Fluid electrolyte- Acid base imbalances - midterm 1 Flashcards
Chloride is inversely proportionate too? it is also regulated through the (blank) through the secretion of?
-Proportionate to HC03-
-regulated through the kidneys through the secretion of ADH
What is metabolic alkalosis?
Too much bicarbonate ion (HCO3-) / not enough acid
pH > 7.45
HCO3 > 26 mEq/L
Management for hypovolemia?
↑fluid replacement,
isotonic fluids - IV Normal Saline
Monitor VS, Ins/Outs, weight
Why is PH important? What is it needed for?
Needed to maintain membrane potential integrity (maintain the speed of enzyme reactions and regulated speed of nerve impulse conduction and muscle fibre contraction)
Membrane excitability, the enzyme systems, and all chemical reactions depend on the pH being in that range of 7.35-7.45
Acid releases H+ ion, Base receives H+ ion
Causes of hypernatremia?
Excess water loss or sodium intake (thinking eating slaty bar food)
Diabetes Insipidus
Heat Stroke
Management for hypernatremia?
Hypotonic IV solution,
sodium restrictions,
diuretics
What is kussmaul breathing? What does it result in?
Kussmaul breathing = hyperventilation – hyperventilation results in alkalosis so the respiratory system is trying to shift towards alkalosis
What is Hyponatremia?
The volume of fluid the cell stays the same, hyponatremia is a decrease of Na+ serum levels in the cell
Hypertonic Vs hypotonic Vs Isotonic solutions?
Isotonic – concentration equivalent to 0.9% NaCl– normal saline solution – no shrinking or swelling
Hypertonic – concentration > 0.9% NaCl ECF – cells shrink
Hypotonic – concentration < 0.9% NaCl ECF – cells expand
ECF has a higher concentration of? ICF has a higher concentration of?
ECF has a higher concentration of sodium and chloride and a smaller amount of potassium
ICF has a higher concentration of potassium and a smaller concentration of sodium and chloride
Signs and symptoms of hypernatremia?
Thirst,
seizures,
dry mucous membranes
Signs and symptoms hypokalemia?
ECG changes,
ventricular dysrhythmias,
leg cramps,
lethargy
Management of hyperklemia?
Increase fluids,
calcium gluconate,
insulin,
bicarb,
dialysis
Causes of metabolic alkalosis?
Excess loss of acid:
Vomiting, gastric suction
↑Aldosterone
Excessive intake of base:
Antacid overdose
Vomiting or the loss of chloride stimulates the retention of bicarbonate
Too much aldosterone results in bicarbonate retention
What is hyperkalemia?
Potassium levels > 5.0mmol/L
Causes of hypervolemia? What kind of response is it?
Excess fluid intake
Increased fluid retention
Secondary response to increased sodium content
Signs and symptoms of hyponaterima?
Dry skin,
↑urine output,
cramping, headache,
seizures
Causes for respiratory alkalosis?
Hypoxemia : low O2 in the blood
Pulmonary disease
Heart failure, anemia
High altitudes :lower pressure, we are going to dry and breath more and deeper but we are actually just blowing all of our CO2 off
Hyperventilation
Fever, anxiety
If the problem is a metabolic issue which system will trigger the buffer effect?
Respiratory system will trigger the buffer effect
How do the kidneys handle nonvolatile gases?
3rd line defence system
Sulfuric, phosphoric, and other organic acids
Eliminated by the renal tubules
Need to be exceeded via kidneys
Not fast SLOW (hours to days)
High concentration of hydrogen yield a?
Low PH (acidic substances)
Where sodium goes?
Water follows
What is kussmaul breathing? What does it result in?
Kussmaul breathing = hyperventilation – hyperventilation results in alkalosis so the respiratory system is trying to shift towards alkalosis
Causes of hypokalemia?
GI losses
Malnutrition
Diuretics
Alkalosis
What causes hypovolemia?
Excess fluid loss
Hemorrhage
Decreased intake
Third spacing
Causes of hyperklemia?
Increased intake
Renal dysfunction
Tissue trauma
Acidosis
Medications
To maintain the body’s normal PH (7.35 - 7.45) the H+ must be?
H+ must be neutralized by buffers and excreted via the lungs or kidneys
What causes metabolic acidosis?
Causes – excessive loss of HCO3- or too much H+
Renal failure
Diarrhea
Ecess production of non-volatile acids
Diabetic ketoacidosis
What is hyperventilating? Signs and symptoms?
-Resp acidosis
-Hyperventilating - not filling lungs with enough oxygen - not looking at what the rep rate is - we look at O2 stats
Very much so like hypoxia
Signs and Symptoms:
Headache, blurred vision, restlessness, disorientation, tremors
Start with an increased respiratory rate – eventually depressed as the respiratory center adapts to the increased CO2 (COPD)
Respiratory acidosis or alkalosis is caused by?
Caused by the lungs
Management of hypervolemia?
Fluid/sodium restrictions, diuretics
Monitor VS, Ins/Outs, Weight
What is metabolic acidosis?
Not enough bicarbonate ion (HCO3-) / too much acid
pH < 7.35
HCO3 < 22 mEq/L
Low PH state causes? High PH state causes?
pH – low – acidosis you would be in a state of acidemia
pH – high alkalosis in a state of alkalemia
Management of hyponatermia?
Water restriction,
sodium replacement, hypertonic IV solution
Causes and symptoms of respiratory acidosis?
Causes:
Depression of respiratory center, paralysis of respiratory muscles, drug overdose causing depressed ventilation
Decreased gas exchange in alveoli – pneumonia, pulmonary edema, emphysema, asthma, bronchitis
Slow / shallow breathing
(Head injury, spinal cord injury, drug overdose)
Decreased gas exchange in alveoli (Pneumonia, emphysema)
Capillary hydrostatic pressure Vs Capillary Osmotic pressure?
There is a high hydrostatic pressure in the capillary (fluid is trying to move out) at the same time there is an osmotic pressure in the capillary trying to pull fluid in (hydrostatic pressure is higher so fluid moves out into the intracellular space)
At the venous end due to the dilution caused by the extra fluid from the arteriol end, the hydrostatic pressure is unchanged (it is our BP), but the oncotic pressure is greater due to the tissues being diluted – so fluid will move back in to the capillary.
If the lungs are functioning properly it is a (blank) situation, if the lungs are not functioning properly it is a (blank) situation)
IF LUNGS NOT FUNCTION PROPERLY = RESPIRATORY
PROBLEM
IF LUNGS ARE FUNCTION PROPERLY IT IS A METABOLIC ISSUE
When we are over processing we will go into a?
acidic state
what is Respiratory acidosis?
Too much CO2
PCO2 > 45 mm Hg
pH < 7.35
Alveolar hypoventilation – excess CO2 in blood
Increasing and decreasing respiratory rate in metabolic issue will
Increasing the respiratory rate will remove more carbon dioxide from the body – formula will shift to the right H+ will decrease = raise pH
Decreasing the respiratory rate will retain CO2 – formula will shift to the left – H+ will increase = lower pH
Signs and symptoms of metabolic alkalosis?
Weakness, muscle cramps, hyperactive reflexes, tetany (involuntary contraction of muscles), convulsion, atrial tachycardia, confusion
Causes of hyponaterima?
Water excess (ADH)
Fluid loss
Renal disease
Diuretics
What is respiratory alkalosis?
Too little carbon dioxide - hyperventilating Ph is going to be high because our CO2 is being blown off
Metabolic acidosis or alkalosis is caused by?
Caused by anything except the lungs
Ph will go (blank) in metabolic acidosis?
pH will go low
Management of hypokalemia?
Increased diet intake,
correct acid base balance
Monitor renal function
How does the regulation of chloride through ADH secretion work? What does it cause?
Regulated by secretion of ADH
↑ Plasma osmolality – occurs with water deficit or sodium excess in relation to TBW
- Hypothalamic increases thirst & increases water reabsorption
↓ circulating blood volume caused by vomiting, diarrhea, or excessive sweating leads to decrease in blood pressure
How does the renal system control PH?
Excreting or conserving acid: H+ and/or
Conserving or excreting base: bicarbonate (HCO3-)
Hydrostatic pressure?
Hydrostatic pressure - pressure exerted existing within a liquid at rest with respect to its surroundings
Pressure that blood exerts in capillaries is blood pressure – as fluid is pushed into the interstitial area – interstitial fluid increases and therefore interstitial hydrostatic pressure also increases
Hydrostatic pressure refers to thepressure that any fluid in a confined space exerts
Signs and symptoms of hypervolemia?
Weight gain,
SOBOE,
orthopnea,
crackles,
wheeze,
cough,
↓BP,
weak pulse,
pitting edema
Water follows?
Sodium
An imbalance of one electrolyte often produces an?
An imbalance in another electrolyte
Signs and symptoms of hypovolemia?
Weight loss,
dilute urine,
dizzy,
↓skin turgor,
thirst,
confusion,
nausea, ↑temp
In Respiratory Acidosis and Alkalosis what will try to compensate?
Kidneys will try to compensate
In metabolic acidosis and alkalosis what will try to compensate?
Lungs will try to compensate
What is hypernatremia?
The volume of fluid in the cell stays the same, hypernaterima is excess serum Na+ in the cell
Na+ serum > 15mmol/L
We consider chloride as a major ion in our? What kind of motion is it?
Major anion in our ECF
Passive motion
What is respiratory alkalosis?
Too little carbon dioxide - hyperventilating Ph is going to be high because our CO2 is being blown off
What is metabolic alkalosis?
Too much bicarbonate ion (HCO3-) / not enough acid
pH > 7.45
HCO3 > 26 mEq/L
Signs and symptoms of metabolic acidosis? What does it cause?
Headache (lethargy - confision, decreased BP, hyperkalemia, muscle twitching, warm flushed skin, nausea, vomiting, diarrhea
High serum K+ - Metabolic acidosis causes potassium to move from cells to extracellular fluid
Signs and symptoms of Hyperklemia?
Cardiac dysrhythmia,
irregular pulses,
hyperactive bowels
Respiratory system exerts CO2 by?
Respiratory system excretes CO2 by increasing or decreasing ventilation rate
Increase release of CO2 by increasing our respiratory rate
Decrease release of CO2 by decreasing our respiratory rate
What is the pressure at the arterial and venous end of the capillaries?
At the arterial end, capillary hydrostatic pressure is higher than capillary oncotic pressure so water flows out of capillary
At the venous end, the pressures are reversed so water flows back into the capillary
