Chapter 5: Water, Electrolyte, Acid-Base, and Hemodynamic Disorders Flashcards by Robin Sautter

What is the order from largest to smallest of fluid compartment sizes in the body?

ICF > ECF

interstitial > vascular

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What are the most important ECF and ICF cations?

Na+ and K+

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What is the equation for pOsm?

pOsm = 2(Na+) + serum glucose/18 + serum BUN/2.8 = 275-295 mOsm/kg

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What direction does H2O shift during hyponatremia?

from ECF to ICF

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What type of fluid causes NON-pitting edema?

exudates and lymphatic fluid

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What type of fluid causes PITTING edema?

transudates

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What are causes of pitting edema (transudate)?

chronic liver dz (decreased albumin production)
malabsorption syndrome (poop it out)
nephrotic syndrome (pee it out)
low protein intake (Kwashiorkor)

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MCC lymphedema

postradical mastectomy

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What is the ratio of ECF to ICF?

⅓ to ⅔

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What is the sequelae of hyponatremia?

H2O moves from ECF to ICF –> cerebral edema –> mental status changes

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What is the sequelae of hypernatremia?

H2O moves from ICF to ECF –> neurons shrink –> mental status changes

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What 2 molecules control water in the ECF?

Na+ and glucose

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H2L shifts do NOT occur with alterations in urea concentration. Why?

B/c urea is a permanent solute and diffuses b/t the ECF and ICF without altering the osmotic gradient.

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What findings are seen with a DECREASE in total body Na+?

decrease skin turgor
dry mucus membranes
decrease BP
increase pulse when sitting/standing up

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What findings are seen with an INCREASE in total body Na+?

pitting edema

body cavity effusions

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What clinical conditions result in an isotonic loss of fluid?

hemorrhage

diarrhea

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MCC of low osmolarity in plasma?

hyponatremia (usually d/t prob in the kidney)

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When serum Na+ is <120, the answer is ALWAYS…

SIADH

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What are causes of SIADH?

Small cell carcinoma of the lung
sulfonylurea medications (diabetes)

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In oral rehydration therapy for cholera, what molecules must be included in the treatment to be effective?

glucose and Na+

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What part of the vasculature controls your diastolic BP?

peripheral resistance arterioles

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What is the treatment for isotonic loss?

normal saline

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Baroreceptors are innervated by which nerves?

CN 9 and 10

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Will you show signs of dehydration if you only lose water?

NO. You will show signs of dehydration if you lose H2O AND Na+

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What does the TILT Test show?

Hypovolemic State e.g. lady was lying down, her BP and pulse were normal but when they sat her up, the BP decreased and pulse went up.

What is the Rx for isotonic gain?

restrict water and loop diuretics

What can cause hypertonic loss?

loop diuretics/thiazides (excessive) Addison decrease in 21-hydroxylase

What is the Rx for hypertonic loss?

infuse normal saline or equivalent

What occurs if you correct for hyponatremia too rapidly?

central pontine myelinolysis

What can cause hypotonic fluid gain?

compulsive water drinker

What is the Rx for hypotonic water gain?

restrict water

Heavy metal poisoning (Pb or Hg) damages what organ? What is this condition called?

Proximal tubule cells undergo coagulation necrosis --> nephrotoxic acute tubular necrosis --> hyponatremia, hypoglycemia, hypouricemia, and hypophosphatemia Called FANCONI Syndrome

What causes K+ to move out of cells?

acidosis digitalis beta-blockers succinylcholine

What causes K+ to move into the cell?

insulin | beta2- agonists

What is the MCC of hypokalemia?

loop diuretics

What is the ECG change seen with hyperkalemia?

peaked T waves

What is the MCC of respiratory acidosis?

chronic bronchitis

What is the MCC of respiratory alkalosis?

anxiety

What are risk factors for venous thrombi?

stasis hyper coagulable state endothelial damage

MC site for venous thrombosis

deep veins, lower extremity below the knee

What type of embolism results from fracture of a long bone?

fat embolism

How long does it take for a fat embolism to typically occur?

1-3 days

How long does it take for an amniotic fluid embolism to occur?

during labor or immediately postpartum

What is the pathogenesis of decompression sickness?

rapid ascent causes nitrogen gas bubbles in vessel lumens and tissue (e.g. joints)

What findings will you see in a patient with hypovolemic shock in terms of CO, LVEDP, PVR, and mixed venous oxygen content (MVO2)?

CO decreased LVEDP decreased PVR increased MVO2 decreased (blood moving slower through vessels so O2 is able to be absorbed in tissue more)

What physical findings will you see in a patient with hypovolemic shock?

cold/clammy skin hypotension tachycardia decreased urine output

What is the treatment for hypovolemic shock?

fluid replacement

What is the MC site of infection leading to sepsis?

lungs

What is the MCC of death in ICUs?

septic shock

MCC of sepsis due to gram + organisms

coagulase-negative Staphylococci

MCC of gram negative septic shock

E. coli

MCC of fungal septic shock

Candida species

What is the most important factor for producing septic shock in Gram positive pathogens?

lipoteichoic acid

What findings will you see in a patient with septic shock in terms of CO, LVEDP, PVR, and mixed venous oxygen content (MVO2)?

CO increased LVEDP decreased PVR decreased MVO2 increased (tissues unable to extract O2 from blood b/c moving too quickly)

What physical findings will you see in a patient with septic shock?

warm skin strong peripheral pulses hypotension DIC (d/t endotoxins which activate macrophages, complement system, and tissue thromboplastin)

What findings will you see in a patient with cardiogenic shock in terms of CO, LVEDP, PVR, and mixed venous oxygen content (MVO2)?

CO decreased LVEDP increased PVR increased MVO2 decreased

MCC of death in shock

Multiple Organ Dysfunction Sydrome (MODS)

What is the main factor controlling the TPR or PVR?

radius of ARTERIOLES

What controls the viscosity in the blood?

hemoglobin

What organ suffers greatest from decreased blood flow?

Kidney

What type of damage occurs to the kidney with decreased blood flow and how?

decreased blood flow --> ischemia (esp. of medulla) --> acute tubular necrosis --> oliguria and increased BUN/Cr ratio --> eventual COAGULATION NECROSIS

If an African American woman comes into your office with microscopic hematuria, what should you test for and why?

Test for Sickle Cell Trait Low O2 content in the medulla can induce sickling

Where in the brain is the respiratory center?

medulla oblongata

Barbiturates will lead to respiratory acidosis or alkalosis?

respiratory acidosis

A "thumb print" sign with a swollen epiglottis in a child with inspiratory stridor is most likely indicative of what type of infection?

acute epiglottis due to H. influenzae

MCC of meningitis in 1 mo - 18 years?

N. meningitis

Paralysis of the diaphragm will decrease or increased CO2 in the body?

increase

Paralysis of the diaphragm due to many diseases (polio, ALS, Guillain-Barre) will result in a respiratory acidosis or alkalosis?

respiratory acidosis