Electrolyte Imbalances and Lab Values Made Easy - with Kendall Wyatt MD, RN

[Music] okay welcome everybody so today we're going to go over electrolyte really going to simplify everything with electrolytes and make them really simple let's go and get started my name is dr. Kendall Wyatt and we're going over electrolyte a little bit about me I start out as paramedic with charity school now finished med school and just starting as a resident in Charleston West Virginia so I do internal medicine learning internal medicine and I'd like to teach a lot of nurses I think it's a lot of fun so let's get started with really simplified topic here everything you're to see today is from the Peconic learning system now all the images you're going to see are from the big monic learning system if you've never heard of stigmata thick my takes all the fun or all the boring faction you know and turns them into fun characters so you're learning drugs and visas you need to learn more friend verses heparin and tons of other things you can learn a war fairy and all about a scene to remember laundering pt/inr and a hippie heron fun crazy bird who likes to smoke a peace pipe to remember monitoring PTT and of course antidotes and everything else so it's super fun you could try it out for free but everything you're going to see is reference back usually to the pig monic system so if you have questions that's not all I'm going to see but everything you're going to see is really from there so let's get started really into the nitty-gritty of the topics so we're going to go over today well today we're going to be going over really an overview of physiology just a brief snippet of physiology we're going to talk about some body fluids and then we're going to go into knowing the normal values and then simply the simplified trends well really what you need to know for that alekhya lecture like super simple and easy if you follow along you you're never going to fail you for all of the all the electrolytes you really need to know then we'll do it just a quick little recap at the end and talk about putting it all together with some more physiology but if you need to know some more details you can check out some video videos or you can request one at least lead nice comments don't leave any mean comments nobody likes me in common just just kick me yourself so first off let's jump right into fluid volume now I'm not going to go into great detail on fluid volumes but here's just a good idea we know that everything we're talking about is in the fluid part of the body the body's made up of 60% water so we can take every human and multiply their way by 60% get an understanding that it's all that that's the percentage of of liquid or flute water in the body now when you break that down a little bit more you know that there's intracellular volume and extracellular volume now this is going to build throughout the entire presentation but you need to know that of this 60% you can break it down over here in this next section and two-thirds or 66% intracellular so inside the cell and then one-third or thirty three percent is outside the cells now just that simple inside the cells outside the cell and when we're talking about electrolytes you should know that everything we're measuring on lab is outside the cells that's going to be inside the extracellular fluid zhonya but anyway so when you take the ECF you can break that down into interstitial fluid which is 80% of the ECF volume and then the other 20% plasma so we're going to go over this in detail in different videos but you can take 100 kilogram first things you want to make a simple math problem 100 kilograms yes I know a little little on the heavy side but then you can easily tell us that 60% of X that fluid is that person's water and then break down those fluid volumes 40 meters 20 and 16 to 4 so out of 100 kilogram person they have 4 litres of plasma so that's a lot of plasma of course maybe if you're a poor student maybe you donated some plasma but you can see it's not the largest portion of what you've got in fluid volume but of course it it gets really made now when we're talking about everything today Before we jump into the actual electrolyte we're going to vary at the very end go back through some physiology up and mentioning some membrane potentials and how everything works but as we're looking at cells and talking about these things if you're trying to build on physiology or learn part of physiology the inside of the cell is going to be inside of our circle here of our example of our cardiac myocyte and then there's going to be on the ECF bowi on the outside of the cell what is going to be outside of course inside the cells positive outside the zone or inside the cells negative and outside the self positive so we're going to go over this in the end and really just go recap everything you went with kind of a good example to see how it works and how the channels work with the different electrolytes the most important thing you need to know are the normal ranges you can't go into any of them really which is not having those normal ranges in the tip of your tongue now before I talk about the normal range I'm going to go over everything in one of them in great detail it's just I've ordered them from the smallest one to the largest one and that's actually how we measure it is the total quantity in the ECF volume the extracellular fluid space so it's the amount from the smallest to largest so we should look at it so if we look at magnesium Boston calcium chloride sodium you can see here that I've ordered them from 1.5 to 2.5 then 2.5 to 4.5 three point five to five and eight point five to ten ten point five and 95 205 and sodium is 135 to 145 but if you take those normal lab by lab values you can actually take this and apply it to everything if you just kind of remember the nurses in this order and remember that it's a tiny amount and you see a volume of magnesium versus a larger quantity of sodium in easia then they may give you so they're ordering ordering we're going to go through them in that order as well so we've got our little funny characters in here to help your member or magnesium magazine 1.5 to 2 phosphorous 2.5 to 4.5 and then of course our potassium is our potassium banana and our calcified cow is eight point five with the eight ball to the ten ten chlorides 95 to 105 got a little chlorine dispenser and sodium is our salt shakers for 135 145 now everyone always usually writes in or they ask if they ask themselves well my book says this is potassium three point five and five point two or my book says three point seven two four point one nine and those are minor variation remember that loud by using your measurements vary between lab textbook and everything on a standardized exam unless you have an evil instructor a standardized exam is going to give you a range a number that's clearly out of range it's not going to give you a number that's let's say potassium here three point five to five they're not going to give you five point one expects you to notify that as an abnormal lab value they're going to be very off so it's going to be like five point seven they're going to give you a number that's going to be very out of the range so that those tiny little variations aren't going to matter unless you have a needle instructor I know they're out there I mean I think it's kind of cool to do this because they should know that these do look very by lab by now sometimes they'll give you one and they're telling you to test in your book so just keep that in mind in a standardized exam not going to be that big of a deal so you can put and remember your set even if they very promote we've got here today but again when we're going to go each over each one of these individually but the number one thing is going to trip you up is not knowing on your thing again you're not given the lab values on that school exam they give you a sheet with all the lab values that you can go open up and reference but I'm going to tell you what those extra precious seconds of being I'm just identified the lab value now I'm going to make your test exam easier but they're also going to help you later on because then you really just memorize the numbers and it's important really to know especially as it applies straight back to love to physiology so here's another example and one thing that's important to really understand when we talk about all the lab lies is that they they different concentrations so the composition percentages inside the cells in the ICF intracellular fluid sodium is much different than what it is in the extracellular fluid well what does that really mean well here's just a visual representation just to really give you an overview idea we're going to talk about everything here in the ECF volume as far as the quantity libraries are not measured by total body volume is measured by the quantity in the ECF and however that appears in the easier so you can see that the most abundant one of course and by our chart is going to be sodium is the most abundant followed by chloride is the second most abundant absolutely correct but if we looked inside the cells well the most abundant one is potassium and of course them right right behind that is phosphorus inside the cell there's just a tiny little bit of sodium will it really tiny tiny amount and we're going to go over that again at the very end to just kind of show you how those switch around to create and actually put their membrane potential and how neurons fire so just the easy way now when we're talking about again I can't say enough that the lab values just measure the volume in the ECM so you don't need to try to memorize those because you should be able to just understand if you if you learn one well the other one is usually the opposite as where it means we always teach with lots of electrolyte imbalances so along with that you know you can always so learn them in a sig monic system it's the one big thing that I recommend you just absolutely to learn all the lab values at minimum go try it out to fine can remember the calcium cow going sitting down for dinner you remember the chlorine-chlorine dispenser pool jumping into the 105 it's just a lot of fun to help you memorize a lot of things that's literally or just giant list of things that are often hard to understand now next I want to really go over simplifying the function now when you simplify the function we're not saying that this is an only scenario we're creating a concept of it so that you can apply that concept to everything you else you need to know so what happened in the ECF if you have an increased amount of this electrolyte that's what we're going to go over today and if you could write that down you can memorize that then if you don't have enough of anomie CF or a low volume then it's the opposite super simple and that's really how just to make this a lot easier now this is a giant list but we're going to go over each of them individually again but we can think about magnesium being in charge of muscle relaxation phosphorus yeah muscle contraction essentially potassium is interrupt on either excitation and calcium in a neuronal excitation as well as bones and things in other parts of the body yes I put that in there just because everyone always pointed out chlorides really in charge of acid-base I'm a big function in monitoring managing your acid base and then sodium itself is extracellular excitation so we just talked about what's the most abundant one the ECF and the extracellular fluid well it's sodium so sodium is the most abundant and sodium is most abundant in the ECF and it's also in charge of extracellular excitation so you're literally just compounding things as we go here when we look at potassium potassium if we simplify the function in charge of intracellular excitation so then potassium is also the most abundant one inside the cell so it's super easy if you just kind of follow along and we're going to go through each one of them individually now as we talk about each one of the electrolyte balances themselves we're just going over the simplified function and some basic signs and symptoms you can we're going to be making some videos or I'm going to make a video of just each individual one with more causes and treatments to really simplify each electrolyte individually so if you want to go into a greater in depth of thing you can check those out we're going to be made Publishing them over time now when you think through all these electrolyte imbalances you need to know the normal range what is the normal value range you can't miss that don't don't miss that one now is the most important because if you can't get the normal range you're going to get a question and you're not going to go whether it's high or low you're not go whether it's opposite or whatever because you messed up the numbers if you think about the basic function then it's super easy to then say well one of the other systems isn't going to affect and you can think through and understand the concept and that's the easiest way to learn something and be able to apply it across the board rather than just trying to memorize one particular thing and then try to memorize too much memorize too little on contingent consciousness a lot easier so let's start about my median or magnesium magazine so when we look at magnesium the normal lab value range is 1.5 to 2.5 now it's nearly equivalent now the units are you know usually not something they're going to trick you up with on exam but you can also easily tell because there's going to be a few of them that are milligrams a deciliter and that's because those are desert those are special ones they're not regular plain electrolytes that you're measuring now what's the theme of magnesium magnesium is pretty much simplified function is a muscle relaxation so if you have extra magnesium or enough magnesium then it's going to be relaxing muscles essentially it's how you can think about and if there's a relatively small ECF amount so it's small amount me extracellular fluid volume which proper means that if we give it IV then it could have a pretty significant impact so if we actually think about what happens if I have not enough and too much if I have too much magnesium and I have hypermagnesemia what happens well the muscles are way too relaxed that's exactly what you see is signs and symptoms you're going to see decreased deep tendon reflexes that's the biggest one right deep tendon reflexes are going to be decreased or absent and critical level respiratory depression because of the diaphragm the muscle you're going to see muscle weakness bradycardia all across the board all the muscles will be slowed down nearly relaxed there's many chilling and hanging out like a low magnesium magazine character here now when you don't have enough magnesium you have a low magnesium well what happens in a low magnesium causes all muscles to get excited they get there easily excited they don't excite the buckle that is easily excited relate you have muscle excitation twitching trimmer increase deep tendon reflexes and even up to the point of seizures as well as tachycardia course you can see how those two literally are opposites as one and then is the other one and then there's normal right in the middle so magnesium of the simplified function is relaxing everything now if I took this and I just took just magnesium and I want to apply that to other things as you're learning just magnesium you know we can give magnesium sulfate essentially right magnesium sulfate we can give as a drug we give that to stop preterm labor contractions so actually slowing that uterus convey your calm down don't be so excited relax and stop contracting it's not time to push that baby out right that's exactly what happens but how do we monitor when we've given too much magnesium magnesium toxicity what is it well it's going to be exactly the same things hypermagnesemia you're going to see decreased or absent deep tendon reflexes and that's the sign to say uh-oh too much magnesium stop withhold decreased notify whatever you need to do to with you know to know that that's too much magnesium super simple you can learn the electrolyte balance you can learn about giving the drug and you can learn all the side effects just by kind of simplifying all this function and making sure you know that normal electrolyte values and of course because it's because in here is some the very origin site because the magnesium love is a small ECM volume it's very possible to majorly change that electrolyte which are small doses so it's something we always have to monitor you can go inside the big mark system into just examples of the pig - you're going to learn it will play the audio for you in a condensed form and eat you all about it as well as the antidote for hypermagnesemia one of my favorites calcium gluconate or our calcified caliber too low glucose just because I think he's a weird women have to remember so along with that super easy easy and when you think about them there are some things called with the litter laxatives that magnesium laxatives right so magnesium lacks it is what they did well they relax the GI so that you can just let it all out and that's kind of exactly how it done how the system works so you can kind of think things through in this simplified function let's move on to the next one phosphorus phosphorus is a tricky one just because there's a lot more thing to kind of understand around it so I don't want to I'm not going to harp on this one a lot but essentially it's two point five four point five milligrams a deciliter and it's milligram to deciliter because there are phosphorus and phosphates in general so we're measuring all the phosphates and with that phosphorus which is the way it can be compounded because it's pio pio 3p oh four minus three well I can remember I always mix up the two numbers at the end so uh but uh but the thing that is is phosphorus has them a very small etf amount as well and it's primarily responsible for muscle contraction so when we think about somebody who's in renal failure who can't create a lot you know they can't create a bicarb buffer so then they build up a lot of phosphorus and what happens they end up with muscle twitching end up with some problems along the hyper phosphate ania and you can kind of think through those and lots of examples the fox president isn't as commonly tested exception scenarios against the diseases and so we talk about hyper falsity Mia again muscle excitation in general and we've got our little 2.5 as our four fork and our five hand help you remember the normal lab life and of course we don't have enough box for it then you're going to think of muscles going to be a lot of weight they're only too relaxed as well it's nothing that we see without other diseases like renal failure and whatnot now one of the highest year ones is potassium potassium a three point five two five million clip in two meter you got to know it right away you can't miss potassium probably such a high yield question it's going to be across the board if you didn't get something on potassium I would be shocked but potassium is a volatile electrolyte kind of like the little weak electrolyte XA there's lots of drugs that can make you excrete too much potassium but the calcium is a small you see X amount three point five two front really very small you know so I always think this loan is it this sensitive the ones we don't hurt their feelings so we've got our potassium banana in here and when we think about potassium it's in charge of intracellular excitability well that's because most of the potassium in our body is inside itself and what do you need to remember our potassium itself is that I am very cardiac sensitive cardiac myocytes are especially sensitive to just in flexing and changes of Pataky and it don't the other thing is going to kill you first so if you think about anything with them when you think about a lot of your questions and prioritization questions and what do you need first well just think about what's going to kill you first and one of the things that's going to be a serious detriment to the patient is a potassium abnormality because of the risk for rythme so how do we identify those arrhythmias how do we know what are the identity as we know with a low potassium in a high status well we have too much potassium we know that it's interesting so the insides of the cells are going to be excited that means they're probably likely to fire more so you see we actually see a very strong repolarization because of the exchange of the potassium and we see a very characteristic classic increase of peeps tall peach t-wave so pqrst on the ECG on that t way you're going to see a big big tall TT way it's going to be abnormal you usually can see it and it's going to say oh there's a you know a total Pig T wave you wonder what that potassium is it might be a little high you get a patient in real failure again who can't excrete things out then you maybe if you look at that ECG you're going to see that 12 PQ enjoys well they're project building up all kinds of toxins they can't get rid of especially potassium so what about them be to the opposite what about the hypokalemia and so not enough potassium well not enough potassium we're going to see a lot of paresthesias pair scissors pins and needle feeling and but you also see a flat youth-team wave so you see exactly the opposite about salt peach tea way now you can also see something calling you way pqrst and then a little you win which is again just because of that repolarization abnormality because of membrane potentials can't them they can't balance in the cardiac myocytes they're very sensitive to changes in potassium so we're going to separately go to to help you with Ephesians up in ECG stuff it's all out there you can go see those and really see how how those them those T waves and things change so here's our pic monix on me as you can see lots of things along with height so hyperkalemia you're going to end up with a lot of them waiting at the paralysis type from in the skeletal muscles and you also see kind of a hyperactive diarrhea symptoms and these we've got a weak grouping muscle in here but of course here's our tall tea man on a tee way to help you remember that so there's a good example right there drawing that tall peak teaming it's usually not quite that big this vid exaggerated here to help you out so and then of course the hypo clean is exactly the opposite flattened p-wave a new wave we've got our new wave guy here and of course them you see a lot of constipation of course our courts con tiling now calcium is one that's tough it's tough because it has a lot of complex parts of it you may not need to really understand but I'm going to explain the basics then add on to it you might need to listen to it again to kind of put it together so calcium is eight point five to ten milligrams of deciliter now what do we use what's counting for yes in the bones and in the tissues of things yes fine so remember only our lab way is measured ECM volume and calcium has an electrolyte in the ECF its function there is a lot of neuronal excitability and stabilization of the channel especially cardiac myocytes well so and the cardiac myocytes there how about how we get our refractory period so that you can't have a tetany essentially in your heart and I talked about that again in a second so neuronal excitability so what happens is if we think about lab tests themselves how do we measure calcium so calcium lab tests are completely different when you think about calcium remember it's measured in milligrams at deciliter so that's measuring the whole calcium complex calcium and everything that's there not just the electrolyte itself and that's really important as you're looking at a lot of the lab values and you see these signs and symptoms to go along with it when you're looking at a total calculus the total calcium is found in the ECF and that's measured in three different parts so we different types of calcium that's that the lab test itself is measuring we could measure free electrolyte ionized free calcium but that lab test is much more expensive and it's not necessary for what for to be able to understand what's going on in the symptoms so when we look at lab tests we've got a pretty consistent break in we've got I&I precalc Nexus CA 2 plus that's the free active wasn't reading housing that's there that's able to actually bind to the cell to cause to cause action but and that's about fifty percent but forty percent of the calcium is super important to know that it's bound to protein now what is the most important protein in the slide and we need to know that I so important to albumin that's right if you set off humans then you got it right albumin is the most abundant protein and albumin is really like I feel like it's your best friend you invite over they just carry everything around it's a really important binder carries lots of drugs but it's specifically also cows carries carries calcium now when we look at one of the things he did well before I say that the last one is a is a chelated or or essentially calcium as a complex so you can have a calcium bound with something else in it some a calcium something right and it's bound together as a molecule and that's floating around in there as well but it's not active until it's split free that's about ten Burson so most 50% of all the calcium is free-floating and can actually cause signs and symptoms but let's think about protein there for a second because this is important when you think about that proteins bound in and again albumin is that major protein is bound to where is our human mate well albumin is made in liver right we're almost all the proteins liver so patient has liver failure or liver problem with a liver not functioning correctly they may not be able to make enough albumin or if you have somebody who starved in a severe starvation state they may not be able to make enough albumin so if you don't have enough albumin then what happened well you may end up with a total body calcium that looks on a lab test as low so the calcium may look like it's 6.5 and that's why we use a cute little andy dandy equation to actually take that and look at the albumin and say oh well it's 80% bla bla bla looks great that's a normal Kalki that's why you're going to see a lot of practitioners look at that and like oh that's fine that's a normal calcium it's a corrected calcium because our lab test is only measured that ionized free and our body is only keeping that ionized free calcium level at the normal homeostasis amount to not cause signs and symptoms that's where you can really see that in the commonly common confusion point there's a lot of people write in about so just like we have here we we can't be calcium correct without human levels in a what appears on the lab tests of total calcium magnesium which actually then isn't low when it's corrected so if you correct it with the albumin and then it's still low then you're going to see a lot of signs and symptoms with your patients so if it's acute and it's a cute low calcium with what is that oh what's the what's the procedure you need to monitor after that this is a thyroid thyroid surgery especially a thyroidectomy where you may actually remove the parathyroid glands and that's where we'll talk about all those details of each individual one in the actual lectures four for each intellectually but you can think of there unless it's acute um you need to make sure you check in the human so what happens in hypocalcemia and hypercapnia well our basic weather neuronal excitability here we go neuronal excitability is that simplified function so we're going to excite site cells with calcium that ionized free so but why does neuronal of citation why does it if we have hypercalcemia why does it cause decrease muscle contraction why is it cause muscle weakness well the neuro of citation is essentially like a stabilizer it's the one that keeps everything from going crazy that's really a you have to think about it instead of thinking more about the exact ones it's a little tricky to understand and again we're coming back to a lot of membrane physiology and free ionized calcium but with this I like to just use this to something that I know and if you can remember hypocalcemia so there's a couple things of hypocalcemia or hippo cal here that cause a lot of classic signs and symptoms and super-high-end questions that you're gonna see a lot hypocalcemia that means we're going to dip with a lot of easily excitable muscles because cal seems not there to kind of stabilize those membrane channels and say hey calcium it's okay you can calm down so if we don't have enough calcium we end up with diarrhea excess diarrhea this is a smooth muscle and the G is going nuts excreting everything out you end up with technique well technique of skeletal muscle because calcium essentially is in charge of the refractory period in the heart which isn't there in that skeletal muscle so we can see two classic signs and things with hypocalcemia one of the two classic sizes thinking that you need to know hmm what are they you should be either get one of them right here well one of them is pretty so sign now for so sign is essentially that's drawing into the fingers and some of the throw it all away in the classic questions if you were to put a blood pressure cuff on their arm and pump it up you would see that in rolling in and see for so sign and then the other one is shows shows Dex sign I always them I always end up having to stop to pronounce shows text sign so show sec sign is actually when you tap on the facial nerve of a patient what's going to happen when you talk about facial nerve bum bum bum with them what's going to happen is they're going to twitch the facial nerve muscles are hyper hyperactive or excessively easily excitable so they're going to they're going to twitch and twitter in they're going to see a twitch and they're just common questions that you're going to see out there but there are some example reading with see a good trousseau syndrome in their life so a target event Lex so with hypercalcemia a hypercalcemia sir you're going to have way too much too much calcium than that ECF amount so what happens is you end up seeing a lot of decrease muscle contraction and in constipation essentially now we came back to hypocalcemia now remember we talked about the the fluid levels amount and we say what if a patient when you tie in love the concepts here if you have a patient hyperventilating a classic hyperventilate is going to be breathing out breathing way too fast you can check the acid base lecture to really get this to cut to tie it in there if you breathe way to that you're gonna blow off a lot of co2 co2 is acidic so then you're going to make your body very alkalotic and if you have respiratory alkalosis what happens is you're breathing and you're blowing off co2 making your body alkali it's very fast and break quick but one's a classic signs seem to be see your knees rolling endings of the hand and that's because of a shift of the ionic count so the ionic calcium then because your blood is alkaline it buys more binds more to proteins like albumin and creates a report a transient type of calcium which then causes trousseau sine and that's why you see if you ever seen by hyperventilate they say I can't feel my hands I have all these pins and needles and my and I can't they're done I'm paralyzed and they're actually dig in because it's for so sine a transient for so time because of that transient hypocalcemia with metabolic or respiratory alkalosis because they're blowing off all the co2 you can kind of them you don't need to be able to tie and lots of things like this at certain levels but it's good to be able to tie in concepts with someone you know was something you don't so you can check out the pic monix anywhere we've got two number ones they'll be remember hypocalcemia as well as hypercalcemia and you can remember lots of things so when we have a high calcium level you want to then get it you know get rid of it and we can give lots of things diuretics to be able to decrease the calcium as well as some binders and my god now with sodium if you want to think of simple again simplified things out just make it easy sodium normal value 135 145 new equipment a liter perfect so it's mostly we start up simplistic simplifying it for extracellular excitability so extracellular so it's exciting things from outside of itself extracellular great but what's happening with sodium is weird because it's really a sensitive the fluid balances so when we talk about fluid volumes of cells and you talk about the odd moles of and the concentration of solute in it in a solution sodium is the one that literally literally literally sodium salt well sodium salt is always going to try to diffuse out to create this homeostasis amount for what happens is you can have transient hypo or hyper or hypernatremia and we see a lot of hypernatremia so an excess amount of sodium in them each leader of your fluid when we have dehydration so if i'm being hydrated and i have decreased amount of extracellular fluid because i let it all out of my skin or peter oil whatever it is you have a decreased amount of fluid you end up with a hyper concentrated amount of sodium so what happens well you end up with hypernatremia hypernatremia type symptoms the first one you're going to see of course is you're thirsty because your body wants to get that that volume down to up to a normal amount and of course you can see dry and flush skin as well now you kind of see some other things with them with muscles and whatnot but I'd only go into that and it just gets more confusing because so many of the men more muscle now with hyponatremia see below fluid volume you can have excess amount of fluids as well so you can end up with some extra amount of fluid you can't have it extracellular excitation and you end up with some some cramping again problems of muscle firing and then not just lots of confusion week important points with hyponatremia is a low sodium voice and things are sodium sodium levels need to be corrected very slowly very important because if you do what happens to be a hypernatremia well what happens is your body's trying to create that normal sodium level so it's going to try to pull the fluid levels out of the cells and into the extracellular fluid the body will try to do that in correct itself so you can't correct the sodium low sodium too fast because you can actually then force a lot of fluid in and cause something called central pontine myelinolysis which I'm not gonna go into right now but job anyway sodium ism is an interesting one because you can have it because of a couple different reasons of course them lots of scienter signs incentives you can go learn inside of our Pig moment to really get the stem now let's just put it all together really quick let's do a quick review and understand what we're talking about with each one of these really kind of think through each one so when we talk about cellular exchange I'm not going into rapid details of the physiology we're going to talk through it again so you can think about some of these concepts and how they go together when you move things across the cellular membrane there's diffusion so diffusion just is um if I've got a hundred over here and I've got two over here and I've got a membrane well there are four is to let me take some of the ones over here and put them over on that side and everything there's going to buzz want to be equal in a perfect world if there's a easy membrane for it to go through then we have active transport we actually have energy using active means energy in transport one to the other because of certain membrane potentials or whatnot anytime the perfect homeostasis of everything is working normally gets off kilter and one is there's too much up here or too much inside if there's too much in the outside that it's going to be trying to easily more force its way into the cells because that high concentration so the cells have to work harder and pump electrolytes via active transport one way or the other which causes a lot of signs and symptoms that you're going to see so when we think about this we've got our here's our same image again we see our SEF volumes the number of most abundant one is sodium and in the IC at the most abundant one is potassium so those two actually are a good cellular exchanger so they actually put things inside the zone back out normally and here's let's use an example of our cardiac myocyte so we have a cardiac myocyte here a heart shell inside of a normal heart cells normally you have a negative charge now people always get confused with them when you say that we say what is there's lots of potassium inside cells and those are all our K pluses how come the cell itself is negative I just want to essentia to understand without going too much into membrane potentials themselves for this particular video but if you just remember that there's lots of potassium inside the cell how can you remember that there's lots of potassium inside the cell well the easy way I remember time is or used to remember before I did in back in the day I guess is we have a crush injury you have a patient with a severe crushing room and I crushed my whole arm and it just smashes all the cells or I have a burn injury where I burn lots of cells and they just explode what is the one electrolyte that you're super worried about its potassium that patient is at risk for hyperkalemia because there's lots of potassium inside the cells there were a high volume inside that today guys were free now we're all going outside into the blood being reabsorbed in the extracellular fluid that's why those patients are at risk for hyperkalemia and that's how you can remember that there's lots of potassium inside the cell now all cells have a negative charge outside the cells in the ECMO there's usually a positive charge and the most abundant one there being sodium and lots of well how do we remember that remember glad buddies again 135 145 on our sodium now normally there's a normal thing going on with the cells here where we've got lots of our potassium moving inside the cells to basically go in and keep that nice negative charge and it's a lot of because potassium itself has a membrane potential minus 92 I think and and sodium has a membrane potential for action potential of a positive number calcium over politics I mean look at the membrane potential thing if you understand physiology we'll get that but what's important to know is that there needs to be energy this is normally negative there needs to be energy and things to help this what we call the sodium potassium ATPase pump now it's ATPase because ATP means energy adenosine triphosphate but ATP 8 means it needs to break down ATP a-any so it needs in design so we're breaking off an adenosine triphosphate enzyme it's binding to this and it's able to pump in to potassium but it has to move out 3 sodium so it's able to keep this membrane membrane potential there and actually keep everything up and keep every everything in homeostasis now along with the cardiac myocyte itself there are members there are channels instead of cardiac myocyte and here's our little channel and students in here and the one thing with them so that the cells don't just run amuck and go crazy these channels essentially are stabilized by calcium and that's why calcium is a good stabilizer drug if you have a patient who's having drums we can give them a calcium North calculated medication to stabilize the heart as well because it's a stabilizer of membrane channels especially in cardiac myocytes again some of this is really simplified in its lung membrane physiology goes along with it so you can watch a membrane match and potential video to really understand the difference here and they come back and put this together if you do if this is in a ravine for you so it's definitely something that done as a it's good to understand and I recommend it so I'll see if I can't then make a different video to really understand this a little bit more so after we reviewed everything the biggest thing is remember to review all those topics make sure you know the last line and think of a simplified function for each yes I know not a cure-all every single time but for 90% of most of what you need to know it's going to be right there it's going to be the best thing to use as a basis and understanding yes there are always little scenarios here and there but as you're learning things in the beginning and you're really just trying to get a grasp of it and make sure you remember it it's so much easier to remember seeing put it all together so you can I'm in the comment section there'll be some playlists that actually go into learning much like balancing and memorize our magnesium magnesium magazine man relaxing remember hypermagnesemia super relaxing I recommend pick monic for sure my it's a great product not just because I work there but we're I'm going to be making a study guide and kids a lot of this in a printed form for you but just don't forget those normal Rangers know the basic function of each one of them and definitely get it down my name is Kendall Wyeth I appreciate you coming make sure you subscribe to the channel put the little subscribe button Yujin which is right there and check out some my other videos but you know most importantly just share with your friends we appreciate it I'm Kendall Wyatt and always as always we appreciate your watching send nice comments maybe some cookies and good luck studying I don't know why we get so mad when I just take drinks in my cup I love this Cup I get so thirsty my mouth gets dry I talk too much some people say I talk too much

Channel: Kendall Wyatt MD

Views: 322,144

Rating: 4.8618488 out of 5

Keywords: Nursing, Nursing electrolytes, electrolyte imbalances, hypermagnesemia, hypomagnesemia, hyperkalemia, hypokalemia, potassium, sodium, magnesium, nursing ati, electrolytes, electrolytes made easy, nclex, nclex study, nursing help, nursing tutor, hypochloridemia, hyperchloridemia, hypophosphatemia, hyperphospohatemia, nursing school

Id: -8j88apIoO8

Length: 39min 11sec (2351 seconds)

Published: Wed Mar 22 2017