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IM NEPHRO > ABD_E 2 > Flashcards

ABD_E 2 Flashcards

1
Q

Minerals (inorganic substances) are dissolved within and form ions called

A

electrolytes

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2
Q

Fluid compartments
- Interstitial fluid volume varies
- Volume of blood (women < men)

A

Extracellular fluid (ECF)

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3
Q

Fluid compartments
- Water content varies most here due to variation in:
+ Tissue types (muscle vs. fat)
- Distinct from ECF due to plasma membrane transport

A

Intracellular fluid (ICF)

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4
Q

Fluid balance
- Primarily absorption along digestive tract
- As nutrients and ions are absorbed, osmotic gradient created causing passive absorption of water

A

Gains

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5
Q

Fluid balance
- Mainly through urination (over 50%) but other routes too
- Digestive secretions are reabsorbed similarly to ingested fluids

A

Losses

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6
Q
  • Very different composition
  • Are at osmotic equilibrium
  • Loss of water from ECF is replaced by water in ICF
A

ICF and ECF compartments balance

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7
Q

Occurs in minutes to hours and restores osmotic equilibrium

A

Fluid shift

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8
Q
  • Results in long-term transfer that cannot replace ECF water loss
  • Homeostatic mechanisms to increase ECF fluid volume will be employed
A

Dehydration

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9
Q
  • These are fluids that have osmotic pressure in the range of 280-300 mOsm/L.
  • the same as osmotic pressure of plasma, these fluids do not cause any fluid shifts between the extracellular and intracellular spaces.
  • When administered, the fluids may move into the interstitial space, but
    will still remain as extracellular fluid.
  • Examples include normal saline (0.9% NaCl), lactated Ringer’s and dextrose 5% in water (D,W).
A

Isotonic Fluids

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10
Q
  • These are fluids that have an osmolality of less than 280 mOsm/L (containing relatively few crystalloid molecules).
  • These fluids cause an osmotic shift of fluid into the cell (i.e. cells swell).
  • These fluids are used for hydration purposes.
  • Examples include sodium chloride 0.45%
A

Hypotonic Fluids

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11
Q
  • These are IV fluids that have an osmolality of greater than 300 mOsm/L and contain relatively large amounts of crystalloid molecules.
  • These are IV fluids that have more osmotic pressure than human plasma.
  • These fluids cause an osmotic shift of fluid from the intracellular space to the extracellular space (cells shrink).
  • Examples of include dextrose 10% in water, dextrose 10% in 0.9% NaCl, dextrose 50% in water
A

Hypertonic Fluids

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12
Q

Dextrose Water Solutions:
-Hypotonic
- Isotonic
- Hypertonic

A
  • 2.5% GW (hypotonic)
  • 5% GW (isotonic)
  • 20% and 50% GW (hypertonic).
    These solutions provide both fluids and carbohydrates for energy
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13
Q

Sodium Chloride Solutions:
- Hypotonic
- Isotonic
- Hypertonic

A
  • 0.9% NaCl (isotonic) the most common
  • 0.45% NaCl (hypotonic)
  • 0.2% NaCl (hypotonic)
  • 5% NaCl (hypertonic)
  • 3% NaCl (hypertonic)
    These solutions are mainly used for electrolyte replacement and for extracellular fluid replacement.
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14
Q

NaCl w/ Dextrose Sol

A
  • 1/5” GS is (5% dextrose + 0.18% NaCl) (isotonic)
  • 1/3 GS is (5% dextrose + 0.29% NaCl) (isotonic)
  • 1/2 GS is (5% dextrose + 0.45% NaCl) (isotonic)
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15
Q

Multiple ELectrolyte Sol:

A
  • Ringers solution: contain (Na + Cl + K+ Ca)
  • Ringer lactate solution: contain (Na + Cl + K + Ca + lactate)
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16
Q

Colloid Solutions:

A
  • human albumin
  • Hemaccel (gelatin solution)
  • Dextran
  • Hydroxyethyl starches (Hetastarch)
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17
Q
  • store in a 70-kg person exceeds 3500 mEq, with less than 2% located in extracellular uid.
  • balance of it is primarily maintained by oral intake and renal elimination.
  • Extracellular is dependent on multiple factors, including acid-base balance, the activity and sensitivity of insulin, sodium-potassium adenosine triphosphate dependent exchange channels, and blood insulin and catecholamine levels.
A

K

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18
Q

Major gain of K is through

A

digestive tract absorption

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19
Q

Major loss of K is excretion by

A

kidneys

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20
Q
  • Primary ECF potassium regulation by
  • Controlled by aldosterone regulating Na/K exchange pumps in
A
  • kidneys
  • DCT and collecting duct of nephron
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21
Q

Potassium is highest in ___ due to Na/K exchange pump

A

ICF

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22
Q

Factors Controlling Potassium Balance

A
  • Approximately 100mEq of K ions are absorbed by the digestive tract each day
  • roughly 98% of the K content of the human body is in the ICF, rather than the ECF
  • The K+ conc. in the ECF is relatively low. The rate of K+ entry from the ICF through leak channels is balanced by the rate of K+ rcovery by the Na+/K+ exchange pump.
  • When K balance exists, the rate of urinary K+ excretion matches the rate of digestive tract absorption
23
Q
  • Below 2 mEq/L in plasma
  • Can be caused by:
    + Diuretics
    + Aldosteronism (excessive aldosterone secretion)
  • Symptoms
    + Muscular weakness, followed by paralysis
    + Potentially lethal when affecting heart
A

Hypokalemia

24
Q
  • Above 8 mEd/L in plasma
  • Can be caused by:
    + Chronically low pH
    + Kidney failure
    + Drugs promoting diuresis by blocking Na/K pumps
  • Symptoms
    + Muscular spasm including heart arrhythmias
A

Hyperkalemia

25
Q
  • involves the electrical conduction system of the heart.
  • These changes include gradual prolongation of the PR interval (with eventual loss of the P wave), prolongation of the QRS complex, ST- segment elevation, and peaking of T waves that can ultimately lead to ventricular arrhythmias
A

HYPERKALEMIA

26
Q

Cardiac conduction changes usually occur when the plasma potassium concentration exceeds ___ mmol/L, but they may develop at lower levels in the setting of acute hyperkalemia.

A

6.5

27
Q

Options for acute management rely on _________ and include administration of calcium chloride, sodium bicarbonate, and insulin with glucose

A
  • membrane stabilization
  • intracellular shifting of potassium
28
Q

tall peaked T waves is suggestive of

A

hyperkalemia

29
Q

absence of P waves, suggesting a junctional rhythm; however, in hyperkalemia

A

the atrial muscle may be paralyzed while the heart is still in sinus rhythm.

30
Q
  • For every 1-mmol/L decrease in plasma potassium concentration, the total body potassium store decreases by approximately 200 to 300 mmol.
  • Characteristic electrocardiographic changes include gradual prolongation of the QRS interval, with subsequent development of prominent U waves.
A

HYPOKALEMIA

31
Q

Hypokalemia is associated with

A
  • increased incidence of atrial
  • ventricular arrhythmias
  • low serum potassium in acute MI
  • weakness and potentiate the effect of neuromuscular blocking agents.
32
Q

Tx of Hypokalemia

A
  • consider the patient’s total body potassium levels and the chronicity of
    the hypokalemia.
  • Intravenous potassium replacement should be gradual to avoid acute overcorrection and hyperkalemia.
  • Respiratory and metabolic alkalosis should be avoided because alkalosis will worsen hypokalemia secondary to intracellular shifting.
33
Q

is dependent on the relationship of total body sodium levels and total body water.

A

Serum sodium concentration

34
Q

Therefore the treatment of abnormal serum sodium concentrations must take into account

A
  • total body sodium stores
  • total body water
35
Q
  • is defined as serum sodium concentration of greater than 145 mmol/L and is often associated with a deficiency in total body water.
  • Manifestations include mental status changes, hyperreflexia, ataxia, and seizures.
  • Free water deficit can be calculated as follows: free water deficit, in liters = (0.6 x weight, in kg) x ([serum sodium/140] - 1).
A

HYPERNATREMIA

36
Q

Tx for Hypernatremia

A
  • Free water is administered to correct hypernatremia
  • IM or IV vasopressin for severe central diabetes insipidus
  • hyprevolemic hypernatremia: diuretics to allow for elimination of both water and sodium while free water is administered.
37
Q
  • is a serum sodium concentration of less than 135 mmol/L.
  • may present with mental status changes, lethargy, cramps, decreased deep tendon reflexes, and seizures.
  • A serum sodium concentration of less than 120 mmol/L is a potentially life-threatening condition, with associated mortality rates reported to be as high as 50%.
A

HYPONATREMIA

38
Q

Mngt: Hyponatremia

A
  • If the correction of hyponatremia occurs too rapidly, a demyelinating brainstem lesion—central pontine myelinolysis—may cause permanent neurologic damage.
  • severely symptomatic patients: correct sodium at a rate of 1 to 2 mmol-L-1-h-1 until the serum sodium concentration reaches 125 to 130
    mmol/L.
  • hypervolemic or euvolemic hyponatremia, hypertonic (2%—-3%) saline may be used to treat symptomatic patients or patients who would not tolerate additional intravascular volume.
39
Q

The total serum calcium concentration comprises three fractions:

A
  • 50% protein-bound calcium,
  • 5% to 10% anionbound calcium,
  • 40% to 45% free, or ionized, calcium
40
Q

Maintenance of a normal serum calcium concentration
involves ______, which regulate the release and uptake of calcium and
phosphorus by the kidneys, bones, and intestines through negative-feedback regulation.

A

parathyroid hormone and calcitonin

41
Q

Common causes of hypercalcemia include

A
  • hyperparathyroidism
  • malignancies that increase mobilization of calcium from bone.
42
Q

Symptoms of HYPERCALCEMIA

A
  • nausea,
  • polyuria, and
  • dehydration
  • Electrocardiographic monitoring may demonstrate prolonged PR intervals, wide QRS complexes, and shortened QT intervals as hypercalcemia worsens.
43
Q

Avoidance of respiratory alkalosis may be beneficial because alkalosis lowers the plasma potassium concentration, potentially exacerbating _____

A

cardiac conduction abnormalities

44
Q

Management of hypercalcemia includes

A
  • hydration and
  • diuresis to promote renal elimination.
  • In acute toxicity or renal failure, hemodialysis should be considered.
45
Q

Multiple factors contribute to the development of hypocalcemia:

A
  • Acquired hypoparathyroidism after neck surgery is a common cause because of decreased parathyroid hormone levels.
  • Respiratory or metabolic alkalosis induces hypocalcemia by increasing protein binding to calcium, thereby decreasing the amount of ionized calcium.
46
Q

Factors that contribute to hypocalcemia

____ decreases the conversion of vitamin D to 1,25-dihydroxyvitamin D, thereby decreasing intestinal and bone absorption while increasing serum phosphate levels; the phosphate then combines with calcium and precipitates as CaPO4

A

Renal failure

47
Q

Factors that contribute to hypocalcemia

Massive blood transfusion may also result in hypocalcemia secondary to _____ (ethylenediaminetetra-acetic acid in transfused blood, which chelates calcium).

A

anticoagulants

48
Q

Factors that contribute to hypocalcemia

Hypocalcemia is often ____, although severe hypocalcemia may be associated with a prolonged QT interval, bradycardia, peripheral vasodilation, and decreased cardiac contractility, any of which can cause
hypotension.

A

asymptomatic

49
Q

Neurologic manifestations of hypocalcemia include

A
  • perioral numbness,
  • muscle cramps,
  • tetany,
  • hyperreexia,
  • seizures.
50
Q

Several factors guide calcium replacement therapy, including

A
  • the absolute serum calcium level,
  • the rapidity of the drop in serum calcium concentration,
  • the underlying disease process.
51
Q

Calcium causes ____, and _____ may be associated with morbidity.

A
  • vasoconstriction
  • extravascular infiltration
52
Q

In patients who have no symptoms, ____ may be the most appropriate treatment.

A

observation

53
Q

____ contains three times the amount of calcium compared with calcium gluconate.

A

Calcium chloride

IM NEPHRO (7 decks)

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