Fluids/Acid Base Flashcards
What is the distribution of water in the human body?
intracellular - 2/3 of TBW
extra: 1/3 of TBW
What is the normal urine output in infants? adults?
infants: 1mL/kg/hr
adults: 0.5-1mL/kg/hr
What are 3 reasons for oliguria?
low blood flow to kidney -check heart
kidney prob
post renal obstruciton
What is the distribution for extra?
plasma: 1/12 of TBW
interstitial: 1/4 of TBW
What is the distribution of plasma?
85% is venous
15% is arterial
What are the 4 diff types of fluid replacement?
normal saline
d51/2NS
D5W
lactated ringers
What is used to increase intravascular vol?
normal saline
lactated ringers
When is lactated ringers contraindicated w/increasing intravascular vol?
NOT maintenance
pt has hyperkalemia
What is used to dilute med?
D5W
What can used to correct hypernatremia?
D5W
Pt has mental status changes, poor turgor, and oliguria? What other sx? Cx?
hypovolemic
sx: apathy, orhtostatic hypotension, tachycardia, hypothermia
cx: internal/external bleeding, V/D, sepsis, polyuria (DKA), third spacing
How to dx hypovolemia?
monitor urine output and wt
labs: HIGH serum Na, LOW urine Na
kidneys: BUN/Cr >20:1
How to tx hypovolemia?
increase intravascular vol
maintain urine output: 0.5-1mL/kg/hr
What PE to expect from hypovolemia?
wt gain edema JVD INCREASE CVP AND PCWP RALES
What can cause hypervolemia?
CHF
nephrotic sx
cirrhosis
ESRD
Tx hypervolemia?
restrict fluids
What does aldosterone do? ADH?
aldosterone increases reuptake of Na
ADH increases reuptake of H20
Where is Na -ECF or ICF?
ECF
What haps when there is a high intake of Na consumption?
increase in ECF
Where is Na reabsorbed in the nephron?
proximal tubule
Aldosterone increases Na reabsorption and ___ secretion from ____?
potassium secretion
form teh late distal tubules
Hypothalamus has __ to control H20?
osmoreceptors
Hypo/hyper natremia is caused by?
too much or too little water
Hypo/hyper volemia is caused by?
too much or too little Na
What is the value of hyponatremia?
What to do w/ head trauma pts - na levels? Why?
normal or hypernatremic b/c if hyponatremic the water will move INTO brain cells –> increased ICP
How can hyponatremia be classified?
hypotonic
euvolemic
isotonic
hypertonic
How can hypotonic hyponatramia be classified?
hypovolemic
euvoemic
hypervolemic
What is hypovolemic hypotonic hyponatremia?
low fluids and low Na
low urine Na output 20 - no Na but on top of that body is forcing water out (diuretic) + Na
What is euvolemic hypotonic hyponatremia?
ECF is ok but low Na
- SIADH
- drinking too much water
What is hypervolemic hypotonic hyponatremia?
too much water but OK Na
- CHF
- nephrotic sx
What is isotonic hyponatremia?
increase in plasma that lowers plasma Na concentration but the amt of sodium in plasma is NORM -> d/t elevated protein or lipis
What is hypertonic hyponatremia?
osmotic shift of water OUT of cells –> hyperglycemia increase osmotic pressure so water shifts from cells INTO ECT –> diluting Na
What sx to look for if suspecting hypotnatremia?
NEUROLOGICAL DEFECTS - brain cell swelling
- HA
- muscle twitching
- hyperactive deep tendon reflexes
Hyponatremia -Pt has high serum osmolality?
hypertonic hyponatremia
- hyperglycemia
- mannitol
Hypontaremia - pt has normal serum osmolality?
pseudohyponatremia
-check for high lipids
Hyponatremia - pt has “true hypontremia” + low Na in body?
measure urine Na
-20: diuretic, low aldosterone
Hyponatremia - pt has true hyponatremia and normal Na?
SIADH
Hyponatremia - pt has true hyponatremia and high Na?
CHF
nephrotic dz
How to tx isotonic an dhypertonic hyponatremias?
tx underlying disorder
How to tx hypotonic hyponatremia?
mild-no water
mod: loop diuretics
severe: hypertonic saline - not too fast to avoid central pontine dmyelination
What number is hypernatremia?
> 145
