Common Problems Flashcards
Low sodium on renal panel but no sx, order what next?
- Serum osmo (if normal, pt has no problem) <270 low
- Are they wet, dry, or normal by clinical sx
- If low, order urine sodium (if >20, kidney problem)
4.
Serum osmo is 2 x the sodium
Euvolemic think endocrine!!!!
Risk factors for fungal infectious fever
Chronic illness
immunosupression
chronic ATB use
if sodium is high, where is the water going?
if urine osmo is low, they are not concentrating, think DI
non-infectious causes of fever
Auto immune disease:
giant cell arteritis, IBS, thyroid issues, UC, RA/Lupus
Post-op- atelectasis, dry
Drug fever >102 - Neuroleptic malignant syndrome,
serotonin syndrome
Dehydration
Anion gap formula
(NA+K)- (HCO3+Cl)
Nrml is 7-17
higher the gap, sicker the pt
Most common complication of enteral feeding?
Diarrhea
Most common complication of perenteral feeding?
Delivery mechanism: IV probs
3.5-5 normal range
Albumin, potassium, phosphorus
Ratio of solute to fluid is the same on both sides of the membrane
Iso-osmolar
270-290 normal
osmolar content
What hormone causes men to have increased H&H?
Testosterone
Transfuse at what H&H?
8/24
What is the best indicator of protein malnutrition?
Pre-albumin
What is the average serum osmolality?
280-285
What is the first thing to order in a patient with low sodium?
Sodium osmolality
Low sodium, normal osmo (284-295)
Isotonic hyponatremia
Lab error
No treatment except to order statin
low sodium, serum osmo <270
What’s next?
Check clinical volume?
Wet, dry or normovolemic
Low sodium, low serum osmo, wet clinical picture
Wet: retaining water, diluting water
liver, heart or kidney failure
Fix underlying problem then:
water restriction
Low sodium, low osmo, dry picture
Next step?
Sodium loss exceeds water loss
Check urine sodium >20=kidney, <10 other sources
Where is it going?
Kidney, anus (diarrhea), mouth (vomit), pores (sweat)
If kidney, diuretic use-STOP, ACE, mineralocorticoid deficiency
Hyponatremia, low osmo, euvolemic
Hypothyroidism is most common cause
Hyponatremia, hyper osmo >290
Some other substance is too high in the blood, body attempts to fix it by getting rid of sodium which is plentiful in the body
Most common cause is hyperglycemia!
FIx the sugar!
Hypernatremia
Due to loss of free water, where did it go?
Mouth, kidney, anus, pores
If lots of urine, DI
If urine osmo is high, not from the kidney
Potassium
Ion of diastole- if too high, diastole never ends, permanent rhythm!
Broad T waves, decreased amplitude, U waves
Hypokalemic
Failure to convert with shock?
Hypokalemia
Ca+
Contraction Ion for heart and neuro system
Increased DTR’s, Chovestek’s sign, Trousseau’s Sign, prolonged QT
Hypocalcemia
Give IV calcium gluconate
Calcium is bound to what substance?
Albumin
Carpopedal spasm with BP cuff around the thigh
Trousseau’s sign
Normal calcium
8.5-10.5
Ionized calcium 4.5-5.5
Normal Ca+ in a pt with low albumin?
pt is actually hypercalcemic
Serum calcium > 12
Medical emergency
(muscle weakness, N/V, fatigue),
possibly d/t thiazide diuretics
Give NS with loop diuretic, may need HD
Adjuvant therapy for pain
Lyrica, antileptic
Carb cal/gm
Protein:
Fat:
Alcohol:
Carb 4cal gm
Protein: 4cal/gm
Fat: 9 cal/gm
Alcohol: 7 cal/gm
Best assessment of TPN efficacy?
Nitrogen balance
Neg? not enough protein
Pos? Extra protein
Heparin is an aldosterone antagonist
Lose sodium, reabsorb potassium, risk for hyperkalemia
Hyperventilating- what is the ABG finding?
Respiratory alkalosis, stocking glove paresthesias
Most common post-op acid/base imbalance?
Metabolic alkalosis (they are dry)
Give fluid/ NS
Most important thing in I&D?
Fluid irrigation
What electrolyte abnormality is an absolute contraindication for succinylcholine?
Hyperkalemia
What med is used for metabolic alkalosis?
Diamox/Acetazolamide
also used in closed angle glaucoma
If the pH and Bicarb are Both in the same direction, its metaBolic!
resp opposite, metabolic =
pH and Co2 oppostie=respiratory
