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Questions and Answers
What characterizes dilutional hyponatremia?
What characterizes dilutional hyponatremia?
- Na+ depletion with water loss
- Increased Na+ concentration in the blood
- Na+ loss with water retention (correct)
- Excessive Na+ intake
Which symptom is most commonly associated with hypovolemic hyponatremia?
Which symptom is most commonly associated with hypovolemic hyponatremia?
- Hypertension
- Seizures (correct)
- Increased skin turgor
- Weight gain
What is a common physical sign of hypervolemic hyponatremia?
What is a common physical sign of hypervolemic hyponatremia?
- Bounding tachycardia (correct)
- Low blood pressure
- Dehydration
- Decreased heart rate
What constitutes depletional hyponatremia?
What constitutes depletional hyponatremia?
In the case of hypernatremia, what is the main body defense mechanism?
In the case of hypernatremia, what is the main body defense mechanism?
What can cause hypernatremia?
What can cause hypernatremia?
What would NOT be a typical treatment for mild hypernatremia?
What would NOT be a typical treatment for mild hypernatremia?
Which of the following symptoms indicates severe neurological impairment from hyponatremia?
Which of the following symptoms indicates severe neurological impairment from hyponatremia?
What condition is indicated by a serum phosphorus level greater than 4.5 mg/dl?
What condition is indicated by a serum phosphorus level greater than 4.5 mg/dl?
Which treatment is appropriate for severe hyperphosphatemia in patients with good kidney function?
Which treatment is appropriate for severe hyperphosphatemia in patients with good kidney function?
Which major extracellular anion is secreted in the stomach as hydrochloric acid?
Which major extracellular anion is secreted in the stomach as hydrochloric acid?
What is the primary cause of hypochloremia?
What is the primary cause of hypochloremia?
Which condition is NOT associated with hyperphosphatemia?
Which condition is NOT associated with hyperphosphatemia?
Which electrolyte imbalance is characterized by a serum chloride level greater than 106 mEq/L?
Which electrolyte imbalance is characterized by a serum chloride level greater than 106 mEq/L?
What is a common treatment for hypochloremia?
What is a common treatment for hypochloremia?
Which underlying condition is associated with respiratory acidosis that may contribute to hyperphosphatemia?
Which underlying condition is associated with respiratory acidosis that may contribute to hyperphosphatemia?
What is the normal range for PaCO2?
What is the normal range for PaCO2?
Which condition is indicated by a pH value lower than 7.35?
Which condition is indicated by a pH value lower than 7.35?
Which buffer system is most effective in the renal tubules?
Which buffer system is most effective in the renal tubules?
What occurs when the body's pH rises above 7.45?
What occurs when the body's pH rises above 7.45?
How do the lungs respond to high levels of CO2 in the blood?
How do the lungs respond to high levels of CO2 in the blood?
What role do kidneys play in maintaining acid-base balance?
What role do kidneys play in maintaining acid-base balance?
What is the purpose of chemical buffers in the blood?
What is the purpose of chemical buffers in the blood?
What is the expected action of the body when pH is low due to acidosis?
What is the expected action of the body when pH is low due to acidosis?
Which IV therapy is considered a volume expander?
Which IV therapy is considered a volume expander?
What is a characteristic of total parenteral nutrition?
What is a characteristic of total parenteral nutrition?
Which option is a potential sign of hypovolemia related to IV ammonium chloride use?
Which option is a potential sign of hypovolemia related to IV ammonium chloride use?
Which statement accurately describes the pH level condition indicated?
Which statement accurately describes the pH level condition indicated?
What type of solution is 0.45% NaCl classified as?
What type of solution is 0.45% NaCl classified as?
Which symptom is NOT associated with hypomagnesemia?
Which symptom is NOT associated with hypomagnesemia?
What is a common cause of hypomagnesemia?
What is a common cause of hypomagnesemia?
Which of the following is an effect of magnesium deficiency on the cardiovascular system?
Which of the following is an effect of magnesium deficiency on the cardiovascular system?
What treatment would be appropriate for a patient with mild hypomagnesemia?
What treatment would be appropriate for a patient with mild hypomagnesemia?
Which of the following symptoms is classified under gastrointestinal issues related to hypomagnesemia?
Which of the following symptoms is classified under gastrointestinal issues related to hypomagnesemia?
What sign is commonly seen with magnesium deficiency reflecting neuromuscular excitability?
What sign is commonly seen with magnesium deficiency reflecting neuromuscular excitability?
What electrolyte level is defined as hypomagnesemia?
What electrolyte level is defined as hypomagnesemia?
Which of the following is NOT a common risk factor for developing hypomagnesemia?
Which of the following is NOT a common risk factor for developing hypomagnesemia?
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Study Notes
Magnesium
- Plays a critical role in energy production as ATP (adenosine triphosphate)
- Essential for protein synthesis and carbohydrate metabolism
- Involved in cardiovascular function, contributing to vasodilation
- Regulates muscle contractions
Hypomagnesemia
- Serum magnesium levels below 1.5 mEq/L
- Often caused by poor dietary intake, inadequate GI absorption, or excessive loss through the GI or urinary systems
- High risk clients: chronic alcoholism, malabsorption, GI or urinary disorders, sepsis, burns, or wounds requiring debridement.
- Symptoms: muscle weakness, leg/foot cramps, hyperactive deep tendon reflexes (DTRs), tetany, Chvostek's and Trousseau's signs, tachycardia, hypertension, EKG changes, dysphagia, anorexia, nausea/vomiting
Sodium
- Major extracellular cation
- Plays a crucial role in water balance
- Maintains osmotic pressure and nerve impulse transmission
Hyponatremia
- Serum sodium levels below 135 mEq/L
- Types:
- Dilutional: results from sodium loss and water gain
- Depletional: insufficient sodium intake
- Hypovolemic: sodium loss exceeds water loss
- Hypervolemic: edema, hypertension, weight gain, bounding tachycardia
- Isovolemic:
Hypernatremia
- Excess sodium relative to body water
- Thirst serves as the body's primary defense
- Caused by water deficit, overuse, or ingestion of sodium
- Can also be caused by diabetes insipidus
- Symptoms:
- Poor skin turgor
- Tachycardia
- Decreased blood pressure (BP)
- Orthostatic hypotension
Phosphorus
- Important for energy metabolism
- Involved in bone formation, cell signaling, and regulating acid-base balance
Hyperphosphatemia
- Serum phosphorus levels above 4.5 mg/dl
- Caused by impaired kidney function, cell damage, hypoparathyroidism, respiratory acidosis, diabetes ketoacidosis (DKA), or increased dietary intake
- Symptoms:
- Anorexia
- Apathy
- Confusion
- Cyanosis
- Hypotension
- Loss of reflexes
- Muscle twitching
- Nausea
- Paresthesia
- Polyuria
- Vomiting
- Weakness
Chloride
- Major extracellular anion
- Works with sodium to maintain water balance
Hypochloremia
- Serum chloride levels below 96 mEq/L
- Caused by decreased intake, decreased absorption, metabolic alkalosis, or diuretics
- Symptoms:
- Arrhythmias
Hyperchloremia
- Serum chloride levels above 106 mEq/L
- Rarely occurs alone
- Caused by:
- Dehydration
- Kidney disease
- Excessive sodium intake
Acid-Base Balance
- A complex process involving the regulation of hydrogen ion (H+) concentration in the body
- Normal pH range: 7.35 to 7.45
- Three main regulatory systems maintain pH:
- Chemical buffers
- Respiratory system
- Kidneys
Chemical Buffers
- Act immediately
- Combine with acids or bases to neutralize harmful effects
- Types:
- Bicarbonate buffer system
- Phosphate buffer system
- Protein buffer system
Respiratory System
- Lungs regulate blood carbon dioxide (CO2) levels
- CO2 + H2O = Carbonic acid
- High CO2: slower breathing (holding onto carbonic acid, lowers pH)
- Low CO2: faster breathing (blowing off carbonic acid, raises pH)
- More effective than chemical buffers, but effects are temporary
Kidneys
- Regulate blood pH over time
- Reabsorb or excrete acids / bases into the urine
- Produce bicarbonate
ABG Results
- Uncompensated Alkalosis:
- pH > 7.45
- PaCO2 Normal
- Compensated Alkalosis:
- pH within normal range (7.35-7.45)
- PaCO2 lower
- Metabolic Alkalosis:
- pH > 7.45
- High HCO3
- Respiratory Alkalosis:
- pH > 7.45
- Low PaCO2
IV Therapy
- Crystalloids (volume expanders):
- Isotonic (D5W, 0.9% NaCl, Lactated Ringers): used to replace fluids and electrolytes
- Hypotonic (0.45% NaCl): used to hydrate cells
- Hypertonic (D5/0.9% NaCl, D5/0.45% NaCl): used to increase blood pressure
- Colloids (plasma expanders): draw fluids into the bloodstream
- Albumin
- Plasma protein
- Dextran
Total Parenteral Nutrition (TPN)
- Highly concentrated, hypertonic solution
- Used for clients with high caloric and nutritional needs
- Contains electrolytes, vitamins, acetate, micronutrients, and amino acids
- Lipid emulsions are provided in addition to TPN
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