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CLIN MED3: GU/Renal > Electrolyte Disorders > Flashcards

Electrolyte Disorders Flashcards

1
Q

What is the normal serum osmolality

A

280-295mOsm/kg

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2
Q

what is Osmolality

A

concentration of all particles in water (body fluid)

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3
Q

what is tonicity

A

osmotic pressure caused by particle restriction to one side of the cell membrane

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4
Q

what are the values of isotonic

A

280 - 295 mOsm/kg

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5
Q

what are the values of hypotonicity

A

<280 mOsm/kg

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6
Q

what are the values of hypertonicity

A

> 300 mOsm/kg

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7
Q

what is normal sodium levels

A

135-145 mEq/L

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8
Q

what is sodiums function in the human body

A

conduct nerve impulses
contraction of muscles
tonicity

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9
Q

what is the concentration of hypnatremia

A

<135 mEq/L

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10
Q

what is most hyponatremia secondary to

A

dilution, not low total sodium

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11
Q

what are the three types of hyponatremia

A

isotonic hyponatremia
hypotonic hyponatremia
hypertonic hyponatremia

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12
Q

what is another name for isotonic hyponatremia

A

psuedohyponatremia

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13
Q

what are common causes of isotonic hyponatremia

A

elevated triglycerides
elevated LDL
Hyperproteinemia from Multiple Myeloma

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14
Q

what is the treatment of isotonic hyponatremia

A

treat hypertriglyceridemia and/or LDL
-statin, fibrates, niacin, fish oil
Multiple Myeloma
- immunotherapy

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15
Q

What is another name for hypertonic hyponatremia

A

translational hyponatremia

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16
Q

what is hypertonic hyponatremia

A

hyponatremia (< 135) with high osmolality (>280-295)

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17
Q

what is hypotonic hyponatremia defined as

A

serum sodium < 135 and low serum osmolality < 280

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18
Q

how is hypotonic hyponatremia further classified

A

by volume status:
-hypovolemia hypotonic hyponatremia
- euvolemic hypotonic hyponatremia
- hypervolemic hypotonic hyponatremia

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19
Q

what is hypovolemic hypotonic hyponatremia

A

result of renal or extra renal volume loss with hypotonic fluid replacement
ADH stimulated to maintain intravascular volume

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20
Q

what are the causes of hypovolemic hypotonic hyponatremia

A

extra renal salt loss: dehydration, diarrhea, vomiting
renal salt loss: diuretics, ACEIs, kidney disease, mineralocorticoid (aldosterone) deficiency, cerebral salt wasting

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21
Q

What is euvolemic hypotonic hyponatremia primarily related to

A

ADH dysfunction or free water replacement of losses

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22
Q

what are the causes of euvolemic hypotonic hyponatremia

A

wide range:
adrenal insufficiency
SIADH
Hypothyroidism
thiazide diuretics
NSAIDs
ACEIs
etc.

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23
Q

what is hypervolemic hypotonic hyponatremia

A

related to edema and third spacing
reduced intra-vascular volume - ADH secretion in attempt to maintain
results in retention of free water, fluid overload, dilutional hyponatremia

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24
Q

what are causes of hypervolemic hypotonic hyponatremia

A

cirrhosis
heart failure
nephrotic syndrome
advanced kidney disease (impaired in water excretion)

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25
Q

what are severe symptoms of hyponatremia

A

seizure, coma, respiratory arrest

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26
Q

what are mild to moderate symptoms of hpyonatremia

A

headache, fatigue, lethargy, N/V, dizziness, ataxia, confusion and muscle cramps

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27
Q

what labs should be ordered for hyponatremia

A

serum electrolytes (CMP/CMP)
Creatinine
serum osmolality
urine osmolality
- thyroid function, LFTs, adrenal function testing

28
Q

what are signs of hypovolemia

A

diminished BP and pulses
tachycardia
decreased skin turgor

29
Q

what are the signs of hypervolemia

A

JVP
edema
orthopnea

30
Q

what iis the treatment of hypotonic hyponatremia

A

restriction of free water or hypotonic solutions

31
Q

what is the reatement of hypovolemic hypotonic hyponatremia

A

volume resuscitation
isotonic fluids: LR or normal saline

32
Q

what is the treatment of hypervolemic hypotonic hyponatremia

A

reduce volume
diuresis with loops, dialysis or both

33
Q

What is the treatment of isotonic hyponatremia

A

treat underlying cause: lower cholesterol, tx other protein pathologies
check lab for potential lab errors

34
Q

what is the treatment of hypertonic hyponatremia

A

correct glucose: insulin, isotonic fluid:NS
discontinue any offending agents: mannitol, osmotic laxatives

35
Q

when do you admit patients with hyponatremia for treatment

A

symptomatic patients or severe hyponatremia

36
Q

what is the risk of rapid correction of hyponatremia

A

osmotic demyelination syndrome (ODS)

37
Q

What is osmotic demyelination syndrome (ODS)

A

rapid rise in sodium concentration pulls water from the brain
results in cerebral demyelination (can occur outside the pons)
symptoms are progressive and often irreversible

38
Q

what are symptoms of ODS

A

AMS
weakness or paryalysis in arms and legs
stiffness
impaired sensation
difficulty with coordination
coma
“locked in” syndrome
death

39
Q

what is the treatment of ODS

A

supportive care
IV NS/5% dextrose
DDAVP
Plasmapheresis (?)

40
Q

what are the different types of hypernatremia

A

always hyperosmolar state
hypovolemic - loss of TBW&raquo_space; sodium
euvolemic - free water deficit
hypervolemic - pure sodium increase (and water follows)

41
Q

what are the primary causes of hypernatremia

A

free water loss
hospitalized/institutionalized pt without free water access
excess sodium intake (rare)
primary hyperaldosteronism (usu mild and asymp)

42
Q

what are symptoms of hypernatremia

A

signs of dehydration: orthostasis, oliguira
lethargy, irritability, weakness are early signs
hyperthermia, delirium, seizures, coma if severe
sodium > 185

43
Q

what test can be used to help identify cause of water losses

A

Fractional excretion of sodium FENa

44
Q

what is the treatment of hypernatremia

A

admit symptomatic pts
correct any cause of fluid loss
hypovolemia - isotonic NS fluid
Euvolemia- D5W - excretion of excess sodium in urine
hypervolemia - D5W + diuretics

45
Q

what is normal potassium levels

A

3.5 to 4.5 mEq/L

46
Q

what is the function of potassium in the human body

A

maintain ICF
maintain electrochemical gradient
muscle contraction
balance of pH
nerve signal transmission
cardiac refractory period

47
Q

what is the lab volume that indicates hypokalemia

A

serum potassium < 3.5 mEq/L

48
Q

what can hypokalemia be due to

A

inadequate intake
movement of K+ from ECF -> ICF
extra-renal K+ losses
Renal K+ losses

49
Q

what are causes of extrarenal K+ losses

A

diarrhea, vomiting, laxative abuse, Zollinger-Ellison syndrome, villous adenoma

50
Q

what are causes of Renal K+ losses

A

aldosterone, loop diuretics, Cushings syndrome, renin-producing tumor
dependent on Mg+ movements

51
Q

what are symptoms of Hypokalemia

A

muscular weakness, fatigue, muscle cramping
constipation or ileus
if severe: flaccid paralysis, hyporeflexia, hypercapnia, tetany, rhabdomylosis

52
Q

what diagnostic test can help ID causes of K+ losses

A

urinary potassium concentration
< 20 mEq/L = extrarenal losses
> 40 mEq/L = renal losses

53
Q

what can be seen on EKG with hypokalemia

A

broadening of T waves
prominent U waves
PVCs
depressed ST segments

54
Q

what is the treatment of hypokalemia

A

oral supplementation (dietary/diuretic associated losses)
IV potassium repletion (if severe)

55
Q

what is the value for hyperkalemia

A

Potassium level > 5 mEq/L

56
Q

what are causes of hyperkalemia

A

decreased K+ excretion (renal disease)
shift of K+ from ICF- ECF
excessive K+ intake
pseudo-hyperkalemia

57
Q

what are the signs/symptoms off hyperkalemia

A

muscle weakness
urine, oliguria, anuria
respiratory distress
Decreased cardiac contractility
ECG changes
Reflexes, hyperreflexia or areflexia (flaccid)

58
Q

what can you see on EKG with Hyperkalemia

A

Bradycardia
prolonged PR interval
Peaked T waves
QRS widening
Biphasic QRS complex

59
Q

what is the treatment of hyperkalemia

A

withhold exogenous K+
ID and treat underling cause
correction of hyperkalemia: shift K+ back to ICF, remove K+ from body, dialysis

60
Q

what is a hyperkalemic emergency

A

muscle weakness/paralysis
EKG changes
and/or
serum potassium > 6.5mEq/L

61
Q

what is the treatment of a hyperkalemic emergency

A

calcium
insulin, sodium bicarbonate, albuterol
hemodialysis if due to renal disease/severe symptoms/serum K
potassium binding medications
Diuretics

62
Q

What are potassium bidning medicatiosn

A

SCZ (Lokelma)
Patriomer (veltassa)

63
Q

what are the complications of hypotonic fluid

A

cell lysis - dont give wiht blood products
diluation hyponatremia if prone to water retention
risk of elevated ICP
can exacerbate hypotension and hypovolemia

64
Q

what are the indications for hypertonic fluid

A

Hyponatremia (NaCl)
when we need calories too
osmotic diuresis
hypoglycemia

65
Q

what are the complications of Hypertonic fluid

A

ICF - intravascular and interstitial
-fluid overload
pulmonary edema (3rd spacing)
hyperglycemia if includes dextrose

CLIN MED3: GU/Renal (11 decks)

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