Module 3 Flashcards
Fluid & Electrolytes, Acid-Base Balance, Renal, and Pulmonary
What is the major numbers for Calcium?
8.5-10.5
What lab values indicate dehydration?
GFR < 60
Creatinine > 1.3
What lab values indicate overhydration?
BUN < 6
Na < 135
ADH: role, fluid control, influence on kidneys, location
Reduces UO
Increases water reabsorption by making COLLECTING DUCTS more permeable to water
Stimulates K+ secretion
Aldosterone: role, fluid control, influence on kidneys, location
Produced in renal cortex (DISTAL TUBULES and COLLECTING DUCTS)
Promotes reabsorption of Na and water in kidneys (Increases Na+, decreases K+)
Patho of hypernatremia
“Big and bloated”
Brain cells shrink, moves water from intra- to extracellular space
Patho of hyponatremia
“Depressed and deflated”
Brain cells swell, water moves into intracellular space
S/S of hypernatremia
Thirst, confusion, irritability, muscle twitching, seizures
S/S of hyponatremia
N/V, HA, confusion, lethargy, seizures, coma
Patho of hyperkalemia
“Tight and contracted”
Increased cell excitability
Patho of hypokalemia
“Low and slow”
Decreased cell excitability
S/S of hyperkalemia
Muscle weakness, paralysis, bradycardia, heart block, N/D, tingling/numbness,
EKG: peaked T-waved, widened QRS
S/S of hypokalemia
Muscle cramps, weakness, fatigue, constipation, decreased DTRs,
EKG: flattened T-waves, prominent Q waves, ST depression
Acronym for hypercalcemia
“Moans, groans, and stones”
Acronym for hypocalcemia
“CATS go numb”
S/S of hypercalcemia
Fatigue, weakness, confusion, kidney stones,
EKG: shortened QT
S/S of hypocalcemia
Convulsions, arrhythmias, tetany (cramps), spasms (Trousseau and Chvosteks), slowing of function - fatigue/lethargy, paresthesia, laryngospams
Which electrolyte has an inverse relationship with calcium?
Phosphorus
Causes of respiratory acidosis
“DEPRESS” -
Drugs and disease, edema, PNA, resp centers of brain, emphysema, spasms of bronchi (asthma), Sac elasticity damage (COPD)
Causes of respiratory alkalosis
“TACHYPNEA” -
Temp increase, Asa toxicity, Controlled ventilation too fast, Yelp (pain, anx, fear), Pneumothorax, Embolism in lungs, Altitude
Causes of metabolic alkalosis
Vomiting/gastric suctioning “ALKALI” -
Acid loss in stomach, Low chloride, hypoKalemia, Aldosterone elevated, Loop and thiazide diuretics, Infusing too much bicarb
Causes of metabolic acidosis
“ACIDS”
Accumulation of lactate, Chronic diarrhea, Impaired renal rxn, DKA, Salicylate toxicity
Where in the nephron absorbs Na?
Proximal convoluted tubule, ascending loop
Where in the nephron absorbs K?
Proximal convoluted tubule
Where is fluid absorbed in the nephron?
Proximal convoluted tubule, descending loop
Where does ADH work in the nephron?
Collecting ducts
Where does aldosterone work in the nephron?
Collecting ducts & distal tubule
Normal GFR
≥ 90
GFR in ESRD
< 15
What is the role of the RAAS system?
regulates BP and fluid balance
Renin?
Enzyme from kidneys that responds to low BP or SNS activation
Converts angiotensinogen -> angiotensin I
Angiotensin I?
Protein that constricts blood vessels
Converted to angiotensin II by ACE
Angiotensin II?
Vasoconstrictor, more active form.
Triggers ADH and aldosterone release.
Aldosterone?
Promotes Na and water retention
ADH (vasopressin)
Increases water retention (no Na)
Stage I AKI
Initial
Hour-day onset
Subtle symptoms, reversible injury
Stage II AKI
Decreased UO
Hyperkalemia, hyperphosphatemia, hypocalcemia, metabolic acidosis
Stage III AKI
Gradual increase in UO, risk of dehydration
Electrolyte loss
Stage IV AKI
Gradual return to normal fxn, has potential residual damage
Prerenal AKI causes
Hypovolemia, decreased CO, shock
Minimal UO
400-500 mL/day in adults
Intrinsic AKI causes
Nephrotic drugs, glomerular nephritis, autoimmune diseases, infections, sepsis
Postrenal AKI causes
Kidney stones, ureteral obstruction, bladder outlet obstruction, prostate hypertrophy
Alveoli and inflammation
Immune cells recognize pathogens and release IL-1, IL-6, and TNF which leads to further immune cell recruitment causing inflammation, capillary leakage and fluid accumulation.
Increased capillary permeability allows fluid, proteins and immune cells to fill alveoli creating dense appearance. This disrupts O2 and CO2 exchange.
Role of mast cells in asthma
Bond to IgE releasing histamines, leukotrienes, and prostaglandins.
Role of eosinophils in asthma
Attracted by IL-5, release cytotoxic granules leading to tissue damage and inflammation in airway
Role of leukotrienes in asthma
Bronchoconstrictors
What acid-base imbalance happens in chronic bronchitis and why?
Respiratory acidosis
(Has difficulty removing CO2)
Patho of emphysema
Destruction of alveolar walls, air trapping, and structural changes such as bullae formation, bronchiole collapse, and diaphragm flattening
What protein deficiency increases susceptibility to emphysema? Explain what it is.
Alpha-1 Antitrypsin
Autosomal recessive disorder.
Protein from liver that protects lung/liver from damage.
Normal FEV1/FVC ratio
80%
What causes hypokalemia?
Metabolic alkalosis and insulin excess
What inflammatory cells are involved in chronic bronchitis?
Interleukins (IL-8), TNF, and protease
What is the role of Mag in potassium disorders?
Dec mag levels cause K excretion
