hyponatremia
most common cause is _____!!!
examples are _____, _____, _____
fluid overload
CHF
ARF SIADH
water excess
parathyroid hormone and calcitonin
PTH:
increases resorption of _____; stimulates _____ reabsorption of _____; inhibits renal reabsorption of _____
calcitonin:
inhibits _____ in bone
bone renal calcium phosphate osteoclasts
alterations in water movement: edema clinical manifestations: -localized vs. generalized -dependent edema -pitting edema -"third space" -swelling and puffiness -tighter fitting clothes and shoes -weight gain
treatment:
- _____ adematous limbs
- use _____ or devices
- avoid _____
- restrict _____ intake
- take _____ agents
elevate compression stockings prolonged standing salt diuretic
aldosterone
-increases renal _____ and _____ reabsorption; increases renal excretion of _____ and _____
sodium
water
potassium
hydrogen ion
acidemia
-_____ pH will initiate the formation of _____ (_____) from _____ (_____) referred to as _____, in the _____ of the _____ of a pH of _____
arterial ammonium (NH4) ammonia (NH3) acidemia tubular lumen kidney 7.25
atrial natriuretic peptide
-increases _____ and _____
renal sodium
water excretion
antidiuretic hormone
increases _____, _____ of the arterioles
renal water reabsorption
vasoconstriction
calcium and phosphate
- regulated by three hormones
1. _____ - _____ plasma _____ levels via kidney reabsorption
2. _____ - is fat-soluble steroid; _____ calcium absorption from the _____
3. _____ - _____ plasma calcium levels
-bottom line point: parathyroid hormone (PTH) so Ca and Phosphate is influenced with PTH, calcitonin and vitamin D
parathyroid hormone (PTH) increases calcium vitamin D increases GI tract calcitonin decreases
hypernatremia
- elevate _____ always implies a _____
- simple dehydration: tx: _____
- failure to produce _____ in the _____ or the _____ are insensitive to _____
- _____ of _____ can cause hypernatrenia
serum sodium free water deficit normal saline replacement AHD brain kidney ADH hypersecretion aldosterone
dehydration decrease sodium (hyponatremia)
-can result in _____, _____, and _____
weak pulse
tachycardia
weight loss
hypernatremia
- serum sodium >147 mEq/L
- related to _____ gain or _____ loss
- water movement from the _____ to the _____
- -_____
- manifestations: _____, _____, _____, _____, and _____
- treatment: _____
sodium water ICF ECF intracellular dehydration intracellular dehydration convulsions pulmonary edema hypotension tachycardia isotonic salt-free fluids
hypokalemia
- potassium level <3.5 mEq/L
- causes:
- reduced potassium intake
- increased potassium entry into cell
- increased potassium loss
- treatment:
- replace potassium orally and/or intravenously
- manifestations:
- decreased _____
- _____ weakness
- _____ atony
- cardiac _____
- _____ on electrocardiogram (ECG)
- causes:
- _____
- _____
neuromuscular excitability skeletal muscle smooth muscle dysrhythmias U wave repeated blood administration pancreatitis
hypermagnesemia
- MCC of hypermagnesemia is _____
- caused by the overuse of magnesium containing _____ or from _____ administration, during premature _____ when it is administered as _____
- it is _____ to have hypermagnesemia without having _____
- leads to _____ and loss of _____ reflexes
renal failure laxatives iatrogenic labor tocolytic rare renal insufficiency muscle weakness deep tendon
hyperkalemia
- potassium level >5.5 mEq/L
- rare as a result of efficient renal excretion
- causes:
- increased intake
- shift of K+ from ICF to ECF
- decreased renal excretion
- hypoxia
- acidosis
- _____ deficiency
- cell trauma
- one important cause of hyperkalemia include _____ and _____
insulin
renal failure
Addison disease
water movement between the ICF and ECF
- osmolality: how much solute in a solution
- _____: water movement between the _____ compartment and the _____ compartment
- –sodium for the ECF
- –potassium for the ICF
- aquaporins: a family of water channel proteins that provide permeability to water
osmotic forces
ICF
ECF
respiratory acidosis
causes:
-depression of the respiratory center (brainstem trauma, oversedation)
-respiratory muscle paralysis
-disorders of the chest wall (kyphoscoliosis, _____, flail chest)
-disorders of the lung parenchyma (pneumonitis, pulmonary edema, emphysema, asthma, bronchitis)
pickwickian syndrome
Hypocalcemia
-Causes are _____ and _____:
Blood transfusions are a common cause of hypocalcemia because the _____ used in storing _____ binds with _____. Pancreatitis causes a release of _____ into soft-tissue spaces; consequently, the free fatty acids that are formed bind calcium, causing a decrease in _____.
repeated blood transfusions pancreatitis citrate solution whole blood calcium lipases ionized calcium
Hypocalcemia :Two clinical signs of hypocalcemia are the _____ and _____
- Chvostek sign: clinicalsignof existing _____seen inhypocalcemia. It refers to an abnormal reaction to the stimulation of the_____.
- Trousseau sign: a test for latent tetany in which _____ is induced by inflating _____ on the upper arm to a pressure exceeding _____ blood pressure for _____
Chvostek sign Trousseau sign nerve hyperexcitability tetany facial nerve carpal spasm sphygmomanometer cuff systolic 3 mins
the pathophysiologic process of edema
- is related to an _____ in the forces favoring _____ from the _____ or _____ into the _____
- the most common mechanisms are _____, _____, _____ and _____, and _____
increases fluid filtration capillaries lymphatic channels tissues increased capillary hydrostatic pressure decreased plasma oncotic pressure increased capillary membrane permeability lymphatic obstruction sodium retention
hypokalemia
- low K imbalance causes:
- _____
- _____
- _____ block
- weakness _____
- _____
- _____
paralytic ileus sinus bradycardia atrioventricular skeletal muscles cardiac dysrthythmias smooth muscle atony
hypotonic hyponatremia euvolemic
water excess
-compulsive water drinking, causing water intoxication (primary polydipsia)
-decreased urine formation
-syndrome of inappropriate ADH (SIADH)
–ADH secretion causes water reabsorption
-manifestations:
cerebral edema, muscle twitching, headache and weight gain
- treatment:
- _____; may need _____ solution
fluid restriction
hypertonic sodium chloride IV
hyperkalemia
mild attacks
-tingling of lips and fingers, restlessness, intestinal cramping and diarrhea. EKG changes is _____ on the ECG!
severe attacks
-muscle weakness, loss of muscle tone, flaccid paralysis and cardiac arrest
treatment:
-_____, _____ and/or _____, _____, _____ resins, _____
peaked T waves calcium gluconate insulin glucose Na+ bicarbonate cation exchange dialysis
hyponatremia
- serum sodium level <135 mEq/L
- sodium deficits cause plasma hypoosmolality and cellular swelling
- _____; low intake; _____ hyponatremia; _____ hyponatremia; _____ hyponatremia
manifestations:
_____, _____, _____, _____, _____, and _____
treatment:
- depends on underlying disorder
- restrict water intake
- administer intravenous (IV) fluids
pure sodium deficits dilutional hypotonic hypertonic lethargy headache confusion apprehension seizures coma
- the pathophysiologic process of edema is related to _____
- _____ results of _____ and _____ retention
lymphatic obstruction
increased capillary hydrostatic pressure
sodium
water
