Fluid Imbalances Workshop - Complete

Question 1

How can a patient have a large anion gap despite having an alkaline blood pH?

Answer 1

Multiple conditions presenting simultaneously:

Metabolic Acidosis, Metabolic Alkalosis, Respiratory Acidosis

Question 2

Which unmeasured anion can explain a large anion gap?

Answer 2

Ketones

Question 3

Why is sodium NOT a good indicator of dehydration?

Answer 3

Your body can balance it out in the long term - it is so important for neural tissue and action potentials, cell function, etc…

Question 4

What are the 2 main response mechanisms to dehydration?

Answer 4

Aldosterone secretion

ADH secretion

Question 5

What are 3 reasons a vomiting, starved patient could experience hypokalemia?

Answer 5

1) Vomit is higher in potassium than blood

2) Aldosterone secretion because of dehydration leads to excretion of potassium

3) As hydrogens move into the blood stream to balance out intra/extracellular concentrations, potassium ions are repelled into cells because of similar positive charge

Question 6

What happens when potassium is pushed into cells during alkalosis?

Answer 6

The potassium pushed into kidney cells ends up being excreted into the urine.

Question 7

What two mechanisms concerning hydrogen and potassium can compete during a case like this?

Answer 7

Hypokalemia correction of moving potassium out of cells into serum - causes hydrogen ions to to move into cells

Alkalosis drives hydrogen ions out of cell and potassium ions back inside the cell

Question 8

What is this patient’s driving problem?

Answer 8

Dehydration (Aldosterone release)