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Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
Acid-Base, Fluids and Electrolytes
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Acid-Base, Fluids and Electrolytes

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  • 1.  Fluid and Electrolytes  At the end of this lecture, we will be able to:  Discuss the importance of homeostasis.  Enumerate and discuss the importance of laboratory assessment of fluid and electrolyte balance.  Interpret laboratory results of fluids and electrolytes.  correlate clinically
  • 2.  Acid-Base Balance  Discuss the control of pH in the blood with emphasis on the role of lungs/kidneys  Enumerate and discuss the four major possible abnormalities of acid-base balance  Metabolic vs Respiratory  Acidosis vs Alkalosis  Compensated vs Uncompensated  Correlate clinically
  • 3.  A delicate balance of fluids, electrolytes, acids and bases is required to maintain good health.  This balance is called Homeostasis.
  • 4.  Intracellular fluid (ICF) found within the cells of the body  constitutes 2/3 of total body fluid in adults  major cation is potassium   Extracellular fluid (ECF) found outside the cells  accounts of 1/3 of total body fluid  major cation is sodium 
  • 5.  Osmosis   Solutes   movement of water across cell membranes from less concentrated to more concentrated substances dissolved in a liquid Osmolality  the concentration within a fluid
  • 6.  Diffusion   Filtration   movement of molecules in liquids from an area of higher concentration to lower concentration fluid and solutes move together across a membrane from area of higher pressure to one of lower pressure Active Transport  substance moves across cell membranes from less concentrated solution to more concentrated requires a carrier and energy.
  • 7.    Urine Insensible fluid loss Feces
  • 8.     Sodium Potassium Chloride Phosphate    Magnesium Calcium Bicarbonate Electrolytes are important for: Maintaining fluid balance Contributing to acid-base regulation Facilitating enzyme reactions Transmitting neuromuscular reactions
  • 9.   Sodium (Na) NV 135-145 mEq/L Potassium (K) NV 3.5 – 5.5 mEq/L Ion-selective electrodes most common method  Atomic absorption spectroscopy reference method   Osmolality NV 275-300mOsm/kg H2O  Freezing point depression, most common method (serum or urine)
  • 10.   Hypernatremia Conditions causing dehydration and absolute Na excess Hyponatremia Conditions causing loss of Na and increase in body water (dilutional)
  • 11.   Hyperkalemia  Conditions causing absolute increase in body K and extracellular shift of K Hypokalemia  Conditions causing loss of K, decreased K intake, and intracellular shift of K
  • 12.  Hyperosmolality (osmolal gap)  Normal: dehydration, high Na, azotemia, DI  Moderately elevated: Ketoacidosis, Renal and lactic acidosis  Markedly elevated: alcohol ingestion and poisoning of selected substances
  • 13.  Water Distribution  60% of BW  60% ICF and 33% ECF  8% in plasma  freely permeable  Na, K, glucose, urea and protein  balance between intake and body loss
  • 14.  Sodium Distribution major EC cation 135 to 145 mmol/L relatively impermeable leakage is actively pump out by Na-K ATPase balance intake and loss excessive intake contributes to hypertension massive internal turnover
  • 15.  Potassium Distribution major IC cation constant tendency to diffuse down its concentration gradient opposed by Na-K ATPase EC concentration is accessible for measurement
  • 16. Changes in H2O content independent of the amount of solute will alter osmolality  Water Loss  movement from ICF to ECF  stimulation of ADH secretion  stimulates thirst center  ECF volume is directly dependent upon the total sodium content  Sodium Balance: regulated by its renal excretion (GFR, aldosterone); atrial natriuretic hormone and natriuretic factor (cardiac glycosides) which acts against Na-K ATPase 
  • 17.  Abnormalities:  Combined Water and Sodium Depletion  Pure Water Depletion  Pure Sodium Depletion (Hyponatremia)  Combined Water and Sodium Excess  Pure Water Excess  Pure Sodium Excess (Hypernatremia)
  • 18.  Hypotonic fluid loss  thirst, dryness of mouth, difficulty of swallowing, weakness, confusion  weight loss, dry mucous membrane, decreased saliva secretion, loss of skin turgor, decreased urine volume  Causes:  Increased Loss: renal, GIT, lungs, skin  Decreased Intake
  • 19. Isotonic or hypotonic fluid loss  hypertonic loss (excessive sweating)  corresponding decrease in ECF  response: aldosterone, inc. reabsorption, low GFR  increased Hct and plasma protein  reduced ECF volume  peripheral circulatory failure  plasma Na concentration  isotonic loss = decreased  hypotonic loss = increased  Causes: Excessive Loss or Inadequate Intake 
  • 20. Failure of normal excretion Excessive intake (iatrogenic)
  • 21. Impairment of water excretion hyponatremia load is shared by ICF and ECF cerebral over-hydration causes: increased intake and decreased excretion
  • 22. Peripheral edema, dyspnea, pulmonary edema, venous congestion, HPN, effusions, weight gain Causes: Increased Intake, Decreased Excretion mostly has paradoxical hyponatremia due to defect in free water excretion
  • 23.    Plasma Na is dependent upon relative amounts of Na and water in the plasma Indications for serum Na determination:  dehydration or excessive fluid loss - as a guide to appropriate replacement  on parenteral fluid replacement who are unable to indicate or respond to thirst  with unexplained confusion, abnormal behavior or signs of CNS irritability Correlated with clinical observations
  • 24.    Balance is controlled by kidneys and GIT related to Hydrogen Ions Kidney: complete reabsorption and active secretion  amount of Na for reabsorption  relative availability of K and H  ability to secrete H  aldosterone concentration  rate of flow of tubular fluid
  • 25.   GIT: secreted in gastric juice, reabsorb in the SI, secreted in LI in exchange of Na movement between ECF and ICF  influence of insulin  integrity of cell membranes  Na-K ATPase  H ion concentration
  • 26.       Output exceeds intake inadequate intake is rarely the sole cause increased loss drug therapy redistribution in the ECF and ICF asymptomatic, neuromuscular disturbance, cardiac, renal (impaired concentration), metabolic alkalosis
  • 27.      Excessive intake if excretion is decreased iatrogenic and parenteral decreased excretion redistribution of ECF and ICF spurious (hemolysis, delayed separation, contamination)
  • 28.   Hypokalemia  low ST wave  T depression/inversion  prolonged PR interval  prominent U wave Hyperkalemia  peaking of T waves  loss of P waves  abnormal QRS complexes  ventricular fibrillation
  • 29.  Acid-Base balance is: the regulation of HYDROGEN ions. 
  • 30.      The acidity or alkalinity of a solution is measured as pH. The more acidic a solution, the lower the pH. The more alkaline a solution , the higher the pH. Water has a pH of 7 and is neutral. The pH of arterial blood is normally between 7.35 and 7.45
  • 31.  The more Hydrogen ions, the more acidic the solution and the LOWER the pH  The lower Hydrogen concentration, the more alkaline the solution and the HIGHER the pH
  • 32.  Know what is normal.
  • 33.  Regulate pH by binding or releasing Hydrogen  Most important buffer system:  Bicarbonate-Carbonic Acid Buffer System  (Blood Buffer systems act instantaneously and thus constitute the body’s first line of defense against acidbase imbalance)
  • 34.  Lungs  help regulate acid-base balance by eliminating or retaining carbon dioxide  pH may be regulated by altering the rate and depth of respirations  changes in pH are rapid,  occurring within minutes  normal CO2 level  35 to 45 mm Hg
  • 35.  Kidneys  the long-term regulator of acid-base balance  slower to respond  may take hours or days to correct pH  kidneys maintain balance by excreting or conserving bicarbonate and hydrogen ions  normal bicarbonate level  22 to 26 mEq/L.
  • 36.     Age  especially infants and the elderly Gender and Body Size  amount of fat Environmental Temperature Lifestyle  stress
  • 37.     Respiratory Acidosis Respiratory Alkalosis Metabolic Acidosis Metabolic Alkalosis
  • 38.  Mechanism  Hypoventilation or Excess CO2 Production  Etiology  COPD  Neuromuscular Disease  Respiratory Center Depression  Late ARDS  Inadequate mechanical ventilation  Sepsis or Burns  Excess carbohydrate intake
  • 39.   Symptoms  Dyspnea, Disorientation or coma  Dysrhythmias  pH < 7.35, PaCO2 > 45mm Hg  Hyperkalemia or Hypoxemia Treatment  Treat underlying cause  Support ventilation  Correct electrolyte imbalance  IV Sodium Bicarb
  • 40.  Risk Factors and etiology  Hyperventilation due to  extreme anxiety, stress, or pain  elevated body temperature  overventilation with ventilator  hypoxia  salicylate overdose  hypoxemia (emphysema or pneumonia)  CNS trauma or tumor
  • 41.  Symptoms  Tachypnea or Hyperpnea  Complaints of SOB, chest pain  Light-headedness, syncope, coma, seizures  Numbness and tingling of extremities  Difficult concentrating, tremors, blurred vision  Weakness, paresthesias, tetany  Lab findings  pH above 7.45  CO2 less than 35
  • 42.  Treatment  Monitor VS and ABGs  Treat underlying disease  Assist client to breathe more slowly  Help client breathe in a paper bag  or apply rebreather mask  Sedation
  • 43.  Risk Factors/Etiology  Conditions that increase acids in the blood  Renal Failure  DKA  Starvation  Lactic acidosis  Prolonged  Toxins diarrhea (antifreeze or aspirin)  Carbonic anhydrase inhibitors - Diamox
  • 44.   Symptoms  Kussmaul’s respiration  Lethargy, confusion, headache, weakness  Nausea and Vomiting  Lab:  pH below 7.35  Bicarb less than 22 Treatment  treat underlying cause  monitor ABG, I&O, VS, LOC, NaHCO3
  • 45.  Risk Factors/Etiology  Acid loss due to  vomiting  gastric suction  Loss of potassium due to  steroids  diuresis  Antacids (overuse of)
  • 46.   Symptoms  Hypoventilation (compensatory)  Dysrhythmias, dizziness  Paresthesia, numbness, tingling of extremities  Hypertonic muscles, tetany  Lab: pH above 7.45, Bicarb above 26  CO2 normal or increased w/comp  Hypokalmia, Hypocalcemia Treatment  I&O, VS, LOC  give potassium  treat underlying cause
  • 47.  1. Look at the pH  is the primary problem acidosis (low) or alkalosis (high)  2. Check the CO2 (respiratory indicator)  is it less than 35 (alkalosis) or more than 45 (acidosis)  3. Check the HCO3 (metabolic indicator)  is it less than 22 (acidosis) or more than 26 (alkalosis)  4. Which is primary disorder (Respiratory or Metabolic)?  If the pH is low (acidosis), then look to see if CO2 or HCO3 is acidosis (which ever is acidosis will be primary).  If the pH is high (alkalosis), then look to see if CO2 or HCO3 is alkalosis (which ever is alkalosis is the primary).  The one that matches the pH (acidosis or alkalosis), is the primary disorder.
  • 48.  The Respiratory system and Renal systems compensate for each other  attempt  ABG’s show that compensation is present when  the   to return the pH to normal pH returns to normal or near normal If the nonprimary system is in the normal range (CO2 35 to 45) (HCO3 22-26), then that system is not compensating for the primary. For example:  In respiratory acidosis (pH<7.35, CO2>45), if the HCO3 is >26, then the kidneys are compensating by retaining bicarbonate.  If HCO3 is normal, then not compensating.
  • 49. THE END

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