Exam 2: Fluids, Electrolytes, and Acid-Base Balance

Question 1

What is the distribution of fluid in the body?

Answer 1

2/3 intracellular, 1/3 extracellular (interstitial and intravascular)

Question 2

What are the forces affecting fluid distribution?

Answer 2

Osmotic and hydrostatic (capillary and interstitial)

Question 3

What is osmotic pressure?

Answer 3

pulling pressure, movement of things (lots of sodium in the vessel pulls water in

Question 4

What is hydrostatic pressure?

Answer 4

pushing pressure, blood against the blood vessel

Question 5

What are normal and abnormal excretion mechanisms?

Answer 5

Normal: urine, sweat, feces, respiration
Abnormal: vomiting, diarrhea

Question 6

What causes volume deficit?

Answer 6

vomiting, diarrhea, excessive diuretics, hemorrhage

Question 7

What causes volume excess?

Answer 7

Iatrogenic, heart failure, renal failure

Question 8

Clinical manifestations of volume deficient

Answer 8

depends on amount of fluid loss, tachycardia, orthostatic hypotension, dizziness, syncope, dry mucus membranes, skin tenting, prolonged capillary refill

Question 9

Clinical manifestations of volume excess

Answer 9

edema, JVD (jugular vein distention), dyspnea, orthopnea

Question 10

What is Hyponatremia?

Answer 10

relative excess of water (decrease sodium concentration)

Question 11

What is hypernatremia?

Answer 11

relative water deficiency (increased sodium concentration)

Question 12

Causes of hyponatremia

Answer 12

iatrogenic, water poisoning, SIADH, Diuretics, Replacement of fluids due to vomiting/ diarrhea with water but no salt

Question 13

Causes of Hypernatremia

Answer 13

Iatrogenic, diabetes insipidus, prolonged vomiting or diarrhea without volume replacement, diaphoresis

Question 14

How does sodium imbalance impact cells?

Answer 14

Hyponatremia causes cells to expand (decreased osmolality), Hypernatremia causes cells to shrink (increased osmolality)

Question 15

Clinical manifestations of abnormalities in sodium concentration

Answer 15

headache, nausea/vomiting, CNS dysfunction, confusion, seizures, coma

Question 16

What system is Sodium imbalance connected with?

Answer 16

Neurological

Question 17

What system is potassium imbalance connected with?

Answer 17

Muscular (smooth, cardiac, skeletal)

Question 18

What system is calcium imbalance connected with?

Answer 18

Neuromuscular (less cardiac but still some smooth and skeletal)

Question 19

What is edema?

Answer 19

swelling caused by excess fluid in tissues

Question 20

What are normal and abnormal electrolyte excretion mechanisms?

Answer 20

Normal: urine, feces (diarrhea (potassium, magnesium), Fat malabsorption (calcium, magnesium)), sweat
Abnormal: vomiting/diarrhea, fistula/wound drainage, nasogastric suction

Question 21

What is Hypokalemia? Causes

Answer 21

two little potassium, diarrhea, vomiting, alkalosis, potassium-wasting diuretics, excess insulin

Question 22

What is Hyperkalemia? Causes

Answer 22

too much potassium, renal failure, iatrogenic (blood transfusion or iv potassium), aldosterone inhibition (medications), insufficient insulin

Question 23

Hypokalemia clinical manifestations

Answer 23

muscle weakness, cardiac arrythmia, abdominal distention/ ileus

Question 24

Hyperkalemia clinical manifestations

Answer 24

muscle weakness, cardiac arrythmia, intestinal cramps/diarrhea

Question 25

What is Hypocalcemia? Causes

Answer 25

too little calcium, dietary insufficiency, vitamin D deficiency, renal failure, fat malabsorption (pancreatitis), large blood transfusions (citrate)

Question 26

What is Hypercalcemia? Causes

Answer 26

too much calcium, vitamin D excess, Milk-Alkali syndrome, cancer (bone tumors, multiple myeloma, leukemia), Thiazides, Paget disease

Question 27

Hypocalcemia clinical manifestations

Answer 27

increased neuromuscular excitability (paresthesias, muscle twitching/ cramping, tetany , hyperactive reflexes, Trousseau/ Chvostek signs, cardiac arrhythmias,

Question 28

Hypercalcemia clinical manifestations

Answer 28

decreased neuromuscular excitability (personality changes/ fatigue, nausea & vomiting, constipation, muscle weakness, diminished reflexes), cardiac arrythmias

Question 29

What is the normal blood pH?

Answer 29

7.35 - 7.45

Question 30

Buffer mechanisms of the Acid-Base Homeostasis

Answer 30

carbonic acid, hemoglobin, phosphate

Question 31

Lung mechanisms of the Acid-Base Homeostasis

Answer 31

exhalation of CO2

Question 32

Kidney mechanisms of Acid-Base Homeostasis

Answer 32

HCO3-, Phosphate, NH3/NH4+

Question 33

Renal proximal tubule function???

Answer 33

excretion of metabolic acid. Hydrogen ions secreted into the renal tubular lumen combine with filtered bicarbonate, buffers, or ammonia

Question 34

Metabolic Acid-Base Disturbances

Answer 34

Acidosis: decrease HCO3-
Alkalosis: increase HCO3-

Question 35

Respiratory Acid-Base Disturbances

Answer 35

Acidosis: increase CO2
Alkalosis: decrease CO2

Question 36

What questions to ask when measuring the acid-base imbalance

Answer 36

What is the pH? Acidosis or Alkalosis
What is the PCO2? Does this explain the pH
What is the HCO3-? Does this explain the pH

Question 37

Causes of metabolic acidosis

Answer 37

DKA, toxin ingestion (ASA/Methanol), severe infection, burns

Question 38

Causes of metabolic alkalosis

Answer 38

vomiting, intake of bicarbonate (antacids), hypokalemia, hyperaldosteronism

Question 39

Causes of respiratory acidosis

Answer 39

Opioids, COPD, Asthma, Chest injury

Question 40

Causes of repertory alkalosis

Answer 40

hyperventilation