid Types
1. Body fluids contain solutes.
2. The amount or concentration of solutes in the fluid determines the osmolality of the fluid.
3. The greater the amount of solutes in the fluid the greater the osmolality is of the fluid.
4. Fluid with a greater amount of solutes in it and thus greater osmolality is referred to as a
hypertonic solution.
5. Fluids with equal amounts of solute are called isotonic.
6. Fluids with lesser amounts of solute and thus lesser osmolality are referred to as hypotonic.
7. Intravenous fluids differ in tonicity. Some are isotonic while others are hypotonic or
hypertonic.
D. Fluid Movement
1. Solutes are transported throughout the body by fluid.
2. Fluids and solutes move in different ways across the cell membrane and elsewhere in the
body.
3. Passive transport requires no energy. Two types of passive transport are diffusion and
osmosis.
4. Diffusion is the passive transport of solutes from an area of higher concentration to an area
of lower concentration.
5. Osmosis is the passive movement of fluid from the area of less solute concentration to the
area of higher solute concentration. This movement continues until the solute concentration
is equalized.
6. Osmosis occurs when a hypertonic fluid is next to a hypotonic fluid. Fluid will move from
the hypotonic to the hypertonic fluid until the solute concentration is equal.
7. The fluid shifts between hypertonic, hypotonic and isotonic is the basis for treating different
fluid disorders with different intravenous fluids.
8. For instance, in dehydration the cells have lost fluid and have a greater concentration of

solutes within. Administering a hypotonic intravenous fluid will cause fluid to shift from
inside the blood vessel to inside the cell. Administering hypertonic intravenous fluid will
cause fluid to shift from inside the cell across into the blood vessel making the
dehydration even worse.
9. Other solutes have to be actively transported. Active transport requires the use of energy in
the form of ATP to move solutes from an area of lower concentration to an area of higher
concentration. The prime example of active transport is the sodium-potassium pump.
The movement of sodium and potassium in and out of the cell creates an electrical charge
which permits the transmission of neuromuscular impulses.
E. Movement in and out of the Capillaries
1. Fluids, solutes, and gases move from capillaries to cells and interstitial spaces and vice
versa. This process is referred to as capillary filtration.
2. Two types of pressure, hydrostatic and colloidal osmotic pressure, are responsible for the
movement across capillary walls. These pressures need to remain in balance.
3. Hydrostatic pressure is the result of blood pushing against the capillary wall; it forces fluids
and solutes out of the capillary.
4. Colloidal osmotic pressure is the counterbalance to hydrostatic pressure. It is created by the
large protein molecules (albumin) which remain inside the capillary. Fluid and solutes are
pulled back into the capillary by the albumin.
5. Hydrostatic pressure is greater than colloidal osmotic pressure on the arterial side.
The reverse is true with colloidal osmotic pressure exceeding hydrostatic on the venous
side. This is necessary for instance for oxygen to be delivered to cells on the arterial side and
carbon dioxide to be picked up on the venous side.

F. Regulation of Fluid Balance

1. The kidneys are primarily responsible for reabsorbing or excreting fluid and electrolytes as
needed.
2. Antidiuretic hormone (ADH or vasopressin), produced by the hypothalamus , reduces
diuresis and increases water retention.
3. Renin-angiotensin-aldosterone is produced in the adrenal cortex. Angiotensin II is a
powerful vasoconstrictor. Aldosterone causes reabsorption of sodium and thus water.
Angiotensin II and Aldosterone work together to maintain blood pressure.
4. Atrial natiuretic peptide produced in the atria acts as the counterbalance to reninangiotensin-aldosterone by causing vasodilatation and reducing fluid volume.

II. Electrolytes
A. Types
1. Electrolytes are substances that separate into electrically charged particles or ions when
placed in solution.
2. Anions are electrolytes that produce a negative charge; bicarbonate, chloride, and
phosphorous are anions.

3. Cations are electrolytes that produce a positive charge; calcium, magnesium, potassium, and
sodium are cations.
4. Positive and negative ions balance one another out to produce electroneutrality.
B. Sodium
1. Sodium is the most abundant extracellular fluid cation.
2. Sodium is needed to maintain the proper extracellular fluid osmolality which is needed to
preserve fluid volume and fluid distribution. This occurs because sodium attracts fluid; water
follows sodium.
3. Sodium helps transmit impulses in nerves and muscles.
4. Sodium combines with chloride or bicarbonate to regulate acid-base balance.
5. Sodium imbalances lead to fluid imbalances. Neurologic symptoms may be seen
when fluid shift causes cerebral edema.
C. Potassium
1. Potassium is the major intracellular cation.
2. Along with sodium, potassium directly affects neuromuscular transmission.
3. It is also involved in acid-base balance because potassium can come out of the cell so
excess hydrogen can come into the cell.
4. Sodium and potassium have an inverse relationship. The kidneys conserve sodium by
excreting potassium. The body is not able to conserve potassium even when potassium
levels are low.
5. Imbalances of potassium cause problems with nerve and muscle function. Severe
imbalances can cause cardiac symptoms.

D. Magnesium
1. Magnesium affects the nervous and cardiovascular systems because it is involved in sodium
and potassium ion transport.
2. Neurologic symptoms such as altered level of consciousness and abnormal deep tendon
reflexes are seen with magnesium imbalances.
3. Magnesium is needed for the production of parathyroid hormone. Since parathyroid
hormone maintains the calcium level , magnesium influences calcium levels.

E. Calcium and Phosphorous

1. Calcium plays a role in cell membrane permeability and impulse transmission; it affects
the contraction of cardiac, smooth, and skeletal muscle.
2. Calcium also plays a role in the blood-clotting process.
3. Calcium and phosphorous form bones and teeth.
4. Calcium and phosphorous have an inverse relationship. A high calcium level usually means
a low phosphorous level. A low calcium level usually means a high phosphorous level.
5. Imbalances of calium and/or phosphorous can cause neuromuscular and cardiac problems.