Fluids, Electrolytes, and Acid-Base Balance
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Questions and Answers

A patient presents with lethargy, loss of reflexes, and dysrhythmias. Which of the following electrolyte imbalances is most likely?

  • Hypercalcemia
  • Hypermagnesemia (correct)
  • Hypomagnesemia
  • Hypokalemia

    • Which of the following is a common cause of respiratory acidosis?

  • Hyperventilation
  • Hypoventilation (correct)
  • Prolonged vomiting
  • Diarrhea

    • Which of the following is TRUE regarding the bicarbonate buffer system?

  • It is the primary mechanism for maintaining acid-base balance in the body.
  • It is a long-term mechanism for compensating for acid-base imbalances.
  • It is not involved in the regulation of acid-base imbalances.
  • It is a short-term mechanism for compensating for acid-base imbalances. (correct)

    • A patient with a history of chronic alcoholism presents with tremors, confusion, and seizures. What is the most likely electrolyte imbalance present?

    <p>Hypomagnesemia (D)</p> Signup and view all the answers

    What is the main electrolyte responsible for maintaining acid-base balance in the body?

    <p>Bicarbonate (HCO3-) (C)</p> Signup and view all the answers

    A patient with excessive vomiting is at risk for which acid-base imbalance?

    <p>Metabolic alkalosis (A)</p> Signup and view all the answers

    Which of the following is NOT a cause of metabolic acidosis?

    <p>Hypoventilation (A)</p> Signup and view all the answers

    Which organ plays a crucial role in long-term regulation of acid-base balance?

    <p>Kidneys (C)</p> Signup and view all the answers

    Which of the following is a common side effect of Magnesium-based laxatives and antacids?

    <p>Hypermagnesemia (A)</p> Signup and view all the answers

    Which of the following are NOT considered sensible fluid losses?

    <p>Skin (B)</p> Signup and view all the answers

    What is the primary extracellular cation?

    <p>Sodium (D)</p> Signup and view all the answers

    Which of the following is NOT a cause of hypernatremia?

    <p>Fluid volume overload (D)</p> Signup and view all the answers

    What is the normal range for potassium?

    <p>3.5-5 mEq/L (B)</p> Signup and view all the answers

    Which of the following is a sign or symptom of hypocalcemia?

    <p>Tetany (A)</p> Signup and view all the answers

    A patient presents with muscle weakness, constipation, and cardiac dysrhythmias. What electrolyte imbalance is most likely present?

    <p>Hypokalemia (D)</p> Signup and view all the answers

    Which of the following medications can contribute to hypokalemia?

    <p>Thiazide and Loop diuretics (C)</p> Signup and view all the answers

    In children, insensible losses of fluid are primarily through which route?

    <p>Skin (C)</p> Signup and view all the answers

    What is the goal of fluid resuscitation in a child with moderate to severe dehydration?

    <p>20 ml/kg boluses (C)</p> Signup and view all the answers

    What electrolyte is considered safe to administer only once urine output is adequate?

    <p>Potassium (D)</p> Signup and view all the answers

    Which of the following contributes to the increased risk of dehydration in the elderly?

    <p>Impaired mobility (C)</p> Signup and view all the answers

    Which of the following is an appropriate method for assessing fluid balance?

    <p>Assessing multiple indicators, including weight, skin turgor, urine output, and vital signs (D)</p> Signup and view all the answers

    Flashcards

    Fluid Distribution

    The division of body fluids into compartments: 65% intracellular, 35% extracellular.

    Electrolytes

    Mineral salts that dissolve in water, separating into ions crucial for body functions.

    Diffusion

    Movement of ions from high to low concentration.

    Osmosis

    Movement of water from low to high solute concentration.

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    Fluid Volume Overload Symptoms

    Signs include weight gain, hypertension, and pitting edema.

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    Fluid Volume Deficit Symptoms

    Signs include weight loss, hypotension, and dry mucus membranes.

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    Fluid Balance in Children

    Children have higher dehydration risk due to greater output than intake.

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    Hyponatremia

    Low sodium levels (<136 mEq/L) caused by excess water or loss of salt.

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    Hypernatremia

    High sodium levels (>145 mEq/L) due to dehydration or excess sodium.

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    Hypokalemia

    Low potassium levels (<3.5 mEq/L), often due to GI losses or diuretics.

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    Hyperkalemia

    High potassium levels (>5 mEq/L) from kidney failure or excessive intake.

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    Hypocalcemia

    Low calcium levels (<9 mg/dL) due to deficiencies or kidney failure.

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    Hypercalcemia

    High calcium levels (>10.5 mg/dL) due to prolonged immobilization or tumors.

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    Tenting Turgor

    Signs of dehydration where skin remains elevated when pinched.

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    Electrolyte Normal Ranges

    Sodium: 135-145, Potassium: 3.5-5, Calcium: 8.4-10.5 mg/dL.

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    Hypomagnesemia

    Magnesium levels less than 1.8 MEQ/L, often due to malnutrition or laxative use.

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    Hypermagnesemia

    Magnesium levels greater than 2.6 MEQ/L, often caused by kidney failure or magnesium-based medications.

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    Acidosis

    A condition where body fluids have excess acid, indicated by pH less than 7.35.

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    Alkalosis

    A condition with excess base in the body fluids, indicated by pH greater than 7.45.

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    Blood pH Normal Range

    Normal blood pH ranges from 7.35 to 7.45.

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    Respiratory Acidosis

    Condition where pH decreases and CO2 increases (pH < 7.35, CO2 > 45).

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    Metabolic Acidosis

    Condition with decreased pH and bicarbonate levels (pH < 7.35, HCO3 < 22).

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    Bicarbonate Buffer System

    System that helps maintain pH balance via bicarbonate retention and hydrogen excretion.

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    Causes of Alkalosis

    Metabolic or respiratory causes including antacid overuse or hyperventilation.

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    Signs of Hypermagnesemia

    Symptoms include lethargy, loss of reflexes, and can lead to cardiac arrest.

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    Study Notes

    Fluids, Electrolytes, and Acid-Base Balance

    • Fluids are water with dissolved or suspended substances (glucose, proteins, ions, cells).
    • Electrolytes are mineral salts that dissolve in water and separate into ions (charged particles). Cations include sodium, potassium, calcium, and magnesium. Anions include chloride, bicarbonate, and phosphate.
    • Fluid distribution in the body includes: 65% intracellular (inside cells), 35% extracellular (outside cells); 25% interstitial (between cells), 8% intravascular (in blood vessels), and 2% transcellular (in small fluid pockets).
    • Homeostasis is maintained through diffusion (high to low), osmosis (low to high), filtration (high to low), and active transport (low to high using ATP).
    • Edema results from an error in filtration.
    • Factors affecting intake and absorption include fluid intake (food, G-tube), thirst triggered by hypovolemia, increased blood osmolality, or decreased blood volume. Fluid distribution includes filtration between spaces (kidneys, vascular/interstitial), and osmosis between cells. Fluid Output includes sensible losses (kidneys/urine, diarrhea, emesis) and insensible losses (lungs, skin).

    The Renin-Angiotensin-Aldosterone System (RAAS)

    • The renin-angiotensin-aldosterone system (RAAS) increases blood volume and increases blood pressure.
    • Renin is made by the liver, aldosterone is produced by the adrenal glands, ADH is made in the hypothalamus and released by the posterior pituitary, ANP is made by atrial cells in the heart, and renin is produced by the heart.
    • Direct effects of RAAS include constricting arteries, increasing cardiac output, increasing blood pressure and volume, decreasing glomerular filtration rate, and increasing thirst.
    • Aldosterone causes nephron distal tubules to reabsorb more sodium and water, increasing blood volume.
    • Atrial natriuretic peptide (ANP) decreases blood volume and pressure by increasing the glomerular filtration rate, decreasing sodium reabsorption, and inhibiting renin, aldosterone, and ADH release.

    Fluid Balance

    • Signs and symptoms of fluid volume overload include weight gain, hypertension, tachycardia, bounding pulse, crackles, dyspnea, orthopnea, and pitting edema. Jugular vein distension is also observed.
    • Signs and symptoms of fluid volume deficit include weight loss, hypotension (orthostatic first), tachycardia, tachypnea, poor/tenting turgor, dry cracked mucous membranes, and scant, dark urine (oliguria).

    Fluid Balance in Children

    • Children are at greater risk of dehydration than adults.
    • Fluid and electrolyte imbalances occur more frequently and rapidly in pediatric patients, necessitating prompt management.
    • Infants and young children have difficulties compensating for fluid losses. Insensible losses through skin increase with fever. A child loses approximately 7ml/kg every 24 hours for each degree above 99.

    S/S of Dehydration in Children

    • Mild dehydration presents with normal appearance, increased thirst, and decreased urine output (UOP).
    • Moderate dehydration presents with tacky mucosa, decreased tears, decreased UOP, increased thirst, and slightly sunken orbits. Lethargy, poor turgor, tachycardia, and tachypnea are also observed.
    • Severe dehydration presents with dry, cracked mucosa, absent tears, oliguria/anuria, intense thirst, sunken orbits, tenting turgor, tachycardia (>160), tachypnea, hypotension (<70), and cool and mottled skin.

    Fluid Resuscitation in Children

    • The goal is to maintain fluid and electrolyte balance.
    • Oral hydration is preferred for alert children.
    • The goal is 10ml/kg/hour plus losses from the previous hour. Parenteral routes are used for moderate to severe dehydration. 
    • Administer 20ml/kg fluid boluses. 
    • Use infusion pumps for precise intake and output measurement (I&O). 
    • Treatment focuses on addressing the underlying cause of the fluid imbalance.

    Fluid Balance in the Elderly

    • Elderly individuals are at greater risk of fluid volume deficit due to decreased body water percentage, decreased thirst mechanism, difficulties obtaining fluids due to mobility issues, and potential medication-induced fluid excretion.

    Electrolytes

    • Electrolytes include sodium (135-145mEq/L), potassium (3.5-5mEq/L), calcium (8.4-10.5mg/dL), magnesium (1.5-2.5mEq/L), chloride (95-105mEq/L), bicarbonate (22-26 Arterial/24-30 Venous), and phosphate (2.7-4.5mg/dL).
    • Hyponatremia (<136mEq/L) and hypernatremia (>145mEq/L) are electrolyte imbalances affecting sodium levels, each with different causes, symptoms, and critical findings.
    • Hypokalemia (<3.5mEq/L) and hyperkalemia (>5mEq/L), related to potassium levels, involve a range of causes, symptoms, and critical findings
    • Hypocalcemia (<9mg/dL) and hypercalcemia (>10.5mg/dL), related to calcium levels, present with a variety of causes, symptoms and critical findings.
    • Hypophosphatemia (<3mg/dL) and hyperphosphatemia (>4.5mg/dL), related to phosphate levels, involve a range of causes, symptoms, and critical findings.
    • Hypomagnesemia (<1.8mEq/L) and hypermagnesemia (>2.6mEq/L) include a range of causes, symptoms and critical findings for magnesium levels.
    • ECG changes in hyperkalemia may include peaked T waves, prolonged QRS intervals, and wide QRS complexes.

    Acid-Base Balance

    • pH is the potential to accept more hydrogen. High pH represents alkalosis (base), and low pH represents acidosis.
    • The body has two primary types of acids: carbonic acid (H2CO3) that is expelled during exhalation, and metabolic acids (lactic and citric acids) that are expelled through the kidneys.
    • The bicarbonate buffer system regulates acid-base balance by absorbing or releasing hydrogen ions.
    • Blood buffers (bicarbonate, phosphate, hemoglobin, and plasma proteins) act immediately to bind hydrogen ions.
    • Respiration regulates carbon dioxide levels, impacting acid-base balance.
    • Kidneys regulate bicarbonate and hydrogen excretion, a slower but more effective process
    • Normal pH range is 7.35-7.45, with CO2 levels typically 35-45mmHg, and bicarbonate (HCO3) ranging from 22-26mEq/L.

    Acid-Base Imbalances

    • Causes and associated findings are provided for metabolic and respiratory acidosis and alkalosis in the patient presentations.

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    IB Fluids, Electrolytes and Acid-Base Balance Lecture Notes PDF

    Description

    Explore the crucial concepts of fluids, electrolytes, and acid-base balance in the human body. This quiz covers fluid distribution, homeostasis mechanisms, and factors affecting fluid intake and absorption. Test your knowledge on the intricacies of body fluids and their importance in maintaining health.

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