Hypoxemia with respiratory alkalosis

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I am doing ABG's, its confusing already, but i was going to ask what are your simple "abc" explanations for "hypoxemia" being the primary cause of respiratory alkalosis.

I want the causes to make more sense to me,and the calcuations, but im working on it, day by day, ill get it hopefully.

you asked:

howcome in alkalosis you have "pulmonary emboli" but in acidosis have alot of respiratory things like "pneumonia", "copd" it kind of sounds like "p emboli" can go with acidosis

for pulmonary emboli we learned that it was in the early stages of pulmonary emboli that one would expect respiratory alkalosis. as another poster stated it is due to the hyperventilation that would be seen in early stages of pe.

http://realnurseed.com/abgm4.htm

http://www.ekgusa.com/ceol/abgmap/abgindex.html

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Thanks for the site, that will help with practicing. I am continuing to go back to review it all, but im moving on to fluid and electrolyte also so I can be able to cover everything and go back. Do you or anybody share any good sites or explanations of fluid and electrolyte, I probably will come up with some questions regarding both now. Hypotonic, Isotonic, and Hypertonic, i understand what happens but i dont know what is actually happening......and when they say osmolality does that refer to how much water?...i am still reading through fluid and e, but i know i will have questions...

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websites - fluid/electrolytes and tonicity of iv fluids. take what you can use and skip the rest. if anything varies from your class notes or professors teaching then go with what you learn at your school.

hope this helps.

you asked: when they say osmolality does that refer to how much water? osmolality is the amount of chemicals dissolved in the fluid portion of the blood (serum).

google search "hypotonic iv solution"

1. chapter 14-19 - shelton state community college

fluid and electrolytes, and acid base balances and imbalances

http://74.125.93.132/search?q=cache:vwcqf4ytpq4j:faculty.sheltonstate.edu/~jwilliams/nur105%2520fluids%2520and%2520electrolytes06%2520web%2520page1.rtf+hypotonic+iv+solutions&cd=8&hl=en&ct=clnk&gl=us

2. a closer look at iv fluids

(good explanation of saline solutions and dextrose solutions, some of their uses in the hospital and their complications to watch for.

http://findarticles.com/p/articles/mi_qa3689/is_199810/ai_n8826281/

3. restoring electrolyte balance

http://rn.modernmedicine.com/rnweb/article/articledetail.jsp?id=158213

4. hypertonic, isotonic, hypotonic iv solutions

potter & perry's fundamentals of nursing

by jackie crisp, patricia ann potter, catherine

http://books.google.com/books?id=4drbi3suhmcc&pg=ra2-pa125&lpg=ra2-pa125&dq=isotonic+hypotonic+hypertonic+iv+fluids&source=bl&ots=w3po7urel9&sig=yoiyiymv0ekfihw4czctpewzfgm&hl=en&ei=trfqsodoc8zulafz9ecocg&sa=x&oi=book_result&ct=result&resnum=3&ved=0cbiq6aewajgk#v=onepage&q=isotonic%20hypotonic%20hypertonic%20iv%20fluids&f=false

5. iv fluid selection

http://vig.pearsoned.co.uk/samplechapter/0131186116.pdf

iv fluids come in four different forms:

- colloids

[color=#548dd4]- [color=#548dd4]crystalloids (discussed below)

- blood and blood products

- oxygen carrying solutions

[color=#00b050]glucose (dextrose in water solutions)

dextrose 5% in water isotonic d5w

dextrose 10% in water hypertonic d10w

[color=#00b050]saline solutions

0.45% sodium chloride 0.45% ns

or (1/2 normal saline) hypotonic ½ ns

hypotonic solutions expand the intracellular compartment, (or move fluid from the blood vessels into the bodies cells) and are indicated for hypertonic dehydration, gastric fluid loss, and cellular dehydration from excessive diuresis

0.9% sodium chloride isotonic ns

or (normal saline) (0.9% ns) or (0.9% nacl)

isotonic solutions can temporarily expand the extracellular compartments during times of circulatory insufficiency, replenish sodium and chloride losses, treat diabetic ketoacidosis, and replenish fluids in the early treatment of burns and adrenal insufficiency. because their tonicity is similar to that of blood, their also the standard flush solutions used with blood transfusions

3% - 5% sodium chloride hypertonic (3% -5% ns) or (3% -5% nacl)

[color=#00b050]glucose (dextrose in saline solutions)

dextrose 5% in 0.9% hypertonic (d5w & ns) or (d5ns)

sodium chloride

hypertonic saline such as 5% dextrose in 0.9% sodium chloride solution are used cautiously to treat severe hyponatremia.

precautions: closely monitor your patient for complications, such as electrolyte imbalances, calorie depletion, and increased intracranial pressure (icp). because hypertonic solutions pull water from the intracellular space into the extracellular space, fluid volume and icp can increase. watch for fluid overload in patients with heart failure or hypertension.

glucose dextrose 5% in 0.45% sodium chloride

hypertonic (d5w & 1/2ns) or (d5 1/2ns)

[color=#00b050]electrolyte solution

lactated ringers isotonic lr or ringers

or ringers lactate (contains, sodium chloride , potassium, calcium and sodium lactate)

[color=#548dd4]iv solutions are either [color=#548dd4]isotonic, hypotonic or hypertonic. a simple way i think of this is that all iv solutions are water with something added to it to make a tonic. the additive is either sodium or dextrose or electrolytes, or a combination of sodium and dextrose. our normal body fluids are slightly salty or have a small amount of saline like the iv solution of 0.9% normal saline. so 0.9% ns is called isotonic or having the same amount of tonic as our body fluid. our body also has dextrose or glucose which is food for our bodies and brain.

in general [color=#548dd4]isotonic solutions are used most commonly for extracellular (ex. fluid volume deficit after prolonged vomiting). the decision to use a hypotonic or hypertonic solution is based on the specific fluid and electrolyte balance. for example the patient with a hypertonic fluid imbalance will generally receive a hypotonic iv to dilute the extracellular fluids and rehydrate the cells. all iv fluids should be given carefully, especially hypertonic solutions, because these pull fluid into the vascular space resulting in an increased vascular volume that can lead to pulmonary edema, particularly in patients with heart or renal failure. certain additives, most commonly vitamins or

potassium chloride (kcl), are frequently added to iv solutions. however, under no circumstances can potassium chloride (kcl) be given as an iv bolus. a direct iv infusion of (kcl) is fatal.

if an iv solution is to contain additives a doctors order must be obtained that includes the required additives.

patients with normal renal function who are (npo) receiving nothing by mouth should have potassium added to iv solutions. the body cannot conserve potassium and even when the serum level falls, the kidneys continue to excrete potassium. if there is no potassium intake orally or parenterally, hypokalemia can develop quickly. conversely the nurse should verify that the patient has adequate urine output before administering an iv solution containing potassium because hyperkalemia can quickly develop.

when iv administration is required the nurse must know the correct ordered solution the equipment needed, the procedures required to initiate an infusion, how to regulate the infusion and maintain the system, how to identify and correct problems, and how to discontinue the infusion if necessary.

[color=#548dd4]hypertonic solutions have a tonic or tonicity that is higher than the plasma in the body or higher than 0.9%ns. when administering a hypertonic solution, the fluid will pull water from the cells into the intravascular space (blood vessels).

[color=#548dd4]hypotonic solutions have a tonic or tonicity that is lower than the plasma in the body or lower than 0.9%ns. when administering a hypotonic solution, the fluid will quickly move from the intravascular space (blood vessels) into the cells.

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Wow, thanks for your explanation! , I am looking at your notes step by step and im understanding it better. Hopefullly if i have questions you are someone else can try to answer. THANKS ALOT!

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Exam time..i have random questions throughout the day, pls answer if you can , and make the explanation ABC if possible...

When someone has SIADH howcome the serum osmolality drops

And in Diabetes Insipidus howcome your urine is diluted, whats behind that pls if anybody nkows

thanks, i may have more coming through the day...

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exam time..i have random questions throughout the day, pls answer if you can , and make the explanation abc if possible...

when someone has siadh howcome the serum osmolality drops

our "blood serum" and "urine" have "water" and "molecules or particles = na+,k+ etc."

so the blood serum has "water" and "stuff" or "electrolytes"

(like koolaid has water and koolaid powder particles.)

osmosis - "the water" - water movement in the body.

water moves across a membrane from an area of higher water concentration to an area of lower water concentration.

osmolality - "the stuff" or "electrolytes" "the osmols or molecules or # of particles in the blood, urine etc."

in di and siadh think of the "adh" "water" and "na+"

in di the kidneys can't hold onto urinary water. (urinating up to 16-30 liters a day of clear urine, not yellow)(polyuria, polydipsia)

in siadh the kidneys can't concentrate urine they are holding onto excess water.

what is serum osmo?

serum osmo is the amount of "stuff" "na+" in the blood serum.

the kidneys filter the blood. they are reabsorbing water back into the bloodstream and diluting the serum na+. that means the serum osmolality is low because the salt is diluted in all that excess water.

when someone has siadh howcome the serum osmolality drops

because in siadh, you are holding onto excess water in the serum and it is diluting the sodium which means the serum osmolality drops.

and in diabetes insipidus howcome your urine is diluted, whats behind that pls if anybody nkows

di is caused by head trauma, strokes or hypophysectomy(removal of the pituitary gland) the pituitary is not producing the normal amount of adh so anti diuretic hormone is low. adh makes your kidneys hold onto water but since adh is low your kidneys are urinating excessively instead of holding onto water. (urinating up to 16-30 liters a day of clear urine not yellow)

i just remember that in diabetes type i and ii the signs are 3 p's- polyuria, polydipsia, and polyphagia. and in diabetes insipidus they have polyuria and polydipsia too. (so basically the 3 p's go with all your diabetes)

here it is in abc

siadh syndrome of innappropriate (or increased) anti diuretic hormone

increased adh

kidneys inability to concentrate urine

adh is also called vasopressin

diuretics make you urinate

anti diuretic makes you hold water and dilutes the na+

when osmo receptors detect high serum osmolality then adh is released into the blood stream.

in siadh the serum osmolality is low, but an oat cell carcinoma of the lung or, head trauma or, stroke has caused the pituitary not to work correctly and adh is released anyway. the increased adh causes the kidneys to reabsorb water even though the body does not need any extra water. this water is reabsorbed into the blood serum and dilutes the na+ and the serum osmolality is low.

diabetes insipidus

kidneys inability to conserve urinary water.

decreased adh - also called vasopressin

increased anti diuretic hormone makes you hold water and dilutes na+. but in di a head trauma or stroke or removal of the pituitary gland (hypophysectomy) has caused the pituitary not to work correctly and the adh is low so low anti diuretic hormone causes the kidneys not to hold water and the body is urinating excessively up to 16-30 liters a day. then the body is thirsty. so there is polyuria and polydipsia.

siadh [color=paleturquoise]..................................................di

>adh-kidneys hold water-dilutes na+ [color=paleturquoise]........

diuretics make you urinate [color=paleturquoise]........................cardinal signs:

adh makes you hold onto water [color=paleturquoise].................extreme polyuria

too much water dilutes serum sodium [color=paleturquoise].........large amounts of dilute urine

have fluid volume excess [color=paleturquoise].........................specific gravity below 1.006

caused by: [color=paleturquoise]...........................................caused by:

oat cell carcinoma of lung [color=paleturquoise]........................hypophysectomy

stroke, head trauma [color=paleturquoise]...............................stroke, head trauma

lab values: [color=paleturquoise]............................................lab values:

serum na+ (low)145

serum osmo (low)

urine na+ (high)> [color=paleturquoise]....................................urine na+ (low)

urine osmo (high)>1200 [color=paleturquoise]............................uriine osmo (low)

urine specific gravity> 1.032 [color=paleturquoise].....................urine specific gravity

treatments: [color=paleturquoise]...........................................treatments:

fluid restriction to 80ml/day.[color=paleturquoise]......................increase oral fluids

demeclocycline causes diuresis [color=paleturquoise]..................vasopressin - pitressin

diuretics [color=paleturquoise]................................................ddavp -desmopressin

increase oral sodium [color=paleturquoise]................................decrease sodium intake

or hypertonic iv fluids [color=paleturquoise]..............................or hypotonic iv or iv d5w

report wt. gain 2 lbs in one day [color=paleturquoise].................polyuria 4-16-30 liters a day

possible need for lifelong medication [color=paleturquoise].....possible need for lifelong medication

the end

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