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44 Cards in this Set
- Front
- Back
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Hyponaturemia - Causes
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GI Losses: Vomiting, diarrhea, NG suctioning
Renal Loss: Kidney disease resulting in salt waisting; diuretics; adrenal insufficiency Skin Loss: excessive perspiration, burns Psychogenic polydipsia Syndrome of Inappropriate ADH (SIADH) |
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Hyponaturemia - Physical Examination
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Apprehension, personality change, postural hypotenion, postural dizziness, abd cramping, nausea and vomiting, tachycardia, dry mucous membranes, convulsions and coma
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Hyponaturemia - Lab Findings
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Serum sodium level below 135 mEq/L
Serum osmolality 280 mOsm/kg Urine specific gravity below 1.010 (If not caused by SIADH) |
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Hypernaturemia - Causes
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Excess salt intake: ingestion of large amounts of concentrated salt solutions, iatrogenic administration of hypertonic saline solution parenterally
Excess aldosterone secretion Diabetes insipidus Increased sensible and insensible water loss Water deprivation |
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Hypernaturemia - Physical Examination
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Extreme thirst, dry flushed skin, dry and sticky tongue and mucous membranes, postural hypotenision, fever, agitation, convulsions, restlessness, and irritability
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Hypernaturemia - Lab Findings
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Serum sodium levels above 145 mEq/L
Serum osmolality 300mOsm/kg Urine specific gravity 1.030 (if not caused by diabetes insipidus) |
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Hypokalemia - Causes
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Use of potassium waisting diuretics
Diarrhea, vomiting, or other GI losses Alkalosis Excess aldosterone secretion Polyuria Extreme sweating Excessive use of K+ free IV solutions Treatment of diabetic ketoacidosis with insulin |
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Hypokalemia - Physical Examination
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Weakness and fatigue, muscle weakness, nausea and vomiting, intestinal distention, decreased bowel sounds, decreased deep tendon reflexes, ventricular dysrhythmias, paresthesias and weak, irregular pulse.
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Hypokalemia - Lab Findings
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Serum potassium levels below 3.5 mEq/L
ECG abnormalities: flattened T wave, ST segment depression, U wave, potentiated digoxin effects (ventricular dysrhythmias) |
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Hyperkalemia - Causes
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Renal failure
FVD Massive cellular damage (Trauma or burns) Iatrogenic administration of large amount of K+ Intravenously Adrenal Insufficiency Acidosis, especially diabetic ketoacidosis Rapid infusion of stored blood Use of K+ sparing diuretics Ingestion of K+ salt substitutes |
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Hyperkalemia - Physical Examination
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Anxiety, dysrhythmias, paresthesia, weakness, abd cramps, diarrhea
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Hyperkalemia - Lab Findings
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Serum K+ level above 5.0 mEq/L
ECG abnormalities: peaked T wave, widened QRS complex (bradycardia, heart block, dysrhythmias); eventually QRS pattern widens and cardiac arrest occurs. |
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Hypocalcemia - Causes
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Rapid administration of blood transfusions containing citrate
Hypoalbuminemia Hypoparathyroidism Vit D deficiency Pancreatitis Alkalosis Chronic renal failure (kindeys unable to eliminate phosphate causes decrease in calcium) Chronic alcoholism |
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Hypocalcemia - Physical Examination
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Numbness and tingling of the fingers and cumoral area, hyperactive reflexes, positive Trousseau's sign (carpopedal spasm with hypoxia), positive Chvostek's sign (contraction of facial muscles when facial nerve is tapped), tetany, muscle cramps, and pathological fractures (chronic hypocalcemia)
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Hypocalcemia - Lab Findings
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Serum ionized calcium below 4.5 mEq/L
Total serum calcium below 8.5 mg/dL ECG abnormalities: ventricular tachycardia |
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Hypercalcemia - Causes
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Hyperparathyroidism
Osteometastasis Osteoporosis Paget's disease Prolonged Imobilization Acidosis Thiazide diuretics |
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Hypercalcemia - Physical Examination
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Anorexia, nausea and vomiting, weakness, hypoactive reflexes, lethargy, flank pain from kidney stones, decresed LOC, personality changes, and cardiac arrest
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Hypercalcemia - Lab Findings
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Serum ionized calcium above 5.5 mEq/L
Total serum calcium about 10.5 kg/dL X-ray examination showing generalized osteoporosis, widespread bone cavitation Radiopaque uninary stones Elevaled BUN level 25mg/100mL Elevaled creatine level 1.5mg/100mL caused by FVD or renal damage caused by urolithiasis ECG abnormalities: heart block |
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Hypomagnesemia - Causes
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Inadequate intake: malnutrition or alcoholism
Inadequate absorption or loss: diarrhea, vomiting, NG drainage, fistulas, or diseases of the SI Excessive loss resulting from thiazide diuretics Aldosterone excess Polyuria |
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Hypomagnesemia - Physical Examination
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Muscular tremors, hyperactive deep tendon reflexes, confusion and disorientation, tachycardia, hypertension, dysrhythmias, and positive Trousseau and Chvostek's signs.
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Hypomagnesemia - Lab Findings
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Serum magnesium level below 1.5 mEq/L
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Hypermagnesemia - Causes
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Renal Failure
Excess oral or parenteral intake of magnesium |
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Hypermagnesemia - Physical Examination
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Acute elevations in magnesium levels: hypoactive deep tendon reflxes, decreased depth and rate of respirations, hypotenison, and flushing.
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Hypermagnesemia - Lab Findings
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Serum Magnessium level above 2.5 mEq/L
ECG abnormalities: prolonged QT interval, AV block |
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Isotonic Imbalances: FVD - Causes
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GI losses: diarrhea, vomiting or drainage from fistulas or tubes
Loss of plasma or whole blood, such as with burns or hemorrhage Excessive perspiration Fever Decreased oral intake of fluids Use of diuretics |
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Isotonic Imbalances: FVD - Physical Examination
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Postural hypotension, tachycardia, dry mucous membranes, poor skin tugor, thirst, confusion, rapid weight loss, slow vein filling, flat neck veins, lethargy, oliguria (<30 mL/hr), weak pulse
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Isotonic Imbalances: FVD - Lab Findings
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Urine specific gravity >1.030
Increased hemotocrit level >50% Increased BUN >25 mg/100mL (hemoconcentration) |
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Isotonic Imbalances: FVE - Causes
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CHF
Renal failure Cirrhosis of the liver Increased serum aldosterone and steriod levels Excessive sodium intake or administration |
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Isotonic Imbalances: FVE - Physical Examination
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Rapid weight gain, edema (especially in dependant areas), hypertension, polyuria (if renal mechanisms and normal), neck vein distention, increased blood and venous pressure, crackles in lungs, confusion.
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Isotonic Imbalances: FVE - Lab Findings
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Decreased hemotocrit levels <38%
Decreased BUN levels <10 mg/100 mL (hemodilution) |
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Osmolar Imbalances: Hyperosmolar Imbalance (Dehydration) - Causes
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Diabetes insipidus
Interruption of neurologicaly driven thirst drive Diabetes ketoacidosis Osmotic diuresis Administration of hypertonic parenteral fluids or tube feeding formulas |
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Osmolar Imbalances: Hyperosmolar Imbalance (Dehydration) - Physical Examination
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Dry and sticky mucous membranes, flushed dry skin, elevated body temp, irritability, convulsions, coma
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Osmolar Imbalances: Hyperosmolar Imbalance (Dehydration) - Lab Findings
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Increased serum sodium level >145 mEq/L
Increased serum osmolality >295 mOsm/kg |
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Osmolar Imbalances: Hypoosmolar Imbalance (Water excess) - Causes
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SIADH
Excess water intake |
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Osmolar Imbalances: Hypoosmolar Imbalance (Water excess) - Physical Examination
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Decreased LOC, convusions, coma
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Osmolar Imbalances: Hypoosmolar Imbalance (Water excess) - Lab Findings
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Decreased serum sodium level <135 mEq/L
Decreased serum osmolality <280 mOsm/kg |
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Osmolar Imbalances: Hypoosmolar Imbalance (Water excess) - How would you treat it?
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Administer loop diuretics
Hyper or Iso saline solutions Restrict fluids and increase sodium intake. |
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Sodium Na+ (Range)
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135-145 mEq/L
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Potassium K+ (Range)
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3.5-5.0 mEq/L
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Calcium Ca2+ (Range- Ionized and Total)
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Ionized: 4.5-5.5 mg/dL
Total: 8.5-10.5 mg/dL |
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Bicarbonate HCO3- (Range- arterial and venous)
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Arterial: 22-26 mEq/L
Venous: 24-30 mEq/L |
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Chloride Cl- (Range)
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95-105 mEq/L
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Magnesium Mg2- (Range)
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1.5-2.5 mEq/L
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Phosphate Po43- (Range)
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2.8-4.5 mg/dL
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