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Hypernatremia
- Na > 145
- Intense thirst
- Restlessness
- Agitation
- Seizure
- Coma
- Weight gain
- Edema
- Elevated BP & CVP
Can be caused by DI, Osmotc diureses and saltwater near drowning.
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Hyponatremia
- Na < 135
- Confusion
- Postural hypotension
- Nausea and vomiting
- Dry mucous membranes
Can be caused by diarrhea, vomiting, diuretics, adrenal insufficiency, burns, weeping wounds
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Hyperkalemia
- > 5.5
- Irritability
- Anxiety
- Abdominal cramping
- Irregular pulse
- Tall peaked T wave
- Widening QRS
- Cardiac irritability
May be caused by acidosis, tissue catabolism, crush injuries, lysis of cells, renal disease, ace inhibitors.
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Hypokalemia
- < 3.5
- Fatigue
- Muscle cramps
- Paresthesia
- Decreased DTR
- Bradycardia
May be caused by GI losses, renal losses, alkalosis, tissue repair, insulin administration, starvation.
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Hypercalcemia
- > 11
- Lethargy weakness
- Confusion, ataxia
- Nephrolithiasis
- Bone fractures
May be caused by multiple myeloma, hyperparathyroidism, vitamin D overdose.
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Hypocalcemia
- < 9
- Hyperreflexia
- Chvosteks sign
- Trousseaus sign
- Laryngeal spasm
- Tetany & seizures
Can be caused by chronic renal failure, elevated phosphorous, primary hypoparathyroidism, acute pancreatitis, chronic alcoholism.
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Hyperphosphatemia
- Acute & chronic renal failure, kidneys unable to excrete phosphate.
- Cancer states where calcium and phoshate bind.
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Hypophosphatemia
Malnourished, malabsorptionsyndromes
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Hypermagnesemia
- Renal failure
- Adrenal insufficiency
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Hypomagnesemia
- Chronic alcoholism
- NG suction
- Prolonged malnutrition
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Isotonic
- No net change.
- Expands only the ECF. (0.9% NS) Ideal fluid replacement for patient with volume deficit.
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Hypotonic
Fluid goes into the cell. (0.45% NS) Expands both compartments. Do not use for fluid resucitation.
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Hypertonic
Fluid is pulled out of the cell. (D10%) Expands ECF by pulling water out of the cells. Unchecked can cause volume overload.
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ABG Interpretation
- First name = Compensated or uncompensated
- Last name = alkalosis or acidosis
- Look at Ph for first and last name (7.35 – 7.45)
- < 7.35 = uncompensated acidosis
- 7.35 to 7.40 = compensated acidosis
- > 7.45 = uncompensated alkalosis
- 7.40 to 7.45 = compensated alkalosis
- Middle name = respiratory or metabolic
- Look at PCO2 and PCO3
- CO2 – respiratory component (Acid) (35-45)
- <35 = respiratory alkalosis
- >45 = respiratory acidosis
- CO3 – metabolic component (Base) (23-26)
- <23 = metabolic acidosis
- >27 = metabolic alkalosis
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