Exam 1: fluid, electrolyte imbalances

Question 1

what are the etiology of fluid volume deficit (hypovolemia)?

Answer 1

o water deprivation (confusing or coma, loss of thirst, inability to communicate)
o water loss (diarrhea, diabetes insipidus, excessive diuresis, hemorrhage, wound drainage, sweating)

Question 2

Clinical manifestations of hypovolemia: (9)

Answer 2

o weight loss, weak pulses, tachycardia, thirst, decreased urine output, shrinkage of brain, increased hct, flattened neck veins, normal/decreased BP

Question 3

what are the etiology of fluid volume excess (hypervolemia)?

Answer 3

o excessive pure water intake, excessive IV hypotonic solution administration, drinking water to replace isotonic fluid losses, tap water enemas, SIADH, renal water retention, hypersecretion of aldosterone

Question 4

Clinical manifestations of hypervolemia: (7)

Answer 4

o edema, increased BP, bounding pulse, weight gain, venous distension, can develop into pulmonary edema, HF

Question 5

what is a good indicator for dehydration?

Answer 5

• high Na=dehyration/fluid volume deficit (shortage)

Question 6

etiology of hypernatremia

Answer 6

**serum sodium >145
o Excessive hypertonic solutions, hyperaldosteronism, cushing syndrome
o Hypovolemic (loss Na and water), euvolemic (loss of free water), or hypervolemic (increase body water and greater Na) depending of ECF water
 Risk factors: age, mental state, fever, diarrhea, vomiting, DM, tube feedings, diuretics

Question 7

clinical manifestation of hypernatremia

Answer 7

o CNS symptoms; weakness, lethargy, muscle twitching, hyperreflexia, confusion, coma
o intracellular dehydration
o Hyperchloremia, bicarb deficits (hyperchloremic metabolic acidosis)

Question 8

treatment for hypernatremia

Answer 8

-oral fluids
-isotonic salt-free fluid

Question 9

what is a good indicator for over hydration?

Answer 9

• hyponatremia
  -serum sodium <135
  -fluid overload!

Question 10

etiology of hyponatremia:

Answer 10

o Vomiting, diarrhea, renal losses from diuretics, inadequate aldosterone secretion, SIADH, hypothyroidism, PNA, glucocorticoid deficiency, inadequate intake of Na, water intoxication, SSRIs, cirrhosis, HF

Question 11

clinical manifestation of hyponatremia:

Answer 11

o Nausea/vomiting, headache confusion, lethargy, seizures, coma, hypotension, tachycardia, decreased urine output, weight gain, edema
o Less than 120= cell swelling

Question 12

treatment of hyponatremia

Answer 12

-Water restriction
- hypertonic saline solution
-ADH receptors antagonist (vaptans)

Question 13

what happens to potassium levels when there is tissue damage?

Answer 13

potassium levels rises b/c cell contents leaks out

Question 14

what electrolyte levels should you monitor when urine output decreases?

Answer 14

potassium and mg
*these can only be excreted by the kidneys

Question 15

etiology of hyperkalemia

Answer 15

serum K >5.0
o Excess dietary or IV K intake, renal failure, K sparing diuretics, hypoaldosteronism
o excessive intake, shift from ICF to ECF with change of cell permeability like from cell trauma,
o decreased renal excretion, use of stored whole blood, boluses of pcn G, K replacement, hypoxia, acidosis, insulin deficits, Digitalis overdose, renal failure, hypoaldosteronism, drugs that decrease renal K excretion

Question 16

clinical manifestation of hyperkalemia

Answer 16

o muscle weakness, paralysis, dysrhythmias, increased neuromuscular irritability
o Dysrhythmias, (peaked T waves, prolonged PR, absent P wave, or widened QRS)
o anxiety, tingling, numbness

Question 17

treatment of hyperkalemia

Answer 17

-EKG
- calcium gluc
-glucose
-insulin
-dialysis

Question 18

etiology of hypokalemia

Answer 18

serum potassium <3.5
o Diarrhea, vomiting, starvation, inadequate replacement, K losing diuretics, hyperaldosteronism
o Most common cause; alkalosis!!!
o insulin admin, treatment of anemia with Vit B12 or folate, familial hypokalemic periodic paralysis (rare disease), DKA, GI/renal disorders, diuretics, hyperaldosteronism from adrenal adenoma, magnesium deficiency, some antibiotics

Question 19

clinical manifestations of hypokalemia:

Answer 19

o Hypotension,
o ECG changes (flattened T waves, ST depression, peaked P wave, prolonged QT),
o V fib, cardiac arrest, lethargy, fatigue, muscle weakness

Question 20

treatment of hypokalemia

Answer 20

-ekg
-K replacement
**concurrent with hypomagnesemia

Question 21

etiology of hypercalcemia:

Answer 21

serum Ca >10.5
o Hyperparathyroidism, tumors, sarcoidosis, bone mets w/ calcium resorption, excessive vit D, prolonged immobilization, acidosis

Question 22

clinical manifestations for hypercalcemia:

Answer 22

o Fatigue, weakness, lethargy, anorexia, nausea, constipation, mental status changes, impaired renal fx, kidney stones, EKG changes

Question 23

treatment for hypercalcemia (4)

Answer 23

o Oral phosphate
o IV NS for renal secretion
o Calcitonin
o Denosumab
 human monoclonal antibody for the treatment of osteoporosis, treatment-induced bone loss, metastases to bone, and giant cell tumor of bone.
o Treat underlying condition causing hypercal

Question 24

etiology for hypocalcemia:

Answer 24

• Concentration levels <9, ionized levels <5.5
• Etiology:
  o Nutritional deficiencies, inadequate intestinal absorption, decreased PTH, decreased vitamin D, deposition of ionized Ca into bone or soft tissue, removal of parathyroid glands, malabsorption of fat, bone mets, blood transfusions, pancreatitis, alkalosis, hypoalbuminemia

Question 25

clinical manifestations for hypocalcemia

Answer 25

o Tingling, muscle spasms (particularly in hands and feet), cramping, hyperactive bowel sounds, fractures, tetany in severe cases o Chvostek sign (tap face) and Trousseau sign (contraction of hand) o convulsions, tetany, EKG changes

Question 26

treatment for hypocalcemia

Answer 26

o IV calcium gluconate, PO calcium replacement

Question 27

Pseudohyponatremia

Answer 27

o Hyponatremia with normal tonicity o rare condition o serum sodium is low but the serum osmolality and tonicity is normal or above normal; o low Na concentration with normal osmolality may be an artifact due to the accumulation of other plasma constituents (triglycerides or proteins) in plasma

Question 28

True hyponatremia:

Answer 28

o Hyponatremia with hypotonicity, o most common form of hyponatremia** o usually caused by impaired renal water excretion in the presence of continued water intake

Question 29

Dilutional hyponatremia:

Answer 29

o Hyponatremia with hyperosmolality, o usually d/t hyperglycemia o the increase in glucose in ECF moves water from the cells to the ECF and dilutes Na concentration o the Na concentration falls about 1.6 for every increase of 100 glucose

Question 30

what is the definition of edema?

Answer 30

disproportionate amt of fluid in the interstitial space

Question 31

what does oncotic pressure do?

Answer 31

it makes the movement of water into capillary greater than movement of water into interstitial compartment

Question 32

what are usually the causes of edema? (5)

Answer 32

o 1) increased capillary venous hydrostatic pressure o 2) decreased capillary oncotic pressure o 3) lymphatic obstruction/dysfunction o 4) increased capillary permeability o 5) sodium and water retention.

Question 33

what can increased capillary hydrostatic pressure result from? (2)

Answer 33

-venous obstruction -sodium and water retention

Question 34

how does venous obstruction affect hydrostatic pressure?

Answer 34

it causes hydrostatic pressure to increase behind the obstruction, pushing fluid from the capillaries into the interstitial spaces

Question 35

what are common causes of venous obstructions? (5)

Answer 35

-venous blood clots -hepatic obstructions -right HF -tight clothing around the extremities -prolonged standing

Question 36

what causes decreased plasma oncotic pressure?

Answer 36

losses or diminished production of plasma albumin

Question 37

what happens when there is a decreased oncotic attraction fluid within the capillary?

Answer 37

it causes the fluid to move into the interstitial space, resulting in edema

Question 38

what can liver disease or protein malnutrition cause?

Answer 38

decreased synthesis of plasma protein and decreased oncotic pressure

Question 39

what can cause loss of plasma proteins? (3)

Answer 39

-glomerular diseases of the kidney (nephrotic syndrome) -hemorrhage -serous drainage from open wounds or burns.

Question 40

what is increased capillary permeability usually associated with? (2)

Answer 40

-inflammation -the immune response ( these responses are often the result of trauma such as burns or crushing injuries, neoplastic disease, allergic rxn, and infections)

Question 41

why is edema caused by increased capillary permeability often very severe?

Answer 41

because of loss of proteins from the vascular space, which decreases capillary oncotic pressure and increases interstitial oncotic pressure with both processes facilitating fluid movement into the interstitial space.

Question 42

classifications for: pitting edema

Answer 42

-few proteins in the fluid -increased capillary venous hydrostatic pressure, decreased capillary oncotic pressure

Question 43

classification for: non-pitting edema

Answer 43

-fluid has lots of protein in it -increased capillary permeability, lymphatic obstruction

Question 44

clinical manifestions of: metabolic acidosis (8)

Answer 44

- Headache -lethargy -confusion and coma later -deep, rapid respirations (kussmaul) -anorexia -vomiting -diarrhea -dysrhythmias

Question 45

clinical manifestions of: metabolic alkalosis (6)

Answer 45

-Weakness -muscle cramps -hyperactive reflexes -respirations are slow -confusion -convulsions

Question 46

what is contraction alkalosis

Answer 46

also known as hypochloremia metabolic alkalosis  occurs when acid loss is caused by vomiting or gastric suctioning with depletion of ECF sodium, chloride, and potassium * This is loss of fluids from the body that are low in bicarb

Question 47

examples of contraction alkalosis (3)

Answer 47

-diuretic therapy (thiazide/loop) -vomiting -GI suction

Question 48

loss of hydrogen ions occurs d/t: extrarenal

Answer 48

usually results from GI losses or shift of hydrogen ions from EC to IC compartment

Question 49

loss of hydrogen ions occurs d/t: renal

Answer 49

usually occurs d/t increase mineralocorticoid activity (i.e. Hyperaldosteronism, Cushing’s, congenital adrenal hyperplasia, renal artery stenosis)

Question 50

etiology of respiratory alkalosis

Answer 50

o alveolar hyperventilation, low CO2 o stimulation of ventilation is precipitated by hypoxemia. o High altitudes o Hypermetabolic states o Fevers, anemia, thyrotoxicosis, o Salicylate intoxication o anxiety or panic attack disorder o Improper use of mechanical ventilators can cause iatrogenic respiratory alkalosis. o Secondary respiratory alkalosis may develop from hyperventilation stimulated by metabolic acidosis, causing a mixed acid-base disorder.

Question 51

what is the normal anion gap

Answer 51

14-18

Question 52

cation in ECF

Answer 52

most cations in the ECF are Na and a little potassium

Question 53

anion in ECF

Answer 53

most anions in the ECF are Cl bicarb

Question 54

if the metabolic acidosis is present and the gap is normal

Answer 54

 we know that the cause is a loss of bicarbonate- usually from GI tract or kidneys, also known as “hyperchloremic metabolic acidosis” * diarrhea (all secretions below stomach are rich in bicarb) * renal tubular acidosis o type 1 distal RTA o type 2 proximal RTA o type 4 hyperK RTA  all involve a defect in bicarb reabsorption and hydrogen ion excretion and are characterized by a + urinary anion gap

Question 55

what causes elevated anion gap metabolic acidosis? (9)

Answer 55

**caused by the addition or retention of acid (usually results of renal defect) o Paraldehyde, o lactic acidosis, o uremia, o methanol, o salicylates, o ethanol, o ethylene glycol, o DKA, o starvation

Question 56

why is normal anion gap metabolic acidosis also referred to as hyperchloremic metabolic acidosis?

Answer 56

b/c when a bicarb is lost, more chloride is reabsorbed, keeping the gap normal

Question 57

what are some causes of normal anion gap metabolic acidosis? (3)

Answer 57

-diarrhea -laxative abuse -drainage via fistulas, surgical drains, and urinary diversions

Question 58

relationship among acidosis and alkalosis with: hydrogen

Answer 58

- as the H increases; pH decreases -the greater the H; the more acidic -the less the H; the more alkalotic

Question 59

relationship among acidosis and alkalosis with: Calcium

Answer 59

-levels drop in alkalosis -levels rise in acidosis

Question 60

relationship among acidosis and alkalosis with: potassium

Answer 60

o K rises about 0.3 for each 0.1 decrease in pH in respiratory acidosis o K rises about 0.7 for each 0.1 decrease in pH in metabolic acidosis o K falls about 0.3 for each 0.1 increase in pH (alkalosis)  Low K is seen in metabolic alkalosis  High K is seen in metabolic acidosis

Question 61

what is the relationship between Mg and Phos

Answer 61

-inversely proportional -if one goes down, the other goes up

Question 62

what are the causative factors of hypertonic imbalances? (3)

Answer 62

-increased sodium (hypernatremia) -water deficit -hyperglycemia

Question 63

what are the causative factors for hypotonic imbalances? (6)

Answer 63

-decreased sodium (hyponatremia) -water excess -nephrotic syndrome -cirrhosis -HF -isotonic dehydration treated with IV D5W (glucose in D5W solution is metabolized in water, contributing to hyponatremia)

Question 64

What disease can cause hypotonic imbalances? (3)

Answer 64

-nephrotic syndrome -cirrhosis -HF