Acids Bases and electrolytes Flashcards Preview

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Flashcards in Acids Bases and electrolytes Deck (23):
1

A condition of acid base disorder with normal pH

Respiratory alkalosis

2

How does the body compensate for A/B imbalance?

Resp disorders are compensated metabolically and metabolic disorders are compensated respiratory.

3

Anion Gap Equation

Na - (Cl- + HCO3-); normal value <11

4

What protein needs to be considered in AG acidosis and how?

Albumin, which is decreased in many conditions (hemorrhage, inflammation, nephrotic syndrome, paraproteinemia).

5

Normal ABG values

pH: 7.35-7.45, Bicarb: 24+/- 2, PaCO2: 35-45, PaO2: 80-100.

6

MUDPILES

Methanol, uremia, DKA, Paraldehyde, Isoniazid/Iron/Ischemia, lactic acidosis, ethelene glycol, starvation/salicylates.

7

DURHAM

Diarrhea, ureteral diversion, RTA, hyperalimentation, addison's, ammonium, Misc: amphotericin B, toluene

8

Winter's formula

For calculating predicted change in pH for a CO2 level. pCO2= 1.5HCO3- + 8 (+/-2)

9

Osmolar Gap

=2Na + BUN/2.8 + glucose/18. Significant if difference from measured value is >10.

10

Hypotension and shock in children

This is a LATE finding

11

Hypervolemic hypotonic hyponatremia

Edema in the presence of low intravascular volume. Causes: CHF, liver failure, nephrotic syndrome, hypocortisolemia, hypothyroidism.

12

Euvolemic Hypotnic Hyponatremia

Due to pain, nausea or SIADH.

13

Hypovolemic Hypotonic hyponatremia

extrarenal: diarrhea, burns, vomiting, sweat. Renal: diuretics, addison's, salt wasting disease. Tx: isotonic saline over 24 hours. Caution: CPM.

14

Hypotonic Hyponatremia types

Hypovolemic, euvolemic, hypervolemic

15

Hypertonic Hyponatremia

Due to high levels of glucose or mannitol, causing free water into vascular compartment, diluting the Na level.

16

Pseudohyponatremia

measurement error due to high TAGs or paraproteinemia

17

Types of hyponatremia

Hypotonic Hyponatremia (3 types), hypertonic hyponatremia, and Pseudo/isotonic hyponatremia

18

central pontine myelinolysis

Characterized by acute paralysis, dysphagia, dysarthria and other neurological symptoms. Most commonly caused by rapid correction of hyponatremia.

19

Volume loss estimates/stages

1) Up to 750ml or 15%. Compensated physiologically!
2) 750-1500ml/15-30%. Tachycardia. Some delay to capp refill.
3) 1500-2000ml/30-40%. Cool, pale, clammy. Decreased urine output, Lower BP (2000ml/40%. Fast weak pulse. Altered LOC. no urine output. Hypotension to below 70 SP.

20

Electrolyte of concern in someone immoblized for a fracture.

Calcium. This can lead to hypercalcemia, with consequent constipation, kidney problems (nephrocalcinosis, nephropathy), hypertension. Monitor urinary Ca/Cr ratio and serum Ca.

21

Black kid in northern climate with no supplements presenting with fracture...

Rickets. Normal Ca but low serum P and high urinary P. ALP can be high.

22

Fanconi Syndrome

Proximal rental tubular acidosis (loss bicarb). Polyuria, polydipsia, rickets/osteomalacia, acidosis, hypokalemia, hyperchloremia. Growth failure.

23

Three types of dehydration (Clipp file)

1) Isotonic/Isonatremia: most common. vomit, diarrhea. (12 hr replace)

2) Hypotonic/Hyponatremic: drinking too much water when dehydrated. Adrenal crisis. sweating. CPM danger - 24 hr replace.

3) Hypertonic/Hypernatremic: highest mortality risk (correct over 24/48hr). Excess salt, DKA, diabetes insipitus, breast feeding failure, boiled milk/formula. (caustion=cerebral edema).