Final Review

Basic Blood Gas Scale
  - pH: 7.35-7.45 (ideal: 7.4)
  - PaCO2: 35-45 mmHg
  - HCO3: 22-26 mEq/L

Causes:
  - Hypoventilation/impaired ventilation
    - Chronic Obstructive Pulmonary Disease (COPD)
    - Asthma
    - Pneumonia (PNA)
    - Opioid overdose
    - Airway obstruction
Clinical Manifestations:
  - Acute:
    - Confused or altered mental status
    - Drowsy, irritable
    - Low heart rate, shallow respirations
  - Chronic:
    - Dull headache
    - Daytime sleepiness
    - Impaired memory and personality changes
Treatment:
  - Treat underlying cause
  - Mechanical ventilation
  - Pharmacologic therapy (bronchodilators, antibiotics, naloxone)

Causes:
  - Hyperventilation, excessive CO2 loss
    - Anxiety (most common, e.g., panic attacks)
    - Pain
    - Pulmonary disorders (hypoxia)
    - Fever/infection
Clinical Manifestations:
- Signs of anxiety

Causes:
  - Excess acid and loss of HCO3
    - Diabetic Ketoacidosis (DKA)
    - Hypovolemia
    - Diarrhea
    - Ostomy/fistulas
    - Acute Kidney Injury (AKI)/Chronic Kidney Disease (CKD)
Clinical Manifestations:
  - Hot, dry, flushed skin
  - Weakness, fatigue, malaise
  - Hypotension, dysrhythmias
Chronic Effects:
- Skeletal problems
Treatment:
  - DKA: require fluids and insulin
  - Diarrhea: administer anti-diarrheal medications
  - Pharmacotherapy: Sodium Bicarbonate (IV push in emergencies, IV or PO)
    - Caution against over-correction

Causes:
  - Loss of H+ or excess HCO3 (e.g., due to excessive antacid use)
  - Hypokalemia
  - Diuretics
Clinical Manifestations:
  - Dizziness, confusion, lethargy
  - Dysrhythmias
  - Respiratory depression/failure and hypoxemia
  - Nausea/vomiting/anorexia
Treatment:
  - Treat underlying cause (e.g., stop suctioning, replace fluids/electrolytes, patient education)
  - Cardiac monitoring
  - Promote H+ retention and HCO3 excretion

Partial Compensation:
- pH is abnormal
Full Compensation:
- pH is normalized but other gas parameters may be abnormal

Normal Range: Sodium 135-145 mEq/L
Critical High: >160 mEq/L
Causes:
  - Impaired thirst mechanism (commonly seen in older adults)
  - Profuse sweating
  - Diarrhea
  - Diabetes insipidus (excessive urination)
  - Cushing’s Syndrome
  - Misuse of electrolytes
Clinical Manifestations: (Mnemonic: "Fried Salted")
  - Fever (low grade, elevated temp)
  - Restlessness/agitation/irritability
  - Increased fluid retention, fluid volume excess (FVE)
  - Edema
  - Dry mouth/mucous membranes
  - Skin flushes
  - Low urinary output
  - Thirst (excessive)
  - Elevated blood pressure
  - Decreased energy/lethargy
Treatment:
- Fluid replacement at a moderate rate

Critical Low: <115 mEq/L
Causes:
  - Diuretics
  - Renal disease
  - Vomiting/diarrhea
  - Heart failure
  - Fluid overload
Clinical Manifestations: (Mnemonic: "SALT LOSS")
  - Stupor/coma
  - Anorexia
  - Lethargy/weakness/fatigue
  - Tremors/muscle twitching
  - Seizures
  - Stomach/abdominal cramping
Treatment:
  - Sodium-containing fluids
  - Increase sodium-rich food intake (e.g., pickles, cured meats, canned/frozen foods, cheeses)
  - Hypertonic saline in severe cases

Normal Range: Potassium 3.5-5.0 mEq/L
Critical High: >7.0 mEq/L
Causes:
  - Potassium-sparing diuretics
  - Excessive potassium intake
  - Acidosis
  - Severe tissue trauma
  - Renal failure and adrenal insufficiency
Clinical Manifestations: (Think "Cardiac Muscle")
  - Dysrhythmias
  - Cardiac arrest
  - Nausea/vomiting/abdominal cramping
  - Diarrhea
  - Paresthesias (pins and needles sensation)
Treatment:
  - Insulin to shift potassium back into cells
  - Calcium gluconate
  - Sodium polystyrene sulfonate (Kayexalate) to excrete potassium through the bowel

Critical Low: <2.5 mEq/L
Causes:
  - Potassium-wasting diuretics
  - Corticosteroid use
  - Amphotericin B antibiotics
  - Severe vomiting
  - Gastric suctioning
Clinical Manifestations: (Think "Cardiac Muscle")
  - Muscle cramping/weakness
  - Risk for digoxin toxicity
  - Hypoactive bowels
  - Irregular, weak pulse
Treatment:
- Potassium replacement via dietary intake or supplements

Normal Range: Chloride 95-105 mEq/L
Hyperchloremia Causes:
  - Diarrhea
  - Renal failure
  - Overactive parathyroid
Manifestations:
- Weakness
- Increased thirst
Treatment:
  - Diuretics
  - IV fluids
  - Dialysis

Types:
  - Prerenal: Causes include hypovolemia from hemorrhage, excess fluid loss, burns, low cardiac output from heart failure.
  - Intrarenal: Caused by nephrotoxic agents like contrast dye.
  - Postrenal: Occurs due to obstruction after the kidney, such as BPH, renal calculi, or cancer.
Manifestations/Phases:
  - Initiation Phase: Asymptomatic, can last hours to days.
  - Maintenance/Oliguric Phase: Decrease in GFR and possible tubular necrosis.
  - Recovery/Diuretic Phase: GFR returns to pre-injury levels; kidneys may still function abnormally during this phase.

Causes:
  - Diabetic nephropathy
  - Hypertensive nephrosclerosis
  - Chronic glomerulonephritis or pyelonephritis
  - Polycystic kidney disease or systemic lupus erythematosus.
Key Management Strategies:
  - Control hypertension and diabetes.
  - Regular monitoring of potassium, phosphorus, and protein intake.
  - Low sodium diet and physical activity.

Access Ports Types:
- Fistulas, tunnel dialysis catheters, grafts.
Complications:
- Monitor for signs of infection, bleeding, and complications like low blood pressure.
- Avoid using the arm for blood pressure or venipuncture where access ports are.

Insulin Types:
  - Rapid-acting (e.g., aspart/lispro):
    - Onset: 15 mins
    - Peak: 1-1.5 hours
    - Duration: 3-5 hours
  - Short-acting (e.g., Regular):
    - Onset: ~30 mins
    - Peak: 2-3 hours
    - Duration: 4-6 hours
  - Intermediate-acting (e.g., NPH):
    - Onset: 2 hours
    - Peak: 6-8 hours
    - Duration: 12-16 hours
  - Long-acting (e.g., glargine):
    - Onset: Unidentified
    - Peak: No peak
    - Duration: 24 hours
Oral Agents:
  - Metformin: First line for T2D, suppress glucogenesis, increase glucose uptake.
  - Sulfonylureas (e.g., glipizide): Stimulate insulin release; caution with beta-blockers.
  - Thiazolidinediones (e.g., pioglitazone): Increase insulin sensitivity; caution for fluid retention and LDL.
  - DPP-4 inhibitors (e.g., sitagliptin): Increase insulin release and lower glucagon secretion.

Anticholinergics: Decrease mucus production; contraindicated in BPH and narrow-angle glaucoma.
Glucocorticoids: Prevent/reduce inflammation; side effects include weight gain and infection risk.
Beta-Blockers: Monitor heart rate and avoid in asthmatics due to bronchoconstriction risk.

Contact Precautions: For MRSA, c. diff, and similar pathogens.
Droplet Precautions: For influenza, strep, pneumonia, etc.
Airborne Precautions: For TB, measles, varicella; negative pressure room required.

Maintain a strong understanding of electrolyte imbalances, acid-base disorders, renal function, endocrine management, and infection control to provide high-quality patient care and promote safety in clinical environments.