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NUE 325: Pathopharm I > Electrolytes > Flashcards

Electrolytes Flashcards

1
Q

Function of fluid

A
  • transports nutrients and waste to and from cells
  • acts as solvent for electrolytes/non electrolytes
  • helps maintain body temp, digestion/elimination, acid-base balance, lubrication of joints and body tissue
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2
Q

Composition of body fluid

A

Water that contains dissolved or suspended substances
- 50-60% of body wt is water

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3
Q

Fluid compartments

A
  • intracellular: inside the cells
  • extracellular: outside the cell
  • interstitial fluid: between the cells
  • intravascular fluid: plasma (part of blood)
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4
Q

Movement of fluid and electrolytes

A
  • diffusion
  • facilitated diffusion
  • active transport
  • osmosis
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5
Q

Osmosis

A

Movement of water down its concentration gradient
- from low solute env to high solute env across a semipermeable membrane
- stops when conc differences disappear or hydrostatic pressure builds and opposes further movement

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6
Q

Diffusion

A

Movement of molecules from an area of high conc to low conc
- movement stops when conc are equal

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7
Q

Osmotic pressure

A

Amount of pressure needed to prevent the movement of water across a cell membrane

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8
Q

Colloids

A

Substances that inc colloid oncotic pressure
- move fluid from interstitial compartments to plasma compartment

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9
Q

3 primary colloids

A
  • albumin
  • globulin
  • fibrinogen
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10
Q

How to measure colloids

A

Total protein level
-not an indicator of protein nutrition

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11
Q

Colloid oncotic pressure dec w

A

Age
Overall malnutrition
- can be replaces with colloid replacements

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12
Q

Hydrostatic pressure

A

Force of fluid in compartment pushing against the cell membrane (or vessel wall)
- generated by bp
- at capillary level—> major force that pushes water out of vascular into interstitial

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13
Q

Oncotic pressure

A

Aka colloid oncotic pressure
Caused by plasma colloids in solution
- plasma has lots of colloids and the interstitial space has few so plasma proteins attract water and pull fluid from tissues into vascular space

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14
Q

Hydrostatic and oncotic

A

Hydro pushes fluid out of capillaries
Oncotic pulls fluid into capillary

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15
Q

Electrolyte influence

A

Fluid balance, acid base balance, nerve impulses, muscle contractions, heart rhythm, other cell functions
- function collaboratively so a change in one is going to influence changes in others

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16
Q

Electrolytes

A

Substances that are electrically charged when in solution

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17
Q

Conc of electrolytes depend on

A
  • intake
  • absorption
  • distribution
  • excretion
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18
Q

Where do we find electrolytes

A

Intracellular
- K, Mg, Ph
Extracellular
- Na, Cl, bicarbonate

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19
Q

What happens if electrolyte imbalance occurs

A

We replace abnormal losses with a fluid and electrolyte similar to that which was lost

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20
Q

Normal Na level

A

136-145 med/L

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21
Q

K levels

A

3.5-5.0 meq/L

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22
Q

Mg levels

A

1.7-2.2 mg/dl

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23
Q

Ca levels

A

9-11 mg/dL

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24
Q

Ph levels

A

3.2-4.3 mg/dL

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25
Q

Hypo/hypernatremia

A

-below 136 and above 145

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26
Q

Sodium key points

A

Main ECF cation which governs osmolality and influences water distribution
- sodium sucks water towards it
- activates muscle and nerve cells —> important for AP

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27
Q

Causes of hyponatremia

A
  • GI loss: vomiting/etc. fistulas, NG suction
  • renal losses: diuretics, adrenal insufficiency
  • skin loss: burn skin, wounds
  • fasting diets or polydipsia
  • excess hypotonic fluid
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28
Q

S/s of hyponatremia

A
  • confusion/ altered LOC
  • anorexia, muscle weakness
  • can lead seizure
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29
Q

Hyponatremia altered LOC explained

A

Cells in the brain swell
- more solutes in the cells than vascular space

30
Q

Dilutional hyponatremia

A

hypervolemic: too much volume in the vascular space
- extra fluid dilutes the Na down
- increase bp, wt gain, bounding/rapid pulse, inc urine sp gravity

31
Q

Depletion hyponatremia

A

Hypovolemic: Low Na
- hypovolemia, dec bp, tachy pulse, dry skin, wt loss, dec urine sp gravity

32
Q

Treatment of hyponatremia

A
  • slow Na replacement PO/IV
  • can do normal saline
  • fluid restrictions
  • treating underlying problem
33
Q

Why is Na replacement slow

A

Too much Na too fast will in Na in vascular space, so fluid moves out of cells (specifically brain) and dehydrate the cell causing the altered LOC

34
Q

Causes of hypernatremia

A

-IV fluids, tube feeds, near drownings in salt water—> excess Na intake
- not enough water intake or too much water loss due to cog impairment, diarrhea, high fever, heatstroke
- profound dieresis

35
Q

S/s of hypernatremia

A
  • altered LOC, confusion, seizure, coma
  • extreme thirst (hyperosmolaity)
  • dry, sticky mucous membranes
  • muscle cramps
36
Q

Hypernatremia treatment

A

If water is lost to quickly, then add water
If na is in excess, then remove na
- gradually adjust over 48 hr period to avoid edema of cerebral cells

37
Q

Potassium

A

Intracellular ion that helps regulate the excitability and electrical status
- helps control intracellular osmolality
- diet is main source
- kidneys main source of loss

38
Q

Normal values of k

A

3.5-5 mEq/L

39
Q

Causes of hypokalemia

A

Renal or GI losses like diuresis
Acid base disorders —> k leaves ECF into ICF

40
Q

S/s of hypokalemia

A
  • cardiac rhythm disturbance (heart attack)
  • muscle weakness, leg cramps
  • dec bowel motility, constipation, nausea, lieu’s
  • potassium and ATP pump *
41
Q

Hypokalemia treatment

A

Potassium chloride

42
Q

Hyperkalemia cause

A
  • dec potassium output (renal failure, not peeing)
  • burns, crash, injuries, sepsis (K lives in cells, so when many die they release K into blood)
  • drugs (K sparing, ACE, ARBS, NSAIDS)
43
Q

Hyperkalemia s/s

A

Cardiac rhythm disturbance
- muscle weakness, cramps
- abdominal cramping

44
Q

Hyperkalemia treatment

A

Diuretics or drugs

45
Q

Magnesium

A

Helps stabilize cardiac muscle cells by blocking/controlling movement of K OUT of cardiac muscles
- also helps stabilize smooth muscles

46
Q

Hypomagnesium causes

A
  • diuresis
  • GI or renal losses
  • limited intake (fasting/starvation)
  • alc abuse
  • pancreatitis
  • hyperglycemia
47
Q

Hypomagnesium treatment

A
  • Treat cause
  • replacement oral or IV
48
Q

Hypomagnesium s/s

A
  • hyperactive reflexes
  • confusion
  • cramps
  • tremors
  • seizures
  • nystagmus
49
Q

Hyper magnesium cause

A

Increased intake accompanies with renal failure
- renal failure and OB pts
- healthy ppl pee it out

50
Q

Why can OB pts get hyper magnesium

A

Given mg sulfate to prevent pre eclampsia, eclampsia and seizures

51
Q

Hyper magnesium s/s

A
  • lethargic
  • floppiness
  • muscle weakness
  • dec reflexes
  • flushed/warm skin
  • dec pulse/BP
52
Q

Hyper magnesium treatment

A

Stop replacement
- if chronic, then dialysis

53
Q

Calcium

A

Hormones released from thyroid and parathyroid glands control amount of Ca absorbed/released from bone

54
Q

When is majority of Ca

A

Bone

55
Q

Ca functions

A
  • enzyme rxns
  • effects membrane potentials and nerve excitability
  • helps in release of hormones, NTs, and chemical mediators
  • influences cardiac contractility and automaticity
  • necessary for blood clotting
56
Q

Hypocalcemia cause

A
  • unable to mobilize Ca from bone
  • hypoparathyroidism
  • hypomagnesium
  • increase renal loss
  • inc binding
  • dec intake of absorption, dec vitamin D
  • acute pancreatitis
  • thyroid/parathyroid surgery
57
Q

Hypocalcemia s/s

A

Increased neuromuscular excitability
- parasthesias (numbness/tingling)
- muscle cramps, bone pain, tetany, laryngeal spasms, hyperactive reflexes
- prolonged QT interval
- positive Chvostek’s and Trousseau

58
Q

Chovsteks

A

Ipsilateral twitching of the circumoral muscles in response to gentle tapping of the facial nerve just anterior of the ear

59
Q

Trousseau

A

Carpal spasm upon inflation of BP cuff to 20 mmHg Obote pts sbp for 3 mins

60
Q

Treatment of hypocalcemia

A

IV: ca chloride/ca gluconate., given through central line typically
Oral: elemental Ca, Ca carbonate (tums), may also need vitamin D (active form in impaired liver and or kidney function)

61
Q

Hypercalcemia causes

A

Hyperparathyroidism
Cancer (breast, lung, hemotological)

62
Q

S/s of Hypercalcemia

A

Calcium acts like a sediative, fatigue, lethargic, confusion, weakness, leading to seizure/coma, kidney stones
- dec excitability

63
Q

Treatment of hypercalcemia

A

Adequate hydration
- inc urine output
- diuretics and NaCl (na excretion accompanied w Ca)
- dialysis in renal failure

64
Q

Phosphorus location

A

Mostly found in bone, some intracellular
- tiny amount in blood

65
Q

Forms of P

A

Organic: intracellular
Inorganic: circulating and measured

66
Q

Function of P

A
  • role in bone formation
  • essential for ATP formation and enzymes need for glucose, protein, fat metabolism
  • part of RNA, DNA
  • acid base buffer
  • normal function of WBC and platelet
67
Q

Hypophsophatemia cause

A
  • dec absorption
  • antacids OD
  • severe diarrhea
  • inc kidney elimination
  • malnutrition (alcoholism, TPN, recovery)
68
Q

Hypophosphatemia s/s

A

Tremor, parasthesia, confusion to coma, seizure, muscle weakness, joint stiff, hemolytic anemia, platelet dysfunction, impaired WBC

69
Q

Causes of hyperphosphatemia

A

Kidney failure
- laxative/enemas with P
- shift form intracellular to extracellular due to trauma or heat stroke
- hypoparathyroidism

70
Q

S/s hyperphosphatemia

A

Usually asymptomatic
- usually the symptoms of hypocalcemia: muscle spasms, parathesia, tetany

71
Q

Treatment for p imbalance

A

Hypophosphatemia: oral or IV replacement given over a long period of time, inc risk of calcification
Hyperphosphatemia: treat cause, ca based p binders, hemodialysis

NUE 325: Pathopharm I (23 decks)

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