Fluids, Electrolytes, And Acid/base

Front 1

Body fluids present in . . .?

Back 1

in cells.
in the space b/t cells and outside blood vessels (interstitial).
in the blood vessels

Front 2

Function of fluid?

Back 2

maintain cell shape-
transport gases, nutrients, wastes-
generate electrical activity-
transform food into energy-

Front 3

Fluid compartments?

Back 3

Intracellular inside cell
Extracellular outside cell
a. interstitial
b. intravascular- fluid of blood.
c. transcellular- in CSF; and in spaces like the peritoneal, pleural, & pericardial cavities.

Front 4

Total Body Water

muscle more than fat*

Back 4

adult male 60% TBW
Adult female has less d/t (more fat)
Obese adults 45% TBW
Elderly adults 45% TBW d/t loss of muscle mass

Front 5

TBW maintained by _____ & ______?

Back 5

thirst and ADH hormone

Front 6

ADH is?

acts on DCT for increased fluid re-absorption.

Back 6

antidiuretic hormone, secreted by posterior pituitary, synthesized by hypothalamus. stimulates kidneys to reabsorb h2o when ECF volume is low

Front 7

Electrolytes

Back 7

substances that dissolve in solution to form ions (+ cation or - anion)
distribution depends on charge.
any + can transfer with another +
same goes for any -

Front 8

ICF

Back 8

contains 2/3 of TBW
potassium is major cation
largest compartment

Front 9

ECF

Back 9

contains 1/3 of TBW-
sodium is major cation but has other cations and anions.
Cl- is main ECF anion
its the ECF levels that are drawn for labs-

Front 10

The distribution of electrolytes b/t body compartments is influenced by _______________?

Back 10

their electrical charge-

Front 11

Movement of H2O

Back 11

osmosis, hydrostatic pressure, colloid osmotic pressure

Front 12

Osmosis

Back 12

fluid moves across a semi-permeable membrane (permeable to H2O) but little else).
moves along a gradient of higher to lower concentrations-

Front 13

Hydrostatic Pressure

Back 13

is the force of the fluid. the pushing force behind the fluid that can push H2O out

Front 14

Osmolarity

Back 14

concentration of molecules in the H2O
it can pull water
usual serum osmality is around 280-295 mOsm/kg, it can increase in volume deficits and decrease in volume excesses

Front 15

Colloid Osmotic Pressure

Back 15

osmotic pressure is the pulling force created by the stuff that cant pass through the membrane.

Front 16

Isotonic IVF

Back 16

concentration of particles is equal to ICF or ECF. 0.9% NaCl is the baseline for %; or 5% dextrose for example. will neither shrink nor swell the cells. Lactated Ringers (LR)

Front 17

Hypertonic IVF

Back 17

concentration of particles is greater than ICF so cells shrink b/c now there is more stuff in the ECF than the ICF. % of solutes will be higher than in baseline 0.9%-
3%NS, D5W in 1/2NS, D10W

Front 18

Hypotonic IVF

Back 18

concentration of dissolved particles is less than ICF so the cells swell b/c now there is more stuff in the ICF than there are in the ECF. % of solutes will be less than in 0.9%. ex. 0.45% or 1/2NS

Front 19

Edema

Back 19

accumulation of fluid within interstitial spaces. edema cant be visually observed until IFV has ^ 2.5 to 3X

Front 20

Edema

Causes?

Back 20

^ capillary hydrostatic pressure in excess fluid volume, some type of venous obstruction.
decreased capillary osmotic pressure in starvation, liver fail
^ capillary permeability: trauma, burns, inflammation

Front 21

Edema

Types?

Back 21

localized with inflammation, injury
thrombophlebitis-
generalized as a result of CHF
pulmonary-
dependent- usually in LE
lymphedema- blocked, or removed (mastectomy)

Front 22

Edema

Assessments for . . .

Back 22

daily wt. gain of 2.2 in 24h is concern
visual, compare sides, monitor I&Os, measure & compare, pitting or not, lung sounds

Front 23

Sodium Balance

Back 23

Na+, most abundant cation in body and in ECF, 135-145 mEq/L, helps regulate H2O, regulates osmolality, helps reg. acid/base b/c part of Na bicarb, nerve impulse,

Front 24

Sodium Balance

regulated by?

Back 24

reg. by the renin-angiotensin-aldosterone system.

aldosterone acts on 'late distal tubule'
to reabsorb Na+, H2O, and excrete K+

Front 25

Hyponatremia

Back 25

low serum sodium levels

less than 135 mEq/L

Front 26

Hyponatremia

Causes?

Back 26

H2O retention (hemodilution) common
loss of Na+ through skin, GI tract, kidneys
^ Na+ shift into cells-
diuretics,

Front 27

Hyponatremia

How it presents?

Back 27

ability to depolarize and repolarize affected: confusion, depressed reflex, seizures, coma, and SxS of fluid of volume overload

Front 28

Hyponatremia

Treatment?

Back 28

strict I&Os, loop diuretic use in volume excess, saline admin, if severe Na+ loss may require hypertonic solution administration.

Front 29

Hypernatremia

Back 29

increased ECF Na+ levels

higher than 145 mEq/L

Front 30

Hypernatremia

Causes?

Back 30

net gain of Na+, net loss of water
rapid infusion of Na+, thirst defect, loss of fluids that have low level Na+, hypodipsia (impaired thirst),

Front 31

Hypernatremia

How it presents?

Back 31

dry skin, dry M&Ms, lowered salivatory and tear production, or signs associated with fluid volume deficits, neuro signs for sure

Front 32

Hypernatremia

Treatment?

Back 32

focus on underlying cause
sodium restrict intake, oral hydration preferred

Front 33

Potassium

Back 33

normal level 3.5-5.5 mEq/L
major cation of ICF
most in muscle so losses occur with age as muscle mass loss

Front 34

Potassium Balance

Regulation?

Back 34

aldosterone - saves Na+ kicks K+
Insulin causes K+ to move from ECF back to cells-
Na+/K+ pump,
K+/H+ exchange system- K+ gets excreted in urine and gets replaced by H+ (one for one)

Front 35

Hypokalemia

Back 35

decreased serum K+ < than 3.5 mEq/L

Front 36

Hypokalemia

Causes?

Back 36

inadequate nutrition, excess loss @ GI tract or skin, diuretics (Loop), metabolic alkalosis promotes movement of K+ into cells in exchange for H+,

Front 37

Hypokalemia

How it presents?

Back 37

postural hypotension, EKG changes, arrhythmia, muscle weak & cramps, decrease GI motility, K+ is abundant in myocardium.

Front 38

Hypokalemia

Treatment?

Back 38

focus on underlying cause-
^ dietary intake- fresh fruit veggies, salt subs
K+ supplements-
IV K+CL- (NO IV PUSH FOR K+)

Front 39

Hyperkalemia

Back 39

serum K+ greater than 5.5 mEq/L

Front 40

Hyperkalemia

Causes?

Back 40

RF most common as decreased renal elimination.
cell injury leading to K+ into ECF
metabolic acidosis b/c of the relationship b/t K+ and H+!!!
rapid IV K+

Front 41

Hyperkalemia

How it presents?

Back 41

earliest symptom is paresthesias
general muscle weakness/dyspnea
EKG changes

Front 42

Hyperkalemia

Treatment?

Back 42

goals are to prevent complications, treat underlying cause(s)-
restrict K+ intake
Loop diuretics
kayexalate- med that assist with cation exchange
Hemodialysis
Insulin & glucose ^ cell uptake of K+

Front 43

Calcium Ca+

Back 43

serum range of 8.5-10.5 mg/dL
forms bone and teeth, assist in membrane permeability, impulse transmission, affects muscular contractions cardiac, smooth, and skeletal (it calms). promotes blood clotting b/c its required for all but 2 steps of the process

Front 44

Calcium

Regulation?

Back 44

reg by parathyroid gland, Calcitonin takes out of ECF, albumin levels b/c about 1/2 Ca+ is bound to the protein, Vitamin D needed to absorb Ca+
Phosphorus-inverse relationship

Front 45

Hypocalcemia

Back 45

Ca+ < than 8.5 mg/dL

Front 46

Hypocalcemia

Causes?

Back 46

intake issues, RF d/t to inability for kidney to activate vitamin D for Ca+ absorption and also leads to ^ phosph.
hypoparathyroidisim
diarrhea, lack of vitamin D, diuretics

Front 47

Hypocalcemia

How it presents?

Back 47

paresthesias, tetany, dysrythmias, fractures, bone pain, osteoporosis
^ risk of bleeding-

Front 48

Hypocalcemia & Tetany

Tetany is involuntary muscle contractions-

Back 48

Chvostek's sign is tapping on face under temple where facial nerve emerges to elicit twitch in lip, nose, etc.

Trousseau's sign uses BP cuff inflated for 3 minutes to look for contraction of fingers and hand.

Front 49

Hypocalcemia

Treatment?

Back 49

identify cause. if Tetany present IV Ca+ slowly. ^ oral intake of Ca+ & vitamin D.

Front 50

Hypercalcemia

Causes?

Back 50

serum Ca+ above 10.5 mg/dL

hyperparathyroidism, some CA produce ectopic PTH, prolonged immobilization

Front 51

Hypercalcemia

How it presents?

Back 51

decreased neuromuscular excitability, dull consciousness-even stupor
bradycardia & dysrythmias
constipation, possible Kx stones

Front 52

Hypercalcemia

Treatment?

Back 52

hydratation, loop diuretics

Front 53

The Acid / Base balance system-

Back 53

imbalances are due to changes in H+ concentration-

Acid is a molecule that release H+
Base is a molecule capable of combing with, or accepting H+

Front 54

Carbonic Acid (H2CO2)

Bicarbonate (HCO3)

Back 54

a weak acid derived from CO2

is a weak base-

Front 55

pH and H+ have what kind of relationship?

Normal pH is 7.35 - 7.45

Back 55

an inverse relationship-
a decrease in H+ raises pH = alkalosis

a ^ in H+ lowers pH = acidosis

Front 56

Normal ABG values

Back 56

pH is 7.35 - 7.45
< pH = acidosis, > pH = alkalosis
PaCO2 is 35 - 45
< PaCO2 = alkalosis
> PaCO2 = acidosis
HCO3 is 22-26
< HCO3 = acidosis
> HCO3 = alkalosis

Front 57

AbNormal ABG values

When HCO3 is mostly affected it is of a metabolic origin-

Back 57

Metabolic Alkalosis is characterized by pH > 7.45 & HCO3 > 26

Front 58

AbNormal ABG values

When PaCO2 is mostly affected it is of a respiratory origin-

Back 58

Respiratory Acidosis is characterized by pH < than 7.35 & PaCO2 > 45
Respiratory Alkalosis is characterized by pH > 7.45 & PaCO2 < 35

Front 59

Acid / Base

Regulators, how many mechanisims? What are they?

Back 59

3 systems.
ICF & ECF chemical buffers
Respiratory system
Kidneys/Renal system

Front 60

ICF & ECF chemical buffers
immediate effects-

Protein buffer system

Back 60

Protein Buffer System
largest system in body, immediate effect, Fx as either acid or base, located within cells mostly H+ & CO2 diffuse across membrane by intracellular proteins.

Front 61

ICF & ECF chemical buffers

Bicarbonate buffer system

Back 61

uses H2CO3 (carbonic acid) as its weak acid and HCO3 (bicarb) as its weak base. very efficient system.

Front 62

ICF & ECF chemical buffers

H+ & K+ exchange system

Back 62

can move freely b/t cells and exchange from ICF to ECF.

Front 63

Respiratory system
PaCO2 of 35 - 45 normal
effects within minutes to hours
When metabolic imbalance the compensatory mech. is respiratory-

Back 63

works through elimination or holding of CO2.
hypoventilation 'holding of CO2' decreases pH = acidosis.
hyperventilation 'blowing off CO2'
increases pH = alkalosis

Front 64

Renal System
HCO3 of 22-26 mEq/L normal
makes long term adjustments in pH-
not immediate, but long lasting effect-

Back 64

makes its long term adjustments to pH by producing and reclaiming bicarb and through the reabsorbing and/or excreting of H+

Front 65

Renal System

When there is a respiratory imbalance the compensatory mechanism is the metabolic pathway-

Back 65

the kidneys will produce or reclaim bicarb and excrete or reabsorb H+

Front 66

Metabolic Acidosis

Characterized by?

Back 66

pH < than 7.35 &
HCO3 < than 22 mEq/L

Front 67

Metabolic Acidosis

Causes?

Back 67

^ production/ingestion of acids
excess lactic acid production that occurs w/ exercise, shock, cardiac arrest; Renal failure, ^ bicarb loss through diarrhea, gut suctioning; ketoacidosis

Front 68

Metabolic Acidosis

How it presents?

Back 68

marked to progressive weakness, fatigue, progressing to coma or stupor-
dysrythmias, N&V, abdm pain, increased respirations rapid and deep
'Kussmaul's respirations

Front 69

Metabolic Acidosis

Treatment?

Back 69

compensatory is ^ respirations rapid and deep (although not exactly an immediate occurrence) to blow off more CO2 and increase pH -
may give sodium bicarb-
monitor K+ b/c of the rapid effects of the exchange buffer system with H+
mechanical ventilation as needed-

Front 70

Metabolic Alkalosis

Characterized by?

Back 70

pH > than 7.45 &
HCO3 > than 26 mEq/L

Front 71

Metabolic Alkalosis

Causes?

Back 71

excess bicarb intake-
^ bicarb retention-
excess H+ dumping d/t vomiting or NG suction-

Front 72

Metabolic Alkalosis

How it presents?

Back 72

many are asymptomatic-
respirations slow and shallow to hold more CO2 to decrease the pH-
SxS of hypokalemia: ekg changes, postural hypotension, muscle cramp, decrease GI motility

Front 73

Metabolic Alkalosis

Treatment?

Back 73

monitor for decreased serum K+ b/c of exchange buffer system with H+
correct cause-
KCl & IV fluids,

Front 74

Respiratory Acidosis

Characterized by?

Back 74

pH < than 7.35 &
PaCO2 > 45 mm Hg

Front 75

Respiratory Acidosis

Causes?

Back 75

Acute: narcotic OD (depressed RR), lung diseases, chest injuries, airway obstructions, anything that can impair good gas exchange:
Chronic: COPD, Carbohydrate rich diets (they produce large amounts of CO2)

Front 76

Respiratory Acidosis

How it presents?

Back 76

SxS related to hypoxemia leading to hypoxia- restlessness & anxiety, progressing to decreased level of consciousness to coma- increase ICP d/t cerebral vasodilation r/t hypercapnia
tachycardia, diaphoresis, rapid shallow respirations. Cyanosis as a late sign-

Front 77

Respiratory Acidosis

Treatment?

Back 77

improve ventilation, correct underlying cause if can:
Compensation for an acute respiratory acidosis is by intracellular buffering with proteins and phosphates. Compensation for chronic, or more long term is renal retention of bicarbs.

Front 78

Respiratory Alkalosis

Characterized by?

Back 78

pH > than 7.45 &
PaCO2 < 35 mm Hg

Front 79

Respiratory Alkalosis

Causes?

Back 79

hyperventilation as with panic attacks, anxiety, severe pain, and fever, etc.
blowing off too much CO2:
hypoxemia, pneumonia, and other things that cause increased respirations

Front 80

Respiratory Alkalosis

How it presents?

Back 80

restlessness, anxiousness, dizziness,
decreased ICP, eventual inhibition of respiratory drive d/t lowered CO2 (CO2 is the stimulant to breathe), cerebral vasoconstriction, cardiac arrhythmias, decrease myocardial contractility, hypocalcemia

Front 81

Respiratory Alkalosis

Treatment?

Back 81

O2 to prevent hypoxemia, correct underlying cause, breath in bag,