BMS 561 - Ion Imbalance

what is the normal range for sodium

135-145

what is the normal range for chloride

98-108

what is the normal range for potassium

3.5-5

what is the normal range for calcium

4-5

what is the normal range for phosphorus

2.5-4.5

what is the normal range for magnesium

1.8-2.4

what roles does calcium play in the body

blood clotting, hormone secretion, receptor functions, nerve transmission, and muscular contraction
- has inverse relationship with phosphorus
- has synergistic relationship with magnesium

what is the main source of calcium

dietary intake
vitamin d aids in absorption

what regulates calcium release

vitamin k, parathyroid hormone, calcitonin
excreted through gi tract

what are the causes of hypercalcemia

inc intake or release: calcium antacids, calcium supplements, cancer, immobilization, corticosteroids, vitamin d deficiency, hypophosphatemia
deficit excretion: renal failure, thiazide diuretics, hyperparathyroidism

what are the manifestations of hypercalcemia

CV: dysrhythmias and ECG changes (excess calcium can delay repolarization and prolong the period of time the cell can be restimulated)
neural
gi: anorexia, nausea and vomiting due to neural effects
urinary: renal calculi, polyuria, dehydration

what are the treatments for hypercalcemia

manage symptoms, phosphate (stimulate ca abs), inc mobility, calcitonin, IV fluid (dilution), diuretics

what accounts for 90% of hypercalcemia cases

primary hyperthyroidism and cancer

what are the causes of hypocalcemia

excessive losses: hypoparathyroidism, renal failure, hyperphosphatemia, alkalosis, pancreatitis, laxatives, meds
deficient intake: dec dietary intake, alcoholism, abs decreases, hypoalbuminemia

what are the manifestations of hypocalcemia

CV: dysrhythmias and ECG changes
blood: inc bleeding tendencies
neural
muscular: tremors and muscle spasms
gi: inc bowel sounds and abdominal cramping
positive trousseau’s and chvostek’s signs

what is the treatment for hypocalcemia

calcium replacement, vitamin d, dec phosphorus

describe magnesium

intracellular cation
difficult to detect insufficiency
stored in bone and muscle
dietary intake is the main source
excreted through kidneys

what is the function of magnesium in the body

muscle and nerve function, cardiac rhythm, immune function, bone strength, blood glucose management, blood pressure, energy metabolism, protein synthesis

what is magnesium’s role in the heart

stabilizes rhythm
calcium homeostasis
prolongs pr and qrs intervals
shortens qt interval (torsades de pointes)

what is magnesiums role in the endocrine system

req for PTH release

describe hypermagnesemia

causes: renal failure, excessive laxative and antacid use
manifestations: similar to hypercalcemia
diagnosis: history, physical exam, blood chemistry
treatment: diuretics, dialysis, and IV calcium

describe hypomagnesemia

causes: inadequate intake, chronic alcoholism, malnutrition, pregnancy, diarrhea, diuretics, stress
manifestation: inc in cardiac instabilities, intracellular hypokalemia, blocks PTH secretion independent of calcium levels

how much water is in the body

60% of body weight
intracellular = 2/3
extracellular = 1/3

what are the hypothalamic osmoreceptors

ADH = handles osmolarity or water movement
Aldosterone = handles pressure in kidneys or sodium movement (water follows)

describe diuretics

promote fluid excretion = inc renal sodium abs
acts at the thick ascending loop
thiazide like: acts at distal convoluted tubule
- blocks na/cl symport
- inc k loss and uric acid and ca retention
aldosterone antagonists: act at last distal convoluted tubule

what can hypovolemia cause

hemorrhage and dehydration

what can hypervolemia cause

water intoxication
edema

what are the causes of cirrhosis

not caused by trauma to liver or acute causes
caused by years of chronic injury
- altered blood flow in liver = inc hydrostatic pressure → portal hypertension → ischemia and necrosis/hepatocyte damage

describe the cirrhosis cause - alcohol related liver disease

heavy alcohol use can cause chronic liver injury
more deaths than any other cause

describe the cirrhosis cause - chronic hepatitis C

liver infection spread by contact with blood
causes injury and inflammation

describe the cirrhosis cause - chronic hepatitis B and D

liver infection spread by contact with body fluids
causes injury and inflammation
hep D only infects people who already have hep B

describe the cirrhosis cause - nonalcoholic fatty liver disease

fat builds up in the liver
associated with obesity, diabetes, protein malnutrition, CAD, corticosteroid meds

describe the cirrhosis cause - autoimmune hepatitis

about 70 percent female

describe the cirrhosis cause - disease that damage or destroy bile ducts

causes bile to back up in the liver
most common condition is primary biliary cirrhosis
- bile ducts become inflamed and disappear

describe the cirrhosis cause - inherited diseases

CF, alpha-1 antitrypsin deficiency, hemochromatosis, glycogen storage diseases

what are the manifestations of cirrhosis

ascites: buildup of fluid in abdomen
- inc hydrostatic pressure, dec colloid osmotic pressure, inc capillary permeability
- can put pressure on vena cava which inhibits blood return

what is the treatment for ascites of cirrhosis

paracentesis or diuresis

what are the causes of dehydration

dec fluid intake, inc fluid output, fluid shift between compartments

describe isonatremia

most common form of dehydration
water and na lost in equal proportions
cause: fluid loss from extracellular space
manifestations: dry mucus membranes, red skin turgor, tachycardia, red urine output
treatment: rapid infusion of isotonic saline

describe hyponatremia

absolute or relative na loss
causes: vomiting, diarrhea, sweating with water replacement
fluid shifts from vascular to intracellular compartment
treatment: restore blood volume, stop movement of water into cells, rapid correction can cause neurological issues

describe hypernatremia

absolute or relative water depletion
causes: diabetes insipidus, T1DM, diarrhea
excess sodium intake
manifestations: thirst, lethargy, brain shrinkage
treatment: slow correction to prevent cerebral edema, initial fluid replacement with 0.9% saline then hypotonic solutions