electrolytes 2

8/4/2019 Electrolytes 2

1/54

1

ELECTROLYTES PATHWAY

by JVRosano, OD MACT RN MAED


2/54

2

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


3/54

3

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


4/54

4

Electrolyte Imbalance


5/54

5

Electrolyte Imbalance


6/54

6

Types

of Ions

CATIONS OR POSITIVE CHARGE1. Na2. K

3. Ca4. Mg5. H

ANIONS OR NEGATIVE CHARGE1. Cl2. PO4

3. HCO3


7/54

7

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


8/54

8

Hypernatremia Cause: hyperaldosteronism or FVD

S/sx:

Na=increased brain activityH2O=FVD or FVEHypokalemia

Mgt: restrict Na and H2O


9/54

9

Hyponatremia Cause: hypoaldosteronism or FVE

S/sx:

Na=decreased brain activityH2O=FVE or FVDHyperkalemia

Mgt: restrict H2O and give Na oraland IV (NaCl)


10/54

10

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


11/54

11

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


12/54

12

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


13/54

13

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


14/54

14

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


15/54

15

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


16/54

16

Hypercalcemia Cause: hyperparathyhroidism

S/sx:

deep bone painlithiasis formation (calcium stones)

HYPOPHOSPHATEMIA (low energystore)

Mgt: parathyroidectomy, hydration,prevent fracture reduce Ca intake,DIALYSIS


17/54

17

Hypocalcemia Cause: hypoparathyroidism

S/sx:

TETANY=tingling, Trousseau,Chvosteks and laryngeal spasmHYPERPHOSPHATEMIA(calcification)

Mgt: oral, tablet and calciumgluconate IVrespiratory support for laryngeal

spasm


18/54

18

Phosphate

Negatively charged ion (anion)

Hydrogen buffer

Energy formation ATP, metabolizes nutrients 2,3 DPG diphosphoglycerate (delivers O2)


Source: same with Calcium Regulated by Calcitonin


19/54

19

Calcitonin

LOW LEVEL OF PHOSPHATETRIGGERS

THYROID GLAND CALCITONIN

EFFECTSGIT:

PO4 ABSORPTIONKIDNEYS: PO4 REABSORPTION

CALCIUM EXCRETION


20/54

20

Magnesium

Positively charged ion(cation)

Aids in nerve impulse

transmission Plays a role for nutrients

metabolism


Source: chocolates, drybeans, meats, nuts, seafoods

Regulated by Parathormone


21/54

21

Hypermagnesemia Cause: RF most common

S/sx:

DTRs decrease

decrease RR

sensorium changesHYPERCALCEMIA

Mgt: laxatives, diuretics, DIALYSIS


22/54

22

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


23/54

23

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


24/54

24

Chloride Relative to Na and H ion

Acid by nature

Found chiefly in the GIT

High level = acidosis

Low level = alkalosis

Inverse to HCO3


25/54

25

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


26/54

26

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


27/54

27

Acid Base Regulation

1. Buffer System

2. Respiratory Center

3. Kidneys


28/54

28

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


29/54

29

1. Buffer System THE PROTEIN BUFFER SYSTEMHCl + NaNH3 NH4 + NaCl

THE HEMOGLOBIN SYSTEMSECOND LEVEL OF BUFFER

most important buffer


30/54

30

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)


31/54

31

2. Respiratory System

CO2 + H2O H2CO3 H + HCO3


32/54

32

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)


33/54

33

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


34/54

34

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=


35/54

35

After injection

Maintain extension position, no activity

8H

Apply pressure 5-15 min

Observe the site

Distal, 5 ps


36/54

36

5 Ps

Pulselessness

Pain

Paresthesia

Poikilothermia

Pallor


37/54

37

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


38/54

38

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


39/54

39

HCO3 bicarbonate

Normal value: 22-26 meq/L

By nature its alkali same Example:

20 = Metabolic Acidosis = H=pH

28 = Metabolic Alkalosis = H=pH


40/54

40

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


41/54

41

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


42/54

42

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


43/54

43

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


44/54

44

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


45/54

45

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


46/54

46

comparatively

pH = 7.33 HCO3 = 20 PaCO2 = 32 Uncompensated Metabolic Acidosis

pH = 7.35

HCO3 = 30 PaCO2 = 48 Compensated Metabolic Alkalosis


47/54

47

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


48/54

48

pH = 7.45

HCO3 = 23

PaCO2 = 34

Simple Respiratory Alkalosis


49/54

49

pH = 7.34

HCO3 = 21

PaCO2 = 43

Metabolic Acidosis


50/54

50

pH = 7.48

HCO3 = 27

PaCO2 = 34

Mixed Alkalosis


51/54

51

pH = 7.32

HCO3 = 29

PaCO2 = 48

Uncompensated RespiratoryAcidosis


52/54

52

pH = 7.33

HCO3 = 29

PaCO2 = 48

Pa O2 = 65

Uncompensated RespiratoryAcidosis

With Moderate Hypoxemia


53/54

53

pH = 7.48

HCO3 = 28

PaCO2 = 48

Pa O2 = 50

Uncompensated MetabolicAlkalosis

With Severe Hypoxemia


54/54

54

tnk u po!

electrolytes 2

Documents