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40 Cards in this Set

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norms for pH, bicarb, Pco2?
pH < 7.4: acidosis (**7.36)
pH > 7.4 alkalosis (** 7.44)
* bicarb > 25: Met alkalosis; < 25: acidosis;
* PCO2 > 40: resp acidosis, < 40: alkalosis
what's formula to correct metab acidosis?
Na bicarb = wt x 0.3 x base deficit
up 16 months, infants have average bicarb of ?
22
what's renal threshold of bicarb in term neonates?
21
pH 7.15, Pco2: 75?
resp acidosis: morphine; CNS dysnfucntion
pH 7.55, PCO2 25 ?
resp alkalosis
pH 7.55; PcO2 55; bicarb: 48?
met alkalosis w/ resp compensation (hypoventilation):
eg: pyloric stenosis:
pH 7.48, pCO2 20, bicarb 15?
resp alkalosis w/ metabolic compensation;
-high altitude: breathing fast b/c of thin air; ypoxia-->hyperventilation--> resp alkalosis
* compensation: increased excretion of bicarb by kidneys
what's normal AG? and how calc?
AG: 8-12; Na - (Cl + bicarb)
non AG acidosis causes? what's most common?
most common: diarrhea; USED CARP
Ureterostomy
small bowel fistula
extra chloride
Diarrhea
Carbonic anhydrase inhibitors use
adrenal insufficiency
RTA
pancreatic fistula
what presents w / hi ammonia, but no metabolic acidosis;
inborn errors of metabolism; urea cycle defects
lots of urine, high serum osmolatlity; dilute urine; cause and tx?
DI; no ADH; (peeing out all water), leaves you w/ hi serum Na;
tx: drink water adn DDAVP
males, dilute urine, hypernatremic dehydration; ? inheritance?
nephrogenic DI; no response to
GI losses leads to ? Na in urine?
low urine Na (< 10); kidney holds on to Na
low UOP; concentrated urine; cause?
Nl K, hi urine Na (> 25); hi plasma volume; low BUN; hi BP;
causes
urine: high osmoalality, hi [Na]; tx?
SIADH
- surgery, infx, axon (GBS), day after: post op; Head and hemorrhage);
tx: fluid restriction; then duiretic: democlocyline (- ADH) or fludrocortisone
whats maintenance fluid rate for pt w/ renal failure w/ oliguria?
1/3 (calc maint fluid) + urine volume; w/ D5 0.2 NS
what meds cause hyponatremia?
vincristine- SIAdH
cyclosphasmaide: decreased water excretion
thiazide: blocks renal sodium and chloride reabsorption
low serum Na, but total body sodium is NL; urine [Na] is high
-dx?
dilutional hyponatremia
after surgery; low albumin; urine Na < 10; edema; ? cause
third spacing of fliud
weakness, paralysis, constipation and ileus, polyuria; what electrolyte imbalance causes this?
hypokalemia:
-poor intake (AN);
- Loss: 1) Gi: vomiting, diarrhea
- 2) renal (diuretics, RTA, excess aldo)
flat T waves, ST depression, PVC; severe: U wave
Hyopkalemia
weakness, prolonged QT?
hypo calcemia
weaness and diarrhea, prolonged PR or QT
hypmagnesemia
muscle weakness, no EKG changes?
hypoglycemia and hyponatremia
peaked T waves, when ? ; no P waves, wide QRS
hyperkalemia; K > 10
infant w/ abd mass, hypotensive; non palpable pulses, distant heart sounds; EKG: wide QRS;
Whats dx and tx?
hyperkalemia; Calcium gluconate to protect heart;
cause: adrenal failure;
other causes: excess intake, not enuf out (renal failure; hypoladosteronism; redistrubtin (acidosis; H goes into cell, K out);
-cell breakdown (pseudohyperkalemia)
mild cases of hyperkalemia, tx?
glucose/insulin;
-Na bicarb
-inhaled albuterol
-lasix/furosomide
-oral polysterene resin
what does alkalosis do to K and H inside/outside of cell?
alkalosis causs K to move into cell (IC fluid) and moves H out--> lower measured serum potasium;
acidosis causes H to go into cell and K out of cell***
calculate FeNA; and what defines low urinary Na loss vs high urinary Na loss?
FeNA = urine Na/Serum Na // Ur Cr/ Plasma Cr;
low value: FeNa < 1.5: low urinary Na loss; ~ pre renal azotemia
high value FeNa > 2.5: high urinary Na loss
**very symptomatic; diarrhea; long cap refill; usu h/o of juice/water w/ dehydration; when severe ~ sz
hyponatremic dehydration;
tx: 3 % saline solution;
Desired Na - measured Na x wt x 0.6 = A;
maintenance Na : 3 mEq/kg/day
Add Maintenance to A: amount of Na needed to replace over 24 hours
improperly mixed formula, irritable, lethargic, doughy skin, high pitched cry; sz;
hypernatremic dehdyration; Na > 150 ; due to water loss or sodium gain
look good,? na changes?
hypernatremic dehdyration vs hyponatremic dehdyration: causes pontine damage
taccy w/ decreased tear production, low UOP and increased urine concentration; ? how much dehydrated ;and how much short fliuds?
5% = 50 cc/kg;
add this to maintenance fliud = total fliud kid shud receive over 24 hours
-half over first 8 hours; halft over next 16 hours
taccy w/ decreased tear production, + sunken eyes, poor skin turgor, sunken fontanelle;
- ? percent dehydration?
10% = 100cc/kg short;
- over 24 hours , need maintenace + 100cc/kg;
emergency phase: 20 cc/kg over an hour = bolus;
then take whatever left over adn give over next 7 hours; and otehr half over next 16 hours
never drop the Na more than ??? in a 24 hour period?
not more than 10-12 in a 24 hour period or risk of cerebral swelling
taccy w/ decreased tear production, + sunken eyes, poor skin turgor, sunken fontanelle; + shock; delayed cap refill
- ? percent dehydration? and ?fliud deficit
15% dehdyrated + 150 cc/kg;
keep giving 20 cc/kg boluses until see improvement; then give what is left over during next 7 hours AND the rest over next 16 hours
w/ hypernatremic dehdyration; maintence fluid and correction should be calculated for 24 hours; do you need emergency phase ? boluses??
no since ECF volume is maintained ; ?? (pg 205)
? whats best fliud replacement for teen football player?
plain water
?best fliud replacement for toddler w/ vomiting: ?
2-2.5% glucose solution w/ [NA] = 60-90 mEQ/L
toddler 2-3 days V/D; some clear liguids is tolerated, dry mmm; milkd taccy, what's best management?
ORS + regular diet of carbs, fruits, veggs; infants hud get fulls strength formula