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balance of fluids, electrolytes, and acids and bases is required to maintain good health. balance is called Homeostasis.

€ This

€ Intracellular

fluid (ICF)

‡ found within the cells of the body ‡ constitutes 2/3 of total body fluid in adults ‡ major cation is potassium
€ Extracellular

fluid (ECF)

‡ found outside the cells ‡ accounts of 1/3 of total body fluid ‡ major cation is sodium

€ Osmosis

‡ movement of water across cell membranes from

less concentrated to more concentrated
€ Solutes

‡ substances dissolved in a liquid
€ Osmolality

‡ the concentration within a fluid

€ Diffusion

‡ movement of molecules in liquids from an area of higher

concentration to lower concentration
€ Filtration

‡ fluid and solutes move together across a membrane

from area of higher pressure to one of lower pressure
€ Active


‡ substance moves across cell membranes from less concentrated solution to more concentrated - requires a carrier

€ Urine € Insensible € Feces

fluid loss

€ Sodium € Potassium € Chloride € Phosphate € Magnesium € Calcium € Bicarbonate

Electrolytes are important for: . Maintaining fluid balance . Contributing to acid-base regulation . Facilitating enzyme reactions . Transmitting neuromuscular reactions

€ Acid-Base

balance is:

‡ the regulation of HYDROGEN ions.

€ The

acidity or alkalinity of a solution is measured as pH. € The more acidic a solution, the lower the pH. € The more alkaline a solution , the higher the pH. € Water has a pH of 7 and is neutral. € The pH of arterial blood is normally between 7.35 and 7.45

€ The

more Hydrogen ions, the more acidic the solution and the LOWER the pH

€ The

lower Hydrogen concentration, the more alkaline the solution and the HIGHER the pH

€ Know

what is normal.

€ Regulate

pH by binding or releasing Hydrogen important buffer system:

€ Most

‡ Bicarbonate-Carbonic Acid Buffer System x (Blood Buffer systems act instantaneously and thus constitute the body¶s first line of defense against acidbase imbalance)

€ Lungs

‡ help regulated acid-base balance by

eliminating or retaining carbon dioxide ‡ pH may be regulated by altering the rate and depth of respirations ‡ changes in pH are rapid,
x occurring within minutes

‡ normal CO2 level x 35 to 45 mm Hg

€ Kidneys

‡ the long-term regulator of acid-base balance ‡ slower to respond x may take hours or days to correct pH ‡ kidneys maintain balance by excreting or

conserving bicarbonate and hydrogen ions
‡ normal bicarbonate level x 22 to 26 mEq/L.

€ Age
‡ especially infants and the elderly

€ Gender

and Body Size Temperature

m am ount of fat
€ Environmental € Lifestyle
‡ stress

€ Respiratory

Acidosis € Respiratory Alkalosis € Metabolic Acidosis € Metabolic Alkalosis

€ Mechanism

‡ Hypoventilation or Excess CO2 Production
€ Etiology

‡ COPD ‡ Neuromuscular Disease ‡ Respiratory Center Depression ‡ Late ARDS ‡ Inadequate mechanical ventilation ‡ Sepsis or Burns ‡ Excess carbohydrate intake

€Symptoms ‡ Dyspnea, Disorientation or coma ‡ Dysrhythmias ‡ pH < 7.35, PaCO2 > 45mm Hg ‡ Hyperkalemia or Hypoxemia €Treatment ‡ Treat underlying cause ‡ Support ventilation ‡ Correct electrolyte imbalance ‡ IV Sodium Bicarb

€ Risk
x x x x x x x

Factors and etiology
extreme anxiety, stress, or pain elevated body temperature overventilation with ventilator hypoxia salicylate overdose hypoxemia (emphysema or pneumonia) CNS trauma or tumor

‡ Hyperventilation due to

€ Symptoms ‡ Tachypnea or Hyperpnea ‡ Complaints of SOB, chest pain ‡ Light-headedness, syncope, coma, seizures ‡ Numbness and tingling of extremities ‡ Difficult concentrating, tremors, blurred vision ‡ Weakness, paresthesias, tetany ‡ Lab findings
x pH above 7.45 x CO2 less than 35

€ Treatment

x Monitor VS and ABGs x Treat underlying disease x Assist client to breathe more slowly x Help client breathe in a paper bag x or apply rebreather mask x Sedation

€ Risk


‡ Conditions that increase acids in the blood x Renal Failure x DKA x Starvation x Lactic acidosis ‡ Prolonged diarrhea ‡ Toxins (antifreeze or aspirin) ‡ Carbonic anhydrase inhibitors - Diamox

€Symptoms ‡ Kussmaul¶s respiration ‡ Lethargy, confusion, headache, weakness ‡ Nausea and Vomiting

‡ Lab:
x pH below 7.35 x Bicarb less than 22

€Treatment ‡ treat underlying cause ‡ monitor ABG, I&O, VS, LOC

Sodium Bicarb?

€ Risk


‡ Acid loss due to x vomiting x gastric suction ‡ Loss of potassium due to x steroids x diuresis ‡ Antacids (overuse of)

€Symptoms ‡ Hypoventilation (compensatory) ‡ Dysrhythmias, dizziness ‡ Paresthesia, numbness, tingling of extremities ‡ Hypertonic muscles, tetany ‡ Lab: pH above 7.45, Bicarb above 26
x x CO2 normal or increased w/comp Hypokalmia, Hypocalcemia

€Treatment ‡ I&O, VS, LOC ‡ give potassium ‡ treat underlying cause

€ Respiratory € Opposite € Metabolic € Equal

€1. €2. €3.

Look at the pH Check the CO2 (respiratory indicator) Check the HCO3 (metabolic indicator) is primary disorder (Resp. or

x is the primary problem acidosis (low) or alkalosis (high) x is it less than 35 (alkalosis) or more than 45 (acidosis)

x is it less than 22 (acidosis) or more than 26 (alkalosis)

€4. Which Metabolic)?

x If the pH is low (acidosis), then look to see if CO2 or HCO3 is acidosis (which ever is acidosis will be primary). x If the pH is high (alkalosis), then look to see if CO2 or HCO3 is alkalosis (which ever is alkalosis is the primary).
x The one that matches the pH (acidosis or alkalosis), is the primary disorder.

€ The

Respiratory system and Renal systems compensate for each other ‡ attempt to return the pH to normal € ABG¶s show that compensation is present when ‡ the pH returns to normal or near normal € If the nonprimary system is in the normal range (CO2 35 to 45) (HCO3 22-26), then that system is not compensating for the primary.

For example: ‡ In respiratory acidosis (pH<7.35, CO2>45), if the HCO3 is >26, then the kidneys are compensating by retaining bicarbonate. ‡ If HCO3 is normal, then not compensating.