Term
| Which electrolyte has the greatest effects on cellular osmolality? |
|
Definition
|
|
Term
| What term is defined as the number of particles or osmoles dissolved in a solution? |
|
Definition
|
|
Term
| What is the osmolality gap formula? What difference suggests a hyperosmolar state? |
|
Definition
measured osmolality - calculated osmolality
Osmolality Gap >10gm/dl suggests hyperosmolar state |
|
|
Term
| What is the formula to calculate osmolality? |
|
Definition
| (2 x Serum Na) + (BUN/2.8) + (Glucose/18) |
|
|
Term
| What are the exogenous osmoles? |
|
Definition
|
|
Term
| What effect does aldosterone have on sodium? |
|
Definition
| Increases NA and water retention at the expense of K excretion |
|
|
Term
| What amount of Na is considered hyponatremia, at what level do symptoms present? |
|
Definition
Serum Na < 135mEq/L
Symptoms present at <120mEql/L |
|
|
Term
| Which type of hyponatremic state is described as a decrease in total body sodium because of total body water decrease resulting in a decrease in ECF, which is common in trauma and marathon runners? |
|
Definition
|
|
Term
| Which type of hyponatremic state is described as total body water increases while Na remains normal, and while the ECF increases only minimally but without edema? |
|
Definition
|
|
Term
| Which type of hyponatremic state is described a total body sodium increase with a "huge" total body water increase causing a markedly increased ECF with the presence of edema? |
|
Definition
| Hypervolemic hyponatremic |
|
|
Term
| Which type of hyponatremic state is described as a water shift from the intracellular to the extracellular compartment, with a resultant dilution of sodium, the total body water and serum Na remain unchanged? What does this condition occur with? |
|
Definition
| Redistributive hyponatremia; Occurs with hyperglycemia or administration of mannitol |
|
|
Term
| Which type of hyponatremic state is described as a dilution of the aqueous phase by excessive proteins or lipids, where the total body water and Na stay unchanged? What conditions does this state commonly occur with? |
|
Definition
| Pseudohyponatremia; Occurs with hypertriglyceridemia and MM - common with tumors |
|
|
Term
| In which hyponatremic state can edema but seen? |
|
Definition
| Hypervolemic hyponatremia |
|
|
Term
| Which type of Hypovolemic state does SIADH cause? |
|
Definition
|
|
Term
| Which type of hyponatremic state is caused by trauma or marathon runners? |
|
Definition
|
|
Term
| Which type of hyponatremic state is caused by hyperglycemia or mannitol administration? |
|
Definition
| Redistributive hyponatremia |
|
|
Term
| Which type of hyponatremic state is caused by MM or hypertriglyceridemia? |
|
Definition
|
|
Term
| What type of urine is seen with SIADH? |
|
Definition
| Concentrated or hyperosmolar urine |
|
|
Term
| Which drugs can lead to SIADH? |
|
Definition
| Ectasy, Narcotics, SSRIs, Lithium, Cytoxan, |
|
|
Term
| Which condition causes a non-osmotic release or enhancement of ADH action leading to pathologic H2O retention and Hponatremia? |
|
Definition
|
|
Term
| Which condition is characterized by adequate levels of circulating ADH, but collective tube unresponsiveness to ADH leading to excessive renal H2O losses and hypernatremia? |
|
Definition
|
|
Term
| Which condition is described as absence or deficiency of ADH from the posterior pituitary which leads to the inability of the kidney to concentrate the urine causing excessive renal H2O loss and hypernatremia? |
|
Definition
|
|
Term
| Which electrolytes do thiazide diuretics effect? |
|
Definition
| increase excretion of Na and K |
|
|
Term
| What affect does aldosterone deficiency have on electrolytes? |
|
Definition
| increase Na and water loss |
|
|
Term
| What does K depletion in cells cause? |
|
Definition
|
|
Term
| What type of hyponatremic state does CHF cause? |
|
Definition
|
|
Term
| What type of hyponatremic state does nephrotic syndrome cause? |
|
Definition
|
|
Term
| Which type of hyponatremic state is caused by renal failure? |
|
Definition
|
|
Term
| At what level of serum Na is hypernatremia considered? |
|
Definition
|
|
Term
| What are the sx of hypernatremia? |
|
Definition
| Tremors, Irritability, Ataxia (loss of coordinated movement) |
|
|
Term
| What is the major defense against the development of hypernatremia? |
|
Definition
|
|
Term
| What is the MCC of hypernatremia? |
|
Definition
| hypovolemic hypernatremia |
|
|
Term
| What type of hypernatremic state is caused by dehydration? |
|
Definition
| hypovolemic Hypernatremia |
|
|
Term
| What type of hypernatremic state is caused by profuse sweating? |
|
Definition
| hypovolemic hypernatremic |
|
|
Term
| What type of hypernatremic state is caused by Vomiting or diarrhea? |
|
Definition
| Hypovolemic hypernatremic |
|
|
Term
| Based on the Na imbalances, how are DI and DM differentiated? |
|
Definition
DI - hypernatremia (water diuresis)
DM - hyponatremia (solute diuresis) |
|
|
Term
| What type of Na imbalance is caused by skin/lung losses? |
|
Definition
| Normovolemic Hypernatremia |
|
|
Term
| What type of Na imbalance is caused by Cushing's syndrome? |
|
Definition
| Hypervolemic Hypernatrenmia |
|
|
Term
| What type of Na imbalance does Hyperaldosteronism cause? |
|
Definition
| Hypervolemic Hypernatremic |
|
|
Term
| Which electrolyte functions to increase neuromuscular excitability, causes contraction of the heart, helps maintain intracellular fluid volume and is important in H ion exchange? |
|
Definition
|
|
Term
|
Definition
Kidneys (Proximal tubule - in notes)
(Aldosterone works on the Principal cells in the Collecting duct which regulate K as well - not in notes) |
|
|
Term
| What is considered to be a low serum K? |
|
Definition
|
|
Term
| What is the MC cause of hypokalemia? |
|
Definition
|
|
Term
| What effect does hyperaldosterone have on K concentration? |
|
Definition
|
|
Term
| What effect does hypomagnesemia have on K concentration? Explain. |
|
Definition
| Causes hypokalemia - diminishes Na-K ATPase and enhances aldosterone secretion |
|
|
Term
| What effect does alkalosis have on K concentration? |
|
Definition
|
|
Term
| What effect does insulin have on K concentration? |
|
Definition
|
|
Term
| At what levels of serum K is hyperkalemia determined? |
|
Definition
|
|
Term
| What effect does acidosis have on K concetration? |
|
Definition
|
|
Term
| What effect does insulin deficiency have on K concentration? |
|
Definition
|
|
Term
| What effect do ACE Inhibitors have on K concentration? |
|
Definition
|
|
Term
| What effect does spirinolactone have on K concentration? |
|
Definition
| Spirinolactone is a K sparing diuretic, so it can lead to hyperkalemia |
|
|
Term
| What effect does hypoaldosteronism have on K concentration? |
|
Definition
|
|
Term
| If a pt presents with muscle weakness, cardiac arrhythmias/arrest (with peaked T waves on EKG), what electrolyte imbalance do you suspect? |
|
Definition
|
|
Term
| What does excess sweating stimulate and what are its effects? |
|
Definition
| Stimulate aldosterone and causes conservation of NA and Cl |
|
|
Term
| What electrolyte imbalance is usually found with hypernatremia? |
|
Definition
|
|
Term
| What effects does dehydration have on Cl concentration? |
|
Definition
|
|
Term
| What effect does hyperventilation (respiratory alkalosis) have on Cl concentration? |
|
Definition
|
|
Term
| What effect does diarrhea (metabolic acidosis) have on Cl concentrations? |
|
Definition
|
|
Term
| What effect does renal tubular acidosis (failure to reclaim HCO3) have on Cl concentration? |
|
Definition
|
|
Term
| What electrolyte imbalance is found in parallel with hyponatremia? |
|
Definition
|
|
Term
| What effect does prolonged vomiting have on Cl concentrations? |
|
Definition
|
|
Term
| What effect does metabolic alkalosis have on Cl concentrations? |
|
Definition
|
|
Term
| What effect does pyelonephritis have on Na and Cl concentrations? |
|
Definition
| Causes loss of both Na and Cl, leading to hypochloremia and hyponatremia |
|
|
Term
| What is the formula for Anion Gap? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What gives you a low anion gap? |
|
Definition
|
|
Term
| What can cause elevated anion gap? |
|
Definition
M - Methanol ingestion
U - Uremia
D - Diabetic Ketoacidosis
P - Paraldehyde or Phosphate
I - Iron, Isoniazid, Ischemia
L - Lactic Acidosis
E - Ethanol & Ethylene glycol
S - Salicylate & Starvation |
|
|
Term
| What are the normal Na values? |
|
Definition
|
|
Term
| What are the normal potassium values? |
|
Definition
|
|
Term
| What are the normal Cl levels? |
|
Definition
|
|
Term
| What are the normal Bicarb levels? |
|
Definition
|
|
Term
| What is the normal anion gap? |
|
Definition
|
|
Term
| What are the Na and Cl levels in Isotonic fluid? What are the two types of isotonic fluids? |
|
Definition
Na = 154
Cl = 154
Normal Saline and Lactate Ringers |
|
|
Term
| What is the % concentration of Hypotonic IV fluids? What is the amount of Na and Cl? What is it called? |
|
Definition
% = .45%
Na = 77
Cl = 77
1/2 Normal Saline |
|
|
Term
|
Definition
| Glucose with free water (no osmolality) |
|
|
Term
| What is the % saline for hypertonic solution? What is it used for? How much Na is in it? |
|
Definition
3%
Used for Symptomatic hyponatremia
Na = 513 |
|
|
Term
| Which IV solution has tonicities close to that of plasma? |
|
Definition
| Normal Saline and Ringer's Lactate |
|
|
Term
| What amount of glucose is contained in D5 Saline or D5 Ringer's lactate? |
|
Definition
|
|
Term
| Which IV fluid is best for Shock, Hemorrhage or Burns? |
|
Definition
| Normal Saline (or Ringer's Lactate) |
|
|
Term
| If given with blood transfusions, what can hypotonic fluids cause? |
|
Definition
|
|
Term
| Which IV solution is used to expand ECFV in a hypertonic pt? |
|
Definition
|
|
Term
| What IV solutions might be used to treat severe hyperglycemia? |
|
Definition
|
|
Term
| Can pure H2O be giving via IV? Why or Why not? |
|
Definition
| NO, b/c it causes hemolysis |
|
|
Term
| Which type of IV solution might be used to deliver meds in a non-diabetic pt? |
|
Definition
|
|
Term
| Which IV solution is used in states of ECFV overload during a KVO (Keep Vein Open)? |
|
Definition
|
|
Term
| Why should potassium IV be used cautiously? |
|
Definition
| Dangerous due to risk of Acute Hyperkalemia |
|
|
Term
| How many meqv can you add of K per liter? Why? |
|
Definition
| no more than 20 meqv, K is irritating to veins |
|
|
Term
|
Definition
Profound, life threatening hypokalemia
Used if oral K can't be tolerated |
|
|
Term
| What is the monitoring needed for a pt on IV fluids? |
|
Definition
- Daily weights
- Strict I & O's
- Electrolytes
- BUN/Cr |
|
|
Term
| What conditions can significantly increase your daily H2O requirements? |
|
Definition
Fever
Mechanical Ventilation
GI Loss |
|
|
Term
| What is the amount of H2O loss due to fever, for each degree fahrenheit? |
|
Definition
| 60 - 80 ml/24 hours for each degree fahrenheit |
|
|
Term
| What is the normal daily requirement for H2O per day? |
|
Definition
|
|
Term
| How many cc of H2O are lost per day in the urine? |
|
Definition
|
|
Term
| How many cc of H2O are lost per day in the lungs, skin and stool? |
|
Definition
|
|
Term
| What can administration of saline solutions w/out K supplementation result in? |
|
Definition
| Can result in hypokalemia b/c INCREASED DISTAL DELIVERY OF NA+ AND INCREASED SODIUM - POTASSIUM EXCHANGE LEADING TO LOSS OF K IN URINE |
|
|
Term
| Because of their relationship, what will an increase in PCO2 cause with H concentration? |
|
Definition
|
|
Term
| Because of their relationship, what will an decrease in PCO2 cause with H concentration? |
|
Definition
|
|
Term
| Because of their relationship, what will an increase in HCO3 cause with H concentration? |
|
Definition
| Inversely related so H will decrease |
|
|
Term
| Because of their relationship, what will an decrease in HCO3 cause with H concentration? |
|
Definition
| Because the are inversely related H will increase |
|
|
Term
| What is the normal serum pH? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What is the normal PHCO3? |
|
Definition
|
|
Term
| What is high CO2 considered? What is it caused by? |
|
Definition
| Respiratory acidosis; Hypoventilation |
|
|
Term
| What is low CO2 considered? What is it caused by? |
|
Definition
| Respiratory alkalosis; Hyperventilation |
|
|
Term
| What is low HCO3 considered? |
|
Definition
|
|
Term
| What is high HCO3 considered? |
|
Definition
|
|
Term
| What are Disorders that are either metabolic or respiratory called? |
|
Definition
| simple acid/base disorders |
|
|
Term
| What are more than one acid base disturbance present called? |
|
Definition
| Mixed acid base disorders |
|
|
Term
| What is the formula for determining appropriate compensation in Metabolic Acidosis? |
|
Definition
Winter's formula =
[1.5 x (HC3) + 8] (+/- 2) |
|
|
Term
| What is the formula for determining expected level of compensation for metabolic alkalosis? |
|
Definition
PCO2 =
[(0.9 x (HCO3) + 16)] +/-2 |
|
|
Term
| In acute respiratory acidosis, what is the expected change in HCO3 for every 10mm PCO2? |
|
Definition
| 1mEq/L change in HCO3 for every 10 mm PCO2 |
|
|
Term
| In chronic respiratory acidosis, what is the expected change in HCO3 for every 10mm PCO2? |
|
Definition
| 3.5mEq/L change in HCO3 for every 10mmHg change in PCO2 |
|
|
Term
| In acute respiratory alkalosis, what is the expected change in HCO3 for every 10mm PCO2? |
|
Definition
| 2mEq/L change in HCO3 for every 10mmHg change in PCO2 |
|
|
Term
| In chronic respiratory alkalosis, what is the expected change in HCO3 for every 10mm PCO2? |
|
Definition
| 4mEq/L change in HCO3 for every 10mmHg change in PCO2 |
|
|
Term
| What are the major UNmeasured cations, not accounted for in anion gap? |
|
Definition
| calcium, magnesium, gamma globulins and potassium |
|
|
Term
| What is the major UNmeasured anions, not accounted for in the anion gap formula? |
|
Definition
| negatively charged plasma proteins (albumin), sulphate, phosphates, lactate and other organic anions |
|
|
Term
| In which condition does the anion gap need to be adjusted downward due to a higher level of anions present in the condition? What is the correction amount? |
|
Definition
| hypoalbuminemia; For every 1 g decline in albumin (4g is normal) you must decrease the anion gap normal by 2.5 |
|
|
Term
| What is chronic respiratory acidosis commonly caused by? What type of increase in CO2 can you see with this d/o? |
|
Definition
| COPD; CO2 can increase to 90 - 110 without a severe reduction in pH |
|
|
Term
| What will you see in a simple acid/base disorder? What is suspect of a mixed d/o? |
|
Definition
HCO3 and PCO2 will both increase together or decrease together in a simple d/o.
If the HCO3 and the CO2 have an inversely proportional change (one increases while the other decreases) then expect a mixed d/o |
|
|
Term
| What type of acid/base d/o does hyperventilation lead to? |
|
Definition
|
|
Term
| What type of acid/base d/o does diarrhea cause? |
|
Definition
|
|
Term
| What type of acid/base d/o does excessive vomiting cause? |
|
Definition
|
|
Term
| What type of acid/base d/o do diuretics cause? |
|
Definition
|
|
Term
| Which type of acid/base d/o might a brainstem injury cause? |
|
Definition
|
|
