Fundamental 41s Fluid, Electrolyte, and Acid-Base Balance Flashcards
What is Hypernatremia
Loss of relatively more water than salt: Diabetes insipidus, Osmotic diuresis, Greatly increased insensible perspiration & respiratory water output without water increased water intake, gain of relatively more salt than water: overuse of salt tablets, administration of tube feeding or hypertonic parenteral fluids, difficulty swallowing fluids, as in Parkinsons lack of access to water or deliberate water deprivation, inability to respond to thirst(immobility, aphasia), or dysfunction of osmoreceptor-driver thirst drive.
What are the physical and laboratory signs of hypernatremia?
Extreme thirst, dry and flushed skin, postural hypotension, fever, restlessness, confusion, agitation, coma, seizures if develops rapidly or is very severe. Lab: Serum Na+ level >145mEq/kg, and serum osmolality >295 mOsm/Kg, urine specific gravity 1.030.
What is hyponatremia?
Gain of relatively more water than salt. Excessive ADH, Psychogenic polydipsia or forced excessive water drinking, Excessive IV administration of 5% dextrose in water(D5W), use of hypotonic irrigating solutions, Tap-water enemas, Loss of more salt than water, Renal salt-wasting disease, Replacement of large body fluid output (diarrhea, vomiting, gastric suction) with water but not salt.
What are the physical and Laboratory signs of hyponatremia?
Apprehension, nausea & vomiting, headaches, decreased level of consciousness(confusion, lethargy, muscle weakness, coma), seizures if develops rapidly or is very severe. Serum Na+ <135mEq/L and serum osmolality 280 mOsm/kg or less, urine specific gravity below 1.010.
What contains K+
Fruits, Potatoes, instant coffee, Molasses, Brazil nuts.
What is Hypokalemia
Its abnormally low potassium concentration in the blood. It results from decreased potassium intake and absorption, a shift of potassium from the ECF into cells, and an increased potassium output.
Common Causes of Hypokalemia are:
Increased output of potassium such as diarrhea, repeated vomiting, and use of potassium wasting diuretics.
What are the physical and laboratory signs of Hypokalemia?
Bilateral muscle weakness that begins in the quads and may ascend to respiratory muscles, abdominal distention, decreased bowel sounds, constipation, cardiac dysrhythmias; signs of digoxin toxicity at normal digoxin levels. Serum K+ < 3.5mEq/L; possible ECG abnormalities.
What is Hyperkalemia?
Its abnormally high potassium ion concentration in the blood. Its general causes arte increased potassium intake and absorption, shift of potassium from cells into the ECF, decreased potassium output. People with oliguria (decreased urine output) are at high risk for hyperkalemia, so remember to check urine output before administering IV solutions containing Potassium.
What are the physical and laboratory signs of Hyperkalemia?
Bilateral muscle weakness in quadriceps, transient abdominal cramps & diarrhea, cardiac dysrhythmias, cardiac arrest. Serum K+ >5mEq/L possible ECG abnormalities.
What is Hypocalcemia?
Abnormally low calcium concentration in the blood.
Related causes of hypocalcemia:
Decreased intake & absorption of Ca+, calcium deficient diet, Vitamin D deficiency(end-stage renal disease), Chronic diarrhea, laxative misuse, steatorrhea(eg., pancreatitis because calcium binds to undigested fat in their feces & is excreted), shift of Ca+ from ECF into bone or inactive form: hypoparathyroidism, Alkalosis, Hyperphosphatremia (end-stage renal disease), increased Ca+ output: Steatorrhea, or Chronic diarrhea.
What are the physical and laboratory signs of hypocalcemia?
positive Chvostek’s sign ( contraction of facial muscles when facial nerve is tapped), positive Trousseau’s sign (carpal spasm with hypoxia), numbness & tingling of fingers & circumoral (around the mouth) region, hyperactive reflexes, muscle twitching and cramping, tetany, seizure, laryngospasms, cardiac dysrhythmias. Total serum Ca+ <4.5mg/dL, ECG abnormalities possible.
What is Hypercalcemia?
Abnormally high calcium concentration in the blood. Hypercalcemia results from increased calcium from bones into the ECF, &decreased calcium output.
Imbalances and related causes of Hypercalcemia:
Increased Ca+ intake & absorption, milk-alkali syndrome, shift of Ca+from bone into ECF: Prolonged immobilization, hyperparathyroidism, Bone tumors, Nonosseous cancers that secrete bone-resorbing factors factors, decreased Ca+ outpute: use of thiazide diuretics.
What are physical and laboratory signs of Hypercalcemia?
Anorexia, nausea & vomiting, constipation, fatigue, diminished reflexes, lethargy, decreased level of consciousness, confusion, personality change, cardiac dysrhythmias possible flank pain from renal calculi; with hypercalcemia caused by shift of calcium from bone: pathological fractures; signs of digoxin toxicity at normal digoxin levels. Total serum Ca+>10.5mg/dL, or serum ionized Ca>5.3mg/dL; possible ECG abnormalities.
What is Hypomagnesemia?
Its abnormally low magnesium concentration in the blood. It’s general causes are decreased magnesium intake & absorption, shift of plasma magnesium to its inactive bound form, & increased magnesium output.
What are the imbalances and related causes of hypomagnesemia?
Decreased Mg+ intake & absorption, malnutrition, chronic alcoholism, chronic diarrhea, laxative misuse, steatorrhea (eg,. pancreatitis), shift of Mg+ into inactive form: Rapid administration of citrated blood, increased Mg+ output: Aldosterone excess, use of thiazide or loop diuretics, Steatorrhea, chronic diarrhea or other GI losses.
What are the physical and laboratory signs of hypomagnesemia?
Postive Chvosteks & Trouseau’s signs, hyperactive deep tendon reflexes, insomnia, muscle cramps& twitching, grimacing, dysphagia, tachycardia, hypertension, tenaty, seizures, cardiac dysrhythmias; signs of digoxin toxicity at normal digoxin levels. Serum Mg+ level < 1.5mEq/L.
What is hypermagnesemia?
Its abnormally high magnesium concentration in the blood.
What are the imbalances and related causes of hypermagnesemia?
Increased Mg+ intake & absorption: Excessive use of Mg+ containing laxative and antacids, Parenteral overload of magnesium, decreased Mg+ output: End-Stage renal disease, Adrenal insufficiency..
What are the physical and laboratory sign of hypermagnesemia?
Lethargy, hypoactive deep tendon reflexes, bradycardia, hypotension; acute elevation in magnesium levels: flushing, sensation of warmth; severe hypermagnesemia: flaccid muscle paralysis, decreased rate & depth of respirations, cardiac dysrhythmias, cardiac arrest. Serum Mg+ level >2.5mEq/L possible ECG abnormalities.
What does the term fluid mean?
Fluid means water that contains dissolved or suspended substances such as glucose, mineral salts, and proteins. Fluid amount = Volume, Fluid concentration = Osmolality, Fluid composition (electrolyte concentration), Degree of acidity = pH. People who are more acidic tend to have more health issues.
What is ECF?
Fluid outside the cells. ECF has 2 major divisions (intravascular fluid and interstitial fluid) and minor division(transcellular fluids). ECF contains 1/3 of total body water. The extracellular fluid compartment includes all water and electrolytes outside of cells (interstitial fluid, plasma, and lymph).
What is intravascular fluid?
Its the liquid portion of the blood(plasma).
What is Interstitial fluid?
It located between the cells & outside the blood vessels. The fluid between the cells which is sometimes called the “third space.” This can be blood, lymph, bone, and connective tissue water and the transcellular fluids.
What are transcellular fluids?
cerebrospinal, pleural, peritoneal, & synovial fluids are secreted by epithelial cells.
What are electrolytes?
fluid in the body compartments contains mineral salts known technically as electrolytes. An electrolyte is a compound that separates into ions (charged particles) when it dissolves in water. Ions that are positively charged are called cations: ions that are negatively charged are called anions.
What is osmolality?
Osmolality of a fluid is a measure of the number of particles per kilogram of water.
What determines the tonicity of a fluid?
Particles that can’t cross the cell membrane easily.
What is isotonic?
Fluid with the same concentration of nonpermeant particles as normal blood. Isotonic solution is the same concentration as blood plasma; expand fluid volume without causing fluid shift.
What is hypotonic?
Its a solution thatt is more dilute than the blood. Hypotonic solution: Lower concentration than blood plasma; moves fluid into the cells causing them to enlarge.
What is hypertonic?
A solution is more concentrated than normal blood. Hypertonic solution: higher concentration than blood plasma; pulls fluid from cells causing them to shrink.
What electrolytes are higher in concentration in ECF than in the ICF?
Na+, Cl-, & HCO-3
What electrolytes are higher in concentration in ICF than in ECF?
K+, Mg+, and PO3/4-
How do cells maintain their high intracellular electrolyte concentration?
By Active Transport.
Active Transport:
Requires energy in the form of ATP to move electrolytes across cell membrane against the concentration gradient ( from areas of lower concentration to areas of higher concentration). Example is the sodium-potassium pump, which moves Na+ out of a cell & K+ into it, keeping ICF lower in Na+ and higher in K+ than the ECF. Active transport = Movement of ions against osmotic pressure to an area of high pressure; require energy (ATP).
What is diffusion?
Diffusion is passive movement of electrolytes or other particles down the concentration gradient (from areas of high concentration to areas of lower concentration). Within a body compartment electrolytes diffuse easily by random movements until the concentration is the same in all areas.
What is osmosis?
Water moves across cell membrane by a process in which water moves through a membrane that separates fluids with different particle concentrations.
What is osmotic pressure?
An inward-pulling force caused by particles in the fluid. Osmotic pressure = drawing power of water(osmolality).
What is filtration?
Fluid moves into and out of capillaries (between vascular ad interstitial compartments. Filtration Is the net effect of four forces, two that tend to move fluid out of capillaries and small venules and two that tend to move fluid back into them. Filtration can also be described as the movement of fluid through a cell or blood vessel membrane because of hydrostatic pressure differences on both sides of the membrane.
What is Hydrostatic pressure?
Its the force of the fluid pressing outward against a surface. Example such as capillary hydrostatic pressure is a relatively strong outward-pushing force that helps move fluid from capillaries into the interstitial area. Interstitial fluid hydrostatic pressure is a weaker opposing force that tends to push fluid back into capillaries. Another description of hydrostatic pressure is it a “water pushing” pressure, because it is the force that pushes water outward from a confined space through a membrane.
What are colloids?
Blood that contains albumin and other proteins. These proteins are much larger than electrolytes, glucose and other molecules that dissolve easily. Most colloids are too large to leave capillaries in the fluid that is filtered, so they remain in the blood.
What is colloid osmotic pressure?
Its also called oncotic pressure which is an inward-pulling force caused by blood proteins that helps move fluid from the interstitial area back into the capillaries. Colloid or Oncotic pressure = keeps fluid in the intravascular compartment by pulling water from the interstitial space back into the capillaries.
What is edema?
Accumulation of excess fluid in the interstitial space. Diseases such as heart failure is an example when venous congestion from a weakened heart, which no longer pump effectively, increasing capillary hydrostatic pressure, causing edema by moving excessive fluid into the interstitial space. Another example of edema is inflammation which happens when capillary blood flow and allows capillaries to leak colloids into the interstitial space. The resulting increased capillary hydrostatic pressure and increased interstitial colloid osmotic pressure produce localized edema in the inflamed tissues.
Fluid output normally occurs through four organs:
The skin, lungs, GI tract, and kidneys. Abnormal fluid output includes vomiting, wound drainage, or hemorrhage.
What is insensible water loss?
Water loss that is continuous and not perceived by the person.
What is sensible water loss?
Loss of fluid from the body through the secretory activity of the sweat glands and the exhalation of humidified air from the lungs.
What does ADH do?
ADH regulates the osmolality of the body fluids by influencing how much water is excreted in urine. It is synthesized by neurons in the hypothalamus that release it from the posterior pituitary gland. ADH circulates in the blood to the kidneys, where it acts on the collecting ducts. It causes renal cells to resorb water, taking water from the renal tubular fluid and putting it back in the blood. This action decreases urine volume, concentrating the urine while diluting the blood by adding water to it.
More ADH is released if the body fluids become more concentrated. What factors increase ADH levels?
Severely decreased blood volume, for example, dehydration, hemorrhage, pain, stressors, and some medications.
ADH levels decrease if body fluids become too dilute. This allows more water to be excreted in urine, creating a larger volume of dilute urine and concentrating the body fluids back to normal osmolality. What factors cause ADH levels to decrease?
Ethyl alcohol decreases ADH release, which causes people to urinate frequently when they drink alcoholic beverages.
Disequilibrium:
This exists when the hydrostatic pressure is not the same in both spaces. This means that the two spaces have a graded difference(gradient) for hydrostatic pressure: one space has a higher hydrostatic pressure than the other.
An example of hydrostatic filtering force:
Blood pressure is an example as it moves whole blood from the heart to capillaries where filtration can occur to exchange water, nutrients, and wastes products between the blood and the tissues.
Edema
Tissue swelling with fluid collection develops with changes in normal hydrostatic pressure differences, such as in patients with right-sided heart failure. In this condition, the volume of blood in the right side of the heart increases greatly because the right ventricle is too weak to pump blood efficiently into the pulmonary blood vessels.
Concentration gradient:
Exists when two fluid spaces have different amounts of the same type f particles.
Facilitated diffusion or facilitated transport:
When diffusion across a cell-membrane require the assistance of a membrane-altering system ( e.g., insulin). Glucose can cross the cell membrane down its concentration gradient when insulin binds to receptors on the cell wall, making glucose much more permeable.
Osmolarity:
Is the number of milliosmoles in a liter of solution; osmolarity is the number of milliosmoles in a kilogram of solution. The normal osmolarity value for plasma and other body fluids ranges from 270 to about 300 mOsm/L. Osmolarity = concentration of solution.
Hyperosmotic or hypertonic:
Fluids with osmolarities greater than 300 mOsm/L. These fluids have a greater osmotic pressure than do isosmotic fluids and tend to pull water from the isosmotic fluid space into the hyperosmotic fluid space until an osmotic fluid space into the hyperosmotic fluid space until an osmotic balance occurs.
Hypo-osmotic or hypotonic:
Fluids with osmolarities of less than 270mOsm/L. Hypo-osmolar fluids have a lower osmotic pressure than isosmotic fluids, and water is pulled from hypo-osmotic fluid space into the isosmotic fluid space.
Solubility:
Is how well a particle type dissolves in water.
Obligatory urine output:
The minimum volume amount of urine per day needed to excrete toxic waste products is 400 to 600 mL.
Insensible water loss;
Water loss from the skin , lungs, and stool because the body has no mechanisms to control this loss. Insensible water loss is about 500 to 1000mL/day. This loss increases greatly during thyroid crisis, trauma, burns, states of extreme stress, and fever. Insensible water loss also increases when the environment is hot and dry.
What are the three hormones that help control critical fluid and electrolyte balance?
Aldosterone, ADH, and NP.
Aldosterone:
A hormone secreted by the adrenal cortex whenever sodium levels in the ECF are decreased. Aldosterone prevents both water and sodium loss. Aldosterone prevents excessive kidney excretion of sodium. It also helps prevent blood potassium levels from becoming too high.
Natriuretic peptides(NPs):
Hormones secreted by special cells that line the atria of the heart.
Renin:
When the kidneys sense that blood pressure, blood volume, blood oxygen levels, and the blood osmolarity is getting low, they begin to secrete a substance called “renin” that sets into motion a group of hormonal and blood vessel responses to ensure that blood pressure is raised back up to normal.
Whats the most common type of fluid loss?
Isotonic dehydration.
Hypovalemia:
Circulating blood volume is decreased and leads to inadequate tissue perfusion. Fluid deficit. Hypovalemia occurs when excess fluid is lost.
ICF
Intracellular fluid / fluid within cells; consist of s2/3 of total body water. The ICF compartment includes all the water and electrolytes within cells.
Fluid compartments:
The average adult female is 52% water by weight, while a male is 63% water, the difference due to the female’s additional adipose tissue.
Transcellular fluid
Includes the cerebrospinal fluid of the central nervous system, fluids within the eyeball, synovial fluids of the joints, serous fluid within body cavities, and exocrine gland secretions.
Extracellular Fluids
Have high concentrations of sodium, chloride, and bicarbonate ions, and lesser amounts of potassium, calcium, magnesium, phosphate, and sulfate ions.
Intracellular fluid
has high concentrations of potassium, phosphate, and magnesium ions, and lesser amounts of sodium, chloride and bicarbonate ions.
Where is the thirst control center located?
Its located in the hypothalamus.
Osmoreceptors
Monitor the serum osmotic pressure. When osmolarity increases (blood becomes more concentrated), the hypothalamus is stimulated resulting in thirst sensation. Salt increases serum osmolarity.
Average adult fluid intake:
200-2700 mL per day
Oral intake of fluid:
Accounts for 1100 - 1400 mL per day
solid foods:
about 800 - 1000 mL per day
Oxidative metabolism:
about 300 mL per day.
Who is at risk for dehydration:
Those unable to respond to thirst mechanisms, e.g., infants, patient with neuro or psych problems, and older adults.
What affects the release of ADH?
Pain, stress, circulating blood volume effect the release.
Increase in ADH:
= decrease in urine output = body save water (body trying to maintain homeostasis).
Renin’s actions
Renin acts to produce angiotensin I which converts to angiotensin II which causes vasoconstriction, increasing renal perfusion.
Angiotensin II
Stimulates the release of aldosterone when sodium concentration is low.
Angiotensinogen:
is an a-2-globulin produced constitutively and released into the circulation mainly by the liver. It is a member of the serpin(most serpins help control certain chemical reactions by blocking (inhibiting) the function of proteins, specifically enzymes called serine proteases) family, although it is not known to inhibit other enzymes, unlike most serpins. Plasma angiotensinogen levels are increased by plasma corticosteroid, estrogen, thyroid hormone, and angiotensin II levels. Angiotensinogen is also known as renin substrate. Human angiotensinogen is 453 amino acids long. The first 12 amino acids are the most important for activity. Asp-Arg-Val-Tyr-Ile-His-Pro-Phe-His-Leu-Val-Ile…
ACE Inhibitors:
ACe is a target for inactivation by ACE inhibitor drugs, which decrease the rate of AII production. Angiotensin II increases blood pressure by stimulating the Gq protein. In vascular smooth muscle cells (which in turn activates contraction by an IP3-dependent mechanism). In addition, angiotensin II acts at the Na/H exchange in the proximal tubules of the kidney to stimulate Na reabsorption. This ultimately results in an increase in blood volume, pressure, and pH. Hence, ACE inhibitors are major anti-hypertensive drugs.
How is Angiotensin II degraded to Angiotensin III
By angiotensinases located in red blood cells and the vascular beds of most tissues. It has a half-life in circulation of around 30 seconds, whereas, in tissue, it may be as long as 15-30 minutes.
Sensible loss:
Is loss that can be perceived by the senses and can be measured. If you’ve lost it, you know you’ve lost it! Urine, of course is a “sensible” loss- it can be seen, felt, and measured! Sweat is very sensible, and is produced only when there is need to lose excess heat from the body.
Causes of electrolyte imbalances:
Excessive sweating
Fluid loss leading to dehydration Excessive
Excessive vomiting
Diuretics like Lasix (K+ depletion)
Massive blood loss
Dehydration may go unnoticed in hot, dry climates
Renal failure
Hyponatremia - low sodium /symptoms:
Seizures Personality changes Nausea/vomiting Tachycardia Convulsion Normal Na ( 135-145)
Hypernatremia symptoms:
Excessive Na in ECF Loss of water Diarrhea Insensible water loss water deprivation Gain of Sodium Diabetes insipidus Heat stroke
Hypokalemia -low Potassium symptoms
Severe leg cramps flaccid muscles fatigue irregular pulse chest discomfort EKG changes T wave flattens Normal Potassium (3.5-5)
Hyperkalemia symptoms;
CNS Nausea and vomiting Peripheral Nervous system Tremors, twitching Heart Bradycardia, peaked T wave
Acid buffering:
Buffers are pairs of chemicals that work together to maintain normal pH of bod fluids:
Bicarbonate + Hydrogen ion———–>Carbonic acid
or
Carbonic acidHydrogen ion + Bicarbonate
Acid excretion systems:
Lungs excrete carbonic acid and kidneys excrete metabolic acids.
Process of excreting carbonic acid:
When you exhale, you excrete carbonic acid in the form of CO2 and water through the lungs.
Process of excreting metabolic acids:
The kidneys excrete all acids except carbonic acid.
Acid/base homeostasis disturbed:
Decreased pH causes Acidosis, stimulating brain and arterial receptors, increased respirations, decreased blood CO2, decreased H2CO3(carbonic acid), and increased in pH to restore homeostasis.
Acid/base homeostasis disturbed causing Alkalosis:
Increases pH causes Alkalosis, stimulates brain and arterial receptors, decreased respirations, increased blood CO2, increased H2CO3( carbonic acid) and decrease in pH to restore homeostasis.
Buffer:
A buffer is a substance that can absorb or release H+ to correct an acid-base imbalance. Arterial pH is an indirect measure of hydrogen ion concentration. Greater concentration of H+, more acidic, lower pH.
Lower concentration of H+:
More alkaline, higher pH
Why is it necessary to maintain regulation of Acid-base balance?
The pH is a reflection of the balance between CO2 (regulated by lungs) and bicarb (regulated by kidneys). Normal H+ level is necessary to maintain cell membrane integrity and maintain speed of cellular enzymatic actions.
Acidosis
A condition that tends to make the blood relatively too acidic.
Alkalosis
A condition that tends to make the blood relatively too basic(alkaline).
Respiratory Acidosis
Arises from alveolar hypoventilation; the lungs are unable to excrete enough CO2. The PaCO2 rises, creating an excess of carbonic acid in the blood which decreases pH.
CO2 increases, pH decreases
Causes of Respiratory Acidosis:
Impaired gas exchange such as COPD, pneumonia, severe acute asthma episode, airway obstruction, extensive atelectasis, OSA
Impaired neuromuscular function such as Resp. muscle weakness or paralysis from hypokalemia or neurologic dysfunction, Resp. muscle fatigue, resp. failure, chest injury
Dysfunction of brainstem resp.control such as, Drug overdose with resp. depressant, central sleep apnea
Signs and symptoms of Respiratory Acidosis:
headache, light headedness, decreased LOC,cardiac dysrhythmias, warm and flushed skin, muscular twitching.
Lab:
ph < 7.35
PaCO2 > 45mm Hg
HCO3 level normal if uncompensated or >26mEq/L
Respiratory Alkalosis;
Arises from alveolar hyperventilation; the lungs excrete too much carbonic acid (CO2 and water).
CO2 decreases, pH increases
Causes of Respiratory Alkalosis:
Hypoxemia, acute pain, anxiety, psychological distress, prolonged sobbing, inappropriate mechanical ventilator settings, stimulation of brainstem respiratory control: head injuries meningitis gram-negative sepsis salicylate overdose
Signs and symptoms of Respiratory Alkalosis:
Increase rate and depth of respirations
Hyperventilation- light headed, numbness and tingling of extremities
Lab:
pH > 7.45
paCO2<22mEq/L
K+ level may be decreased
Ionized Ca2+level may be decreased below 4.5mg/dL
Metabolic Acidosis
Occurs from an increase of metabolic acid or a decrease of base(bicarbonate). The kidneys are unable to excrete enough metabolic acids, which accumulate in the blood, or bicarbonate is removed from the body directly as with diarrhea.
HCO3 decreases and pH increases
Causes of Metabolic Acidosis:
Increase of metabolic acid
Ketoacidosis(diabetes, starvation, alcoholism)
Hypermetabolic state(severe hyperthyroidism, burns, severe infection)
ESRD, acute kidney infection
Lactic acidosis(Circulatory shock)
Ingestion of acid or acid precursors(methanol, ethylene glycol, boric acid, salicylate overdose)
Decrease of base(bicarbonate)
diarrhea
pancreatic fistula
Renal tubular acidosis
Symptoms of Metabolic Acidosis:
Decreased LOC, abdominal pain, cardiac dysrhythmias
Lab:
pH5mEq/L
Metabolic Alkalosis
Occurs from direct increase of base(HCO3) or a decrease of metabolic acid, which increases blood HCO3 by releasing it from its buffering function.
HCO3 decreased, pH decreases
Causes of Metabolic Alkalosis:
Increased of base (bicarbonate) Excessive administration of NaHCO3 Massive blood transfusion (liver converts citrate to HCO3) Mild or moderate ECV deficit Decrease of metabolic acid: excessive or prolonged vomiting Prolonged gastric suctioning Hypokalemia Excess aldosterone
Symptoms of Metabolic Alkalosis:
Light headed, numbness and tingling of fingers, toes and circumoral region, confusion, decreased LOC, cardiac dysthymias(may be caused by Hypokalemia) Lab: pH>7.45 PaCO2 normal or >45mmHg HCO3 >26mEq/L K+ <4.5mg/dL
