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Lab Modules > Module 1 - Fluids, Electrolytes, and Acid-Base Balance > Flashcards

Module 1 - Fluids, Electrolytes, and Acid-Base Balance Flashcards

1
Q

Total body water is __ % of total body weight

A

60

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2
Q

Intracellular fluid is __% of total body water

A

67

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3
Q

Extracellular fluid is __% of total body water

A

33

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4
Q

Plasma is ___% total body water

A

6.6

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5
Q

Interstitial fluid is ___% of total body water

A

26.4

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6
Q

Plasma and interstitial fluid make up ??

A

extracellular fluid

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7
Q

What is blood plasma?

A

Yellow liquid component of blood that suspends whole blood cells, proteins, glucose, clotting factors, electrolytes, hormones and CO2

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8
Q

What is blood serum?

A

Blood plasma WITHOUT the clotting factors (fibrinogen, prothrombin)

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9
Q

Na+ and Cl- are high _____ of the cell

A

outside

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10
Q

K+ is high _____ the cell

A

inside

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11
Q

Why are fluids important?

A
  • To maintain homeostasis (euvolemia)

- To replenish the fluids lost through normal physiologic activities

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12
Q

What are insensible losses? Examples?

A

Losses we can’t see or measure:

  • perspiration
  • respiration
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13
Q

What are sensible losses?

Examples?

A

Losses we can see and measure:

  • urination
  • feces
  • wound drainage
  • GI losses
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14
Q

To maintain fluid balance, the average person requires ________mL of water per day

A

2000-3000

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15
Q

Hypertonic

A

[solute] > serum

*draws fluid out of the cell and into the intravascular space

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16
Q

Isotonic

A

[solute] = serum

*fluid stays in the intravascular space

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17
Q

Hypotonic

A

[solute] < serum

*fluid shifts out of the intravascular space and into the cell

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18
Q

Hypertonic solution is __% NaCl

A

3% NaCl (513 mmol/L)

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19
Q

Isotonic solution is __% NaCl

A

0.9% NaCl (154 mmol/L)

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20
Q

Hypotonic solution is __% NaCl

A

0.45% NaCl (77 mmol/L)

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21
Q

Serum contains ______ mmol/L of Na+

A

145

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22
Q

See slide 9 for calculating serum osmolality

A

ok

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23
Q

Why do we care about calculating serum osmolality?

A
  • Highly concentrated solutions are irritating to veins (phlebitis) or can damage tissue
  • Depending on concentration, may require central line access (a larger vessel)
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24
Q

Replacing fluids:

Resuscitation

A

patient is clearly volume depleted

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25
Q

Replacing fluids:

Maintenance

A

patient is NPO (nothing by mouth), poor oral intake

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26
Q

What is the recommended fluid replacement for resuscitation?

A

Give fluid bolus of 500 mL crystalloid (Na+ 130-154 mmol/L) over 15 minutes (can repeat up to 2000mL)

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27
Q

What is the recommended fluid replacement for maintenance ?

A

Normal daily fluid and electrolyte requirements:

  • 25-30mL/kg/day water
  • 1 mmol/L/kg/day Na+, K+, Cl-
  • 50 - 100 g/day of glucose

*Works out to approximately 100-120 mL/hr

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28
Q

What are electrolytes?

A

substances that ionize when’d dissolved in solvents such as water

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29
Q

What do electrolytes do?

A
  • Maintain the body’s fluid balance and osmolality
  • Maintain the body’s pH balance
  • Maintain proper fcn of cells
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30
Q

Na+ is most abundant in ______ fluid (maintained by Na+/K+ ATPase pump)

A

extracellular

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31
Q

______ results in water entering cells

A

Hyponatremia

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32
Q

_____ results in water getting drawn out of cells

A

Hypernatremia

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33
Q

Abnormal sodium levels usually indicate a problem with _____ balance

A

water

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34
Q

Sodium balance is mainly controlled by the ________ with the help of aldosterone, ADH and atrial natriuretic peptide

A

KIDNEY

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35
Q

Describe what happens if sodium level is low (or low blood pressure)

A
  • Anti-diuretic hormone is released from posterior pituitary gland
  • Aldosterone is released
  • Kidney reabsorbs Na+ and water
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36
Q

Describe what happens if sodium level is high (or high blood pressure)

A
  • Atrial natriuretic hormone is released from the heart

- Kidney excretes Na+ and water

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37
Q

What levels constitute mild hyponatremia?

A

130-135 mmol/L

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38
Q

What levels constitute moderate hyponatremia?

A

125 - 129 mmol/L

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39
Q

What levels constitute severe hyponatremia?

A

< 125 mmol/L

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40
Q

Symptoms of hyponatremia?

A
  • asymptomatic
  • impaired attention
  • gait changes (trouble walking)
  • falls
  • N/V
  • altered mental status
  • seizures
  • respiratory arrest = death
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41
Q

What type of medication can cause low sodium and low volume?

A

Diuretics (dump Na+ and water)

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42
Q

What types of medication can cause low sodium but normal volume?

A
  • NSAIDs
  • SSRIs
  • illicit drugs
  • carbamazepine
  • cyclophosphamide
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43
Q

Treatment for low sodium/low volume?

A

0.9% NaCl to rehydrate patient and correct Na+

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44
Q

Treatment for low sodium/normal volume?

A

fluid restriction, diuresis (loop diuretics)

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45
Q

Treatment for low sodium, too much fluid?

A

fluid restriction, diuresis (loop diuretics)

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46
Q

Formula for sodium deficit?

A

Sodium deficit = [0.6 x weight(kg)] x (desired Na+ - actual Na+)

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47
Q

For sodium correction: Correct no more than ________

A

9 mmol/L/day

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48
Q

What level constitutes severe hypernatremia?

A

> 160 mmol/L

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49
Q

Symptoms of hypernatremia?

A
  • thirst
  • lethargy
  • restlessness
  • irritability
  • ataxia
  • tremors
  • seizures
  • coma
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50
Q

Treatment for hypovolemic hypernatremia?

A

fluids (D5W or 0.2% NaCl in D5W)

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51
Q

Treatment for euvolemic hypernatremia?

A

vasopressin (ADH)

*THIS DOESN’T MAKE SENSE WTF

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52
Q

Treatment for hypervolemic hypernatremia?

A

Diuretics (get rid of Na+ and water) or dialysis

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53
Q

Potassium is most abundant in ______ fluid

A

intracellular

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54
Q

What is potassium important for?

A

proper conduction of action potentials (muscle excitability)

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55
Q

potassium is __% renally eliminated

A

90

56
Q

_____ pushes K+ inside cells

A

insulin

57
Q

______ activate Na+/K+ ATPase

A

B-agonists (epinephrine)

58
Q

______ dump K+, keep Na+ and water

A

aldosterone

59
Q

What is metabolic alkalosis ?

A

decreased K+ levels

60
Q

What is metabolic acidosis ?

A

increased K+ levels

61
Q

What levels constitute mild hypokalemia?

A

3.1-3.5

62
Q

Symptoms of mild hypokalemia?

A

often asymptomatic

63
Q

What levels constitute moderate hypokalemia?

A

2.5 - 3.0

64
Q

Symptoms of moderate hypokalemia?

A

cramping, weakness, malaise, myalgias

65
Q

What levels constitute severe hypokalemia?

A

< 2.5

66
Q

Symptoms of severe hypokalemia?

A

ECG changes

67
Q

What causes hypokalemia?

A
  • excessive GI loss (vomiting, diarrhea, NG suction)
  • decreased intake (malnourished)
  • excessive renal loss (diuretics)
  • acid-base balance (metabolic alkalosis)
68
Q

Hypokalemia can cause ______ toxicity

A

Digoxin

69
Q

What levels constitute mild hyperkalemia?

A

5.5 - 6.0 mmol/L

70
Q

What levels constitute moderate hyperkalemia?

A

6.1 - 7.0 mmol/L

71
Q

What levels constitute severe hyperkalemia?

A

> 7.1 mmol/L

72
Q

Symptoms of mild hyperkalmia

A

usually asymptomatic

73
Q

Symptoms of moderate hyperkalemia?

A

cardiac arrhythmias

74
Q

Symptoms of severe hyperkalemia?

A
  • cardiac arrhythmias
  • weakness
  • paralysis
  • respiratory failure
  • sudden cardiac arrest
75
Q

Causes of hyperkalemia?

A
  • excessive intake (supplements, salt substitutes)
  • impaired renal function
  • redistribution to extracellular fluid
  • psudeohyperkalemia (hemolysed blood sample)
  • DRUGS (K+ sparing diuretics, ACEi, ARBs)
  • missed dialysis session
76
Q

Treatment of hyperkalemia?

A

calcium gluconate, insulin & dextrose, salbutamol, dialysis

77
Q

Caution with intravenous potassium?

A

K+ can cause arrhythmias and death

78
Q

Max rate of K+ for peripheral line

A

20 mmol/hr

79
Q

Max concentration of K+ for peripheral line

A

80 mmol/L

80
Q

Max rate of K+ for central line

A

40 mmol/hr

81
Q

Max concentration of K+ for central line?

A

200 mmol/L

82
Q

Cl- is a major ______ anion

A

extracellular

83
Q

What regulates chloride balance?

A

sodium and bicarbonate

84
Q

What level is severe hypochloremia?

A

< 75 mmol/L

85
Q

Causes of severe hypochloremia?

A
  • severe loss of GI fluids
  • metabolic alkalosis (too much bicarb) *holding onto bicarbonate which is an anion, therefore chloride is excreted and lost
  • renal losses (loss of sodium, chloride follows)
  • drugs (i.e. PPIs lower stomach acidity)
86
Q

What level is severe hyperchloremia?

A

> 125 mmol/L

87
Q

Causes of hyperchloremia

A
  • sodium and water retention

- metabolic acidosis (too many H+ ions) *bicarb is excreted, H+ is retained therefore Cl- is retained

88
Q

Most magnesium resides in the ______ space or in bone

A

intracellular

89
Q

Levels of severe hypomagnesemia?

A

< 0.5 mmol/L

90
Q

Symptoms of hypomagnesemia

A

neuromuscular hyperirritability (tremors, tetany, arrhythmias, seizures)

91
Q

Causes of hypomagnesemia?

A
  • reduced intestinal absorption (malnutrition, alcoholism, malabsorption syndromes)
  • increased urinary/fecal losses (diarrhea, loop and thiazide diuretics)
  • intracellular shifts
92
Q

Levels of mild-moderate hypermagnesemia

A

1-1.5 mmol/L

93
Q

Symptoms of mild-moderate hypermagnesemia?

A

usually asymptomatic

94
Q

Levels of hypermagnesemia?

A

> 1.5 mmol/L

95
Q

Symptoms of severe hypermagnesemia?

A

nausea, headache, drowsiness, hypocalcemia, deep tendon reflexes absent, hypotension, bradycardia, ECG changes, paralysis, death

96
Q

Causes of hypermagnesemia?

A
  • chronic kidney disease (unable to eliminate)
  • excess magnesium intake
  • addison’s disease (not enough mineralocorticoids)
  • lithium
97
Q

Treatment of hypermagnesemia?

A
  • stop excessive intake
  • IV calcium
  • dialysis
98
Q

Calcium found in _____ fluid

A

extracellular

99
Q

How much calcium is free?

A

45% of total calcium

100
Q

What is the formula for Corrected calcium?

A

Ca corrected = Ca serum + 0.02*(40-albumin)

101
Q

Level o fever hypocalcemia?

A

< 1 mmol/L

102
Q

Symptoms of hypocalcemia?

A

Muscles: myalgia, numbness, tingling, tetany, hyperreflexia
Cardiac: arrhythmias, hypotension
CNS: seizures

103
Q

Causes of severe hypocalcemia?

A
  • vitamin D deficiency
  • hypoparathyroidism
  • renal disease
  • malabsorption or pancreatitis
  • hypomagnesemia
  • drug causes (bisphosphantes, calcitonin, furosemide)
104
Q

Level of mild hypercalcemia?

A

2.6-3.0 mmol/L

105
Q

Symptoms of mild hypercalcemia?

A

usually asymptomatic, constipation

106
Q

Level of moderate-severe hypercalcemia?

A

> 3.0 mmol/L

107
Q

Symptoms of moderate-severe hypercalcemia?

A

nausea, abdominal pain, constipation, kidney stones, polydipsia, polyuria, dehydration, hypertension, shortened QT intervals, stupor, coma

108
Q

Causes of hypercalcemia?

A
  • hyperparathyroidism
  • malignancy
  • drug causes (tamoxifen, lithium, thiazide diuretics, vitamin D)
109
Q

Treatment of hypercalcemia?

A
  • treat underlying disorder
  • reduce calcium intake
  • cinacalcet
  • parathyroidectomy
110
Q

Phosphorus found primarily in ______ space

A

intracellular

111
Q

Level for mild-moderate hypophosphatemia

A

0.3 - 0.8 mmol/L

112
Q

Symptoms of mild-moderate hypophosphatemia

A

usually asymptomatic

113
Q

Level for severe hypophosphatemia

A

< 0.3 mmol/L

114
Q

Symptoms of severe hypophosphatemia

A

rhabdomyolysis, hemolysis, platelet dysfunction, cardiac/respiratory failure, encephalopathy, seizures

115
Q

Causes of hypophosphatemia

A
  • inadequate intake
  • increased excretion
  • intracellular shift
116
Q

Level for mild-moderate hyperphosphatemia

A

1.6 - 2.3 mmol/L

117
Q

Symptoms of hyperphosphatemia?

A

usually asymptomatic

118
Q

Level for severe hyperphosphatemia

A

2.4 mmol/L

119
Q

Symptoms for severe hyperphosphatemia

A

Gi disturbance, lethargy, urinary obstruction (renal stones), red eye, pruritus

120
Q

Causes of hyperphosphatemia?

A
  • excessive intake

- decreased elimination (renal disease)

121
Q

Treatment of hyperphosphatemia?

A
  • phosphate binders (calcium carbonate, sevelamer, lanthanum)
  • increase urinary excretion (acetazolamide, dialysis)
122
Q

What are arterial blood gasses used to determine?

A
  • oxygenation status

- acid-base status

123
Q

pH determines?

A

how acidic/basic is the blood

124
Q

pCO2 determines?

A

what the lungs are doing

125
Q

HCO3 determines?

A

how much bicarb is in the blood

126
Q

____% of total CO2 is bicarbonate

A

95

127
Q

Acidemia

A

arterial pH < 7.35

128
Q

Alkalemia

A

arterial pH > 7.45

129
Q

Acidosis

A

a process that will result in academia if left unopposed (usually caused by decreased HCO3 and/or increased pCO2)

130
Q

Alkalosis

A

a process that will result in alkalemia if left unopposed (usually caused by increased HCO3 and/or decreased pCO2)

131
Q

Metabolic alkalosis

A

increased HCO3

*lungs try and retain pCO2

132
Q

Metabolic acidosis

A

decreased HCO3

*lungs try to blow off more pCO2

133
Q

Respiratory alkalosis

A

decreased pCO2

*kidneys try to excrete bicarbonate

134
Q

Respiratory acidosis

A

increased pCO2

*kidneys try to retain bicarbonate

135
Q

What is normal anion gap?

A

8-16 mmol/L

136
Q

formula for anion gap

A

Anion gap = Na+ - [Cl- + HCO3-]

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