Complications: Malignant Hyperthermia

What to Check?

 Family History: If your family has a history of this condition (autosomal dominant), be vigilant.

What Happens?

 Hypermetabolism of Skeletal Muscle: Your muscles start using energy faster than normal.
 Skeletal Muscle Issues: Your muscles become stiff and too hot (late sign).

How It Shows Up?

 Tachycardia: Your heart beats too fast.

 Tachypnea: You breathe rapidly.
 Hypercarbia: There's too much carbon dioxide in your blood.
 Ventricular Dysrhythmias: Your heart rhythm gets messed up.
 Hyperthermia: Your body temperature shoots up.
 Muscle Contracture: Your muscles contract and don't relax properly.
 Hypoxemia: Not enough oxygen in your blood.
 Lactic Acidosis: Build-up of acid in your blood.
 Hemodynamic Changes: Your blood pressure and circulation may get unstable.

How to Treat It?

 Dantrolene (Dantrium): This medicine slows down your metabolism to help.

 Symptomatic Support: We also treat the symptoms you're experiencing.

Remember, if you have a family history of this condition, be extra cautious and consult a healthcare
professional.

Osmosis - What Happens?

 Water Movement: Water naturally moves from where there's less stuff (solute) to where there's
more stuff.
 Through a Filter: This happens through a special filter (semipermeable membrane).
 No Effort Needed: It's like water sliding through without needing any energy (passive process).

Osmotic Pressure - What Is It?

 Pressure to Stop Water: Imagine you need to push back to stop the water from moving.
 Depends on Stuff Amount: How hard you have to push depends on how much stuff (solute) is in
the water.
So, osmosis is about water moving through a filter because it wants to balance the amount of stuff on
both sides. Osmotic pressure is like the pushback needed to stop this water movement, and it depends
on how much stuff is in the water.

Plasma Osmolality - Normal Range 275-295 mOsm/kg

 If it's below 275, you have too much water in your blood.
 If it's above 295, you have too little water in your blood.
 It's affected by sodium and glucose levels in your blood.

Urine Osmolality - Normal Range 100-1300 mOsm/kg

 If it's below 100, your body is trying to get rid of extra water.
 If it's above 1300, your body is trying to hold on to more water.
 It's influenced by how much you drink and a hormone called ADH.

So, think of plasma osmolality as a measure of how much water is in your blood, and urine osmolality as
a way your body controls that water level. High or low values can indicate water imbalances.

ECF and ICF isotonic Constant movement, with no net gain. explen
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ECF (Extracellular Fluid) and ICF (Intracellular Fluid) Isotonic - Constant Movement with No Net Gain

Imagine you have two buckets: one is your ECF, and the other is your ICF. Both buckets have the same
amount of water, and they have the same concentration of stuff dissolved in the water, making them
"isotonic."

Now, picture a tiny door between these buckets. Water molecules can pass through this door in both
directions. What happens?

 Water moves back and forth through the door all the time. It's like a busy street with traffic
going in both directions.
 But even though there's a lot of movement, when you look at the buckets as a whole, they
always have the same amount of water and the same concentration of stuff. There's no net gain
or loss.

This constant movement of water molecules without an overall change in the water level or
concentration is what we mean by ECF and ICF being "isotonic." It's like a balanced seesaw – it might tilt
one way and then the other, but it always stays level in the end.

Hydrostatic PUSH Pressure:

  Think of it like a gentle "push" from water inside your blood vessels.
 This push is similar to your blood pressure (BP), which keeps blood moving.
 As you go deeper into your body, this push gradually becomes weaker.
 At the start of tiny blood vessels (arteries), it's strong and helps "push" water out.

Oncotic (Colloidal Osmotic) PULL Pressure:

 Imagine proteins in your blood acting like magnets for water.

 These proteins "pull" water towards them, kind of like how magnets attract metal.
 So, wherever there are more of these proteins, they "pull" fluid in that direction.

In simple terms, hydrostatic pressure is like a gentle water push from inside your blood vessels, and
oncotic pressure is like proteins inside your blood pulling water toward them. Together, they help
balance the movement of fluids in your body.

Reasons why the Fluid Shifts: EdemaFrom plasma to Interstitium Venous hydrostatic pressure rises
Heart failure, liver failure, venous insufficiency Plasma oncotic pressure decreases Lack of plasma
proteins Excessive loss, inadequate intake/synthesis Interstitial oncotic pressure rises Trauma, burns,
inflammation. Make it easy to understand.
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Reasons for Fluid Shift Leading to Edema (from Plasma to Interstitium)

Imagine your body as a house with rooms separated by doors, and there's water trying to move from
one room to another.

1. Venous Hydrostatic Pressure Rises:

 This is like a situation where the water pressure in one room (the veins) increases.
 It can happen if the heart isn't pumping well (heart failure), the liver isn't working properly (liver
failure), or the veins in your legs have trouble sending blood back to the heart (venous
insufficiency).
 When the pressure is high in the veins, water can "leak" out into the next room (the
interstitium).

2. Plasma Oncotic Pressure Decreases:

 Think of this as a situation where there are fewer magnets (plasma proteins) in one room (the
blood).
 It can occur when you don't have enough plasma proteins, maybe because you're losing them
excessively (like in kidney disease) or not getting enough through your diet.
  With fewer "magnets" in the blood, water isn't as attracted to stay there, so it moves into the
interstitium.

3. Interstitial Oncotic Pressure Rises:

 Here, imagine the interstitium (the space between your cells) becomes more attractive to
water, like it suddenly has more magnets.
 This can happen due to trauma, burns, or inflammation in that area, making the interstitium
more appealing to water.

In all these cases, it's like doors between rooms in your body, and changes in pressure or attraction
cause water to flow where it shouldn't, leading to edema, which is the buildup of excess fluid in tissues.

Interventions to get the Fluid to Shift From Interstitium to Plasma Increase the plasma osmotic/oncotic
pressure IV Colloids or Hypertonic solutions Increase tissue hydrostatic pressure TED hose Make it easy
to understand.
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Interventions to Move Fluid from Interstitium to Plasma:

Imagine you have a water leak from one room (interstitium) to another (plasma), and you want to fix it.

1. Increase Plasma Osmotic/Oncotic Pressure:

 Think of this as making the water in the plasma more attractive, so it goes back into the plasma
room.
 You can do this by giving special IV solutions called colloids or hypertonic solutions. They act like
magnets for water, pulling it back into the blood.

2. Increase Tissue Hydrostatic Pressure:

 Imagine using something like a tight rubber band (TED hose) around the room with the leak (the
interstitium).
 By squeezing this room a bit, you increase the pressure inside it.
 Higher pressure in the interstitium helps push the water back into the plasma room.

So, to stop the leak and move the water from the interstitium back into the plasma, you can use IV
solutions that attract water or put pressure on the interstitium using things like TED hose.

Distribution of Body Water First Spacing – normal distribution Normal distribution of fluid in ICF and ECF
compartments Second Spacing – abnormal accumulation of interstitial fluid Edema Third Spacing –
trapped fluid Ascites, edema with burns make it easy to understand
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Distribution of Body Water

Imagine your body as a container with different rooms for water. How the water is distributed can tell
us about your health.

First Spacing - Normal Distribution:

 This is like having water nicely spread in the right places.

 The water is where it should be, in the right rooms (ICF and ECF compartments).

Second Spacing - Abnormal Accumulation of Interstitial Fluid:

 Here, water starts to gather in the wrong places, like the hallways and corridors of your house.
 It's not where it's supposed to be (interstitial space), and this can cause swelling called
"edema." Imagine water leaking from rooms into the hallways.

Third Spacing - Trapped Fluid:

 This is when water gets stuck in strange places, like secret rooms you didn't know you had.
 Think of it as water hiding in these secret rooms, like "ascites" (fluid in your belly) or edema that
forms pockets in your body when you have burns.

So, when we talk about these spacings, we're really looking at how water is behaving in your body. First
spacing is normal, like it's supposed to be. Second spacing is when water starts to collect in odd places,
causing swelling. And third spacing is when water gets trapped in unexpected spots, causing hidden
problems.

Hypothalamic Regulation Trigger (Osmoreceptors): Fluid deficit or increased plasma osmolality Action:
Increased thirst Antidiuretic hormone (ADH) release Outcome: Increased free water Decreased plasma
osmolality make it easy to understand
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Hypothalamic Regulation - How Your Body Manages Water:

Imagine your body has a smart control center in the brain called the hypothalamus, which helps
manage your water levels.

Trigger (Osmoreceptors - Like Water Sensors):

 These are like tiny sensors in your body.

  They notice when you don't have enough water or when your blood becomes too concentrated
(like adding too much salt to soup).

Action (What Your Body Does):

 When these sensors sense a problem (like low water or high concentration), your body takes
action.
 It makes you feel thirsty, so you want to drink more water.
 It also releases a hormone called antidiuretic hormone (ADH).

Outcome (What Happens):

 When you drink more water (because you're thirsty), you get more free water in your body.
 ADH helps your kidneys hold onto water, so you don't pee it out as much.
 These actions result in more water in your body and lower the concentration of stuff in your
blood (plasma osmolality goes down).

So, think of your hypothalamus like a smart control center that detects when you need more water and
makes you thirsty and holds onto water in your body to keep things balanced.

Renal Regulation Primary organ for fluid and electrolyte balance Kidneys filter plasma volume to
maintain: Normal plasma osmolality Electrolyte balance Blood volume Acid-base balance Activation of
the RAAS Renin-angiotensin aldosterone system Make it easy to understand.
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Renal Regulation - How Your Kidneys Manage Your Body's Fluid and Electrolytes:

Imagine your kidneys as the body's "cleaning and balancing" system.

Primary Organ for Balance:

 Your kidneys are like the main control center for keeping the right amount of water and salts in
your body.

Kidneys' Job:

 They act like a filter, making sure your blood has the right amount of water and the correct
balance of salts.
 They do this to maintain normal blood concentration (plasma osmolality), keep your salts in
check, control how much blood you have, and balance the acidity in your body (acid-base
balance).
RAAS (Renin-Angiotensin Aldosterone System) - The Kidneys' Helper:

 Think of this as the emergency team that the kidneys call when there's a problem.
 When the kidneys sense something's off, like low blood pressure or low blood volume, they
activate the RAAS.
 The RAAS system helps raise blood pressure and keep your body's fluid and salt levels in
balance.

So, your kidneys are like the body's filters, making sure everything is just right in your blood. And when
they need backup, they call in the RAAS team to help out. Together, they keep you healthy and
balanced.

Cardiac Regulation Natriuretic peptides Antagonist to renin-angiotensin-aldosterone system (RAAS)

Trigger Increased volume and high sodium levels Outcome Decreased volume and BP By sodium and
water excretion. make it easy to understand?
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Cardiac Regulation - How Your Heart Helps Control Blood Pressure:

Think of your heart as a smart regulator for your blood pressure.

Natriuretic Peptides - The Heart's Helpers:

 These are like little messengers sent out by your heart when it senses a problem.
 They act as the opposite of the RAAS (Renin-Angiotensin-Aldosterone System), which tries to
raise blood pressure.

Trigger (When Natriuretic Peptides Kick In):

 Your heart releases these peptides when it notices there's too much blood volume and too
much salt (sodium) in your blood.

Outcome (What Natriuretic Peptides Do):

 These peptides help your body get rid of extra salt and water.
 By doing this, they lower the blood volume and reduce blood pressure.
 Essentially, they tell your kidneys to let go of some salt and water, which helps your body relax
and lower the pressure in your blood vessels.

So, think of natriuretic peptides as your heart's messengers. When there's too much salt and water,
they tell your kidneys to let go of some, which helps bring your blood pressure down to a healthier
level.
explain it again
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Cardiac Regulation - How Your Heart Helps Control Blood Pressure:

Imagine your heart as a clever manager keeping an eye on your blood pressure.

Natriuretic Peptides - The Heart's Helpers:

 These are like little messengers your heart sends out when it senses trouble.
 They work against the RAAS system, which usually tries to raise blood pressure.

Trigger (When Natriuretic Peptides Get Busy):

 Your heart releases these peptides when it notices there's too much blood in your blood vessels
and too much salt (sodium) in your bloodstream.

Outcome (What Natriuretic Peptides Do):

 These messenger peptides tell your kidneys to let go of some salt and water.
 By doing this, they reduce the amount of fluid in your blood vessels.
 This, in turn, lowers your blood pressure.
 Essentially, they help your body get rid of extra salt and water, which relaxes your blood vessels
and brings your blood pressure down to a healthier level.

So, picture natriuretic peptides as your heart's messengers. When they sense too much salt and water,
they send a message to your kidneys: "Let go of some fluid!" This helps lower your blood pressure and
keeps your body in balance.

Gastrointestinal Regulation Oral intake makes up majority of water intake Digestive fluids secreted and
reabsorbed (8000 mL/day) Small amount of fecal fluid excreted Diarrhea and vomiting limit
reabsorption causing fluid/electrolyte loss make it easy to understand
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Gastrointestinal Regulation - How Your Digestive System Manages Fluids:

Think of your digestive system as a water manager for your body.

Oral Intake - Where Most Water Comes From:

 Most of the water you need comes from what you drink and eat.
 When you sip a drink or eat watery foods, you're taking in water.

Digestive Fluids - The Body's Plumbing:

  Your body also has special fluids for digesting food.
 These fluids help break down what you eat, and most of them get reabsorbed into your body
(about 8000 mL or 8 liters a day).

Fecal Fluid - What You Don't Need:

 After your body takes what it needs from the digestive fluids, there's just a small amount left.
 This leftover fluid, along with other waste, becomes poop.

Diarrhea and Vomiting - When Things Go Wrong:

 Sometimes, your digestive system gets upset, and you might have diarrhea or vomiting.
 When this happens, your body can't absorb fluids and electrolytes properly.
 Instead, you lose them, which can lead to dehydration.

So, your digestive system is like a water manager. It takes in water when you eat and drink, uses some
for digestion, and gets rid of the rest as waste. But when you have diarrhea or vomit, it messes up this
process, and you lose important fluids and electrolytes, which isn't good for your body.

Insensible Water Loss Vaporization from lungs and skin, regulates body temp Loss of water only Loss
increased by increased temperature and exercise. make it easy to understand
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Insensible Water Loss - Mysterious Water Evaporation:

Imagine your body like a natural air conditioner that cools you down without you even knowing it.

How It Works:

 Your body constantly loses a little bit of water through two secret channels: your lungs and your
skin.
 This water loss is so tiny that you don't even feel it, hence the name "insensible" because it's
not noticeable.

Why It Happens:

 One of the main jobs of this water loss is to help regulate your body temperature.
 When you get hot, like when it's warm outside or when you're exercising, your body releases a
bit more water through your skin and breath.
 As this water evaporates, it cools you down, just like a breeze on a hot day.
So, think of insensible water loss as your body's silent way of staying cool. It's like a hidden cooling
system that releases a bit of water through your skin and breath, helping you stay comfortable even
when you're working hard or when it's hot outside.

Fluid Volume Deficit Causes: Abnormal fluid loss, inadequate fluid intake, or plasma to interstitial fluid
shifts Clinical Manifestations: Lethargy, dry mucous membranes, decreased turgor, decreased urine
output, tachycardia, hypotension Treatments: Correct underlying cause and replace fluid and
electrolytes IV Lactated Ringers, Normal Saline, Blood
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Fluid Volume Deficit - When You Don't Have Enough Fluid:

Imagine your body is like a water tank, and sometimes, that tank doesn't have enough water in it.

Causes (Why It Happens):

 It can occur when you lose too much fluid in an abnormal way (like through excessive sweating
or diarrhea).
 Or, it might happen when you're not drinking enough water to keep your tank filled.
 Sometimes, fluid can shift from your blood into other body spaces, leaving your tank low.

Clinical Manifestations (How It Makes You Feel):

 When your tank is running low on water, you might feel tired and sluggish (lethargic).
 Your mouth might feel dry, and your skin might lose its elasticity (decreased turgor).
 You could urinate less, your heart might beat faster (tachycardia), and your blood pressure
might drop (hypotension).

Treatments (How to Fix It):

 First, it's important to address what's causing the deficit, whether it's excessive loss or not
enough intake.
 To replenish your water tank, you may need fluids and electrolytes. Doctors can provide these
through an IV with solutions like Lactated Ringers, Normal Saline, or even blood if you've lost a
lot of blood.

In simple terms, fluid volume deficit happens when your body doesn't have enough water. It can make
you feel tired and dry. The treatment involves finding the cause and giving you fluids to fill up your tank
again, often through an IV.
Fluid Volume Excess Causes: Excessive intake, abnormal retention, shift from interstitium to plasma
Clinical Manifestations: Lethargy, peripheral edema, dyspnea, distended neck veins, weight gain,
hypertension Treatments: Identify and correct cause, remove fluid and maintain electrolyte balance
Diuretics, fluid restriction, sodium restriction. make it easy to understand
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Fluid Volume Excess - When You Have Too Much Fluid:

Imagine your body is like a container, and sometimes, that container gets filled up with too much water.

Causes (Why It Happens):

 This can occur when you take in too much fluid, like drinking too many liquids.
 It might also happen when your body holds onto water instead of letting it out as urine.
 Sometimes, fluid from other parts of your body shifts into your blood, overfilling your container.

Clinical Manifestations (How It Makes You Feel):

 When your container is overflowing, you might feel tired and sluggish (lethargic).
 You might notice swelling in your legs or other body parts (peripheral edema).
 Breathing can become difficult (dyspnea), and the veins in your neck might look swollen
(distended neck veins).
 You could gain weight rapidly, and your blood pressure might rise (hypertension).

Treatments (How to Fix It):

 First, it's important to figure out why you have too much fluid in your container.
 To remove the excess fluid and get your balance right, you might need diuretics (medications
that help you pee), limiting your fluid intake, and reducing your salt intake (sodium restriction).

In simple terms, fluid volume excess is when your body's container has too much water. It can make you
feel heavy, swollen, and breathless. Treating it involves finding the cause and using methods like
diuretics, limiting fluids, and reducing salt to get rid of the extra fluid.

Hypokalemia < 3.5 mEq/L

Decreased Intake
Failure to replace losses
Decreased food and fluid intake (starvation, NPO)
Metabolic alkalosis
Increased Insulin
Tissue Repair
Increased loss
GI losses: vomiting and diarrhea
Potassium losing diuretics

Renal losses
Diuretics
Dialysis
Skin losses: diaphoresis