Module 1 - Fluids, Electrolytes, and Acid-Base Balance Flashcards
(136 cards)
1
Q
Total body water is __ % of total body weight
A
60
2
Q
Intracellular fluid is __% of total body water
A
67
3
Q
Extracellular fluid is __% of total body water
A
33
4
Q
Plasma is ___% total body water
A
6.6
5
Q
Interstitial fluid is ___% of total body water
A
26.4
6
Q
Plasma and interstitial fluid make up ??
A
extracellular fluid
7
Q
What is blood plasma?
A
Yellow liquid component of blood that suspends whole blood cells, proteins, glucose, clotting factors, electrolytes, hormones and CO2
8
Q
What is blood serum?
A
Blood plasma WITHOUT the clotting factors (fibrinogen, prothrombin)
9
Q
Na+ and Cl- are high _____ of the cell
A
outside
10
Q
K+ is high _____ the cell
A
inside
11
Q
Why are fluids important?
A
- To maintain homeostasis (euvolemia)
- To replenish the fluids lost through normal physiologic activities
12
Q
What are insensible losses? Examples?
A
Losses we can’t see or measure:
- perspiration
- respiration
13
Q
What are sensible losses?
Examples?
A
Losses we can see and measure:
- urination
- feces
- wound drainage
- GI losses
14
Q
To maintain fluid balance, the average person requires ________mL of water per day
A
2000-3000
15
Q
Hypertonic
A
[solute] > serum
*draws fluid out of the cell and into the intravascular space
16
Q
Isotonic
A
[solute] = serum
*fluid stays in the intravascular space
17
Q
Hypotonic
A
[solute] < serum
*fluid shifts out of the intravascular space and into the cell
18
Q
Hypertonic solution is __% NaCl
A
3% NaCl (513 mmol/L)
19
Q
Isotonic solution is __% NaCl
A
0.9% NaCl (154 mmol/L)
20
Q
Hypotonic solution is __% NaCl
A
0.45% NaCl (77 mmol/L)
21
Q
Serum contains ______ mmol/L of Na+
A
145
22
Q
See slide 9 for calculating serum osmolality
A
ok
23
Q
Why do we care about calculating serum osmolality?
A
- Highly concentrated solutions are irritating to veins (phlebitis) or can damage tissue
- Depending on concentration, may require central line access (a larger vessel)
24
Q
Replacing fluids:
Resuscitation
A
patient is clearly volume depleted
25
Replacing fluids:
| Maintenance
patient is NPO (nothing by mouth), poor oral intake
26
What is the recommended fluid replacement for resuscitation?
Give fluid bolus of 500 mL crystalloid (Na+ 130-154 mmol/L) over 15 minutes (can repeat up to 2000mL)
27
What is the recommended fluid replacement for maintenance ?
Normal daily fluid and electrolyte requirements:
- 25-30mL/kg/day water
- 1 mmol/L/kg/day Na+, K+, Cl-
- 50 - 100 g/day of glucose
*Works out to approximately 100-120 mL/hr
28
What are electrolytes?
substances that ionize when'd dissolved in solvents such as water
29
What do electrolytes do?
- Maintain the body's fluid balance and osmolality
- Maintain the body's pH balance
- Maintain proper fcn of cells
30
Na+ is most abundant in ______ fluid (maintained by Na+/K+ ATPase pump)
extracellular
31
______ results in water entering cells
Hyponatremia
32
_____ results in water getting drawn out of cells
Hypernatremia
33
Abnormal sodium levels usually indicate a problem with _____ balance
water
34
Sodium balance is mainly controlled by the ________ with the help of aldosterone, ADH and atrial natriuretic peptide
KIDNEY
35
Describe what happens if sodium level is low (or low blood pressure)
- Anti-diuretic hormone is released from posterior pituitary gland
- Aldosterone is released
- Kidney reabsorbs Na+ and water
36
Describe what happens if sodium level is high (or high blood pressure)
- Atrial natriuretic hormone is released from the heart
| - Kidney excretes Na+ and water
37
What levels constitute mild hyponatremia?
130-135 mmol/L
38
What levels constitute moderate hyponatremia?
125 - 129 mmol/L
39
What levels constitute severe hyponatremia?
< 125 mmol/L
40
Symptoms of hyponatremia?
- asymptomatic
- impaired attention
- gait changes (trouble walking)
- falls
- N/V
- altered mental status
- seizures
- respiratory arrest = death
41
What type of medication can cause low sodium and low volume?
Diuretics (dump Na+ and water)
42
What types of medication can cause low sodium but normal volume?
- NSAIDs
- SSRIs
- illicit drugs
- carbamazepine
- cyclophosphamide
43
Treatment for low sodium/low volume?
0.9% NaCl to rehydrate patient and correct Na+
44
Treatment for low sodium/normal volume?
fluid restriction, diuresis (loop diuretics)
45
Treatment for low sodium, too much fluid?
fluid restriction, diuresis (loop diuretics)
46
Formula for sodium deficit?
Sodium deficit = [0.6 x weight(kg)] x (desired Na+ - actual Na+)
47
For sodium correction: Correct no more than ________
9 mmol/L/day
48
What level constitutes severe hypernatremia?
> 160 mmol/L
49
Symptoms of hypernatremia?
- thirst
- lethargy
- restlessness
- irritability
- ataxia
- tremors
- seizures
- coma
50
Treatment for hypovolemic hypernatremia?
fluids (D5W or 0.2% NaCl in D5W)
51
Treatment for euvolemic hypernatremia?
vasopressin (ADH)
*THIS DOESN'T MAKE SENSE WTF
52
Treatment for hypervolemic hypernatremia?
Diuretics (get rid of Na+ and water) or dialysis
53
Potassium is most abundant in ______ fluid
intracellular
54
What is potassium important for?
proper conduction of action potentials (muscle excitability)
55
potassium is __% renally eliminated
90
56
_____ pushes K+ inside cells
insulin
57
______ activate Na+/K+ ATPase
B-agonists (epinephrine)
58
______ dump K+, keep Na+ and water
aldosterone
59
What is metabolic alkalosis ?
decreased K+ levels
60
What is metabolic acidosis ?
increased K+ levels
61
What levels constitute mild hypokalemia?
3.1-3.5
62
Symptoms of mild hypokalemia?
often asymptomatic
63
What levels constitute moderate hypokalemia?
2.5 - 3.0
64
Symptoms of moderate hypokalemia?
cramping, weakness, malaise, myalgias
65
What levels constitute severe hypokalemia?
< 2.5
66
Symptoms of severe hypokalemia?
ECG changes
67
What causes hypokalemia?
- excessive GI loss (vomiting, diarrhea, NG suction)
- decreased intake (malnourished)
- excessive renal loss (diuretics)
- acid-base balance (metabolic alkalosis)
68
Hypokalemia can cause ______ toxicity
Digoxin
69
What levels constitute mild hyperkalemia?
5.5 - 6.0 mmol/L
70
What levels constitute moderate hyperkalemia?
6.1 - 7.0 mmol/L
71
What levels constitute severe hyperkalemia?
> 7.1 mmol/L
72
Symptoms of mild hyperkalmia
usually asymptomatic
73
Symptoms of moderate hyperkalemia?
cardiac arrhythmias
74
Symptoms of severe hyperkalemia?
- cardiac arrhythmias
- weakness
- paralysis
- respiratory failure
- sudden cardiac arrest
75
Causes of hyperkalemia?
- excessive intake (supplements, salt substitutes)
- impaired renal function
- redistribution to extracellular fluid
- psudeohyperkalemia (hemolysed blood sample)
- DRUGS (K+ sparing diuretics, ACEi, ARBs)
- missed dialysis session
76
Treatment of hyperkalemia?
calcium gluconate, insulin & dextrose, salbutamol, dialysis
77
Caution with intravenous potassium?
K+ can cause arrhythmias and death
78
Max rate of K+ for peripheral line
20 mmol/hr
79
Max concentration of K+ for peripheral line
80 mmol/L
80
Max rate of K+ for central line
40 mmol/hr
81
Max concentration of K+ for central line?
200 mmol/L
82
Cl- is a major ______ anion
extracellular
83
What regulates chloride balance?
sodium and bicarbonate
84
What level is severe hypochloremia?
< 75 mmol/L
85
Causes of severe hypochloremia?
- severe loss of GI fluids
- metabolic alkalosis (too much bicarb) *holding onto bicarbonate which is an anion, therefore chloride is excreted and lost
- renal losses (loss of sodium, chloride follows)
- drugs (i.e. PPIs lower stomach acidity)
86
What level is severe hyperchloremia?
> 125 mmol/L
87
Causes of hyperchloremia
- sodium and water retention
| - metabolic acidosis (too many H+ ions) *bicarb is excreted, H+ is retained therefore Cl- is retained
88
Most magnesium resides in the ______ space or in bone
intracellular
89
Levels of severe hypomagnesemia?
< 0.5 mmol/L
90
Symptoms of hypomagnesemia
neuromuscular hyperirritability (tremors, tetany, arrhythmias, seizures)
91
Causes of hypomagnesemia?
- reduced intestinal absorption (malnutrition, alcoholism, malabsorption syndromes)
- increased urinary/fecal losses (diarrhea, loop and thiazide diuretics)
- intracellular shifts
92
Levels of mild-moderate hypermagnesemia
1-1.5 mmol/L
93
Symptoms of mild-moderate hypermagnesemia?
usually asymptomatic
94
Levels of hypermagnesemia?
> 1.5 mmol/L
95
Symptoms of severe hypermagnesemia?
nausea, headache, drowsiness, hypocalcemia, deep tendon reflexes absent, hypotension, bradycardia, ECG changes, paralysis, death
96
Causes of hypermagnesemia?
- chronic kidney disease (unable to eliminate)
- excess magnesium intake
- addison's disease (not enough mineralocorticoids)
- lithium
97
Treatment of hypermagnesemia?
- stop excessive intake
- IV calcium
- dialysis
98
Calcium found in _____ fluid
extracellular
99
How much calcium is free?
45% of total calcium
100
What is the formula for Corrected calcium?
Ca corrected = Ca serum + 0.02*(40-albumin)
101
Level o fever hypocalcemia?
< 1 mmol/L
102
Symptoms of hypocalcemia?
Muscles: myalgia, numbness, tingling, tetany, hyperreflexia
Cardiac: arrhythmias, hypotension
CNS: seizures
103
Causes of severe hypocalcemia?
- vitamin D deficiency
- hypoparathyroidism
- renal disease
- malabsorption or pancreatitis
- hypomagnesemia
- drug causes (bisphosphantes, calcitonin, furosemide)
104
Level of mild hypercalcemia?
2.6-3.0 mmol/L
105
Symptoms of mild hypercalcemia?
usually asymptomatic, constipation
106
Level of moderate-severe hypercalcemia?
> 3.0 mmol/L
107
Symptoms of moderate-severe hypercalcemia?
nausea, abdominal pain, constipation, kidney stones, polydipsia, polyuria, dehydration, hypertension, shortened QT intervals, stupor, coma
108
Causes of hypercalcemia?
- hyperparathyroidism
- malignancy
- drug causes (tamoxifen, lithium, thiazide diuretics, vitamin D)
109
Treatment of hypercalcemia?
- treat underlying disorder
- reduce calcium intake
- cinacalcet
- parathyroidectomy
110
Phosphorus found primarily in ______ space
intracellular
111
Level for mild-moderate hypophosphatemia
0.3 - 0.8 mmol/L
112
Symptoms of mild-moderate hypophosphatemia
usually asymptomatic
113
Level for severe hypophosphatemia
< 0.3 mmol/L
114
Symptoms of severe hypophosphatemia
rhabdomyolysis, hemolysis, platelet dysfunction, cardiac/respiratory failure, encephalopathy, seizures
115
Causes of hypophosphatemia
- inadequate intake
- increased excretion
- intracellular shift
116
Level for mild-moderate hyperphosphatemia
1.6 - 2.3 mmol/L
117
Symptoms of hyperphosphatemia?
usually asymptomatic
118
Level for severe hyperphosphatemia
2.4 mmol/L
119
Symptoms for severe hyperphosphatemia
Gi disturbance, lethargy, urinary obstruction (renal stones), red eye, pruritus
120
Causes of hyperphosphatemia?
- excessive intake
| - decreased elimination (renal disease)
121
Treatment of hyperphosphatemia?
- phosphate binders (calcium carbonate, sevelamer, lanthanum)
- increase urinary excretion (acetazolamide, dialysis)
122
What are arterial blood gasses used to determine?
- oxygenation status
| - acid-base status
123
pH determines?
how acidic/basic is the blood
124
pCO2 determines?
what the lungs are doing
125
HCO3 determines?
how much bicarb is in the blood
126
____% of total CO2 is bicarbonate
95
127
Acidemia
arterial pH < 7.35
128
Alkalemia
arterial pH > 7.45
129
Acidosis
a process that will result in academia if left unopposed (usually caused by decreased HCO3 and/or increased pCO2)
130
Alkalosis
a process that will result in alkalemia if left unopposed (usually caused by increased HCO3 and/or decreased pCO2)
131
Metabolic alkalosis
increased HCO3
| *lungs try and retain pCO2
132
Metabolic acidosis
decreased HCO3
| *lungs try to blow off more pCO2
133
Respiratory alkalosis
decreased pCO2
| *kidneys try to excrete bicarbonate
134
Respiratory acidosis
increased pCO2
| *kidneys try to retain bicarbonate
135
What is normal anion gap?
8-16 mmol/L
136
formula for anion gap
Anion gap = Na+ - [Cl- + HCO3-]
