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UF Health University of Florida
Department of Anesthesiology College of Medicine
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Clinical Overview

Acid-Base and Electrolytes

Hypernatremia
Hyponatremia
DKA

Acid-Base Disorders in the ICU

*Please take the quiz below the video to receive credit.

Objectives

  1. Review the roles of the renal and respiratory system in acid-base homeostasis
  2. Discuss simple steps in analyzing ABGs
  3. Review acid-base disorders
  4. Review anion gap and delta gap
  5. Determine the appropriate treatment for specific acid-base disorders

Articles

Lecture

Quiz

Name(Required)
1. Interpret this ABG: pH 7.27, PaCO2 53, PaO2 50, SaO2 79%, HCO3 24(Required)
2. Interpret this ABG: pH 7.52, PaCO2 29, PaO2 100, SaO2 98%, HCO3 23(Required)
3. Interpret this ABG: pH 7.18, PaCO2 44, PaO2 92, SaO2 95%, HCO3 16(Required)
4. Interpret this ABG: pH 7.30, PaCO2 30, PaO2 68, SaO2 92%, HCO3 14(Required)
5. Interpret this ABG: pH 7.60, PaCO2 56, PaO2 92, SaO2 98%, HCO3 35(Required)
6. Interpret this ABG: pH 7.38, PaCO2 62, PaO2 93, SaO2 97%, HCO3 35(Required)
7. Immediately postoperatively, an ABG returns with the following values: pH 7.26, pCO2 60mmHg, and a PO2 62 mmHg. The patient is currently mechanically ventilated with rate of 10, Vt 400cc, PEEP 0cmH20, FiO2 40%, I:E ratio of 1:3 and currently with a SaO2 of 97%. What next steps should be taken to correct the acid/base abnormality?(Required)
8. A patient is admitted to the ICU meeting criteria for severe sepsis. After being intubated and placed on mechanical ventilation, the initial ABG drawn returns with the following values: pH 7.20, pCO2 50 mmHg, and PO2 80mmHg. SaO2 is 95% with the current ventilator settings: RR 14, Vt400cc, PEEP 5cm H2O, FiO2 40%, with an I:E ratio of 1:2. What next steps should be taken to correct the acid/base abnormality?(Required)
9. A patient is admitted the ICU meeting criteria for severe sepsis and requires being placed on mechanical ventilation. Overnight, pulmonary function continues to worsen and, the next day, meets criteria for ARDS. The most recent ABG shows the following values: pH 7.20, pCO2 55mmHg, and a PO2 50mmHg. SaO2 is 85% on the following ventilator settings: RR 14, Vt 500cc, PEEP 5cm H2O, FiO2 70%,, with a I:E ratio of 1:2. Peak airway pressure is 55. Interpret this ABG Interpretation:(Required)
10. A patient with severe COPD is being weaned from mechanical ventilation. His most recent ABG shows the following values: pH 7.35, pCO2 65mmHg, and pO2 78mmHg. His O2 saturation is 96% on the following ventilator settings: PS 12, PEEP 5cm H2O, FiO2 40%. What ventilator change or changes should be made?(Required)

Hypernatremia

*Please take the quiz below the video to receive credit.

Objectives

  1. Understand the causes of hypernatremia and normal physiology of sodium regulation
  2. Describe the appropriate workup of hypernatremia and polyuria
  3. Discuss management strategies for hypernatremia

Articles

Lecture

Quiz

Name(Required)
1. When evaluating a patient with hypernatremia, what test would allow one to differentiate between renal causes and non-renal causes?(Required)
2. Causes of central diabetes insipidus include all of the following except:(Required)
3. Generally, how much of the free water deficit should be replaced in the first 24hrs(Required)
4. In a polyuric patient whose UOP is greater than 3L/day, an osmolar excretion rate greater than 1000mOsm/day would indicate which of the following as a possible cause of the polyuria?(Required)
5. All of the following are listed as definite causes of drug induced DI except:(Required)
6. An 80 y/o female who lives alone fell and fractured her hip and was not found until 2 days later. Exam showes skin tenting, dry mucous membranes and orthostatic hypotension. Na 152, K 5.4, Cl 112, HCO3 31, Cr 2.3. Urine Na 8, Urine Osm 820. What is the cause of her hypernatremia?(Required)
7. Which would be the most appropriate choice as the first step in managing her hypernatremia(Required)
8. A 22 y/o male with bipolar disorder is admitted with epigastric pain and made NPO pending the results of GI workup. The next morning his labs are as follows. Na 149, K 4, Cl 115, HCO3 28, Glucose 160, BUN 25, Cr 1.0, Plasma osm 300, 24hr UOP 3L, Urine osm 307, What is the likely cause of his hypernatremia?(Required)
9. What underlying factor must be present for hypernatremia to occur from extrarenal processes?(Required)
10. After calculating a hypernatremic patient’s free water deficit, they are started on a D5W infusion. 2 Hours later. Urine Na 70, Urine K 30, plasma Na 152, Plasma K 5.0. Which of the following is mostly likely true?(Required)

Hyponatremia

*Please take the quiz below the video to receive credit.

Objectives

  1. Define osmolality and osmolarity and understand how they relate to sodium regulation physiology in the body
  2. Understand physiological effects of changes in serum sodium
  3. Discuss the appropriate workup and management strategies for hyponatremia

Articles

Lecture

Quiz

"*" indicates required fields

Name*
1. Where is the ADH release from?*
2. T/F. Severe hyponatremia <125 mEq/L?*
3. Causes of hypovolemic hyponatremia*
4. T/F. Goal rate of Na correction is 10-12 mEq/L in a 24-hour period*
5. What are some of the causes of hypervolemic hyponatremia?*
6. What can cause of pseudo-hyponatremia?*
7. What is consider true hyponatremia*
8. If a pt blood glucose is 450 mg/dL, and his serum Na is 130 mEq/L. what is his corrected sodium?*
9. In a hypovolemic hyponatremic patient, who was receiving loop diuretics? What should their urine sodium be?*
10. Which of the following symptoms most correlate with severe hyponatremia?*

Diabetic Ketoacidosis & Hyperglycemic and Hyperosmolar State

*Please take the quiz below the video to receive credit.

Lecture

Quiz

"*" indicates required fields

Name*
1. Which of the following confirms diagnosis of DKA?*
2. Which of the following crystalloid solutions is closest to a physiological state?*
3. Which of the following is a contraindication to insulin therapy in DKA?*
4. Which of the following is not an effect of insulin on the body?*
5. The onset of DKA is usually within hours after cessation of insulin.*
6. The onset of HHS is usually within hours after cessation of insulin.*
7. Which of the following is NOT true regarding HHS?*
8. While in the resuscitative phase of DKA, a patient has a potassium of 4.9 and is started on an insulin infusion. Which of the following is the best intervention?*
9. Phosphorous repletion is necessary, as it is necessary for ATP production.*
10. Euglycemic DKA is common with which of the following medications?*