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McCance ch. 3
electrolytes, acid/base
| Question | Answer |
|---|---|
| volatile acids | H2CO3-carbonic acid eliminate as CO2 (respiratory) |
| nonvolatile acids | metabolic-sulfuric acid, phosphoric acid, lactic acid, ketoacids eliminate as HCO3 (kidneys) |
| Buffers | Bicarbonate (HCO3), plasma protein (hgb), phophate(HPO4), ammonia(NH3) |
| Acidemia | pH < 7.35 |
| Alkalosis | pH > 7.45 |
| Anion gap | [Na + K] - [HCO3 + Cl] = 10/12 mEq/L; unmeasured negative anions |
| hyperchloremic metabolic acidosis | met acidosis with normal anion gap; diarrhea, renal failure, uretosigmoidoscopy, prox renal tubule acidosis |
| hypochloremic metabolic alkalosis | volume depletion with loss of metabolic acids; prolonged vomiting |
| Metabolic acidosis causes | increased H+ load (lactic acid-shock; ketoacids-DKA; ingestion-ASA, methanol. decreased H+ excretion: uremia, distal tubule acidosis |
| Metabolic acidosis symptoms | early-HA, lethargy; kussmaul resp, N/V/D, severe-coma, dysrythmia, hypotension |
| metabolic alkalosis causes | excess loss of acids-vomiting; GI suction; excess bicarb intake, hyperaldosteronism, hypokalemia, diuretics |
| metabolic alkalosis symptoms | weakness, muscle cramping, HYPOCALCEMIA sx!, slow respirations, atrial tachycardia, left shift |
| hypocalcemia symptom | (increase binding of Ca to albumin in alkalosis) easier action potential; paresthesia, numbness/tingling of mouth, fingers; tetany, seizures |
| respiratory acidosis causes | acute-airway obstruction-sedation, pneumonia, asthma;etc. or chronic(COPD) renal compensate to normal pH p few days |
| respiratory acidosis symptoms | headache, restlessness, blurred vision, apprehension with lethargy, muscle twitching, tremors, convulsions, death; skin may be pink from vasodilation of CO2 |
| hypercapnia | excessive CO2 |
| Respiratory alkalosis causes | hypoxia stimulate respirations: pulmonary edema, CHF. hypermetabolic state-fever, anemia, thyroidtoxicosis, early ASA poison; hysteria, cirrhosis, gram neg sepsis |
| Respiratory alkalosis symptoms | dizziness, confusion, paresthesia, convulsion, coma, sx of hypocalcemia |
| TBW | men-60%, women-50%, children 60-65%, infants-70% 2/3 ICF, 1/3 ECF (plasma, interstitial fluid) |
| Favors Filtration | capillary hydrostatic pressure (BP) interstitial oncotic pressure |
| Oppose Filtration | plasma oncotic pressure (protein) interstitial hydrostatic pressure |
| mechanisms of edema | lymph obstruction, > capillary hydrostatic pressure, < capillary oncotic pressure, > capillary permeability |
| Na+ | major ECF cation, 136-145 mEq/L, regulate by aldosterone (renin-angiotensi-aldosterone) |
| Water | follows Na+; low osmolality, low blood volume release ADH |
| hyponatremia | < 135 mEq/L;(excess water) water in > water out-dilutional; impaired GFR; SIADH; Na+ loss > water: diuretics, CHF, GI loss |
| hypernatremia | >147 mEq/L; (water deficit )inadequate free water, DI, Cushings, > aldosterone, wrong IVF. |
| Cerebral Edema | Hypotonic Imbalance: hyponatremia, water excess-cerebral cell sweilling. Too quickly correcting hypernatremia. |
| causes of K+ imbalance | pH, aldosterone-keep Na+/K+ loss; insulin-move K+/insulin into cells. |
| hyperkalemia | >5.5 mEq/L. acidosis, DKA, cell trauma, Addison's dx. hypopolarized cell membrane |
| hypokalemia | <3.5 mEq/L. resp alkalosis, GI loss, renal-low Mg+ assoc with low K+, hyperaldosterone. less excited cell membrane |
| Calcium | inverse relationship with HPO4-, PTH stimulate Ca++, Vit D-kidneys, Calcitonin inhibit Ca++, 50% protein bound. 8.6-10.5 mg/dl |
| hypocalcemia | <8.5 mg/dl. > binding of Ca++, alkalosis. small stimuli need for action potential. paresthesia, carpopedal spasms, hyperreflexia, convulsions, tetany, prolong QT interval |
| hypercalcemia | hyperparathyroid-bone mets, sarcodosis-> Vit D, acidosis. loss of membrane excit. fatigue, weakness, nausea, const., bradycardia, blocks |
| hypophosphatemia | < 2 mg/dl. malabsp, alcoholism, anatacids, hyperparathyroid, Vit D deficiency, resp alk. < O2 transport-left shift, brady, block. weakness; platelet, leukocyte dysfunction |
| hyperphosphatemia | > 4.5 mg/dl. cell destruction-ca tx . similar sx as hypocalcemia |
| Magnesium | major ICF cation. 1% in serum. works with Ca++, enzyme activity, neuromscl excitability. 1.8-2.4 mg/dl |
| hypomagnesemia | < 1.5 mg/dl. malnutrition, malabsp, alcoholism, diabetes. inhibit K+ channels-hypokalemia. s/sx of hypocalcemia |
| hypermagnesemia | >2.5 mg/dl. renal failure, Mg antacids. depress muscle cnt/nerve fnct. M/V, weakness, hypotension, bradycardia, resp depression |
| normal pH | 7.38-7.42 |
Created by:
Sniffen group
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