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Patho > Electrolyte/ Fluids/ Acid base Imbalances > Flashcards

Electrolyte/ Fluids/ Acid base Imbalances Flashcards

1
Q

Signs and symptoms of hyponatremia? SALT LOSS

A

S-seizures and stupor
A-abdominal cramping and altered (confusion)
L-lethargic
T-tendon reflexes diminished, trouble concentrating

L-loss of urine and appetite
O-orthostatic hypertension, over active bowel sounds
S-shallow respirations (happens late due to skeletal muscle weakness)
S-spasms of muscles

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2
Q

What will cause excessive NA+ intake leading to HYPERnatremia? (2)

A

Hypertonic solutions and GI tube feedings

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3
Q

Causes of HYPERMAGNESEMIA?

MAG

A

M-Mg containing antacids and laxatives
A-Addisons disease
G- glomerular filtration insufficiency ( renal disease)

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4
Q

What are the signs and symptoms of metabolic acidosis

A

Warm, dry, pink skin, tachypnea “Kussmaul’s respiration’s” , hypotension, drowsiness, confusion or coma, headaches, decreased DTR ‘s and muscle tone, flaccid paralysis, cardiac dysrhythmias, anorexia, N/V

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5
Q

S/sx of HYPERNATREMIA (7 systems)

A

Cardiopulmonary: tachycardia, orthostatic HTN, edema

Neuro: agitated, confused, seizures, coma, irritability, dizziness.

MSK: restlessness, weakness

GI: hyperactive bowel sounds

GU: decreased urinary output

SKIN: hyperthermia, flushed skin, dry MM

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6
Q

S/sx of HYPERCALCEMIA?

WEAK + 2 additional

A

W- weakness in msls but severe associated with lethargy
E-EKG changes (shortened QT interval, tachycardia for mild and bradycardia for severe)
A-abdominal cramping and constipation
K-kidney stone formation

Additional: bone pain, hypophosphatemia

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7
Q

What are causes of hypervolemia, fluid volume excess?

A

Heart failure, steroids, SIADH, fluid shifts, excessive sodium intake, decreased cardiac function, intake of fluid without replacement of electrolytes, abnormal renal function

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8
Q

What are colloids?

A
  • Large molecules that help draw fluid into the intravascular space such as blood products.
  • don’t form a true solution but instead a suspension.
  • they never truly mix
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9
Q

S/sx of HYPOCALCEMIA?

CRAMPS + 3

A

C-confusion
R-reflexes are increased
A-arrhythmias (EKG changes prolonged ST segment and QT intervals, bradycardia)
M-msl cramps
P-positive Trousseaus, paresthesias in ext and face.
S- sign of Chetvoskis

Osteoporosis, diarrhea, hyperactive bowel sounds.

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10
Q

Where is magnesium absorbed?

A

In the small intestine

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11
Q

Sx/signs of HYPONATREMIA (6 systems)

A

Cardiopulmonary: tachycardia, hypotension/HTN, shallow respirations.

Neuro: ALOC, confused, dizzy, headache, seizures, stupor.

MSK: msl spams, msl weakness, decreased DTRs, fatigue, lethargy

GI: abdominal cramping and overactive bowel sounds

GU: reduced urine output d/t dehydration

SKIN: hypothermia

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12
Q

What are 8 causes of overproduction of hydrogen ions that leads to metabolic acidosis

A

DKA, starvation, lactic acidosis, heavy exercise, hypoxia, ethanol and salicylate intoxication, sepsis, and burns

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13
Q

S/sx of HYPERMAGNESEMIA?

LETHARGY

A 
L- lethargy
E- EKG changes ( prolonged PR intervals and widened QRS) 
T-tendon reflexes reduced 
H-hypotension
A- arrhythmias ( bradycardia) 
R-respiratory arrest
G- GI issues (N/V) 
C- cardiac arrest, coma
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14
Q

What causes an extracellular shift leading to HYPERkalemia?

A
  • tumor lysis syndrome
  • tissue injury
  • decreased insulin
  • acidosis
  • hyperglycemia
  • uncontrolled diabetes
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15
Q

What is the role of sodium?

A

Helps regulate water inside the cell and outside of the cell

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16
Q

Normal Calcium values in the serum?

A

9-10.5 mg/dL

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17
Q

What causes an increase in K+ intake leading to HYPERkalemia?

A
  • K+ rich foods
  • salt substitutes
  • IV push
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18
Q

What are the EKG changes in HYPERkalemia?

A

Widened QRS, peaked T waves, PVCs.

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19
Q

What causes intracellular shifts leading to HYPOkalemia?

A
  • increased insulin
  • hypoglycemia
  • alkalosis
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20
Q

Where is calcium absorbed, stored, and excreted from?

A

It is absorbed in the small intestine, stored in the bones, and excreted by the kidneys.

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21
Q

In comparison to Cushing’s disease how is Addison’s disease different?

A

It leads to adrenal insufficiency where not enough aldosterone is secreted

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22
Q

What causes increased K+ excretion leading to HYPOkalemia?

A
  • GI losses (V/D/prolonged suctioning)
  • renal losses ( diuretics, steroids, and kidney diseases)
  • skin losses ( excessive sweating, burns, wound drainage)
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23
Q

What are the EKG changes in HYPOkalemia?

A

ST depressions and T wave inversions

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24
Q

Signs and symptoms of respiratory acidosis

A

Tachycardia, HTN, dyspnea, tachypnea, pallor or cyanosis, anxiety, irritability, disorientation, confusion, coma, or dysrhythmias

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25
Q

What are the 4 general causes of HYPERNATREMIA?

A
  • Increased Na+ intake
  • Na+ retention
  • Fluid loss
  • decreased water intake
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26
Q

What are the complications of hypervolemia? There are two

A

Pulmonary edema and hyponatremia

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27
Q

Signs and symptoms of respiratory alkalosis

A

Tachypnea, neurological symptoms like giddiness , dizziness, syncope, convulsions, or coma. Weakness, paresthesias, tetani, tachycardia

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28
Q

Systems most affected by K+ imbalance

A

Cardiac and skeletal

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29
Q

What are the causes of HYPOMAGNESEMIA?

LOW MAG

A

L-low consumption of Mg ( malnutrition)
O- other electrolytes (low K and low ca)
W-wasting Mg in the kidneys (diuretics)

M-malabsorption syndromes
A-alcohol ingestion
G-glycemic issues

Additionally:

  • diarrhea/suction
  • administration of blood products
  • aminoglycoside abx
  • cisplatin
  • amphotericin B
30
Q

What are Crystalloids?

A
  • normal Saline and lactated ringer‘s
  • they pass through a semi permeable membrane
  • form a true solution
  • solution truly mixes together and can’t separate out the different molecules
31
Q

What are 3 causes of inadequate elimination of hydrogen ions that leads to metabolic acidosis

A

Renal failure, liver failure, dehydration

32
Q

PH, CO2, HCO3 values for respiratory alkalosis

A

PH > 7.45
C02 < 35 mmHg
HCO3 is within normal limits or compensating

33
Q

What causes a decrease in K+ excretion leading to HYPERkalemia?

A
  • dehydration
  • kidney disease
  • fluid retaining meds ( NSAIDs and ACE inhibitors )
  • Addisons disease ( adrenal insufficiency) not enough secretion of aldosterone to secrete K+ .

*Note aldosterone retains Na+ and water while secreting K+.

34
Q

What are the effects of hypervolemia?

A

Confusion, SOB, lethargy, muscle weakness, tachycardia, bounding heart, HTN, tachypnea, weight gain, crackles, diminished breath sounds, edema, JVD

35
Q

What are complications of hypovolemia?

A

Hypovolemic shock, falls, renal damage

36
Q

S/sx of HYPOkalemia? (4 systems)

A

Cardiopulmonary- decreased HR, weak and irregular pulse, fluttering in chest, hypotension, shallow breathing, EKG changes.

Neuromuscular- msl weakness, msl cramps, paresthesias, confusion, lethargy, decreased DTRs.

GI- decreased GI motility, constipation, hypoactive bowel sounds.

GU- reduced urine output secondary to polyruia.

37
Q

PH, CO2, HC03 values for respiratory acidosis

A

PH < 7.35
C02 > 45 mmHg
HC03 is normal or compensating

38
Q

What are four causes of Edema?

A

Increase capillary pressure (fluid overload), decreased colloidal osmotic pressure (albumin), increase capillary permeability (inflammation), obstruction of lymphatic flow

39
Q

Causes of respiratory alkalosis

A
  • hypoxemia stimulated hyperventilation
  • salicylate toxicity
  • CNS trauma or tumor
  • excessive exercise
  • Extreme stress
  • early sepsis
  • severe pain
40
Q

What fluid losses lead to HYPERNATREMIA? (3)

A
  • dehydration
  • renal failure
  • sweating
41
Q

What are 2 causes of under production of bicarbonate that leads to metabolic acidosis

A

Renal failure and pancreatitis

42
Q

S/sx of HYPOMAGNESEMIA?

TWITCHING

A 
T-tetany, Trousseaus 
W- weak respirations
I-irritability 
T- Torsads de pointe 
C-cardiac changes (Peaked T waves, ST depression, V tach) Chvostek 
H- HTN, hyperactive DTRs
I- involuntarily movements (seizures) 
N-nausea 
G- GI problems ( hypoactive bowel sounds)

Additionally: paresthesias, weakness, depression, psychosis.

43
Q

What are 2 causes of over elimination of bicarbonate that leads to metabolic acidosis

A

Diarrhea and renal failure

44
Q

What are the effects of hypovolemia?

A

Hemoconcentration, weakness, fatigue, lethargy, tachycardia, hypertension, ALOC

45
Q

Causes of HYPERCALCEMIA? (7)

A

H-hyperparathyroidism
I-increase dietary intake
G- glucocorticoids (suppress absorption of calcium as side effect)
H-hyperthyroidism

C-calcium excretion decreases with Thiazide diuretics, renal failure, and bone cancer.
A-adrenal insufficiency
L-lithium usage (affects parathyroid causing phosphorus to decrease)

Additionally: dehydration

46
Q

PH, CO2, HC03 values for metabolic acidosis

A

PH < 7.35
HCO3 < 22
CO2 is within normal limits or compensating

47
Q

What causes hypervolemia/HYPOnatremia?

A
  1. SIADH
  2. Water intoxication/drowning
  3. HF
  4. Excessive hypotonic solutions
  5. Diabetes insipidus (hyperglycemia)
  6. Ecstasy
  7. Addison’s disease
48
Q

What are signs and symptoms of metabolic alkalosis

A

Tachycardia, hypo ventilation, dysrhythmias, paresthesias, muscle weakness, confusion, and seizures

49
Q

What causes K+ to dilute leading to HYPOkalemia?

A
  • water intoxication

- Cushing’s disease (releases too much aldosterone and too much fluid is retained)

50
Q

Normal Mg serum levels?

A

1.3-2.1 mEq/ L

51
Q

How does Cushing’s cause fluid retention?

A

It produces an increased release of aldosterone from the adrenal gland which acts on the kidneys to hold on to Na+ and water but excrete K+

52
Q

What will increase bicarbonate leading to metabolic alkalosis

A

Oral ingestion or IV administration of bases

53
Q

What are the 4 general causes of HYPOkalemia?

A
  • increased K+ excretion
  • decreased K+ dietary intake
  • intercellular shifts
  • K+ dilution
54
Q

Causes of respiratory acidosis

A
  • Chronic respiratory conditions
  • drowning
  • airway obstruction
  • neuromuscular/neurological diseases
  • hypoventilation
  • inadequate chest expansion
  • sepsis
  • Burns
55
Q

What are 5 causes of an acid deficit leading to metabolic alkalosis

Hint: Decrease in H+

A

G.I. losses, thiazide diuretics , laxative abuse, Cushing’s syndrome, licorice plant intoxication

56
Q

What are the 2 different categories that can cause HYPONATREMIA

A

Loosing too much fluid and Na+ OR gaining fluid without gaining Na+

57
Q

What is the role of magnesium?

A

Cell function, regulation of parathyroid hormone, metabolizing , regulates BP, skeletal msl contraction, effects on DTR’s

58
Q

What causes Na+ retention leading to HYPERnatremia? (4)

A
  • Cushing’s syndrome (increase in aldosterone)
  • increase in aldosterone
  • renal failure
  • corticosteroids
59
Q

What are the three levels of compensation for pH balance

A

Uncompensated, partially compensated, compensated

60
Q

What causes hypovolemia/ HYPOnatremia?

A
  • GI losses
  • renal losses
  • skin losses
61
Q

PH, HCO3, CO2 values for metabolic alkalosis

A

pH > 7.45
HCO3 > 26
CO2 is within normal limits or compensating

62
Q

Causes of HYPOCALCEMIA?

LOW CALCIUM

A

L-lactose intolerance, low parathyroid hormone
O- oral inadequate intake
W-wound drainage

C-crohn’s disease and celiac disease (malabsorption, diarrhea)
A-acute pancreatitis
L-low vitamin D intake
C-chronic kidney disease
I-increase in phosphorus
U-use of certain medications ( laxatives, Mg supp)
M-mobility issues

63
Q

What are possible signs and symptoms of HYPERKALEMIA (4 systems)

A

Cardiopulmonary- irregular pulse, decreased cardiac contractibility (hypotension), EKG changes, respiratory failure, fluttering in chest, V fib.

Neuromuscular- early twitching, cramping, and paresthesias; restlessness, msl weakness. Late flaccid paralysis.

GI- increased GI morality, diarrhea, hyperactive bowel sounds.

GU- oliguria

64
Q

What can cause a fluid volume deficit a.k.a. hypovolemia

A

G I loss, excessive sweating, renal problems, diuretics, hemorrhage, hyperventilation, and DKA

65
Q

Normal serum sodium levels

A

136-145mEq/L

66
Q

normal K+ values

A

3.5-5.0mEq/L

67
Q

What are the 3 general causes of HYPERKALEMIA.

A
  • increase K+ intake
  • decreased K+ excretion
  • extracellular shift
68
Q

Causes of Metabolic acidosis?

ACIDOTIC

A 
A-aspirin toxicity
C-carbohydrates not metabolize ( lactic acid) 
I-insufficiency of the kidneys 
D-diarrhea, DKA
O-ostomy drainage
T-fistula 
I-intake of high fat diet 
C- carbonic anhydrase inhibitors (diuretics)
69
Q

If aldosterone helps retain Na+ and water what does it cause the kidneys to excrete?

A

K+ and H+

70
Q

Causes of metabolic alkalosis?

ALKALI

A 
A-adolsterone production 
L-loop diuretics ( Ladin and thiazides)
K-alkali ingestion 
A-anticoagulate citrate 
L-loss of fluids 
I- increase in Na+ bicarbonate administration
71
Q

Causes of respiratory acidosis?

DEPRESS

A 
D-drugs
E-edema
P-pneumonia 
R- respiratory center damaged
E-emboli 
S-spasms of bronchial tubes
S-sac elasticity
72
Q

Causes of respiratory alkalosis?

TACHYPNEA

A 
T-temperature increase
A-aspirin toxicity
C-controlled mechanical ventilation 
H-hyperventilating 
Y-hysterica ( anxiety)
P-pneumonia, pain (increased HR), pregnancy 
N-neurological injuries 
E-embolism and edema
A-asthma d/t hyperventilating

Patho (11 decks)

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