Baxter PD Nurse Education Participant Guide: PD Basics Course

Module 2: Basic Fluid Transport Principles

Learning Objectives
By the end of this module, you will be able to: Identify the core fluid transport principles necessary for dialysis to occur Describe how a semipermeable membrane makes peritoneal dialysis possible Define the terms ultrafiltration, diffusion, osmosis, osmotic pressure and oncotic pressure Identify improper fluid management

Core Fluid Transport Principle

You will need to know several terms commonly used when referring to the transport nutrients and wastes in the body: Solute any substance that is dissolved in fluid Electrolyte electrically charged molecule, like sodium or potassium Urea waste product which comes from the breakdown of the protein we ingest in our diets Creatinine waste product that is formed when our muscles are used Water contained in the fluid spaces of the body Plasma interstitial or intracellular fluid

Solvent the fluid in which the solute is dissolved

Solution the combination of a solute and a solvent filtration separation of substances through the use of a filter or membrane Ultrafiltration the process of filtration using higher pressure Kidneys use high blood pressure created by the heart and the internal structure of the kidney

Module 2: Basic Fluid Transport Principles 2007 by Baxter International

Baxter PD Nurse Education Participant Guide: PD Basics Course

Movement of Fluid and Solute

Removal of fluid and solute occurs: When fluid and solute are filtered through a semipermeable membrane When the blood is ultrafiltered in the glomerulus, large substances such as blood proteins and blood cells are kept inside the blood vessels, while the filtrate containing water and small solutes passes through the semipermeable vessel wall into the tubules Terminology used in filtration of fluid and solute: Ultrafiltration fluid removal across a semipermeable membrane under pressure Convection removing solute along with the solution's fluid (the solvent), referred to as solvent drag Hydrostatic Pressure pressure of the blood against the walls of the capillaries Glomerular filtration

Movement of fluid and solute: Solution concentration the amount of solute and water molecules in a given solution More water = less solute concentration More solute = less water concentration Random molecular movement: high to low concentration

Semipermeable Membrane
Semipermeable membranes have an important role: Separates fluid spaces Allow solutes and water to pass from the blood to the interstitial fluid to the intracellular fluid and back again depending on two characteristics Size of molecule Size of pores

Module 2: Basic Fluid Transport Principles 2007 by Baxter International

Baxter PD Nurse Education Participant Guide: PD Basics Course

Key Transport Principles

The movement of solutes and water between the cells and the extracellular fluid (ECF) are governed by the same laws of physics that caused the dye and water to move down the concentration gradient until they reached equilibrium.

There exists several key transport principle:

Diffusion - solute moves from a higher to a lower solute concentration Some solutes are not permitted to pass, and remain on their own side of the membrane

Osmosis - movement of water across a semipermeable membrane from an area of lower solute concentration to an area of higher solute concentration Due to the unequal number of solutes per volume of water on each side of the membrane

Osmotic pressure - the pulling pressure exerted by solutes that are able to cross the semipermeable membrane The higher the concentration of solutes, the higher the osmotic pressure exerted, resulting in osmosis

Oncotic pressure - the pulling pressure exerted by solutes that are too large to cross the semipermeable membrane Results in osmosis that may be sustained for a longer period of time

Module 2: Basic Fluid Transport Principles 2007 by Baxter International

Baxter PD Nurse Education Participant Guide: PD Basics Course

Fluid Management
Fluid balance is critical during peritoneal dialysis: If placed in too concentrated an environment, the cell will shrink and die If placed in too dilute an environment, the cell will burst and die Internal balance is key to survival

Module 2: Basic Fluid Transport Principles 2007 by Baxter International

Baxter PD Nurse Education Participant Guide: PD Basics Course

Check Your Learning

Match the correct term to the corresponding diagram.

Fill in the blanks: 1. Size of solute. 2. More water = water concentration. 3. Cell will shrink and die in too 4. Cell will burst and die in too an environment. an environment. and size of control the movement of water and

solute concentration while more solute =

Module 2: Basic Fluid Transport Principles 2007 by Baxter International

Baxter PD Nurse Education Participant Guide: PD Basics Course Crossword: This game provides a review of basic fluid transport principles.

Across 3. The combination of a solute and a solvent. 7. Any substance that is dissolved in fluid. 9. Removing solute along with the solution's fluid (the solvent), referred to as solvent drag." 10. Fluid removal across a semipermeable membrane under pressure. 11. ________ pressure of the blood against the walls of the capillaries. 13. Waste product which comes from the breakdown of the protein we ingest in our diets. 14. Solute moves from a higher to a lower solute concentration. 15. ________ pressure is the pulling pressure exerted by solutes that are too large to cross the semipermeable membrane. Down 1. Separation of substances through the use of a filter or membrane. 2. Electrically charged molecule, like sodium or potassium. 4. Movement of water across a semipermeable membrane from an area of lower solute concentration to an area of higher solute concentration. 5. Solution ________ is the amount of solute and water molecules in a given solution. 6. ________ pressure is the pulling pressure exerted by solutes that are able to cross the semipermeable membrane. 8. Waste product that is formed when our muscles are used. 12. The fluid in which the solute is dissolved.
Module 2: Basic Fluid Transport Principles 2007 by Baxter International

Baxter PD Nurse Education Participant Guide: PD Basics Course

Answer Key
Match the correct term its corresponding diagram.

Fill in the blanks: 1. Size of _molecule_ and size of _pores_ control the movement of water and solute. 2. More water = less solute concentration while more solute = less water concentration. 3. Cell will shrink and die in too concentrated an environment. 4. Cell will burst and die in too _dilute_ an environment.

Module 2: Basic Fluid Transport Principles 2007 by Baxter International

Baxter PD Nurse Education Participant Guide: PD Basics Course Crossword: This game provides a review of basic fluid transport principle.

Across 3. Solution 7. Solute 9. Convection 10. Ultrafiltration 11. Hydrostatic 13. Urea 14. Diffusion 15. Oncotic Down 1. Filtration 2. Electrolyte 4. Osmosis 5. Concentration 6. Osmotic 8. Creatinine 12. Solvent

Module 2: Basic Fluid Transport Principles 2007 by Baxter International