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Water loss in sweating & breathing

insensible water loss

Water loss in urine, feces, wounds

sensible water loss

Fluid compartments

intracellular, interstitial, vascular

Fluid distribution in adults

75% interstitial, 25% vascular

Fluids in neonates

80% weight, 90% in premies

RAAS sequence

renin--> angiotensin1--> angiotensin 2--> aldosterone--> vasoconstriction, Na absorption

ANF fx

atrial pressure up--> ANF--> RAAS & ADH release blocked-->vasodilation & Na excretion

Main ICF cation

K

Main ECF cation

Na

Main ICF anion

P (as PO4)

Main ECF anion

Cl

Cation used in coagulation

Ca

Cation used in enzyme rxns

Mg

Serum [Na]

135-145 mEq/L

Hyponatremia causes

SIADH, Addison's, vomiting/diarrhea, heat stroke, renal failure

Hypernatremia causes

dehydration, diabetes insipidus, loop diuretics, hyperaldosteronism

Serum [K]

3.5-5.0 mEq/L

Hypokalemia causes

Diuretics, vomiting/diarrhea, diabetes insipidus, alkalosis, alcoholism & anorexia. hyperaldosteronism.

Hyperkalemia causes

Burns, crushing injuries, renal failure, metabolic acidosis, Hypoaldosteronism (Addison's)

Serum [Ca]

8.9-10.1 mg/dL

Hypocalcemia causes

Hypoparathyroidism, acute pancreatitis, Vit D deficiency, chemo

Hypercalcemia causes

Hyperparathyroidism, pheochromocytoma, Grave's disease, adrenal insufficiency

Serum [PO4]

2.5-4.5 mg/dL

Hypophosphatemia causes

alcoholism, antacids, acidosis, pancreatitis, G- sepsis, steroids

Hyperphosphatemia causes

Hypoparathyroidism, tumor lysis (lymphomas) renal insufficiency

Serum [Mg]

1.5-2.5 mEq/L

Hypomagnesemia causes

Hypercalcemia, malnutrition

Hypermagnesemia causes

Diabetic ketoacidosis, hemolysis, lithium intoxication, renal failure

Hypervolemia

excess ISOTONIC fluid in ECC

Hypervolemia causes

Burns, congestive heart failure, cirrhosis, nephrotic syn, IV

Hypervolemia s/s

edema, low HCT, normal [Na], low BUN

Hypovolemia

low ISOTONIC fluid in ECC

Hypovolemia causes

Fluid loss (hemorrhage, diabetes, diuretics, vomiting) 3rd space shifts (burns, CHF, peritonitis, hypoalbuminemia)

Hypovolemia s/s

Acute weight loss, dizziness, polydipsia, tachy, hypotension

PaCO2

35-45 mm Hg

PaO2

80-100 mm Hg, drops w/ age

Bicarbonate

22-26 mEq/L

Respiratory acidosis

pH < 7.35, PaCO2 >45 mmHg

Respiratory alkalosis

pH >7.45, PaCO2 , 35 mmHg

Metabolic acidosis

pH <7.35, Bicarb <22 mEq/L

Metabolic alkalosis

pH >7.45, Bicarb > 26 mEq/L

Respiratory acidosis w/ compensatory metabolic alkalosis

pH below 7.35, PaCO2 > 45 mm Hg, bicarb > 26 mEq/L

Metabolic acidosis w/ compensatory respiratory alkalosis

pH below 7.35, PaCO2 <35 mm Hg, bicarb < 22 mm Hg

Anion gap calculation

[Na] - ([Cl] + [HCO3])

Anion gap values

10-14 mEq/L

Inflated anion gap causes

Lactic acidosis, ketoacidosis

Depleted anion gap causes

Hypermagnesemia, multiple myeloma

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