Fluid, Electrolytes, and Acid-Base Disorders (complete) Flashcards
1
Q
How much of the human body is fluid?
A
60%; it acts as a solvent
Can be as low as 45% in older adults due to decreased muscle mass
2
Q
Why is fluid important in the body overall?
A
It plays a vital role in maintaining homeostasis
- regulation of various bodily functions
- electrolytes are the mechanisms that help control cellular function
3
Q
What is intracellular fluid?
A
- fluid found within cells
- approximately 2/3 of the total body fluids
- water diffuses out of the ICF and can cause cell shrinkage or cellular dehydration
- water can enter the cell and lead to swelling of the cell or cellular edema
4
Q
What is extracellular fluid?
A
- most ECF is found within the intravascular compartment of the blood vessels
- contains electrolytes, oxygen, glucose, and nutrients
- cellular waste
- fluid found outside cells (intravascular, interstitial and transcellular fluid spaces)
5
Q
What is the interstitial space?
A
- is filtrate from the blood
- located between the cells and blood
- contains electrolytes (mostly Na+) and water
– no proteins because they are too big; except in inflammation when membrane becomes more permeable
6
Q
What is diffusion?
A
Passive spread of molecules from an area of high concentration to an area of low concentration until equilibrium is reached
(passive diffusion)
7
Q
What is the rate of diffusion determined by?
A
- concentration gradient
- molecular weight of the substance
- temperature of the solution
- the electrical charge
- the availability of a carrier molecule
8
Q
What is osmosis?
A
- molecules of the solvent to pass through the semi-permeable membrane from less concentrated to more concentrated
- water and electrolytes can move
– larger proteins like albumin should not be able to move from ECF - the greater the number of particles on one side, the greater the osmotic (attractive) force
9
Q
What is filtration?
A
Occurs when water moves across membrane due to hydrostatic pressure
albumin plays a role – if too low, results in edema
10
Q
What is the sodium-potassium pump?
A
Uses active transport to move molecules from a high concentration to a low concentration
3 sodium out, 2 potassium in
11
Q
What is facilitated transport?
A
Passing of certain molecules through the membrane with assistance of carrier proteins
12
Q
What is active transport?
A
- substance needs energy to pass through against a concentration gradient
- sodium and potassium require ATPase to keep potassium inside and sodium on the outside
– sodium potassium pump
13
Q
What is hydrostatic pressure?
A
Pushing force by water in the bloodstream
- causes by the heart pumping blood against the capillary tends to push fluid from vascular to the interstitial space
– important for filtration
14
Q
What is osmotic pressure?
A
Pressure exerted by the solutes; in the blood it comes from the electrolytes like sodium and plasma proteins
- pulls water into the bloodstream from the ICF and ISF
- solution with greater number of particles has higher osmotic pressure
- when pressure is high in the blood, it increases movement from the ICF and ISF to the blood
- when pressure is low, it moves fluid out of the blood and into the ICF and ISF
15
Q
What is oncotic pressure?
A
- type of osmotic pressure exerted solely by albumin
- main colloidal protein in blood and maintains oncotic pressure
- attracts water and helps keep it inside the blood vessle
– if too low, fluid goes into the tissues and causes edema - albumin is an indicator of nutrition
– when albumin is low, there is reduced oncotic pressure which raises hydrostatic pressure and pushes fluid into the ISF and ICF
16
Q
What is Starling’s Law of Capillary Forces?
A
Explains the movement of fluid that occurs at every capillary bed
Two major opposing forces:
- hydrostatic pressure (generated by fluid in the capillary)
- osmotic pressure (includes oncotic pressure)
– in each capillary, the blood contains the electrolytes and proteins which exert osmotic pressure
Oppose each other to balance each other out and lead to homeostasis
17
Q
What is the lymphatic system responsible for in the regulation of fluid and electrolytes?
A
Accessory system which returns small proteins and fluid from the interstitial space back into the general circulation
- helps to keep pressures relatively constant
18
Q
What is the renal system responsible for in the regulation of fluid and electrolytes?
A
kidneys regulate concentrations of most substances in the body by filtering plasma and then reabsorbing needed substances back into the vascular system
what we don’t need is excreted
19
Q
What is osmolality?
A
concentration of solutes per kg of solvent
– based on 1 mole dissolved in 1 kg of water
- evaluate hydration based on concentration of fluids to particles
– normal is 282-295 milliosmoles/kg of water
– low means few particles in solutions (lower than normal means well hydrated)
– high means less solution to particles (higher normal means dehydrated)
20
Q
What is osmolarity?
A
Number of osmoles of solutes in 1 liter of solution
Solutes:
- albumin
- sodium: major ECF fluid balance
- potassium: major ICF neuromuscular excitability and acid-base
- PO4: ICF negative anion
- magnesium: enzyme systems; stored in bone
- calcium: neuromuscular irritability, blood clotting, bones
- HCO3: acid-base
- glucose
21
Q
What is tonicity?
A
Concentration (amount) of solutes in solution compared with the bloodstream
Also used to describe 3 types of IV solutions:
- isotonic
- hypertonic
- hypotonic
22
Q
What is an isotonic IV solution?
A
Same tonicity as blood
- no fluid shifts and no change in cell size
- standard is 0.9% NSS
- volume expander and to maintain access
Ex: 0.9% NSS, LR
23
Q
What is a hypertonic IV solution?
A
Higher concentration than the blood
- water moves from area of lower to higher solute concentration
- monitor for fluid overload; but used to treat hypovolemia and replace fluid and electrolytes
- don’t want to dehydrate cells (water moves from cells into ECF)
Ex: 5% dextrose in 0.9% NS, 5% dextrose in LR
24
Q
What is a hypotonic IV solution?
A
Lower concentration than the blood
- water moves from lower concentration to higher solute concentration
- administer slowly to prevent cellular edema (causes cells to swell)
- used for dehydration
Ex: 0.45% NSS
25
What is the role of kidneys in maintaining fluid and electrolyte balance?
- removal of waste
- regulation of blood pressure
- regulation of electrolytes
- acid-base balance
- reabsorption of amino acids, glucose, and water
- RBC, hormone, and enzyme production
26
Kidney: Routes of gains and losses
- daily urine volume of fluid in adults is typically 1.5L
- output is approx 0.1-1 mL of urine per kg of body weight per house
27
Skin: routes of gains and losses
- sensible perspiration
- chief solutes of sweat are sodium, chloride, and potassium
- sweat loss varies from 0-1000mL or more every hour
28
Lungs: routes of gains and losses
- water vapor (insensible loss) is about 400mL per day
- amount is increased with increased respiratory rate and depth; or dry climate
29
GI Tract: routes of gains and losses
- fluid loss via GI tract is about 100mL per day even though about 8L circulates through daily
- bulk of fluid is reabsorbed
- need certain amount of fluid for a bowel movement
30
What is insensible fluid loss and what are examples?
Can not be measure
Ex: fever, skin, respirations
31
What is sensible fluid loss and what are examples?
Can be measured
Examples:
- urine
- feces
- wound/surgical drains
- NGT
- emesis
32
What is hypovolemia (fluid volume deficit)
- *loss of extracellular fluid*
- decrease in tissue perfusion
- can be loss of sodium and water
-- hemorrhage
-- vomiting
-- diarrhea
-- CHF
-- drains
-- poor PO intake
33
What is dehydration?
*Loss of water*
- without equal loss of sodium
- decrease in size of body cells
- results in hypovolemia and hypernatremia
- monitor I/O and weight
34
What happens when volume is low?
- thirst reflex (in hypothalamus; decreases as we age)
- ADH: antidiuretic hormone
-- kidneys
-- stops excretion and reabsorbs water
-- helps maintain osmotic pressure
- RAAS (renin-angiotensin-aldosterone system)
-- when activated, increases blood volume and increases blood pressure
- SNS (sympathetic nervous system)
-- increases HR
-- leads to vasoconstriction
35
Examples of fluid overload
- edema
- pulmonary edema
- edema from low albumin
- other causes
36
What is edema and causes?
- develops when there is excess fluid in the interstitial space and intracellular fluid
Caused by:
- increased hydrostatic pressure in the blood
- OR by osmotic pressure being low (low amount of solutes in the blood)
Can occur in the inflammatory response because of increased vascular permeability allowing fluid to get into the tissues
37
What is pulmonary edema?
Increase in the volume in the blood
- backs up into the pulmonary circulation
-- leads to respiratory distress, lungs can't expand fully, impaired gas exchange
- increases in the hydrostatic pressure (pressure of water) forces the blood out into the alveolar spaces
38
What is edema from low albumin?
- oncotic pressure should equal hydrostatic pressure
- when oncotic pressure is low, hydrostatic pressure increases
-- albumin is allowed to leak from the ECF to the ISF and ICF, edema can occur
occurs from low albumin:
- malnutrition
- renal disease
39
What is dependent edema?
- occurs from venous disease
- standing and compromised circulation, blood pools in legs
40
Sodium intake and fluid overload
- causes pulling of fluid from the cells into the ECF
- cells begin to shrink
- stimulates the thirst reflex in healthy patients
- stimulates RAAS
- increased hydrostatic pressure overwhelms the osmotic pressure
41
What are natriuretic peptides?
Compensatory mechanism for intravascular changes
- natriuresis
Four types:
- Atrial (ANP)
- Brain (BNP)
- C-type (CNP)
- DNP
BNP and ANP: promote natriuresis at the glomerulus by increasing GFR
42
What is natriuresis?
Excretion of sodium and water by the kidneys as a response to ECF overload
43
What is the function of electrolytes?
Neuromuscular balance (Na, Mg, K, Ca):
- mentation, muscles, cardiac rhythm, GI motility
Enhance energy utilization (Na, K, Phos):
- sodium-potassium pump
- removal of wastes
- enhance growth and repair
Regulation of fluid balance (Na, Cl)
- encourage or diminish fluid shifts
44
What happens with electrolyte imbalances?
alterations affect many functions
- muscle contraction
- nerve transmission
45
Action potentials
Action potentials are triggered by changes in sodium and potassium ions
- sodium goes into the cell, potassium leaves the cell
- the positive ions of sodium cause depolarization
-- sodium closes at the peak of the action potential
- potassium continues to leave the cell
46
What is sodium?
Main extracellular electrolyte in blood
*Normal serum level: 135-145 Meq/L*
- maintains the cell membrane potential (important for cellular communication and muscle contraction)
- maintains fluid balance of blood
- maintain osmolality of blood
- can move from ECF to ICF
47
What is the pathophysiology of hyponatremia?
*less than 135 meq/L*
can be caused by overhydration or body losses of salt water take is replaced by just watere
48
Etiologies of hyponatremia
- due to decrease blood volume (non-renal): vomiting, diarrhea, excessive sweating, burns, NGT suctioning, diuretics
- due to increased or normal blood volume: SIADH, CHF, hypotonic IV fluid, cirrhosis, excessive fluid intake, diarrhea, hyperglycemia
- causes a hypo-osmolality
49
What are the clinical manifestations of hyponatremia?
- depend on cause, magnitude, and speed of deficit
- hypovolemia:
-- thirst, dry mouth, orthostatic BP, tachycardia, renal insufficiency
- dilutional hyponatremia:
-- N/V, headache, confusion, muscle weakness, cramps and spasms
*Severe (sodium <115 meq/L)*:
- neurologic: altered mental status, lethargy, seizures, coma
50
Medical and nursing management for hyponatremia
- treat underlying cause
- volume replacement
-- can't go too fast or will cause brain to swell
-- sodium replacement (PO or IV)
-- LR or isotonic saline (0.9%)
- dilutional hyponatremia:
-- water restriction (SIADH)
-- diuretics (loop; prevent fluid overload)
--- not thiazide b/c can worsen hyponatremia
- monitor I/O, weight, GI, and neurological status
51
Pathophysiology of hypernatremia
*Sodium level greater than 145 meq/L*
- occurs when there is a gain of sodium in exces of water
-- or by loss of water in excess to sodium
- can occur in euvoluemic patients or existing fluid volume depletion or excess
Common causes: inadequate fluid intake, diabetes, hypertonic fluid or feeding administration, excessive use of sodium bicarbonate
52
Clinical manifestations of hypernatremia
- primarily neurologic symptoms: disorientation, delusions, hallucinations, fatigue, irritability, behavioral changes
- thirst
- specific gravity and osmolarity are increased (urinary test)
53
More clinical manifestations for hypernatremia
- if kidneys are damaged: ADH issue causing kidneys not to reabsorb water
- too much sodium
- low volume cause stimulation of aldosterone causing reabsorption of water
-- cells become dehydrated
-- respond by transporting electrolytes across cell membrane and alter action potential
-- body tries to fix by making more solutes so need to be careful not to hydrate too quickly or brain will swell
-- shrunken neurons do not work as well because of altered action potential and CNS symptoms are the issue
54
Medical and nursing management for hypernatremia
- treat underlying cause
- use of hypotonic solution OR a non-isotonic solution (D5W or .45%NaCl)
- diuretics
- be aware of food and medications high in sodium
- monitor neurologic status
- monitor I/O
55
What is potassium?
Major intracellular electrolyte
*Normal level: 3.5-5.5 meq/L*
- transported into cells via sodium-potassium pump
- moves from ICF to ECF (can be affected by insulin, pH, epinephrine)
- kidneys are primary regulator
- bulk is in the muscle
-- changes in concentration has neuromuscular effects
56
What does potassium play a role in?
- nerve impulses in cardiac, smooth, and skeletal muscle
- acid-base
- ATP synthesis
- osmotic balance
- urine concentration
57
What is the pathophysiology of hypokalemia?
*Level less than 3.5 meq/L*
Caused by: diuretics!, vomiting, diarrhea, sweating, CHF, NGT suctioning, cirrhosis, GI suctioning, ileostomy, decreased PO intake, metabolic alkalosis, DKA, hypomagnesemia
58
What are the clinical manifestations of hypokalemia?
- typically do not occur until level is below 3.0
- symptoms include:
-- decreased bowel sounds
-- fatigue
-- anorexia
-- N/V
-- muscle weakness
-- leg cramps
-- decreased bowel motility
-- arrhythmias
59
What is the medical and nursing management for hypokalemia?
- treat underlying cause
- increase PO intake of potassium
- IV replacement
-- *never give IV push*
-- very irritating to veins
-- infuse slowly
- correct magnesium deficit
- monitor I/O
- monitor CV and GI status
ideally need a 2nd nurse to check before giving IV replacement because can cause cardiac or respiratory arrest
60
What is the pathophysiology of hyperkalemia?
*Level more than 5.5 meq/L*
Caused by: increased intake, certain medications, cell injuries, intravascular hemolysis, insulin deficiency, DKA, renal disease, metabolic acidosis
61
What are the clinical manifestations of hyperkalemia?
- typically do not occur until level above 6.5, but may be sooner
- symptoms include:
-- fatigue
-- N/V
-- colic
-- weakness
-- ventricular arrythmias
-- cardiac arrest
-- metabolic acidosis
62
What is the medical and nursing management for hyperkalemia?
- decrease PO intake of potassium
- restrict potassium-sparing medications
- administration of kayexalate or patiromer (laxative)
- emergency therapy:
-- IV calcium gluconate, insulin, sodium bicarbonate, hypertonic dextrose solution, beta-2 agonist
- dialysis (more common in renal impairment)
- monitor I/O
- monitor CV, GI, and renal status
63
Effects of hyperkalemia on heart (sorry i drew on this in class)
64
What are foods high in potassium?
- many fruits and veggies
- beans and legumes
- whole-grain bread
- meat
- fish
- oranges/orange juice
- milk
- eggs
- coffee/tea
- cocoa
65
What is acid-base?
Acid: substance which donates H+ to a base
- HCl, nitric acid, acetic acid
Base: substance which accepts or binds H+
- ammonia, bicarbonate (HCO3)
pH reflects the overall H+ concentration in body fluids
- low concentration H+ ions: increases pH
- high concentration H+ ions: decreases pH
66
What is the normal pH range?
7.35-7.45
67
What do abnormal processes cause with acid-base balance?
- the blood to become more acidic (acidosis)
- the blood to become more alkaline (alkalosis)
Can be metabolic or respiratory
68
What is acid-base regulated by?
- lungs
- kidneys
- buffer systems
-- bicarbonate/carbonic acid system
-- buffers up to 90% of hydrogen ions in ECF
69
What is the carbonic acid buffering system?
*Is working all the time to maintain acid base balance*
- carbonic acid has reversible dissociation and releases bicarbonate ions and hydrogen
-- response to increase in pH
-- response to increase in pH
*Used by lungs and kidneys to compensate for changes in pH*
70
The respiratory system and acid-base
- regulates Co2 in the blood by combining with H20, making carbonic acid
- *immediate response but temporary*
- receptors in the brain sense changes in the pH and vary the rate/depth of respiration to regulate CO2 level
-- faster deep breathing: eliminates CO2 from lungs, pulls H+ from the blood and reduces acid *pH increases*
-- slower shallow breathing: retention of CO2, increases acid in blood so *pH decreases*
71
What does the renal system do in acid-base?
- adjust the amount of HCO3- that is reabsorbed or excreted in the urine
- kidneys produce HCO3 and eliminates H+ ions
*Decreased pH: kidneys reabsorb HCO3- and excrete H+*
*Increased pH: excrete HCO3- and retain H+*
takes at least 24 hours to take effect
72
What is compensation?
the process by which the lungs and kidneys attempt to adjust to pH disturbances
73
Potassium and hydrogen
- both are positively charged and move freely in and out of cell
- when H+ is high (acidosis) in the blood (ECF), it trades hydrogen for potassium in the cell (ICF)
-- potassium goes to blood causing hyperkalemia
- when H+ is low (alkalosis) in the blood (ECF), it trades potassium for H+
-- leads to more H+ in the blood, causing hypokalemia
- *potassium shifts are more pronounced in acidosis than alkalosis*
- greater in metabolic than respiratory
74
What is metabolic acidosis?
- excess acid production OR loss of HCO3-
- occur when the cellular metabolism rate increases
-- increased production of acids
-- decreased excretion of acids
-- loss of HCO3
- will see an initial respiratory compensation
*Low pH (<7.35) and low HCO3- (<22)*
*potassium will increase by 0.5 mew for every 0.1 drop in pH*
- cardiac arrythmias are common
- hypotension
- insulin will not work as well
- decreased ATP
75
Potassium change in relation to metabolic acidosis
*potassium will increase by 0.5 mew for every 0.1 drop in pH*
- cardiac arrythmias are common
- hypotension
- insulin will not work as well
- decreased ATP
76
How to recognize metabolic acidosis on labs?
*Low pH (<7.35) and low HCO3- (<22)*
77
Possible causes of metabolic acidosis (from image)
- ketoacidosis (diabetics)
- shock
- severe diarrhea
- impaired kidney function (esp. seen in end-stage renal disease)
78
Warning signs and symptoms of metabolic acidosis
- headache
- lethargy
- anorexia
- deep, rapid respirations (Kussmaul)
- nausea
- diarrhea
- abdominal discomfort (in severe acidosis)
- coma and dangerous dysrhythmias)
Watch potassium level, it will go up
79
Causes of metabolic acidosis according to lecture
*Anything that causes increased acid and decreased bicarbonate*
- anaerobic metabolism (cardiac arrest, severe hypoxemia, ischemia)
- ketoacidosis
- renal failure (unable to regulate bicarbonate)
- salicylate (ASA) intoxication
- severe sepsis
- starvation
- TPN (hyperalimentation)
- diarrhea (loss of bicarb)
- fistulas (loss of bicarb)
- liver failure (not able to make bicarbonate)
80
Compensation and treatment for metabolic acidosis
- will see immediate respiratory changes like Kussmaul
- will see hyperkalemia which could become hypokalemia as treatment begins
- correct underlying metabolic defect:
-- fix hypoxemia
-- restore fluid balance
-- bicarbonate
-- alkalizing agent
-- stop ketosis
-- manage chronic disease
-- treat infection/sepsis
81
What is metabolic alkalosis?
Caused by excessive loss of acids
*Most common acid-base disturbance occurring in hospitalized patients*
- usually kidneys and GI tract are affected and easy to lose H+ ions when there is dysfunction
- loss of gastric secretions in severe vomiting or NGT suctioning
- occurs in hypokalemia (diuretic therapy, hyperaldosteronism Cushing's disease)
*High pH (>7.45) and High HCO3- (>36)*
82
What are the lab values to recognize metabolic alkalosis?
*High pH (>7.45) and High HCO3- (>36)*
83
What are the causes of metabolic alkalosis?
*Loss of acids:*
- nasogastric suction
- hypokalemia
- hypochloremia
- loop or thiazide diuretics
- steroids
- uncontrolled vomiting
*Increase in HCO3-*:
- excessive ingestion of antacids
- excessive use of bicarbonate
- lactate administration in dialysate
84
Warning signs and symptoms of metabolic alkalosis
- cardiac dysrhythmias as a result of dropping potassium
- physical weakness
- muscle cramping
- hyperactive reflexes
- tetany because of decreased calcium
- convulsions
- confusion
hydrogen, calcium and potassium all drop
85
Treatment for metabolic alkalosis
- treat underlying cause
- restore fluid volume
- fix electrolyte imbalance
-- replace potassium
86
What is respiratory acidosis?
Pulmonary ventilation decreases and CO2 is retained; CO2 combines with H2O to increase carbonic acid
- excessive carbonic acid causes drop in pH
- respiratory rate stimulated by medulla to increase to rid CO2
- increase CO2 and H_ ions causes cerebral vessels to dilate and leads to cerebral edema and depressed CNS activity
High PCO2 causes kidneys to hold onto HCO3 (probably the compensatory action)
*Low pH (<7.35) and High PCO2 (>45)*
87
What are the lab values to recognize respiratory acidosis?
*Low pH (<7.35) and High PCO2 (>45)*
88
What are clinical manifestations of respiratory acidosis?
- sudden hypercapnia (elevated PaCO2)
- symptoms: increased HR and RR, mental cloudiness, headache, weakness, cyanosis, arrhythmias
89
Causes of respiratory acidosis from image
- over sedation
- brainstem trauma
- immobility
- respiratory muscle paralysis
- pneumonia
- emphysema
- bronchitis
- COPD
90
Medical or nursing treatment for respiratory acidosis
- correct underlying cause
- bronchodilators
- fluid hydration
- oxygen
- mechanical ventilation (worst case)
91
Causes of respiratory acidosis from powerpoint
*anything that causes hypoventilation and a rise in CO2 levels (hypercapnia)*
- acute pulmonary edema
- CNS depression
- chronic respiratory disease
- disorders of respiratory muscles and chest wall inadequate mechanical ventilation
- oversedation (OD)
- severe pulmonary infections like pneumonia or COVID
92
Physical exam of respiratory acidosis
- respiratory distress, accessory muscle use, high RR, barrel chest, changes in LOC
- hyperresonance on percussion
- lung sounds may have wheezing, crackles or rhonchi
- increased HR and RR
93
Compensation for respiratory acidosis
- kidneys reabsorb HCO3 and excrete H+
those with chronic high CO2 (like in COPD) have normal pH often b/c of kidneys compensating but is very fragile
94
Treatment for respiratory acidosis
- improve ventilation
fix the problem:
- bronchodilators
- oxygen
- steroids
- sedative
- antibiotics
- diuretics
- naloxone (narcan)
- mechanical ventilation
95
What is respiratory alkalosis?
Ventilation increases above what is needed to maintain normal CO2 levels
Excessive amounts of CO2 are exhaled (hypocapnia):
- causes reduction in carbonic acid
- loss of H+ and increased bicarbonate ions
- leads to increased pH
- body compensates by pulling HCO3 into the blood which converts to carbonic acid to lower pH
*high pH (>7.45) and low PCO2 (<35)*
96
What are the lab values to recognize respiratory alkalosis?
*high pH (>7.45) and low PCO2 (<35)*
97
Effects of hypocapnia
Stimulates carotid/aortic bodies; leads to increased HR
Cerebral vasoconstriction leads to blood flow
- causes anxiety, diaphoresis, tingling in fingers, toes and around mouth
- hyperventilation: overexcitation of medulla and pons
- may experience anxiety, irritability
- can have changes in potassium and calcium
-- reduced blood level
-- as H+ moves out of blood, potassium moves back into cell
-- leads to palpitations, dysrhythmias, seizures
98
Causes of respiratory alkalosis
*Anything that causes hyperventilation or decreased PCO2 (hypocapnia)*
- anxiety
- early sepsis
- excessive mechanical ventilation (rate is too high)
- exercise
- fear
- hypermetabolic states like fever
- hypoxemia
- liver failure
- pain
99
Compensation for respiratory alkalosis
If symptoms continue for over 6 hours:
- kidneys increase excretion of HCO3
- reduce excretion of H+ and pH begins to fall
100
Treatment of respiratory alkalosis
- treat underlying cause
- SLOW THE BREATHING
-- reduce anxiety
-- sedation
-- oxygen
-- breathe into paper bag
-- lower fever
101
Chart for resp/met alk/ac
102
Respiratory compensation for acid-base imbalances and medical interventions: chart
103
Renal compensation in acid-base imbalances and medical intervention: chart
104
PH OF 7.25, CO2 OF 60MM HG, AND HCO3 22: what is this showing
respiratory acidosis
105
PH OF 7.5, CO2 OF 45MM HG, AND HCO3 40: what is this showing
metabolic alkalosis
106
PH OF 7.4, CO2 OF 40MM HG, AND HCO3 25: what is this showing
normal
107
PH OF 7.25, CO2 OF 50MM HG, AND HCO3 22: what is this showing
respiratory acidosis
108
PH OF 7.55, CO2 OF 24MM HG, AND HCO3 22: what is this showing
respiratory alkalosis
