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Medicine I > Approach to Common Water and Electrolyte Problems > Flashcards

Approach to Common Water and Electrolyte Problems Flashcards

1
Q

What is the total body water of males & females?

A

F: 50% of body weight
M: 60% of body weight

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2
Q

What are the 2 major subdivisions and their total body water?

A

Intracellular compartment = 40% or 2/3 of total body water

Extracellular compartment = 20% or 1/3 of total body water
-> Intravascular space = 5% or 1/4 of total body water
-> Interstitial space = 15% or 3/4 total body water

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3
Q

How can you expand the extracellular compartment?

A

Give blood, albumin, colloid = these will not move out of the intravascular space bcos they have big sizes

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4
Q

WHat are the best volume expanders?

A

Colloids = better retained in the IC compartment —> INC osmotic pressure —> INC depleting circulating volume —> IMPROVED hypotensive px’s BP

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5
Q

What affects the control of ECF volume? purpose?

A

Afferent limb - sensors for fluid volume homeostasis
Efferent limb - effectors for fluid volume homeostasis (renal)

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6
Q

What organs are part of the afferent limb?

A

Cardiopulmonary
Arterial
CNS sensor
Hepatic volume sensor

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7
Q

What are the diff structures of the efferent limb?

A

Humoral effector system
Renal nerves
Peritubular and luminal factors
GFR

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8
Q

What are the 8 paraemters that aid in diagnosing px w/ volume status dis?

A

Weight
BP
Edema
Pulse
Hgb & Hct
Hand, axillary region
Skin turgor
CV

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9
Q

What is the indication if there is a hx of volume loss & orthostatic hypotension?

A

Moderate volume depletion

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10
Q

What are sx & symptoms of severe volume loss ^ hypovolemic shock?

A

Peripheral cyanosis
Reduced skin turgor (young px)
Marked tachycardia, low pulse
Supine hypotension
Depressed mental status (or loss of consciousness)

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11
Q

WHAT ARE the diff degrees of volume deficit, its PE findings & estimated amt of fluid deficit?

A

Mild
PE: Normal BP
Amt: 3% of BW (1.5-2L)

Moderate
PE: w/ postural hypotension
Amt: 6% of BW (304L)

Severe
PE: Frank hypotension
Amt: 9% BW (>5L)

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12
Q

How do you correct for volume deficit?

A

Replace only 1/2 of the estimated fluid deficit first then re-evaluate
- this will prevent fluid overload or overcorrection

Replace within the first 6-8 hrs

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13
Q

What are the steps in treating volume deficit?

A
  1. Quantify total deficit
  2. QUantify ongoing losses -> Monitor input & output
  3. Estimate basic daily maintenance requirement
  4. Identify concomitant electrolyte & H2O imbalance
  5. Formulate replacement plan
    a. Quantify replacement
    b. Replacement fluid
    c. Rate of replacement

Quantify replacement = deficit + active loss + basic daily req

Replacement fluid = plain NSS/LR; modify acc to concomitant electrolyte imbalance
Rate of replacement = dep on severeity & rate of onset

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14
Q

What is the basic daily req of H2O, Na & K?

for maintenance

A

Water = 2L -2.5L
Na = 50-150 mEq
K = 40-80mEq

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15
Q

What IV soln is used in px who are hypernatremic? What is its precaution?

A

D5 water (dextrose)

to avoid intravascula rhemolysis –> do not give ant hypotonic saine lower than D5 –> RBCs will swell & hemolyze

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16
Q

What is a balanced crystalloid & balanced soln that has veery similar amt of Na & K in the blood?

A

D5 LR (lactated ringer)

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17
Q

What IV soln is given to euvolemic post op px as maintenace fluid?

A

D5 NM (Normosol Maintenance)

u can give this if di pa kaya ni px kumain

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18
Q

What are the 2 choices of crystalloid?

A

0.9% Saline/NSS
Ringer’s lactate

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19
Q

When is NSS given?

A

initial fluid resuscitation but repeated large volumes can cause hyperchloremic acidosis

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20
Q

When is Ringer’s lactate given? When should it be avoided?

A

after NSS has been given and serum Cl has exceeded normal range

avoided: during liver failure, taking Metformin

has low Na, Cl & Osm

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21
Q

What are the diff AEs of resuscitation fluids to?

A

INC Albumin –> INC traumatic brain injury
Hydroxyethyl starch soln –> INC AKI & Renal replacement therapy

Dextrans –> impaired coag & allergic rxns
Crystalloids –> interstitial edema
NSS –> hyperchloremic metab acidosis & AKI

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22
Q

What is the ideal min amt of crystalloid given as intiial fluid therapy to px with sepsis-induced tissue hypoperfusion & hypovoklemia?

A

30mL/kg of crystallloid

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23
Q

Hy

What are the signs of volume depletion in px?

A

Hypotension
SHock
Organ hypoperfusion
AKI

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24
Q

What are the signs of volume overload?

A

Impaired oxygenation
Edema
Hypertension
Organ congestion

25
Q

What is the rel of rate of correction and rate of development of the disorder in fluid therapy?

A

Directly proportional

26
Q

How do you treat volume excess/hypervolemia?

A
  1. Quantify volume excess
  2. Limit fluid/salt intake
  3. GIve a diuretic: loop or distally-acting
  4. Monitor body weight, output
  5. Dialysis/Ultrafiltration
27
Q

How do you treat volume excess/hypervolemia?

A
  1. Quantify volume excess
  2. Limit fluid/salt intake
  3. GIve a diuretic: loop or distally-acting
  4. Monitor body weight, output
  5. Dialysis/Ultrafiltration
28
Q

ADH + Thirst mechanism, what does this indicate?

A

If both are intact –> water balance is ok

29
Q

What stimulates ADH + thirst mechanism?

A

DEC amt of H2O, circulating blood volume
INC serum Na or serum osmolality

30
Q

What are the characteristics of Hypvolemic hyponatremia?

A

DEC in both total body water & sodium levels
HYpovolemia + High UNa (kidney prob)
Hypovolemia + Low Una (<20) (extrarenal loss)

31
Q

What are the characteristics of Hypvolemic hyponatremia?

A

DEC in both total body water & sodium levels
HYpovolemia + High UNa (kidney prob)
Hypovolemia + Low Una (<20) (extrarenal loss)

32
Q

What are the characteristics of Hypvolemic hyponatremia?

A

DEC in both total body water & sodium levels
HYpovolemia + High UNa (kidney prob)
Hypovolemia + Low Una (<20) (extrarenal loss)

33
Q

What are the characteristics of Euvolemic hyponatremia?

A

No changes in body Na levels, only INC in TBW
Euvolemia + High UNA
SIADH

34
Q

What are the characteristics of hypervolemic hyponatremia?

A

INC in total body Na & INC in TBW
Hypervolemia + High UNa (renal failure)
Hypervolemia + Low Una (nephrotic syndrome, cirrhosis, <3 failure)

35
Q

What syndrome has hyponatremia secondary to low Na intake?

A

Beer Potomania Syndrome

alcholics whose sole nutrient is beer

36
Q

What are the dx criteria to confirm diagnosis of SIADH?

A

True hyponatremia (Hypotonic hyponatremia)
Normal thyroid, adrenal, hepatic, renal, cardiac function
Urine Osm >100mOsm/kg
Urine Na: <20mEq/L

37
Q

What are the caues of SIADH?

A

CNS dis
Neoplasm
Pulmonary dis
Drug-induced
Guillan-Barre synd, Pain, Delirium tremens, nausea, psychosis

38
Q

what are the major considerations for hyponatremia therapy?

A

Px w/ chronic hyponatremia -> at risk for Osmotic Demyelination Syndrome
Severity of symptoms determine the urgency & goals of therapy?
Frequent monitoring of Plasma Na conc

39
Q

In Osmotic Demyelination syndrome, what is the amt of Plasma Na correction given? What happens if sudden correction is done?

A

Amt: <8mEq/L
Permanent damage can happen if sudden correction is done

40
Q

How do you manage hypovolemic hyponatremia?

A

Volume resuscitation w/ NSS

41
Q

How do you manage Normovolemic hyponatremia?

A

Limit water intake
Correct endocrine abn
Remove offending drugs

42
Q

How do you manage Hypervolemic hyponatremia?

A

Correct underlying state
Loop diuretics

43
Q

What are causes of acute symptomatic hyponatremia?

A

Post-op (INC ADH)
Exercise w/ Hypotonic fluid replacement
Recreational drugs: Ecstasy

44
Q

How do you tx acute symptomatic hyponatremia?

A

Loop diuretics
Raise Na to >120

45
Q

What are pharmacologic agents for hyponatremia?

A

Loop diuretics
Vasopressin antagonist (Tolvaptan)

ihi dapat ng ihi

46
Q

What is the ECG pattern change in hypokalemia & hyperkalemia?

A

Hyperkalemia = tall or peak T waves
Hypokalemia = low, flat or inverted T waves

47
Q

What are possible causes of hypokalemia?

A

Spurious hypokalemia - false positive
Cellular shifts - K goes out of the cell

48
Q

In what situations does K go out of the cell?

A

If px i taking Insulin, B-agonist drugs, Hyperthyroidism or metab alkalosis

These force out K out of the cell bcos of electrolyte imbalance in the f

49
Q

What condition should you suspect if px has hypokalemia but is HYPERtensive? What should u do then?

A

Hyperaldosteronism state

  1. check plasma renin & aldosterone level
  2. if Aldosterone reabsorbs too much Na = hypertension
  3. if aldosterone relases too much K = hypokalemia
50
Q

What is the cause of hypokalemia if px is normotensive?

A

check urine K & acid base status

High urine K -> kidney loses K
Low urine K -> loss of K outside of kidney

51
Q

What condition has hypokalemia with acidosis?

A

Renal tubular acidosis or diarrhea

remember, u lose a lot of K in these conditions bcos of electrolyte imab

52
Q

What conditions can we see hypokalmemia with alkalosis?

A

Diuretic use
Gitelman syndrome
Bartters disease
Vomiting

53
Q

What should we take note for K replacement?

A

Check renal function
Oral route of admin
Max rate of replacement: 40mEq/hr
Max conc in IV fluid: 40mEq/L
Cardiac monitoring if IV replacement is >10mEq/hr

54
Q

What are the causes of hypertensive hypokalemia with high and low aldosterone?

A

High aldosterone = primary hyperaldosteronism
Low aldosterone = glucocorticoid excess, licorice intake or Liddle’s syndrome

55
Q

What are the causes of Normotensive Hypokalemia with urine K of <15mEq/L?

A

Acidosis = GI loss or poor K intake
ALklalosis = prior use of diuretics

56
Q

What causes normotensive hypokalemia with urine K of >15mEq/L?

A

Acidosis = RTA
Alkalosis = Bartter or Gitelman syndrome, Diuretics, Vomiting

57
Q

What are the replacement guidelines for K?

A

replaced gradually over 24-48hrs & frequent monitoring of serum K

58
Q

What is the mainstay therapy for hypokalemia?

A

Oral replacement with KCl

59
Q

What is the tx for hypokalemia w/ concomitant metabolic acidosis?

A

K HCO3 or K Citrate

Medicine I (8 decks)

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