Module 2 (Exam 1) Flashcards
Fluid-Electrolyte, Acid-Base Disorders and Endocrine Function
ICF (Intracellular fluid)
• 40% of body weight
Interstitial fluid (ISF)
ECF; fluid between the cells
Intravascular fluid (IVF)
ECF; fluid inside the blood vessels
TSF (transcellular fluid)
ECF; CSF, pleural and pericardial cavities, joint spaces
Osmolarity
solute concentration (osmosis and diffusion, hydrostatic (BP-push) and osmotic (pull, regulated by albumin) pressures
Tonicity
osmotic pressure of two solutions separated by a semipermeable membrane
Hypotonic
lower solute concentrations, fluids shift into intracellular space (fat cell)
Hypertonic
higher solute concentrations, fluids shift from ICF to IVF, cell shrinkage
Sensible fluid losses
urine, feces
Insensible fluid losses
sweat, respirations
Thirst mechanism
triggered in hypothalamus by decreased blood volume and higher osmolarity
ADH (antidiuretic hormone)
released from pituitary, promotes reabsorption of water in kidneys
Aldosterone
increases reabsorption of sodium and water in the renal tubules
Atrial natriuretic peptide
stimulates renal vasodilation and suppresses aldosterone, which increases urinary output
Edema (fluid excess)
interstitial space, issue with distribution (not always fluid excess); BP> osmotic pressure
Anasarca
generalized edema
Hypervolemia
• excess fluid in the intravascular space
• excessive sodium/water intake and insufficient losses
Water intoxication
excess fluid in intracellular space, may lead to lysis
Fluid Excess Causes: Excessive Na/H2O (high sodium…)
• high-sodium diet
• polydipsia (excessive thirst)
• hypertonic fluid administration
• free water
• enteral feedings
Fluid Excess Causes: Inadequate H2O/Na Elimination
• hyperaldosteronism
• Cushings syndrome
• inappropriate ADH
• renal, liver, heart failure
Fluid Excess Manifestations
•edema/anasarca/weight gain
•dyspnea
•bounding pulse, tachycardia, hypertension
•polyuria
•jugular vein distention
Hypovolemia
decreased fluid in intravascular space, can occur w/o electrolyte defects
Fluid Deficit
can lead to increase of blood solute levels, cell shrinkage, and hypotension
Fluid Deficit Causes: Excessive Fluid/Na Losses
• GI issues
• excessive diaphoresis
• prolonged hyperventilation
• hemorrhage
• diabetes
•burns/open wounds
• diuretics
Fluid Deficit Manifestations
• thirst
• dry mucous membranes
• decreased skin turgor
• weight loss
• hypotension, tachycardia, weak pulse
• flat jugular
• oliguria
Electrolytes: Sodium (Na) (135-145 mEq/L)
ECF; neurological function (sodium potassium pump); regulates fluid volume; reabsorbed by kidneys
• controls serum osmolarity and water balance
• excreted through kidneys and GI
Electrolytes: Potassium (K) (3.5-5 mEq/L)
ICF; muscle contraction and cardiac conduction; kidneys and GI ELIMINATE
• CANT FLUCTUATE MUCH W/O CAUSING SERIOUS ISSUES
Electrolytes: Calcium (Ca) (4/5 mEq/L)
bone health, neuromuscular and cardiac function, blood clotting, hormone secretion
• inverse relationship with P, synergistic relationship with Mg
• absorbed through GI and excreted in waste
• regulated by vitamin K, parathyroid hormone and calcitonin
Electrolytes: Magnesium (Mg)
ICF; bone and cellular functions; alcoholism leads to low levels of
Electrolytes: Chloride (Cl) (98-108 mEq/L)
ECF; bound to H2O and Na for fluid distribution, excreted through kidneys
Depolarization
Na; increase in membrane potential of cell membrane (cells internal charge becomes more positive)
Repolarization
Na; restoration of resting potential (cells internal charge returns to more negative value)
Hypernatremia Causes (serum osmolarity increases
• excessive sodium (dietary, IVs, Cushing’s syndrome, corticosteroid use)
• deficient water (insufficient intake, prolonged hyperventilation, diuretic use, diabetes insipidus)
Hypernatremia Manifestations
• symptoms of dehydration
• increased thirst and decreased urine output
• restlessness and agitation
• lethargy, weakness, headaches
• BP changes, tachycardia, weak pulse
• edema
• hyperchloremia
Hyponatremia Causes (serum osmolarity decreases)
• deficient sodium (diuretic use, GI losses, diaphoresis, insufficient aldosterone)
• excessive water (IVs, hyperglycemia, renal and heart failure, inappropriate ADH)
Hyponatremia Manifestations (anorexia…)
• anorexia
• GI upset
• dry mucous membranes
• muscle weakness
• hypocholemia
Hyperkalemia Causes
• deficient excretion (renal failure, Addisons disease, Gordon’s syndrome)
• excessive intake (supplements, IVs, increased release from cells like acidosis)
Hyperkalemia Manifestations
• paresthesia (pins and needles)
• muscle weakness/ flaccid paralysis
• bradycardia and EKG dysrhythmias (depressed ST segment, long PR interval)
• cardiac arrest
• respiratory depression
• metabolic acidosis
• abdominal cramping and diarrhea
• hypercholemia
• hyponatremia
Hypokalemia Causes
• excessive loss (GI loss, Cushing’s syndrome, corticosteroids)
• deficient intake (malnutrition, alcoholism)
• increased shift into the cell (alkalosis and insulin excess)
Hypokalemia Manifestations (hyporeflexia…)
• hyporeflexia
• leg cramps
• weak pulse
• hypotension and EKG dysrhythmias
• constipation and ileus
• metabolic alkalosis
• hypocholemia
• hypernatremia
Hypercalcemia Causes
•calcium antacids/supplements, cancer, immobilization, corticosteroids, vitamin D DEFICIENCY, hypophosphatemia
Hypercalcemia Manifestations
• GI symptoms and constipation
• bone pain
• kidney stones
• polyuria and polydipsia
• fatigue, lethargy, confusion
Hypocalcemia Causes
• excessive loss (hypoparathyroidism, renal failure, high phosphate levels, alkalosis, pancreatitis, diarrhea
• deficient intake (alcoholism, hypoalbuminemia)
Hypocalcemia Manifestations
• seizures
• tetany
• paresthesias
• ventricular tachycardia
• positive Trousseau/Chvostek sign
Trousseau’s sign (hypocalcemia)
occlusion of arterial blood flow elicits carpal spasm
Chvostek sign (hypocalcemia)
tapping patients facial nerve prompts facial spasm
Electrolytes: Phosphorus (P) (2.5-4.5 mg/dL)
bones; metabolism and membrane formation, excreted through kidneys
pH reflects…
hydrogen concentration (the more H, the lower the pH)
What systems work together to maintain acid-base balance?
buffers (body fluids), respiratory system, and the renal system
Buffers
chemicals that combine with an acid or base to change pH (immediate reaction until compensation is initiated)
What are the 4 major buffer systems?
bicarbonate-carbonic (1), phosphate (2), hemoglobin (2), protein (4)
What are the roles of K and H in the acid-base balance?
they move interchangeably through cell to balance pH
• with extracellular excess, H moves in of cell for buffering so K moves out
• K imbalance can lead to pH imbalances
Respiratory Regulation
• manages pH by altering CO2 excretion (chemoreceptors)
• SPEEDING UP respirations excreted MORE CO2, DECREASING acidity
• SLOWING DOWN respirations excreted LESS CO2, INCREASING acidity
• responds quickly yet short lived
Renal Regulation
• alters excretion/retention of H or bicarbonate
• more effective and responds slower, but lasts longer by permanently removing H
The respiratory system compensates by…
increasing/decreasing ventilation
PaCO2 (35-45 mmHg)
acidic; partial pressure of CO2; indicates the adequacy of pulmonary ventilation
The renal system compensates by…
producing acidic or alkaline urine
HCO3 (bicarbonate) (22-26 mEq/L)
basic; indicates the activity in kidneys to retain or excrete bicarbonate
Causes of Acidosis
• hypoventilation
• diabetic/metabolic ketoacidosis (renal failure, shock, sepsis, severe diarrhea)
Causes of Alkalosis
• hyperventilation
• metabolic alkalosis (loss of gastric juices, overuse of antacids, K wasting diuretics)
Metabolic Acidosis Causes
• deficiency of bicarbonate (GI and renal losses)
• excess H (tissue hypoxia, ketoacidosis, drugs, renal retention)
Metabolic Acidosis Manifestations
• headache
• malaise, weakness, fatigue, lethargy
• warm and flushed skin
• nausea and vomiting
• anorexia
• hypotension and dysrhythmias
• hyperkalemia
• Kussmaul respirations (hyperventilation)
Metabolic Alkalosis Causes
• excess bicarbonate (excessive antacid use, hypochloremia)
• deficient acid (GI and renal loss, hypokalemia, hypovolemia, hyperaldosteronism)
Metabolic Alkalosis Manifestations (confusion…)
• confusion
• hyperactive reflexes and tetany
• parasthesia
• seizures and coma
• respiratory depression
• dysrhythmias (tachycardia)
Respiratory Acidosis Causes
• CO2 retention, which increases carbonic acid (hypoventilation or decreased gas exchange)
Respiratory acidosis Manifestations
• headache
• tremors and muscle twitching
• vertigo and disorientation
• diaphoresis
• lower BP and dysrhythmias (higher K)
Respiratory Alkalosis Causes
excess CO2, lower carbonic acid (hyperventilation)
Respiratory alkalosis Manifestations
• parasthesia
• fainting, dizziness, vertigo
• nausea and vomiting
• tachycardia and dysrhythmias (lower K)
• dry mouth and excessive diaphoresis
PaO2
partial pressure of oxygen; indicates serum oxygen concentration
Hypothalamic Hormones
• dopamine
• TRH
• CRH
• Somatostatin
• GHRH
• GnRH
Anterior Pituitary Hormones
• prolactin (targets boobs)
• TSH (targets thyroid)
• ACTH (targets adrenal)
• GH (targets liver)
• FSH (targets testes and ovaries)
• LH (same as FSH)
Thyroid gland Hormones
T3, T4
Adrenal Cortex Hormones
cortisol
Liver Hormones
IGFs
Testes/Ovary Hormones
Androgens; estrogen and progesterone
Hypopituitarism Causes
occur suddenly but develops slowly
• congenital defects
• brain trauma or infection, tumors, hypothalamic dysfunction
• autoimmune conditions
• TB
Dwarfism
GH hormone (hypopituitarism); short stature
Diabetes Insipidus
ADH (hypopituitarism); excessive fluid excretion in kidneys
• diluted urine (low urine specific gravity)
• hypernatremia
Hypopituitarism Manifestations
• hypoglycemia, vomiting (cortisol)
• bradycardia, cold intolerance, constipation (thyroxine)
• amenorrhea and micropenis (sex)
• short stature (GH)
• polyuria, polydipsia, hypernatremia (ADH)
Hyperpituitarism Manifestations (headache…)
• headache
• vision problems
• diaphoresis
• sleep apnea
• carpal tunnel, join paint and stiffness
• parasthesia and muscle weakness
Gigantism (hyperpituitarism)
tall stature caused by excessive GH PRIOR to puberty
Acromegaly (hyperpituitarism)
increased bone size by excessive GH in adulthood
Syndrome of Inappropriate Antidiuretic Hormone (SIADH) (hyperpituitarism)
increased renal water retention caused by excessive ADH
• sticky and thick urine (high urine specific gravity)
• hyponatremia
• nausea, vomiting
Hyperprolactinemia (hyperpituitarism)
excessive prolactin that results in menstrual dysfunction and galactorrhea
Cushing’s Syndrome (hyperpituitarism)
excessive cortisol from increased ACTH levels
Hyperthyroidism (hyperpituitarism)
hypermetabolic state caused by excessive thyroid hormones from increased TSH
Diabetes Mellitus
hyperglycemia from defects in insulin production or action, which results in abnormal metabolism because of the glucose transportation issue
Diabetes Mellitus Manifestations
• hyperglycemia
• glucoseria (glucose in urine)
• polyuria, polydipsia, polyphagia
• weight loss
• blurred vision and fatigue
Type 1 Diabetes (insulin dependent, juvenile onset)
develops when immune system destroys pancreatic beta cells; children and YA; exact cause unknown
CANNOT BE PREVENTED
Prediabetes (pancreas)
blood glucose levels higher than normal but not high enough for diagnosis
• cells are insulin resistant by adipokines secreted by adipose cells (also secrete inflammatory substances)
•glucose levels increase which causes pancreas’s to increase insulin production
• hyperglycemia may destroy beta cells
•lifestyle can prevent or delay Type 2
Type 2 Diabetes (pancreas) (non insulin dependent, adult onset)
• 90-95% of newly diagnosed cases
• pancreas gradually loses ability to produce insulin
•usually managed with oral meds or supplemental insulin
Type 2 Diabetes Risk Factors
age, obesity, family history, gestational diabetes history, physical inactivity
Gestational Diabetes (pancreas)
• 2nd-3rd trimester, 40-60% chance of developing diabetes within 5-10 years
Metabolic Syndrome (syndrome X, insulin resistance syndrome)
cluster of risk factors occurring together
• hyperglycemia
• high BP
• hypercholesterolemia (low HDLs and high triglycerides)
Goiter
visible enlargement of the thyroid gland; may affect respiratory and GI
Goiter Causes
• cysts
• thyroiditis
• hyper/hypothyroidism
•iodine deficiency
Iodine Deficiency
leads to decreased T3 and T4, causes increased TSH production to compensate, which causes thyroid hyperplasia and hypertrophy
Hypothyroidism Causes
hypometabolic state
• autoimmune thryoiditis (Hashimotos)
• iatrogenic (resulting from medical treatment)
Hypothyroidism Manifestations
• fatigue and sluggishness, muscle weakness and pain
• cold sensitivity
• facial edema
• unexplained weight gain and hypercholestemia
• hair loss/thinning, brittle nails
• bradycardia and hypotension
Myxedema
rare and life threatening hypothyroidism usually triggered by infection, trauma, CNS suppressants
Myxedema Mainfestations
• hypotension
• respiratory depression
• hypothermia
• lethargy and coma
Hyperthyroidism Causes
hypermetabolic state
• excessive iodine
• Graves’ disease (autoimmune disease that stimulates thyroid hormones)
• thyroid inflammation
Hyperthyroidism Manifestations
• weight loss
• tachycardia and hypertension
• increased appetite
• sensitivity to heat
• tremors and irritability
• exophthalmos (bulging eyes)
Thyrotoxicosis (thyroid storm)
sudden worsening of hyperthyroidism symptoms with infection or stress with fever and abdominal pain
Hypoparathyroidism Causes
•congenital defects
• damage to glands (surgery, radiation, autoimmune)
Hypoparathyroidism Manifestations (parasthesia…)
• parasthesia
• tetany
• dysrhythmias and hypotension
• abdominal cramping and diarrhea
• hair loss and dry brittle nails
Hyperparathyroidism Causes
• tumors
• hyperplasia
• chronic hypocalcemia (renal failure)
• vitamin D deficiency
Hyperparathyroidism Manifestations
• osteoporosis and kidney stones
• polyuria
• constipation and abdominal pain
• weakness and flaccid muscles
• dysrhythmias and hypertension
• nausea and vomiting
• anorexia
Pheochromocytoma
rare tumor of the adrenal medulla that excretes epinephrine and norepinephrine
Pheochromocytoma Manifestations
• hypertension, tachycardia, bounding pulse
• diaphoresis
• severe headaches
• anxiety and extreme fright, pallor
• weight loss
Cushing Syndrome (hypercorticolism) Mainfestations
• trunk obesity and moon face, edema
• muscle weakness and delayed growth
• acne and hursitism
• purple striae
• thin skin and delayed wound healing
• osteoporosis
• insulin resistance
• hypertension and hypokalemia
Addisons disease (hypocorticolism) Manifestations
• hypotension and weight loss
• hypoglycemia and salt craving, hyperkalemia
• extreme weakness and fatigue
• mouth lesions on inside of cheek
• chronic diarrhea
What is the most abundant buffer system?
bicarbonate system
Uncompensated
unpaired result is normal range; one value is normal while the other is not
Partially Compensated
all 3 values are abnormal
If the pH is basic, and the CO2 and HCO3 is acidic, what alkalosis is it?
respiratory
If the pH is acidic, and the CO2 and HCO3 is acidic, what type of acidosis is this?
Metabolic
If the pH is acidic, and the CO2 and HCO3 is basic, what type of acidosis is this?
respiratory
If the pH is basic, and the CO2 and HCO3 is basic, what type of alkalosis is this?
metabolic
FRIED is for…
hypernatremia
FRIED stands for…
Fatigue
Restlessness
Increased BP and fluid retention
Edema
Dehydration symptoms
SALTO is for
HYPOnatremia
SALTO stands for…
Seizures
Abdominal cramping and confusion
Lethargy
Tendon reflexes diminished
Orthostatic hypotension
MURDER is for…
HYPERkalemia
MURDER stands for…
Muscle weakness
Urine output little/none
Respiratory failure
Decreased cardiac contractility
Early muscle twitches
Rhythm changes (tall T, prolonged PR)
7 L’s is for..
HYPOkalemia
7 L’s are…
Lethargy
Low, shallow breaths
Lethal cardiac dysrhythmias
Lots of urine
Leg cramps
Limp muscles
Low BP
“stones, bones, abdominal moans and psychic groans” are for… (2)
HYPERcalcemia and HYPERparathyroidism
CATs go numb is for…(2)
HYPOcalcemia and HYPOparathyroidism
CATs go numb stands for
Convulsions
Arrhythmias
Tetany
WHLK is for…
metabolic acidosis
WHLK stands for..
Weakness and lethargy
Hyperkalemia
Low BP
Kussmaul respirations (hyperventilation)
TRHP is for…
metabolic alkalosis
TRHP stands for…
Tetany and muscle weakness
Respiratory depression (hypoventilation)
Hypokalemia
Parasthesia
HID is for…
respiratory acidosis
HID stands for…
Hypoxia and hypotension
Increased heart rate
Disorientation and confusion
THID is for
respiratory alkalosis
THID stands for…
Tachypnea
Hypocalcemia and hypokalemia
Increased heart rate
Dizziness and fatigue
ADISON stands for…
Aldosterone deficiency
Dark spots/hyperpigmentation
Irritability
Stomach upset
Orthostatic hypotension
Natremia, hypo and hyperkalemia
The 5 P’s are for…
pheochromocytoma
The 5 P’s stand for
Pressure (hypertension)
Pain (headaches)
Perspiration (diaphoresis)
Palpitation (tachycardia)
Pallor
SWEATING is for…
Hyperthyroidism (think wendy williams, graves’ disease)
SWEATING stands for…
Sweating
Weight loss
Exophthalmos (bulging eyes)
Appetite increase
Tachycardia and tremors
Intolerance to heat
Nervousness
Goiter/GI issues
MOMSOTIRED is for…
hypothyroidism
MOMSOTIRED stands for…
Memory loss
Obesity
Muscle weakness
Slowness
Skin and hair is dry
Onset gradual
Tired
Intolerance to cold
SIADH mnemonic
SI “yes” ADH!
stop urination
sticky and thick urine
low sodium
Diabetes Insipidus mnemonic
DIE ADH
DIluted urine
hypernatremia
