Electrolytes & Fluids Flashcards by Arwa Elbaghdady

What are the normal ranges of:
PH
PCO2
HCO3
PO2

PH 7.35-7.45
PCO2 4.5-6
HCO3 22-28
PO2 10-14

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What are the causes of Respiratory acidosis?

-Hypoventilation (inhibition of respiratory center) as in morphine poisoning and COPD

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Respiratory acidosis ABG?

PH⬇️
PCO2⬆️

If compensated: HCO3⬆️
If uncompensated: HCO3 normal

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What are the causes of respiratory alkalosis?

Hyperventilation (stimulation of respiratory center) as in:
Hypoxia
Hypotension
Tumor/fever/meningitis

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Respiratory alkalosis ABG?

PH⬆️
PCO2⬇️

If compensated: HCO3⬇️
If uncompensated: HCO3 normal

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What are the causes of metabolic acidosis?

Diarrhea
DKA and shock
Addison
Hyperkalemia
Peritonitis or bowel ischemia
Excessive saline intake

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Metabolic acidosis ABG?

PH⬇️
HCO3⬇️

If compensated: PCO2⬇️
If uncompensated: PCO2 normal

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What are the causes of metabolic alkalosis?

Vomiting
Conn’s and Cushing disease
Hypokalemia
NGT in ICU patients

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Metabolic alkalosis ABG?

PH⬆️
HCO3⬆️

If compensated: PCO2⬆️
Uncompensated: PCO2 normal

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What is the anion gap?

(Na+K)-(HCO3+Cl)=10-18mmol/L

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What are the causes of normal anion gap (hyperchloremic)

RAGHDA

-RTA (Renal tubular acidosis)
-Addison
-GIT as diarrhea, fistula and ureterosigmoidostomy
-Hyperkalemia
-Drug as acetazolamide
-Ammonium chloride injection

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What are the causes of high anion gap?

MUD PILES

-Methanol
-Uremia
-DKA
-Paraldehyde
-INH and Iron
-Lactate
-Ethanol
-Salicylate

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What are the causes of hypokalemia and how it presents?

Rectal adenoma
Vomiting
Diarrhea
Fistula
Conn’s and Cushing

It presents by cardiac arrhythmias

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What are the ECG highlights in hypokalemia?

U have no P, no T, long PR and long QT

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What is the treatment of hypokalemia?

1/3weightdeficit
Normal K+ is 3.5-5.5

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What are the causes of Hyperkalemia and how it presents?

AHBK RAMDAN

Angiotensin blocker
Heparin and LMWH
B-blocker
K sparing diuretics

Renal failure
Addison
Massive blood transfusion
DKA
Acidosis
Necrosis as burn, trauma and crush syndrome

It presents in the form of cardiac arrhythmias

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What are the highlights of ECG in Hyperkalemia?

Flat P, Tall T and wide QRS

How to treat Hyperkalemia?

1-Stabilize the heart by CA gluconate first
2-Extracellular to intracellular by:
—Insulin and glucose
—B agonist as salbutamol
3-Removal from body by:
—Chelating agent as calcium resin
—Loop diuretics
—Dialysis

What are the causes of hypocalcemia and how it presents?

-Post thyroidectomy
-Acute pancreatitis
-Mg deficiency

It presents as latent tetany (chovosteck sign and trousseau sign) or manifest tetany (carpopedal spasm and convulsions)

What are the ECG highlights in hypocalcemia?

Prolonged QT interval (ventricular contraction)

How is hypocalcemia treated?

10%- 10ml- in 10 mins ca gluconate (on glitches 5%)

What are the causes of Hypercalcemia and how it manifests?

-Metastatic cancer as breast cancer
-Hyperparathyroidism (1ry and 3ry)
-Sarcoidosis, Vit. D and Ca supplementation and milk alkali syndrome

It manifests as follows:
Disease of bone, renal stone, abdominal groan, psychic moan

What are the highlights in the ECG in Hypercalcemia?

Shorten QT interval

What is the treatment of Hypercalcemia?

IV fluids as 3-6L saline 9% over 24h (الكالسيوم اما يزيد، غرقّه)

-Pamidronate (most potent, taken every month)
-Zolindronate (longest, taken every 6 months)
-Calcitonin (quickest but short duration)
-Prednisolone (taken in cases of sarcoidosis, Vit.D intoxication and multiple myeloma)

What are the types of hyponatremia?

Hypervolemic hyponatremia Euvolemic hyponatremia Hypovolemic hyponatremia Pseudo hyponatremia

…..might cause hypervolemic hyponatremia

IV dextrose 5% (أكنّي بديّ العيان مية من غير ملح)

….might cause Euvolemic hyponatremia

SIADH Treated by fluid restriction

What are the causes of hypovolemia hyponatremia?

1-Extrarenal cause (GIT and Skin) (Urine Na<20mmol/L) —Diarrhea —Vomiting —Burn —Sweating —Rectal adenoma 2-Renal cause (Urine Na>20mmol/L) —Diuretic —Addison —Diuretic stage in renal failure

What are the causes of pseudo hyponatremia?

-Multiple myeloma -Hyperlipidemia

When is hyponatremia managed and what is the regimen?

Indications: -Asymptomatic<120 (normal 135-145) -Symptomatic (confusion, heart failure, pulmonary edema) Regimen: 2/3*weight*deficit (125-serum Na)

What is the amount of iron in the body and it’s distribution?

4gm 70%Hb 25%ferritin, transferrin and hemosiderin 4%myoglobin 1% plasma iron

Where is the iron absorbed?

In the small bowl (duodenum)

What is hemochromatosis (iron overload)?

-Primary hemochromatosis is a hereditary disease that runs in families. Over absorption of iron so iron is deposits in joints, heart, liver and pancreas. -Secondary hemochromatosis is associated by anemia, liver disease and a lot of blood transfusions.

How is hemochromatosis diagnosed?

A Prussian blue iron stain demonstrates the blue granules of hemosiderin in hepatocytes and kupffer cells.

What is the effect of Cushing syndrome on Na and water?

⬆️Na and water ⬇️k and H

What is the effect of conn syndrome on Na and water?

⬆️Na and water ⬇️K and H

What is the effect of Addison disease on Na and water?

⬇️Na and water ⬆️K and H

What is the effect of SIADH on plasma and urine Na and osmolarity?

⬇️Blood Na and osmolarity ⬆️Urine Na and osmolarity

Give account on fluid compartment?

Total body fluid: 60% Intracellular: 40% Extracellular: 20% (Interstitial-15%, Plasma-5%)

Glucose 5% or saline free fluid …… ECF and …… osmolarity

Increase Lower

Saline …… ECF and …. osmolarity

Increase Increase (or stay the same)

What are the causes of edema?

-Burn: due to hypoalbuminemia -Inflammation: due to increase permeability