what is the path of extracellular volume regulation
BARORECEPTORS • SYMPATHETIC NERVOUS SYSTEM • RENIN ANGIOTENSIN SYSTEM • VASOCONSTRICTION AND RELEASE OF ALDOSTERONE • ALDOSTERONE (CONSERVES NA++ AND WATER) • ANTIDIURETIC HORMONE • ATRIAL NATRIURETIC PEPTIDE (ANP) • THIRST- WATER LOSS >2%
Thirts mechanism kicks in at what point
water loss great than 2%
hypovolemia know diffrence in subjective and objective finding
Ojective
vomting and diuretics can lead to meabolic shift
Alkalosis
diarrhea, DKA, shock can lead to what type of metabolic shift
acidosis
Patient with WEIGHT GAIN
• INCREASED BP
• EDEMA
• ASCITES
• DECREASED HG, HCT, RBC
• RESPIRATORY ALKALOSIS (PH >7.45, PACO2 < 35)
• CHEST X-RAY-PULMONARY CONGESTION you suspect what type of fluid volume and treat with
hypervolemia FLUID AND NA RESTRICTION • DIURETICS • DIALYSIS • OXYGEN VIA NASAL CANNULA • FOLLOWING SUCCESSFUL TREATMENT • CLEAR LUNGS • NO S3 OR S4 • NORMAL URINARY OUTPUT • NORMAL URINE SPECIFIC GRAVITY • NO EDEMA, NORMAL BP, HR, CVP, AND PCWP
FIRST STEP IN MANAGEMENT hyponatremia
URINE SODIUM (NORMAL 10-20 MEQ/L) • SERUM OSMOLALITY (USUALLY 2X NA = 280) • CLINICAL STATUS • MEASURING URINE SODIUM HELPS TO DETERMINE RENAL FROM NONRENAL CAUSES
Monitor serum Na how often in symptomatic patients needing sodium correction
every 2-4 hours
normals for urine osmolality
URINE SODIUM (NORMAL 10-20 MEQ/L) •
Normals for serum osmolality
SERUM OSMOLALITY (USUALLY 2X NA = 280)
Management of Hypernatremia SEVERE HYPERNATREMIc HYPOVOLEMIa
NS iv
1/2 ns and or D5W will allow for what
fluid into cells
treatment for hypervolemic hypernatriemia
TREAT WITH D5W AND LOOP DIURETICS
which has the highest potassium; Seaweed avocado bananas tomatoes lamb
seaweed
normal calcim
8.5 to 10.5mg/dL
normal ionized Ca
4.5 to 5.5mg/dL
elderly person comes in with low albumin what else would you expect ot be low and what the best way to check this level
Ca will be low so need to check ionized ca
Acidemia increase or decrease ionized calcium
increases ionized calcium
patient getting multiple blood transfusions you expect ca to go
low
Over use of thiazide diuretics affect ca in what way
hypercalcemia
ca greater than 12mg?dl
IF >12 MG/DL –NS INFUSION WITH LOOP DIURETICS
• TEACHING ABOUT DIET, FLUID INTAKE, SIGNS AND SYMPTOMS, PAIN
CONTROL
Hypercalcemia management medication for impaired renal or cardiovascular problem
calcitonin
Hypercalcemia can be managed with Dialysis true or False
True
chronic alcoholic suspect impaired intestinal absorbtion leading to low VitD and lead you to suspect low
phosphorus, Hypophosphatemia
Causes of hypophosphatemia
phosphorus <2.8mg/dL
refeeding syndrome (
insulin spike
hungrey bone syndrome
Increased renal secreation with high PTH osmotic diuretic rickets renal proximal tubular disorder Fanconi syndrome inpaired intestinal absorption vit D deficiency chronic alcoholism
Phosphorus level <1mg/dL cause end organ effects due to lack of
adenosin triphosphate; effects all muscles
urine phosphorus excretion of >100mg in 24 hours mean
high loss of phosphorus hypophosphatemia
what is molarity
moles per liter of solution
what is molality
moles per liter of solvent
what is diffusion
movement of particles or molecules from an area of high concentration to an area of low concentration
Membrane that allows certan materials to pass throughbut not other
selective permeable membrane
A dexcription of the relative solute concentration in a soultion as compred to another solution
tonicity
solution with higher concentratoin than other
hypertonic
solution with lower concentration than other
hypotonic
diffusion regulated by protein channels in the membran and requires no energy input from cell
facilitate diffusion
movement of molecules or ion into or out of cells against it concentration gradietn from low to high and requires an input of enrey
active transport
