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40 Cards in this Set
- Front
- Back
norms for pH, bicarb, Pco2?
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pH < 7.4: acidosis (**7.36)
pH > 7.4 alkalosis (** 7.44) * bicarb > 25: Met alkalosis; < 25: acidosis; * PCO2 > 40: resp acidosis, < 40: alkalosis |
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what's formula to correct metab acidosis?
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Na bicarb = wt x 0.3 x base deficit
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up 16 months, infants have average bicarb of ?
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22
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what's renal threshold of bicarb in term neonates?
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21
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pH 7.15, Pco2: 75?
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resp acidosis: morphine; CNS dysnfucntion
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pH 7.55, PCO2 25 ?
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resp alkalosis
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pH 7.55; PcO2 55; bicarb: 48?
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met alkalosis w/ resp compensation (hypoventilation):
eg: pyloric stenosis: |
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pH 7.48, pCO2 20, bicarb 15?
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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 |
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what's normal AG? and how calc?
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AG: 8-12; Na - (Cl + bicarb)
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non AG acidosis causes? what's most common?
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most common: diarrhea; USED CARP
Ureterostomy small bowel fistula extra chloride Diarrhea Carbonic anhydrase inhibitors use adrenal insufficiency RTA pancreatic fistula |
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what presents w / hi ammonia, but no metabolic acidosis;
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inborn errors of metabolism; urea cycle defects
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lots of urine, high serum osmolatlity; dilute urine; cause and tx?
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DI; no ADH; (peeing out all water), leaves you w/ hi serum Na;
tx: drink water adn DDAVP |
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males, dilute urine, hypernatremic dehydration; ? inheritance?
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nephrogenic DI; no response to
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GI losses leads to ? Na in urine?
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low urine Na (< 10); kidney holds on to Na
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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 |
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whats maintenance fluid rate for pt w/ renal failure w/ oliguria?
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1/3 (calc maint fluid) + urine volume; w/ D5 0.2 NS
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what meds cause hyponatremia?
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vincristine- SIAdH
cyclosphasmaide: decreased water excretion thiazide: blocks renal sodium and chloride reabsorption |
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low serum Na, but total body sodium is NL; urine [Na] is high
-dx? |
dilutional hyponatremia
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after surgery; low albumin; urine Na < 10; edema; ? cause
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third spacing of fliud
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weakness, paralysis, constipation and ileus, polyuria; what electrolyte imbalance causes this?
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hypokalemia:
-poor intake (AN); - Loss: 1) Gi: vomiting, diarrhea - 2) renal (diuretics, RTA, excess aldo) |
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flat T waves, ST depression, PVC; severe: U wave
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Hyopkalemia
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weakness, prolonged QT?
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hypo calcemia
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weaness and diarrhea, prolonged PR or QT
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hypmagnesemia
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muscle weakness, no EKG changes?
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hypoglycemia and hyponatremia
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peaked T waves, when ? ; no P waves, wide QRS
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hyperkalemia; K > 10
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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) |
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mild cases of hyperkalemia, tx?
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glucose/insulin;
-Na bicarb -inhaled albuterol -lasix/furosomide -oral polysterene resin |
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what does alkalosis do to K and H inside/outside of cell?
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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*** |
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calculate FeNA; and what defines low urinary Na loss vs high urinary Na loss?
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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 |
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**very symptomatic; diarrhea; long cap refill; usu h/o of juice/water w/ dehydration; when severe ~ sz
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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 |
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improperly mixed formula, irritable, lethargic, doughy skin, high pitched cry; sz;
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hypernatremic dehdyration; Na > 150 ; due to water loss or sodium gain
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look good,? na changes?
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hypernatremic dehdyration vs hyponatremic dehdyration: causes pontine damage
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taccy w/ decreased tear production, low UOP and increased urine concentration; ? how much dehydrated ;and how much short fliuds?
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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 |
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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 |
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never drop the Na more than ??? in a 24 hour period?
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not more than 10-12 in a 24 hour period or risk of cerebral swelling
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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 |
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w/ hypernatremic dehdyration; maintence fluid and correction should be calculated for 24 hours; do you need emergency phase ? boluses??
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no since ECF volume is maintained ; ?? (pg 205)
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? whats best fliud replacement for teen football player?
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plain water
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?best fliud replacement for toddler w/ vomiting: ?
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2-2.5% glucose solution w/ [NA] = 60-90 mEQ/L
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toddler 2-3 days V/D; some clear liguids is tolerated, dry mmm; milkd taccy, what's best management?
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ORS + regular diet of carbs, fruits, veggs; infants hud get fulls strength formula
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