Agents Affecting the Volume and Ion Cont

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Agents Affecting the Volume and Ion Content of Body Fluids : 

Agents Affecting the Volume and Ion Content of Body Fluids

Objectives : 

Objectives Identify/describe the common etiologies of and treatments for isotonic, hypertonic, and hypotonic volume contractions. Identify/describe the common etiologies of and treatments for respiratory and metabolic acidosis and for respiratory and metabolic alkalosis. Identify the main hormone responsible for regulating renal potassium excretion (or retention), and state the simultaneous effects of that hormone on renal handling of sodium and water.

Objectives : 

Objectives Describe the link between serum insulin and potassium levels, explaining why hyperinsulinism leads to hypokalemia. Identify the main potassium salt that is preferred (in most situations) for preventing or managing hypokalemia, and state why it is generally the preferred salt.

Agents Affecting the Volume and Ion Content of Body Fluids : 

Agents Affecting the Volume and Ion Content of Body Fluids Disorders of fluid volume and osmolality Acid-base disturbances Potassium imbalances Magnesium imbalances

Disorders of Fluid Volume and Osmolality : 

Disorders of Fluid Volume and Osmolality Volume contraction Isotonic contraction Definition and cause: volume contraction in which sodium and water are lost Treatment: fluids that are isotonic to plasma Hypertonic contraction Definition and causes: loss of water exceeds loss of sodium Treatment: hypotonic fluids or fluids that contain no solutes at all

Disorders of Fluid Volume and Osmolality (cont’d) : 

Disorders of Fluid Volume and Osmolality (cont’d) Hypotonic contraction Definition and causes: loss of sodium exceeds loss of water Excessive loss of sodium through the kidney Treatment: infusing isotonic sodium chloride solution for injection Volume expansion Increase in the total volume of body fluid Overdose with therapeutic fluids or disease Diuretics

Acid-Base Disturbances : 

Acid-Base Disturbances Respiratory alkalosis Respiratory acidosis Metabolic alkalosis Metabolic acidosis

Acid-Base Disturbances (cont’d) : 

Acid-Base Disturbances (cont’d) Respiratory alkalosis Causes: hyperventilation Treatment: rebreathe CO2-laden expired breath Respiratory acidosis Causes Retention of CO2 secondary to hypoventilation Depression of the medullary respiratory center Pathologic changes in the lungs Treatment Correct respiratory impairment Infusion of sodium bicarbonate if severe

Acid-Base Disturbances (cont’d) : 

Acid-Base Disturbances (cont’d) Metabolic alkalosis Causes Excessive loss of gastric acid Administration of alkalinizing salts Treatment Solution of sodium chloride plus potassium chloride

Acid-Base Disturbances (cont’d) : 

Acid-Base Disturbances (cont’d) Metabolic acidosis Causes Chronic renal failure Loss of bicarbonate during severe diarrhea Metabolic disorders Methanol and certain medication poisoning Treatment Correcting the underlying cause of acidosis Alkalinizing salt if severe

Potassium Imbalances : 

Potassium Imbalances Regulation of potassium levels Hypokalemia Hyperkalemia

Potassium Imbalances : 

Potassium Imbalances Regulation of potassium levels Primarily by the kidneys Influenced by extracellular pH Insulin has a profound effect on potassium level Hypokalemia Causes and consequences Most common cause is treatment with a thiazide or loop diuretic Adverse effects on skeletal muscle, smooth muscle, blood pressure, and the heart

Potassium Imbalances (cont’d) : 

Potassium Imbalances (cont’d) Hypokalemia (cont’d) Prevention and treatment Potassium salts Oral potassium chloride Intravenous potassium chloride Contraindication to potassium use Hyperkalemia

Potassium Imbalances (cont’d) : 

Potassium Imbalances (cont’d) Hyperkalemia Causes Severe tissue trauma Untreated Addison’s disease Acute acidosis Misuse of potassium-sparing diuretics Overdose with IV potassium

Potassium Imbalances (cont’d) : 

Potassium Imbalances (cont’d) Hyperkalemia (cont’d) Consequences Disruption of the electrical activity of the heart Treatment Withhold foods that contain potassium Withhold medicines that promote potassium accumulation Management Counteract potassium-induced cardiotoxicty Lower extracellular levels of potassium Infusion of sodium bicarbonate

Magnesium Imbalances : 

Magnesium Imbalances Hypomagnesemia Causes Diarrhea Hemodialysis Kidney disease Prolonged intravenous feeding Chronic alcoholics Hypermagnesemia Prevention and treatment Magnesium gluconate and magnesium hydroxide Magnesium sulfate

Magnesium Imbalances : 

Magnesium Imbalances Hypermagnesemia Most common in patients with renal insufficiency

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