14 - Fluid And Electrolyte Flashcards

1
Q

Gold standard for measuring urine concentration of electrolyte?

A

24 hr urine collection

- thought the fractional excretion from spot urine is more convenient

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2
Q

What does fractional excretion help determine? (Results)

A

The kidney’s response to a specific electrolyte

  • Low fractional excretion - renal absorption
  • High fractional excretion - renal wasting
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3
Q

Disorders of sodium concentration are a result of?

A

Water balance

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4
Q

Disorders of ECF volume are a result of?

A

Disturbances in sodium balance

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5
Q

What does serum sodium indicate?

What does it not reflect?

A

Indicates - relative amounts of sodium and water

Does not reflect ECF volume status

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6
Q

Hyponatremia is (level)?

A

Serum sodium <135 mEq/L

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7
Q

Clinical findings of hyponatremia?

A
Nausea
Malaise
HA
Lethargy 
Disorientation

Respiratory arrest
Seizure
Coma
Brainstem herniation

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8
Q

hyponatrema needs to be carefully corrected to avoid?

A

Central pontine myelinolysis

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9
Q

Hyponatremic pts serum osmolality?

A

Can be
low - isotonic hyponatremia
normal- hypotonic hyponatremia
high - hypertonic hyponatremia

Chart on slid 11 if you want

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10
Q

Hypernatremia is (level)?

A

Serum sodium >145mEq/L

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11
Q

Hypernatremia always has?

A

Hyperosmolality

But may still be hypo, eu, or hypervolemic

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12
Q

Urine osmolality is used to measure?

A

The kidneys ability to conserve water

Distinguish between renal and non-renal losses

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13
Q

Tx for hypernatremia?

A

Fluid replacement

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14
Q

Disorders of sodium balance include?

A

Hypervolemia - volume overload
- abnormal na retention

Hypovolemia - decreased ECF volume
- Na excretion > Na input

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15
Q

How is a pts acid-base status measured?

A

Combination of

  • arterial pH
  • PCO2
  • Plasma bicarbonate (HCO3)

Chart of results on slide 16

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16
Q

How do kidneys regulate acid-base balance?

A

Reabsorbing HCO3
Creating new HCO3
Excretion of H

17
Q

Acid base mnemonic?

ROME

A
R - respiratory
O - opposite (respiratory)
—H pH; L PCO2 = alkalosis
—L pH; H PCO2 = acidosis
M - metabolic
E - equal  (metabolic)
—H pH; H HCO3 = alkalosis
—L pH; L HCO3 - acidosis
18
Q

Different acid base d/o s/s?

A

Slid 18 there are pics

19
Q

Analysis of acid-base status steps?

A

Step 1 - determine metabolic vs respiratory
Step 2 - calculate range of compensatory respobses
- determines presence of mixed d/o
Step 3 - calculate anion gap
Step 4 - calculated corrected HCO3
Step 5 - look for clinical signs

20
Q

Acid base d/o results down and dirty?

A
(Metabolic is equal)
Metabolic acidosis (all low)
- L pH; L HCO3; L CO2
Metabolic alkalosis 
- H pH; H HCO3; H CO2
(Respiratory is opposite)
Respiratory acidosis 
- L pH; H HCO3; H CO2
Respiratory alkalosis 
- H pH; L HCO3; L CO2
21
Q

Metabolic acidosis is classified as?

A

Normal
Or
Increased anion gap

Anion gap is slide 21

22
Q

RTA (renal tubular acidosis) must have?

A

Normal anion gap
Normal GFR
NOT CAUSED by diarrhea

23
Q

RTA is?

A

Impaired renal bicarb absorption or hydrogen excretion

Not caused by diarrhea

24
Q

classic distal RTA type I?

A

Hyperchloremic acidosis
- usually hypokalemic

Deficiency in H+ secretion at DCT

Urine will be alkaline (>5.5)

25
___ and ___ are common with RTA type I?
Nephrocalcinosis Nephrolithiasis Chronic acidosis leads to low calcium reabsorption so lots ends up in the urinary tract
26
Proximal RTA type II?
Hyperchloremic acidosis - hypokalemic Deficiency of HCO3 reabsorption - DCT cannot reabsorb HCO3 leads to acidosis
27
Meds that can cause RTA type II?
Carbonic anhydrase inhibitors | - acetazolamide
28
What is fanconi syndrome?
Generalized dysfunction of the proximal tubules - bad reabsorption of HCO3, glucose, amino acids, protein, uric acid, water, phosphorous, K, NA - leads to renal tubular acidosis Basically you pee everything out
29
MC RTA?
Hyporenimeic hypoaldosteroneic RTA type IV
30
Hyporenimeic hypoaldosteroneic RTA type IV?
Aldosterone deficiency Tubular resistance to aldosterone - salt wasting and hyperkalemia
31
Common causes of RTA type IV?
Diabetic neuropathy Tubulointerstitial disease Hypertensive nephrosclerosis AIDS
32
Symptoms of RTA?
Mostly whatever caused it But you will see tachypnea
33
Labs for RTA?
L - blood pH - Serum HCO3 - PCO2
34
RTA tx?
Nephrology referral Correct metabolic abnormalities w alkali stuff
35
TYPE IV RTA specific tx?
Dietary potassium restriction D/C potassium-retaining drugs
36
Differentiating RTA types?
Chart on 32 | Pic on 33
37
What happened to the man who was stopped for having sodium chloride and a nine-volt battery in his car?
He was charged with a salt and battery