Electrolytes 2
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Transcript of Electrolytes 2
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ELECTROLYTES PATHWAY
by JVRosano, OD MACT RN MAED
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Electrolytes Substance responsible
for:
Blood volume regulation
Nerve impulse transmission Muscle contractility, bone
and teeth formation
Acid and base balance,
buffer system Plasma osmolality
Energy storage andnutrients metabolism
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Key Points!
Major source: food intake, SUPPLEMENTS
Excretion: kidneys, GIT, sweat,
Imbalance is usually associated withdiseases:
DM, DI, SIADH, BURNS, CRF, CHF, DIARRHEA,CUSHINGS, ADDISONS, ACIDOSIS
DRUGS: laxatives, diuretics
FOUND in the water compartment
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Electrolyte Imbalance
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Electrolyte Imbalance
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Types
of Ions
CATIONS OR POSITIVE CHARGE1. Na2. K
3. Ca4. Mg5. H
ANIONS OR NEGATIVE CHARGE1. Cl2. PO4
3. HCO3
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Sodium
Positively charged ion (cation)
MAJOR EXTRACELLULARCATION
Maintains plasma osmolality
Important for nerve impulsetransmission
Normal value: 135-145 meq/L
RDA: 0.5 2.7gm/day up to 6gm/day
Source: cooked foods, cannedfoods, cheese, ketchup
Regulated by Aldosterone
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Hypernatremia Cause: hyperaldosteronism or FVD
S/sx:
Na=increased brain activityH2O=FVD or FVEHypokalemia
Mgt: restrict Na and H2O
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Hyponatremia Cause: hypoaldosteronism or FVE
S/sx:
Na=decreased brain activityH2O=FVE or FVDHyperkalemia
Mgt: restrict H2O and give Na oraland IV (NaCl)
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Potassium Positively charged ion (cation)
MAJOR INTRACELLULARCATION
Inhibits cardiac excitability
Normal value: 3.5-5.0 meq/L
Source: banana, orange, potatoor any fresh fruits and rawvegetables
Mainly excreted by the kidneys
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Hyperkalemia Cause: RF most common,
Hypoaldosteronism
S/sx:Heart=bradycardia and peaked T waveGIT=diarrheaMuscle=flaccidity to weakness
Mgt: kayexalate, insulin and DIALYSIScalcium gluconate to improve heartcontraction
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Hypokalemia Cause: diuretics and laxatives or
hyperaldosteronism
S/sx:Heart=tachycadia and inverted Twave, U wave prominent appearance
GIT=constipationMuscle=spasticity to weakness
Mgt: oral, tablet and KCl IV
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Calcium Positively charged ion
(cation)
99% are stored in thebones and teeth
Aids in muscle contraction
Helps in blood coagulation
Normal value: 8.5-10.5mg/dL
RDA: 800 1200 mg/day
Source: dairy products
(milk, cheese, yogurt) BINDS with albumin
Requires vitamin D forintestinal Ca absorption
Regulated by parathormone
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Vitamin D
VITAMIN D INTAKESMALL INTESTINE
BILE and FATSVITAMIN D IS ABSORBED
SKINSUNLIGHT FOR SYNTHESIS
KIDNEYSACTIVE VITAMIN D
1,25 DIHYDROXY-CHOLECALCIFEROL
CALCIUM INTAKESMALL INTESTINE
VITAMIN DCALCIUM ABSORPTION99% BONES AND TEETH
1% BLOOD
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Parathormone
LOW SERUM CALCIUMTRIGGERS PTG
PARATHORMONE
EFFECTS1. GIT
CALCIUM ABSORPTION
2. KIDNEYS CALCIUM REABSORPTION
PO4 EXCRETION3. BONES OSTEOCLAST ACTIVITY
SERUM CALCIUM
HIGH SERUM CALCIUMEFFECTS ARE
OPPOSITE
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Hypercalcemia Cause: hyperparathyhroidism
S/sx:
deep bone painlithiasis formation (calcium stones)
HYPOPHOSPHATEMIA (low energystore)
Mgt: parathyroidectomy, hydration,prevent fracture reduce Ca intake,DIALYSIS
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Hypocalcemia Cause: hypoparathyroidism
S/sx:
TETANY=tingling, Trousseau,Chvosteks and laryngeal spasmHYPERPHOSPHATEMIA(calcification)
Mgt: oral, tablet and calciumgluconate IVrespiratory support for laryngeal
spasm
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Phosphate
Negatively charged ion (anion)
Hydrogen buffer
Energy formation ATP, metabolizes nutrients 2,3 DPG diphosphoglycerate (delivers O2)
Normal value: 1.8-2.6 meq/L
Source: same with Calcium Regulated by Calcitonin
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Calcitonin
LOW LEVEL OF PHOSPHATETRIGGERS
THYROID GLAND CALCITONIN
EFFECTSGIT:
PO4 ABSORPTIONKIDNEYS: PO4 REABSORPTION
CALCIUM EXCRETION
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Magnesium
Positively charged ion(cation)
Aids in nerve impulse
transmission Plays a role for nutrients
metabolism
Normal value: 1.5-2.6 meq/L
Source: chocolates, drybeans, meats, nuts, seafoods
Regulated by Parathormone
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Hypermagnesemia Cause: RF most common
S/sx:
DTRs decrease
decrease RR
sensorium changesHYPERCALCEMIA
Mgt: laxatives, diuretics, DIALYSIS
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Hypomagnesemia Cause: alcoholism
S/sx: (inverse to brain activity)
DTRs increaseincrease RR
change in level of sensorium
HYPOCALCEMIA Mgt: oral tablet of MgSO4 or
parenteral
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Comparatively
Hypomag
S/sx:DTR +++, ++++
BB spastic incontinence,
Decreased VC
BRAIN seizuresHYPOCALCEMIA
Hypermag
S/sx:DTR 0, +
BB flaccid distention,
Decreased VC
BRAIN dec LOCHYPERCALCEMIA
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Chloride Relative to Na and H ion
Acid by nature
Found chiefly in the GIT
High level = acidosis
Low level = alkalosis
Inverse to HCO3
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Chloride Pathways level level
metabolic acidosis metabolic alkalosis
H : HCO3 HCO3 : H blood pH blood pHacidemia alkalinemia
CO2 expulsion CO2 expulsion RR RRH excretion HCO3 excretionacidic urine alkali urineK, Ca, Mg move inside K, Ca, Mg move outsidecausing a high level of these causing a low level of thesein the blood in the bloodblood vessels will dilate blood vessels will spasm O2 supply to vital organs O2 supply to vital organs
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Acid Base Regulation
During Acidosis and Alkalosis
Body will try to compensate
Buffer System HCO3:H2CO3 (20:1) ratio
Phosphate
Protein
Lungs = retention of CO2 or expulsion
Kidneys = excrete or reabsorb HC03 and Hions
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Acid Base Regulation
1. Buffer System
2. Respiratory Center
3. Kidneys
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1. Buffer System NaBICARBONATE-CARBONIC ACIDHCO3:H2CO3 (20:1 ratio)Example:HCl + NaHCO3 H2CO3 + NaCl
H2CO3 H2O + CO2
THE PHOSPHATE SYSTEMNaH2PO4 and Na2HPO4Example:HCl + Na2HPO4 NaH2PO4 + NaClNaOH + NaH2PO4 Na2HPO4 + H2O
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1. Buffer System THE PROTEIN BUFFER SYSTEMHCl + NaNH3 NH4 + NaCl
THE HEMOGLOBIN SYSTEMSECOND LEVEL OF BUFFER
most important buffer
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2. Respiratory System
H ions and CO2
(blood)
Stimulates the
Medulla Oblongata
RRHyperventilation
H ions and CO2
(blood)
H ions and CO2(blood)
Stimulates the
Medulla Oblongata
RRHypoventilation
H ions and CO2
(blood)
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2. Respiratory System
CO2 + H2O H2CO3 H + HCO3
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3. Renal Regulation
H ions and HCO3
(blood)
H tubular excretion HCO3 tubular excretion
Acidic urineOr
H tubular reabsorption HCO3 tubular reabsorption
H ions and HCO3
(blood)
H ions and HCO3
(blood)
H tubular excretion HCO3 tubular excretion
Alkali urineOr
H tubular reabsorption HCO3 tubular reabsorption
H ions and HCO3
(blood)
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How to obtain blood sample?
Allens test - evaluatepatency of radial andulnar artery
Heparinized syringeand container
Pressure dressing, noactivity at the site andcheck 5 ps distal tothe site of puncturedartery
Note if patient is underO2 therapy
Label the sample andsend immediately tothe laboratory
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ABG Responsibilities
Arterial blood
Radial or ulnar artery
Allens test
Prepare Heparinized (Syringe,
specimen container)
Note: 02 therapy,FIO2, temp
Bring specimen to theLAB (ice)
http://images.google.com.ph/imgres?imgurl=http://www.smithsoem.com/images/pd_arterial_blood_sampling.jpg&imgrefurl=http://www.smithsoem.com/pd_bloodsampling.php&h=368&w=200&sz=11&hl=tl&start=2&tbnid=sd57C6x8uBzdtM:&tbnh=122&tbnw=66&prev=/images?q=arterial+blood+gas&svnum=10&hl=tl&lr= -
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After injection
Maintain extension position, no activity
8H
Apply pressure 5-15 min
Observe the site
Distal, 5 ps
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5 Ps
Pulselessness
Pain
Paresthesia
Poikilothermia
Pallor
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Handling of Specimen
Expel all air bubbles immediately
Do not agitate the syringe
Discard frothy specimen
1:1000 U/ml HEPARIN
Place sample in ice
Cool sample to 5 C if it can not beanalyzed quickly
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ABG Interpretation pH potential hydrogen or power of hydrogen
Normal value: 7.35-7.45
H ion reflection: H=pH
H=pH Low pH indicates ACIDOSIS
High pH indicates ALKALOSIS
Example:
7.33 = ACIDOSIS 7.47 = ALKALOSIS
Note: pH change is dependent to CO2 and HCO3 levelin the blood
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HCO3 bicarbonate
Normal value: 22-26 meq/L
By nature its alkali same Example:
20 = Metabolic Acidosis = H=pH
28 = Metabolic Alkalosis = H=pH
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CO2 carbon dioxide
Normal value: 35-45 mm Hg
By nature its acid opposite to pH andHCO3
Example:
48 = Respiratory Acidosis = H=pH 33 = Respiratory Alkalosis = H=pH
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Pa O2 Normal value = 80-100 mmHg
Below 80 is hypoxemia 70-79 mild
60-69 moderate
50-59 severe
Above 100 is hyperoxemia
FIO2 fraction of inspired oxygen By percent above 20%
Mech vent, venturi, high or low flow
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DRILL
pH = 7.33
HCO3 = 20PaCO2 = 40Metabolic Acidosis
pH = 7.47HCO3 = 28PaCO2 = 40
Metabolic Alkalosis
pH = 7.33HCO3 = 24
PaCO2 = 48Respiratory Acidosis
pH = 7.47HCO3 = 24
PaCO2 = 32Respiratory Alkalosis
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DRILL
pH = 7.33HCO3 = 20
PaCO2 = 48Mixed Acidosis
pH = 7.40HCO3 = 28
PaCO2 = 32Mixed Alkalosis
pH = 7.33PaCO2 = 48HCO3 = 20
Mixed Acidosis
pH = 7.40PaCO2 = 32
HCO3 = 28Mixed Alkalosis
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DRILL
pH = 7.33HCO3 = 20PaCO2 = 32
Uncompensated Metabolic Acidosis
pH = 7.47HCO3 = 28
PaCO2 = 48Uncompensated Metabolic Alkalosis
pH = 7.33HCO3 = 28PaCO2 = 48
Uncompensated Respiratory Acidosis
pH = 7.47HCO3 = 20PaCO2 = 32
Uncompensated Respiratory Alkalosis
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DRILL
pH = 7.40HCO3 = 18
PaCO2 = 32Compensated Metabolic Acidosis
pH = 7.35HCO3 = 30PaCO2 = 48
Compensated Metabolic Alkalosis
pH = 7.40HCO3 = 28
PaCO2 = 48Compensated Respiratory Acidosis
pH = 7.44HCO3 = 20PaCO2 = 32
Compensated Respiratory Alkalosis
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comparatively
pH = 7.33 HCO3 = 20 PaCO2 = 32 Uncompensated Metabolic Acidosis
pH = 7.35
HCO3 = 30 PaCO2 = 48 Compensated Metabolic Alkalosis
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DRILL
pH = 7.40HCO3 = 18
PaCO2 = 32FullyCompensated Metabolic Acidosis
pH = 7.35HCO3 = 30
PaCO2 = 48PartiallyCompensated Metabolic Alkalosis
pH = 7.40HCO3 = 28PaCO2 = 48
FullyCompensated Respiratory Acidosis
pH = 7.44HCO3 = 20PaCO2 = 32
PartiallyCompensated Respiratory Alkalosis
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pH = 7.45
HCO3 = 23
PaCO2 = 34
Simple Respiratory Alkalosis
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pH = 7.34
HCO3 = 21
PaCO2 = 43
Metabolic Acidosis
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pH = 7.48
HCO3 = 27
PaCO2 = 34
Mixed Alkalosis
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pH = 7.32
HCO3 = 29
PaCO2 = 48
Uncompensated RespiratoryAcidosis
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pH = 7.33
HCO3 = 29
PaCO2 = 48
Pa O2 = 65
Uncompensated RespiratoryAcidosis
With Moderate Hypoxemia
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pH = 7.48
HCO3 = 28
PaCO2 = 48
Pa O2 = 50
Uncompensated MetabolicAlkalosis
With Severe Hypoxemia
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tnk u po!