Normal Sodium
135-145
Normal Potassium
3.5-5
Normal Calcium
9.0-10.5
Normal Chloride
98-106
Normal Magnesium
1.8-2.6
Normal Osmolarity
270-300
Aldosterone
acts on the kidneys triggering them to reabsorb sodium and water from the urine back into the blood
promotes excretion of potassium
ADH
acts directly on the kidneys to reabsorb water and return it to the blood
Natriuretic Peptides
secreted in response to increased BP and blood volume
Causes increase in urine output
Opposite of Aldosterone and ADH
Understand and know vocab
Renin-Angiotensin-Aldosterone system
Blood pressure drops
Sympathetic Nervous System stimulates
Kidneys (juxtaglomerular cells) to release renin
Renin activates angiotensinogen in the liver
Once activated, turns into angiotensin 1
ACE (found on surface of lung and kidney endothelium) converts Angiotensin 1 to Angiotensin 2
Angiotensin constricts vessels (which increases systemic vascular resistance and increase blood pressure) and increases blood volume
stimulates kidneys (conserve sodium and water)
adrenal cortex releases aldosterone (stimulates kidneys to do this which also lowers potassium)
Pituitary gland releases ADH which causes kidneys to keep water
Goal of RAAS
raise blood pressure through increasing PVR and blood volume
Signs and Symptoms of dehydration
tachycardia
hypotension
weak peripheral pulse
increased respiration rate
dark concentrated urine
Treatment of Dehydration
Who is most at risk for dehydration
Hyponatremia
Cause
decreased consumption
diuretic “thiazides”
vomiting
diarrhea
sweating
Addison’s disease
SIADH
Overload of Fluid
Symptoms
Seizures and stupor
Abdominal cramping
Lethargic
Tendon reflexes diminished
Loss of urine and appetite
Orthostatic hypotension
Shallow respirations
Spasms of muscles
Hypernatremia
Cause
Cushing’s disease
Conn’s syndrome
Hypertonic solutions, corticosteroids
Not drinking enough water
Losing too much water (Diabetes Insipidus)
Burns
Increased sodium intake
Symptoms
Fatigue
Restless, really agitated
Increased reflexes (seizure, coma)
Extreme thirst
Decreased urine output
Hypochloremia
Cause
GI related (vomiting, ileostomy)
Diuretics “thiazide”
Burns
CF
Fluid volume overload
Metabolic alkalosis
Symptoms
same as Hyponatremia
Hyperchloremia
Cause
Hypertonic fluids
Not drinking enough water
Losing too much water
Diarrhea
Conn’s Syndrome
Corticosteroids
Metabolic acidosis
Symptoms
same as Hypernatremia
Hypokalemia
Cause
Loop diuretics
Corticosteroids
Too much insulin
Cushing’s Syndrome
Starvation
Vomiting
Symptoms
Lethargic
Low, shallow respirations
Lethal cardiac dysrhythmias
Lots of urine
Leg cramps
Limp muscles
Low BP and heart rate
Hyperkalemia
Cause
Burns
Tissue damage
Rhabdomyolysis
Addison’s
Renal failure
Medications- K sparing diuretics, ACE inhibitors, NSAIDs
Symptoms
Muscle weakness
Urinary output (little or none)
Respiratory failure
Decreased cardiac contractility
Early: muscle twitches/cramps
Rhythm changes (peaked T waves)
Hypocalcemia
Cause
Decreased PTH
Thyroidectomy
Decreased intake of Calcium
Low vitamin D
CKD
Bisphosphonates
Aminoglycosides
Anticonvulsants
Symptoms
Convulsions
Reflexes Hyperactive
Arrhythmia (prolonged QT interval)
Muscle spasms (calves/feet- tetany)
Positive signs (Trousseaus’s/ Chvostek’s)
Sensation of tingling/numbness (paresthesia)
Hypercalcemia
Cause
Hyperactive PTH
Increased vitamin D
Supplements with too much calcium
Cancer in the bones
Thiazides
Lithium
Symptoms
Weakness of the muscles
EKG changes (shortened QT interval)
Absent reflexes, altered mental status, abdominal distension
Kidney stone formation
Hypomagnesemia
Cause
Not consuming enough
Other electrolyte imbalances
Malabsorption in the small intestine
Proton pump inhibitor
Alcoholism
Symptoms
Trousseau and Chvostek Sign
Weakness
Increased deep tendon reflex
Torsades de pointes/ Tetany
Calcium and potassium levels low
Hypertension
Hypermagnesemia
Cause
Rare
trying to correct low magnesium
L and D patient receiving magnesium sulfate
Decreased renal function
Symptoms
Lethargic
EKG changes
Tendon reflexes absent or diminished
Hypotension
Arrhythmias
Red and hot face
GI issues
Impaired breathing
Confusion
Normal pH
7.35-7.45
Normal CO2
35-45
Normal HCO3
22-26
Normal PO2
80-100
Causes of Metabolic Acidosis
Antifreeze overdose
Cardiac arrest
ASA
Renal failure
DKA
Diarrhea
Signs and Symptoms of Metabolic Acidosis
tachycardia
pulmonary edema
tachypnea
confusion
coma
Causes of Metabolic Alkalosis
diuretic
CF
chewing tobacco
penicillin
too much bicard
Signs and Symptoms Metabolic Alkalosis
seizures
headache
dysrhytmias
Causes of Respiratory Acidosis
COPD
drug overdose
pneumonia
smoke inhalation
airway obstruction
Signs and Symptoms of Respiratory Acidosis
altered LOC
tachycardia
diaphoresis
Causes of Respiratory Alkalosis
shock
anxiety
pain
fever
hypoxia
sepsis
CHF
PE
Signs and Symptoms of Respiratory Alkalosis
seizures
numbness
muscle twitch same osmotic pressure as the blood plasma (doesn't do anything to cells); .9 NS,
lactated ringers are examples; good for patients at risk for fluid overload
Respiratory vs Renal Compensation
What is compensation
How does the body compensate
Hyperventilation and what is occurring in the acid-base balance
Central venous access
Peripheral acess
PICC line
Complications of PICC line
IV site care
Phlebitis
Infiltration
Central line catheter care
Isotonic IV solutions
same osmotic pressure as the blood plasma (doesn't do anything to cells);
.9 NS, lactated ringers are examples;
good for patients at risk for fluid overload
Hypotonic IV solutions
Moves water out of blood and into the cells
Hypertonic IV solutions
Moves water out of body cells and into blood stream
Arteriosclerosis
Atherosclerosis
Types of hypertension
Levels of Hypertension