Flashcards in Acids Bases and electrolytes Deck (23):
A condition of acid base disorder with normal pH
How does the body compensate for A/B imbalance?
Resp disorders are compensated metabolically and metabolic disorders are compensated respiratory.
Anion Gap Equation
Na - (Cl- + HCO3-); normal value <11
What protein needs to be considered in AG acidosis and how?
Albumin, which is decreased in many conditions (hemorrhage, inflammation, nephrotic syndrome, paraproteinemia).
Normal ABG values
pH: 7.35-7.45, Bicarb: 24+/- 2, PaCO2: 35-45, PaO2: 80-100.
Methanol, uremia, DKA, Paraldehyde, Isoniazid/Iron/Ischemia, lactic acidosis, ethelene glycol, starvation/salicylates.
Diarrhea, ureteral diversion, RTA, hyperalimentation, addison's, ammonium, Misc: amphotericin B, toluene
For calculating predicted change in pH for a CO2 level. pCO2= 1.5HCO3- + 8 (+/-2)
=2Na + BUN/2.8 + glucose/18. Significant if difference from measured value is >10.
Hypotension and shock in children
This is a LATE finding
Hypervolemic hypotonic hyponatremia
Edema in the presence of low intravascular volume. Causes: CHF, liver failure, nephrotic syndrome, hypocortisolemia, hypothyroidism.
Euvolemic Hypotnic Hyponatremia
Due to pain, nausea or SIADH.
Hypovolemic Hypotonic hyponatremia
extrarenal: diarrhea, burns, vomiting, sweat. Renal: diuretics, addison's, salt wasting disease. Tx: isotonic saline over 24 hours. Caution: CPM.
Hypotonic Hyponatremia types
Hypovolemic, euvolemic, hypervolemic
Due to high levels of glucose or mannitol, causing free water into vascular compartment, diluting the Na level.
measurement error due to high TAGs or paraproteinemia
Types of hyponatremia
Hypotonic Hyponatremia (3 types), hypertonic hyponatremia, and Pseudo/isotonic hyponatremia
central pontine myelinolysis
Characterized by acute paralysis, dysphagia, dysarthria and other neurological symptoms. Most commonly caused by rapid correction of hyponatremia.
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.
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.
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.
Proximal rental tubular acidosis (loss bicarb). Polyuria, polydipsia, rickets/osteomalacia, acidosis, hypokalemia, hyperchloremia. Growth failure.