Acute & Critical Care Medicine Flashcards
(52 cards)
crystalloids
5% dextrose (D5W)
0.9% NaCl (normal saline, NS)
Lactated Ringer’s (LR)- contains NaCl, KCl etc.
multiple electrolyte injecting (plasma-Lyte)
Colloids
albumin 5%, 25%
Dextran
Hydroxyethyl starch
hyponatremia
Na<135 meq/L
usually not symptomatic till <120 meq/L
symptoms: cerebral edema, increased intracranial pressure (severe: seizures, coma moderate: headache)
types of hyponatremia
- hypotonic hypervolemic hyponatremia
—> fluid overload- tx: diuresis w/ fluid restriction - hypotonic isovolumic hyponatremia
—> Syndrome of inappropriate antidiuretic hormone (SIADH)
—> tx: stop the drug that caused it and diuresis w/ fluid restriction - Hypotonic hypovolemic hyponatremia: can be caused by diuretics, salt-wasting syndrome, blood loss, and adrenal insufficiency.
—> tx: the underlying conditions and manage symptoms
hyponatremia corretion
- should not be too quickly
–> 4-8 meq/L/ 24 hrs - rapid correction so >12meq/L/24hrs can cause demyelinating syndrome
arginine vasopressin
AVP receptor antagonstis (conivaptan and tolvaptan)
used to tx SIADH and hypervolemic hyponatremia.
increase excretion of free water
conivaptan
Vaprisol
tolvaptan
Samsca
hypokalemia
<3.5 meq/l
1meq/l drop is 100-400 meq of total body deficit
hypokalemia max infusion
<= 10 meq/hr
max concentration 100meq/100ml
hypokalemia fatal
admin undiluted or via IV push
hypokalemia and mg
if hypo mg, mg needs to be replaced first
mg is needed for K uptake
hypo mg
< 1.3 meq/L
<1 meq/L
causes are OH, diuretcis, vomting etc.
hypo can develop life-threatening symptoms: seizures, arrhythmias, etc.
hypophosphatemia
< 1mg/DL
IV immunoglobulin
Gammagard, Gamunex-C, Octagam, Privgent
Ms, Myasthenia gravis, Guilllain-Barre syndrome
dopamine dosing
low dose: renal- 1-4mcg/kg/min
- dopamine-1 agonist
medium dsoe: 5-10mcg/kg/min
- beta-1 agonist
high does: 10-20mcg/kg/min
- alpha-1 agonist
dopamine and norepi extravasation
all vasopressors
tx/phentolamine
all vasopressors are vesicants
keep in mind so they SE of arrhythmias, necrosis (gangrene), hyperglycemia, etc.
ALL VASOPRESSORS MUST BE ADMIN BY CENTRAL LINE
epinephrine
adrenalin
EpiPen for anaphylaxis
- alpha-1, beta-1, beta-2 agonists
NorEpi
levophed
-alpha-1 agonist > beta-1 agonists
phenylephrine
- alpha-1 agonsits
vasopressin
vasosstrcit
vasopressin receptor agonists
known as arginine vasopressin (AVP) and antidiuretic hormone (ADH)
- vasoconstriction, no inotropic or chronotropic effects
epi used for IV push, IM
IV push is 0.1 mg/ml (1:10,000)
IM injection or compounding is 1mg/ml (1:1,000)
nitroglycerin
low dose: venous vasodilator
high dose: arterial vasodilator
contra SBP <90 , and w/ PDE-5 inhibitors
SE causes vasodilation: headache, flushing, tachyphylaxis, etc.
use24-48hrs cause tolerance
nitroprusside
nipride
metabolism of nitroprusside results in thiocyanate and cyanide formulation
antidote: sodium thiosulfate + sodium nitrite (nithiodote)
