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Clin path test 4 > Chem lect 19: Electrolytes Acid/Base > Flashcards

Chem lect 19: Electrolytes Acid/Base Flashcards

1
Q

Hyperkalemia

Hypokalemia

A
  • Hyperkalemia
    • can cause cardiac arrest
  • Hypokalemia
    • can cause respiratory arrest
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2
Q

Total body water

A
  • 60% body weight
  • 2/3 in cells
  • 1/3 extracellular
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3
Q

Increase in fluids

Decrease in fluids

A
  • Increase
    • GI (water/food)
    • Renal (resorb water)
  • Decrease
    • Renal (polyuria)
    • GI (vomit & diarrhea)
    • Cooling (fever & sweat)
    • Drainage of effusions
    • chylous/thoracic effusions
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4
Q

Abnormal Body Water Volume

A
  • Dehydration => whole body water depletion
    • chronic renal failure cat
  • Hypovolemia => intravascular fluid depletion
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5
Q

Lidocaine MOA

A
  • Sodium channel blocker
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6
Q

Main intracellular ion

A

Potassium

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7
Q

Electrolyte that controls nerve conductions

heart, etc

A

Ionized calcium

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8
Q

Hypernatremia

A
  • Can cause cellular dehydration and CNS signs
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9
Q

Osmolality

A
  • Regulation of body water movement
  • Osmotic pressure caused by small solutes
    • sodium, chloride, potassium, glucose, urea
  • Proteins contribute miniscule amount (only present in small numbers)
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10
Q

Colloid osmotic pressure

(oncotic pressure)

A
  • primary force holding fluids intravascularly
  • due to plasma proteins
    • more so ablumins >>> globulins
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11
Q

Renin-antiotensin-aldosterone system

A
  • regulation of body water volume
    • sodium determines BP
  • sodium is primary osmotically active particle in ECF
    • water follows sodium
  • Water volume regulated on sodium balance
    • 97 % of sodium always resorbed by kidney
    • 3 % of sodium subject to hormonal regulation
      • activley resorbed if aldosterone is present
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12
Q

DCM

A
  • DCM
    • enlarged and weakened left ventricle
    • decreases hearts ability to pump blood
    • Dobies and big breeds
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13
Q

HCM

A
  • ventricles become abnormally thick
  • Most commonly diagnosed cardiac disease in cats
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14
Q

raas schematic

A

Liver => Angiotensinogen => Kidney => Renin => angiotensin I => ACE => Angiotensin II => Aldosterone

Kidney makes aldosterone

Aldosterone makes kidney increase sodium and decrease potassium

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15
Q

Body volume fluid

Physical

Laboratory

A
  • Physical
    • Hydration parameters
      • skin turgor
      • mm moisture
      • body weight
    • Intravascular Volume and Perfusion parameters
      • MM color & CRT
      • Heart rate and Pulse Quality
      • Blood pressure
      • Central venous pressure
  • Laboratory
    • Hydration parameters
      • PCV/TS
      • Urine specific gravity
    • Intravascular volume and perfusion parameters
      • BUN/Creatinine
      • Lactate
        • will be high in hypovolemia
      • *interpret in light of concurrent disease
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16
Q

Pre-renal azotemia

A
  • High BUN/Creatinine
  • High USG
  • High PCV/TS

*NOT RENAL FAILURE

*This is a patient not urinating

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17
Q

Low BP plus hypovolemia

A

Will eventually cause renal failure

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18
Q

Osmolality short equation

Long equation

A

Na X 2

2 (Na + K) + (Glucose / 18) + (BUN / 2.8)

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19
Q

Testing osmolality

A
  • Not very common
  • usefull for
    • suspected ethylene glycol intoxication
    • suspected pseudohyponatremia
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20
Q

Hyperosmolality

A
  • Increased solute
    • hypernatremia
    • hyperglycemia (severe)
    • Ethylene glycol intoxication
    • mannitol administration
    • increased urea
  • Decreased water
    • hypotonic fluid loss
      • to rumen, for example
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21
Q

Hypoosmolality

A
  • Hyponatremia
    • not all hyponatremics are hypoosmol
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22
Q

Hyperosmolality

Clinical signs

A
  • CNS with hypoosmolality hemolysis
    • due to cellular dehydration or overhydration
    • depends on
      • occurance of fluid shifts (e.g. urea)
      • Severity of change in osmolality
      • Rate of development-physiologic compensation
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23
Q

Colloid Osmotic Pressure (COP)

A
  • Major force holding fluid intravascularly (mm Hg)
  • Regulated by liver synthesis of albumin
  • Globulins are minor contributer
  • Often inferred from plasma protein conc.
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24
Q

Decreased COP

Signs

A
  • Due to loss of fluid from vasculature
  • Depends on how severe and rapid
  • effusions, edema, signs of hypovolemia

Causes

  • Hypoalbuminemia: PLE, PLN, Hepatic failure, others
  • Vascular leak (SIRS): vasculitis, sepsis, pancreatitis, others
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25
Job of aldosterone
* Absorb Na * Dump K
26
Electrolye concentrations
* Sodium * Potassium * Chloride * Bicarbonate Sodium : Potassium ratio * to see if has addisons (no aldosterone)
27
Electrolytes Sample Collection **test question**
* Fasted serum sample separated from clot ASAP * red top tube, no anticoagulant * decreases artifacts due to * postprandial lipemia (calcium) - falsly decreases electrolytes * leakage of intracellular components (potassium) * Heparinized plasma may be used * gree top, lithium heparin * **Do not use anticoagulants that chelate** * **​purple top (potassium EDTA)** * **blue top (sodium citrate)**
28
1. Really high potassium in a blood sample w/o high calcium or magnesium 2. High K level incompatible with life, Ca and Mg too low for life... **test question**
1. Possibly got too much of potassium supplemented fluids in blood sample from catheter line 2. Blood was taken from a purple top and put into tiger top
29
Effect of catheters on vasculature
* Can activate clotting cascade * you are hypercoagulable anytime you have a clot
30
Electrolyte artifacts due to K-EDTA (purple top) **test question**
* K is four times what it should be * Ca and Mg decreased and incompatible with life * EDTA chelates divalent cations * Bicarbonate (TCO2) decreased * looks like acidosis * EDTA = ethylene diaminetraacetic **ACID**
31
Electrolyte Artifacts due to Na-Citrate | (light blue top....?)
* Sodium increased * Na in the anticoagulant * Divalent cations (Ca2+, Mg2+) decreased * citrate chelates divalent cations * Bicarbonate (TCO2) decreased * looks like acidosis * Citrate = Citric **acid** * Chloride decreased * dilution due to excess anticoagulant
32
Sodium Function Regulation Measurement
* Functions * major extracellular fluid electrolytes * major determinant of osmolality * **essential for control of hydration (RAAS)** * Concentration regulated by * Adequate intake (herbivores) * Intestinal absorption * Renal tubular resorption (RAAS) * Measurement * Reflects body sodium content (extracellular electrolyte) * **Interpret in light of hydration status**
33
Sodium Abnormal Concentration Hypernatremia Hyponatremia
* Hypernatremia * inc Na * dec water * Hyponatremia * dec Na * inc water Sodium and water can be lost together * Na and Cl almost always travel together * disorders affecting Na almost always affect Cl * Water follows salt * sodium concentration may be normal, animal will appear dehydrated
34
Hypernatremia Decreased water Increased sodium
* Decreased water * inadequate intake * loss of sodium poor fluid * renal * GI * Insensible * third space sequestration * effusion * rumen * Increased sodium * **Salt poisoning** * Sea water ingestion * Iatrogenic (fluids) \*mild hypernatremia common with dehydration \*severe hypernatremia uncommon
35
Hypernatremia Clinical signs dz examples
* Due to hyperosmolality * depression * dementia * seizures * coma * Depend upon severity and rate of development * compensation (idiogenic osmoles) may occur * Dz examples * lack of ADH secretion = central diabetes insipidus * renal loss of pure water * hypotonic diarrhea * GI loss of sodium poor fluid
36
Hyponatremia (common) Decreased sodium
* Loss of sodium * **GI V/D** * Renal * **Diuresis (primary renal dz, osmotic)** * **Hypoadreocorticism** * addisons (body not making aldosterone) * Third spacing sequestration * chylothorax w/ repeated drainage * uroabdomen * **Deficient intake (herbivores)**
37
Hyponatremia (common) Increased water
* Hyperosmolal NOT from inc Na * Edema * Psychogenic polydipsia * near drowning in fresh water * iatrogenic (fuid admin) * Inappropriate ADH secretion
38
Sodium and water lost together
* Hyponatremia * Calf diarrhea * **measured Na concentration may be normal** * whole body Na can be depleted tho * animal will appear dehydrated +/- hypovolemic
39
Pseudohyponatremia (uncommon)
* Can happen when looking at a lipemic sample as artifact * ion-specific electrodes don't know how to measure lipemic samples * **point of care blood gas machines NOT AFFECTED (ICU)** * **​dry chem analysis, doesn't need water to measure**
40
**Potassium** Functions Concentration affected by Measurement
* Function * major intracellular fluid electrolyte * essential for cardiac and skeletal muscle function * Concentration affected by * external potassium balance * GI, Renal, Sweat * Internal potassium balance * shifts between intracellular and extracellular fluids * Combination of both internal and external * Measurement * poor reflection of body potassium content * **interpret in light of acid base status**
41
Internal Potassium Balance
Metabolic acidosis excess hydrogen ions (H+) * Some H+ are excreted by the kidneys * Some H+ shift intracellularly in exchange for potassium \*Most of K inside the cell \*If lots of H+ outside the cell * ie DKA * H+ exchanged for K * fixing acidosis =\> K goes into cell =\> animal become hypokalemic \*serum biochem measures extracellular K
42
Internal Potassium Balance Acid base
* Potassium shifted extracellularly due to acidosis * leads to whole body cellular depletion of potassium * K+ is excreted by the kidneys when function is normal * concurrent metabolic acidosis and hypokalemia = K depletion
43
Internal Potassium Balance Insulin
* Insulin-dependant potassium glucose symporter * presence of glucose stimulates insulin secretion \*First step for hyperkalemic animal * Give calcium gluconate * stabilizes cardiac myocytes \*Step 2 for hyperkalemic animal * Hook up to ECG \*Step 3 for hyperkalemic animal * give glucose then insulin * drives K into the cell
44
Hyperkalemia will cause
* bradycardia =\> arrhythmias =\> cardiac arrest =\> death
45
Internal Potassium Balance and diabetes
* Can't trust chem values in diabetic animals * Diabetics may be * **hyperkalemic** * **normokalemic** * **hypokalemic** **​​\*With diabetics will measure electrolytes every couple of hours**
46
Insulin deficiency or peripheral tissue resistance
* Glucose spills into urine when renal threshold exceeded * K+ removed from blood by kidneys if function is normal * a diabetic may be **normokalemic**
47
Insulin
* drives potassium and glucose into cells * Potassium needs glucose to go inside the cell * Won't work if you're insulin resistant * treatment of life-threatening hyperkalemia * insulin and dextrose
48
Potassium abnormal concentration Hyperkalemia
* Altered external balance * failure to exrete * Altered internal balance * leakage from damaged cells * shift form ICF to ECF * Spurious
49
Potassium abnormal concentration Hypokalemia
* Altered external balance * inc loss (GI, renal) * dec intake * Altered internal balance * shift from ECF to ICF * Spurious
50
Hyperkalemia (Common) Altered external balance
* Altered external balance * **failure of renal exretion** * **​oliguric/anuric renal failure** * **urinary tract rupture** * **urethral obstruction** * **​Hypoadrenocorticism (addison's)** * Chylothorax w/repeated drainage * Iatrogenic * excessive IF fluid potassium * drugs that dec renal excretion
51
Hyperkalemia (Common) Altered internal balance
* cell membrane damage * muscle necrosis * acute tumor lysis * Inorganic metabolic acidosis (rare cause) * organic acidosis (common) * K+ shifts out of cells but kidneys excrete * Diabetes mellitus * insulin deficiency or tissue resistance
52
Spurious Potassium Measurement Sample issues
* Sample issues * Hemolysis w/K+-rich RBCs or traumatic blood draw * Japanese dog breeds * horses * pigs * primates * Thrombocytosis (\>1 million/microL) * with cushings (macs don't eat old platelets) * Potassium released during clotting * Use heparinized plasma sample to avoid clot * Contamination with potassium containing IV fluid * Dry method with severe hypernatremia
53
Spurious potassium measurement Methodology issues
* Methodology issues * rarely occurs * similar to pseudohyponatremia * lipemia * severe hyperproteinemia * diluted sample method
54
Hypokalemia (common) Altered external balance
* **GI loss** * **vomiting** * **diarrhea** * **abomasal disorder** * **whipworm dz (pseudoaddisons)** * **Inc renal exretion** * **polyuric renal failure (~30% cats with CRF; 10% dogs with CRF)** * **Postobstructive diuresis** * **Diabetic ketoacidosis (DKA) = diabetes mellitus with ketoacidosis** * Dec intake * **usually exacerbates GI or renal loss** * Iatrogenic * drugs that increase renal excretion (Furosemide) * K poor IV fluid \*Usually markred whole body cellular depletion
55
Hypokalemia (Common) Altered internal balance
* Altered internal balance (potassium shifts intracellularly) * Metabolic alkalosis (uncommon) * Iatrogenic * bicarbonate administration * tx for acidosis/hyperkalemia * glucose + insulin therapy * tx for DKA; hyperkalemia
56
Hypokalemia Clinical Signs Dz examples
* depends on severity and rate of development * due to * medullary washout: PU/PD * abnormal membrane electrical potential * skeletal muscle weakness * respiratory arrest * cats: * neck ventroflexion * nephropathy * polymyopathy * ECG changes * arrhythmias * Dz examples * during tx of male cat urethral obstruction (diuresis) * during tx of DKA (shifts into cells)
57
Sodium : Potassium ratio
* \< 27 suggestive of hypoadrenocorticism * \< 19 highly suggestive * Other dz may have a low ratio * renal dz * severe diarrhea (salmonellosis, whipworms) * repeated chylothorax drainage * others * Test useful to help detect underlying Addison's * try to exclue other dz based on other findings * confirm Addisons with ACTH stimulation test
58
Chloride Functions Concentration affected by Selective chloride changes
* Functions * major extracellular fluid anion * component of many secretions * Concentration affected by * NaCl related changes * Cl moves with Na * Selective Cl changes * loss of chloride-rich, sodium poor secretions * gastric HCl * Cl conc varies inversly with bicarb con * to maintain electroneutrality * when bicarb is lost Cl increases * GI or renal
59
Chloride Measurement **test question**
* Measurement * reflects body chloride content * extracellular electrolyte * Interpret in light of hydration status * **Other halides crossreact, and detected as chloride** * **​Epileptics treated with KBr have spurious Cl inc**
60
Chloride abnormal concentration Hyperchloremia
Hyperchloremia * Na related increases * Compensation for dec bicarbonate * Iatrogenic * Spurious
61
Chloride abnormal concentration Hypochloremia
* Hypochloremia * Na related decreases * Loss of Cl rich secretions * Iatrogenic * Spurious
62
Hypochloremia Cl rich gastric secretions not resorbed
* Most Chloride made in stomach....? * Chloride rich gastric secretions (HCl) not resorbed * Ruminants * abomasal dz * High GI obstruction * Monogastrics * **severe** vomiting * High GI obstruction * NG tube suctioning
63
**Hypochloremic metabolic alkalosis with paradoxical aciduria** **TEST QUESTION** **NAVLE**
* Upper GI dz (usually LDA) * dehydration (not drinking) * hypokalemia (not eating) * loss of HCl (Cl sequestered in stomach) * leads to metabolic alkalosis * The deydration leads to * RAAS activation =\> Cl resorption & K excretion * The loss of HCL leads to * metabolic alkalosis =\> alkaline urine \* sequestered Cl=\> resorption of bicarb instead of Cl =\> paradoxical acid urine \*hypokalemia =\> can't exrete K =\> H+ excretion which exacerbates whole sitiation
64
Bicarbonate (TCO2)
* Measurement * serum total CO2 about equal to bicarb conc * Conc also can be calculated by point of care blood gas machines * Conc affected by * Renal prod & conservation of HCO3 * Acid base balance
65
Bicarb to Carbonic acid
Maintain a 20 : 1 ratio Bicarb: main metabolic base Carbonic acid: main respiratory acid

Clin path test 4 (9 decks)

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