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213 - LA2 (T)
Fluid, Electrolye, and Acid Base Balance
| Question | Answer |
|---|---|
| Diffusion VS Osmosis | Diffusion: movement from high to low concentration Osmosis: movement of water from lower solute concentration to higher |
| Normal serum Potassium level | 3.5 - 5 mEq/L |
| Where is ECF located | outside cells; interstitial, intravascular, transcellular (cerebrospinal fluid, synovial joint fluid, digestive juices) |
| Normal serum Sodium level | 135-145 mEq/L |
| Normal serum calcium level | 4.5-5.5 mEq/l OR 9-11mg/dL |
| Three levels of fluid spacing | First - normal ICF/ECF Second - too much fluid interstitially (edema) Third - fluid trapped/unavailable (burns, ascites) |
| Purpose of sodium in the body? | helps maintain serum osmolarity, aids cell functioning (esp. in CNS) |
| Tx for hyponatremia | IV Fluid, Na+ replacement |
| S/S of hyponatremia | confusion, irritability, tachycardia, thready pulse, tremors, dry mucous membranes --> seizures, coma |
| S/S of hypernatremia | THIRST, swollen tongue, weakness, restlessness, orthohypo --> seizures |
| Tx for hypernatremia | -correct fluid imbalance - diuretics to increase kidney excretion - monitor intake/output/daily weight - sodium restricted diet |
| S/S of hypokalemia | shallow resps, muscle cramps, decreased GI motility, -- dysrhythmias |
| S/S of hyperkalemia | slow, irregular HR, decreased BP, muscle weakness, increased GI motility -- cardiac ARREST |
| Tx of hypokalemia | K+ replacement |
| s/s of hypocalcemia | Trousseaus, Chvosteks (tetany), seizures, hyperactive deep tendon reflexes also weak bones/teeth, severe muscle cramping, numb fingers/toes/mouth/lips |
| Define tetany | involuntary muscle contractions (seen as example in Trousseaus/Chvosteks sign) |
| s/s of hypercalcemia | Depressed reflexes, bone pain, lethargy, confusion -- coma |
| Tx of hypercalcemia | cardiac monitoring, lg amnt of fluids (3-4L/day), diuretics |
| Primary purpose of sodium, potassium, calcium | Na+ - to move fluid and maintain osmotic K+ - heart Ca - neuro |
| Which of these solutions are hypotonic? .45% NS 0.9% NS 3% NS | 0.45% NS |
| Which of these fluids is hypertonic? D5W D10W D5NS | D10W, D5NS |
| Indication for a hypotonic solution? | cellular dehydration (seen in DKA, hyperosmolar hyperglycemia) |
| CONTRAindication for a hypotonic solution? Why? | -Pts with increased cranial pressure - can cause fluid to shift TO brain tissue - burn/trauma pts (depletes their outstanding fluid volume when fluid goes into cells and out of vascular/ECF) |
| What does Lactated Ringers NOT contain? | magnesium |
| Indication for a hypertonic solution? What is the risk? Can it be given peripherally? | given in ICU to expand plasma volume (hypovolemia). Risk is fluid overload, fast onset of pulmonary edema. Preferred to be given via central line (solution is vesicant on veins, increased risk of infiltration) |
| indications for an isotonic solution | blood loss, dehydration, surgery, excess vomiting/diarrhea. also used alongside a blood transfusion. |
| normal pH of blood | 7.35 - 7.45 |
| What causes the release of renin? What does renin do? | Low BP, ECF defecit, renal ischemia, increased sodium in urine converts angiotensinogen to angiotensin 1 |
| what converst angiotensin 1 - 2? | angiotensin-converting enzyme |
| what does angiotensin 2 do? | - causes PVS vasoconstriction - releases Aldosterone |
| Aldosterone increases sodium resorption and excretion of K+ in kidneys. How does this help regulate pH and fluid balance? | **as Na+ is absorbed, H+ may be exchanged to regulate swing to acidosis **as Na+ absorbed, H20 follows - maintaining fluid volume and correcting the problem that caused renin to be released in the frist place |
| What's up with ADH | Anti diuretic hormone, directly increases water resorption by kidneys = increased BP (Also called vasopressin) |
| Why would BUN and hematocrit be elevated in a dehydrated patient? | less water in proportion to the solid substances being measured. |
| What is the main cause of hydrostatic pressure in the CVS? | The force of blood (BP) on the blood vessel walls |
| If blood flow to the kidneys is diminished, is mroe or less renin secreted? | more. |
| Which electrolytes would you expect to be diminished from 48 hour frequent vomiting? | Sodium, Potassium, Magnesium, Chloride, bicarbonate |
| What is the risk of rapidly infusing a bolus of KcL IV? | cardiac arrest |
| what solution would you expect to be ordered for dehydration d/t vomiting? | isotonic |
| What does a pH above 7.45 MEAN? | There is a deficit in H+ ions |
| What does a pH below 7.35 mean? | Excess of H+ ions |
| 3 pH regulators in the body | 1. Buffers (circulate and contribute/accept H+ ions to neutralize excess acid/base) 2. Kidneys (excretion) 3. Lungs (speed/slow resps for CO2) |
| How are acids formed in the body? | end products of glucose, fat, protein metabolism |
| H2CO3 is what? | carbonic acid |
| HCO3 is what? | bicarbonate |
| When would IV sodium bicarbonate be indicated? | acidosis |
| How much does 1L of fluid weight? | 1kg / 2.2 lbs |
| What type of ventilation would you see in respiratory acidosis? | Hypoventilation |
| What type of ventilation would you see in respiratory alkalosis? | Hyperventilation |
| ph/bicarb levels and causes of metabolic acidosis | decreased ph, decreased bicarb causes: DKA (increased acid production) -severe diarrhea (lost bicarb) renal failure (decreased excretion) also shock, intestinal suction |
| ph/bicarb levels and causes of metabolic alkalosis | increased ph, increased bicard causes: overuse of antacids diuretics vomiting (d/t stomach being high in acid) gastric suction (same reason) |
| ph/co2 levels in resp. acidosis and causes | decreased ph, increased co2 causes: anything that reduces respirations -drug OD, decreased resp. stimuli, anesthesia, COPD, head injury |
| ph/co2 levels in resp. alkalosis and causes | increased ph, decreased co2 causes: hyperventilation in anxiety, fear, etc mechanical ventilation overactive thyroid (hyperthyroidism causes increased resp drive) |
| What does an ABG dx? Which lab value is for which indication? | acidosis/alkalosis, and if its a resp or kidney (metabolic) problem pCO2 - indicates resp problem bicarbonate - indicates metabolic problem |
Created by:
TanSpe
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