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Fluid & Electrolytes
| Question | Answer |
|---|---|
| normal sodium | 135-145 mEq/L |
| normal potassium | 3.5-5 mEq/L |
| normal BUN | 7-20 mg/dl |
| normal hematocrit | 40-50% |
| normal urine specific gravity | 1.002-1.030 |
| normal glucose | 60-110 mg/dl |
| normal osmolality | 275-295 |
| FVD classic sign | dry mucous membranes, comes later |
| FVD late sign | hypotension |
| FVD, temp changes | decreased temp, blood shunted to central area |
| FVD, respiratory | increased respiratory rate bc acidotic, blowing of CO2; thick and sticky secretions |
| anasarca | severe, generalized third spacing |
| most common site, 3rd spacing | abdomen (ascites, in peritoneal cavity?) |
| primary mediator of fluids | hypothalamus |
| 2nd spacing | stage where fluid moves from one space to another |
| 3rd spacing | fluid in interstitial compartments |
| FVD sodium | normal to high (hemoconcentration) |
| FVD potassium | normal to high (is intracellular, if enough cell death --or sodium levels -- could be high) |
| FVD BUN | high (hemoconcentration); in children may be low but not pathologic |
| FVD glucose | normal to high (stress response, >120) |
| FVD urine specific gravity | high >1.030 |
| FVD osmolality (serum) | >300, more particles ↑ number of particles, concentration |
| FVE hemodynamic signs | full bounding pulses, hypertension, increased CVP, neck vein distension, CHF |
| cerebral edema | seen with FVE, Confusion, dizziness, convulsions, coma |
| pulmonary edema | seen with FVE, Dyspnea, tachypnea, hacking cough, crackles, o2 sat down |
| FVE general signs | weight gain, nonpitting interstitial edema, hepatomegaly/splenomegaly |
| FVE first sign seen | pulmonary edema |
| neck vein distension | sign of FVE but not seen in kids, make sure know baseline for adults |
| goal of Rx for FVE | prevent cerebral edema |
| >>> causes of FVE (10) | renal failure, heart failure, excess fluid intake (without electrolytes), high corticosteroids, high aldosterone, plain water enema, NG irrigations, excess hypotonic IV fluids, SIADH, inappropriately prepared formula (dilute formula) |
| >>> excess fluid intake examples | excessive hypertonic fluids, binge drinking contest, psych disorders, drowning in fresh water, inappropriate dialysis |
| FVE, potassium | normal to high (potassium shift out of cells, rasing levels) |
| FVE, sodium | very low, <125 |
| FVE, BUN | low (hemodilution) |
| FVE, urine spec gravity | low, <1.005 |
| FVE, glucose | normal to high (stress response, >120) |
| decreased sodium and potassium signs | lethargy, weakness |
| increased sodium and potassium signs | increased excitability |
| acid | releases H+ ions in water |
| base | binds to H+ ions in water |
| buffers | prevent major acid-base changes; carbonic acid-bicarbonate, protien, and phosphate buffer system |
| carbonic acid | measured as CO2 |
| acid-base homeostasis | bicarb: carbonic acid = 20:1 |
| carbonic acid-bicarb system | primary system, 50% of activity, to maintain balance l/t have to also use protein and phosphate buffer systems, 1-2 hours to kick in, bicarb is the major ECF buffer |
| alkaline environment | hard for cells to grow |
| >>> Respiratory buffer system, carbonic acid | carbonic acid compensates and dissociates into CO2 and H20, CO2 exhaled by lungs, system activates rapidly but exhausted quickly |
| respiratory buffer system, breathing changes | changes in depth/rate of resp alters it: hypoventilation retains CO2/carbonic acid and causes acidosis, hyperventilation loses CO2 and causes alkalosis |
| renal buffer system: time and effectiveness | works w/in hours/days, more efficient than respiratory can go for longer periods of time |
| renal buffering system, bicarbonate | primary renal component, can be absobed as needed, combines HCl with ammonia to make ammonium, which is easily excreted by kidneys into urine |
| compensation | regulatory mechanism to return pH to normal level by transforming acids and bases within the body |
| primary metabolic disturbance | causes a respiratory compensation |
| acute primary respiratory disturbance | causes an acute metabolic response |
| complete compensation | pH is fully corrected (normal) |
| partial compensation | buffers are in the process of working; pH is low but the bicarb is elevating to compensate (or pH is high but CO2 is elevating to compensate) |
| pH | *negative logarithm of H+ ion concentration in mEq/L (as H+ ion concentration increases, pH decreases)*normal values 7.35 -7.45 (less is acidotic, more is alkalotic) |
| HCO3- (bicarb) | *normal 22-26 mEq/L (decreased in acidosis, increased in alkalosis) |
| BE "base excess" | indicates the amount of bicarb available in the ECF normal value: +/- 2 mEq/L |
| serum anion gap | *Concentration of anions (HCO3- , Cl-, protein, phosphate, & sulfates) and cations (Na+, K+, MG++, & Ca++) | *10-12 mEq/L normal | *increased in metabolic acidosis (but can be normal) | *calculated by Na - Cl + bicarb |
| SaO2 | the percent of Hb saturated with O2, a calculated value (indirect measurement), calculated with pH and PaO2 (combination of O2 sat, PaO2, and Hb), indicates tissue oxygenation |
| PaO2 | amount of oxygen available to bind with hemoglobin, amount of pressure exerted on O2 by plasma |
| the lower the PaO2 pressure, the .... | less oxygen available to bind with Hb |
| dramatic drops in PaO2 | correlate with dramatic drops in oxygen saturation |
| PaO2 normal values | 75-100 mmHg (for every year above 60 drop 1mmHg) |
| PaCO2 | *partial pressure of CO2 | *reflects adequacy of alveolar ventilation, regulated by lungs, alterations indicate resp disturbance | *normal values 35-45 mmHg (less is alkalotic, more is acidotic) |
| respiratory alkalosis managment (4) | correct cause, rebreathe CO2 as needed, alter ventilation rate, sedatives (for anxiety) |
| respiratory alkalosis assessment (7) | VS, ABGs, RR/depth, LOC/anxiety, neuro checks, injury potential, I&O |
| respiratory alkalosis CV signs | tachycardia, palpitations, increased myocardial irritability |
| respiratory alkalosis respiratory signs | rapid shallow breathing (trying to retain CO2, oxygenate), chest tightness |
| respiratory alkalosos CNS signs (10) | paresthesia, dizzyness, confusion, tetany, convulsion, numb/tingling, light headed, anxiety/panic, Loss of consciousness, hyperactive reflexes |
| respiratory alkalosis causes (4) | hyperventilation, sepsis/infection, over ventilation, hepatic cirrhosis |
| respiratory alkalosis: labs | low CO2, pH high >7.45, bicarb normal if no compensation or decreased if compensation, hypokalemia, hypocalcemia |
| respiratory acidosis management (7) | correct cause, CPT, TCDB if able, suction as needed, semi-Fowlers, fluids to thin secretions, low-flow O2 as needed |
| respiratory acidosis assessment (8) | VS, ABGs, RR/depth, apical pulse, LOC, EKG, skin color/nail beds/mucous membranes, I&O |
| respiratory acidosis cardiac signs | hypotension, peripheral vasodilation weak thready pulse, tachycardia, warm flushed skin |
| respiratory acidosis respiratory signs | dyspnea, slow shallow respirations, hypoxia and hypoventilation, cyanosis |
| respiratory acidosis CNS signs (6) | HA, seizures, altered LOC, papilledema, twitching/tremors, drowsy --> coma |
| respiratory acidosis causes (4) | respiratory depression/arrest, inadequate chest expansion, airway obstruction, interference with alveolar capillary exchange |
| respiratory acidosis: labs | pH low <7.35, PaCO2 high >42, HCO3- normal (or elevated with compensation), hyperkalemia |
| metabolic alkalosis mgmnt (3) | correct cause, restore normal fluid balance, adequate chloride (enhance renal absorption of sodium and excretion of bicarb) |
| metabolic alkalosis assessment (6) | VS, ABGs, RR/depth, LOC, I&O, ECG |
| metabolic alkalosis GI signs (3) | n/v, anorexia, paralitic ileus (hypokalemia) |
| metabolic alkalosis CNS signs (10) | dizzy, nervous, tremors, hyperreflexia, paresthesias, irritability, confusion/apathy/stupor, cramps, tetany, seizures |
| met alkalosis respiratory signs (2) | hypoventilation, respiratory failure |
| met alkalosis CV signs (5) | tachycardia, HTN, PVC, atrial tachycardia, dysthrythmias (from FVE) |
| met alkalosis causes (4) | vomiting, NG suctioning, eating bicarb-based antacids, diuretics |
| met alkalosis: labs | increased pH, increased BE, increased bicarb, decreased anion gap (low K and Na) |
| met acidosis mgmnt (6) | correct cause, treat ketoacidosis (fluids, insulin), give alkaline fluids, hydrate, mechanical ventilation if needed, possible dialysis |
| insulin | used to treat metabolic acidosis (ketoacidosis), forces potassium back into cells |
| alkaline fluids for met acidosis | if severe, sodium bicarb if pH<7.20, salts of organic acid (lactate, citrate), tromethamine THAM |
| met acidosis assessment (7) | VS, ABGs, RR/depth, apical and peripheral pulses, ECG (bc of dramatic K changes), LOC, I&O |
| metabolic acidosis CV signs (4) | dramatic affects: hypotension, dysrhythmias, peripheral vasodilation, warm flushed skin (from dilation, leaking of capillaries) |
| metabolic acidosis resp signs | Kussmaul/deep/rapid respirations, trying to blow off CO2 |
| metabolic acidosis CNS signs (6) | think of septic patient: drowsy, HA (from cerebral edema), lethargy, coma, confusion/restless, weakness |
| metabolic acidosis GI signs (3) | n/v, diarrhea, abdominal pain |
| causes of metabolic acidosis | chronic diarrhea, malnutrition, starvation, renal failure, DKA, trauma, shock, sepsis, fever, salicylate toxicity |
| metabolic acidosis: labs | low bicarb, decreased BE, increased anion gap, hyperkalemia (from breakdown of cells from acidosis), high metabolic acids (lactic acids, ketoacids) |
| causes of metabolic acidosis | chronic diarrhea, malnutrition, starvation, renal failure, DKA, trauma, shock, sepsis, fever, salicylate toxicity |
| metabolic acidosis: labs | low bicarb, decreased BE, increased anion gap, hyperkalemia (from breakdown of cells from acidosis), high metabolic acids (lactic acids, ketoacids) |
| alkaline fluids for met acidosis | if severe, sodium bicarb if pH<7.20, salts of organic acid (lactate, citrate), tromethamine THAM |
| met acidosis assessment (7) | VS, ABGs, RR/depth, apical and peripheral pulses, ECG (bc of dramatic K changes), LOC, I&O |
| metabolic acidosis CV signs (4) | dramatic affects: hypotension, dysrhythmias, peripheral vasodilation, warm flushed skin (from dilation, leaking of capillaries) |
| metabolic acidosis resp signs | Kussmaul/deep/rapid respirations, trying to blow off CO2 |
| metabolic acidosis CNS signs (6) | think of septic patient: drowsy, HA (from cerebral edema), lethargy, coma, confusion/restless, weakness |
| metabolic acidosis GI signs (3) | n/v, diarrhea, abdominal pain |
| causes of metabolic acidosis | chronic diarrhea, malnutrition, starvation, renal failure, DKA, trauma, shock, sepsis, fever, salicylate toxicity |
| metabolic acidosis: labs | low bicarb, decreased BE, increased anion gap, hyperkalemia (from breakdown of cells from acidosis), high metabolic acids (lactic acids, ketoacids) |
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