0071643192.pdf

ENDOCRINE, METABOLIC, FLUID, AND

ELECTROLYTE DISORDERS

■ Pickwickian syndrome (obesity-hypoventilation syndrome)

■ COPD

Renal compensation occurs after 48 hours of steady state.

TREATMENT

■ Ventilatory support

■ O 2 may be necessary to treat hypoxia, but may worsen hypercapnia in pa-

tients with COPD or in heavily sedated patients.

Respiratory Alkalosis (åpH+åHCO 3 - )

CO 2 ventilation outpaces production. The most common cause of respiratory

alkalosis in ill patients is a 2° compensatory respiratory alkalosis in response to

a metabolic acidosis (seen in sepsis, DKA).

CAUSES

Primary causes of respiratory alkalosis include:

■ Hyperventilation secondary to anxiety

■ CNS disorder

■ Hypermetabolic states

■ Hypoxia

■ Hepatic insufficiency

■ Aspirin toxicity

TREATMENT

Treatment focuses on identifying and addressing the underlying cause of

tachypnea.

HYPO-/HYPERGLYCEMIA

Insulin Physiology

■ Functions in glucose liver uptake and storage as glycogen

■ Increases lipogenesis and inhibits lypolysis leading to increased triglycerides

Ketones

Production increased during states of cellular starvation. Three types are pro-

duced:

■ β-Hydroxybutyrate: Not detected by serum or urine ketone tests

■ Acetoacetate

■ Acetone: Neutral pH

A lethargic 5-year-old boy is brought in with an empty bottle of his father’s

glipizide. His accucheck is 30 mg/dL, and upon administration of glucose

the boy returns to baseline. When can he be discharged home?

This patient needs to be observed for a minimum of 24 hours with normal

sugars before discharge, usually prompting admission.

Compensation, whether renal

or respiratory, should never

completely correct the pH by

itself. Complete or

overcorrection is an indicator

of another process occurring.

Be careful administering O 2 to

COPD patients. Chronic

hypercapnia in COPD patients

lowers the CO 2 respiratory

drive, leaving hypoxia as the

only respiratory trigger.