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