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184 Cards in this Set

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What percent of the body weight is water in adults?
60 percent
Where is body water excreted?
kidneys, skin, lungs
How is water maintained?
by balance between intake and excretion
What are the two main fluid compartments?
Intracellular fluid
Extracellular fluid
ICF
Intracellular Fluid
ECF
Extracellular Fluid
ICF approximates ____ of total body water?
2/3
ECF represents ____ of total body water?
1/3
What are the primary electrolytes in ICF?
K+, Mg++, PO4
What are the two divisions of ECF?
Intravascular water
Interstitial water
What fraction of ECF is intravascular water?
1/4
What fraction of ECF is interstitial water?
3/4
What are the primary ECF electrolytes?
Na+, Cl-, HCO3-
Definition: Transport system on cellular membrane that maintains electrolyte differences?
Na-K-ATP-ase transport system
Where is the transport system located?
on the cellular membrane
Normal range of Sodium?
135-145 mEq/L
Normal range of Potassium?
3.5-5.0 mEq/L
Normal range of Chloride?
96-100 mEq/L
Normal range of BUN?
8-20 mg/dL
Normal range of Serum Creatinine?
0.6-1.2 mg/dL
Normal range of Calcium?
8.5-10.8 mg/dL
Normal range of Ionized Calcium?
4.6-5.2 mg/dL
What is the equation for Corrected Calcium?
Corrected Calcium = Observed Ca + (Normal Albumin - Observed Albumin)
What is an alternate equation for Corrected Calcium?
Calcium Corrected = [(4.0-normal albumin) (0.8mg/dL)] + Calcium observed
Description: Body water moves freely from areas of low to areas of high osmolality to maintain osmotic equilibrium of all body compartments.
Osmolality
How is osmolality determined?
by the number of particles (ions) in solution
BUN
Blood, Urea, Nitrogen
What is the best way to assess the net gain or loss of fluid?
Weigh the patient
Description: Decrease in volume of both ECF and ICF with an increase in solute concentration, results in increased release of ADH
Water Deficit (Water Depletion)
Description: Expansion of both ECF and ICF with a corresponding decrease in solute concentration, resulting in reduced secretion of ADH
Water Excess (Dilution Syndrome)
How much does a gallon of water weigh?
8 pounds
SIADH
Syndrome of inappropriate antidiuretic hormones
Symptoms: Excessive release of ADH, preserves H2O
SIADH
--|--|--<
Na, Cl, BUN
K, CO2, SCr
glucose (<)
SMA7
Sequential multiple analyzer

--|--|--<
What is the predominant CATION of ECF?
Sodium
What are the three types of Hyponatremia?
Hypervolemic
Hypovolemic
Euvolemic
What usually causes Euvolemic Hyponatremia?
SIADH
Major intracellular cation?
Potassium
Most abundant extracellular anion?
Chloride
Main function of chloride?
maintain extracellular osmolality
Main function of chloride?
maintain extracellular osmolality
What percentage of body weight is represented by Calcium?
2%
What percent of total body calcium is in solution?
0.5%
What percent of calcium is integrated into bones?
99.5%
This usually occurs in patients with DM
Hyperglycemia (high blood sugar)
People in a hyperosmolal state have ____________ and ____________.
hyperglycemia; hypernatremia
People in a hypoosmolal states have __________________.
hyponatremia
The following lab findings are consistent with what condition?: Incresed Se glucose, increased BUN Scr, Increased or decreased K+ and Na+
hyperglycemia
The following lab findings are consistent with what condition?:
Increase solute concentration, increased BUN, Scr, Increased urine specific gravity and osmolality
Water deficit
The following lab findings are consistent with what condition?:
Dilution of solutes (low Se sodium and protein), low BUN, low plasma osmolality
Water excess
The following lab findings are consistent with what condition?:

elevated Se sodium and osmolality, increased BUN reflects decreased renal perfusion, elevated urine osmolality
Hypernatremia
The following lab findings are consistent with what condition?:
low Se sodium, possibly elevated BUN and Scr
Hyponatremia
The following lab findings are consistent with what condition?:
elevated Se K+, evidence of renal impairment, EKG findings
Hyperkalemia
The following lab findings are consistent with what condition?:
Decreased Se K+, EKG findings
Hypokalemia
The following lab findings are consistent with what condition?:
decreased calcium, decreased albumin, phosphate usually elevated, magnesium is usually low, EKG changes
hypocalcemia
What is the fnx of a diuretic?
Eliminated H2O
What is the fnx of an antidiuretic?
preserve H2O
Which electrolyte establishes osmotic pressure relationships betweein ICF and ECF?
sodium
Which type of hyponatremia may be due to excess body water relative to sodium?
Hypervolemic Hyponatremia
Which type of hyponatremia may be due to total body depletion of sodium caused by excesive use of diuretics, chronic renal failure, etc.?
Hypovolemic Hyponatremia
Which type of hyponatremia may occur with normal ECF volume commonly caused by SIADH?
Euvolemic Hyponatremia
How many mEq/kg of Potassium does the body store?
45-55 mEq/kg
How many mEq of Potassium are excreted daily?
35-100mEq
What organ predominately excretes potassium?
Kidneys
Which electrolyte helps maintain extracellular osmolality?
Chloride
Which enzyme is regulated by the renal proximal tubules?
Chloride
What happens to Chloride in the renal proximal tubules?
It is exchanged for bicarbonate ions
Which electrolyte passively flows with sodium and water throughout the nephron?
chloride
Serum level is responsive to what 2 hormones?
Calcitonin and PTH
Parathyroid Hormone
Secreted in response to low circulating ionized calcium; increased absorbtion from SI
Calcitonin
Opposite PTH; secreted by C cells of thyroid gland in response to low levels of ionized calcium
__________ and ___________ influnce Ca2+ regulation
Vitamin D; phosphate
Vitamin D
helps absorption of calcium; activated by sunlight and in the liver
What organ excretes calcium?
kidneys
Which enzyme plays a central role in muscle contraction?
Calcium
What is the corrected calcium level for pt with Hyper calcemia? (mg/dl)
greater than 10.8 mg/dl
What is the formula for Corrected Calcium?
Corrected Ca = Observed Calcium + (Normal Albumin - Observed Albumin)
Lab Findings - increased serum calcium; must be interpreted with albumin
Hypercalcemia
What is the corrected calcium level for pt with Hypocalcemia? (mg/dl)
less than 8.5 mg/dl
Chvosteks sign is a clinical finding in what condition?
hypocalcemia
Trousseau's sign is a clinical finding in what condition?
Hypocalcemia
What is Chvostek's sign?
Unilateral spasm in a facial nerve (hypocalcemia)
What is Trousseau's sign?
BP cuff in upper arm gives a carpal spasm (found in hypocalcemia)
What is the range for urine volume in a normal adult? (ml/d)
1000-1500 ml/d
What percentage of water intake is excreted daily?
50%
What is the normal range for Magnesium?
1.5-2.5 mEq/L
What is the normal range for Phosphorus?
2.5-5.0 mg/dL
Which electrolyte is a cofactor for the phosphorylation of ADP to ATP?
Magnesium
What is the breakdown of Magnesium? (bone, intracellular, extracellular)
50% in insoluble state in bone
45% intracellular
5% extracellular
What percent of Mg exists in insoluble state in bone?
50%
What percent of Mg exists in intracellular state?
45%
What percent of Mg exists in extracellular state?
5%
What fraction of Mg is bound to protein?
1/3
What fraction of Mg is a free cation?
2/3
How is Mg excreted?
via the kidney
Which enzyme is an activator ion, participating in the fnx of many enzymes involved in phosphate transfer reaction?
Magnesium
Which electrolyte exerts physiologic effects on nervous system similar to Ca2+?
Magnesium
Alterations in serum Mg2+ usually provokes an associated alteration in _____?
Ca2+
Alterations in serum _____ usually provokes an associated alteration in Ca2+.
Mg2+
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?
Hypermagnesemia
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
What are athetoid movements?
spastic movements (common in cerebal palsy)
What is nystagmus?
Abnormal eye movement (cross eyed)
What is a positive Babinski response?
Run finger on the sole of foot from heel to toe and the big toe flexes up; common in pt with meningitis.
s/s of hypOmagnesemia
A positive Babinski response is a sign and symptom for what condition?
Hypomagnesemia
The following lab findings are consistent with what condition?:

Serum Mg2+ is low, hypocalcemia and hypokalemia are often present, EKG changes
Hypomagnesemia
What type of relationship exists between magnesium and acetylcholine?
Inverse
What percent of phosphorus is combined with Ca2+ in bones and teeth?
80%
What percent of calcium is incorporated in a variety of organic compounds?
10%
What percent of Phosphorus is combined with proteins, lipids, CHO and other compounds muscle and blood?
10%
What is the breakdown of phosphorus? (bones/teeth, organic cmpds, proteins/lipids)
80% - bones, teeth
10% - organic cmpds
10% - proteins, lipids, CHO, etc.
Which enzyme is the integral agent in energy transfer and in metabolism of CHO, protein and fat?
Phosphorus
Which enzyme is the primary urinary buffer?
Phosphorus
In which enzyme are the metabolism and homeostasis intimately related to Ca2+ metabolism?
Phosphorus
Decrease in ________ or ________ can cause Hypophosphatemia?
phosphate; vitamin D
Patients with Hypophosphatemia are often asymptomatic until the level is below ______ mg/dL?
2 mg/dl
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
What is rhabdomyolysis?
elevated serum CK
Intracellular shifting is a cause of what disease state?
Hypophosphatemia
A phosphate shift from intracellular to extracellular fluid causes what disease state?
Hyperphosphatemia
Hyperphosphatemia is caused by a phosphate shift from ___________ fluid to _____________ fluid.
intracellular; extracellular
An increased intake of vitamin D or phosphate drugs can cause this disease state.
Hyperphosphatemia
Vitamin D can increase absorption of phosphate by up to ____%.
50%
__________ can increase the absorption of phosphate by up to 50%.
Vitamin D
What disease state is uncommon in patients with normal kidney function?
Hyperphosphatemia
What is calciphylaxis?
Precipitation of calcium phosphate crystals in arteries, joints and soft tissues
The following lab findings are consistent with what condition?:

Serum phosphate levels higher than 5mg/dL
hyperphosphatemia
Deposition of calcium-phosphate crystals and include red eye and pruritis are clinical findings in what disease state?
Hyperphosphatemia
Causes of water deficit
Etiologies: reduced intake; unusual losses (GI, diuretics, fluid lossses due to kidney disorders)
Etiologies: reduced intake of water; unusual losses (GI, diuretics, fluid lossses due to kidney disorders)
water deficit
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
water deficit/depletion
s/s of water deficit/depletion
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
Etiologies of dilution syndrome/water excess
-decreased excretion of water
-excessive renal sodium and water retention (as in heart failure, renal failure, nephrotic syndrome, cirrhosis)
-SIADH
-decreased excretion of water
-excessive renal sodium and water retention (as in heart failure, renal failure, nephrotic syndrome, cirrhosis)
-SIADH
water excess/dilution syndrome
S/S of Water excess/dilution syndrome
S/S: weight gain, edema, headache, nausea, vomiting, abdominal cramps, dyspnea, jugular venous distention, rales on pulmonary exam, weakness, stupor, convulsion, coma
S/S: weight gain, edema, headache, nausea, vomiting, abdominal cramps, dyspnea, jugular venous distention, rales on pulmonary exam, weakness, stupor, convulsion, coma
water excess/dilution syndrome
Causes of Hypernatremia
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
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
S/S of hypernatremia
S/S: thirst, weight loss, flushed loss skin, tachycardia and hypotension, oliguria, irritability, ataxia, spasticity, confusion, seizures
What is ataxia?
lack of coordination
S/S: thirst, weight loss, flushed loss skin, tachycardia and hypotension, oliguria, irritability, ataxia, spasticity, confusion, seizures
hypernatremia
S/S of hyponatremia
S/S: thirst, faintness, dizziness, dry mucosa, loss of skin tugor, tachycardia, orthostatic hypotension, oliguria, edema, headache, N/V, convulsion, coma
S/S: thirst, faintness, dizziness, dry mucosa, loss of skin tugor, tachycardia, orthostatic hypotension, oliguria, edema, headache, N/V, convulsion, coma
Hyponatremia
Loss or retention by the kidney depends on...
-Renin-angiotensinogen-aldosterone effects
-blood pH
-serum potassium concentration
-GFR
Etiologies:
-Diminisehd excretion
-Increased supply of K+
-Endocrine Diseases (Addisons disease)
-Metabolic acidosis
-Cell Lysis
-Drugs (NSAIDS, Heparin)
hyperkalemia
Etiologies of hyperkalemia
Etiologies:
-Diminisehd excretion
-Increased supply of K+
-Endocrine Diseases (Addisons disease)
-Metabolic acidosis
-Cell Lysis
-Drugs (NSAIDS, Heparin)
Hyper-
increase
Hypo-
Decrease
S/S of Hyperkalemia
S/S: weakness, abdominal distention, diarrhea, cardiac abnormalities (slow heart rate, ventricular fibrillation, cardiac arrest)
S/S: weakness, abdominal distention, diarrhea, cardiac abnormalities (slow heart rate, ventricular fibrillation, cardiac arrest)
hyperkalemia
Etiologies of Hypokalemia
Etiologies:
-poor intake of K+
-reduced absorption of K+
-increased loss (GI, renal, skin, drugs, hypokalemia without deficit)
Etiologies:
-poor intake of K+
-reduced absorption of K+
-increased loss (GI, renal, skin, drugs, hypokalemia without deficit)
hypokalemia
What causes Hypokalemia without deficit?
insulin, albuterol, etc.
K+ shifted from ECF to ICF
S/S of hypokalemia
S/S: muscle cramping/weakness, parathesias, hyporeflexia
S/S: muscle cramping/weakness, parathesias, hyporeflexia
hypokalemia
What are the two main indications of Hypochloremia/Hyperchloremia?
1. Can indicate a change in fluid status
2. Can indicate an acid-base abnormality
Which two disease states
1. Can indicate a change in fluid status
2. Can indicate an acid-base abnormality
Hypochloremia and Hyperchloremia
Etiologies of Hypercalcemia
Etiologies:
-Increased intake or absorption of Ca+
-Endocrine disorders
-Neoplastic disorders
-Drugs (ie: Tums,Lithium)
Etiologies:
-Increased intake or absorption of Ca+
-Endocrine disorders
-Neoplastic disorders
-Drugs (ie: Tums,Lithium)
hypercalcemia
What are neoplastic disorders?
Cancers that stimulate osteoclast activity
Etiologies of hypercalcemia
Etiologies:
-Increased intake or absorption of Ca+
-Endocrine disorders
-Neoplastic disorders
-Drugs (ie: Tums,Lithium)
S/S of hypercalcemia
S/S: anorexia, N/V, constipation, polyuria, muscle weakness and hyporeflexia, tremor, lethargy, confusion
S/S: anorexia, N/V, constipation, polyuria, muscle weakness and hyporeflexia, tremor, lethargy, confusion
hypercalcemia
Causes of hypocalcemia
Etiologies:
-decreased intake or absorption of Ca++
-Increased loss of Ca++
-Endocrine disease
-Physiologic causes
Etiologies:
-decreased intake or absorption of Ca++
-Increased loss of Ca++
-Endocrine disease
-Physiologic causes
hypocalcemia
S/S of hypocalcemia
S/S: muscle cramps, tetany, convulsions, stupor and dyspnea, dipopia, abdominal cramps, urinary frequency, Chvostek's sign, Trousseau's sign
S/S: muscle cramps, tetany, convulsions, stidor and dyspnea, dipopia, abdominal cramps, urinary frequency, Chvostek's sign, Trousseau's sign
Hypocalcemia
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
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
Main cause of Hypermagnesemia
renal insufficiency
S/S of hypermagnesemia
S/S: muscle weakness, flaccid paralysis, mental obtundation, confusion
S/S: muscle weakness, flaccid paralysis, mental obtundation, confusion
hypermagnesemia
Main cause of Hypomagnesemia
diminished absorption or intake or incresaed loss of magneseium
*obvious answer* BS Question
S/S: weakness, muscle cramps, tremor, marked neuromuscular and CNS hyperiritability, athetoid movements, jerking, nystagmus, positive Babinski response, hypertension, tachycardia, ventricular arrhythmias, confusion, disorentation
Hypomagnesemia
S/S of hypomagnesemia
S/S: weakness, muscle cramps, tremor, marked neuromuscular and CNS hyperiritability, athetoid movements, jerking, nystagmus, positive Babinski response, hypertension, tachycardia, ventricular arrhythmias, confusion, disorentation
S/S of hypophosphatemia
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
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
hypophosphatemia
Causes of Hypophosphatemia
Etiologies:
-Renal diseases-increased renal excretion
-Catabolic states, tissue destruction
-Intracellular shifting
-Decrease in phosphate or vitamin D intake
Etiologies:
-Renal diseases-increased renal excretion
-Catabolic states, tissue destruction
-Intracellular shifting
-Decrease in vitamin D intake
hypophosphatemia
Etiologies of hyperphosphatemia
Etiologies:
-Decreased renal excretion
-Phosphate shift from intracellular to extracellular fluid
-Increased intake of vitamin D
-Ingestion of laundry detergents
Etiologies:
-Decreased renal excretion
-Phosphate shift from intracellular to extracellular fluid
-Increased intake of vitamin D or phosphate drugs
-Ingestion of laundry detergents
hyperphosphatemia
S/S of hyperphosphatemia
S/S: major effects related to hypocalcemia, deposition of calcium-phosphate crystals and include red eye and pruritus, tissue ischemia
S/S: major effects related to hypocalcemia, deposition of calcium-phosphate crystals and include red eye and pruritus, tissue ischemia
Hyperphosphatemia