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House Clinical Pathology > Correction of Electrolyte Imbalance > Flashcards

Correction of Electrolyte Imbalance Flashcards

1
Q

HYPERNATREMIA

Sodium levels greater than _____mmol/L

Produces a state of _____osmolality

A

145

hyper

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2
Q

CAUSES of hypernatremia

•Impaired _____ mechanisms, Coma.

•___ diuresis.

•Diabetic __________

•___________ coma, _______ administration

A

thirst

Solute

ketoacidosis

non ketotic hyperosmolar

mannitol

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3
Q

CAUSES of hypernatremia

•Excessive _____ loss.

•_______________

•_______________

A

water

Neurogenic diabetes insipidus

nephrogenic diabetes insipidus

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4
Q

Clinical features of hypernatremia

Neurological manifestations are as a result of __________

Restlessness

Lethargy

_________reflexia

_________

A

cellular dehydration.

Hyper

Seizures

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5
Q

Clinical features of hypernatremia

_______-______may occur

Rapid decreases in brain volume can ____________ causing _________ or __________________

A

Coma-death

rupture cerebral veins

subarachnoid or intracerebral haemorrhage.

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6
Q

TREATMENT OF hypernatremia

Restore _______ to normal and treat the __________

Water deficit Correction should be done over ______ with a ______tonic solution like __________ in water.

A

plasma osmolality; underlying cause.

48hours; hypo

5% dextrose

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7
Q

Water deficit is calculated by:-

Free water deficit=_______ ((_____/_____)-__)x _____.

A

plasma

Na/140

1

TBW

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8
Q

TREATMENT of hypernatremia

Rapid correction of hypernatraemia can result in ______, cerebral _______,permanent ________ and death.

A

seizures

oedaema

neurological damage

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9
Q

TREATMENT pf hypernatremia

Decrease in plasma sodium concentration should not be faster than ____mmol/L/hour.

A

0.5

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10
Q

Treatment of hypernatremia

Hypernataemia has been demonstrated to increase the MAC for _________

A

inhalational anaesthetics.

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11
Q

Elective surgery is postponed in patients with significant hypernatraemia.

T/F

A

T

Elective surgery is postponed in patients with significant hypernatraemia. Na >150mmol/L

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12
Q

Treatment of Hypernataemia

For Elective surgery

________________ must be corrected prior to elective surgery.

A

Both water and isotonic deficits

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13
Q

Most common electrolyte disorder is ??

A

HYPONATRAEMIA

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14
Q

HYPONATRAEMIA

Caused by cellular ______ with the presence of _____tonicity.

A

oedema

hypo

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15
Q

CAUSES OF HYPONATRAEMIA

RENAL CAUSES.

_______

_______ deficiency

_____ losing nephropathies

osmotic diuresis (___ ,______and ______ )

renal tubular (alkalosis or acidosis?) .

A

Diuretics

mineralocorticoid

salt

glucose, urea and mannitol

acidosis

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16
Q

CAUSES OF HYPONATRAEMIA

EXTRARENAL CAUSES.

_________, diarrhea

_______

_______,______

A

Vomiting

sweating

burns, third spacing.

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17
Q

Third-space fluid shift is the ___________ to a __________ rendering it _______ to the circulatory system.

A

mobilisation of body fluid

non-contributory space

unavailable

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18
Q

CLINICAL MANIFESTATIONS of hyponatremia

Patients with Na >___mmol/L may be asymptomatic. Serious manifestations begin to occur below _____mmol/L.

A

125

120

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19
Q

CLINICAL MANIFESTATIONS of hyponatremia

Early symptoms are (specific or non specific?) and may include anorexia, nauusea and weakness.

Progressive ________ results in lethargy, and confusion, seizures, coma and death.

A

non specific

cerebral oedema

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20
Q

TREATMENT of hyponatremia
The Na deficit= _____x (_____-______)

Excessive rapid correction of hyponatraemia has been associated with _________ in the _______ (central _______________)

A

TBW

desired Na; present sodium

demyelinating lesions in the pons

pontine myelinolysis

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21
Q

TREATMENT of hyponatremia

Rates of correction

Mild symptoms-____mmol/L/h
Moderate symptoms-___mmol/L/h or less
Severe symptoms-___mmol/L/h or less.

A

0.5

1

1.5

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22
Q

Na _____mmol/L is safe for patients undergoing general anaesthesia.

A

130

23
Q

In most cases correct sodium to greater than ___mmol/L for elective proceedures even in the absence of neurological symptoms.

A

130

24
Q

(Lower or higher?) Na concentrations may result in significant cerebral oedema that can manifest intraoperatively as a _____ in ____ or post operatively as _____,______, or _______

A

Lower

decrease in MAC

agitation, confusion or somnolence.

25
Q

MAC = ????

A

Monitored anesthesia care

26
Q

HYPOKALAEMIA
Defined as plasma K less than _____mmol/L

A

3.5

27
Q

HYPOKALAEMIA

A decrease of K from 4 to 3mmol/L represents a ___ to ____ mmol/L deficit

A

100 to 200

28
Q

HYPOKALAEMIA

Plasma K below 3mmol/L represents a deficit anywhere between ____-_____mmol/L of K

A

200-400

29
Q

Causes of hypokakemic

EXCESS RENAL LOSS.

__________excess

primary _______ (______ syndrome; ____ excess

renovascular _______; diuresis

chronic metabolic (acidosis or alkalosis?)

A

Mineralocorticoid

Hyperaldosteronism

Conn’s ; renin

hypertension; alkalosis.

30
Q

Causes of hypokakemic

Gastrointestinal loss. _____ and _____

A

Diarrhoea and vomiting

31
Q

Causes of hypokakemic

ECF-ICF shifts. Acute (acidosis or alkalosis?)

hypokalaemic periodic _____

______ ingestion, _____ therapy

A

alkalosis

paralysis

barium

32
Q

CLINICAL PRESENTATION of hypokalemia

Most patients are asymptomatic until ___________________________

A

plasma K falls below 3mmol/L

33
Q

CLINICAL PRESENTATION of hypokalemia

_______ effects are most prominent and include an abnormal ____ arrhythmias, ___eased cardiac contractility and a labile arterial blood pressure due to autonomic dysfunction

A

Cardiovascular

ECG

decr

34
Q

TREATMENT of hypokalemia

Intravenous replacement is reserved for those at risk for significant _______ manifestations or those with severe __________

A

cardiac

muscle weakness

35
Q

TREATMENT of hypokalemia

K is _____ to peripheral _____ .so, never give more than __mmol/L/h

A

irritating; veins; 8

36
Q

TREATMENT of hypokalemia

______ containing solutions should be avoided because the resulting hyperglycaemia and secondary ______ may actually worsen the low potassium.

A

Dextrose

insulin secretion

37
Q

TREATMENT of hypokalemia

More rapid intravenous potassium replacement (___-___mmol/l/h) requires __________ administration and _____ monitoring

A

10-20

central venous

ECG

38
Q

TREATMENT of hypokalemia

IV replacement should not exceed ____mmol/L/day

A

240

39
Q

general surgery can proceed with K levels of 3-3.5mmol/L.

T/F

A

T

40
Q

ANAESTHETIC CONSIDERATION

In chronic mild hypokalaemia of ____mmol/L without _____ changes anaesthetic risk is minimal.

A

3-3.5

ECG

41
Q

ANAESTHETIC CONSIDERATION

Intraoperatively potassium should be given if _____ or ________ should occur.

A

atrial or ventricular arrhythmias

42
Q

CLINICAL MANIFESTATION of hyperkalemia
The most important are _____ and ______ manifestations.

A

skeletal and cardiac muscle

43
Q

CLINICAL MANIFESTATION of hyperkalemia

Skeletal muscle weakness is generally not seen until _________

A

K levels of 8mmol/L is reached

44
Q

CLINICAL MANIFESTATION of hyperkalemia

Cardiac manifestations occur at ___mmol/l of K and is due to _______

A

7
delayed repolarisation.

45
Q

HYPERKALAEMIA
K > ___mmol/L

Kidneys can excrete as much as ____mmol/L of K per day

A

5.5

500

46
Q

Hyperkalaemia occurs often in normal individuals.

T/F

A

F

Hyperkalaemia rarely occurs in normal individuals.

47
Q

TREATMENT of hyperkaelemia

Hyperkalaemia exceeding ___mmol/l should always be corrected.

A

6

48
Q

TREATMENT of hyperkaelemia

________ of cardiac manifestations and skeletal muscle weakness.

A

Reversal

49
Q

TREATMENT of hyperkaelemia

10% __________ (5-10 mls) to antagonise the effects of hyperkalaemia.

A

Calcium gluconate

50
Q

TREATMENT of hyperkaelemia

When metabolic acidosis is present, give IV _________ usually 45meq will promote _____________ and can reduce plasma K within 15 mins.

A

sodium bicarbonate

cellular uptake of K

51
Q

TREATMENT OF hyperkaelemia

•IV ______ and _______.

•________ in symptomatic patients.

A

GLUCOSE AND INSULIN

Dialysis

52
Q

Anaesthesia and surgery can be taken in patients with hyperkalaemia.

T/F

A

F

Anaesthesia and surgery should not be taken in patients with hyperkalaemia.

53
Q

Most errors fall into this category

Pre analytical, analytical, or post analytical

A

Pre analytical

54
Q

analytical errors are rare

T/F

A

T

House Clinical Pathology (45 decks)

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