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184 Cards in this Set
- Front
- Back
- 3rd side (hint)
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What percent of the body weight is water in adults?
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60 percent
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Where is body water excreted?
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kidneys, skin, lungs
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How is water maintained?
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by balance between intake and excretion
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What are the two main fluid compartments?
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Intracellular fluid
Extracellular fluid |
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ICF
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Intracellular Fluid
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ECF
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Extracellular Fluid
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ICF approximates ____ of total body water?
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2/3
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ECF represents ____ of total body water?
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1/3
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What are the primary electrolytes in ICF?
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K+, Mg++, PO4
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What are the two divisions of ECF?
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Intravascular water
Interstitial water |
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What fraction of ECF is intravascular water?
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1/4
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What fraction of ECF is interstitial water?
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3/4
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What are the primary ECF electrolytes?
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Na+, Cl-, HCO3-
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Definition: Transport system on cellular membrane that maintains electrolyte differences?
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Na-K-ATP-ase transport system
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Where is the transport system located?
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on the cellular membrane
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Normal range of Sodium?
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135-145 mEq/L
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Normal range of Potassium?
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3.5-5.0 mEq/L
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Normal range of Chloride?
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96-100 mEq/L
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Normal range of BUN?
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8-20 mg/dL
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Normal range of Serum Creatinine?
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0.6-1.2 mg/dL
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Normal range of Calcium?
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8.5-10.8 mg/dL
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Normal range of Ionized Calcium?
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4.6-5.2 mg/dL
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What is the equation for Corrected Calcium?
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Corrected Calcium = Observed Ca + (Normal Albumin - Observed Albumin)
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What is an alternate equation for Corrected Calcium?
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Calcium Corrected = [(4.0-normal albumin) (0.8mg/dL)] + Calcium observed
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Description: Body water moves freely from areas of low to areas of high osmolality to maintain osmotic equilibrium of all body compartments.
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Osmolality
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How is osmolality determined?
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by the number of particles (ions) in solution
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BUN
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Blood, Urea, Nitrogen
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What is the best way to assess the net gain or loss of fluid?
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Weigh the patient
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Description: Decrease in volume of both ECF and ICF with an increase in solute concentration, results in increased release of ADH
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Water Deficit (Water Depletion)
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Description: Expansion of both ECF and ICF with a corresponding decrease in solute concentration, resulting in reduced secretion of ADH
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Water Excess (Dilution Syndrome)
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How much does a gallon of water weigh?
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8 pounds
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SIADH
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Syndrome of inappropriate antidiuretic hormones
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Symptoms: Excessive release of ADH, preserves H2O
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SIADH
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--|--|--<
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Na, Cl, BUN
K, CO2, SCr glucose (<) |
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SMA7
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Sequential multiple analyzer
--|--|--< |
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What is the predominant CATION of ECF?
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Sodium
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What are the three types of Hyponatremia?
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Hypervolemic
Hypovolemic Euvolemic |
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What usually causes Euvolemic Hyponatremia?
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SIADH
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Major intracellular cation?
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Potassium
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Most abundant extracellular anion?
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Chloride
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Main function of chloride?
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maintain extracellular osmolality
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Main function of chloride?
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maintain extracellular osmolality
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What percentage of body weight is represented by Calcium?
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2%
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What percent of total body calcium is in solution?
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0.5%
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What percent of calcium is integrated into bones?
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99.5%
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This usually occurs in patients with DM
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Hyperglycemia (high blood sugar)
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People in a hyperosmolal state have ____________ and ____________.
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hyperglycemia; hypernatremia
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People in a hypoosmolal states have __________________.
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hyponatremia
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The following lab findings are consistent with what condition?: Incresed Se glucose, increased BUN Scr, Increased or decreased K+ and Na+
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hyperglycemia
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The following lab findings are consistent with what condition?:
Increase solute concentration, increased BUN, Scr, Increased urine specific gravity and osmolality |
Water deficit
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The following lab findings are consistent with what condition?:
Dilution of solutes (low Se sodium and protein), low BUN, low plasma osmolality |
Water excess
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The following lab findings are consistent with what condition?:
elevated Se sodium and osmolality, increased BUN reflects decreased renal perfusion, elevated urine osmolality |
Hypernatremia
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The following lab findings are consistent with what condition?:
low Se sodium, possibly elevated BUN and Scr |
Hyponatremia
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The following lab findings are consistent with what condition?:
elevated Se K+, evidence of renal impairment, EKG findings |
Hyperkalemia
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The following lab findings are consistent with what condition?:
Decreased Se K+, EKG findings |
Hypokalemia
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The following lab findings are consistent with what condition?:
decreased calcium, decreased albumin, phosphate usually elevated, magnesium is usually low, EKG changes |
hypocalcemia
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What is the fnx of a diuretic?
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Eliminated H2O
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What is the fnx of an antidiuretic?
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preserve H2O
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Which electrolyte establishes osmotic pressure relationships betweein ICF and ECF?
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sodium
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Which type of hyponatremia may be due to excess body water relative to sodium?
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Hypervolemic Hyponatremia
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Which type of hyponatremia may be due to total body depletion of sodium caused by excesive use of diuretics, chronic renal failure, etc.?
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Hypovolemic Hyponatremia
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Which type of hyponatremia may occur with normal ECF volume commonly caused by SIADH?
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Euvolemic Hyponatremia
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How many mEq/kg of Potassium does the body store?
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45-55 mEq/kg
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How many mEq of Potassium are excreted daily?
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35-100mEq
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What organ predominately excretes potassium?
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Kidneys
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Which electrolyte helps maintain extracellular osmolality?
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Chloride
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Which enzyme is regulated by the renal proximal tubules?
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Chloride
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What happens to Chloride in the renal proximal tubules?
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It is exchanged for bicarbonate ions
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Which electrolyte passively flows with sodium and water throughout the nephron?
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chloride
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Serum level is responsive to what 2 hormones?
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Calcitonin and PTH
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Parathyroid Hormone
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Secreted in response to low circulating ionized calcium; increased absorbtion from SI
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Calcitonin
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Opposite PTH; secreted by C cells of thyroid gland in response to low levels of ionized calcium
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__________ and ___________ influnce Ca2+ regulation
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Vitamin D; phosphate
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Vitamin D
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helps absorption of calcium; activated by sunlight and in the liver
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What organ excretes calcium?
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kidneys
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Which enzyme plays a central role in muscle contraction?
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Calcium
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What is the corrected calcium level for pt with Hyper calcemia? (mg/dl)
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greater than 10.8 mg/dl
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What is the formula for Corrected Calcium?
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Corrected Ca = Observed Calcium + (Normal Albumin - Observed Albumin)
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Lab Findings - increased serum calcium; must be interpreted with albumin
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Hypercalcemia
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What is the corrected calcium level for pt with Hypocalcemia? (mg/dl)
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less than 8.5 mg/dl
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Chvosteks sign is a clinical finding in what condition?
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hypocalcemia
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Trousseau's sign is a clinical finding in what condition?
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Hypocalcemia
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What is Chvostek's sign?
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Unilateral spasm in a facial nerve (hypocalcemia)
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What is Trousseau's sign?
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BP cuff in upper arm gives a carpal spasm (found in hypocalcemia)
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What is the range for urine volume in a normal adult? (ml/d)
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1000-1500 ml/d
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What percentage of water intake is excreted daily?
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50%
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What is the normal range for Magnesium?
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1.5-2.5 mEq/L
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What is the normal range for Phosphorus?
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2.5-5.0 mg/dL
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Which electrolyte is a cofactor for the phosphorylation of ADP to ATP?
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Magnesium
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What is the breakdown of Magnesium? (bone, intracellular, extracellular)
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50% in insoluble state in bone
45% intracellular 5% extracellular |
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What percent of Mg exists in insoluble state in bone?
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50%
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What percent of Mg exists in intracellular state?
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45%
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What percent of Mg exists in extracellular state?
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5%
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What fraction of Mg is bound to protein?
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1/3
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What fraction of Mg is a free cation?
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2/3
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How is Mg excreted?
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via the kidney
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Which enzyme is an activator ion, participating in the fnx of many enzymes involved in phosphate transfer reaction?
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Magnesium
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Which electrolyte exerts physiologic effects on nervous system similar to Ca2+?
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Magnesium
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Alterations in serum Mg2+ usually provokes an associated alteration in _____?
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Ca2+
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Alterations in serum _____ usually provokes an associated alteration in Ca2+.
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Mg2+
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What condition is almost always caused by the reuslt of renal insuffficiency and the inability to excrete what has been taken in by food or drugs?
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Hypermagnesemia
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The following lab findings are consistent with what condition?:
Elevated serum Mg2+, Scr, BUN, PO4, K+ and uric acid may be elevated; serum Ca2+ often low, EKG changes |
Hypermagnesemia
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What are athetoid movements?
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spastic movements (common in cerebal palsy)
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What is nystagmus?
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Abnormal eye movement (cross eyed)
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What is a positive Babinski response?
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Run finger on the sole of foot from heel to toe and the big toe flexes up; common in pt with meningitis.
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s/s of hypOmagnesemia
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A positive Babinski response is a sign and symptom for what condition?
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Hypomagnesemia
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The following lab findings are consistent with what condition?:
Serum Mg2+ is low, hypocalcemia and hypokalemia are often present, EKG changes |
Hypomagnesemia
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What type of relationship exists between magnesium and acetylcholine?
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Inverse
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What percent of phosphorus is combined with Ca2+ in bones and teeth?
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80%
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What percent of calcium is incorporated in a variety of organic compounds?
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10%
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What percent of Phosphorus is combined with proteins, lipids, CHO and other compounds muscle and blood?
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10%
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What is the breakdown of phosphorus? (bones/teeth, organic cmpds, proteins/lipids)
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80% - bones, teeth
10% - organic cmpds 10% - proteins, lipids, CHO, etc. |
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Which enzyme is the integral agent in energy transfer and in metabolism of CHO, protein and fat?
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Phosphorus
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Which enzyme is the primary urinary buffer?
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Phosphorus
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In which enzyme are the metabolism and homeostasis intimately related to Ca2+ metabolism?
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Phosphorus
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Decrease in ________ or ________ can cause Hypophosphatemia?
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phosphate; vitamin D
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Patients with Hypophosphatemia are often asymptomatic until the level is below ______ mg/dL?
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2 mg/dl
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The following lab findings are consistent with what condition?:
low serum phosphate levels, often asymptomatic, neurological irritability, evidence of anemia due to hemolysis, elevated serum CK, bone changes similar to osteomalacia |
Hypophosphatemia
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What is rhabdomyolysis?
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elevated serum CK
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Intracellular shifting is a cause of what disease state?
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Hypophosphatemia
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A phosphate shift from intracellular to extracellular fluid causes what disease state?
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Hyperphosphatemia
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Hyperphosphatemia is caused by a phosphate shift from ___________ fluid to _____________ fluid.
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intracellular; extracellular
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An increased intake of vitamin D or phosphate drugs can cause this disease state.
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Hyperphosphatemia
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Vitamin D can increase absorption of phosphate by up to ____%.
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50%
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__________ can increase the absorption of phosphate by up to 50%.
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Vitamin D
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What disease state is uncommon in patients with normal kidney function?
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Hyperphosphatemia
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What is calciphylaxis?
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Precipitation of calcium phosphate crystals in arteries, joints and soft tissues
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The following lab findings are consistent with what condition?:
Serum phosphate levels higher than 5mg/dL |
hyperphosphatemia
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Deposition of calcium-phosphate crystals and include red eye and pruritis are clinical findings in what disease state?
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Hyperphosphatemia
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Causes of water deficit
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Etiologies: reduced intake; unusual losses (GI, diuretics, fluid lossses due to kidney disorders)
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Etiologies: reduced intake of water; unusual losses (GI, diuretics, fluid lossses due to kidney disorders)
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water deficit
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s/s: weight loss, thirst, flushed and loose skin, "dehydrated" appearance (sunken eyes, dry mucous membranes), orthostatic hypotension, tachycardia, oliguria, absence of axillary sweat, hallucination, delirium, coma
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water deficit/depletion
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s/s of water deficit/depletion
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s/s: weight loss, thirst, flushed and loose skin, "dehydrated" appearance (sunken eyes, dry mucous membranes), orthostatic hypotension, tachycardia, oliguria, absence of axillary sweat, hallucination, delirium, coma
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Etiologies of dilution syndrome/water excess
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-decreased excretion of water
-excessive renal sodium and water retention (as in heart failure, renal failure, nephrotic syndrome, cirrhosis) -SIADH |
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-decreased excretion of water
-excessive renal sodium and water retention (as in heart failure, renal failure, nephrotic syndrome, cirrhosis) -SIADH |
water excess/dilution syndrome
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S/S of Water excess/dilution syndrome
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S/S: weight gain, edema, headache, nausea, vomiting, abdominal cramps, dyspnea, jugular venous distention, rales on pulmonary exam, weakness, stupor, convulsion, coma
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S/S: weight gain, edema, headache, nausea, vomiting, abdominal cramps, dyspnea, jugular venous distention, rales on pulmonary exam, weakness, stupor, convulsion, coma
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water excess/dilution syndrome
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Causes of Hypernatremia
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Etiologies:
-deficit of water relative to sodium -loss of water that is not replaced -water loss exceeding sodium losses (fever, burns, renal loses during osmotic diuresis) -Sodium excess with NaCl ingestion |
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Etiologies:
-deficit of water relative to sodium -loss of water that is not replaced -water loss exceeding sodium losses (fever, burns, renal loses during osmotic diuresis) -Sodium excess with NaCl ingestion |
hypernatremia
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S/S of hypernatremia
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S/S: thirst, weight loss, flushed loss skin, tachycardia and hypotension, oliguria, irritability, ataxia, spasticity, confusion, seizures
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What is ataxia?
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lack of coordination
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S/S: thirst, weight loss, flushed loss skin, tachycardia and hypotension, oliguria, irritability, ataxia, spasticity, confusion, seizures
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hypernatremia
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S/S of hyponatremia
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S/S: thirst, faintness, dizziness, dry mucosa, loss of skin tugor, tachycardia, orthostatic hypotension, oliguria, edema, headache, N/V, convulsion, coma
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S/S: thirst, faintness, dizziness, dry mucosa, loss of skin tugor, tachycardia, orthostatic hypotension, oliguria, edema, headache, N/V, convulsion, coma
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Hyponatremia
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Loss or retention by the kidney depends on...
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-Renin-angiotensinogen-aldosterone effects
-blood pH -serum potassium concentration -GFR |
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Etiologies:
-Diminisehd excretion -Increased supply of K+ -Endocrine Diseases (Addisons disease) -Metabolic acidosis -Cell Lysis -Drugs (NSAIDS, Heparin) |
hyperkalemia
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Etiologies of hyperkalemia
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Etiologies:
-Diminisehd excretion -Increased supply of K+ -Endocrine Diseases (Addisons disease) -Metabolic acidosis -Cell Lysis -Drugs (NSAIDS, Heparin) |
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Hyper-
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increase
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Hypo-
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Decrease
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S/S of Hyperkalemia
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S/S: weakness, abdominal distention, diarrhea, cardiac abnormalities (slow heart rate, ventricular fibrillation, cardiac arrest)
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S/S: weakness, abdominal distention, diarrhea, cardiac abnormalities (slow heart rate, ventricular fibrillation, cardiac arrest)
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hyperkalemia
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Etiologies of Hypokalemia
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Etiologies:
-poor intake of K+ -reduced absorption of K+ -increased loss (GI, renal, skin, drugs, hypokalemia without deficit) |
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Etiologies:
-poor intake of K+ -reduced absorption of K+ -increased loss (GI, renal, skin, drugs, hypokalemia without deficit) |
hypokalemia
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What causes Hypokalemia without deficit?
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insulin, albuterol, etc.
K+ shifted from ECF to ICF |
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S/S of hypokalemia
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S/S: muscle cramping/weakness, parathesias, hyporeflexia
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S/S: muscle cramping/weakness, parathesias, hyporeflexia
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hypokalemia
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What are the two main indications of Hypochloremia/Hyperchloremia?
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1. Can indicate a change in fluid status
2. Can indicate an acid-base abnormality |
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Which two disease states
1. Can indicate a change in fluid status 2. Can indicate an acid-base abnormality |
Hypochloremia and Hyperchloremia
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Etiologies of Hypercalcemia
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Etiologies:
-Increased intake or absorption of Ca+ -Endocrine disorders -Neoplastic disorders -Drugs (ie: Tums,Lithium) |
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Etiologies:
-Increased intake or absorption of Ca+ -Endocrine disorders -Neoplastic disorders -Drugs (ie: Tums,Lithium) |
hypercalcemia
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What are neoplastic disorders?
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Cancers that stimulate osteoclast activity
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Etiologies of hypercalcemia
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Etiologies:
-Increased intake or absorption of Ca+ -Endocrine disorders -Neoplastic disorders -Drugs (ie: Tums,Lithium) |
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S/S of hypercalcemia
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S/S: anorexia, N/V, constipation, polyuria, muscle weakness and hyporeflexia, tremor, lethargy, confusion
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S/S: anorexia, N/V, constipation, polyuria, muscle weakness and hyporeflexia, tremor, lethargy, confusion
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hypercalcemia
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Causes of hypocalcemia
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Etiologies:
-decreased intake or absorption of Ca++ -Increased loss of Ca++ -Endocrine disease -Physiologic causes |
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Etiologies:
-decreased intake or absorption of Ca++ -Increased loss of Ca++ -Endocrine disease -Physiologic causes |
hypocalcemia
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S/S of hypocalcemia
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S/S: muscle cramps, tetany, convulsions, stupor and dyspnea, dipopia, abdominal cramps, urinary frequency, Chvostek's sign, Trousseau's sign
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S/S: muscle cramps, tetany, convulsions, stidor and dyspnea, dipopia, abdominal cramps, urinary frequency, Chvostek's sign, Trousseau's sign
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Hypocalcemia
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Calculate the Corrected Calcium for the following (using BOTH equation):
Albumin = 1.9 Ca Uncorrected = 7.7mg/dL |
Calcium corrected = [(4.0-1.9)(0.8mg/dL)] + 7.7mg/dL = 9.38mg/dL
_____________________________ Calcium corrected = 7.7mg/dL + (4.0-1.9) = 9.8mg/dl |
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What disease state is almost always caused by the result of renal insufficiency and the inability to excrete what has been takin in by food or drugs?
|
Hypermagnesemia
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Main cause of Hypermagnesemia
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renal insufficiency
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S/S of hypermagnesemia
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S/S: muscle weakness, flaccid paralysis, mental obtundation, confusion
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S/S: muscle weakness, flaccid paralysis, mental obtundation, confusion
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hypermagnesemia
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Main cause of Hypomagnesemia
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diminished absorption or intake or incresaed loss of magneseium
|
*obvious answer* BS Question
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S/S: weakness, muscle cramps, tremor, marked neuromuscular and CNS hyperiritability, athetoid movements, jerking, nystagmus, positive Babinski response, hypertension, tachycardia, ventricular arrhythmias, confusion, disorentation
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Hypomagnesemia
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S/S of hypomagnesemia
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S/S: weakness, muscle cramps, tremor, marked neuromuscular and CNS hyperiritability, athetoid movements, jerking, nystagmus, positive Babinski response, hypertension, tachycardia, ventricular arrhythmias, confusion, disorentation
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S/S of hypophosphatemia
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S/S: irritability, appreension, weakness, numbness, parathesias, confusion; anorexia, pain in muscles and bones, fractures, acute hemolytic anemia with increased erythrocyte fragility, impaired oxygen delivery to tissues, increased susceptibility to infection from impaired chemotaxis of leukocytes, rhadbomyolysis, platelet dysfunction with petechial hemorrhages
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S/S: irritability, appreension, weakness, numbness, parathesias, confusion; anorexia, pain in muscles and bones, fractures, acute hemolytic anemia with increased erythrocyte fragility, impaired oxygen delivery to tissues, increased susceptibility to infection from impaired chemotaxis of leukocytes, rhadbomyolysis, platelet dysfunction with petechial hemorrhages
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hypophosphatemia
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Causes of Hypophosphatemia
|
Etiologies:
-Renal diseases-increased renal excretion -Catabolic states, tissue destruction -Intracellular shifting -Decrease in phosphate or vitamin D intake |
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Etiologies:
-Renal diseases-increased renal excretion -Catabolic states, tissue destruction -Intracellular shifting -Decrease in vitamin D intake |
hypophosphatemia
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Etiologies of hyperphosphatemia
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Etiologies:
-Decreased renal excretion -Phosphate shift from intracellular to extracellular fluid -Increased intake of vitamin D -Ingestion of laundry detergents |
|
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Etiologies:
-Decreased renal excretion -Phosphate shift from intracellular to extracellular fluid -Increased intake of vitamin D or phosphate drugs -Ingestion of laundry detergents |
hyperphosphatemia
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S/S of hyperphosphatemia
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S/S: major effects related to hypocalcemia, deposition of calcium-phosphate crystals and include red eye and pruritus, tissue ischemia
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S/S: major effects related to hypocalcemia, deposition of calcium-phosphate crystals and include red eye and pruritus, tissue ischemia
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Hyperphosphatemia
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