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Health Differences > Fluid, Electrolyte and Acid-Base balance > Flashcards

Fluid, Electrolyte and Acid-Base balance Flashcards

1
Q

the body’s three major homeostatic mechanisms for managing hydrogen ions (acidity).

A
  1. chemical buffer systems (carbonic acid/bicarb, phosphate, protein buffer)
  2. respiratory mechanism
  3. renal mechanism
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2
Q

Normal serum phosphate

A

2.5-4.5 mg/dL
or
1.8-2.6 mEq/L

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3
Q

Effect of hypernatremia on cells

A

Increase in tonicity of ECF pulls fluid from cells (ICF). This leaves cells depleted.

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4
Q

Type of solution that can be used emergently to expand volume when blood products or cross-matching are not available

A

Colloid “volume expanders”

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5
Q

Hypertonic solution

A

Greater osmotic pressure than serum. Pulls fluid into vasculature and out of cells.

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6
Q

The major intracellular electrolyte

A

Potassium

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7
Q

the chemical buffer systems and lungs are short term solutions to pH disturbances. What organ is needed for long term adjustment?

A

the kidneys

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8
Q

Sometimes, pts getting blood or blood products are prescribed ___ ___ to prevent fluid overload

A

Loop diuretics

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9
Q

in the presence of alkalosis, the kidneys respond by…

A

retaining H+ ions and excreting bicarbonate ions to lower pH

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10
Q

Do colloids have oxygen carrying properties?

A

No, colloids only expand volume, they don’t have the ability to carry oxygen

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11
Q

Which kind of crystalloid fluid can cause hypotension due to decreased intravascular volume?

A

Hypotonic solution

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12
Q

Hypermagnesemia causes

A

Renal failure, excessive mag intake (use of antacids or laxatives containing magnesium)

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13
Q

Most abundant electrolyte in ECF

A

Sodium

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14
Q

plasma bicarb concentration is regulated by

A

the kidneys

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15
Q

Dextrose solutions > 10% must be given via…

A

Central vein (central line or PICC line)

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16
Q

Type of solution known as “plasma expander a” because particles do not pass through capillary walls

A

Colloids

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17
Q

IV potassium should never be administered as a…

A

IV bolus

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18
Q

Resp alkalosis =

A

Low PaCO2 due to alveolar hyperventilation

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19
Q

Respiratory acidosis is caused by

A

Any decrease in alveolar ventilation that results in retention of carbon dioxide.

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20
Q

Two principles of fluid and electrolyte balance

A
  1. Anions and cations must be balanced in each compartment and remain electrically neutral.
  2. Compartments must remain in osmotic equilibrium
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21
Q

Maximum infusion rate for IV KCL solution

A

10 mEq/HR

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22
Q

HCO3-

A

Bicarbonate

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23
Q

A primary excess of carbonic acid in the ECF

A

Respiratory acidosis

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24
Q

normal serum pH

A

7.35-7.45

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25
Q

S/s of hypernatremia

A

Neurological impairment, weakness, confusion, delusions, hallucinations

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26
Q

Cause of hyponatremia

A

Loss of sodium or gain of water (vomiting, diarrhea, sweating, diuretics)

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27
Q

urine pH

A

4.5-8.2

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28
Q

In respiratory and most metabolic acidosis the kidneys excrete ____ ions and conserve ____ ions to increase pH.

A

Excrete hydrogen and conserve bicarbonate

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29
Q

Solution that contains fluid and electrolytes and can freely cross semi-permeable capillary walls

A

Crystalloid solutions

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30
Q

acid-base regulation by the kidneys may take as long as

A

three days

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31
Q

Normal pH

A

7.35-7.45

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32
Q

How do you measure respiratory acidosis or alkalosis with ABGs?

A

PaCO2

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33
Q

how does the phosphate buffer system work?

A

converts the weak base sodium phosphate into the acid sodium phosphate in the kidneys.

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34
Q

Causes of hyperkalemia

A

Renal failure, hyperaldosteronism, use of: KCl, heparin, ACE inhibitors, NSAIDs, potassium-sparing diuretics

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35
Q

Normal ionized calcium

A

4.5-5.1 mg/dL

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36
Q

Chvostek’s sign

A

Tap over facial nerve approx 2 cm anterior to tragus of ear. Watch for twitching. May indicate hyperactive nerves due to hypocalcemia

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37
Q

Causes of hypernatremia

A

Excess water loss or excess of sodium. Fluid deprivation or lack of fluid consumption.

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38
Q

the two fluid compartments in the body

A

ECF and ICF (extracellular fluid and intracellular fluid)

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39
Q

Isotonic solution

A

Osmolality is the same as ECF/plasma. Fluid does not enter or leave the cell (no fluid shift)

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40
Q

Type of crystalloid solution used to treat increased ICP due to cerebral edema

A

Hypertonic solution

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41
Q

H2CO3

A

Carbonic acid

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42
Q

Normal bicarbonate

A

22-26 mEq/L

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43
Q

what percent of weight loss caused by fluid volume deficit is considered life threatening?

A

15%

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44
Q

IV solution that is made from the components of blood that can be processed through centrifugation methods

A 
Blood products:
Packed RBCs (PRBCs)
Plasma
Platelets
Cryoprecipitate
45
Q

If decreasing the resp rate does not fix respiratory alkalosis after approx 6 hrs…

A

The kidneys begin retaining hydrogen and increasing excretion of bicarbonate.

46
Q

s/s of hypokalemia

A

Muscle weakness, leg cramps, paresthesias and dysrhythmias

47
Q

Effects of hyponatremia on cells

A

Decrease in ECF sodium causes fluid to shift into cells since ICF is now hypertonic. This causes swelling and possible rupture of cells

48
Q

Minimum urinary output

A

0.5-1 mL/kg/hour

35-70 mL/h for a 70 kg pt (154 lbs)

50-100 mL/h for a 100 kg pt (220 lbs)

49
Q

Largest fluid loss route

A

Urine ~ 1400 mL/day

50
Q

ECF is composed of…

A
  • intravascular fluid (plasma)
  • interstitial fluid (surrounding cells)
  • transcellular fluid (third space) -mucus, GI, cerebrospinal, pericardial, synovial, etc.
51
Q

s/s of hyperkalemia

A

Muscle weakness, paralysis, dysrhythmias and cardiac arrest

52
Q

common anions in the body

A

Chloride Cl-
Bicarbonate HCO3-
Phosphate PO4-
Sulfate SO4-

53
Q

Normal serum potassium range

A

3.5-5.3 mEq/L

54
Q

major cation in the ECF

A

sodium (Na+)

55
Q

ECF has a bicarbonate to carbonic acid ratio of

A

20:1

20 parts bicarb to 1 part carbonic acid

56
Q

Affect if hypokalemia on cells

A

ECF loses potassium and potassium moves from cells to replace ECF potassium.
This creates an intracellular deficit.
Cells then retain sodium and hydrogen to maintain isotonic fluids.

57
Q

if the blood level of CO2 decreases, resp rate and depth decreases. This allows CO2 retention so that ___ ___ can be formed in the blood

A

carbonic acid

58
Q

s/s of hyponatremia

A

Confusion, hypotension, edema, cramps, weakness, dry skin

*cerebral edema can lead to seizures

59
Q

Maximum (longest acceptable) rate of infusion for blood/blood products

A

4 hrs from the time it leaves the refrigerator

60
Q

Respiratory alkalosis is the result of…

A

Alveolar hyperventilation and increased elimination of CO2

61
Q

how do the lungs assist the carbonic acid/bicarb system?

A

carbonic acid is formed in the lungs (CO2+H2O) and bicarb is formed in the kidneys.

62
Q

ICF is located…

A

inside the cells

63
Q

the most important buffer system of the body

A

carbonic acid-bicarb system

64
Q

Hypertonic solutions should be very closely monitored for?

A

Circulatory overload

65
Q

a substance that prevents body fluids from becoming too acidic or too alkaline.

A

buffer

66
Q

Which crystal loud solution causes cell shrinkage?

A

Hypertonic solutions

67
Q

Summary of metabolic acidosis

A

Deficit of bicarbonate or excess of hydrogen ions in ECF. This causes low pH and low plasma bicarbonate.

68
Q

A primary deficit of carbonic acid in the ECF

A

Respiratory alkalosis

69
Q

Hypotonic solution

A

Osmolality is less than ECF/plasma. Causes water to shift out of vasculature and into cells

70
Q

Normal potassium

A

3.5-5.3 mEq/L

71
Q

Normal chloride range

A

96-106 mEq/L

72
Q

the body’s three chemical buffer systems

A
  1. carbonic acid/sodium bicarb
  2. phosphate buffer system
  3. protein buffer system
73
Q

what organ is the primary controller of the body’s carbonic acid supply?

A

the lungs

74
Q

IV lipid emulsions are indicated for patients…

A

Who are unable to tolerate oral or enteral feedings for seven days or more

75
Q

How do colloids increase intravascular volume?

A

Pulls fluid into the vasculature from interstitial space because large particles can’t pass through semipermeable membranes

76
Q

Hypomagnesemia causes

A

NG suction, diarrhea, alcohol withdrawal, parenteral feeding, sepsis or burns

77
Q

PRBCs

A

Concentrated red blood cells with most of the plasma and platelets removed.

Approx volume of PRBCs is 350 mL/unit vs 500 mL/unit for whole blood.

78
Q

Hypomagnesemia s/s

A

Weakness, tremors, tetany, Sz, heart block, AMS, hyperactive deep tendon reflexes, respiratory paralysis

79
Q

carbonic acid yields ___ and ___

A

carbon dioxide and water

80
Q

Osmolality vs tonicity

A

Osmolality- concentration of particles in body fluid

Tonicity- concentration of particles in IV solution compared to the osmolality of body fluids

81
Q

Mechanisms of K+ loss

A

Vomiting, diarrhea, gastric suction, diuretic use

82
Q

as CO2 is exhaled, the levels of ___ in the blood decreases causing a rise in pH

A

carbonic acid

83
Q

ECF is ___% of Total body weight

A

20%

84
Q

Respiratory acidosis=

A

High PaCO2 due to alveolar hypoventilation.

85
Q

major cation in ICF

A

potassium (K+)

86
Q

Normal serum magnesium

A

1.5-2.5 mEq/L

87
Q

The cells of what body system are most affected by hypernatremia fluid shift from ICF to ECF?

A

Cells of the CNS.

88
Q

Summary of metabolic alkalosis

A

Excess bicarbonate or a decrease in hydrogen ions causes high pH and high plasma bicarbonate concentration.

89
Q

Insensible fluid loss

A

Loss that can’t be measured. Respiration, sweat and feces. Totals approx 1000 mL/day

90
Q

Hypermagnesemia s/s

A

N/V, weakness, flushing, lethargy, loss of deep tendon reflexes, resp depression, coma, cardiac arrest

91
Q

What electrolyte should be closely monitored when pt is receiving multiple blood transfusions?

A

Serum calcium

92
Q

Infusing packed red blood cells allows for increased __ ___ ___ with smaller volume than whole blood.

A

O2 carrying capacity

93
Q

ICF is ___ % of total body weight

A

40%

94
Q

common cations in the body

A

potassium K+
Sodium Na+
Calcium Ca++
Magnesium Mg++

95
Q

Perioheral IV sites should be changed every

A

72-96 hrs

96
Q

IV fluid that contains proteins or other large molecules that increase osmolality without dissolving in the solution

A

Colloid solutions

97
Q

CO2 is a potential acid. When dissolved in water it becomes ____ ____.

A

Carbonic acid

CO2 + H2O = H2CO3

98
Q

Three types of IV solution

A

Crystalloid
Colloid
Blood/blood products

99
Q

Normal sodium range

A

135-145 mEq/L

100
Q

in the presence of acidosis, the kidneys respond by…

A

excreting H+ ions and forming and conserving bicarbonate ions to raise pH

101
Q

If the increased resp rate is not effective in reducing CO2 in respiratory acidosis, next…

A

The kidneys increase elimination of H+ ions (acids) and conserve bicarbonate and sodium ions. The NaHCO3 acts as a buffer and reduces CO2 levels.

102
Q

How are crystal loud solutions classified?

A

By their osmolality compared to serum (hypertonic, hypotonic or isotonic)

103
Q

Normal PaCO2

A

35-45 mmHg

104
Q

Par enteral nutrition formulas can only be administered through…

A

A central line or a PICC line

105
Q

how does the protein buffer system work?

A

plasma proteins and hemoglobin can combine with or liberate H+ ions as needed to adjust pH. It can work both inside or outside the cell.

106
Q

Normal serum calcium

A

8.9-10.1 mg/dL

107
Q

condition of loss of H+ ions or increase of base ions (bicarb) causing plasma pH to increase above 7.45

A

alkalosis

108
Q

condition of excess H+ ions or a loss of base ions (bicarbonate) which decreases plasma pH below 7.35

A

acidosis

109
Q

Crystalloid solution used to treat DKA

A

Hypotonic solutions because is corrects cellular dehydration by pulling fluid into cell.

Health Differences (7 decks)

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