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JD RENAL > Clin Med Electrolytes and Volume > Flashcards

Clin Med Electrolytes and Volume Flashcards

1
Q

HYPONATREMIA

what is most common type of hyponatremia?

A

hypervolemia hypo-osmolar

due to fluid overload

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2
Q

HYPONATREMIA

what does hyperglycemia do to sodium?

A

hyperglycemia can cause a

hyperosmolar HYPONATREMIA

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3
Q

HYPONATREMIA

how does hyperglycemia cause hyponatremia?

A

hyperglycemia causes water to shift from the intracellular compartment to extracellular compartment, causing dilution of sodium

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4
Q

HYPONATREMIA

what does SIADH do to sodium?

A

SIADH causes

hypo-osmolar, euvolemic hyponatremia

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5
Q

HYPONATREMIA

how does SIADH cause hyponatremia?

A

SIADH causes increase in circulating ADH (due to hypersecretion from post pit)

increased ADH –> increased water retention –> more dilute fluid

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6
Q

HYPONATREMIA

at what serum sodium levels do s/s begin to develop?

A

125-130 mEq/L

but pt may be asymptomatic until as low as 110 mEq/L

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7
Q

HYPONATREMIA

mild hyponatremia treatment?

A

fluid restriction only

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8
Q

HYPONATREMIA

severe hyponatremia treatment?

A

fluid restriction AND sodium replacement

SLOOOOWLY

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9
Q

HYPONATREMIA

sodium level goal of severe hyponatremia treatment?

A

135 mEq/L

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10
Q

HYPONATREMIA

injury that occurs if hyponatremia treatment occurs too quickly?

A

CPM

central pontine myelinolysis

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11
Q

HYPONATREMIA

clinical manifestations of hyponatremia?

A

CNS dysfunction symptoms:

cerebral edema –> HA, n/v, weakness, lethargy, sz, coma, permanent brain damage

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12
Q

HYPERNATREMIA

what sodium level indicates hypernatremia?

A

> 145 mEq/L

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13
Q

HYPERNATREMIA

in what volume conditions do we find hypernatremia?

A

hypervolemia

or

hypovolemia

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14
Q

HYPERNATREMIA

what is the most common cause of hypernatremia?

A

MC cause = volume depletion

usually seen with insensible losses from fever, sweating, vomiting, diarrhea, primary hypodipsia

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15
Q

HYPERNATREMIA

in what two ways does DI cause hypovolemic hypernatremia?

A

decreased secretion of ADH from post pit

or

increased renal resistance to ADH (with resultant inability to concentrate urine)

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16
Q

HYPERNATREMIA

what is a common cause for hypervolemia hypernatremia in the hospital setting?

A

aggressive IV admin of NS

or

infusion of hypertonic fluids

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17
Q

HYPERNATREMIA

what are s/s of increased serum sodium?

A

AMS, sz, hyperreflexia, spasticity, lethargy

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18
Q

HYPERNATREMIA

what is the goal of treatment of hypernatremia?

A

normalize serum sodium
restore ECF and ECF compartments
with
hypotonic or isotonic fluids

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19
Q

HYPERNATREMIA

what happens if elevated serum sodium correction occurs too rapidly?

A

administer hypotonic or isotonic fluids slowly!

don’t go too fast, or you may see

cerebral edema,
szs,
permanent brain damage,
death (from cerebral herniation)

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20
Q

what are the most common causes of dyskalemias?

A

medication side effects
dietary intake
renal dysfunction

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21
Q

HYPOKALEMIA

define hypokalemia

A

potassium <3.5 mEq/L

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22
Q

HYPOKALEMIA

what are the most common causes of hypokalemia?

A

increased renal excretion
from diuretic use,
from hyperaldosteronism
from hypomagnesemia

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23
Q

HYPOKALEMIA

what are some other, less common, causes of hypokalemia?

A

alkalosis
insulin
beta 2 adrenergic agonists

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24
Q

HYPOKALEMIA

s/s of hypokalemia?

A

muscle weakness
constipation
fatigue
palpitations

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25
Q

HYPOKALEMIA

EKG s/s of hypokalemia?

A

flat T waves
U wave formation

ST segment depression

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26
Q

HYPOKALEMIA

what is the treatment of mild hypokalemia?

A

oral replacement using KCl

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27
Q

HYPOKALEMIA

what is the treatment of severe hypokalemia?

A 
IV replacement of potassium (10mEq/hr)
WITH TELEMETRY (to watch for arrthymias)

(don’t rebound into hyperkalemia!)

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28
Q

HYPOKALEMIA

what other electrolyte must be checked before replacing potassium?

A

Mg

if concomitant hypomagnesemia is present, Mg must be repleted prior to potassium replacement

(because of the role of Mg in regulating the sodium-potassium-ATPase pump)

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29
Q

HYPERKALEMIA

how is hyperkalemia defined?

A

K+ > 5.0 mEq/L

30
Q

HYPERKALEMIA

hyperkalemia is a common complication seen with:

A

renal insufficiency,
acidosis,
medication side effects
(ACE-I’s, ARBs, aldosterone antagonists)

31
Q

HYPERKALEMIA

common s/s of hyperkalemia?

A

muscle stuff -
muscle weakness
muscle cramping
parasthesias

32
Q

HYPERKALEMIA

common EKG changes seen in hyperkalemia?

A 
tall/peaked T waves
widened QRS
P wave loss
prolonged PR interval
ST depression
33
Q

HYPERKALEMIA

symptomatic hyperkalemia first treatment

A

IV CALCIUM

stabilize cardiac membranes, prevent arrhythmias!!!

34
Q

HYPERKALEMIA

after IV calcium, what treatments are given to restore proper potassium levels?

A

giving oral or rectal resins to bind to potassium and then be pooped out

hemodialysis

35
Q

HYPOCALCEMIA

define hypocalcemia

A

Ca+2 <8.5 mg/dL

36
Q

HYPOCALCEMIA

common causes of low calcium

A

thyroid/parathyroid conditions
Vit D deficiency
chronic renal disease

37
Q

HYPOCALCEMIA

s/s of hypocalcemia

A 
paresthesias
muscle cramping
tetany
     Chvostek sign
     Trousseau sign
38
Q

HYPERCALCEMIA

define hypercalcemia

A

Ca+2 > 10.5 mg/dL

39
Q

HYPERCALCEMIA

common causes of hypercalcemia?

A

hyperparathyroidism
malignancy
immobilization

40
Q

HYPERCALCEMIA

s/s of hypercalcemia?

A 
STONES
BONES
MOANS (lethargy, ab pain/flank pain)
PSYCHIC GROANS (depression, confusion)
FATIGUE OVERTONES
bone pain
nephrolithiasis
ab pain
m. weakness
fatigue
41
Q

HYPOMAGNESEMIA

define hypomagnesemia

A

Mg+2 < 1.5 mEq/L

42
Q

HYPOMAGNESEMIA

what are most common causes of hypomagnesemia?

A

alcoholism
GI loss
refeeding syndrome (?)

43
Q

HYPOMAGNESEMIA

s/s of hypomagnesemia

A

lethargy, confusion

hyperreflexia, paresthesias

44
Q

HYPERMAGNESEMIA

define hypermagnesemia

A

Mg+2 >2.5 mEq/L

this is rare

45
Q

HYPERMAGNESEMIA

most common causes of hypermagnesemia

A

renal failure

antacid abuse

46
Q

HYPERMAGNESEMIA

s/s of hypermagnesemia

A

flaccid paralysis
bradycardia, hypotension
cardiac arrest

47
Q

magnesium’s claim to fame

A

Mg+2 is the 2nd most abundant intracellular cation

it’s vital for
ATP processing
macronutrient and energy metabolism
neuromuscular transmission

48
Q

which form of calcium is most physiologically significant?

A

ionized calcium

is the most physiologically significant
49
Q

what is calcium bound to in serum?

50
Q

hypERphosphatemia presents similarly to

A

hyPOcalcemia

they have an inverse relationship

51
Q

Hypokalemia is associated with (flattened/peaked) _____________T-waves on ECG.

52
Q

Insulin lowers serum potassium levels by activating (enzyme) __________

A

Na/K ATPase

53
Q

list four findings of hypervolemia

A

decreased hct
SOB +/- increased RR
pulm edema
low albumin

54
Q

eight causes of hypervolemia

A

CHF
nephrotic syndrome
cirrhosis
renal failure

corticosteroids/mineralocorticoids
nephropathy
hyperaldosteronism
Kwashiorkor

55
Q

what is the best and easiest to identify sign of fluid increase

A

sudden weight gain

56
Q

what are four common presentations of hypervolemia?

A

sudden wt gain
edema/ascites
pulm edema
paroxysmal nocturnal dyspnea/orthopnea

57
Q

what physical exam findings correspond with hypervolemia?

A 
crackles upon auscultation
bounding pulses
moist skin
JVD
S3 gallop
58
Q

what is used for dx of hypervolemia?

A

decreased hct
decreased O2 sat
CXR - signs of pulm congestion
increased central venous P

59
Q

treatment of hypervolemia?

A

treat underlying cause

  • fluid reduction
    • fluid/salt restriction
    • diuretics
    • hemodialysis

if palliative care situation, treat w/ nitroglycerine and morphine (vasodilate and improve pulm congestion)

60
Q

another name for hypovolemia

A

intravascular volume contraction

61
Q

causes for hypovolemia

A

decreased fluid intake
excess fluid or Na+ loss due to v/d, sweat
burns/hemorrhage/trauma

62
Q

hypovolemia presentation

A 
sudden wt loss
tachy
hypotensive
pale, dry mucous membranes
no skin tenting
63
Q

hypovolemia dx based on….

A

increased hct
increased hgb
increased serum protein
increased BUN/creatinine ratio

64
Q

treatment of hypovolemia

A

allow permissive hypotension in shock pts
- -> administer fluids to maintain survivable BP (not a normal BP!)

MAP target = 55-60

inpatient - replace fluids

65
Q

stages of hypovolemic shock

A

Stage 1: <= 15% blood vol loss (750 mL)

Stage 2: 15-30% blood vol loss (750-1500 mL)

Stage 3: 30-40% blood vol loss (1500-2000mL)

Stage 4: >40% blood vol loss (>2000 mL)

66
Q

hypervolemia - hematocrit goes up or down?

67
Q

hypervolemia - albumin goes up or down?

68
Q

name four main ways hypervolemia presents

A

low hematocrit
SOB +/- increased RR
pulm edema
low albumin

69
Q

s/s of hypERvolemia (name four)

A

sudden wt gain
edema/ascites
pulm edema
paroxysmal nocturnal dyspnea/orthopnea

70
Q

three main findings upon PE for hypERvolemia, plus two

A

crackles in lungs
JVD
increase central venous P

also, lowered Hct
low O2 sat

71
Q

if hypERvolemia is treated with diuretics, what is given?

A

loop diuretics (most effective)
thiazides +/- albumin
K+ supplementation

72
Q

how is hypERvolemia treated palliatively?

A

improve pulmonary congestion

nitro (vasodilation) and morphine

JD RENAL (3 decks)

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