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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
What is the rel of rate of correction and rate of development of the disorder in fluid therapy?
Directly proportional
26
How do you treat volume excess/hypervolemia?
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
How do you treat volume excess/hypervolemia?
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
ADH + Thirst mechanism, what does this indicate?
If both are intact --> water balance is ok
29
What stimulates ADH + thirst mechanism?
DEC amt of H2O, circulating blood volume INC serum Na or serum osmolality
30
What are the characteristics of Hypvolemic hyponatremia?
DEC in both total body water & sodium levels HYpovolemia + High UNa (kidney prob) Hypovolemia + Low Una (<20) (extrarenal loss)
31
What are the characteristics of Hypvolemic hyponatremia?
DEC in both total body water & sodium levels HYpovolemia + High UNa (kidney prob) Hypovolemia + Low Una (<20) (extrarenal loss)
32
What are the characteristics of Hypvolemic hyponatremia?
DEC in both total body water & sodium levels HYpovolemia + High UNa (kidney prob) Hypovolemia + Low Una (<20) (extrarenal loss)
33
What are the characteristics of Euvolemic hyponatremia?
No changes in body Na levels, only INC in TBW Euvolemia + High UNA SIADH
34
What are the characteristics of hypervolemic hyponatremia?
INC in total body Na & INC in TBW Hypervolemia + High UNa (renal failure) Hypervolemia + Low Una (nephrotic syndrome, cirrhosis, <3 failure)
35
What syndrome has hyponatremia secondary to low Na intake?
Beer Potomania Syndrome | alcholics whose sole nutrient is beer
36
What are the dx criteria to confirm diagnosis of SIADH?
True hyponatremia (Hypotonic hyponatremia) Normal thyroid, adrenal, hepatic, renal, cardiac function Urine Osm >100mOsm/kg Urine Na: <20mEq/L
37
What are the caues of SIADH?
CNS dis Neoplasm Pulmonary dis Drug-induced Guillan-Barre synd, Pain, Delirium tremens, nausea, psychosis
38
what are the major considerations for hyponatremia therapy?
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
In Osmotic Demyelination syndrome, what is the amt of Plasma Na correction given? What happens if sudden correction is done?
Amt: <8mEq/L Permanent damage can happen if sudden correction is done
40
How do you manage hypovolemic hyponatremia?
Volume resuscitation w/ NSS
41
How do you manage Normovolemic hyponatremia?
Limit water intake Correct endocrine abn Remove offending drugs
42
How do you manage Hypervolemic hyponatremia?
Correct underlying state Loop diuretics
43
What are causes of acute symptomatic hyponatremia?
Post-op (INC ADH) Exercise w/ Hypotonic fluid replacement Recreational drugs: Ecstasy
44
How do you tx acute symptomatic hyponatremia?
Loop diuretics Raise Na to >120
45
What are pharmacologic agents for hyponatremia?
Loop diuretics Vasopressin antagonist (Tolvaptan) | ihi dapat ng ihi
46
What is the ECG pattern change in hypokalemia & hyperkalemia?
Hyperkalemia = tall or peak T waves Hypokalemia = low, flat or inverted T waves
47
What are possible causes of hypokalemia?
Spurious hypokalemia - false positive Cellular shifts - K goes out of the cell
48
In what situations does K go out of the cell?
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
What condition should you suspect if px has hypokalemia but is HYPERtensive? What should u do then?
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
What is the cause of hypokalemia if px is normotensive?
check urine K & acid base status High urine K -> kidney loses K Low urine K -> loss of K outside of kidney
51
What condition has hypokalemia with acidosis?
Renal tubular acidosis or diarrhea | remember, u lose a lot of K in these conditions bcos of electrolyte imab
52
What conditions can we see hypokalmemia with alkalosis?
Diuretic use Gitelman syndrome Bartters disease Vomiting
53
What should we take note for K replacement?
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
What are the causes of hypertensive hypokalemia with high and low aldosterone?
High aldosterone = primary hyperaldosteronism Low aldosterone = glucocorticoid excess, licorice intake or Liddle's syndrome
55
What are the causes of Normotensive Hypokalemia with urine K of <15mEq/L?
Acidosis = GI loss or poor K intake ALklalosis = prior use of diuretics
56
What causes normotensive hypokalemia with urine K of >15mEq/L?
Acidosis = RTA Alkalosis = Bartter or Gitelman syndrome, Diuretics, Vomiting
57
What are the replacement guidelines for K?
replaced gradually over 24-48hrs & frequent monitoring of serum K
58
What is the mainstay therapy for hypokalemia?
Oral replacement with KCl
59
What is the tx for hypokalemia w/ concomitant metabolic acidosis?
K HCO3 or K Citrate

Medicine I (8 decks)

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