Fluid, Electrolyte, and Acid-Base Regulation

calcium

9-10.5 mg/dL

Circulating calcium within the blood that is not attached to proteins.

potassium

3.5-5 mEq/L

electrolyte for nerve and muscle function, especially for the heart

magnesium

1.3-2.1 mEq/L

Electrolyte that helps with regulation of nerve and muscle function, blood pressure, and blood sugar levels, and making DNA, protein, and bone.

- has long half-life

sodium

136-145 mEq/L

Electrolyte that supports the function of nerves and muscles, maintains normal blood pressure, and regulates fluid balance in the body.

Basic Metabolic Panel (BMP)

- BUN Blood Urea Nitrogen

- CO2 Carbon Dioxide

- CR Creatinine

- glucose

- Cl-- Chloride

- K+ Potassium

- Na+ Sodium

- Ca+ Calcium

Comprehensive Metabolic Panel (CMP)

BMP + Liver enzymes, ALT, ALP, AST, Bilirubin, Protein, Albumin

- BUN Blood Urea Nitrogen

- CO2 Carbon Dioxide

- CR Creatinine

- glucose

- Cl-- Chloride

- K+ Potassium

- Na+ Sodium

- Ca+ Calcium

- Liver enzymes

- ALP Alkaline phosphate

- ALT Alanine transminase

- AST Aspartate aminotransferare

- Bilirubin (total)

- Protein (total)

- Albumin

BUN Indication

kidney function

CO2 indications

Blood bicarbonate level

CR Indication

Kidney function

Glucose Indication

Blood sugar level

Cl-- indication

Blood chloride level

K+ indication

blood potassium level

Na+ Indication

Blood Sodium Level

Ca+ Indication

Liver function

Liver enzymes (ALP, ALT, AST) Indication

Liver function

Bilirubin total Indication

Liver function

Protein total Indication

Total Blood Protein

Albumin Indication

Liver function

Tachycardia

heart rate above expected reference range (greater than 100 bpm)

tachypnea

respiratory rate greater than expected range (greater than 20 breaths per minute)

kidneys

organs that filter the blood and excrete waste as urine

dehydration

excess water loss without a loss of sodium

hypovolemia

decrease in blood volume due to body fluid or blood loss

Antidiuretic hormone (ADH)/vasopressin

A hormone excreted by the hypothalamus in the brain that maintains blood pressure and fluid volume.

hypokalemia

potassium level below expected reference range of 3.5 to 5 mEq/L

caused by:

- meds

- certain cardiac conditions

- GI losses

- metabolic alkalosis

- decreased oral intake of K+

- excessive alcohol use

- chronic kidney disease

- DKA

- excessive sweating

- folic acid deficiency

diuretics

a category of meds that cause increased urination

common manifestations of hypokalemia less than 3 mEq/L

- muscle weakness

- cardiac arrhythmias

- constipation

- fatigue

- paralytic ileus (obstruction in intestine)

- hypotension

- tetany

- rhabdomyolysis (muscle tissue breakdown)

- life threatening cardiac arrhythmias

common manifestations of hypokalemia less than 2.5 mEq/L

- muscle weakness

- cardiac arrhythmias

- constipation

- fatigue

- respiratory paralysis/failure

hyperkalemia

K+ level above expected reference range of 5 mEq/L

causes:

- renal failure

- dehydration

- diabetes mellitus

- medications

- trauma

- excess intake of K+

- burns

- transfusions of packed RBCs

- acidosis

- sepsis

hyponatremia

sodium level below expected ref range of 136 mEq/L

risk factors:

- meds

- chronic or severe vomiting/diarrhea

- drinking excess amounts of water

- excess alcohol intake

- heart, kidney and liver problems

- severe burns

hypernatremia

sodium level above expected ref range of 145 mEq/L

causes:

- loss of body water

- meds

- gastroenteritis

- vomiting

- prolonged suction

- burns

- excessive sweating

- chronic kidney disease

- diabetes

- impaired thirst response

Hypocalcemia causes

calcium level below expected ref range of 9

causes:

- meds that decrease the body's absorption of calcium

- inadequate amount of vitamin D

- hormonal changes (menopause)

- hypoparathyroidism

- renal disease

- multiple blood transfusions

- electrolyte imbalances of magnesium or phosphate

- sepsis

- low albumin levels

hypoparathyroidism

body produces low levels of PTH (Hormone secreted by the parathyroid gland that regulates serum calcium concentration)

ostopenia

low bone mass

hyperparathyroidism

overactive parathyroid gland

chvostek sign

Test which may indicate low calcium or magnesium levels. A positive result results in a twitching response of the side of the face when facial nerves are tapped.

trousseau sign

Test that can indicate low calcium or magnesium levels and spasms in the wrist and hand (carpopedal spasms) when a blood pressure cuff is inflated above the systolic blood pressure.

hypercalcemia

Calcium level above expected reference range of 9 to 10.5 mg/dL (total calcium).

causes:

- cancer

- hyperparathyroidism

- vitamin D toxicity

- meds

- renal failure

Manifestations of hyper calcemia mnemonic: Abdominal groans, painful bones, kidney stones, psychiatric moans, and fatigue overtones

Abdominal groans refer to gastrointestinal manifestations such as constipation, nausea, and vomiting.

Painful bones refer to the aching pain that occurs in cases of hypercalcemia caused by hyperparathyroidism.

Kidney stones refer to the development of calcium renal stones that can cause intense flank pain.

Psychiatric moans refer to confusion and behavioral changes such as delirium and psychosis that can occur.

Fatigue overtones refer to the lethargy and general feelings of malaise that occur with hypercalcemia.

hypomagnesemia

level below expected reference range of 1.3 to 2.1 mEq/L.

Causes:

- Medications

- Decreased intake

- Decreased absorption by the intestines (Crohn's disease, celiac disease)

- Increased excretion by the gastrointestinal tract (diarrhea, pancreatitis)

- Increased excretion by the kidneys

- Excessive alcohol use

- Diabetes mellitus type 2

- Undernutrition

- Severe burns

- Electrolyte imbalances (hypokalemia, hypocalcemia)

hypermagnesemia

Magnesium level above expected reference range of 1.3 to 2.1 mEq/L.

Causes:

- Kidney disease (acute and chronic)

- Excessive intake

- Medications

- Trauma

- Acidotic states

- Hypothyroidism

checking patellar reflexes

High magnesium levels (10 mEq/L or greater) cause muscle weakness and the loss of deep tendon reflexes, which together result in an absent patellar reflex.

hypervolemia

Fluid overload, the body has too much water.

Causes:

- Heart failure

- Kidney failure

- Nephrotic syndrome

- Cirrhosis or end-stage liver disease

urine specific gravity

A test that measures the solutes in a sample of urine and provides information regarding the body's fluid balance. The expected reference range of urine specific gravity is 1.005 to 1.030.

fluid volume deficit

A condition caused by the loss of water; also referred to as hypovolemia.

Causes:

- Blood loss

- Gastrointestinal losses

- Severe burns

- Third spacing

- Excessive sweating

- Fever

- Medications

- Trauma

hypovolemic shock

when the body loses 20 percent or one-fifth of its blood or fluid supply

creatinine (CR)

Reflection of renal function; a byproduct of skeletal muscle contractions (creatine), which is then excreted through the urine.

hemoglobin

A component of the red blood cell that carries oxygen and carbon dioxide to and from the cells.

WBC

5,000 - 10,000

PLATELET COUNT

150,000 TO 400,000

BUN

10 - 20 mg/dL

kidney problems, dehydration

Cr

Creatinine

over 1.3 mg/dL

kidney problems, muscle disorders

RBC

male: 4.7 to 6.1 million cells/microLiter

female: 4.2 to 5.4 million cells/microLiter

glucose

fasting glucose: 70-110 mg/dL

Hgb

male: 14-18 grams/dL

female: 12-16 grams/dL

Hct

male: 42%-52%

female: 37-47%

PT

11 to 12.5 sec

INR

0.9 to 1.2 clients not on warfarin

2-3 clients for warfarin

aPTT

30 to 40 sec for clients not on heparin

46 to 70 sec for clients on heparin

PaCO2 carbon dioxide

35 - 45 mm Hg

below or above reference range = respiratory

HCO3- bicarbonate

21-28 mEq/L

below or above reference range = metabolic

pH

7.35-7.45

below 7.35 acidosis

above 7.45 alkalosis

normal = ok purr

metabolic acidosis

pH low, HCO3 low, PaCO2 normal

respiratory acidosis

pH low, PaCO2 high, HCO3 normal

metabolic alkalosis

pH high, HCO3 high, PaCO2 normal

respiratory alkalosis

pH high, PaCO2 low, HCO3 normal