Exam I Flashcards
hypernatremia: causes
- excess sodium intake (IV, PO)
- decreased water intake
- sodium retention r/t Cushing’s, hyperaldosteronism, renal failure
- excessive free body water loss r/t DI, osmotic diuresis (Mannitol), burns, dehydration, fever/infection, diarrhea
hypoatremia: causes
- decreased sodium intake (IV, PO. dextrose)
- increased sodium loss r/t Addison’s, diuretics, vomiting, diaphoresis, wounds, decreased aldosterone secretion
- excessive free body water r/t SIADH, HF, polydipsia/hyperglycemia, excess intake
sodium imbalances: s/s, treatment
s/s: patient dependent - neuro changes - mucous membranes/thirt (sticky mucous, white membranes) treatment - fluid replacement - stabilize s/s - treat cause
hyperkalemia: causes
- excessive intake
- renal failure
- medications: K sparing diuretics, ACE/ARBs
- burn injuries (due to initial cell lysis)
- acidosis: metabolic (renal failure(
- adrenal insufficiency
hyperkalemia: ECG changes
- tall, peaked T waves
- widened QRS
- flat P wave
- ectopic beats &/or abnormal rhythms
hyperkalemia: treatment
- D50 & insulin IV
- kayexelate
- diuretics
- dialysis
heart protection: - calcium chloride/Ca gluconate
- albuterol
hypokalemia: causes
- deficient intake (IV, PO, NPO status)
- burns (after initial fluid restrictions)
- GI loss: vomiting/diarrhea, prolonged GI suction
- diuretics
- renal artery stenosis
- Cushing’s syndrome/Corticosteroids
- Alkalosis
- hyperinsulinemia
hyperkalemia: s/s
- ECG changes
- muscle cramps & paresthesias: progresses to weakness, flaccidity
- diarrhea, GI symptoms
hypokalemia: s/s
- ECG changes
- weakness, lethargy
- hyporeflexia; possible paralysis
- constipation/ileus
hypokalemia: treatment
IV repletion for K < 3.0 - 25mEq/h - burns if infused too quickly (try and give through central line. works better PO) PO - less expensive - better absorption - common with loop diuretics
Alteration in Carbon Dioxide
- serum CO2 roughly equal to Arterial HCO3
- increased CO2–>metabolic alkalosis
- decreased CO2–>metabolic acidosis
(if it doesn’t say “paCO2 it’s a venous blood draw)
BUN: levels
10-20 mg/dL
- increased BUN= azotemia. pre, intra, postrenal
- decreased BUN= hepatic dysfunction, protein catabolism alterations
- increased BUN + Normal Cr= dehydration
- BUN:Cr ratio 15.5:1 is optimal
Creatinine: levels
- 5-1.1mg/dL (F)
- 6-1.2 mg/dL (M)
- increased Cr indicates renal damage
- rise indicates chronicity of renal disease
- doubling of Cr= 50% renal loss of fx
- decreased Cr reflection of decreased muscle mass
- above 1.2 indicates damage
serum osmolality
- 275-295 mOsm/kg h2o
- concentration of dissolved particles in blood
- quick formula: 2 x Na
- formula: 2(Na)+K+(BUN/3)+(Glucose/18)
reasons for increased serum osmolality
- dehydration
- DKA/HHNK
- DI
- hypernatremia
- metabolic acidosis
reasons for decreased serum osmolality
- overhydration
- SIADH
anion gap
- difference between anions and cations
- normal range: 8-16mEq/L
- formula: Na- (Cl+CO2)= anion gap
increased anion gap
MUDPILES M: methanol U: uremia D: DKA P: paraldehyde I: isoniazid/iron L: lactic acid E: ethylene glycol S: salicylates
decreased anion gap
- hypercalcemia
- hypermagnesemia
- hyperkalemia
reasons for increased WBCs
leukocytosis: excess
- infection
- inflammation
- tissue necrosis
reasons for decreased WBCs
leukopenia: absence
- immunosuppression (we want this in transplant patients)
- autoimmune diseases
granulocytes
Neutrophils: bacterial infections - immature neutrophils "bands" - increased bands--> shift to the left Eosinophils: allergic reactions - parasitic infections Basophils: allergic reactions - no response to bacterial/viral infections People with seasonal allergies/asthma have inherent increase in eosinophils and basophils
alterations in H&H
decreased: - hemorrhage - anemia - menses increased: - severe dehydration - malnutrition usually do a transfusion if lower than 7 & 21
hematologic studies
RBC - increased (dehydration) - decreased (heorrhage, anemia) RDW: red cell distribution width - used to classify anemia - increased with increased erythropoiesis MPV: - useful in diagnosing thrombocytopenia - immature platelets larger - decreased bone marrow production