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Pathology > Lytes acid and base > Flashcards

Lytes acid and base Flashcards

1
Q

All lytes are measured in

A

mEq/L

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2
Q

Sodium level

A

135-145

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3
Q

K+ level

A

3.5-5.0

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4
Q

Ca2+ level

A

4.5-5.5

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5
Q

Phosphate level

A

2.5-4.5

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6
Q

Mg level

A

1.5-2.5

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7
Q

Sodium function

A 
90% of ECF cations
Regulates osmotic forces and H20 balance
For muscle and nerves with K and Ca
Helps with pH through sodium bicarb and sodium phosphate
Particaptes in cell reactions
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8
Q

Hypernatremia

A

> 145
From extra sodium or too little water
It causes intracellular dehydration and movement of water to ECF which may cause hypervolemia

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9
Q

Hypernatremia etiology

A 
1. Excessive water loss from
Diabetes insipidus
Fever
Resp infections (tachypnea)
Diarrhea (osmotic)
2. Too little water
3. Too much sodium
too much Nabicarb
Saltwater near drowning
Over secretion of aldosterone
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10
Q

ADH

A

Vasopressin
Increases solute free water reabsorption
Constricts arteries
Released from hypertonicity

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11
Q

Clinical manifestations

A
  1. Thirst and signs of high ADH (polydipsia, oliguria, anuria)
  2. Intracellular dehydration
  3. H20 out of cells (headache, agitation, restlesness, decreased reflexes, seizures)
  4. Decreased vascular volume - tachy, weak and thready pulse, low BP
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12
Q

Hyponatremia

A

<135
Vomiting, diarrhea (inflammatory) GI suctioning, burns, sweating, lack of salt intake
Some diuretics
Hormone imbalances (low aldosterone high ADH)
Too much water
Kidney failure
Hypeglycemia as it draws water into ECF, lowering serum Na

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13
Q

Clinical manifestations of hyponatermia

A

Cramps, weakness, headache, depression, apprehension, impending doom, personality changes, lethargy, stupor, coma (from nerves not being able to depolarize)
GI - anorexia, nausea, vomting, cramps, diarrhea
Increased ICF causing pitting edema and hypotension

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14
Q

Potassium function

A

Maintaining RMP

Predominant ICF cation

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15
Q

Regulation of K+

A

Kidneys via diffusion, distal tubular cells determines whether it will be secreted into urine or reabsorbed into distal tubules

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16
Q

K+ and diuretics

A

increase flow rate of K+ through distal tubules increasing K+ secretion
There are K+ sparing diuretics which can counter this

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17
Q

K+ and pH

A

H+ accumulate in ICF and kick K+ out of cell

decreased ICF decreases secretion of K+ by distal tubular cells creating a state of hyper K

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18
Q

Hyper K causes

A

> 5.5 mEq/L
From increased K+
or a shift out of cells from
Trauma, burns, crush injuries, acidosis, insulin deficiency, hypoxia
Also decreased renal excretion from renal failure, aldosterone deficit, K+ sparing diuretics, ACE inhibtors, Angiotensin II receptor blockers

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19
Q

Hyper K clinical manifestation

A 
GI
-nausea, vomiting, cramps, diarrhea
Muscles
-paraesthesia
-muscle weakness
Cardiovascular
-arrythmias, cardiac arrest
Oligura
Acidosis
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20
Q

Hypo K

A

<3.5 from

  • Inadeqaute intake
  • Renal loss (non K+ sparing, cushings, aldosteronism, steroids)
  • Vomiting, diarrhea, GI suction, draining GI fistula
  • Transcompartmental shift from ventolin, alkalosis, insulin
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21
Q

Hypo K presentation

A

Impaired ability to concentrate urine (polyuria nocturia)
Anorexia, nausea, vomiting, constipation, abdo distension, paralytic ileus
Muscle flabbiness, weakness, fatigue, paresthesia, paralysis, cramps
ECG changes, postural hypotension
Confusion, depression
Alkalosis

22
Q

Where is calcium

A

99% in bone
.4 ionized
.6 non ionzed (bounded to albumin)

23
Q

Calcium is needed for

A 
Structure (bone teeth)
Clotting
Hormone secretion, cell function
Plasma membrane stability
Transmission of nerve impulses
Contraction of muscles
24
Q

Calcitonin

A

Opposes PTH, and REDUCES blood calcium

25
Q

Calcium/phopshate mediated by

A

PTH
Vit D
Calcitonin

26
Q

Hypercalcemia

A

<12mg/dl
From:
Too much D or calcium
Milk-alkali syndrome
Increased bone resporption (hyperPTH, bone metasis from cancer, immobility)
Decreased elim from thiazides or lithium
Acidosis (decreases Ca binding to albumin)

27
Q

Hypercalcemia clinical manifestations

A

Polyuria, dipsia, flank pain, renal failure, kidney stones
Anorexia, N/V, constipation
Muscle weakness, atrophy, ataxia, loss of tone
Osteopenia (low density but not porosis low), osteoprosis
Lethargy, personality and behaviour changes, stupor coma
hypertension, QT shortening, AV block

28
Q

Hypocalcemia

A

<8.5mg/dl
HypoPTH, hypomag, resistance to PTH
Decreased intake from vit d deficiency, liver or renal failure
Abnormal loss from too much phosphate or renal failure

29
Q

Hypocalcemia etiology

A

increased protein binding or chelation
Increased pH increases serum albumin increases fatty acids or rapid transfusion of citrated blood
Pancreatisi

30
Q

Hypocalcemia clinical manifestations

A

Paraestehsia, cramps, gi spams, carpopedal spasm, tetany (intermittent spasm from PTH), laryngospasm
Hypotension, arrythmias
Osteomalacia, bone pain, fractures, deformities

31
Q

Phosphate overview

A

Mainly in bone
Serum it exists in phospholipids and inorganic compounds
Acts as a buffer and role in high energy stores

32
Q

Hyperphosphatemia

A

<4.5mg/dl
Laxatives or enemas with phosphates
Intracellular to extra shift from trauma, heat stroke, seziures, rhabdo, tumor
Impaired elimination (renal failure or hyperthyroidism)

33
Q

Clinical manifestations

A

same as low calcium

34
Q

Hypophosphatemia

A 
<2mg/dl
Severe diarrhea
Lack of D
Antacids binding phosphates
Increased renal secretion
HyperPTH, DKA, alkalosis malnutrtion
Total parental hyperalimentation, insulin from DKA
35
Q

Hypophosphatemia manifestations

A

Reduced O2 capacity by RBC
ATP issues
2,3 diphospho used to release oxygen, so decrese will shift to left (causing hypoxia)
Hemorrhage from altere leukocyte and platelet function
Irritability, confusion, numbness, weakness, chest pain, convulsions

36
Q

Mg

A

Major intracellular cation

Cofactor in intracellular enzymatic reactions (ATP?)

37
Q

Hypomag

A 
<1.5
From absorption issues (ETOH, starvation, bowel bypass or 
increased losses (diuretics, hyperPT, hyperaldost, DKA)
38
Q

Hypomag clinical manifestations

A

Similar to hypo calc and hypo K because they occur in conjucation
Tachy, hypertensive, arrythmias

39
Q

Hypermag

A

> 2.5
Too much mag sulfate, or kidneys can’t excrete
N/V lethargy, HYPOreflexia, confusion, hypotension, brady, cardiac arrest, resp depression

40
Q

Osmolality definition

A

Refers to concentration of solutes in soluction, term used in reference to extracellular space

41
Q

Isotonic imbalance

A

Changes in body water equal with lytes. No cell shape changes

42
Q

Isotonic volume depletion causes

A

Inadequate fluid

Excessive GI fluid loss, renal loss, skin loss, third space loss

43
Q

Hypertonic imbalance

A

> 0.9% Na+ causes ECF to attract water from intracellular space (ICF dehydration) cells shrink due to water loss

44
Q

Hypotonic imbalance

A

Hypo-osmalar ECF less than 09% from sodium deficinecy or excess water causes edema and decreased plasma volume so symptoms of hypovolemia

45
Q

Metabolic acidosis causes

A

Lactic acid build up from poor perfusion
Kidney failure
DKA
Ingestion of ammounium chloride, salicylates
Loss of bicarb from diarrhea or renal failure

46
Q

Metabolic acidosis clinical

A 
Neuro, resp, GI, CV issues
Headache
Kussmauls
Anorexia
dysrhythmias
Resp increases CO2 exhalation to compensate
47
Q

Metabolic alkalosis

A

Increases in bicarb or loss of acid from GI suctioning or vomiting
Too much bicarb
Diuretics
Causes weakness cramps hyperactive reflexes and tetany
CO2 retained to compensate

48
Q

Resp acidosis

A

Hypercapnia (retained CO2) from depressed vent or decreased alveoli diffusion, chronic or acute
Trauma or oversedation
Resp muscle paraylsis
Kyphoscoliosis, flail, pneumonia, pulmonary edmea, emphysema, asthma, bronchitis
Kidneys compensate by retaining bicarb (HCO3-) and pissing out H+ but takes hours to days

49
Q

Resp acidosis clinical

A

Restlessness, apprehension, lethargy, muscle twitching, tremors, convulsions, coma
CO2 can cross blood brain and drop CSF pH and cause vasodilation

50
Q

Resp alkolosis

A

Hypoxemia (pulmonary disease, CHF, high altitudes) fever, anemia, sepsis, salicyate OD (EARLY) hysteria, improper vent use
Irritates CNS and PNS, dizziness, convulsions
Carpopedal spasm

Pathology (24 decks)

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