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McCance ch. 3

electrolytes, acid/base

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