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POS > E+ > Flashcards

E+ Flashcards

1
Q

FE Na = ?
Utilité ?

A

Fraction excrétion sodium = (Una / Ucr) / (Pna / Pcr)
Faire différence entre pertes rénales vs extra rénale dans HypoNa Hypovolémique
si < 1% –> extra rénales (GI, 3e espace, cutanée, etc)

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2
Q

Causes HypoNa (Hypovolémique + euvolmiques + hypervolémiques) ?
Na U + Osm U ?

A
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3
Q

Osm plasmatique = ?

A

2Na + glucose + urée

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4
Q

Tx HypoNa

A

Aigue (<24-48h) :
- Sx : peut être corrigée plus rapidement, NS 3% 1-2 cc/h/kg ad N +/- lasix
- aSx : tx surtout si HypoNa marquée

Chronique :
- Sx sévères : NS 3%, viser aug Na 1-2 mmol/L /h x 4-6h (mx 8 mmol / 24h)
- aSx : restriction hydrique (1L/j) +/- NS 0,9% et furosémide +/- sel PO

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5
Q

Complication correction trop rapide HypoNa ?
Tx ?

A

central pontine myelinolysis

D5W
DDAVP (ADH)

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6
Q

Max correction HyperNa ?
Risque si correction trop rapide ?

A

Aigue : 1 mEq/h
Chronique 0.7 mEq/h
Max 12 mEq/24h

Oedème cérébral –> engagement

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7
Q

Comment différencier diabète insipide central vs néphrogénique ?

A

Administration DDAVP / desmopressine
Si aug Osm U > 50 % –> cause centrale

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8
Q

Cause entrée/sortie K intracelllulaire

A

Entrée :
Alcalose
Insuline
Catécholamines

Sortie :
Acidose
BB
Exercice
Hyperosm

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9
Q

HyperMg :
- Sx
- Arythmies
- Causes
- Tx

A
  • Léthargie
  • Brady, bloc
  • ECG : aug PR+QT, QRS large
  • IR, lyse tumorale, hypovolmie, acidose Db (souvent chez pts IR qui prennent Rx contenant Mg ex: laxatifs, antiacids)
  • gluconate de Ca
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10
Q

HypoMg :
- Sx
- Arythmies associées

A
  • irritabilité, fasciculations, crmapes, tétanie, hyperreflexie, convulsions
  • Signe Chvostek, Signe Trousseau (spasmes)
  • Torsade de pointe, FV
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11
Q

Causes HypoMg

A

ROH
HypoP
HyperCa
Brûlures
Pertes GI (malabsorp, Vo, Do, TNG, fistule)
Pertes rénales
Rx : cisplatin, cyclosporine, aminosides, tacrolimus

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12
Q

Valeurs N
Na
K
Mg
Ca
P

A

Na 135-145
K 3,5-5,0 mmol/L
Ca 2,2-2,6 mmol/L
Mg 0,75-0.95 mmol/L
P 0.8-1.5 mmol/L

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13
Q

HypoCa
- Sx
- Causes
- Tx

A
  • idem à hypoMg + QT allongé (irritabilité, fasciculations, crmapes, tétanie, hyperreflexie, convulsions, Signe Chvostek, Signe Trousseau )
  • IRC, diurétiques, dim apports
  • Réplétion hypoMg, exclure hypoalb
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14
Q

Cause maligne + fréq d’hyperCa

A

Néo sein
(hyperparathyroidie non malin)

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15
Q

HyperCa
- Sx
- Tx

A
  • léthargie, hyporéflexie, No/Vo, hypoTA, soif, polyurie, dim QT
  • Tx :
    NS 200-300 cc/h + lasix (PAS DE LR)
    (Calcitonine
    Biphosphanate
    Cortico
    Dialyse)
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16
Q

Causes HyperCa

A

HyperPTH
DysT4
Phéo
Insuff surrénalienne

Néo sein
Lymphome

Mx granulomateuses
Immob
Mx Paget

17
Q

Rx causent hyperCa

A

TZD
Lithium
vit A / vit D
Oestrogènes
Tamox
Cortico

18
Q

HypoK Sx + ECG

A

Anorexie
No/Vo
iléus
faiblesse
crampes

ECG : ss dec ST, QT allongé, onde T aplatie ou inversée, ondes U (pas d’ordre)

19
Q

Causes hypoK

A

Redistribution (insuline, ventolin, alcalose, catheco)
diurétiques (sauf spironolactone)
Pertes GI
Hyperaldo

20
Q

Causes HyperK

A
  • IR, IECA, AINS
  • spironolactone
  • digoxine
  • hémolyse
  • acidose
  • rhabdomyolyse
21
Q

HyperK
Sx
ECG

A

Faiblesse, paralysie, irritabilité

Ondes T pointues + QT courts
Disparition ondes P/allongement PR
Bloc AV haut degré
QRS élargi –> Asystolie imminante

22
Q

Tx hyperK

A

Si K > 7 ou changements ECG
Gluconate de calcium (1-2 amp IV, 10 ml 10%)
HCO3
Insuline + dextrose
Kayexalate
Lasix
Dialysis

23
Q

Algorithme acidose métabolique
Causes AG augmenté

A

Anion gap = Na - Cl - HCO3
Trou osm = Osm mesurée - Osm calculée (2Na + urée + glucose)
Trou osm urinaire = (Na+K) - Cl

AG augmenté –> GOLDMARK

24
Q

Calcul compensation tb acido-basique

A

Acute
Rac 0.1
Ral 0.2

Chronique
Rac 0.3-0.4
Ral 0.5

Mal 0.7
Mac 1.2

25
Q

Changements E+ 2nd IRC

A

Hyper : K, Mg, P, urée, créat
Hypo : Na, Ca
Anémie

26
Q

Pré rénal :
Osm ur ?
Na ur ?
FeNa ?

A

> 500
< 20
< 1%

27
Q

Désordres E+ 2nd refeeding

A

Hypo K, Mg, P
hyperglycémie

(2nd shift utilisation lipides –> glucides)

28
Q

anomalies E+ 2nd lyse tumorale

A

(2nd tx leucémie/lymphome, destruction massive de cellules)

HyperP
HyperK
HypoCa
Urémie

POS (12 decks)

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