Fluid & Electrolytes
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| normal sodium | show 🗑
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| normal potassium | show 🗑
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| normal BUN | show 🗑
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| normal hematocrit | show 🗑
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| normal urine specific gravity | show 🗑
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| show | 60-110 mg/dl
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| normal osmolality | show 🗑
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| show | dry mucous membranes, comes later
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| show | hypotension
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| show | decreased temp, blood shunted to central area
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| show | increased respiratory rate bc acidotic, blowing of CO2; thick and sticky secretions
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| show | severe, generalized third spacing
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| most common site, 3rd spacing | show 🗑
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| primary mediator of fluids | show 🗑
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| 2nd spacing | show 🗑
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| show | fluid in interstitial compartments
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| show | normal to high (hemoconcentration)
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| FVD potassium | show 🗑
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| FVD BUN | show 🗑
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| show | normal to high (stress response, >120)
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| show | high >1.030
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| show | >300, more particles ↑ number of particles, concentration
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| show | full bounding pulses, hypertension, increased CVP, neck vein distension, CHF
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| show | seen with FVE, Confusion, dizziness, convulsions, coma
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| pulmonary edema | show 🗑
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| show | weight gain, nonpitting interstitial edema, hepatomegaly/splenomegaly
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| FVE first sign seen | show 🗑
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| show | sign of FVE but not seen in kids, make sure know baseline for adults
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| goal of Rx for FVE | show 🗑
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| show | 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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| show | excessive hypertonic fluids, binge drinking contest, psych disorders, drowning in fresh water, inappropriate dialysis
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| show | normal to high (potassium shift out of cells, rasing levels)
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| FVE, sodium | show 🗑
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| show | low (hemodilution)
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| FVE, urine spec gravity | show 🗑
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| show | normal to high (stress response, >120)
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| show | lethargy, weakness
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| increased sodium and potassium signs | show 🗑
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| show | releases H+ ions in water
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| show | binds to H+ ions in water
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| buffers | show 🗑
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| show | measured as CO2
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| acid-base homeostasis | show 🗑
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| show | 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 | show 🗑
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| >>> Respiratory buffer system, carbonic acid | show 🗑
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| respiratory buffer system, breathing changes | show 🗑
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| renal buffer system: time and effectiveness | show 🗑
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| show | 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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| show | regulatory mechanism to return pH to normal level by transforming acids and bases within the body
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| show | causes a respiratory compensation
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| show | causes an acute metabolic response
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| show | pH is fully corrected (normal)
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| partial compensation | show 🗑
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| show | *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) | show 🗑
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| BE "base excess" | show 🗑
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| serum anion gap | show 🗑
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| show | 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 | show 🗑
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| show | less oxygen available to bind with Hb
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| show | correlate with dramatic drops in oxygen saturation
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| PaO2 normal values | show 🗑
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| PaCO2 | show 🗑
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| respiratory alkalosis managment (4) | show 🗑
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| show | VS, ABGs, RR/depth, LOC/anxiety, neuro checks, injury potential, I&O
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| respiratory alkalosis CV signs | show 🗑
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| respiratory alkalosis respiratory signs | show 🗑
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| show | paresthesia, dizzyness, confusion, tetany, convulsion, numb/tingling, light headed, anxiety/panic, Loss of consciousness, hyperactive reflexes
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| show | hyperventilation, sepsis/infection, over ventilation, hepatic cirrhosis
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| respiratory alkalosis: labs | show 🗑
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| respiratory acidosis management (7) | show 🗑
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| respiratory acidosis assessment (8) | show 🗑
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| respiratory acidosis cardiac signs | show 🗑
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| respiratory acidosis respiratory signs | show 🗑
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| show | HA, seizures, altered LOC, papilledema, twitching/tremors, drowsy --> coma
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| show | respiratory depression/arrest, inadequate chest expansion, airway obstruction, interference with alveolar capillary exchange
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| show | pH low <7.35, PaCO2 high >42, HCO3- normal (or elevated with compensation), hyperkalemia
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| show | 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) | show 🗑
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| show | n/v, anorexia, paralitic ileus (hypokalemia)
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| metabolic alkalosis CNS signs (10) | show 🗑
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| show | hypoventilation, respiratory failure
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| met alkalosis CV signs (5) | show 🗑
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| met alkalosis causes (4) | show 🗑
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| show | increased pH, increased BE, increased bicarb, decreased anion gap (low K and Na)
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| met acidosis mgmnt (6) | show 🗑
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| show | used to treat metabolic acidosis (ketoacidosis), forces potassium back into cells
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| show | if severe, sodium bicarb if pH<7.20, salts of organic acid (lactate, citrate), tromethamine THAM
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| show | VS, ABGs, RR/depth, apical and peripheral pulses, ECG (bc of dramatic K changes), LOC, I&O
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| show | dramatic affects: hypotension, dysrhythmias, peripheral vasodilation, warm flushed skin (from dilation, leaking of capillaries)
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| metabolic acidosis resp signs | show 🗑
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| metabolic acidosis CNS signs (6) | show 🗑
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| metabolic acidosis GI signs (3) | show 🗑
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| show | chronic diarrhea, malnutrition, starvation, renal failure, DKA, trauma, shock, sepsis, fever, salicylate toxicity
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| show | low bicarb, decreased BE, increased anion gap, hyperkalemia (from breakdown of cells from acidosis), high metabolic acids (lactic acids, ketoacids)
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| causes of metabolic acidosis | show 🗑
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| metabolic acidosis: labs | show 🗑
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| alkaline fluids for met acidosis | show 🗑
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| show | 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) | show 🗑
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| show | Kussmaul/deep/rapid respirations, trying to blow off CO2
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| show | think of septic patient: drowsy, HA (from cerebral edema), lethargy, coma, confusion/restless, weakness
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| show | n/v, diarrhea, abdominal pain
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| causes of metabolic acidosis | show 🗑
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| metabolic acidosis: labs | show 🗑
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