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What is an example of an isotonic fluid loss?
- Hemorrhage
- GI losses
- Wound drainage
- Duretics
- Ascites
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What is an example of hypertonic dehydration
*Hypertonic dehydration is when more fluid is lost than solute)
- Inadequate fluid intake
- Watery diarrhea
- Increased solute intake (salt, sugar, etc)
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What are 3 major causes of third-spacing?
Injury or inflammation: massive trauma, crush injuries, abdominal surgery, etc
Malnutrition or liver dysfunctiom: prevents liver from producing albumin; low capillary oncotic pressure
High vascular hydrostatic pressure: heart/renal failure
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What are signs and symptoms of dehyradtion?
- Thirst
- Concentrated urine and low urine output (high specific gravity; normally 1.010-1.030)
- Dry skin/decreased skin turgor
- Decreased tear production
- Sunken eyeballs
- Decreased CO (tachycardia, hypotension, cool extremeties)
- Mental status changes (irritable, lethargy, confusion)
- Acute weight loss
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What are the diagnostic and lab findings that indicated dehydration?
- Increased BUN/hematocrit
- Increased urine specific gravity (>1.030)
- Increased sodium
- Incresed urine/serum osmolarity
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What chronic diseases can cause dehydration?
- Liver disease
- Renal disease
- Cancer
- Diabetes
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What is the treatment for dehydration?
- Manage the cause (ie. stop N/V)
- Oral replacement therapies
- Parenteral therapy for isotonic fluid losses
- Blood products if significant blood loss/hemorrhage
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What can cause a hypotonic fluid excess?
- Repeated plain water enemas, NGT, or bladder irrigations
- Overuse of hypotonic IV fluids
- SIADG
- Polydypsia
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What are signs/symptoms of fluid volume excess?
- Edema
- S3 heart sound (gallop)
- Tachypnea, cough
- Crackles
- Normal HR, bounding peripheral pulses
- Weight gain > 3lbs within 2-5 days
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What diagnostic/lab findings would be present in a situation with an excess of fluid volume?
- BUN and HCT decreased (hemodilution)
- Serum osmolality low (<275)
- Serum sodium low (<125)
- Arterial blood gases (ABG) low <po2
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How do you treat excess fluid volume?
- Reduce water/salt intake
- Loop diuretics causing K+/Na+ loss (ie. Lasix)
- Treat underlying conditions (ie. organ failure)
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What is the difference between a cation/anion, and what are some major examples of each?
- Cations: position ions
- ie. Na, K, Ca, Mg, H
- Anions: negative ions
- ie. Cl, HCO3
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What is hyponatremia and what causes it?
Hyponatremia is low blood sodium
- Caused by
- Vomiting/diarhea
- Excessive sweating
- Low salt intake
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What is hypernatremia and what causes it?
Increased blood sodium levels
- Caused by
- Increased intake
- Fluid restriction
- Hypovolemia
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What are signs/symptoms of hyponatremia?
hyponatrema- low serum osmolality; water into the cells)
- Decreased vascular volume
- Confusion
- Muscle cramps/weakness
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What are signs/symptoms of hypernatremia?
hypernatremia= high serum osmolality; water out of the cells
- Thirst
- Dry mucus membranes
- Restless, disoriented
- Crackles in the lungs
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What regulates potassium, and what is the normal range of potassium in the blood
Normal= 3.5-5.3 mEq/L
- Regulated by
- Dietary intake
- Renal secretion
- Serum pH (acidosis K+ moves out of the cells)
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What is hypocalcemia, what is it caused by, what are the signs/symptoms, and how do you treat it?
Hypocalemia= serum Ca levels <8.6
- Causes:
- Inhibited Ca absorption from GI tract
- Increased Ca extcretion
- Signs:
- CV, respiratory, neuromuscular, GI, tetany
- Treatment:
- Admin Ca
- Monitor for seizures
- Reduce stimuli
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What is hypercalcemia, what is it caused by, what are the signs/symptoms, and how do you treat it?
Hypercalemia= serum Ca levels >10mg/dL
- Causes:
- Increased Ca absorption/decreased Ca excretion
- Signs:
- GI, kidney stones, bone pain
- Management:
- Discontinue Ca, diuretics
- Admin normal saline
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What is the normal pH of the ECF?
7.35-7.45
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What regulates the amount of H+ ions in the body?
Chemical buffer systems (w/in seconds)
Respiratory system (w/in 1-3 min)
Renal (hours-days)
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What types of acid do the following product?
Aerobic respiration of glucose
Anaerobic respiration of glucose
Incomplete oxidation of fatty acids
Aerobic respiration of glucose= Carbonic acid
Anaerobic respiration of glucose= Lactic acid
Incomplete oxidation of fatty acids= Acidic ketone bodies
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How does the respiratory control of pH work?
Increased Co2 and decreased pH stimulate pulmonary ventilation
Increased pH inhinits pulmonary ventilation
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What rids the body of metabolic acids?
The kidneys
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To lower pH, the kidneys _______ bicarbonate and the lungs ______ Co2
excrete bicarbonate (HCO3-)
retain Co2
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To raise pH, the kidneys _______ bicarbonate and the lungs ______ Co2
retain bicarbonate
excrete Co2
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What happens in respiratory acidosis?
- Hypoventilation causes increased PCo2
- Causes respiratory acidosis
- Respiratory rate increases (decreases Co2)
- Increased H+ generation and bicarb secretion
- Homeostasis restored
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What happens in Resiratory alkalosis?
- Hyperventilation causes decreased Co2
- Respiratory alkalosis
- Inhinition of chemoreceptors
- Decreased respiratory rate (increased CO2)
- Increased H+ generation and bicarb secretion
- Homeostasis
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What happens in Metabolic Acidosis, what causes it, what are the symptoms, and what is the treatment?
Metabolic acidosis= too much H+ produced
Causes: renal failure, DKA, starvation, lactic acidosis, prolonged diarrhea, toxins
Symptoms: Kussmaul's respiration, lethargy, confusion/headache, pH <7.35, bicarb <22
Treatment: treat underlying cause, monitor ABG
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What happens in Metabolic Acidosis, what causes it, what are the symptoms, and what is the treatment?
Metabolic alkalosis: too much bicarbonate
Causes: vomiting, gastric suction, loss of potassium (from steroids, diuresis, antacids overuse)
Symptoms: hypoventilation, dysrhythmias, dizziness, numbness/tingling, pH >7.45, Bicarb >26, hypokalemia/hypocalcemia
Treatment: give potassium, treat underlying cause
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