fluids, electrolytes, and acid-base for surgery
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| causes of volume loss | blood loss, GI fluid loss (NV),
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| causes of excess volume | volume replacement, renal failure, SIADH
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| signs of interstitial fluid deficit | decreased tissue turgor, dry skin and mucous membranes, fissuring of tongue, reduced tongue volume, if severe- sunken eyes
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| causes of hyponatremia | excess water, excess sodium loss, hyper-lipidemia or -proteinemia
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| causes of excess water | ingestion, physiologic response to surg stress, starvation or hypovolemia, SIADH, incr AHD, cardiac/renal/hepatic Dz
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| excess Na loss etiology | thiazide diuretics, met alkalosis, ketoacidosis, adrenal insuff
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| clinical signs of hyponatremia | same as cns dysfxn b/c cerebral and spinal cord swelling
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| 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.
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| Tx of hyponatremia | stop diuretics, stop excess water intake, correct slowly
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| hypernatremia | serum Na > 150 mEq/L
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| hypernatremia etiology | hypothalamic abnormalities, GI loss, excess diuretic, diabetes insipidus, burns, sweating, drugs(alcohol, ampho B, colchicine, lithium, colchicine, phenytoin), Cushings, hyperaldosteronism,
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| clinical symptoms | like dehyddration, fever, tachy, twitching, restlesness, weakness, delirium, coma, seizures, and death (one cause is intracranial hemorrhage from cell shrinkage)
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| Tx of hypernatremia | correct the water deficit slowly. every 3 mEq above 140 mEq/L = a liter of watr deficit.
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| HYPOKALEMIA | serum K < 3.5 mEq/L. There may also be deficits of Mg, P, Ca.
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| Etiology of HYPOKALEMIA | inadequate intake, GI los, renal loss, iatrogenic ( thiazides, loop diuretics, CAIs)
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| Mg deficit causes ?? | decr distal renal tubular K resorption, can't be corrected without fixing the Mg
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| HYPERKALEMIA | serum potassium > 5.0 mEq/L
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| 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
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| Rxs that cause hyperkalemia | spironolactone, amiloride, NSAIDs, beta-adrenergic antagonists, ACEIs, digitalis,
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| 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
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| 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
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| Dx of hyperkalemia | measure serum K level, also check BUN, creatinine, and urine output b/c kidneys are usually compromised in hyperkalemic pts
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| 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
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| 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
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| 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
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| metabolic and respiratory acidosis | pH way down, PaCO2 up, HCO2 down
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| metabolic acidosis and respiratory alkalosis | pH nml, PaCO2 down, HCO2 down
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| metabolic alkalosis and respiratory acidosis | pH nml, PaCO2 up, HCO2 up
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| metabolic alkalosis and respiratory alkalosis | pH way up, PaCO2 down, HCO2 up
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| albumin levels: nml | 3.5 - 5.5 g/dL
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| albumin level: mild malnutrition | 3.0 - 3.5 g/dL
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| albumin level: moderate malnutrition | 2.1 - 3.0 g/dL
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| severe malnutrition albumin level | < 2.1 g/dL
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| 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.
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