Acute Exam 3

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

1. Blood pressure drops

2. Sympathetic Nervous System stimulates

3. Kidneys (juxtaglomerular cells) to release renin

4. Renin activates angiotensinogen in the liver

5. Once activated, turns into angiotensin 1

6. ACE (found on surface of lung and kidney endothelium) converts Angiotensin 1 to Angiotensin 2

7. 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