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serum electrolytes

fluids, electrolytes, and acid-base for surgery

QuestionAnswer
causes of volume loss blood loss, GI fluid loss (NV),
causes of excess volume volume replacement, renal failure, SIADH
signs of interstitial fluid deficit decreased tissue turgor, dry skin and mucous membranes, fissuring of tongue, reduced tongue volume, if severe- sunken eyes
causes of hyponatremia excess water, excess sodium loss, hyper-lipidemia or -proteinemia
causes of excess water ingestion, physiologic response to surg stress, starvation or hypovolemia, SIADH, incr AHD, cardiac/renal/hepatic Dz
excess Na loss etiology thiazide diuretics, met alkalosis, ketoacidosis, adrenal insuff
clinical signs of hyponatremia same as cns dysfxn b/c cerebral and spinal cord swelling
severity of clinical signs of hyponatremia by level- 120-130 and < 120 120- 130: irritability, weakness, fatigue, incr DTRs, fasciculations if rapid onset. < 120: seizure, coma, areflexia, death.
Tx of hyponatremia stop diuretics, stop excess water intake, correct slowly
hypernatremia serum Na > 150 mEq/L
hypernatremia etiology hypothalamic abnormalities, GI loss, excess diuretic, diabetes insipidus, burns, sweating, drugs(alcohol, ampho B, colchicine, lithium, colchicine, phenytoin), Cushings, hyperaldosteronism,
clinical symptoms like dehyddration, fever, tachy, twitching, restlesness, weakness, delirium, coma, seizures, and death (one cause is intracranial hemorrhage from cell shrinkage)
Tx of hypernatremia correct the water deficit slowly. every 3 mEq above 140 mEq/L = a liter of watr deficit.
HYPOKALEMIA serum K < 3.5 mEq/L. There may also be deficits of Mg, P, Ca.
Etiology of HYPOKALEMIA inadequate intake, GI los, renal loss, iatrogenic ( thiazides, loop diuretics, CAIs)
Mg deficit causes ?? decr distal renal tubular K resorption, can't be corrected without fixing the Mg
HYPERKALEMIA serum potassium > 5.0 mEq/L
etiology of hyperkalemia from diet if pt has renal failure, blood transfusion, Catabolism: crush injury, hemolysis, breakdown of large hematomata, stress or starvation, too rapid rewarming after hypothermia, K shift out of cell: acidosis, insulin deficit
Rxs that cause hyperkalemia spironolactone, amiloride, NSAIDs, beta-adrenergic antagonists, ACEIs, digitalis,
signs of hyperkalemia cardiac: EKG w/ peaked T waves in precordial @ 6-7 mEq/L, >7 causesflat P waves, incr PR intervals, decr QT intervals, wide QRS, depressed ST, and heart block. >8 EKG is sine wave of QRS and T
worst case scenario of hyperkalemia at > 8 mEq/L the sine wave effect of blended wide QRS and elevated T will become V fib and cardiac arrest
Dx of hyperkalemia measure serum K level, also check BUN, creatinine, and urine output b/c kidneys are usually compromised in hyperkalemic pts
Tx of mild hyperkalemia mild is < 6 mEq/L. restrict K intake, eliminate Rx causes, tx volume or acid-base problem. may use k wasting diuretics
Tx of worse hyperkalemia (6.5 - 7.5 mEq/L) Give 10 units insulin IV w/ 25 gms glucose over 5 minutes OR infuse bicarbonate or NaHCO3 OR oral/anal dose of Na polystyrene sulfonate removes K from body. Monitor with EKG
TX of WORST hyperkalemia (> 7.5 mEq/>) if pt has cardiac toxicity (via EKG) give IV 10-30 mL 10% calcium gluconate over five minutes while using other methods to rid the body of K. Monitor with EKG
metabolic and respiratory acidosis pH way down, PaCO2 up, HCO2 down
metabolic acidosis and respiratory alkalosis pH nml, PaCO2 down, HCO2 down
metabolic alkalosis and respiratory acidosis pH nml, PaCO2 up, HCO2 up
metabolic alkalosis and respiratory alkalosis pH way up, PaCO2 down, HCO2 up
albumin levels: nml 3.5 - 5.5 g/dL
albumin level: mild malnutrition 3.0 - 3.5 g/dL
albumin level: moderate malnutrition 2.1 - 3.0 g/dL
severe malnutrition albumin level < 2.1 g/dL
low albumin means ________ for Ca levels? the most common cause of low total Ca is low blood protein levels, especially a low level of albumin. In this condition, only the bound calcium is low. Ionized calcium remains normal and calcium metabolism is being regulated appropriately.
Created by: acthom on 2010-09-02



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