Disorders of Fluid, Electrolyte, and Acid-Base Balance

Disorders of Fluid, Electrolyte, and Acid-Base Balance

Homeostatic mechanisms maintain significance in optimizing the body’s functionalities. Disruptions in homeostasis have been associated with several pathologies and consequential depression of the body’s functionality. Disorders of fluid, electrolyte, and acid balances are a representation of the consequences of disrupted homeostasis. This paper details disorders of fluid, electrolyte, and acid-base balance through the lens of a case study.

The case presented is of an 18-year-old female with anorexia nervosa. She was previously admitted to an equating disorder clinic with a BMI of 13.9. She complained that her feet and hands were fat. The nurses revealed to the patient that she had low levels of a particular protein in her body and that eating a healthy diet would make the fat on her feet and hands go away.  The most likely protein being referred to by the nurse in the case is albumin. Albumin is a serum protein that plays important physiologic roles. As a binding protein, it transports substances like hormones and therapeutic agents. It also maintains colloidal osmotic pressure. Albumin provides the bulk of the plasma colloidal osmotic activity accounting for close to 80%. Its negative charge attracts sodium ions, holding them but not binding them through the Gibbs-Donan effect, further increasing its intrinsic osmosis (Chen et al., 2021). This makes it an important modulating component of fluid homeostasis.

Disruptions in albumin homeostasis equally have an effect on intravascular oncotic pressure. Deficiency of decrease in serum albumin due to whichever cause results in lowered oncotic pressure with consequent fluid leakage from the intravascular component into the interstitial space. This often manifests as edema, most notable in the palms and toes. Decreases in serum oncotic pressures, seen in hypoalbuminemia, have also been associated with parallel decreases in the interstitial osmotic pressures, thereby disrupting the oncotic gradient and maintaining the interstitial-intravascular fluid balance (Chen et al., 2021). The consequence build-up of fluids in the interstitial space manifests as edema.

Edema is often more prominent in the extremities but may present anywhere in the body. Pitting and non-pitting edema differ in their response to pressure. Pitting edema responds to pressure with an indentation left on the edematous part of the body upon application of pressure. This type of edema has a multifactorial cause but is often a local problem involving venous vasculature. It is usually indicative of an apparent fluid overload in the body that may be attributable to liver disease, lung disease, pregnancy, medication use, hypoproteinemia, as in hypoalbuminemia, and heart failure (Besharat et al., 2021). A sedentary lifestyle, high salt intake, and immobility have been implicated as risk factors for this condition.

Non-pitting edema, on the other hand, is unresponsive to pressure, with no indentation observed upon applying pressure to the edematous area. This type of edema often results from three main etiologies: lipedema, myxedema, and lymphedema (Besharat et al., 2021). Lipedema occurs when fat cells grow fast and retain fluid. It is common in women and is often painful. Myxedema is a non-pitting swelling often noted in various body parts and is often linked to severe and advanced hypothyroidism. Lymphedema occurs due to blockage of lymphatic flow. The consequent swelling occurs due to the accumulation of lymphatic fluid.

Amanda’s weakened state and consequent immobility may worsen her edema and predispose her to pressure ulcers. Prolonged immobility, for whatever reason, may result in the development of edema on the skin (Okino et al., 2022). This may be due to gravity-dependent blood pooling and the release of antidiuretic hormones. Gravity-dependent pooling of fluids is often seen in the extremities. The antidiuretic hormone released as a consequence of immobility causes water retention, thereby precipitating edema. Prolonged immobility in the patient’s case above may worsen her edema due to fluid retention and fluid pooling in the extremities.

Prolonged mobility may also predispose the patients above to pressure ulcers. Pressure ulcers are injuries to the soft tissues or skin that occur due to prolonged exertion of pressure on an area of the body. Edema remains a modulating factor for pressure ulcers (Okino et al., 2022). It increases the propensity of the skin area to break down as it compromises the integrity of the skin. Compromises in skin integrity occur when the skin is damaged, lacks effective recovery means, and is exposed to injurious agents. In edema, micro-circulation to the skin is disrupted, resulting in decreased nutritious nourishment. In the presence of prolonged immobility, pressure is continuously applied to the edematous skin areas and further increases their likelihood of breaking down. The patient in the case presented may develop pressure ulcers due to a combination of being immobile and having edema in some parts of her body.

Hypoalbuminemia, evidenced in the patient case presented, remains a modulating factor for fluid dysregulation. The consequent edema the patient manifests results from fluid leakage into the interstitial tissues. Hypoalbuminemia has a multifactorial cause. Malnutrition has been implicated as a common cause of low serum albumin. Anorexia nervosa, a causal factor for malnutrition, has been shown to be skewed towards the female gender. Martínez-González et al. (2020) report that anorexia is a leading cause of malnutrition among girls and women, with teen girls being at exceptionally high risk of this condition. The subsequent malnutrition may result in homeostatic disruptions, with fluid dysregulation being the result, as seen in the patient case above.

Hypoalbuminemia has also been shown to have some genetic predilection. Congenital hypoalbuminemia is a rare autosomal recessive disorder caused by several mutations within the albumin gene. This disorder often manifests with low circulating serum albumin in the absence of any other causal factors. While congenital albuminemia is sometimes thought to be a benign condition among adult populations due to partial compensation of albumin with other serum proteins, mild manifestations of hypoalbuminemia are sometimes seen among some adults with the disease (Minchiotti et al., 2019). These manifestations include but are not limited to mild edema, fatigue, and hypotension.

Ethnic and racial variations in disease predisposition have remained a factor in modern healthcare. Whereas ethnic predilection to hypoalbuminemia does not exist, several features within the constructs of race and ethnicity may lead to hypoalbuminemia. Nutritional deficiency and consequent malnutrition disproportionately affect ethnic minority groups. These communities suffer from poverty with restricted resources to obtain healthy food options. Kwashiorkor, a form of protein malnutrition in infants and children, is more common in impoverished communities. This highlights the ethnic differences in hypoalbuminemia and, consequentially, fluid dysregulation disorders.

Factors that predispose to hypoalbuminemia can often result in homeostatic disruptions. Temporal variables to homeostasis may result in alterations in physiologic functionalities. As seen in hypoalbuminemia, alterations in albumin production or excretion cause considerable changes in the albumin levels and may have downward spiral effects at the tissue levels. This is similar to all homeostatic balance drivers, such as electrolytes and acid-base balance.

The case presented details of the effects of homeostasis disruptions on physiologic functionalities. Low albumin levels can result in fluid leakage and edema. Pitting and non-pitting edema and physiologic presentations with variable etiologies. Regardless of the type, edema is a modulating factor for skin integrity compromises. In the presence of immobility, as seen in the patient’s case above, pressure ulcers may occur.

 References

Besharat, S., Grol-Prokopczyk, H., Gao, S., Feng, C., Akwaa, F., & Gewandter, J. S. (2021). Peripheral edema: A common and persistent health problem for older Americans. PLOS ONE, 16(12). https://doi.org/10.1371/journal.pone.0260742

Chen, C. B., Hammo, B., Barry, J., & Radhakrishnan, K. (2021). Overview of albumin physiology and its role in pediatric diseases. Current Gastroenterology Reports, 23(8). https://doi.org/10.1007/s11894-021-00813-6

Martínez-González, L., Fernández-Villa, T., Molina, A. J., Delgado-Rodríguez, M., & Martín, V. (2020). Incidence of anorexia nervosa in women: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 17(11), 3824. https://doi.org/10.3390/ijerph17113824

Minchiotti, L., Caridi, G., Campagnoli, M., Lugani, F., Galliano, M., & Kragh-Hansen, U. (2019). Diagnosis, phenotype, and molecular genetics of Congenital Analbuminemia. Frontiers in Genetics, 10. https://doi.org/10.3389/fgene.2019.00336

Okino, K., Aoki, M., Yamane, M., Kataoka, Y., Nitta, A., & Kohmura, C. (2022). Prolonged sitting causes leg discomfort in middle-aged adults: Evaluation of shear wave velocity, calf circumference, and discomfort questionaries. Journal of Clinical Medicine, 11(14), 4024. https://doi.org/10.3390/

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Case Study 1: Disorders of Fluid, Electrolyte, and Acid-Base Balance

Amanda is an 18-year-old with anorexia nervosa. She was recently admitted to an eating disorders clinic with a BMI of 13.9, and although she was a voluntary patient, she was reluctant about the treatment. She was convinced that she was overweight because her clothes felt tight on her. She complained that even her hands and feet “were fat.” One of her nurses explained that the protein in her blood was low. The nurse further explained that as difficult as it may be to believe, eating a normal healthy diet would make the “fat hands and feet” go away.

What protein do you suspect the nurse was referring to? How would a deficiency in this protein contribute to edema?

What is the difference between the physiology of pitting and nonpitting edema?

Because of her weakened condition, Amanda was moved around the ward in a wheelchair when she was not on bed rest. How does this affect her edematous tissues?

In your discussion, be sure to evaluate the presence and effects of alterations in the homeostatic state secondary to gender, genetic, ethnic, and temporal variables.

Case Study Assignment Requirements

Make sure all of the topics in the case study have been addressed.

Cite at least three references in your case study paper; this may include peer-reviewed journal articles, textbooks, or evidence-based practice websites to support the content.

All reference sources must be within 5 years.

Do not use sources such as Wikipedia or UpToDate as a reference.

Assignments must have at least four full pages of analytic content, double-spaced (the cover and reference pages do not count in the page count, but must be included with the assignment), and follow APA 7th edition format.