health mod electro and fluid pt 2

Week 3 material

metabolic acidosis

hyperkalemia associated

hypokalemia causes

b2 ag (terbutaline, albuterol), diuretics, amphotericin, gastro losses, low intake, hypomag

hypokal treatment

pills, aldosterone antagonists, iv, magnesium

hyperkal causes

intake, decreased elim, unresponsive to aldosterone, metabolic acidosis, hemolyzed sample

Hyperkal symptoms

Muscle weakness, ecg/arrythmia

hyperkal treatment

1)If arrythmia then cacl/cagluc periph 2)insulin or insulin with dextrose <250 3)albuterol 4)bicarb if acidotic 5)dialysis/resin exchange

hyperkal alternate treatment

loop diuretics with normal renal fxn, lokelma+SPS

hypomagnesium causes (Gi absorb + renal elim)

GI loss, renal disorder, magnesium citrate laxative overuse, diuretics, ampho B, tacrolimus, cyclosporine

hypomag treatment

oral tablets then bolus

hypermag treatment

Ca for arrythmia, bolus, NS preferred unless acidosis,loops, hemodialysis if renal failure. Reduce intake.

Calcium is more bound to albumin when

metabolic alkalosis occurs

hypocal causes

hypopth, vit d deficit, renal fail, hypomag, loops, calcitonin

hypocal symptoms

cramps, seizure, arrythmia, dermatitis, ecg issues

hypocal treatment

Oral cal, vit d, bolus

hypercal symptoms

constipation, n/v, kidney stones, coma, ecg changes (short qt)

hypercal treatment- asymptomatic>12

Bolus(unless hf), IV Loop, IV Calcitonin, IV Glucocorticoids, IV Bisphosphonate

Hypercal treatment-symptomatic ok kidneys

Bolus(unless hf), loop, calcitonin, glucocort

Hypercal treatment-symptomatic bad kidneys

Hemodialysis, calcitonin, glucocort

Hypophos causes

Low Gi absorb (sucralfate, cacarb, sevelamer), Increased excretion (acetazolamide) Redistribution (Insulin, alcohol, ketoacidosis)

Hyperphos causes

Low GFR, sodium phosphate enema, bisphos (-nate), rhabdomyolysis

Base excess

Indicates alkalosis, positive

Acidemia/alkalemia values

<7.35 >7.45

Lungs regulate which component

PaCO2 via ventilation

Kidneys regulate which component

HCO3 via cl excretion, less cl = more basic

Ideal BG values

pH 7.4, pCo2 40±5 HCO3 24±2

Metabolic acid compensatory

40-1.3(24-bicarb)

Metabolic alk compensatory

40-0.6(bicarb-24)

metabolic acid general causes

higher inorganic acid, high acid from renal failure, low bicarb

metabolic acid non-anionic gap causes

diarrhea, cacl, rapid ns

metabolic acid causes anionic gap (mudpiles)

methanol, urea, diabetic ketoacidosis, paraldehyde, isoniazid/ischemia, lactic acid, ethylene glycol, salicylates/starvation

mudpiles lactic acid drugs

metformin, linezolid, propofol, pento/phenobarb, ativan

Plasmalyte, LR, NS, D5W pH

7.4, 6.5, 5.5, 5

Metab acid treatment

Treat disorder, replace body fluid, give bicarb by mouth or bolus, or sodium acetate if good liver

metabolic alk causes (saline responsive)

vomiting, diuretics, too much bicarb, k deficit

metabolic alk causes saline resistant

excess mineralcorticoid, mg deficit, milk-alkali, blood transfusion, estrogen

metabolic alk treatment saline responsive

correct disorder, give NS bolus, 2nd acetazolamide with K, 3rd arginine hcl(good liver/kidney)

metabolic alk treatment saline resist

change mineralcort, give spironolactone, give K

resp acid causes

sedatives, stroke, asthma/copd, brainstem injury

resp alk causes

anxiety, pain, anemia, high altitude