Fluids & Electrolytes

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correct cause, CPT, TCDB if able, suction as needed, semi-Fowlers, fluids to thin secretions, low-flow O2 as needed: respiratory acidosis management (7)
low, <1.005: FVE, urine spec gravity
indicates the amount of bicarb available in the ECF: BE "base excess" (normal value: +/- 2 mEq/L)
weight gain, nonpitting interstitial edema, hepatomegaly/splenomegaly: FVE general signs
seen with FVE, Dyspnea, tachypnea, hacking cough, crackles, o2 sat down: pulmonary edema
correlate with dramatic drops in oxygen saturation: dramatic drops in PaO2
VS, ABGs, RR/depth, apical and peripheral pulses, ECG (bc of dramatic K changes), LOC, I&O: met acidosis assessment (7)
increased excitability: increased sodium and potassium signs
hypoventilation, respiratory failure: met alkalosis respiratory signs (2)
dyspnea, slow shallow respirations, hypoxia and hypoventilation, cyanosis: respiratory acidosis respiratory signs
stage where fluid moves from one space to another: 2nd spacing
changes in depth/rate of resp alters it: hypoventilation retains CO2/carbonic acid and causes acidosis, hyperventilation loses CO2 and causes alkalosis: respiratory buffer system, breathing changes
HA, seizures, altered LOC, papilledema, twitching/tremors, drowsy --> coma: respiratory acidosis CNS signs (6)
*partial pressure of CO2: PaCO2 --> *reflects adequacy of alveolar ventilation, regulated by lungs, alterations indicate resp disturbance. *normal values 35-45 mmHg (less is alkalotic, more is acidotic)
correct cause, rebreathe CO2 as needed, alter ventilation rate, sedatives (for anxiety): respiratory alkalosis managment (4)
VS, ABGs, RR/depth, apical pulse, LOC, EKG, skin color/nail beds/mucous membranes, I&O: respiratory acidosis assessment (8)
works w/in hours/days, more efficient than respiratory can go for longer periods of time: renal buffer system: time and effectiveness
normal to high (hemoconcentration): FVD sodium
high >1.030: FVD urine specific gravity
normal to high (stress response, >120): FVD glucose
dramatic affects: hypotension, dysrhythmias, peripheral vasodilation, warm flushed skin (from dilation, leaking of capillaries): metabolic acidosis CV signs (4)
buffers are in the process of working; pH is low but the bicarb is elevating to compensate (or pH is high but CO2 is elevating to compensate): partial compensation
correct cause, restore normal fluid balance, adequate chloride (enhance renal absorption of sodium and excretion of bicarb): metabolic alkalosis mgmnt (3)
primary system, 50% of activity, to maintain balance l/t have to also use protein and phosphate buffer systems, 1-2 hours to kick in, bicarb is the major ECF buffer: carbonic acid-bicarb system
prevent cerebral edema: goal of Rx for FVE
*Concentration of anions (HCO3- , Cl-, protein, phosphate, & sulfates) and cations (Na+, K+, MG++, & Ca++): serum anion gap --> *10-12 mEq/L normal, *increased in metabolic acidosis (but can be normal), *calculated by Na - Cl + bicarb
low (hemodilution): FVE, BUN
carbonic acid compensates and dissociates into CO2 and H20, CO2 exhaled by lungs, system activates rapidly but exhausted quickly: >>> Respiratory buffer system, carbonic acid
full bounding pulses, hypertension, increased CVP, neck vein distension, CHF: FVE hemodynamic signs
60-110 mg/dl: normal glucose
chronic diarrhea, malnutrition, starvation, renal failure, DKA, trauma, shock, sepsis, fever, salicylate toxicity: causes of metabolic acidosis
amount of oxygen available to bind with hemoglobin, amount of pressure exerted on O2 by plasma: PaO2
275-295: normal osmolality
the percent of Hb saturated with O2, a calculated value (indirect measurement), calculated with pH and PaO2 (combination of O2 sat, PaO2, and Hb), indicates tissue oxygenation: SaO2
VS, ABGs, RR/depth, LOC/anxiety, neuro checks, injury potential, I&O: respiratory alkalosis assessment (7)
tachycardia, palpitations, increased myocardial irritability: respiratory alkalosis CV signs
vomiting, NG suctioning, eating bicarb-based antacids, diuretics: met alkalosis causes (4)
low bicarb, decreased BE, increased anion gap, hyperkalemia (from breakdown of cells from acidosis), high metabolic acids (lactic acids, ketoacids): metabolic acidosis: labs
hypotension, peripheral vasodilation weak thready pulse, tachycardia, warm flushed skin: respiratory acidosis cardiac signs
seen with FVE, Confusion, dizziness, convulsions, coma: cerebral edema
fluid in interstitial compartments: 3rd spacing
pH low <7.35, PaCO2 high >42, HCO3- normal (or elevated with compensation), hyperkalemia: respiratory acidosis: labs
hard for cells to grow: alkaline environment
*normal 22-26 mEq/L (decreased in acidosis, increased in alkalosis): HCO3- (bicarb)
decreased temp, blood shunted to central area: FVD, temp changes
think of septic patient: drowsy, HA (from cerebral edema), lethargy, coma, confusion/restless, weakness: metabolic acidosis CNS signs (6)
measured as CO2: carbonic acid
if severe, sodium bicarb if pH<7.20, salts of organic acid (lactate, citrate), tromethamine THAM: alkaline fluids for met acidosis
tachycardia, HTN, PVC, atrial tachycardia, dysthrythmias (from FVE): met alkalosis CV signs (5)
increased respiratory rate bc acidotic, blowing of CO2; thick and sticky secretions: FVD, respiratory
abdomen (ascites, in peritoneal cavity?): most common site, 3rd spacing
renal failure, heart failure, excess fluid intake (without electrolytes), high corticosteroids, high aldosterone, plain water enema, NG irrigations, excess hypotonic IV fluids, SIADH, inappropriately prepared formula (dilute formula): >>> causes of FVE (10)
causes an acute metabolic response: acute primary respiratory disturbance
pH is fully corrected (normal): complete compensation
3.5-5 mEq/L: normal potassium
sign of FVE but not seen in kids, make sure know baseline for adults: neck vein distension
releases H+ ions in water: acid
respiratory depression/arrest, inadequate chest expansion, airway obstruction, interference with alveolar capillary exchange: respiratory acidosis causes (4)
normal to high (potassium shift out of cells, rasing levels): FVE, potassium
n/v, anorexia, paralitic ileus (hypokalemia): metabolic alkalosis GI signs (3)
paresthesia, dizzyness, confusion, tetany, convulsion, numb/tingling, light headed, anxiety/panic, Loss of consciousness, hyperactive reflexes: respiratory alkalosos CNS signs (10)
Kussmaul/deep/rapid respirations, trying to blow off CO2: metabolic acidosis resp signs
prevent major acid-base changes; carbonic acid-bicarbonate, protien, and phosphate buffer system: buffers
binds to H+ ions in water: base
hypotension: FVD late sign
pulmonary edema: FVE first sign seen
correct cause, treat ketoacidosis (fluids, insulin), give alkaline fluids, hydrate, mechanical ventilation if needed, possible dialysis: met acidosis mgmnt (6)
causes a respiratory compensation: primary metabolic disturbance
135-145 mEq/L: normal sodium
VS, ABGs, RR/depth, LOC, I&O, ECG: metabolic alkalosis assessment (6)
primary renal component, can be absobed as needed, combines HCl with ammonia to make ammonium, which is easily excreted by kidneys into urine: renal buffering system, bicarbonate
severe, generalized third spacing: anasarca
hyperventilation, sepsis/infection, over ventilation, hepatic cirrhosis: respiratory alkalosis causes (4)
dizzy, nervous, tremors, hyperreflexia, paresthesias, irritability, confusion/apathy/stupor, cramps, tetany, seizures: metabolic alkalosis CNS signs (10)
bicarb: carbonic acid = 20:1: acid-base homeostasis
very low, <125: FVE, sodium
40-50%: normal hematocrit
used to treat metabolic acidosis (ketoacidosis), forces potassium back into cells: insulin
1.002-1.030: normal urine specific gravity
normal to high (is intracellular, if enough cell death --or sodium levels -- could be high): FVD potassium
less oxygen available to bind with Hb: the lower the PaO2 pressure, the ....
excessive hypertonic fluids, binge drinking contest, psych disorders, drowning in fresh water, inappropriate dialysis: >>> excess fluid intake examples
regulatory mechanism to return pH to normal level by transforming acids and bases within the body: compensation
high (hemoconcentration); in children may be low but not pathologic: FVD BUN
*negative logarithm of H+ ion concentration in mEq/L (as H+ ion concentration increases, pH decreases): pH --> *normal values 7.35 -7.45 (less is acidotic, more is alkalotic)
increased pH, increased BE, increased bicarb, decreased anion gap (low K and Na): met alkalosis: labs
n/v, diarrhea, abdominal pain: metabolic acidosis GI signs (3)
rapid shallow breathing (trying to retain CO2, oxygenate), chest tightness: respiratory alkalosis respiratory signs
75-100 mmHg (for every year above 60 drop 1mmHg): PaO2 normal values
7-20 mg/dl: normal BUN
dry mucous membranes, comes later: FVD classic sign
lethargy, weakness: decreased sodium and potassium signs
low CO2, pH high >7.45, bicarb normal if no compensation or decreased if compensation, hypokalemia, hypocalcemia: respiratory alkalosis: labs
hypothalamus: primary mediator of fluids
normal to high (stress response, >120): FVE, glucose
>300, more particles ↑ number of particles, concentration: FVD osmolality (serum)

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