Chapter 45: Agents Affecting the Volume and Ion Content of Body Fluids

Question 1

volume contraction

Answer 1

decrease in total body water

Question 2

Volume expansion

Answer 2

• increase in total body water

Question 3

isotonic contraction

Answer 3

• volume concentration in which sodium and water are lost in isotonic proportions
• decrease in total volume; no change in osmolality

Question 4

isotonic contractions effect

Answer 4

• vomiting, diarrhea, kidney disease, and misuse of diuretics

Question 5

isotonic contraction treatments

Answer 5

• fluids that are isotonic to plasma
• 0.9% Normal Saline

Question 6

hypertonic contraction

Answer 6

• loss of water exceeds loss of sodium
• reduced ECF volume; increase in osmolality

Question 7

hypertonic contraction causes

Answer 7

• excessive sweating, osmotic diuresis
• secondary to extensive burns or CNS disorders that interfere with thirst

Question 8

hypertonic contraction treatment

Answer 8

• hypotonic fluids (0.45% sodium chloride or solutions that contain no solutes at all (D5W))
• drinking water

Question 9

hypotonic contraction

Answer 9

• loss of sodium exceeds loss of water
• both volume and osmolality of extracellular fluid are reduced

Question 10

hypotonic contraction causes

Answer 10

• excessive loss of sodium through the kidney (diuretic therapy, chronic renal insufficiency, lack of aldosterone)

Question 11

hypotonic treatment

Answer 11

• mild: infusing isotonic sodium chloride solution
• severe: hypertonic solution (3%) NaCl

Question 12

volume expansion

Answer 12

• increase in total volume of body fluid
• may be isotonic, hypertonic, or hypotonic

Question 13

volume expansion causes

Answer 13

• overdose with therapeutic fluids
• disease states (congestive heart failure, nephrotic syndrome, cirrhosis with ascites)

Question 14

volume expansion treatment

Answer 14

• diuretics
• agents used fro heart failure

Question 15

acid base balance is maintained by which symptoms

Answer 15

• bicarbonate-carbonic acid buffer system
• respitory system
• kidneys

Question 16

acid- base disturbances

Answer 16

• respiratory alkalosis
• respiratory acidosis
• metabolic alkalosis
• metabolic acidosis

Question 17

respiratory alkalosis causes

Answer 17

hyperventilation (decrease in CO2)

Question 18

respiratory alkalosis treatment

Answer 18

• mild: none
• more severe: rebreathe CO2 (laden expired breath)

Question 19

respiratory acidosis causes

Answer 19

• retention of CO2 secondary to hypoventilation

Question 20

respiratory acidosis treatment

Answer 20

• correction of respiratory impairment
• infusion of sodium bicarbonate

Question 21

metabolic alkalosis causes

Answer 21

• excessive loss of gastric acid
• administration of alkalizing salts

Question 22

metabolic alkalosis treatment

Answer 22

• solution of sodium chloride plus potassium chloride

Question 23

metabolic acidosis causes

Answer 23

• chronic renal failure
• loss of bicarbonate during severe diarrhea
• metabolic disorders
• poisoning by methanol and certain medications

Question 24

metabolic acidosis treatment

Answer 24

• correction of the underlying cause
• alkalinizing salt if severe

Question 25

what is the most abundant intracellular cation

Answer 25

potassium (K)

Question 26

potassium has a major roles in

Answer 26

- conducting nerve impulses - maintaining the electrical excitability of muscle - regulating acid base balance

Question 27

potassium is regulated mainly by the

Answer 27

kidneys

Question 28

hypokalemia

Answer 28

serum potassium levels less than 3.5

Question 29

what is the most common cause of hypokalemia

Answer 29

treatment with thiazide or loop diuretic

Question 30

causes of hypokalemia

Answer 30

- treatment with thiazide or loop diuretic - excessive insulin - alkalosis

Question 31

treatment for mild hypokalemia

Answer 31

- oral potassium chloride (KCL)

Question 32

oral potassium chloride side effects

Answer 32

- abdominal discomfort, nausea and vomiting, diarrhea

Question 33

oral pottassium chloride should be taken with

Answer 33

meals or a full glass of water

Question 34

treatment for severe hypokalemia

Answer 34

IV potassium chloride

Question 35

IV potassium chloride must be

Answer 35

DILUTED (40 or less)

Question 36

potassium chloride must never be administered by

Answer 36

IV push

Question 37

hypokalemia treatment must be avoided in patients

Answer 37

who are predisposed to hyperkalemia - severe renal impairment, use of potassium-sparing diuretics, hypoaldosterone

Question 38

what is the principle complication of hypokalemia

Answer 38

hyperkalemia - asses renal function and changes in ECG

Question 39

hyperkalemia causes

Answer 39

- severe tissue trauma, untreated addisons disease - acute acidosis - potassium sparing diuretics or overdose with oral or IV potassium

Question 40

hyperkalemia conseqeunces (earliest signs)

Answer 40

- disruption of the electrical of the heart - mild: T wave heightens; PR prolonged - severe: cardiac arrest

Question 41

hyperkalemia noncardiac signs

Answer 41

- confusion, anxiety, dyspnea, weakness or haviness of legs, numbness/tingeling of hanfs

Question 42

hyperkalemia treatment

Answer 42

- withhold foods that contain potassium (potatoes, bananas, raisins, oranges, mushrooms) - withhold potassium sparing diuretics, potassium supplements - oral or rectal administration of sodiun polystyrene sulfonate [Kayexalate] - calcium salt - infusion of glucose and insulin

Question 43

hypomagnesemia causes

Answer 43

diarrhea, hemodialysis, kidney disease, prolonged IV feeding, chronic alcoholism, hypermagnesia

Question 44

hypomagnesemia treatment

Answer 44

- magnesium oxide - magnesium sulfate

Question 45

mypomagneseia adverse effects

Answer 45

- respitory paralysis - cardiac arrest

Question 46

hypermagnesemia is most common in patients with

Answer 46

renal insufficency

Question 47

mypermagnesemia effects

Answer 47

- muscle weakness, hypotension, sedation, and ECG changes - risk of cardiac arrest