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| ECV contains what 3 elements? |
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| What is Albumin's role in ECV? |
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| Most important osmotically active colloid in ECV (pulls water with it)and is 4g/L in serum, but only 1g/L in interstitial fluid. |
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| 4cc/2kilo/10 on hourly basis |
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| Rx most commonly written by surgeons for fluids |
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| 125 cc/hour of lactated ringers |
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| Exceptions to adding fluid maintance |
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| Happens due to inflammation when vessels become leaky. Happens during surgery sometimes. |
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| 1cc/kg/hr, min 0.5cc/kg/hr Below 35cc/hr start to worry. |
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| from loss of water without salts. Ex. Burns, fever, hyperventilation, dehydration. |
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| from loss of water with salts. Ex. Diuretics, NGT, vomiting, hypoproteinism |
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| 1/2 in first 24 hours to prevent complications |
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| from GI losses most of the time, NGT, renal losses, prolonged NPO. Losing a ton of acid when throwing up, kidneys freak out and preserve hydrogen ions, pees out potassium to keep acid base normal. Lose K and Na both ways. |
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| Primary danger in Hypokalemia |
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| Typical symptoms of Hypokalemia |
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| Weakness and ileus (dilated loops of small bowel) |
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| Treatment for Hypokalemia |
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| Common reasons for Hyperkalemia |
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| Overadministration, poor renal excretion, or transcellular shift |
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| Treatment for Hyperkalemia |
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| IV Calcium- reverses hyperkalemia. |
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| cardiac arrythmias, ECG changes (spiked T waves), sudden death |
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| nerve conduction, muscle contraction, coagulation |
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| Where is Calcium absorbed? |
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| in duodenum- if they have had Whipple procedure, issue with calcium absorption |
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| What controls Calcium in serum? |
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| Parathyroid- turns up and down levels of calcium from bone to blood. |
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| Hyperparathyroid Hormone or Malignancy |
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| Symptoms of Hypercalcemia |
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| Fatigue, muscle weakness, depression, anorexia. Can lead to cardiac arrythmias if too high. |
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| Treatment for Hypercalcemia |
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| NS hydration and lasix, sometimes calcitonin (anti PTH) and biphosphonates |
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| Usually post parathyroid surgery. Low albumin because calcium is bound to albumin. |
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| numbness/tinling around mouth, muscle spasms, can lead to tetany. |
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| usually hidden reason that other lytes are unable to be corrected. |
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| High in Renal Failure, avoid foods high in PO4. |
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| Treatment for PO4 and MG abnormality |
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| Acidosis, hyperkalemia (heart issues), volume (cant unload water- CHF,PE), symptomatic uremia |
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| pH/PCO2/PO2/HCO3/Base Deficit |
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pCO2 > 40
Retaining CO2
Sedation, head inury |
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PCO2 < 40
Blowing of CO2
Pain, fever, sepsis, anxiety, hyperventilation |
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| 2 common reasons for Metabolic Acidosis |
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1. Hypoperfusion of tissue (low blood flow) leading to lactic acidosis
2. Renal Impairement and inability to get rid of acids |
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| Hgb O2 dissociating curve |
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| 30 is 60, 60 is 90, 40 is 75 |
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