Term
| In a female, total body weight is __% solids and __% fluids. |
|
Definition
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|
Term
| In a male, total body weight is __% solids and __% fluids. |
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Definition
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Term
| Of the fluids making up our total body weight, _/_ is ICF and _/_ is ECF. |
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Definition
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Term
| What are the cation electrolytes in the plasma? |
|
Definition
sodium
potassium
calcium
magnesium |
|
|
Term
| What are the anion electrolytes in the body? |
|
Definition
chloride
bicarbonate
phosphate
sulfate
organic acids (lactate)
total protein |
|
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Term
| Know these normal ranges. of cations and anions |
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Definition
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|
Term
| How are the compositions of ICF and ECF ions maintained? |
|
Definition
selective permeability of cell membranes
active ion pumps |
|
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Term
| The movement of water about a cell membrane is what? |
|
Definition
passive:
-colloid osmotic gradients intravascular vs. interstitial spaces (extracellularly
-osmolar gradients intracellularly vs extracellularly |
|
|
Term
| Which electrolytes are in the ICF? |
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Definition
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|
Term
| Which electrolytes are in the ECF? |
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Definition
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|
Term
| When balancing fluid and sodium, what is the normal osmolarity? |
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Definition
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|
Term
| What are the driving forces for osmolarity? |
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Definition
| Na resorption and excretion |
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Term
| Where is sodium resorbed? |
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Definition
| in distal tubules in exchange for potassium and hydrogen ion |
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Term
| What does ECV reduction stimulate? |
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Definition
| juxtaglomerular apparatus to secrete renin then promotes secretion of angiotensin I and conversion to angiotensin II, aldosterone |
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Term
| What else senses reduction in ECV? |
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Definition
| volume receptors in the right atrium (bc don't have enough blood coming back from the body to the heart) |
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Term
| What does aldosterone help maintain? |
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Definition
|
|
Term
| What suppresses aldosterone? |
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Definition
| ECV expansion (increases Na and decreased K) |
|
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Term
| Where is ADH produced? what does it regulate? |
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Definition
posterior pituitary
regulates volume and osmolarity |
|
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Term
|
Definition
| tubular resorption of water |
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Term
| When are intracranial receptors initiated to tell ADH to be released? |
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Definition
when the plasma osmolarity is increased
(so if have a lot of protein (increased osmo) receptors will be stimulated to produce more fluid) |
|
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Term
| Can the right and left atrial receptors also stimulate ADH production? |
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Definition
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Term
| When aldosterone triggers sodium to be resorbed, where does this occur and what does it actively exchanged for? |
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Definition
distal convoluted tubules
exchanged for K and H ions |
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Term
| When water is resorbed secondary to ADH, where does this resorption occur? |
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Definition
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Term
| What does dysfxn of this renin-angiotensin system lead to? |
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Definition
decreased amt of water in body
increased amount of Na in the body
increased blood osmolality
decreased circulating blood volume (bc have less body water) |
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Term
| What stimulates ADH and thirst? |
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Definition
decreased amt of water in body
increased amt of Na in body
increased blood osmolality
decreased circulating blood volume |
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Term
| Osmoreceptors are stimulated where that stimulate the release of ADH? |
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Definition
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|
Term
| Osmoreceptors are stimulated where that stimulate the release of ADH? |
|
Definition
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|
Term
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Definition
|
|
Term
| What is pH the measurement of? |
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Definition
the mgmt of hydrogen ions
-maintained at 7.4 +/- 0.5 |
|
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Term
| What 3 mechanisms maintain the pH? |
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Definition
burrfering systems in plasma
ventilatory changes for CO2 excretion
renal tubular excretion of hydrogen ions |
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Term
| What are the 2 main determinants of intracellular buffering? |
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Definition
excessive CO2 retention or excretion
& reciprocal K ion exchange |
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Term
| What effects CO2 retention or excretion? |
|
Definition
50% of fixed acid loads (lactate)
95% of hydrogen ion changes |
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Term
| In alkalosis, _ moves extracellularly and _ moves intracellularly. |
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Definition
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Term
| In acidosis, _ moves extracellularly and _ move sintracellularly. |
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Definition
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|
Term
| Intracellular regulation of acid/base balance can have significant clinical effect, especially regarding what? |
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Definition
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|
Term
| What are important determinants of intracellular pH? |
|
Definition
pulmonary regulation of PaCO2.
renal tubular regulation of HCO3. |
|
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Term
| What ratio basically determines extracellular pH? |
|
Definition
HCO3/H2CO3
-As one increases, the other increases to compensate |
|
|
Term
| What are the normal serum values of HCO3 and PaCO2? |
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Definition
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|
Term
| Postoperatively, what is done with regards to fluids and electrolytes? |
|
Definition
maintenance
resuscitation
replacement of losses |
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Term
| Children >5 kg to young adult, how is fluid replaced? |
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Definition
First 10 kg 100 ml/kg
Second 10 kg 50ml/kg
Weight > 20 kg 20 ml/kg |
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Term
Children >5 kg to young adult, how is fluid replaced?
-same slide, but different answer... read book. |
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Definition
4 ml/kg first 10 kg
2 ml/kg second 10 kg
1 ml/kg > 20 kg |
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Term
| How is fluid replaced in adults who are 25-55 yrs old? |
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Definition
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|
Term
| How is fluid replaced in adults who are 55-65 yrs old? |
|
Definition
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|
Term
| How is fluid replaced in adults who are >65 yrs old? |
|
Definition
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|
Term
| What is a third space fluid loss? |
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Definition
| fluid sequestered into extracellular and interstitial spaces (postoperatively usually) |
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Term
| What are the 4 conditions that occur bc of third space fluid losses? |
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Definition
Peritonitis
Intestinal obstruction
Soft tissue inflammation/edema
Traumatic losses |
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Term
| Diminished volume is noticed when hemodynamic changed begin to occur, name 3 hemodynamic changes that clue you into third space fluid losses. |
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Definition
Tachycardia
Narrowed pulse pressures
Hypotension |
|
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Term
| What 2 ways help to tell you if somebody is adequately resuscitated? |
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Definition
urine output
resolution of symptoms. |
|
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Term
| Check out slide 25 and 26 on the composition of body fluids. |
|
Definition
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Term
| When there is decreased volume of body fluids, it is usually in the face of what 2 conditions? |
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Definition
loss of blood
loss of GI fluid |
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Term
| When there is excessive gain in volume, it is usually in the face of what 3 conditions? |
|
Definition
volume replacement
renal failure
SIADH |
|
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Term
| Trauma can cause volume depletion in what 3 ways? |
|
Definition
hemorrhage
burns
crush injury |
|
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Term
| Surgery can cause volume depletion in what 3 ways? |
|
Definition
blood loss
GI loss
insensible loss |
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Term
| Drains can cause volume depletion in what 3 ways? |
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Definition
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Term
| Medical conditions can cause volume depletion in what 5 ways? |
|
Definition
pancreatitis
bowel obstruction
peritonitis
soft tissue infection
hyperglycemia |
|
|
Term
| What 2 drugs can cause volume depletion? |
|
Definition
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|
Term
| When 10% of the ECV is depleted, what is seen on PE? |
|
Definition
thirst
mild decrease in UOP |
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Term
| When 20% of the ECV is depleted, what is seen on PE? |
|
Definition
drowsiness
tachycardia
moderate decrease UOP
increase Hct
WBC
BUN/Cr |
|
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Term
| When 30% of the ECV is depleted, what is seen on PE? |
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Definition
coma
hypotension
tachycardia
oliguria |
|
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Term
| When correcting volume, what do you need to know? |
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Definition
| what fluid was lost and how quickly? |
|
|
Term
| If the fluid loss deficit is moderate when should it be replaced? |
|
Definition
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|
Term
| If the fluid loss deficit is severe when should it be replaced? |
|
Definition
|
|
Term
| When monitoring UOP, what should the rate be for adults? kids? |
|
Definition
adults: 0.5 ml/kg/hr
children: 1 ml/kg/hr |
|
|
Term
| Who usually has volume excess? |
|
Definition
elderly
renal failure
CHF
hepatic disease
surgery
trauma |
|
|
Term
| during surgery and trauma, why does volume excess occur? |
|
Definition
| increase ADH and aldosterone |
|
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Term
| Na higher than what is considered hypernatremia? |
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Definition
|
|
Term
| What is hypernatremia usually due to? |
|
Definition
high sodium
decreased water
if water moves from ICF to ECF |
|
|
Term
| During hypernatremia cells _________. |
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Definition
|
|
Term
| What are some causes of hypernatremia? |
|
Definition
hypertonic IV solution
oversecretion of aldosterone
loss of pure water
insufficient intake of water (hypodipsia)
loss of water and salt |
|
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Term
| What are 2 ways in which pure water can be lost? |
|
Definition
respiratory infection (water vapor loss)
diabetes (polyuria) |
|
|
Term
| What are some conditions in which water and salt can be lost? |
|
Definition
gastrointestinal
osmotic diuresis
DI
excessive sweating |
|
|
Term
| What are the clinical manifestations of hypernatremia? |
|
Definition
thirst
lethargy
neurological dysfxn due to dehydration of brain cells
decreased vascular volume. |
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|
Term
|
Definition
|
|
Term
| How is hypernatremia calculated? |
|
Definition
TBWD males = [(140 – SNa+) x 0.6 x IBW (kg)]/ 140
TBWD females = [(140 – SNa+) x 0.5 x IBW (kg)]/ 140
-for every 3.5 mEq the Na is over 140, there is an estimated free water deficit of 1 L |
|
|
Term
| What are the txs of hypernatremia? |
|
Definition
isotonic salt-free IV fluid
oral solutions preferable |
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Term
| Hyponatremia is an overall decrease in Na in the ___. |
|
Definition
|
|
Term
| What are the types of hyponatremia? |
|
Definition
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|
Term
| Depletional hyponatremia is due to Na loss... what 4 things cause depletional hyponatremia? |
|
Definition
diuretics
chronic vomiting
chronic diarrhea
decreased aldosterone
decreases Na intake |
|
|
Term
| what 4 things cause dilutional hyponatremia? |
|
Definition
renal dysfxn with increased intake of hypotonic fluids
excessive sweating-->increased thirst-->intake of excessive amount of pure water
SIADH, oliguric renal failure, severe congestive heart failure and cirrhosis all lead to IMPAIRED RENAL EXCRETION OF WATER
Hyperglycemia- attracts water |
|
|
Term
| What is pseudohyponatremia? |
|
Definition
| spurious lab value due to hyperglycemia, hyperlipidemia or hyperproteinemia. |
|
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Term
| What are the neurological manifestations of hyponatremia? |
|
Definition
| Lethargy, headache, confusion, apprehension, depressed reflexes, seizures and coma |
|
|
Term
| What are the muscular symptoms of hyponatremia? |
|
Definition
|
|
Term
| What are the GI symptoms of hyponatremia? |
|
Definition
nausea
vomiting
abd cramps
diarrhea |
|
|
Term
| How is hyponatremia treated? |
|
Definition
limit water intake
discontinue meds. |
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|
Term
| Hypokalemia is defined as serum K<___ mEq/L |
|
Definition
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|
Term
| Why should you be careful if the pt is hypokalemic and diabetic? |
|
Definition
insulin gets K into cell
Ketoacidosis can occur where H replaces K, which is lost in urine. |
|
|
Term
|
Definition
|
|
Term
| What losses can cause hypokalemia? |
|
Definition
GI losses
renal losses
hypokalemic hypochloremic metabolic alkalosis |
|
|
Term
| With hypokalemia, what is the rule? |
|
Definition
| increase pH 0.1 unit causes decrease serum potassium 0.4 to 0.5 mEq |
|
|
Term
| What should also be checked for with hypokalemia? |
|
Definition
|
|
Term
| Hypokalemia can be caused by a decreased intake of K or an increased loss of K... what are some reasons in which K will be lossed? |
|
Definition
chronic diuretics
acid/base imbalance
trauma and stress
increased aldosterone
redistribution bw ICF and ECF |
|
|
Term
| What neuomuscular disorders manifest bc of hypokalemia? |
|
Definition
weakness
flaccid paralysis
respiratory arrest
constipation |
|
|
Term
| What cardiovascular disorders manifest bc of hypokalemia? |
|
Definition
dysrhythmias
appearance of U wave
flat or inverted T
Postural hypotension
cardiac arrest |
|
|
Term
| How is hypokalemia treated? |
|
Definition
| increased K intake (slowly and preferably by foods) |
|
|
Term
| Hyperkalemia is a K > ___ mEq/L. |
|
Definition
|
|
Term
| With hyperkalemia, what should be checked for? |
|
Definition
|
|
Term
| What are some causes of hyperkalemia? |
|
Definition
renal dz
Massive cellular trauma
Insulin deficiency
Addison’s disease
Potassium sparing diuretics
Decreased blood pH
Exercise causes K+ to move out of cells |
|
|
Term
| What are some early clinical manifestations of hyperkalemia? |
|
Definition
hyperactive muscles
paresthesia |
|
|
Term
| What are some later manifestations of hyperkalemia? |
|
Definition
muscle weakness
flaccid paralysis |
|
|
Term
| Hyperkalemia does what cardiovascularly? |
|
Definition
peaked T wave
dysrhythmias
bradycardia
heart block cardiac arrest |
|
|
Term
| If there is time, how is hyperkalemia treated? |
|
Definition
| decrease intake of K and increase renal excretion. |
|
|
Term
| What is used to tx hyperkalemia? |
|
Definition
Insulin 10 units + glucose 25 g
Albuterol
Kayexalate and lasix
Bicarbonate
Ca++ gluconate counters effect on heart |
|
|
Term
| What does hypercalcemia result from |
|
Definition
Hyperparathyroidism
Hypothyroid states
Renal disease
Excessive intake of vitamin D
Milk-alkali syndrome
Certain drugs
Malignant tumors |
|
|
Term
With hypercalcemia of malignancy, what do the tumor products promote?
tumor growth in bone causes what? |
|
Definition
|
|
Term
| With hypercalcemia, what do you normally also see? |
|
Definition
|
|
Term
| What are the effects of hypercalcemia? (stones, abd groans, and psych overtones) |
|
Definition
Many nonspecific – fatigue, weakness, lethargy
Increases formation of kidney stones and pancreatic stones
Muscle cramps
Bradycardia, cardiac arrest
Pain
GI activity also common
Nausea, abdominal cramps
Diarrhea / constipation
Metastatic calcification |
|
|
Term
| How is hypercalcemia treated? |
|
Definition
NS
lasix
steroids
calcitonin
phosphate
dialysis |
|
|
Term
| What differentiates hypocalcemia from hypercalcemia? |
|
Definition
| hypocalcemia has Hyperactive neuromuscular reflexes and tetany |
|
|
Term
| In severe cases, what does hypocalcemia have? |
|
Definition
|
|
Term
| What is hypocalcemia caused by? |
|
Definition
Renal failure
Lack of vitamin D
Suppression of parathyroid function
Hypersecretion of calcitonin
Malabsorption states
pancreatitis
Widespread infection or peritoneal inflammation |
|
|
Term
| What 2 signs show up with hypocalcemia? |
|
Definition
|
|
Term
| How is hypocalcemia treated? |
|
Definition
IV calcium for acute
Oral calcium and vitamin D for chronic |
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