IV fluids & their tonicityNursing 3366 Pathologic Processes: Implications for Nursing Lecture Notes: Alterations in Intracellular Functions and Fluid and SoluteBalanceObjectives /outcomes for this subject:DESCRIBE/DISCUSS/IDENTIFY:1. the concepts of physiologic and pathophysiologic fluid shifts between the body’s fluid compartments as driven by alterations in osmolality, oncotic pressure, tonicity, hydrostatic pressure, and control mechanisms such as RAAS, natriuretic peptide system, & ADH.2. the effect of alterations of key molecular substances such as sodium, potassium, and calcium on electrical properties of cells.3. normal cellular metabolism and its alternate states, including anaerobic metabolism and the processes of glycogenesis, glycogenolysis, and gluconeogenesis.4. the relationship of all the above to certain disease processes and signs and symptoms (S&S), including:- fluid overload and fluid deficit states.- basic states of acidosis and alkalosis.- hyperpolarized and hypopolarized plasma membrane.- alterations of glucose availability.- alterations in usage of certain vitamins.5. the deeper meaning of all the above when compared to chaos theory, Einstein’s theory of relativity, and DaVinci’s drawing of Vitruvian Man (…just kidding….)****************************************************************Outline for Alterations in Fluids, Electrolytes, & Intracellular FunctionsI. Overview A. Alterations in cellular-level functionB. Etiology of these disruptionsII. Hypoxia’s effect on cellular-level functionA. Overview of hypoxiaB. Sequelae of hypoxiaIII. Effect of nutritional alterations on cellular-level function.A. OverviewB. A review of NORMAL glucose use and back-up systemsC. Examples of disease processes related to cellular metabolism “back-up plans”D. Examples of other disorders that can contribute to disruption in metabolic pathwayIV. Alterations in solute status A. A&P overview of select solutes B. A&P overview of normal electrical function of cellsC. A&P overview of body fluid compartmentsD. Cellular electrical problems secondary to alterations in electrolyte balanceE. Acid / base sequelae of solute imbalance, ie, acid / base imbalanceV. Fluid shift pathologiesA. Overview of fluid-related problemsB. Increased blood concentration (water loss)C. Decreased blood concentration (water gain; protein loss).1BE SURE to look over these notes carefully prior to class … there are several important pieces of information that need to be reviewed ahead of time tobe absorbed properly and prepare you to fully understandthe lecture.If you find that you are struggling with this material (some of it is pretty complex), go back & read or reread Prep closely review this info prior to class, as we will not go over it in depth in lectureReview separate document “THE METABOLIC PATHWAY & DISTURBANCES” prior to lecture & bring to class with lecture notes.I. Overview A. Alterations in cellular-level function1. Many normal daily changes in body homeostasis can affect the metabolic pathway (upon which we depend for energy in the form ofATP), and usually the body can adjust & maintain equilibrium—sort of an ongoing “fine-tuning.”2. But there are also problems that more seriously disrupt homeostasisof cellular metabolism and the provision of ATP for body needs; it is more difficult for the body to adjust & return to equilibrium in these cases.3. Many of the disorders & disease processes that we will study in this course either CAUSE or are CAUSED BY some sort of cellular-level disruption that eventually leads to decrease in ATP.B. Etiology of these disruptions include:1. hypoxia —decrease in amount of oxygen to cell or ability to use oxygen appropriately (part II)2. nutritional problems such as decreased glucose & vitamin availability for cell use (part III)3. changes in balance of electrolytes & other solutes, including acid/base imbalance (part IV)4 changes in fluid distribution (V).II. Hypoxia (decrease in oxygen)—effect on cellular-level functionA. Overview of hypoxia: has a spectrum of etiology and seriousness: from simply overworked muscles in extreme exercise (the muscles use up immediate available oxygen), to someone who is having difficulty breathing & therefore cannot get enough oxygen to the heart to circulate it to the tissues, to someone whose artery in the arm is cut, so the tissues distal to the trauma cannot get oxygen, and so on.B. Sequelae of hypoxia (see page 2 of concept map)1. if there is hypoxia: a. cellular metabolism has to “recycle” through glycolysis rather than continue down the usual aerobic pathwayb. this is because glycolysis is the only step that can operate under normal, aerobic conditions, AND can also operate under anaerobic conditions2. positive side to anaerobic glycolysis:a. it can give 2 molecules of ATP per molecule of glucose to give energy to the cell.2FYI: All of above imbalances rarely “stand alone”—usually one abnormality triggers another; ex: a bacteria causes disturbance in permeability of lung cells’ plasma membrane there is pathological influx of water into cells causes swelling in organelles such as mitochondria interrupts electron transport chain functioning no ATPsto fuel energy needs of lung cells breathing is compromised hypoxia (diminished O2 to cells) reliance on glycolysis lactic acidosis further disturbance in function of lung cellsAerobic– O2 ispresent (this is the ideal, “normal” situation). Anaerobic– low or absentb. thus, it is a temporary stop-gap measure that keeps your bodygoing until the cells can get more O2 so that aerobic metabolism can be re- established.3. negative side to anaerobic glycolysis:a. 2 molecule of ATP is not enough to keep going for a long time.b. also, every time the metabolic process must “recycle” throughglycolysis, multiple molecules of pyruvate (pyruvic acid)accumulate, resulting in ________________________.4. summary: two main sequela result from hypoxia: a. deficiency of ATP for cellular functions; ex—without ATP, the Na / K pump of each cell cannot maintain normal electrical cell membrane status and propagation of electrical impulses will be disrupted.b. altered acid/ base balance, especially acidosis; significance:acidosis from something like hypoxia or reliance on gluconeogenesis (more on this in next section) can dangerously tip body pH out of its narrow, desirable range fairly quickly