fluid/electrolytes Flashcards
(85 cards)
1
Q
normal range sodium
A
135-145; maintains h2o balance
impulse transmission, muscle contraction, fluid and electrolyte balance
2
Q
normal range potassium
A
3.5-5; transmission of nerve and muscle impulses
resting membrane potential, action potentials of nerves and muscles, maintain intracellular volume
3
Q
normal range chloride
A
104-106; buffer and regulates acid-base
regulating osmotic pressure, forming HCl in gastric acid. controlled indirectly by ADH and processes that affect renal reabsorption of sodium
4
Q
normal range calcium
A
9-11; nerve impulse transmission; heart contractions
5
Q
normal range BUN
A
10-20; urea is by product of metabolism
6
Q
Normal range creatinine
A
0.7-1.2; produced by your muscle metabolism
7
Q
normal range co2
A
22-26 buffer
8
Q
normal range magnesium
A
1.5-2.5 nerve conduction and muscle tissue function
9
Q
sum of cations in body=sum of anions in body
A
both 153
10
Q
phosphates
A
regulate pH, controlled by aldosterone and renal system
11
Q
excess Sodium
A
hypernatremia thirst CNS deterioration Increased interstitial fluid cellular dehydration net loss of water or sodium gain dehydration
12
Q
Sodium deficit
A
Hyponatremia CNS deterioration often age related etiology due to decreased renal function fingerprint edema muscle cramps, weakness, fatigue nausea, vomiting, cramps, diarrhea apathy, lethargy, headache depression of deep tendon reflexes
13
Q
excess potassium
A
hyperkalemia (decreased renal elimination, excessively rapid administration, mvmt of K+ from ICF to ECF) ventricular fibrillation ECG changes CNS changes Weakness
14
Q
Potassium deficit
A
Hypokalemia (inadequate intake, excessive GI, skin, renal losses-diuretic therapy, or redistribution to ECF from ICF) bradycardia ECG changes CNS changes Fatigue
15
Q
excess calcium
A
hypercalcemia
thirst
CNS deterioration
Increased interstitial fluid
16
Q
calcium defict
A
hypocalcemia tetany Chvostek's, Trousseau's signs Muscle twitching CNS changes ECG changes
17
Q
Excess Magnesium
A
hypermagnesemia
Loss of deep tendon reflexes (DTR’s)
Depression of CNS
Depression of neuromuscular function
18
Q
Magnesium deficit
A
hypomagnesemia
hyperactive DTR’s
CNS changes
19
Q
nonelectrolytes
A
urea
glucose
creatinine
bilirubin
20
Q
isotonic fluid
A
280-300 mOsm/kg
21
Q
Hypotonic fluid
A
less than 280 mOms/kg
used to hydrate the cells
cells draw in water and swell
22
Q
Hypertonic fluid
A
greater than 300 mOsm/kg
draws fluid from the cells
23
Q
increase ECF osmolality
A
cells shrink
24
Q
decrease ECF osmolality
A
cells swell
25
The rules of fluid replacement
```
replace blood with blood
plasma with colloid
resuscitate with colloid
ecf depletion with saline
rehydrate with dextrose
```
26
how does the body regulate our fluid volume?
```
Thirst
ADH
RAAS
SNS
ANP
```
27
adh
increases water reabsorption
increases urine concentration
decreases serum concentration
28
disorders of ADH
SIADH
| Diabetes Insipidis
29
SIADH
overproduction of ADH
fluid retention, edema
low sodium triggers increased ADH
HYPONATREMIA
30
diabetes insipidus
lack of ADH
| damage to hypothalamus or pituitary gland
31
nephrogenic diabetes insipidus
failure of kidneys to respond to ADH and vasopressin
32
Renin
enzyme produced and released by kidney in response to decreased renal perfusion secondary to decreased circulating volume or increased SNS stimulation
Renin interacts with angiotensinogen to produce angiotensin 1
33
angiotensin 1
converted to angiotensin 2 in lungs by converting enzyme ACE
34
angiotensin 2
stimulates secretion of aldosterone
35
aldosterone
mineralocorticoid hormone released by the adrenal cortex which acts upon the distal portion of the renal tubule
- slowly boosts water reabsorption by the kidneys by increasing the reabsorption of NaCl
- acts as a volume regulator bc sodium retention leads to water retention
36
ANP
atrial natriuretic peptide
hormone released by the cardiac atria in response to increased atrial pressure
released in resonse to any condition that causes elevated cardiac filling pressures
effect of angiotensin 2
37
First spacing
normal distribution of fluid in ICF and ECF (the vascular space)
38
second spacing
abnormal accumulation of interstitial fluid (edema)
39
Third Spacing
Fluid accumulation in part of body where it is not easily exchanged with ECF (ascites)
40
hematocrit
%RBC in whole blood
increases with dehydration (hemoconcentration)
decreases with overhydration (hemodilution)
normal male 40-54%
normal female 37-47%
41
BMP
BUN blood urea is a byproduct of metabolism and is primarily excreted by the kidneys in urine
normal 7-20 mg/dL
42
urine osmolality
measures solute concentration of urine
24 hour specimen 300-900 mOsm/kg
urea, creatinine, and uric acid are the primary determinants of urine osmolality
43
urine specific gravity
elevates the kidney's ability to conserve or excrete urine
| normal 1.010-1.020
44
Fluid Volume Excess
```
neck vein distension
pulmonary edema
weight gain
peripheral edema
full, bounding pulses, elevated BP
congestive heart failure
```
45
fluid volume deficit
```
sunken eyeballs
dry mucus membranes
weight loss
increased respiratory rate
decreased skin turgor
flattened neck veins
increased heart rate
decreased BP
```
46
acidosis
an abnormal process which would lower arterial pH if there were no secondary changes in response to the primary etiological factor
too many circulating H+
47
Alkalosis
an abnormal procss which would raise arterial pH if there were no secondary changes in response to the primary etiological factor
not enough H+ in ECF
48
acidemia
arterial pH less than 7.35
49
alkalemia
arterial pH greater than 7.45
50
normal pH ACID BASE BALANCE
7.35-7.45
51
normal PaCO2 RESP
35-45 mm Hg
52
normal HCO3- KIDNEY
22-26 mEq/L
53
pulmonary embolism
respiratory alkalosis
54
hypotension
metabolic acidosis
55
vomiting
metabolic alkalosis
56
severe diarrhea
metabolic alkalosis
57
cirrhosis
resp alkalosis
58
renal failure
metabolic acidosis
59
sepsis
respiratory alkalosis, metabolic acidosis
60
pregnancy
resp alkalosis
61
diuretic use
metabolic alkalosis
62
COPD
resp acidosis
63
respiratory acidosis
carbonic acid excess caused by blood levels of CO2 above 45 mmHG
hypercapnia-high levels of CO2 in blood
breathing too slow
depression of respiratory center in brain -drugs, head trauma
paralysis of respiratory or chest muscles
emphysema
64
adult respiratory distress syndrome
acute respiratory acidosis
65
pulmonary edema
acute respiratory acidosis
66
pneumothorax
acute respiratory acidosis
67
treatment of respiratory acidosis
restore venitlation
IV lactate solution
treat underlying dysfunction or disease
68
Respiratory Alkalosis
carbonic acid defict
pCO2 less than 35 mm HG (hypocapnea)
most common acid-base imbalance
breathing is too fast
69
causes of respiratory alkalosis
```
high altitudes
pulmonary disease and congestive heart failure caused by hypoxia
acute anxiety
fever, anemia
cirrhosis
gram - sepsis
```
70
treatment of respiratory alkalosis
treat underlying cause
breathe into a paper bag
IV Choloride containing colution Cl- replace lost HCO3-
71
metabolic acidosis
HCO3- deficit (less than 22 mEq/L)
72
Causes to metabolic acidosis
diarrhea or renal dysfunction (loss of HCO3-)
accumulation of acids (lactic acid or ketones)
Failur of kidneys to excrete H+
73
Symptoms of metabolic acidosis
headache, lethargy
nausea, vomiting, diarrhea
coma
death
74
treatment of metabolic acidosis
IV lactate solution
75
metabolic alkalosis
HCO3= excess (greater than 26 mEq/L)
76
causes of metabolic alkalosis
```
excess vomiting and diarrhea=loss of stomach acid
excessive use of alkaline drugs
certain diuretics
endocrine disorders
heavy ingestion of antacids
severe dehydration
```
77
symptoms of metabolic alkalosis
```
respiration is slow and shallow
hyperactive reflexes (tetany)
often related to depletion of electrolytes
atrial tachycardia
dysrhythmias
```
78
treatment of metabolic alkalosis
electrolytes to replace those lost
IV Chloride containing solution
treat underlying disorder
79
interpreting the ABG
note whether the pH is low (acidosis) or high (alkalosis)
| decide which value (pCO2=resp or HCO3- =metabolic) is outside normal range
80
Compensation?
look at the value that doesnt correspond to the observed pH change. If it is within normal range, then there is NO COMPENSATION occurring. If it is outside the normal range, the body is partially compensating for the problem.
81
hypertonic hyponatremia
osmotic shift of water from the ICF to the ECF compartment (hyperglycemia)
82
hypotonic hyponatremia
most common
| caused by water retention
83
hypovolemic hyponatremia
```
water is lost along with sodium
excessive sweating due to heat
heavy exercise
vomiting and diarrhea
a lack of aldosterone increases renal losses of sodium and cortisol deficiency leads to increased release of ADH with water retention.
```
84
Euvolemic or Normovolemic hypotonic hyponatremia
retention of water with dilution of sodium while maintaining the ECF volume within normal range.
Result of SIADH
risk increases post op
high ADH levels increase water reabsorption by kidney
85
hypervolemic hypotonic hyponatremia
```
hyponatremia+edema associated disorders
decompensated heart failure
advanced liver disease
renal disease
effective circulating volume is often sensed as inadequate by baroreceptors resulting in increased ADH levels
abuse of MDMA (ecstasy)
```
