Fluid Balance 3

  1. What is an example of an isotonic fluid loss?
    • Hemorrhage
    • GI losses
    • Wound drainage
    • Duretics
    • Ascites
  2. 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)
  3. 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
  4. 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
  5. 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
  6. What chronic diseases can cause dehydration?
    • Liver disease
    • Renal disease
    • Cancer
    • Diabetes
  7. 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
  8. What can cause a hypotonic fluid excess?
    • Repeated plain water enemas, NGT, or bladder irrigations
    • Overuse of hypotonic IV fluids
    • SIADG
    • Polydypsia
  9. 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
  10. 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
  11. 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)
  12. 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
  13. What is hyponatremia and what causes it?
    Hyponatremia is low blood sodium

    • Caused by
    • Vomiting/diarhea
    • Excessive sweating
    • Low salt intake
  14. What is hypernatremia and what causes it?
    Increased blood sodium levels

    • Caused by
    • Increased intake
    • Fluid restriction
    • Hypovolemia
  15. What are signs/symptoms of hyponatremia?
    hyponatrema- low serum osmolality; water into the cells)

    • Decreased vascular volume
    • Confusion
    • Muscle cramps/weakness
  16. 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
  17. 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)
  18. 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
  19. 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
  20. What is the normal pH of the ECF?
  21. 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)
  22. 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
  23. How does the respiratory control of pH work?
    Increased Co2 and decreased pH stimulate pulmonary ventilation

    Increased pH inhinits pulmonary ventilation
  24. What rids the body of metabolic acids?
    The kidneys
  25. To lower pH, the kidneys _______ bicarbonate and the lungs ______ Co2
    excrete bicarbonate (HCO3-)

    retain Co2
  26. To raise pH, the kidneys _______ bicarbonate and the lungs ______ Co2
    retain bicarbonate

    excrete Co2
  27. 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
  28. 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
  29. 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
  30. 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
Card Set
Fluid Balance 3
Pharm 505