Fluid and Electrolytes

Question	Answer
normal sodium	135-145 mEq/L
normal potassium	3.5-5 mEq/L
normal BUN	7-20 mg/dl
normal hematocrit	40-50%
normal urine specific gravity	1.002-1.030
normal glucose	60-110 mg/dl
normal osmolality	275-295
FVD classic sign	dry mucous membranes, comes later
FVD late sign	hypotension
FVD, temp changes	decreased temp, blood shunted to central area
FVD, respiratory	increased respiratory rate bc acidotic, blowing of CO2; thick and sticky secretions
anasarca	severe, generalized third spacing
most common site, 3rd spacing	abdomen (ascites, in peritoneal cavity?)
primary mediator of fluids	hypothalamus
2nd spacing	stage where fluid moves from one space to another
3rd spacing	fluid in interstitial compartments
FVD sodium	normal to high (hemoconcentration)
FVD potassium	normal to high (is intracellular, if enough cell death --or sodium levels -- could be high)
FVD BUN	high (hemoconcentration); in children may be low but not pathologic
FVD glucose	normal to high (stress response, >120)
FVD urine specific gravity	high >1.030
FVD osmolality (serum)	>300, more particles ↑ number of particles, concentration
FVE hemodynamic signs	full bounding pulses, hypertension, increased CVP, neck vein distension, CHF
cerebral edema	seen with FVE, Confusion, dizziness, convulsions, coma
pulmonary edema	seen with FVE, Dyspnea, tachypnea, hacking cough, crackles, o2 sat down
FVE general signs	weight gain, nonpitting interstitial edema, hepatomegaly/splenomegaly
FVE first sign seen	pulmonary edema
neck vein distension	sign of FVE but not seen in kids, make sure know baseline for adults
goal of Rx for FVE	prevent cerebral edema
>>> causes of FVE (10)	renal failure, heart failure, excess fluid intake (without electrolytes), high corticosteroids, high aldosterone, plain water enema, NG irrigations, excess hypotonic IV fluids, SIADH, inappropriately prepared formula (dilute formula)
>>> excess fluid intake examples	excessive hypertonic fluids, binge drinking contest, psych disorders, drowning in fresh water, inappropriate dialysis
FVE, potassium	normal to high (potassium shift out of cells, rasing levels)
FVE, sodium	very low, <125
FVE, BUN	low (hemodilution)
FVE, urine spec gravity	low, <1.005
FVE, glucose	normal to high (stress response, >120)
decreased sodium and potassium signs	lethargy, weakness
increased sodium and potassium signs	increased excitability
acid	releases H+ ions in water
base	binds to H+ ions in water
buffers	prevent major acid-base changes; carbonic acid-bicarbonate, protien, and phosphate buffer system
carbonic acid	measured as CO2
acid-base homeostasis	bicarb: carbonic acid = 20:1
carbonic acid-bicarb system	primary system, 50% of activity, to maintain balance l/t have to also use protein and phosphate buffer systems, 1-2 hours to kick in, bicarb is the major ECF buffer
alkaline environment	hard for cells to grow
>>> Respiratory buffer system, carbonic acid	carbonic acid compensates and dissociates into CO2 and H20, CO2 exhaled by lungs, system activates rapidly but exhausted quickly
respiratory buffer system, breathing changes	changes in depth/rate of resp alters it: hypoventilation retains CO2/carbonic acid and causes acidosis, hyperventilation loses CO2 and causes alkalosis
renal buffer system: time and effectiveness	works w/in hours/days, more efficient than respiratory can go for longer periods of time
renal buffering system, bicarbonate	primary renal component, can be absobed as needed, combines HCl with ammonia to make ammonium, which is easily excreted by kidneys into urine
compensation	regulatory mechanism to return pH to normal level by transforming acids and bases within the body
primary metabolic disturbance	causes a respiratory compensation
acute primary respiratory disturbance	causes an acute metabolic response
complete compensation	pH is fully corrected (normal)
partial compensation	buffers are in the process of working; pH is low but the bicarb is elevating to compensate (or pH is high but CO2 is elevating to compensate)
pH	negative logarithm of H+ ion concentration in mEq/L (as H+ ion concentration increases, pH decreases) normal values 7.35 -7.45 (less is acidotic, more is alkalotic)
HCO3- (bicarb)	*normal 22-26 mEq/L (decreased in acidosis, increased in alkalosis)
BE "base excess"	indicates the amount of bicarb available in the ECF normal value: +/- 2 mEq/L
serum anion gap	Concentration of anions (HCO3- , Cl-, protein, phosphate, & sulfates) and cations (Na+, K+, MG++, & Ca++) 10-12 mEq/L normal increased in metabolic acidosis (but can be normal) calculated by Na - Cl + bicarb
SaO2	the percent of Hb saturated with O2, a calculated value (indirect measurement), calculated with pH and PaO2 (combination of O2 sat, PaO2, and Hb), indicates tissue oxygenation
PaO2	amount of oxygen available to bind with hemoglobin, amount of pressure exerted on O2 by plasma
the lower teh PaO2 pressure, the ....	less oxygen available to bind with Hb
dramatic drops in PaO2	correlate with dramatic drops in oxygen saturation
PaO2 normal values	75-100 mmHg (for every year above 60 drop 1mmHg)
PaCO2	partial pressure of CO2 reflects adequacy of alveolar ventilation, regulated by lungs, alterations indicate resp disturbance *normal values 35-45 mmHg (less is alkalotic, more is acidotic)
respiratory alkalosis managment (4)	correct cause, rebreathe CO2 as needed, alter ventilation rate, sedatives (for anxiety)
respiratory alkalosis assessment (7)	VS, ABGs, RR/depth, LOC/anxiety, neuro checks, injury potential, I&O
respiratory alkalosis CV signs	tachycardia, palpitations, increased myocardial irritability
respiratory alkalosis respiratory signs	rapid shallow breathing (trying to retain CO2, oxygenate), chest tightness
respiratory alkalosos CNS signs (10)	paresthesia, dizzyness, confusion, tetany, convulsion, numb/tingling, light headed, anxiety/panic, Loss of consciousness, hyperactive reflexes
respiratory alkalosis causes (4)	hyperventilation, sepsis/infection, over ventilation, hepatic cirrhosis
respiratory alkalosis: labs	low CO2, pH high >7.45, bicarb normal if no compensation or decreased if compensation, hypokalemia, hypocalcemia
respiratory acidosis management (7)	correct cause, CPT, TCDB if able, suction as needed, semi-Fowlers, fluids to thin secretions, low-flow O2 as needed
respiratory acidosis assessment (8)	VS, ABGs, RR/depth, apical pulse, LOC, EKG, skin color/nail beds/mucous membranes, I&O
respiratory acidosis cardiac signs	hypotension, peripheral vasodilation weak thready pulse, tachycardia, warm flushed skin
respiratory acidosis respiratory signs	dyspnea, slow shallow respirations, hypoxia and hypoventilation, cyanosis
respiratory acidosis CNS signs (6)	HA, seizures, altered LOC, papilledema, twitching/tremors, drowsy --> coma
respiratory acidosis causes (4)	respiratory depression/arrest, inadequate chest expansion, airway obstruction, interference with alveolar capillary exchange
respiratory acidosis: labs	pH low <7.35, PaCO2 high >42, HCO3- normal (or elevated with compensation), hyperkalemia
metabolic alkalosis mgmnt (3)	correct cause, restore normal fluid balance, adequate chloride (enhance renal absorption of sodium and excretion of bicarb)
metabolic alkalosis assessment (6)	VS, ABGs, RR/depth, LOC, I&O, ECG
metabolic alkalosis GI signs (3)	n/v, anorexia, paralitic ileus (hypokalemia)
metabolic alkalosis CNS signs (10)	dizzy, nervous, tremors, hyperreflexia, paresthesias, irritability, confusion/apathy/stupor, cramps, tetany, seizures
met alkalosis respiratory signs (2)	hypoventilation, respiratory failure
met alkalosis CV signs (5)	tachycardia, HTN, PVC, atrial tachycardia, dysthrythmias (from FVE)
met alkalosis causes (4)	vomiting, NG suctioning, eating bicarb-based antacids, diuretics
met alkalosis: labs	increased pH, increased BE, increased bicarb, decreased anion gap (low K and Na)
met acidosis mgmnt (6)	correct cause, treat ketoacidosis (fluids, insulin), give alkaline fluids, hydrate, mechanical ventilation if needed, possible dialysis
insulin	used to treat metabolic acidosis (ketoacidosis), forces potassium back into cells
alkaline fluids for met acidosis	if severe, sodium bicarb if pH<7.20, salts of organic acid (lactate, citrate), tromethamine THAM
met acidosis assessment (7)	VS, ABGs, RR/depth, apical and peripheral pulses, ECG (bc of dramatic K changes), LOC, I&O
metabolic acidosis CV signs (4)	dramatic affects: hypotension, dysrhythmias, peripheral vasodilation, warm flushed skin (from dilation, leaking of capillaries)
metabolic acidosis resp signs	Kussmaul/deep/rapid respirations, trying to blow off CO2
metabolic acidosis CNS signs (6)	think of septic patient: drowsy, HA (from cerebral edema), lethargy, coma, confusion/restless, weakness
metabolic acidosis GI signs (3)	n/v, diarrhea, abdominal pain
causes of metabolic acidosis	chronic diarrhea, malnutrition, starvation, renal failure, DKA, trauma, shock, sepsis, fever, salicylate toxicity
metabolic acidosis: labs	low bicarb, decreased BE, increased anion gap, hyperkalemia (from breakdown of cells from acidosis), high metabolic acids (lactic acids, ketoacids)

Teachers and Webmasters: Copy-and-paste the HTML code below into your web page to have these flashcards displayed on your web page.

<script type="text/javascript"> var cardWidth=400; var cardHeight=300; var adjustFont=true;</script><script type="text/javascript" src="http://www.studystack.com/flashcardjs-120546"></script><a href="http://www.studystack.com"><h5>More flashcards, word search, and hangman provided by StudyStack.com</h5></a>

Favorite Labeled Images

IVC Lesson 11

Beef Production

Buen Viaje lv.2 ch 8

French Emotions

HHS Shrek

MedTemCP5 Word+Pics

Poultry