Exam 2 - Pathophysiology

Words to know

Sodium electrolyte range

135 and 145 milliequivalents per liter (mEq/L)

Maintaining fluid balance, nerve function, and muscle contraction

Hyponatremia

Cause: excessive water intake and diuretics

Symptoms: headache, confusion, coma

Tx: 3% NS and fluid restriction

Hypernatremia

Cause: excessive salt intake

Symptoms: lethargy, irritability, seizure, weakness

FRIED: Fatigue, Restlessness, Increased reflexes, Extreme thirst, Dry mouth and skin

Tx: rehydrate with D5W and increase water intake

Potassium electrolyte range

3.5 to 5.0 milliequivalents per liter (mEq/L)

Hyperkalemia

Cause: excessive K+ intake, renal dysfunction and ACE inhibitors

Symptoms: cardiac arrythmias (peaked T), cramping, diarrhea, & irritability

Tx: Limit intake of K+ rich foods, loop diuretics, insulin, dialysis and Kayexalate

Hypokalemia

Cause: loop & thiazide diuretics, IV administration of insulin

Symptoms: WALT: weakness, arrhythmias (U wave), lethargy and thready pulse

Tx: PO and IV potassium and increased K+ in the diet 2

Calcium electrolyte range

Ca+ 8.5-10.5 mg/dL

Hypercalcemia

Cause: overactive thyroid gland and cancer

Symptoms: N/V, constipation, and thirst

Tx: decrease calcium in the diet, increase mobility and phosphorous

Hypocalcemia

Cause: diuretic use, and removal of parathyroid glands

Symptoms: numbness, tingling, Chvotek’s sign, tetany, Trousseau’s sign

Tx: increase Ca+ in the diet, and IV/PO calcium

Magnesium electrolyte range

Mg+ 1.5-2.5 mEq/L

Hypermagnesemia

Cause: excessive mg+ intake (laxatives and antacids), and renal dysfunction

Symptoms: muscle weakness, bradycardia, asystole, tremors and slow reflexes

Tx: Dialysis, increase fluid intake, and stopping medications that contain Mg+

Hypomagnesemia

Cause: diuretics, undernutrition, long-term alcohol use disorder, NGT suction, diarrhea, administration of tube feedings or parenteral nutrition

Symptoms: N/V, weakness, tremors, tetany, leg cramps, seizures, change in mental status, hyperactive DTRs, change in mental status, respiratory paralysis

Tx: Increase Mg+ in the diet, and PO/IV magnesium

Chloride electrolyte range

Cl - 98-108 mmol/L

Hyperchloremia

Cause: often seen in metabolic acidosis, hypernatremia, increased chloride retention from by the kidneys, and hyperparathyroidism

Symptoms: tachypnea, weakness, lethargy, decreased cognition, coma

Tx:IVF and diuretics

Hypochloremia

Cause: seen often in metabolic alkalosis, excessive use of loop diuretics, NGT suction, kidney disease, severe V/D

Symptoms: fatigue, weakness, respiratory distress, numbness and tingling, muscle cramps, confusion

Tx: Saline solution administration

Phosphorus electrolyte range

PO4- 2.5 – 4.5 mg/dL

Hyperphosphatemia

Cause: impaired kidney excretion, hypoparathyroidism, Excessive Vitamin D, excessive phosphate in diet, DKA

Symptoms: hyperreflexia, anorexia, muscle weakness, decreased mental status

Tx: With normal kidney function: volume repletion with saline and diuresis with a loop diuretic such as furosemide or bumetanide

Hypophosphatemia

Cause: administration of calories to malnourished patients (refeeding syndrome), ETOH withdrawal, hyperventilation, diuretic use, GI absorption problems

Symptoms: muscle weakness, slurred speech, dysphagia, irritability, confusion, seizures, coma

Tx: oral phosphate supplementation and bioactive vitamin D (calcitriol)

Serum osmolality normal range?

275 - 295 mOsm/kg (milliosmoles per kilogram)

BUN (Blood Urea Nitrogen) normal range?

10 - 20 mg/dL

Dehydration lab values?

—Hct (more than 3xHgb)

—BUN > 20

—Specific Gravity > 1.030

—Serum Osmolality > 295 mOsm/kg water

—Serum sodium > 145 mEq/L

—Anti-diuretic hormone (ADH)

—Serum Potassium and Sodium

ABG Analysis

pH = 7.35 - 7.45

PaCO2 = 35mmHg - 45mmHg

HCO3 = 22mEq/L - 26mEq/L

Anion gap normal range?

8 - 12 mEq/L