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- Body temperature- Pulse / BP

Diagnostic Findings:

- Level of Na in blood (HIGH)- Level of Na in urine (LOW)

Management:

Fluid intake (48 hours) If cannot take in fluid orally, use IV Fluid (D5W)

2. Potassium (K+) [Normal: 3.5 5.0 mEq/L] K+ gets in the body though the food Gets out of the body by:

GUT via Urine~ (90% of K+) GIT via Feces~ (10% of K+)

a. Hypokalemia Potassium Deficit Less than 3.5 mEq/L

Causes:

- Intake of food HIGH in K+o Patients with starvation diet

Banana, Citrus Fruits, Green Leafy Veggies Potassium Content!

Beef, Pork and Chicken Potassium Content!- Gastric suctioning- Vomiting (Hyperemesis Gravidarum)- Cushings Syndrome (Hyperaldosteronism K+ Excretion!)

Manifestations:

1. Easy Fatigability2. Peristalsis of the stomach muscles (ANOREXIA)3. Constipation4. ECG Tracings:

a. U-Wave~ For children its normal = Extra excitability Abnormal for adults

b. Flattened T-Wavec. Depressed ST-Segment

Plan of Care:

Food with HIGH Potassium Content! Augmenting of K+ Supplements

o [Calcium Dural] per oremo Potassium Chloride (KCl) If cannot take orally, use IV form of KCl

In the form of IV Drip! Assess the URINE OUTPUT!

UO: NO K+b. Hyperkalemia

Potassium Excess More than 5.0 mEq/L

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Causes:

- Intake of food HIGH with Potassium- Disorders:

o UO (Renal Failure)o Addisons Disease ( Aldosterone)

K+ EXCRETION K+ RETENTION

o Destruction of Cells (Escape of K+ from the cells) Burns Metastatic Cancer Large Bed Sore

Diagnostic Findings:

- Serum Potassium is greater than 5 mEq/L- ECG

o Affectation of T-Wave Tall T-wave Prolonged QRS Complex (QRS only occupies 2 small

squares 0.08s)

Prolonged PR IntervalManifestations:

Presence of muscle cramps Intestinal colic (Due to hypermotility) Muscular weakness

Plan of Care:

- Intake of food HIGH in Potassium- Diuretics (K+ Wasting Diuretics)- The MD will order insulin

o (Short-acting/Rapid Acting) Regular Insulino Administer: IV not SQo Insulin transports K+ back to the cell to decrease the K+ in the

ECFo Administer with D10W / D50W

- Give Cation-Exchange Resin (Kayexalate)o It is effective if there are 2 3 bowel movements during the dayo Potassium is being excreted if more bowel movements

3. Calcium (Ca+) [Normal: 8.5 10.5 mg/dL]a. Hypocalcemia

Calcium Deficit Less than 8.5 mg/dL

How Does Potassium Perform Acid-Base Balance

NormalBalance: Under normal conditions, the K+ content in

the ICF is greater than in the ECF. H+ Ions is low in both

compartments

Acidosis: H+ Ions in the ECF increases due to some conditions,

and the H+ ions move into the ICF. To have balance, K+ ions

leave the cell and move into the ECF, causing

HYPERKALEMIA

Alkalosis: More H+ ions are in the ICF than in the ECF. So, theH+ ions move out of the ICF and into the ECF, to have balance,

the K+ in the ECF move into the ICF, causing HYPOKALEMIA

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Acid Base Balance

2 Important Systems in the Regulation of Acid-Base Balance

1. Lungs Compensates FASTERa. Respiration Exchange of O2 and CO2b. Ventilation Actual taking in and taking out of air

2. Kidney Compensates BETTER

Respiratory

Situations:

Climb from ground floor and then to the top floor; Hyperventilation, what will happen?Respiratory Alkalosis or Respiratory Acidosis?? Duty at around 2 10 PM, Walking on the streets at 10:30 PM, then someone suddenly followed you, what

will happen?

Respiratory Alkalosis or Respiratory Acidosis?? Someone is strangling you, what will happen?

Respiratory Alkalosis or Respiratory Acidosis?? You are choking on your food, what will happen?

Respiratory Alkalosis or Respiratory Acidosis?? From being choked, someone gave you CPR, what will happen?

Respiratory Alkalosis or Respiratory Acidosis??

3 Parameters Are Used in Acid-Base Balance 1. pH

It is the ACIDITY / ALKALINITY of the blood It is the RATIO between BASE and ACID A more precise definition is the negative representation of Hydrogen ion concentration

within the body

HYDROGEN is an ACID DONORH H2 Acidosis H H2 Alkalosis

Acidosis Alkalosis

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Normal pH: 7.35 7.45 STRICT VALUE of pH

7.4 NORMAL 7.41 7.45 ALKALOTIC 7.35 7.39 ACIDOTIC

pH Compatible with LIFE is 7 7.9!! ACCORDING TO MAM YAN 2. pCO2 (Partial Pressure of Carbon Dioxide)

A measure of respiratory functioning pCO2 is an ACID! Normal pCO2: 35 45 mmHg

3. HCO3 (Bicarbonate) A measure of metabolic functioning HCO3 Is a BASE! Normal HCO3: 22 26 mEq/L

DIFFERENT TYPES OF ACID-BASE BALANCE1. Uncompensated

a. Metabolic Acidosis UncompensatedParameter Amount Interpretation

pCO2 41 Normal

HCO3 20 Metabolic Acidosis

pH 7.31 Acidosis

b. Respiratory Alkalosis UncompensatedParameter Amount Interpretation

pCO2 30 Respiratory Alkalosis

HCO3 24 Normal

pH 7.58 Alkalosis In uncompensated acid-base imbalance, there is ONE ABNORMAL SYSTEM The other system is NORMAL and is MADAMOT (Does nothing to compensate ) The pH remains abnormal and it follows the condition of the existing abnormal system

2. Compensateda. Respiratory Acidosis Partially Compensated

Parameter Amount Interpretation

pCO2 50 Respiratory Acidosis

HCO3 29 Metabolic Alkalosis

pH 7.33 Acidosis

b. Metabolic Alkalosis Fully CompensatedParameter Amount Interpretation

pCO2 60 Respiratory Acidosis

HCO3 31 Metabolic Alkalosis

pH 7.41 Alkalosis (Strict Value 7.4)

In compensated acid-base imbalance, the two systems are ABNORMAL!! The primary abnormal system influences the other system to compensate! The pH determines if it will be considered PARTIALLY COMPENSATED or FULLY

COMPENSATED !!

JUST REMEMBER THE STRICT VALUE OF pH WHICH IS 7.4!!!

pCO2 Respiratory Acidosis

pCO2 Respiratory Alkalosis

HCO3 Metabolic Alkalosis

HCO3 Metabolic Acidosis

Situations:pCO2 = 60 RAC

HCO3 = 30 MAL

pH = 7.42 N(AL)

pCO2 = 60 RAC

HCO3 = 30 MAL

pH = 7.38 Acidosis