Fluid and Electrolyte Balance Quiz

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Questions and Answers

What is a common cause of dehydration?

Chronic kidney disease

Profuse urination (correct)

Elevated sodium levels

Excessive oral intake of fluids

Which assessment finding is indicative of hypervolemia?

Low blood pressure

Dry mucous membranes

Increased hematocrit levels

Rapid weight gain (correct)

What can be a consequence of fluid excess on the cardiovascular system?

Decreased heart rate

Improved circulation

Presence of S3 heart sound (correct)

Hypotension

Which symptom would NOT typically be associated with dehydration?

Pitting edema Signup and view all the answers

When monitoring a patient for symptoms of dehydration, which finding is most concerning?

High urine specific gravity Signup and view all the answers

Which intervention is appropriate for a patient experiencing hypervolemia?

Monitor daily weights Signup and view all the answers

Which diagnostic finding is expected in a patient suffering from fluid overload?

Decreased osmolality Signup and view all the answers

In the context of managing edema, which approach should be prioritized?

Restrict fluid intake Signup and view all the answers

What is the average daily fluid intake for an adult in milliliters?

2500 mL Signup and view all the answers

What type of dehydration is characterized by a primary loss of electrolytes, particularly sodium?

Hypotonic dehydration Signup and view all the answers

Which of the following processes does NOT require ATP?

Filtration Signup and view all the answers

What mechanism primarily governs the movement of water through a semipermeable membrane?

Osmosis Signup and view all the answers

What is the typical range of fluid output from the kidneys in milliliters per day?

1500-2000 mL Signup and view all the answers

Which type of dehydration causes an increase in plasma osmolarity?

Hypertonic dehydration Signup and view all the answers

What is primarily lost through insensible losses?

Water Signup and view all the answers

What is the indentation depth for a leg classified with 3+ pitting edema?

6 mm Signup and view all the answers

Which of the following factors does NOT contribute to fluid elimination from the body?

Metabolic oxidation Signup and view all the answers

What are potential causes of third-spacing?

Hypoalbuminemia Signup and view all the answers

Which nursing intervention is significant for managing fluid imbalances?

Weigh the client daily Signup and view all the answers

What characteristic differentiates brawny edema from pitting edema?

Tissue is hard and shiny Signup and view all the answers

Which of the following is a priority electrolyte that can be imbalanced?

Sodium Signup and view all the answers

What can lead to hypotension as a complication of third-spacing?

Fluid translocation to interstitial space Signup and view all the answers

Which finding might indicate an excess of fluid in the body?

Edema Signup and view all the answers

What is a common symptom associated with electrolyte deficits?

Mental status changes Signup and view all the answers

What serum sodium level is classified as hyponatremia?

Below 135 mEq/L Signup and view all the answers

Which of the following is not a common cause of hypernatremia?

Profuse diaphoresis Signup and view all the answers

What is a common assessment finding in a patient experiencing hypokalemia?

Flat T waves on EKG Signup and view all the answers

Which management strategy is appropriate for treating hypernatremia?

Fluid replacement with 0.45% NaCl Signup and view all the answers

What is the recommended nursing management for patients with hypokalemia?

Monitoring for EKG changes Signup and view all the answers

Which symptom is typically observed in a patient with hypernatremia?

Dry, sticky mucous membranes Signup and view all the answers

Which laboratory finding would indicate hypokalemia?

K+ < 3.0 mEq/L Signup and view all the answers

What dietary approach is suggested for a patient with hyponatremia?

Foods high in sodium Signup and view all the answers

What serum magnesium level is indicative of hypomagnesemia?

< 1.3 mEq/L Signup and view all the answers

Which nursing intervention is essential for monitoring a patient with hypomagnesemia?

Check for positive Chvostek and Trousseaus signs Signup and view all the answers

What symptom is most commonly associated with hypermagnesemia?

Flushing and lethargy Signup and view all the answers

What is the primary medical management for treating hypomagnesemia?

Oral or IV magnesium administration Signup and view all the answers

In a patient with hypermagnesemia, which vital sign should be monitored closely?

Blood pressure and respiratory rate Signup and view all the answers

What effect does hypomagnesemia have on the neuromuscular system?

Muscle cramps or spasms Signup and view all the answers

Which foods are particularly rich in magnesium that should be encouraged for patients with hypomagnesemia?

Green leafy vegetables and nuts Signup and view all the answers

If a patient receiving IV magnesium develops loss of deep tendon reflexes, what is the primary concern?

Potential magnesium toxicity Signup and view all the answers

What physiological response occurs in the kidneys during respiratory acidosis?

Increase HCO3 concentration Signup and view all the answers

Which clinical symptom would most likely be associated with respiratory alkalosis?

Hypokalemia Signup and view all the answers

In which situation would respiratory acidosis most likely occur?

Narcotic overdose Signup and view all the answers

What is the primary disturbance indicated by ABG #5, with a pH of 7.51?

Metabolic alkalosis Signup and view all the answers

What would be the likely interpretation of ABG #6 with a pH of 7.35?

Respiratory acidosis Signup and view all the answers

If a patient exhibits symptoms of hyperventilation and anxiety, which acid-base condition may they be experiencing?

Respiratory alkalosis Signup and view all the answers

What is the significance of HCO3 levels during respiratory alkalosis?

Decreased HCO3 indicates compensation Signup and view all the answers

Which ABG finding is indicative of a condition characterized by hypoventilation?

Low pH and high PaCO2 Signup and view all the answers

Which of the following components primarily make up body fluids?

Water and electrolytes Signup and view all the answers

What is the average percentage of body weight that is considered body water in adults?

60% Signup and view all the answers

In which fluid compartment is the majority of body water found?

Intracellular fluid Signup and view all the answers

Which of the following is not a common mechanism that helps regulate fluid and electrolyte balance?

Cell division Signup and view all the answers

Which type of fluid imbalance is characterized by an insufficient volume of fluid within the body?

Hypovolemia Signup and view all the answers

What distinguishes dehydration from hypovolemia?

Dehydration refers to increased fluid loss or insufficient intake. Signup and view all the answers

Which of the following is a common way the body loses fluid?

Respiration and perspiration Signup and view all the answers

What is the primary function of electrolytes within body fluids?

To maintain fluid volume and balance pH Signup and view all the answers

What is a primary symptom of hyponatremia?

Elevated body temperature Signup and view all the answers

Which of the following causes is NOT associated with hypernatremia?

Prolonged diarrhea Signup and view all the answers

Which dietary recommendation is beneficial for a patient with hypokalemia?

Consume potassium-rich foods Signup and view all the answers

One of the main causes of hypokalemia is the use of which type of medication?

Potassium-wasting diuretics Signup and view all the answers

What is considered the primary loss in hypertonic dehydration?

Water Signup and view all the answers

How is isotonic dehydration primarily characterized?

Equal loss of water and electrolytes Signup and view all the answers

What assessment finding may indicate a patient is experiencing hypernatremia?

Confusion and lethargy Signup and view all the answers

What is the method called that involves the movement of water through a semipermeable membrane?

Osmosis Signup and view all the answers

Which of the following is a late sign of hyponatremia?

Seizures Signup and view all the answers

What is a key nursing management strategy for a patient with hypernatremia?

Assess vital signs frequently Signup and view all the answers

What is the recommended daily fluid intake for an adult in milliliters?

2500 mL Signup and view all the answers

Which process promotes the movement of fluid according to pressure differences?

Filtration Signup and view all the answers

Which of the following would be a common diagnostic finding in a patient with hypokalemia?

Flat T waves and prominent U waves Signup and view all the answers

The majority of fluid loss from the body occurs primarily through which mechanism?

Urination Signup and view all the answers

What is the primary function of the sodium-potassium pump in fluid and electrolyte balance?

Transporting sodium ions out of cells Signup and view all the answers

Which of these has the highest insensible fluid loss during a given day?

Skin perspiration Signup and view all the answers

Which condition is characterized by the lungs attempting to compensate by altering pCO2 levels?

Metabolic alkalosis Signup and view all the answers

What is a common assessment finding in a patient with respiratory acidosis?

Cyanosis Signup and view all the answers

Which of the following is a typical cause of metabolic alkalosis?

Vomiting Signup and view all the answers

What medical management strategy is appropriate for addressing metabolic alkalosis?

Potassium administration Signup and view all the answers

Which symptom is associated with respiratory alkalosis due to increased respiration rates?

Dizziness Signup and view all the answers

In respiratory acidosis, what is the primary issue affecting the patient's respiratory function?

Inadequate CO2 excretion Signup and view all the answers

Which assessment finding indicates a metabolic state characterized by decreased respiratory rate and depth?

Hypoventilation Signup and view all the answers

Which nursing intervention is vital for monitoring a patient with respiratory alkalosis?

Perform frequent arterial blood gas analysis Signup and view all the answers

Which assessment finding is most indicative of hypocalcemia?

Laryngospasm Signup and view all the answers

What would likely be a diagnostic finding in a patient experiencing hypercalcemia?

Serum calcium > 10 mg/dL Signup and view all the answers

Which symptom is commonly associated with hypercalcemia?

Nausea Signup and view all the answers

Which medical management option is appropriate for treating hypocalcemia?

Oral calcium and vitamin D Signup and view all the answers

How is Trousseau's sign typically observed?

Inflated blood pressure cuff causing spasms Signup and view all the answers

What is a primary cause of hypomagnesemia?

Prolonged gastric suction Signup and view all the answers

Which of the following is a common consequence of hypercalcemia in the cardiovascular system?

Cardiac arrhythmias Signup and view all the answers

In the context of calcium imbalances, which symptom is more likely to manifest during hypocalcemia than hypercalcemia?

Seizures Signup and view all the answers

What compensatory mechanism occurs in the kidneys during respiratory acidosis?

Increased HCO3 concentration Signup and view all the answers

Which symptom is NOT typically associated with respiratory alkalosis?

Severe chest pain Signup and view all the answers

Which ABG interpretation corresponds to a patient experiencing mild metabolic alkalosis?

pH 7.52, PaCO2 43, HCO3 31 Signup and view all the answers

How does a narcotic overdose lead to respiratory acidosis?

Retention of carbon dioxide Signup and view all the answers

In ABG #3, what does a pH of 7.36 indicate?

Respiratory acidosis Signup and view all the answers

What laboratory result in ABG #2 indicates a primary metabolic problem?

pH 7.45, PaCO2 30, HCO3 19 Signup and view all the answers

Which finding in ABG #5 with a pH of 7.51 reflects primary alkalosis?

Increased HCO3 Signup and view all the answers

What effect do the kidneys have during respiratory alkalosis?

Decreased HCO3 production Signup and view all the answers

Study Notes

Timby's Introductory Medical-Surgical Nursing, 13e - Chapter 16: Caring for Clients With Fluid, Electrolyte, and Acid-Base Imbalances

Objectives:
- List three chemical components of body fluid.
- Name the two main fluid locations and their subdivisions in the human body.
- State the average daily fluid intake for adults.
- List four ways the body loses fluid.
- Identify five processes for relocating water and dissolved chemicals in the body.
- Name three mechanisms regulating fluid and electrolyte balance.
- List two types of fluid imbalances.
- Explain the difference between hypovolemia and dehydration.
- Explain hemoconcentration and hemodilution.
- Identify assessment findings and nursing interventions for hypovolemia.

Fluid and Electrolyte Intro

Fluid and electrolyte balance is a dynamic process crucial for life and homeostasis.
Body fluid is comprised of water, electrolytes, bases, acids, and other components (cells, proteins, glucose, and chemicals).
Dehydration is the most common fluid imbalance in older adults.
Nurses are responsible for recognizing, preventing, and treating fluid and electrolyte imbalances.

Fluid and Electrolyte Balance #1

Body fluids include body water and dissolved substances (solutes).
Body fluids serve as a medium for chemical reactions, carrying nutrients and waste in and out of cells.
Components of body fluid include water, O2, CO2, H, electrolytes (carry electrical charge), acids (release hydrogen), and bases (bind with hydrogen).
Fluids regulate fluid volume and buffer blood, maintaining pH balance.

Fluid and Electrolyte Balance #2 - Body Fluid Compartments

The human body is 60% water.
Intracellular fluid (ICF) is the fluid within cells (approximately 35-40% of body weight).
Extracellular fluid (ECF) is fluid outside cells (approximately 50-60% of body weight).
- ECF further subdivided into interstitial fluid (between cells, ~10-15% body weight) and intravascular fluid (within blood vessels, ~5% body weight, plasma).

Distribution of Body Water

66% of body water is intracellular, residing inside cells.
33% of body water is extracellular, found outside cells.
- 25% is interstitial fluid between cells.
- 8% is blood plasma.

Intake and Output

Average adult fluid intake is 2,500 mL/day (range 1,800-3,600 mL/day).
Daily intake calculation: depends on initial 10 kg of weight (100 ml/kg), next 10 kg (50 ml/kg), and remaining kg (15 ml/kg).
Fluid intake mostly oral, while fluid elimination occurs through urination, bowel movements, perspiration, breathing (insensible losses, sweat, exhaled air).

Fluid Intake and Output (mL)

Ingested water: 1,300 mL
Ingested food: 1,000 mL
Metabolic oxidation: 300 mL
Total Intake: 2,600 mL
Fluid Output:
- Kidneys: 1,500 mL
- Skin (insensible loss): 600-900 mL
- Skin (sensible loss): 0-5,000 mL
- Lungs: 400 mL
- Gastrointestinal: 100 mL
- Total Output: 2,600-2,900 mL

Three Types of Dehydration

Hypotonic dehydration: primarily a loss of electrolytes (sodium).
Hypertonic dehydration: primarily a loss of water.
Isotonic dehydration: equal loss of water and electrolytes. Considered the most common type.

Distribution of Fluids and Electrolytes

Physiological processes involve continuous translocation of fluid and chemical exchanges through active or passive transport.
Four processes govern movement through semipermeable membranes:
- Osmosis: movement of water.
- Tonicity: solute concentration in the water.
- Filtration: movement of fluid based on pressure differences.
- Diffusion: passive or facilitated movement of molecules across cell membranes along a concentration gradient.
- Active Transport: requiring energy to move solutes against a concentration gradient (e.g., sodium-potassium pump).

Fluid Balance

Maintaining plasma osmolarity (ratio of solutes to water in plasma) crucial.
Intake influenced by thirst.
Output includes urine, perspiration, breathing, and bleeding.
Pressure sensors (in blood vessels) regulate fluid balance.
Primary regulators are the renin-angiotensin-aldosterone system (RAAS) and antidiuretic hormone (ADH).
- RAAS involves angiotensin II (vasoconstriction to elevate blood pressure).
- ADH helps conserve water by increasing circulating blood volume.

Regulation of Fluid Review

Movement through capillary walls depends on hydrostatic pressure (blood pressure) and osmotic pressure (influenced by protein in plasma).
Osmoreceptors in the hypothalamus sense serum osmolality and trigger ADH release.
Baroreceptors are sensitive to changes in blood volume.
Natriuretic peptides—produced in heart muscles/ventricles and the brain—cause vasodilation and sodium excretion.

Fluid Imbalances #1- Hypovolemia

Hypovolemia: low volume of extracellular fluid (ECF).
Causes: vomiting, diarrhea, wounds, profuse urination, hemorrhage, perspiration, diuretics, low fluid intake.
High-risk patients: lethargic, sick, elderly, or those with dementia.
Dehydration: low ICF and ECF volumes.
Assessment findings: thirst, low blood pressure, changes in mentation, weak/rapid pulse.
Diagnostic findings: high hematocrit, high urine-specific gravity, electrolyte imbalances, potential blood clots.
Nursing management: restoring fluid, avoiding caffeine/sodium restriction, close monitoring for dehydration symptoms.

Fluid Imbalances #2 - Hypervolemia

Hypervolemia: high volume of water in intravascular fluid compartment, or fluid volume excess.
Causes: excessive oral or IV fluid intake; heart failure; kidney disease; adrenal gland dysfunction; circulatory overload.
Assessment findings: rapid weight gain, pitting or nonpitting edema, dependent edema, moist lung sounds, distended jugular veins.
Neuro and respiratory changes, high blood pressure.
Diagnostic findings: low hematocrit and blood cell count, low urine-specific gravity, hemodilution.
Nursing/medical management: restricting oral or parenteral fluids, diuretics to decrease fluid, limiting sodium & monitoring for dehydration.

Fluid Excess

Fluid volume excess (hypervolemia) results in excess fluid in the intravascular compartment.
Key symptoms include edema (localized water accumulation), changes in mental status (confusion or altered consciousness), increased blood pressure, rapid pulse, and an increased respiratory rate.
Clinical manifestations include pulmonary congestion, difficulty breathing (dyspnea), and an elevated heart rate (tachycardia).

Nursing Care Plan: Hypervolemia

Daily weight measurements (report 2 lb weight gain in 24 hours).
Detailed intake and output monitoring.
Assessment of thirst and promoting fluid restrictions where appropriate.
Monitoring respiratory status (lung sounds, respiratory rate and effort).
Assessing cardiovascular function (blood pressure, heart rate, jugular venous distention).
Evaluating skin for edema.
Managing or addressing edema (patient's posture, elevation of affected extremities).
Monitor for signs of fluid overload and electrolyte imbalances.
Monitor hematocrit levels.

Third-Spacing

Third-spacing involves fluid shifting from intravascular space to interstitial tissues.
Causes: hypoalbuminemia, burns, severe allergic reactions, and post-surgical complications, such as after a mastectomy, or other surgical procedures.
Assessment findings include ascites (abdominal fluid accumulation), generalized edema, and low central venous pressure (CVP).
Diagnostic findings may include hemoconcentration and/or borderline blood counts.
Treatment is aimed at returning fluid to the intravascular compartment, often through albumin infusions.
Diuretics may be used in cases of fluid overload.

Nursing Management of Fluid Imbalances

Restore fluid volume deficit or excess.
Education: 8–10 glasses of water daily, avoiding caffeine.
Monitor the daily weight gain/loss, especially a 2 lb gain in 24 hours.
Assess mental status for changes.
Monitor urine specific gravity (for color, clarity, and odor).
Monitor blood pressure (BP), intake and output (I&O), and respiratory status.
Assess for edema.

Electrolyte Imbalances Review

Electrolyte imbalances are deficiencies or excesses in electrolytes, often accompanied by fluid shifts and changes.
Deficiencies can be caused by vomiting, diarrhea, diuretic use, kidney failure, and dietary deficiencies, while conditions like burns, kidney failure, excessive ingestion of electrolytes, endocrine issues, and crushing injuries can lead to excesses.
Key priority electrolytes: sodium, potassium, calcium, and magnesium.

Electrolytes

Active chemicals carrying electrical charges (positive cations and negative anions).
Major cations: sodium, potassium, calcium, magnesium, hydrogen ions.
Major anions: chloride, bicarbonate, phosphate, sulfate, proteinate ions.
ICF primarily contains K+, while ECF primarily contains Na+.
Electrolyte concentrations differ across fluid compartments, impacting physiological function.

Sodium Imbalances #1 - Hyponatremia

Hyponatremia: low serum sodium (<135 mEq/L).
Causes: profuse diaphoresis or diuresis, loss of GI secretions, Addison disease, and dilution (e.g., syndrome of inappropriate antidiuretic hormone (SIADH)).
Assessment findings: mental confusion, cerebral edema, weakness, anorexia, elevated body temperature, tachycardia, and weak pulses; severe cases: respiratory arrest and seizures.
Management: high-sodium foods, IV fluids, and/or supplemental sodium.
Close monitoring for early and late signs/symptoms and vital signs is crucial.

Sodium Imbalances #2 - Hypernatremia

Hypernatremia: high serum sodium (>145 mEq/L).
Causes: diarrhea, excessive salt intake, fever, decreased water intake, severe burns, Cushing's syndrome, or diabetes insipidus (DI).
Assessment findings: thirst, dry/sticky mucous membranes, decreased urine output, fever, lethargy, and even coma.
Treatment: fluids (hypotonic IV solutions like 0.45% saline or 5% dextrose) and restricting sodium intake.
Monitor patient for late /serious signs/symptoms (swollen dry tongue, nauseau, vomiting, increased muscle tone)

Potassium Imbalances #1 - Hypokalemia

Hypokalemia —low serum potassium (<3.0 mEq/L).
Causes: potassium-wasting diuretics, gastrointestinal fluid loss, and corticosteroid use.
Assessment findings: fatigue, weakness, nausea, cardiac dysrhythmias, flaccid paralysis, paresthesia, leg cramps, confusion, and slow respiratory rate, low blood pressure.
Diagnostic findings: low potassium level (<3.5 mEq/L), changes evident by electrocardiogram (ECG or EKG).
Management: potassium-sparing diuretics, increasing potassium-rich foods, oral supplements, slowly administered intravenous (IV) potassium supplements.
Close monitoring needed, including cardiac output evaluation (EKG).

Potassium Imbalances #2 - Hyperkalemia

Hyperkalemia —high serum potassium (>5.5 mEq/L).
Causes: renal failure, excessive potassium intake, certain medications, and Addison’s disease.
Assessment findings: muscle weakness, cardiac dysrhythmias, paralysis, decreased reflexes and decreased respiratory rate, nausea, and vomiting, and cardiac arrest.
Diagnostic findings: high potassium level (>5.5 mEq/L), and EKG changes.
Management: decreasing potassium intake, medications like insulin or glucose to help shift potassium into cells, diuretics, kayexalate, dialysis, and supportive care.
Close monitoring crucial, especially for cardiac changes and function.

Calcium Imbalances #1 - Hypocalcemia

Hypocalcemia: low serum calcium (<8.8 mg/dL).
Causes: vitamin D deficiency, hypoparathyroidism, burns, pancreatitis, corticosteroids, blood transfusions, intestinal malabsorption, and medications.
Assessment: circumoral paresthesia (a tingling or numbness around the mouth), muscle cramps, Chvostek sign (facial twitching), Trousseau sign (carpal spasm), bleeding, tetany, bone pain, constipation, weakness, anxiety, laryngeal spasms.
Diagnostic: low calcium level (<8.8 mg/dL).
Treatment: calcium supplements (oral or IV) and vitamin D; careful monitoring for treatment response to control symptoms and avoid complications.

Calcium Imbalances #2 - Hypercalcemia

Hypercalcemia: high serum calcium (>10 mg/dL).
Causes: parathyroid tumors, multiple fractures, Paget's disease, prolonged immobilization, chemotherapy, and multiple myeloma.
Assessment: deep bone pain, constipation, anorexia (loss of appetite), polyuria (excessive urination), pathological fractures, kidney stones, fatigue, nausea, cardiac arrhythmias, muscle weakness, and altered mental status.
Diagnostic: high calcium level (>10 mg/dL).
Treatment: addressing the underlying cause (e.g., parathyroid tumor); IV saline, medications (e.g., diuretics like Lasix, corticosteroids, calcitonin), and promoting kidney stone removal.

Hypercalcemia and Hypocalcemia

CNS symptoms in Hypocalcemia: irritability, anxiety, paresthesia, seizures, laryngeal spasm, and bronchospasm.
CNS symptoms in Hypercalcemia: decreased ability to concentrate, increased need for sleep, depression, confusion, coma, and death.
CVS symptoms in Hypocalcemia: heart failure, whereas CVS symptoms in Hypercalcemia: arrhythmias, bradycardia, and cardiovascular collapse.
MSK symptoms in Hypocalcemia: muscle cramps, whereas MSK symptoms in Hypercalcemia: muscle weakness.

Magnesium Imbalances #1 - Hypomagnesemia

Hypomagnesemia: low serum magnesium (<1.3 mEq/L).
Causes: alcoholism, diabetic ketoacidosis (DKA), renal disease, burns, malnutrition, intestinal malabsorption, low magnesium intake, prolonged gastric suction, and chronic alcoholism.
Assessment: tachycardia, paresthesias, neuromuscular irritability, headaches, hypertension, mental changes, leg cramps, and Chvostek and Trousseau signs. Severe cases: anxiety, depression.
Diagnostic: low magnesium (serum magnesium < 1.3 mEq/L).
Treatment: oral or IV magnesium supplements, dietary adjustments, and addressing underlying causes.

Magnesium Imbalances #2 - Hypermagnesemia

Hypermagnesemia: high serum magnesium (>2.1 mEq/L).
Causes: renal failure, excessive antacids or laxative use, hyperparathyroidism.
Assessment: flushing, hypotension, lethargy, bradycardia, muscle weakness, coma, deep tendon reflexes (DTR) decreased, shallow respirations, and hypoactive bowel sounds.
Diagnostic: high serum magnesium levels (>2.1 mEq/L).
Treatment: reduce magnesium intake (oral and intravenous), mechanical ventilation, and support the heart and respiratory systems.

Acid-Base Balance

Crucial for maintaining normal physiologic function at a pH ranging from 7.35-7.45. Death occurs quickly if outside this narrow balance.
Chemical regulation is accomplished by buffering systems (carbonic acid (H2CO3) and bicarbonate (HCO3)).
Organ systems regulate acid-base balance:
- Lungs regulate the amount of carbonic acid (H2CO3)
- Kidneys regulate bicarbonate (HCO3).
Acidosis: excess of acid or bicarbonate loss, while alkalosis is an excess of base or acid loss.

Arterial Blood Gases (ABGs)

Normal pH: 7.35-7.45.
Normal PaCO2: 35-45 mmHg.
Normal HCO3-: 22-26 mEq/L.
ABGs help asses the condition of the lungs and the kidneys.

Acid-base Imbalances #1 - Metabolic Acidosis

Decreased plasma pH with bicarbonate loss.
Causes: shock, myocardial infarction (MI), starvation, diabetic ketoacidosis (DKA), severe diarrhea, renal failure, and aspirin overdose.
Findings: deep/rapid breathing (Kussmaul respirations), nausea, headache, flushing, abdominal pain, weakness, and vomiting.
Treatment: address underlying cause, replace lost fluids/electrolytes, and consider bicarbonate administration in severe cases.

Acid-base Imbalances #2 - Metabolic Alkalosis

Increased plasma pH with bicarbonate excess.
Causes: excessive bicarbonate intake, vomiting, gastric suction, and diuretic use.
Findings: anorexia, nausea, paresthesias, confusion, and decreased respirations.
Treatment: address the underlying cause, and consider potassium replacement and/or chloride administration, and or correction of underlying acid-base imbalance.

Acid-base Imbalances #3 - Respiratory Acidosis

Elevated carbon dioxide (CO2) levels due to inadequate CO2 elimination.
Causes: pneumothorax, pulmonary edema, asthma, pneumonia, drug overdose, and head injuries.
Findings: cyanosis, tremors, respiratory insufficiency, decreased respiratory rate (<12 breaths per minute), and lethargy.
Treatment: addressing underlying cause, airway management (e.g., suctioning), bronchodilators, and potential antibiotics.

Acid-base Imbalances #4 - Respiratory Alkalosis

Reduced carbon dioxide (CO2) levels due to hyperventilation.
Causes: anxiety, fever, overactive thyroid, aspirin poisoning, and mechanical ventilation.
Findings: increased respiratory rate, lightheadedness, numbness/tingling in extremities, paresthesias (including fingers and toes), sweating, and panic attacks.
Treatment: rebreathing techniques (e.g., brown-bag breathing), sedatives, and identifying/correcting the underlying cause.

Questions #3 and Answer

Question: Which acid-base disturbance is characteristic of a narcotic overdose?
Answer: B) Respiratory acidosis.
Rationale: Narcotic overdoses slow breathing, leading to CO2 retention and respiratory acidosis.

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Test your knowledge on fluid and electrolyte balance with this quiz. Explore key concepts such as dehydration, hypervolemia, and their effects on the cardiovascular system. Ideal for nursing students and healthcare professionals looking to enhance their understanding of fluid management.