Cation. Anion. Kidney
Na+. Cl- Bun
135-145. 95-105. 4.5-11
K+. Co2- Cr
3.5-5. 23-30. .6-1.2
Glu 60-110
<Low Na+ <135
HypERvolemic HypoNa
Vol overload,CHF, kidney prob. Tx= Na restrictions & diuresis.
Hypovolemic HypONa
Vol depleted, burns vomit. Tx= isotonic fluids
Euvolemic HypONa
Rt amt H2O but not working rt. SIADH, normal bun/Cr too much vol dilutes Na in body. Tx= fluid restriction, diuresis ( only raise Na by 0.5 meq per hr)
PT can cause distended abdomen
High Na >145
HypERvolemic HypERNa
too much NS, Cushing syndrome, aldosterone, 2 much NaHCo2 TX=hypotonic soln, lasix
Hypovolemic HypERNA
sweat, diarrhea,urine na<10 TX=isotonic fluids
Euvolemic HypERNa
Normal H2O content but hi Na free H2O loss DI TX= DDAVP & fluid replacement for hi UO
K+
3.5-5 meq/l. Major intracellular Cation. Regulated by kidneys, essential for CNS,❤️,& muscle.
HypER K+= burns, adrenal insufficiency, METABOLIC ACIDOSIS . H+ ions will shift into cell and K+ will shift out= homeostasis (don’t treat since it’s false high). Slow V-tach. Peaked T-waved
HypO K+ DKA, hypotension
CBC
RBC 4.6-6.2 If low=Fe deficiency, high w altitude
Hgb M- 14-18, F 12-16 transfuse if < 7.
Hct M 42-52% F 37-47% Hct is 3x the Hgb. High Hct= dehydration, polycythemia, low = anemia , over hydrated.
PLT 150-400 made in bone.
For every 1 unit of Prbc, the Hgb rises by 1 & Hct rises by 3.
WBC
4500-11000
Responds to inflammatory response.
The differential=
NEVER= Neutrophils 45-75% segs. Bacterial, Fungi (left Shift=mature neutrophils being used up by infection.
LET= Lymphocytes 18-45% Regulated T & B cells
MONKEYS= Monocytes 1-10% phagocytic cleans up
EAT= Eosinophils 0-7% Allergic Rxn, Parasite, Asthma
BANANAS= Basophils 0-2% Inflammatory responses
COAGS
INR .8-1.2. Coumadin
PT 11-13 Prothrombin (time it takes plasma to clot)
PTT 25-35. Looks at Heparin
AMONIA <40 produced by body during breakdown of Protein = liver failure
BHG Beta hydroxy butyrate 0.4-0.5
Mag 1.5-2.5
Phos3-4.5
Ca 8.8-10.2
BHB predominant ketone at onset DKA
Mg formed in bone. High means renal failure. Causes loss in deep tendon reflex. Low= seen in a lot of ICU pt, associated w low K+ have CNS effects irritable
Phos= reciprocal to Ca+. If hi= tetany, Sz
Ca+ essential for coag & neuro function. Parathyroid & vitamin D influence Ca value. Low Ca in kidney dx, high Ca confused, weakness, arrythmia, hypotension. Low Ca get Chvostik sign (cheek) & Trousseau sign ( hand flex w bp on same arm)
Troponin
CKMB
PRO BNP
Troponin < 0.04 Protein essential for ❤️ contractions, binding site for Ca+. If MI, levels won’t rise for 2-3 hrs, will peak at 12 hrs
CKMB creatinine kimase muscle brain. < 0.3 found in ❤️& skeletal muscle of > 2.5= ❤️ damage.
PRO BNP b-type naturistic peptide. Based on ventricular stretch . <125 for 0-74yo, < 450 for 75-99 yo.
osmolality 275-295 & Urine specific gravity
1.005-1.030
Body regulates osmolality by withholding ADH. The more hydrated the cell is, will have low osmo, the more hemoconentated cell, the osmo will be high. High osmo= dehydration, DI, low osmo=dilute state, SIADH
Low urine sp. Gr. More dilute urine
High sp. Gr =hemoconentated
SIADH - Serum osmo will b low & so sp. gr. high
Na-(Cl + HCO3) + K
Corrected anion gap. When u don’t have an ABG. Uncorrected anion gap is Na -(Cl + HCO3)= If > 12 you have metabolic acidosis.
Corrected ag if>20= metabolic acidosis
Magnesium 1.5-2.5
If treating low mag, and note absent patellar reflex, stop infusion
Electrolytes that can cause prolonged Q-T segment
Potassium
Calcium
Magnesium
Ca+
8.5-10.5. Reciprocal w phosphorus
